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 hits a bump on the road, it sends Joy and Earl out of the ambulance on 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, but 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 trys bacon, Joy uses her boobs, Darnell trys postcards/photos, Catalina reads celebrity magazines, thay all sing to him, and as a last resort use firecrackers. All they do is 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, in The Hickeys his life is changing. 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 croses off the list item they did while earl is in a coma, and realizes that crossing off list items makes Earl some how better. This changes events on The Hickeys, he comes back and decides to stay.
Billie confides in Joy that she is expecting a baby. Half way through the conversation Earl and Randy listen in, and believe that they are talking about a professional male escort. Earl devises a plan with Randy, he pretends to go to work and hide in the closet hoping to catch her in the act. However, he is found out and Billie confesses to Earl that she's pregnant. Earl is overjoyed by the news. Earl begin reading up on boy baby names, Billie looks up girl baby names, while Randy checks out uncle nicknames. Earl and Billie prepare for the birth, by taking birthing training, and set up the baby's crib. Billie has the baby, albeit in the hospital elevator and Randy comes to rescue them.
Time is 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.