Following Nate's AVM seizure, Maggie follows Nate's ambulance to the hospital. In the emergency waiting room with David, Maggie answers the doctor's questions about Nate's physical and emotional well-being in the moments before he collapsed. Although she doesn't state it explicitly, Maggie reveals that she and Nate had sex earlier in the evening.
Claire is dismayed to discover that her new boyfriend Ted is a Republican. The pair is heatedly arguing about politics when Claire gets a phone call with news about Nate's seizure. Ted goes with Claire to the hospital and stays by her side in the waiting room all night, earning her trust.
A doctor at the hospital tells the family that Nate was suffering from a new Arteriovenous malformation which ruptured, causing a hemorrhage in his brain. Nate is rushed into the operating room immediately to stop the bleeding, but during the surgery he slips into a coma.
Meanwhile, no one in the family is able to reach Ruth because she's camping in the woods with Hiram. Although Ruth isn't in the mood for sex, Hiram is feeling very amorous. When he doesn't want to take no for an answer, Ruth leaves him alone in the tent. The next morning, the two argue and Ruth stomps off into the wilderness by herself. Later, she happens upon a bus filled with Chinese tourists, who give her a ride back to Los Angeles
While unconscious, Nate dreams that his arm merely fell asleep the night before and there was no seizure. In his alternate, dream life, he and Maggie profess their love for each other, then Nate goes home and calmly asks Brenda for a divorce.
When Nate wakes from his coma the family delightedly rallies around him. He has some weakness on his left side but the doctors say that with physical therapy he will likely return to normal. Later, Brenda tells Nate that she knows about his affair with Maggie but she's willing to forgive him. Nate surprises Brenda when he says he's tired of fighting and thinks they should give up struggling to keep their marriage together.
With David seated by Nate's hospital bed, the two brothers take a nap and have a shared dream that they're on a surfing trip with Nathaniel, getting stoned in the back of the Deadwagon. When they arrive at the ocean, Nate jumps in the water and encourages his brother to join him but David suddenly becomes nervous about sharks. When David awakens from the dream, he finds that Nate has died.
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.