When J.D. asks Dr. Cox to give the residents a pep talk, Dr. Cox takes things a little too far by telling them that inevitably, they will eventually kill a patient or two, which causes J.D. to wonder whether he has ever specifically let someone die through his own incompetence and comes to the conclusion that he hasn't yet, though Dr. Cox is of the impression that it will happen eventually. Elsewhere, Elliot fights for an ex-drug addict patient to receive a heart valve, and becomes frustrated when Molly goes against her professionally about it. Carla decides to clean 'Rowdy', and loses him. This leads her to replace the stuffed dog with a replica called 'Steven', who is 3 inches shorter.