Brenda struggles with morning sickness as she studies the home video of Nate's 2002 wedding to Lisa. Together, Nate and Brenda watch the Kimmel and Fisher families nervously prepare for the ceremony on the video. Brenda assures Nate that their upcoming wedding will be different from the first ceremony in every way.
Federico meets women through an online dating service, but his overly-high standards prevent him from settling on anyone special. When Vanessa won't agree to be Federico's wedding date, he invites a woman named Sharon instead.
Claire and Billy, who are happily committed to each other and rarely apart, decide to move in together. When Nate and Brenda host a pre-wedding dinner party for the family, Claire gets high with her brothers outside but is unable to convince them that Billy's mental health has improved.
After months of dealing with the consequences of George's Depressive Psychosis and electroconvulsive therapy treatments, Ruth is on the brink of mental exhaustion herself. Once he returns home from the hospital, George suffers from short-term memory loss and disorientation, but insists on attending Nate's wedding anyway. Ruth finally reaches her breaking point at the wedding when Claire takes a compromising photograph of George. To everyone's shock, an enraged Ruth slaps Claire, accusing her of "trying to make a statement" about Ruth's choice to marry George before she really knew him.
Two days before her wedding, Brenda suffers a miscarriage but Nate and Brenda decide to go ahead with the wedding anyway.
Listening to the ceremony inspires David to be more supportive of Keith's dreams of starting a family. Although David would prefer to adopt children who are looking for a home, he agrees to continue looking for a surrogate mother to bear their child if that's what Keith wants. At the wedding reception, David and Keith reach a compromise by deciding to pursue surrogacy and adoption at the same time.
After the wedding ceremony, Brenda wanders off alone, still high from pain medication and despondent over her lost baby. She imagines that Lisa is taunting her for having infertility problems. Nate finds Brenda and convinces her to re-join the party, telling her that the best days of their life together are yet to come.
Six Feet Under focuses on the cathartic journey of the extended Fisher family, whose personal trials and tribulations are played out against the solemn backdrop of an independent funeral home in LA.
This past season, story elements established in the first four seasons reach a series of emotional climaxes, with Ruth overwhelmed by her mentally fragile husband George, Nate struggling to reaffirm his relationship with Brenda while raising his daughter Maya, David and Keith longing for children of their own, Claire trying to broaden her horizons, and Federico attempting to fill the void left by Vanessa. By season's end, each of the main characters will come to embrace the cycle of life - birth, death, and rebirth - in ways that are both unique and interconnected.