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"Sweet Dee Has a Heart Attack" is the tenth episode of the fourth season of It's Always Sunny in Philadelphia.


After Dee is hospitalized for a heart attack, she and Dennis try to adopt a healthier lifestyle. Charlie and Mac become office workers to get on-the-job health insurance.


7:00PM on a Monday

Cold Opening[]

Frank is smoking pot out of an enormous bong. When Dee comes out to ask "What the shit is this?", Frank, baked out of his mind, starts babbling nonsense phrases like "Go download me a hoagie off the Internet" and "Think there's pigeons in this bar?", greatly amusing Dennis, Mac, and Charlie. Dee, however, starts saying she "feels weird", and that her arm is numb. The others are annoyed by her, amused by Frank's stoned rambling. Dee tells them that she needs help, and collapses. After Dennis asks, "God, what is her problem?", the title of the show is revealed: "Sweet Dee Has a Heart Attack."

Act I[]

Dee is in the hospital, telling Dennis, Mac, and Charlie that she has had a heart attack, and that she is a "ticking time bomb." The others, of course, make this all about themselves, Dennis saying he is fearful now because he has the same genes as Dee, Mac and Charlie worrying because they "lead a rock & roll lifestyle." They all decide to do all they can to avoid Dee's fate.

A doctor comes in and says that they must discuss how Dee is going to be paying for her stay. The others seem genuinely surprised you have to pay to stay in the hospital. Dee says that she's on Frank's policy. Frank then shows up in a hospital gown, which his ass is hanging out of. He says he is there for a "full body scan." Dee asks him to show the doctor the insurance card, and Frank tells them that "I cancelled that shit when you were 9." Since it is now clear Dee has no insurance, she is kicked out of the hospital.

Back at Charlie's apartment, Mac and Charlie decide they must get a job that will give them health insurance. They find a prospect, a job offering "salary and benefits." Frank comes in, still in his hospital gown, which he explains he is wearing so he can "let my ass breathe." He has a wide variety of pills in a bag, anti-anxiety drugs, which he starts gobbling down while drinking beer.

Dee and Dennis join a health club, so they can get in shape. They decide to try "cardio", but as soon as they get on treadmills, they decide they aren't ready, and need to buy "shakes" and new outfits.

Mac and Charlie are being interviewed for a job. They give the hiring manager one resume for both of them, which he says he's never seen before. The interviewer is confused as to which line of the resume refers to which of them. He tells them that the job is a "mailroom gig" and there's only one spot, but when Mac and Charlie say they're willing to split the job and work at minimum wage (which Charlie calls a "government wage"), they're both hired.

Act II[]

Dee and Dennis are back at the gym, now taking "fat burners" and wearing new gym clothes. They go into a spinning class. The leader of the class asks if anyone has "any ailments I should know about", and Dee says she just had a heart attack. Dennis hates the techno he's playing, so he walks over to the stereo, shuts the music off, and starts flipping through his CD's. After he doesn't see anything he likes, Dennis offers to go out to his car and get his Steve Winwood CD. The teacher says he picks the music, and tells both of them they shouldn't be there. Dennis and Dee leave the gym, after "dogging" the teacher. Dennis gets the Steve Winwood CD, goes back in, and puts in the Steve Winwood CD, which they leave there. They decide that, instead of exercise, they should just take more supplements.

At work, Charlie is delivering mail. Mac is trying to "network" instead of helping Charlie deliver the mail. When Mac is asked to deliver mail to someone who's on vacation, he hits on a plan: hang out in the guy's office and pretend to be the "new guy", a scheme he borrows from the '80s movie The Secret of my Success.

Frank is wandering the streets in a haze, looking completely disoriented. The meds are kicking in.

Mac goes to the mailroom and sees Charlie smoking, frantically trying to sort the mail. Charlie is sorting the mail by his perception of how important it is—but he admits most of it gets burned.

Frank is being escorted into a mental hospital. A cop tells the nurse that he was found wandering without any ID, "and be careful, I think he crapped himself." The hospital, and the patients, are very reminicient of the movie One Flew Over The Cuckoo's Nest, which was Danny DeVito's film debut.

Mac is hanging out in the office of the guy on vacation. When the phone rings, he answers it, but it's Johnson, the actual occupant of the office, who's calling in to check his voice mail. When Johnson demands his "full name", Mac hangs up.

Act III[]

Continuing their new strategy of better living through chemicals, Dee and Dennis have purchased Botox and are preparing to inject themselves. The instructions are in Spanish, which Dee claims she can read. Dee injects Dennis around his eye. Dennis' eye soon swells up horribly, and Dee thinks that she may have switched the vials and injected his eye with collagen.

Back at the mental hospital, it's medication time. Frank meekly takes his pills and shuffles along.

