Earl and Billy lie in the street after being hit by a car. Earl, in a coma, flashes back to when he was a young kid at home. While his parents argued, he would turn on the TV and get lost watching the "typical" American family in order to drown out his pain. While in his coma, Earl creates a "TV World" to drown out his pain from the accident.
Back in the real world, Randy finds Earl on the ground while the paramedics decide to help Billy first. Randy, afraid that God will take Earl, tries to get the paramedics to help him. Earl, in his coma, recalls times in the past when Randy could have helped him, but didn't. This time Randy decides not to run. He puts Earl in the back of the ambulance and drives off, leaving the paramedics and Billy behind.
Randy is driving the ambulance when he finds Joy, Darnell, and Catalina with a broken-down car on the side of the road. Randy pulls up and tells them to get in; he needs their help. Joy tries to wake Earl using a trick she would use during sex - twisting his nipples - but when he doesn't respond, she knows it's bad.
In TV World, set in what appears to be the 1950s, Earl is married to Billy. Joy and Darnell pay them a visit to drop off their wedding gift: a used toaster that their cat crapped in. When Joy tells Earl that they've bought the house next door, Earl has to figure out a way to keep them away. Back in the real world, on the ambulance, Darnell tries to shock Earl's heart back to a normal beat, but Randy's bad driving causes him to shock Earl's head and then do the same to himself.
Joy tries to save Earl by jumping on top of him to perform CPR, but Catalina opens the ambulance doors to let his spirit escape in case he dies. When Randy hits a bump on the road, it sends Joy and Earl out of the ambulance on the gurney. In TV World, Earl thinks Randy is pushing him around his living room. He tells Billy that having Randy move in is the only way to keep Joy away. Back in the real world, Joy jumps off the moving gurney to avoid a semi truck, but the truck, not seeing Earl, keeps moving with the gurney attached to its grill.
Joy, Randy, Catalina and Darnell find the semi and the gurney in the front yard of Sissy the truck driver's house. When they find Earl's mustache hair on Sissy's face, they know he's in the house. Joy talks to the crazy Sissy in order to get Earl out of there. Once they finally get him to the hospital, the doctor gives a grim report on his health.
Back at Club Chubby, Catalina finds Earl's list in the parking lot. Randy is determined to get Earl to wake up, so he decides to have the group try different stimuli to bring him out of the coma: bacon, boobs, postcards/photos, celebrity magazines, singing to him, and even firecrackers. But nothing works.
Even though the stimuli do nothing for Earl in the real world, they provide content for TV World: Paris Hilton cooks bacon in the kitchen, Randy is a cowboy with a gun, and Earl grabs Billy's boobs while Paris says, "That's hot." Back in the real world, Randy kneels by Earl's bedside to pray for him, asking God for advice.
Randy tells Joy they have to find the young faith healer who helped them before. Joy is a believer, so they head off to find the healer, only to discover the young boy has lost his faith. He changed his mind about helping people after he saw Earl and Joy hurt people on the news. Randy shows him Earl's list to prove that Earl has turned his life around, but when Joy mouths off, the boy shuts down again.
Doctors at the hospital are meeting in Earl's room to discuss taking his organs for donation. While things aren't going well for Earl in the real world, things are changing in TV World. His got a promotion at his job on "TV," but it means leaving all of his friends and family for good. In the real world, to prove that Joy is not evil, Darnell videotapes her "doing good things" to show to the faith healer. It works; the boy agrees to help Earl.
Back at the hospital, Randy and Joy bring the faith healer to Earl's room. The young boy tries, but nothing happens. His father walks in to tell the boy that the whole faith healer trick was fake. He made the whole thing up so they could make money. In the end, the truth ends up setting the young boy free to be a normal kid.
Randy sits next to Earl's bed in the hospital. In Earl's TV World, he says goodbye to everyone and walks out of the door, "following the light." But back in the real world, Randy reminds Earl of all the good things he has done. Randy takes the liberty of crossing a few things off the list and as he does this, he realizes that Earl is becoming stronger. Turns out the best way to help Earl is the list.