Episode guides from TV.com

45. Cindy Plumb
First aired: 9/5/2006
Writer: Ryan Murphy
Director: Ryan Murphy
Guest star: Brooke Shields (Faith Wolper), Kathleen Turner (Cindy Plumb), Larry Hagman (Burt Landau), Sanaa Lathan (Michelle Latham)

Sean and Christian may be celebrating a milestone surgery, but it looks like the future of McNamara/Troy is in jeopardy. Julia tells Sean some devastating news about the baby. Christian decides to redecorate his apartment after a disturbing appointment with his psychiatrist.

46. Blu Mondae
First aired: 9/12/2006
Writer: Lynnie Greene, Richard Levine
Director: Michael M. Robin
Guest star: Richard Chamberlain (Arthur), Thad Luckinbill (Mitchell), Nate Mooney (Alex), Angela Little (Blu Mondae), Sanaa Lathan (Michelle), Willam Belli (Cherry Peck)

Sean and Julia make a big decision regarding their unborn baby. Julian and Sean hit troubled waters with their new boss and begin to realize what it really means to have sold their business. Matt's family doesn't quite get his decision to pursue a new path in his life.

47. Monica Wilder
First aired: 9/19/2006
Writer: Brad Falchuk
Director: Elodie Keene
Guest star: Jennifer Hall (Monica Wilder), Mario López (Dr. Mike Hamoui), Sanaa Lathan (Michelle), Michelle Wolff (Candy), Carly Reeves (Christian's Sex Tape Partner)

Sean and Julia are looking for a nanny. Sean wants to turn to Christian for support after his hidden desires are revealed. But Chistian is busy going to the gym because he thinks he's too fat.

48. Shari Noble
First aired: 9/26/2006
Writer: Jennifer Salt
Director: Nelson McCormick
Guest star: Julie Warner (Megan O'Hara), Robert LaSardo (Escobar Gallardo), Sanaa Lathan (Michelle), Larry Hagman (Burt Landau), Melissa Gilbert (Shari Noble), Cher Ferreyra (Butch Bartender)

After her nipple was bitten off by a dog, Shari Noble comes in to have it reconstructed before her husband returns from Iraq. Julia meets a breast-feeding expert. Christian and Liz hits a lesbian bar where Christian tries to attract one of the women there but she's attracted to Liz instead. Sean and Christian meet with a kidney specialist for one of their patients.

49. Dawn Budge
First aired: 10/3/2006
Writer: Hank Chilton
Director: Elodie Keene
Guest star: Jacqueline Bisset (James), Rosie O'Donnell (Dawn Budge), Misti Traya (Mallory Budge)

A lottery winner offers Christian a fortune. Christian certainly needs the money since he's being blackmailed by James. Christian and Sean are trying to get Matt away from Kimber and Scientology. Sean offers something to Julia.

50. Faith Wolper, PhD
First aired: 10/10/2006
Writer: Sean Jablonski
Director: Sean Jablonski
Guest star: Jennifer Hall (Monica Wilder), Sanaa Lathan (Michelle Latham), Larry Hagman (Burt Landau), Brooke Shields (Faith Wolper), Peter Dinklage (Mr. Sawyer), Robert LaSardo (Escobar Gallardo)

Sean soon discovers that Monica Wilder doesn't intend to leave him alone. Christian's therapist has an obsessive torment to reveal. And Burt Landau proposes an unusual solution upon learning that Christian and Michelle are having an affair.

51. Burt Landau
First aired: 10/17/2006
Writer: Brad Falchuk
Director: Charles Haid
Guest star: Rosie O'Donnell (Dawn Budge), Larry Hagman (Burt Landau), Sanaa Lathan (Michelle)

Dawn Budge needs an ear transplant. Burt Landau suffered a stroke and asks Christian and Sean to fix his face. Also Liz needs a new liver and turns to Sean and Christian for help.

52. Connor McNamara
First aired: 10/24/2006
Writer: Jennifer Salt, Hank Chilton
Director: Patrick McKee
Guest star: Ruth Williamson (Mrs. Grubman), Peter Dinklage (Marlo Sawyer)

A secret from Sean's childhood compels him to move up Conor's surgery, despite Julia's apprehension and Marlowe's objection; Hedda Grubman (Ruth Williamson) visits Christian to make her final request for cosmetic surgery.