Mac and Charlie are freaking out. Charlie says he has discovered a "major conspiracy": the name "Pepe Silvia" keeps appearing in the mail, but Charlie has discovered there is no Pepe Silvia there. He says that when he went to go see "Carol in HR" about it, that office was deserted as well, and he can't find half the employees mail is addressed to. "This office is a god damn ghost town!" Mac tells Charlie that all those people do exist, and they're demanding their mail. He fears that they're going to get fired, and Charlie tells him "We're not going to get fired, because we've already been fired." Charlie tells Mac to calm down, and asks "Barney", "the guy who tipped me off to Pepe Silvia" to give Mac a cigarette. A tall man in a top hat and trenchcoat is seen standing next to Charlie, but Mac says he can't see him either, and then Charlie looks again and he's gone. Mac tells Charlie he's lost his mind.

At a free clinic, Mac, Charlie, Dennis, and Dee wait to get treatment for their various ailments, and wonder where Frank is. Frank, apparently of sound mind (well, as sound as it ever is), wakes up in the mental hospital, and asks a large Native American man to throw a water fountain through the window so he can escape (again referencing the movie One Flew Over the Cuckoo's Nest.) Frank climbs out the window and scampers off to freedom.



Guest Starring[]

  • Judi Barton as Nurse
  • Michael Naughton as HR Guy


  • Kathleen Mary Carthy as Doctor
  • Danso Gordon as Spin Class Instructor
  • Roy Jackson as Policeman
  • Tim Sampson as Native American
  • Gaetano Vincini as Martini


  • Alan Gray as Asylum Patient
  • Sherry Perkov as Featured nurse


  • It's always hard to find the theme colors of It's Always Sunny in Philadelphia. In this episode we see it reflected on the Spin Class instructor's outfit. Dee insults him by calling him a bumble bee and coach "dick and balls".
  • There are multiple references to the movie One Flew Over the Cuckoo's Nest (which was Danny DeVito's film debut) in this episode:
    • A character is named "Martini", which is also the name of Danny DeVito's character in the film. Like DeVito's Martini, this Martini sits perched on the back of his chair, and he is playing a card game with no regards to the rules. His repeated line "Hit me, Mac" is directly taken from the film.
    • The orderlies wear white uniforms with black bow ties, like the orderlies in the film.
    • The head nurse resembles Nurse Ratched, though one hopes that she isn't like Nurse Ratched in other ways.
    • Light "easy-listening" music plays in the background at the mental hospital, as in the film.
    • There is a large, mute Native American, similar to the character of Big Chief (see below)
    • All the patients line up for "medication time", as in the film, taking it out of white paper cups with little cups of juice.
    • The episode ends with the "Chief" throwing a fountain through a window, though here it's to help Frank escape, whearas in the movie Big Chief does it for his own escape.
    • The music at the end of the episode is the closing theme to the film.
    • One of the nurses address the mute Native American Chief which is Similar to Big Chief while he waiting for medication in line.
  • Tim Sampson, who plays the Native American, is the real-life son of Will Sampson who played the Chief in "One Flew Over the Cuckoo's Nest". He played a similar role in a parody of the film that features in Mettle, a 2001 episode of the British sitcom Spaced.
  • Dennis and Dee "donate" to the spinning instructor with horrible musical taste a Steve Winwood CD (probably "Back in the High Life") containing the timeless classic "Higher Love". Later, Dennis mentions that he "own[s] all of Steve Winwood's shit". ("The Gang Buys a Boat")
  • In this episode, the song "Oh Yeah" by Yello (which Mac identifies as "Day Bow Bow") acts as Mac and Charlie's main theme as "office workers". 
  • The "chart" that Charlie puts on a wall to try to figure out Pepe Silvia's identity, along with his frenzied, manic tone of voice during that speech, is a reference to the movie A Beautiful Mind. Additionally, "Barney", the man Charlie sees wearing the trenchcoat and fedora, resembles William Parcher, a mysterious character from the film whom John Nash believes is giving him assignments from the U.S. Government, but [SPOILER ALERT] who turns out not to exist at all--he is merely Nash's hallucination.
  • The name "Pepe Silvia" is a reference to Sylvia Nasar, the writer of the book "A Beautiful Mind" on which the film is based upon.
  • Series Co-Creator and actor Charlie Day made his acting debut as a mailroom clerk in "Mary and Rhoda".
  • Michael Naughton who plays the HR guy, also plays the waiter in later seasons at Guigino's Restaurant.
  • According to the phone display when Mac talks to Johnson (Tues Sep 2), this episode takes place during the first week of September.


