Sean operates on Matt's self-circumcised penis, while Matt discovers the truth about Vanessa (guest star Kate Mara). Christian is forced to play hardball with ageing, widowed socialite Mrs Grubman (guest star Ruth Williamson), who threatens McNamara/Troy with a malpractice suit after an accident during her surgery. Julia comes to terms with her parenting after facing criminal charges for flushing Frisky the gerbil down the toilet. An obese woman requests drastic surgery in time for her upcoming high school reunion, leading Christian and Grace to butt heads over her mental state. Guest starring Sophia Bush and Roma Maffia.