'This Is Us' Fall Finale Ends on a Heart-Stopping Moment That Will Change Everything

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Warning: If you have not watched Tuesday’s fall finale of This Is Us, do not proceed -- major spoilers ahead! Everyone else, you may go on. (To read our exclusive finale Q&A with one of the stars of This Is Us, click here.)

Something bad happened on Christmas Eve.

For the Pearson family on This Is Us, Christmastime means coming together, but on Tuesday’s dramatic fall finale, they also experienced an unexpected tragedy. For much of the episode, the old family adage that “nothing bad ever happens on Christmas Eve” was repeated time and time again -- first by Rebecca (Mandy Moore), then by Randall (Sterling K. Brown) -- but in the present, it simply wasn’t the case.

EXCLUSIVE: 'This Is Us' Star on 'Shocking' Fall Finale Cliffhanger

Things between Toby (Chris Sullivan) and Kate (Chrissy Metz) had been at a romantic standstill. But on the night before Christmas, Toby surprised his ex-girlfriend by flying across the country -- sitting in a middle seat on the plane (now that’s love) -- to spend the holiday with her. It was a big moment for the on-again couple; after all, Kate broke things off before Thanksgiving to get a better handle on her weight loss and life.

This time, Toby declared that he was back on the weight-loss diet too -- only he was primarily doing it for himself, but also for Kate (so she’d be with him). “The one thing I cannot live without is you,” Toby told Kate under the mistletoe, as members of her family looked on. Soon after, the two had sex, with Toby noticeably winded from their intimate moment upstairs.

Later, everything seemed to be normal as the extended family took part in Christmas carols and story time with Randall’s daughters. But as Toby was getting up to help clean up, he suddenly collapsed on the living room table. Was it a heart attack? Something related to blood pressure? A previously undisclosed condition?

Toby was rushed to the hospital, where he lie unconscious on the operating table as doctors tried to save him, the closing montage paralleling a similar experience with Dr. K (Gerald McRaney) decades ago on Christmas Eve.

RELATED: Milo Ventimiglia Continues to Recreate Emotional 'This Is Us' Push-Up Scene

Following Tuesday's episode,Sullivan opened up to ET about the shocking cliffhanger. “It’s definitely going to keep people on their toes for a few weeks while we take a break. It was shocking,” he said. “It’s a difficult thing to have to watch your character -- who I’ve come to love and enjoy playing -- have to go through something like that.” For more on Sullivan’s thoughts on the fall finale, read our exclusive Q&A.

What else happened on the final This Is Us episode of the year? The other big moments featuring your favorite TV family:

Dr. K Doesn’t Die


When young Kate was admitted to the hospital for appendicitis on Christmas Eve, Dr. K -- the same doctor who gave the stirring lemonade speech to Jack in the premiere -- also happened to be there for a far more serious health condition. Though it seemed like Dr. K wasn’t going to make it (he was “curious” about the “great beyond”), Jack, Rebecca and the kids made sure to keep him company as his family tried to make their way to him “to say goodbye,” he ominously said -- only the universe had other plans for Dr. K, who received a very special snow globe from young Randall as a thank you gift. After undergoing surgery, he woke up with the Pearsons by his side. It’s a Christmas miracle (really, we need more Dr. K in our lives)!

RELATED: 'This Is Us': Randall Takes a Trip Down Memory Lane With Jack

Kate Gets the Harsh Truth About Gastric Bypass

On Christmas Eve, Kate and Rebecca visited a gastric bypass surgeon about the aftereffects of undergoing weight-loss surgery, including the various dangers that come with it if the strict diet isn’t followed. While Kate was processing the information, her mother had a noticeably harder time coming to grips with her daughter’s possible new reality. When Kate revealed that she took Prozac for depression, Rebecca was horrified; the same when Kate admitted she binge-ate, which Rebecca wasn’t aware of. In a moment between mother and daughter, Rebecca asked Kate point-black, “Did I do this to you?” “I don’t know,” Kate admitted, tempering the conversation for at least another day.

Randall Talks a Co-Worker Off the Ledge


At his boss’ annual holiday party, Randall -- recent purchaser of a boat -- went in search of his co-worker, Andy (Jimmi Simpson), to try and unbuy the boat only to find his friend (who was going through a divorce after having a year-long affair and losing money at work) standing eerily close to the ledge as he contemplated suicide. Andy wrongly believed Randall had the “perfect” life, quickly learning that he had his own personal hardships -- from Rebecca’s decades-long secret to William abandoning him as a baby.

In a plea for his friend to step off the ledge and confront his issues instead of running away from them, Randall told Andy his daughter would forgive him no matter what. “That’s how kids work and she will forgive you,” Randall advised, before possibly offering a clue to what he may have experienced with his own father, Jack (Milo Ventimiglia). “It is your job as her father to stay here until she is ready…” Randall wasn’t finished with his talk with Andy before his wife, Beth (Susan Kelechi Watson), interrupted the conversation, causing him to freak out when he saw Andy was nowhere to be found. Did he jump? A huge relief came over Randall as he saw Andy briskly walking inside, before uttering the family’s holiday mantra: “Nothing bad happens on Christmas Eve.”

RELATED: The Men of 'This Is Us' Tug at Our Heartstrings by Recreating Push-Up Scene

William Has a Boyfriend


Who did William (Ron Cephas Jones) cavort with before Randall came into his life? The episode revealed that William once was friends with a man named Jessie (Denis O’Hare), with whom he had been romantically involved, only it took Randall’s eldest daughter, Tess, for him to realize that. “Dad, Grandpa’s gay, or at least bi,” Tess said matter-of-factly, as William and Jessie were at the piano. Randall’s reaction was of pure surprise and shock at the revelation. Honestly, Brown should win the Emmy just for this moment alone:


Kevin and Sloane Get Closer (Maybe)


When Olivia (Janet Montgomery) left the Pearsons’ childhood cabin, she also abandoned the play she was starring in with Kevin (Justin Hartley), causing the production to be canceled for the holidays. Sloane (Milana Vayntrub), the playwright, persuaded Kevin to go over to her family’s Hanukkah dinner, where it seemed the two were getting chummy. (It’s Kevin though, so who knows!) It was after Sloane’s retelling of the origins of Hanukkah that Kevin proposed that they put on the play on their own, with Sloane taking over Olivia’s role. Could this be the start of something new?

Do you think Toby survives? Tell us what you thought of the fall finale by commenting below or tweeting us at @etnow! 

This Is Us returns Tuesday, Jan. 10 at 9 p.m. ET/PT on NBC.

RELATED: Sterling K. Brown Talks Tension During Thanksgiving Episode

Watch a scene from the fall finale of This Is Us below. 

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