Mac: This is the perfect opportunity! I'm gonna hang out in his office and pretend I'm the new guy.
Charlie: Uh, I don't think that's gonna work, dude.
Mac: Uh, have you seen The Secret of My Succe$s?
Charlie: Uhhh, they're gonna catch on to you.
Mac: Uhhh, yeah, but before they do, I will come up with an idea that'll save the company millions and they'll be forced to promote me!
Charlie: Uhhhhhhhh, are you sure? How's that movie end, dude?
Mac: Uhhhh...I can't remember it. Oh, Yeah! He bangs that old lady, and then they play that song from the 80's. "Day Bow Bow".
Charlie: What the hell's "Day Bow Bow"?
Mac: [singing Yello's "Oh Yeah"] Day Bow Bow. Chik. Chik-chika!

Dee: Ah shit Dennis, I think I might have injected Mexican collagen into your eye!
Dennis: Oh God, I think I'm going blind in one eye.

Charlie: You wanna talk about stress? You wanna talk about stress?! OK! I've stumbled onto a major company conspiracy, Mac--how 'bout that for stress?
Mac: What the hell are you talking about?
Charlie: This company is being bled like a stuck pig, Mac, and I've got a paper trail to prove it. Check this out. [Goes to a wall covered in paper and string] [Yello's "Oh Yeah!" comes on in the background] Take a look at this.
Mac: Jesus Christ, Charlie!
Charlie: That right there is the mail. Now let's talk about the mail. Can we talk about the mail, please, Mac? I've been dying to talk about the mail with you all day, OK? "Pepe Silvia," this name keeps coming up over and over again. Every day Pepe's mail is getting sent back to me. Pepe Silvia! Pepe Silvia! I look in the mail, and this whole box is Pepe Silvia! So I say to myself, "I gotta find this guy! I gotta go up to his office and put his mail in the guy's goddamn hands! Otherwise, he's never going to get it and he's going to keep coming back down here." So I go up to Pepe's office and what do I find out, Mac? What do I find out?! There is no Pepe Silvia. The man does not exist, okay? So I decide, "Oh shit, buddy, I gotta dig a little deeper." There's no Pepe Silvia? You gotta be kidding me! I got boxes full of Pepe! All right, so I start marchin' my way down to Carol in HR and I knock on her door and I say, "Carol! Carol! I gotta talk to you about Pepe." And when I open the door what do I find? There's not a single goddamn desk in that office! in HR. Mac, half the employees in this building have been made up. This office is a goddamn ghost town. ["Oh Yeah!" ends in the background]
Mac: OK, Charlie I'm going to have to stop you right there. Not only do all of these people exist, but they've been asking for their mail on a daily basis. It's all they're talking about up there. Jesus Christ, dude, we are going to lose our jobs.
Charlie: Well, calm down because here's one thing that's not going to happen.
Mac: What?
Charlie: We're not gonna get fired.
Mac: We're not?
Charlie: Because we've already been fired.
Mac: We've lost our jobs!
Charlie: Yeah. About 3 days ago a couple pink slips came in the mail. One for you and one for me. So what did I do? I mailed them halfway to Siberia.
Mac: If we've lost our jobs, then that means we've lost our health insurance. That means all of this was for nothing! Goddammit, dude, I am having a panic attack. I am actually having a panic attack.
Charlie: Well, will you settle down and have a another cup of coffee?
Mac: I am, bro.
Charlie: All right, well, fine. You know what, Barney? Give this guy a cigarette, he's freakin' out. [turns to a man in black trench coat and hat standing next to him]
Mac: Huh? Who?
Charlie: Barney. He's the one who tipped me off to Pepe Silvia.
Mac: Barney? Who the hell is Barney?
Charlie: You don't see Ba- [Looks around and Barney's disappeared] Oh shit! Where the hell did he...? [the last part of Yello's "Oh Yeah" comes on in the background; Doo, Bow Bow!]
Mac: You've lost your mind! You've lost your goddamn mind, Charlie! [Chick Chika-chika!]


File:Danny DeVito - It's Always Sunny Over the Cuckoo's Nest

Season 4 Episodes
  1. "Mac and Dennis: Manhunters"
2. "The Gang Solves the Gas Crisis"
3. "America's Next Top Paddy's Billboard Model Contest"
4. "Mac's Banging the Waitress"
5. "Mac and Charlie Die (Part 1)"
6. "Mac and Charlie Die (Part 2)"
7. "Who Pooped the Bed?"
 8. "Paddy's Pub: The Worst Bar in Philadelphia"
 9. "Dennis Reynolds: An Erotic Life"
10. "Sweet Dee Has a Heart Attack"
11. "The Gang Cracks the Liberty Bell"
12. "The Gang Gets Extreme: Home Makeover Edition"
13. "The Nightman Cometh"