 The episode follows the story of Patti Miller , ( Stephanie D 'Abruzzo ) , a patient who mysteriously starts hearing everyone 's speech as singing . It was written by Debra Fordham , who also wrote most of the lyrics . The episode 's music was composed by Fordham , Scrubs ' resident composer Jan Stevens , The Worthless Peons ' Paul Perry , Tony Award @-@ winning Broadway orchestrator Doug Besterman , and the Avenue Q writing team of Jeff Marx and Robert Lopez . The episode was directed by Will Mackenzie . 
