Randy and Joy decide to make up for the time Earl ruined his parents' vacation to American Samoa. The Hickeys hadn't been on a holiday since their honeymoon; that's when Kay got pregnant with Earl, leaving Carl terrified that holidaying would lead to more offspring. Randy and Joy swing by the Hickeys' place, where Carl and Kay are shocked to find out that Earl's in a coma, which is reasonable. Making the shock somewhat harder for them to handle is finding out he's been that way for a month, and Randy never thought to mention it when he was by for lunch just last week. They're also shocked to find out the coma came after Earl got of prison. "Earl was in prison?" says Carl, even though Earl is like Cheers' Norm of the Camden county lockup.
More shocks come in the discovery that Randy is making the medical decisions for his brother, which include Remove Tonsils (relatively benign, if unnecessary), and Do Not Resuscitate (potentially fatal). "In my defense, I was pretty drunk," explains Randy. I imagine it's a good thing for Earl that so many medical procedures are beyond Randy's pronunciation capabilities. I'd be suggesting a moustache-ectomy myself.
Here's what happened: Earl, Randy and Joy were all set to housesit while Kay and Carl went to American Samoa ("Come See Why The Japanese Wanted It" is the brochure come-on). It's a trust exercise for the then-wayward Hickey boys, but Mom and Dad still cleaned out the liquor cabinet. Considering Joy shows up yelling "Tick tock, it's booze o'clock!" that was probably a smart move.
A trip to the grocery store is in order, where some nervous dude tosses a duffel bag in the back of the El Camino when a passing cop car spooks him. Turns out he thought the car was abandoned, since it's such a piece of crap, and is surprised to see Earl drive off. The gang finds the duffel bag when they get home, and it's full of pot.
Well, if you were trying to show your mom you could be trusted to look after the house while she's gone, what would you do? That's right: you'd decide to bag the pot and sell it, but only to bad people. And Earl's mom was worried!
You'd also head back to the store to try to trade pot for groceries. Unfortunately, the pot's former owner is still in the parking lot, and he takes the gang hostage at gunpoint, and they all head back to the Hickey house.
Unfortunately, Earl's parents are there, since their flight was delayed (damn you, American Airlines! How many drug deals must you queer!). They've found the pot. "Well, this trust exercise went horribly wrong!" wails Kay. Carl destroyed the pot, which freaks out the dealer, since this was his first major deal and he's supposed to demonstrate he's middle-management material. So he's kind of like a drug-dealing Jim Halpert, only with more ambition and less-adorable messy hair.