Since Earl has been in the hospital for about a month, they decide it's time to kick him out. After giving Randy an offer he can't refuse, he takes Earl off their hands. Randy puts him in a shopping cart and off they go. Back in Earl's alternate world, time is flying by. Age has gotten the best of them, but now he spends his time remembering the good ole days.
Randy runs into Patty, Camden's resident hooker, who offered him an old wheelchair to get Earl around. Back at the Crab Shack, Randy straps Earl in and off he goes. It has a huge sound system and everything. Darnell is a bit worried that Randy is taking care of Earl on his own, but Randy, determined to do it on his own, takes Earl on his daily activities.
#241 on Earl's list was trailer park neighbor Derek. He was fired after getting to work late when Randy and Earl buried his car in dirt so he wouldn't interrupt their sleep during the day. When Randy goes to make amends with Derek, he finds out Derek's sold sold his car to the woman next door. When she gets into the car, Earl is in the backseat where Randy left him. She sprays him with pepper spray.
Randy tries to find another item on the list that Earl can do while in his coma. Next, the Hansen kids. Earl and Randy were always jealous of the kids next door, Tiffany and Brett, because they got to go on great vacations. Trying to make amends, Randy fails by laughing at what happened to them when Earl and Randy stole their wheelchairs.
Randy goes to go resuce Earl from the parking lot, where he is frying due to the sun. In Earl's alternate world, Randy pays them a visit. Back at the bar, Randy is getting Earl some sponge water. Tiffany from earlier has figured a way to let Randy cross her off the list. Make her ex-boyfriend jealous at his Killerball game.
At the Killerball game Tiffany is working hard to make Earl look great. Joy and Darnell are concerned with Earl's appearance. Randy is confident that Earl just needs to cross something off his list to get better.
The game gets heated when one of the players gets kicked off. Brett decides to put Earl in the game, so Randy does it. In Earl's alternate world, Earl continues to remember the crazy times in his life. Old Darnell and Joy come to visit them.
Randy is using the joystick to keep Earl in the game. Earl even gets the ball at one point and Randy takes him to the goal to score and tie the game. However, Randy drops the joystick, which activated the boom box and bubbles on Earl's wheelchair. While Earl is rocking out in the chair, the game continues. Tiffany finally gets under her ex's skin and makes amends.
Since Earl made the ex jealous and won Brett the game, Randy crosses them off the list. Plus, Derek even gets friendly with his neighbor who was afraid to drive alone since Earl frightened her in the car. So they started to carpool.
Karma finally kicks in and his alternate world doesn't fit anymore. So, Earl walks off that set and back into reality.