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 known as The Hickeys to drown out his pain from the accident. During The Hickeys, Earl's list is finished, dinner was always waiting, any problem could be solved in a half hour, and Earl is married to Billie.
Set in what appears to be the 1950s, and Earl is a Sr. Accounting Executive. Back in the real world, Randy steals the ambulance to help Earl, and along the way he picks up Joy, Darnell, and Catalina. In The Hickeys, Joy and Darnell pay them a visit to drop off their wedding gift: a used toaster that their cat crapped in, since they were not invited to the wedding. When Joy tells Earl that they've bought the house next door, Earl clutches his heart.
Back in the real world, Darnell and Catalina try to use a defibrillator to restart his heart, but due to Randys driving, they zap Earl's head then Darnell's. Randy then hits a bump on the road, sending Joy and Earl out of the ambulance and onto the gurney. In The Hickeys, Earl thinks its Randy pushing him around his living room. He tells Billie that having Randy move in is the only way to keep Joy away. Earl forgets how much of a slob Randy is so they hire Catalina to clean up after him. With the mess gone, Joy doesn't mind being around Randy anymore.
Back in the real world, finally at the hospital Earls heart monitor crosses over in The Hickeys where earl thinks its faulty smoke detectors.
The gang decides to try different stimuli to bring him out of the coma: Randy tries bacon, Joy uses her boobs, Darnell trys postcards/photos, Catalina reads celebrity magazines, they all sing to him, and as a last resort, they use firecrackers. All they did was provide content for The Hickeys: Paris Hilton cooks bacon in the kitchen, Randy is a cowboy with a gun, and Earl grabs Billie's boobs while Paris says, "That's hot."
While things get worse for Earl in the real world, his dream life in The Hickeys changes. Earl gets a promotion at his job, but it means leaving all of his friends and family for good. He says goodbye to everyone and walks out of the door, "following the light". Back in the real world, Randy crosses off a list item they did while earl was in the coma, and realize that crossing off list items make Earl somehow better. This also changes events on The Hickeys, where he comes back and decides to stay.
Billie confides in Joy that she is expecting a baby. Halfway through the conversation, however, Earl and Randy listen in, believing they're talking about a male escort. Earl devises a plan with Randy, pretending to go to work and hide in the closet, hoping to catch her in the act. However, his cover is blown and Billie confesses to Earl that she's pregnant. Earl is overjoyed by the news and begins reading up on boy baby names, while Billie looks up girl baby names, and Randy checks out uncle nicknames. Earl and Billie prepare for the birth by taking birthing training and setting up the baby's crib. Billie has the baby, albeit in the the hospital elevator with Randy eventually rescuing them.
Time's flying by and age has gotten the best of them. Earl spends his time remembering the good old days as Randy comes to visit the couple. Earl continues to remember the crazy times in his life as an old Darnell and Joy come to visit them.
After Randy, in the real world, completes more and more of Earl's list items, karma finally kicks in and his alternate world doesn't fit anymore. Earl walks off that set and back into reality.