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Gabrielle, Susan, and Lynette rush to the hospital in the middle of the night after receiving a phone call from Danielle telling them about Rex’s heart attack. Bree confides that she feels guilty because she and Rex were having a fight when he had his heart attack and that now he needs a pacemaker. Before his operation, Rex apologizes for being a bad husband. After not getting any better, the doctor suggests to Rex that maybe Bree was tampering with his medication. Rex writes her a note telling her that he understands, and then dies not knowing the real truth. Minutes later, a doctor calls Bree to tell her that Rex has died. She numbly sits in her empty dining room, looking at the chair where Rex would normally sit. She goes into typical Bree coping mode by polishing the silver but then she dissolves into heartbroken sobs. Lynette’s marriage takes a dramatic turn after an upset Tom, who accidentally quit his job under false pretenses due to Lynette’s manipulation, vows that it is now her turn to go back to work and he’ll be staying home with the kids. And Lynette may just take his offer. Carlos finally learns that John and Gabrielle have been lovers for a while, and vows revenge as he is carted off to jail. Mike takes Paul out to a deserted quarry, intending to shoot him. After realizing it’s about Dierdre, Paul reveals why Mary Alice killed herself: a drugged-out Dierdre sold them her baby to feed her habit. They fled Utah and changed their names, but she still found them. Mary Alice killed Dierdre by accident when she came to forcibly take Zach/Dana back from them and they hid her body where they thought it would never be found — in a toy chest buried under their new pool. In the end Mike doesn’t kill Paul, but goes home where Zach is waiting for him, while pointing a gun at Susan.

Susan and Mike decide to move in together, much to Edie’s displeasure, who schemes against them using Susan’s friends. Meanwhile, Lynette takes steps to make sure Annabel (guest-star Melinda McGraw) doesn’t come between her and Tom, and the consequences land Tom out of work. Bree comes to a realization about her “buddy” George the pharmacist (guest-star Roger Bart), who continues to interfere in her and Rex’s lives. Rex has another heart attack, though prior to it, it seems George has permanently put in a wrench in Bree and Rex’s relationship. Carlos’ legal problems take a turn for the worse, when Gabrielle decides to leave him after discovering the truth about the birth control. Carlos’ subsequent actions increases his jail time to eight years. Mike goes after Paul thanks to Felicia, and Susan goes after Mike, though she doesn’t find him. Mrs. Huber’s journal reveals some secrets. Lastly, two new faces arrive on Wisteria Lane.

George Williams (guest-star Roger Bart) continues to worm his way into Bree’s life. After Edie spies Bree with George at a restaurant, Bree begins to feel guilty about sharing her intimate feelings with George; Rex’s health continues to depreciate. Lynette tries to spice things up with Tom who, she fears, is losing interest. Meanwhile, Mr. Shaw consults with Paul, and ends up lying to Susan about Mary Alice and Dana. However, he does come through with the goods on Mike, but Susan is not convinced that Mike is a bad guy.

After talking with Kendra (who Susan recognized from a picture in the file she received on Mike), Susan learns that Mike killed a cop in self-defense, and forgives him. Carlos lies to Gabrielle, and tells her that Mama tampered with her birth control; Gabrielle tells John that she is pregnant, and John doesn’t take the news well. Lastly, Felicia takes action to help Zach, and to get rid of Paul for good.