Gail tries her hand at surgery
Credit: Kevin Estrada/FOX

Well, Gail did say she's not a doctor.

As last week's episode foreshadowed, Phil is very, very sick — with appendicitis, to be exact. And as Gail learns, the only way to treat appendicitis is to remove the appendix. Otherwise? There's a "100-percent chance," she says, the patient will die. The problem is there's a 100-percent chance that no one in the house knows even the slightest bit about surgery.

This could have been a wacky and ultimately uplifting plot about the crew coming together to do something seemingly impossible, and in some ways, it is: Todd and Tandy head to the morgue in an attempt to find some cadavers for Gail to practice on and end up almost bringing her Gordon's dead body instead, and Carol and Melissa have a brief heart-to-heart about feelings while digging through hospital supply closets. But from the very beginning of the episode, when everyone's surrounding Phil trying to figure out what to do next, there's an ominous heaviness present. This obstacle is not one Last Man's playing just for jokes, and they make that very clear from the onset.

While the earthbound characters struggle to cobble together a last-minute surgery, Mike's back in the space station and chatting up his new friend. After trying out a couple names for the baby worm (including Dennis Rodman), Mike lands on the perfect one: Phil. His decision is sweet to begin with but holds extra gravity once you realize that, oh, yeah, Mike probably thinks Phil is long dead and wants to name his one and only friend left after him. It's a way for Mike to have his brother there with him, a symbolic gesture that speaks volumes about Mike's loneliness and grief.

Instead of falling into old habits once returning to the station, Mike decides to make a move and board the descent module. It's obviously risky, or else Mike would have probably tried it out years ago. But he also just nearly killed himself because he didn't know what else to do, so now seems like an especially appropriate time for just go for it. So that's what he does.

By the end of the episode, Mike is clutching Worm Phil in the descent module and Gail is opening up Phil with Todd there to help. Neither of them really, truly knows what the hell they're doing, but they're left with no other option. If Gail doesn't remove the appendix, Phil dies. If Mike doesn't try to get that module down to earth, he's abandoned in space for what he probably correctly assumes is forever. They're both screwed, basically.

Mike's mission seems to be literally falling apart, with sparks flying and fire surrounding the exterior — and so is Gail's: Phil starts bleeding out, and the episode's final moments cut between Mike's farewell speech to Worm Phil and Gail's frantic attempt to save Phil. We don't see what happens to Mike, but we do hear that telltale beep signaling that the patient has flatlined. Phil is dead.

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If this were Grey's Anatomy, or, you know, a real hospital, maybe they could rally and bring him back. But here they don't have the skills or knowledge or materials to do that. Like so many other moments from this season, this one so vividly points to just how different their lives are from our own. In our world, an appendectomy is no big deal — hell, Daily Show host Trevor Noah returned to work just a day after he had one this past November. In theirs, it might as well be neurosurgery.

Because of this, I highly doubt the second half of the season will open with a, "Hey, we figured it out, and Phil's okay, but hope you enjoyed that climatic finale!" It wouldn't make sense within the show's world, and it wouldn't stay true to the show's tone: Yes, it's a comedy, but it's a comedy about a tiny group of people struggling through life after everyone — everyone! — they knew and loved diedThat is an incredibly dark premise, something I occasionally forget until an episode like this reminds me that it's completely within Last Man's framework to kill a recurring character off. Last Man is not here to show us that everything always has a happy ending. It's here to show us that it doesn't — but that doesn't mean it's not worth trying to get one anyway.

Episode Recaps

The Last Man on Earth
Will Forte stars as Phil Miller, the last man on Earth, who is just trying to get by in Tucson, Arizona.
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