53. Liz Cruz
First aired: 10/31/2006
Writer: Lynnie Greene, Richard Levine
Director: Richard Levine
Guest star: Larry Hagman (Burt Landau), Sanaa Lathan (Michelle), Peter Dinklage (Marlo Sawyer), Jacqueline Bisset (James), Alanis Morissette (Poppy)

Liz has cosmetic surgery at the request of her new girlfriend, Poppy (Alanis Morissette); a desperate James uses Christian to lure Michelle into helping her steal another kidney; and Sean offers a surgical consult to Marlowe, who wants a leg-lengthening procedure in order to impress the woman he loves.

54. Merrill Bobolit
First aired: 11/7/2006
Writer: Sean Jablonski, Brad Falchuk
Director: Charles Haid
Guest star: Robert LaSardo (Escobar Gallardo)

Sean and Christian receive an unexpected visit from Dr. Merrill Bobolit (Joey Slotnick), who's out of jail and in need of their professional services. Meanwhile, Escobar Gallardo (Robert LaSardo) blackmails the surgeons into visiting him in prison and performing surgery on his face; Christian, Sean and Julia learn something unexpected about Matt; and Julia jeopardizes her marriage by telling Sean the truth about her relationship with Marlowe.

55. Conor McNamara, 2026
First aired: 11/14/2006
Writer: Ryan Murphy
Director: Craig Zisk
Guest star: Peter Dinklage (Marlo Sawyer), Jennifer Elise Cox (Annie McNamara, 2026), Stark Sands (Conor McNamara, 2026)

In 2026, 20-year-old Conor (Stark Sands) copes with his emotional scars at a family gathering prior to surgery on his other hand, but Annie (Jennifer Elise Cox) can't shake the torment left by her upbringing. And in 2006, Sean and Julia's marriage is at a crossroads.

56. Diana Lubey
First aired: 11/21/2006
Writer: Sean Jablonski
Director: Charles Haid
Guest star: Catherine Deneuve (Corrine Lubey)

Even though he doubts his ability to maintain a long term relationship Christian proposes to Michelle and a lonely Sean takes a pathological case for rationalities that have as much to do with himself as with the patient, and James requires to use McNamara/Troy for her own operations.

57. Reefer
First aired: 11/28/2006
Writer: Lynnie Greene, Richard Levine
Director: Lynnie Greene
Guest star: Charles Haid (Reefer), Jacqueline Bisset (James), Alanis Morissette (Poppy)

Sean drinks heavily as he spends a gloomy Christmas without his family; Christian receives an unexpected gift when a 3-year-old Wilber comes back into his life; and James forces Michelle to help as she takes drastic measures to fill her holiday kidney quota.

58. Willy Ward
First aired: 12/5/2006
Writer: Jennifer Salt
Director: Michael M. Robin
Guest star: James Eckhouse (Dr. Schwartz), Jacqueline Bisset (James), Sanaa Lathan (Michelle Landau), Alanis Morrissette (Poppy)

Sean comes to a decision regarding his future, but first he performs a face-lift on a ventriloquist who tells him he needs the surgery to “compete” with his puppet. Meanwhile, Gina (Jessalyn Gilsig) returns with a request regarding Wilber that Christian is not inclined to grant; James ends her association with Escobar; Matt attempts to rekindle the spark with Kimber; and Liz breaks up with Poppy (Alanis Morissette).

59. Gala Gallardo
First aired: 12/12/2006
Writer: Hank Chilton, Ryan Murphy
Director: Ryan Murphy
Guest star: Jack Yang (Chiyo), Idalis DeLeon (Gala Gallardo), Robert LaSardo (Escobar Gallardo), Sanaa Lathan (Michelle Landau)

In the fourth-season finale, Sean weighs a major decision concerning the practice, and Michelle's dark past comes to light, threatening her relationship with Christian. Meanwhile, Escobar seeks cosmetic surgery for his wife (Idalis DeLeon), who was attacked by an enemy of his.