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This week’s episode of Girls includes many moments of self-reflection, a few deaths, and one surprising revelation. Editor and fellow Girls recapper Tricia Romano is out so I will be reviewing “Painful Evacuation” alone. There will be spoilers in this post and I’m disclosing them right now.

The episode begins with Hannah interviewing an established female writer, Ode Montgomery. Hannah asks about her writing process, Montgomery answers. She muses about part-time sex work, how to be a writer, and that “childlessness is the natural state of the female author.” This scene is optically a counterpoint to last week’s bottle episode. Later, we learn its deeper significance.

Over at Marnie’s apartment, the kind of Girls sex scene that we should be more than used to by now—satisfying for him, her not so much—unfolds between Ray and Marnie. Post-sex, he suggests that they hang out, and she callously rejects that idea. Instead, she heads uptown to see Desi, in what appears to be some sort of counselling session. Marnie complains about the burden that Desi’s mental health issues have placed on her. Desi, in tears, calls her a narcissist. Their mediator (played by Okieriete Onaodowan of the original Broadway cast of Hamilton) listens and points out to Marnie that Desi has a point. Marnie takes it in as Desi gets the last word: “Clean up your side of the street, Marnie Marie.” This is the most appreciation I’ve ever felt for his character.

Meanwhile, Ray goes to work at his coffee shop, where he’s being bored by one customer’s stories of New York past. When that customer dies right then and there, it sends Ray into shock and mourning. His boss Hermie tells Ray that this death is an opportunity to reflect on Ray’s own priorities. Ray feels patronized by the advice and storms out.

As Jessa is studying signs of childhood sociopathy (“Oh God, I did so much of this stuff”), Adam storms in, enraged by the acting job he just quit. Played by Adam Driver, his anger builds and builds into a classic spell, and just when he seems like he’s going to start breaking things, Jessa calms him down with an idea: They’ll make their own movie—and it’ll be real. As much as their relationship broke Hannah’s heart, I can’t help feel appreciative of the way his violence is so elegantly diffused by her coolness in this moment. They work on movie ideas. A light bulb goes off: Of course their film will be about their betrayal of Hannah. Of course.

Hannah is dealing with a UTI, for which Elijah provides no relief, neither in the form of painkillers nor requested back tickles. Following the advice of her mother, Hannah ends up in the ER. And her doctor (surprise!) is Joshua (played by Patrick Wilson), with whom Hannah shared a romantic weekend in season 2’s “One Man’s Trash” episode. He tells her (surprise!) that she has a UTI, as if she didn’t already know that. And also (surprise!) that she’s pregnant. Yep.

Later, Ray has resumed his existential crisis in Shoshanna’s apartment. Kindly, she coaxes him into recognizing that he does, as suggested, have unused potential, and that he really ought to appreciate Hermie’s advice. Ray goes to Hermie’s to thank him—and finds Hermie dead, too.

End scene. Credits.

It’s hard to think about anything other than Hannah’s pregnancy, and it’s hard to do much beyond mentally seesawing between will-she and won’t-she get an abortion. Other things worthy of consideration: how Marni handles her narcissism, how Jessa and Adam handle this film project, how Ray handles his existential crisis, and is Shoshanna even a main character anymore? Check back here next week for possible answers.