As small earthquakes rock the estate, Monica goes into labour. Ian is forced to comfort her while they wait for the midwife but Monica tries to delay the birth until Frank arrives, unaware that he is in a coma.
One of the quakes knocks Frank off his stool at The Jockey, and Jamie and Karen are forced to phone an ambulance but say he fell outside out of fear of legal action. Frank is rushed to hospital but remains in a coma suffering from strange dreams.
Carl confuses everyone by taking Katie on a daily trip to the local park. His motives are less than altruistic however, he is pretending to be a single parent to Katie to attract a local girl, Bindy. Things take a turn however when he hears that Frank has been rushed to hospital and leaves Katie with Bindy. Only returning to collect her, he is unable to find Bindy and the address she gave him is a burned out house. Panicking, he is forced to try and recall her face (due to his main focus always being her chest) and track her down before Mandy or the Maguires find out.
Kelly finds herself pregnant but can't bring herself to tell Shane, so heads for an abortion alone. Kelly can't bring herself to take the pill however and when Shane finds out he follows a Maguire tradition and proposes.
Frank is seen using the urinal in the men's toilet in The Jockey. Lillian walks up and the sound of a zip is heard followed by the sound of urination. After a few seconds Frank looks over and realizes that it's Lillian, he looks down and realizes that she is urinating with a penis. She says "get a good eye-full won't you mate?" as a stunned Frank watches her begin to walk away. He turns around and looks only to find himself alone in the toilet, with not enough time passing for Lillian to have left, he looks around confusedly. This is a reference to earlier in the episode, as well as a long standing gag, that Frank often makes jokes about Lillian being a man.
- David Threlfall - Frank Gallagher
- Annabelle Apsion - Monica Gallagher
- Gerard Kearns - Ian Gallagher
- Elliott Tittensor - Carl Gallagher
- Rebecca Ryan - Debbie Gallagher
- Johnny Bennett - Liam Gallagher
- Tina Malone - Mimi Maguire
- Sean Glider - Paddy Maguire
- Ciaran Griffiths - Micky Maguire
- Nicky Evans - Shane Maguire
- Aaron McCusker - Jamie Maguire
- Rebecca Atkinson - Karen Maguire
- Samantha Siddall - Mandy Maguire
- Kelli Hollis - Yvonne Karib
- Warren Donnelly - Stan Waterman
- Qasim Akhtar - Chesney Karib
- Sarah Byrne - Meena Karib
- Dystin Johnson - Norma Starkey
- Alice Barry - Lillian Tyler
- Micael Legge - Tom O'Leary
- Amanda Ryan - Carrie Rogers
- Sally Carman - Kelly Ball
- Lola & Macy Yoxall - Katie Maguire
- Kirsty-Leigh Porter - Bindy
- Andrew Grose - Dr Fosborough
- Justine Adams - Nurse
- Casey Ellis - Lad
- Emma Bispham - Health Worker
- Narrator: Frank Gallagher.
- Monica reveals that she knows Ian is gay, saying that she has known he was "that way" since he was young.
- In Frank's coma dream, Monica acts like Sheila and has a picture of Sheila's face on a stick as a mask. Frank refers to her as "Monica Sheila".
- Unusual for a series finale, all of the characters from this episode would return in Series 6 without departing during the first episode. Steve and Fiona departed in Series 2, Sue, Marty, Veronica and Kev departed at the end of Series 3 as regulars. But they all returned briefly in the first episode of Series 4, and Carol Fisher left the show at the end of Series 4.
- This is the first series finale of Shamless since 2005 that did not feature a wedding.
- Frank's coma dream involves seeing himself on UK TV shows Celebrity Big Brother, I'm a Celebrity...Get Me Out of Here! and Strictly Come Dancing.
- Stella Gallagher is born.
Ian: Is it [baby] on its way? Monica: Well a gallon of water out the fanny is a definite sign. Ian: Don't say "fanny"!
Liam: Is he a nurse or a doctor? Debbie: Nurse, they're just chatting. If he was a doctor they'd be crawling up his arse. Liam: I'd never be a male nurse. Debbie: Why not, It's not gay. Liam: I know it isn't, but you spend all day shaving men's pubes off. Debbie: Who told you that? Liam: Gary on reception.
Kelly: Is there a Maguire tradition if you knock a girl up? Paddy: There is, never give your real name.