[Warning: This story contains spoilers from Sunday's Nurse Jackie season finale.]
Life came full circle during Sunday's Season 4 finale of Showtime's Nurse Jackie as Edie Falco's damaged character faced life and death at All Saints.
After a short stint in rehab, Jackie spent the season clean and sober despite facing some of (if not the) biggest personal and professional challenges: divorce, a temperamental teenage daughter and a by-the-book demanding boss (Bobby Cannavale).
In Sunday's finale, Jackie's world crumbled when Dr. Cruz (Cannavale) -- frustrated after Jackie has tossed out the rulebook and taken charge of the hospital's ER (better than he ever could) -- fired her on the spot for insubordination and her sketchy past.
Then, just as she was sneaking back into All Saints to be there for O'Hara's (Eve Best) delivery, Cruz's son Charlie (Jake Cannavale) was brought in after an overdose with the former enemies unable to revive the kid that became one of Jackie's rehab confidants.
"It's a profound loss for Jackie," executive producer Richie Jackson tells The Hollywood Reporter. "She is the caretaker to the most vulnerable people and when he relapsed and died, that really shook her -- both her feelings for him and also her concern for her own sobriety and how fragile her sobriety is at this point."
"When you see somebody who has the same struggles you do and that they don't survive, there's a little bit of 'Thereabouts the grace of God,'" Jackson adds.
After leaning on everyone around her for support in a way that she'd never done before -- O'Hara as a sponsor of sorts and Zoey (Merritt Wever) for help at home with her daughters and as a way to ensure she didn't fall back into old behavior -- Jackie noted (multiple times) that the consequences she was facing only started happening once she got sober.
Jackson notes that it's ultimately her fight to stay sober that audiences see in the final moments of the season when the homeless artist referred to as God draws a giant Jackie on the roof of the hospital that comes after she experiences O'Hara's birth and Charlie's death.
"We showed life and death in the same few moments and then she says, 'I made it!' and that's her saying, 'I'm going to stay on this sobriety; I want to live, I'm choosing to live,'" he says.
While Jackson and new showrunner Clyde Phillips (Dexter) -- who will replace co-creators Linda Wallem and Liz Brixiuswho parted ways with the series in April -- have yet to start breaking stories for Season 5, the exec producer says it will be interesting to watch an addict who still has an addictive personality but isn't using anymore.
"She's still a drug addict; she just isn't using the drugs of choice and it will be interesting to watch her trying to stay sober and explore where that behavior comes out in other places," Jackson says. "The other thing that doesn't change is her makeup is still that of a secret keeper; she took the drugs to manage her emotions and her inner-life and now that she doesn't have that and she's feeling more, she's more exposed."
"She's completely raw and doesn't have the protective shell that she had with drugs," he continues. "She's no longer managing her emotions with that so she's exposed in a way she has never been before."
Jackson says he and Phillips have discussed building on the consequences Jackie has paid this season in the newly announced fifth season and noted that there's even more pressure on her now to stay sober.
"We certainly don't want to end up back where we were; it's all not going to be OK now," he confirms. "We have this death of a person who was very important to her and she's been fired so we're going to build on that."
As for whether Cannavale could return, Jackson said it was more of a story question as producers would love to see him return. "We just have to figure out what is the next story after you lose your child," he said.
Hit the comments with your thoughts on the Nurse Jackie season finale.