Loser
performed by Beck

Frank has recovered from his post-operative delirium and discovers, much to his surprise, his marriage to Sheila. At the hospital, Frank discovers that his transplant medication will produce a number of unwanted side effects, and he still can't drink alcohol. Fiona is tempted by a fellow inmate in prison. Ian and Mickey wake up in each other's arms, but Mickey finds Ian in a depressed state. Svetlana and Mickey come to an understanding about their child and how to raise him. Following a random drug test, Fiona is released from jail due to overcrowding and has a renewed probation. Fiona's probation officer secures her a job waiting tables and required to attend regular Narcotics Anonymous meetings. After a kind gesture by Carl, Bonnie worries that he may be falling in love with her. Sheila's petition to adopt the Native American children is denied and they are sent to live with their great-grandfather. Mickey's worries about Ian cause him to seek out the help of Debbie and Carl who recognize his symptoms. Following an initiation at Amanda's sorority, Lip and Mandy run into each other at a restaurant but she isn't pleased to see him, though Lip is clearly still concerned about her. With Fiona back in the house, Debbie and Carl are thrilled, but soon break the news about Ian. Fiona concludes that Ian is bipolar and suggests hospitalizing him, to which Mickey disagrees with saying that he will care for Ian. Sheila and Sami come to blows at the hospital, and everyone is distracted long enough for Carl to escape with Frank. The two eventually reconcile with Sammi's trailer occupying the vacant lot next to Sheila's house. Frank and Carl stop at the edge of lake Michigan and look off into the distance, with the two of them sharing a bottle of alcohol together. Later that night, a woman driving a Maserati and her male companion pull up outside the Gallagher household. The passenger is revealed to be Jimmy - using the alias 'Jack' - who is very much alive.

On an academic scholarship, Paul Tannek (Jason Biggs) is a fish out of water kid from the upstate New York who arrives in New York City. In the fall of 1999, attending college at NYU, Paul runs into repeated complications and mishaps, usually brought on by his roommates, three spoiled, obnoxious party animals. When Paul is branded a loser and kicked out by his roommates, he settles in a room at a veterinary clinic. Afterwards, almost by accident, he meets and falls in love with Dora Diamond (Mena Suvari), a fellow student who is dating their unscrupulous literature professor, Edward Alcott (Greg Kinnear).