The return of Dr. Ron Ramirez to Sacred Heart from his philanthropic work abroad, sparks some doubts in Carla's mind about her feelings for Turk. When she accepts a dinner date with him, J.D. is torn between telling Turk the truth and keeping his promise to Carla. Back at the hospital, Elliot takes a stand for her patient despite the fact that Dr. Cox believes he is a drug addict faking abdominal pain to get medication. Meanwhile, the Janitor introduces J.D. and Turk to his "twin" brother, but they aren't buying it.