- “As I looked at all the relationships around me, some that had gone on forever, some that were reignited, and some that had just begun, I realized something: it should have been me.”— J.D.'s narration
Elliot's proposal prompts several members of the hospital staff to begin showing J.D. sympathy, as they believe he still has feelings for Elliot and assume he is sad about her engagement, but he maintains that he is fine. The proposal also causes each of the main characters to have a fantasy about being married to Elliot, and saddens her sorority sister Melody, because Melody is the last single sister. Turk urges J.D. to take advantage of the situation and score. Despite his many attempts, she continually shrugs him off, forcing him to take many a cold shower.
Meanwhile, Carla, who is not emotionally ready for sex with Turk, treats a pair of elderly patients who exhibit the same symptoms, but seem to have no connection to one another. After Dr. Cox and Dr. Kelso quickly deduce the patients have syphilis, the patients inspire Carla by explaining sex is revitalizing.
At Keith's official proposal to Elliot, Melody asks why J.D. is so persistent in having sex with her, noting he "doesn't seem like the notch-in-a-bedpost type." As J.D. looks around and sees everyone's relationships – from Cox's "forever" relationship with Jordan to Turk's reignited passion with Carla to the newly engaged Elliot and Keith – he realizes it is because he has once again fallen in love with Elliot. His fantasy about being married to Elliot contrasts significantly with the comedic dreams of the other characters in that they have a normal, truly happy relationship. He finishes the night with another cold shower (this time out of mournful regret rather than sexual frustration) and with his narration (in a parallel to "My Fault"), "it should have been me."
- Keith re-proposes to Elliot in front of her friends.
- After denying it to everybody, even himself, J.D. realizes that he's still in love with Elliot.
- Two elderly patients give Carla sexual advice.
- Turk, Dr. Cox, the Janitor, Carla, Kelso and J.D. all have fantasies in which they are married to Elliot:
- Janitor having a family of 6 children with her. The 3 girls are dressed as doctors and the3 boys are dressed as janitors. Elliot asks if Janitor thinks that they're "pigeonholing" the children, to which Janitor responds it doesn't matter as the children aren't theirs anyway.
- Dr. Cox growing frustrated with how annoyingly neurotic she is and ends up murdering her two days after their marriage. He is consequently arrested and told he is going to "fry." After the fantasy, Cox states that it was "worth it".
- Turk putting on a stereotypical white highbrow accent, living a stereotypically WASP lifestyle with Elliot and talking to her before she goes to work. After she leaves, he cheats on her with the hot Latina maid 'Lupita' (Carla). After the fantasy, Turk complains that he hasn't had sex in so long that he's fantasizing about his own wife.
- Dr. Kelso and Elliot dining on opposite ends of a very long table. She says, "I hate you," before Kelso says "I know." After the fantasy, Kelso says, "different wife, same story."
- Carla relaxing with Elliot, with them planning to have "tender, emotional sex" , then cuddle, and then go shoe shopping, at which point they kiss each other. Upon returning to reality, Carla wistfully says "life would be so much simpler..."
- J.D. and Elliot relaxing on the couch. J.D. saying he is happy Elliot is his wife, and Elliot agreeing, followed by a kiss.
- J.D. imagines a magical trip to Narnia with Melody being a lonely mermaid and Turk being half goat.
The Janitor fails to fix the sprinkler and it randomly turns on and soaks J.D., The Todd, Kelso and Turk mid episode. He also uses the phrase 'God is watching' to get Todd and J.D. to admit the truth.
J.D.'s Girl Names
Episode Running Gags
- Any male character who cannot achieve sexual satisfaction, will end up taking a cold shower (hence the title of the episode).
- J.D. gets annoyed that people keep mistaking a resident for him, and rants that he looks nothing like him.
- Keri Russell as Melody O'Harra
- Chris Dougherty as Jerry
- Frank Cameron as Dr. Mickhead
- Cantrell Harris as Policeman
- Bruce Kirby as Mr. Bilbray
- Marjorie Lovett as Mrs. Sheldon
- Randall Keenan Winston as Leonard
- "Stolen" by Dashboard Confessional
- “Whoa, you can't go to Boob Town! That, my friend, is a gated community.”— Melody
- “God is watching. How many times have you gotten laid this year?”— Janitor
- “Bagel”— Todd
- “Bagel”— Todd
- [Making zero symbol with hand]
- The Janitor's marriage scene was intended to be more serious, but was changed so J.D's scene with Elliot was more poignant.
- The fantasy where J.D. realizes he still has feelings for Elliot is rare because instead of looking off to the left, he continues to look straight at her.
- This episode may have been influenced by Season 7 Episode 21's episode of "The Mary Tyler Moore Show" titled "My Three Husbands." In this episode Mary's co-workers all fantasize about married life with her.
- Elliot was an Omega Beta Gamma in college, which is a fictional sorority. This is a play on J.D. calling the OB/GYN girls, who were trying to recruit Elliot, a sorority.
- Todd says "'Tis better to have loved and lost, than never to have loved at all-five", a reference to "In Memoriam" (1850) by Alfred, Lord Tennyson.