The episode begins a year from the current timeline in the Annapurna Himalayas.
Miles narrates the episode and informs the audience that for this moment to make sense, we have to go back to the night before his sister's big surgery.
Everyone is toasting Ali and remaining positive. Just then, Miles gets a Friend Suggestion: Ali.
The next morning, Ali asks Trish to come to the hospital early because she wants to ask her to be her power of attorney in case anything were to happen during surgery.
Trish is shocked, and she knows it's going to be an issue for Arthur, but Ali is adamant that this is what she wants.
Of course, when Arthur and Miles find out, they aren't pleased.
Ali realizes she left her Bible at home, and asks Miles to go get it for her so she can have it for the surgery.
Miles is hesitant but agrees thinking this is what the God Account intended.
He cannot find the Bible at his apartment, so he goes to Ali's bar with Cara and grabs it.
They have less than an hour to get back to the hospital, so they jump on the subway, which endures mechanical issues.
Miles plunges forward when the train comes to a halt, hits his head, and falls unconscious.
He regains consciousness shortly after and realizes he needs to get back to the hospital. He maneuvers his way to the front of the train to talk to the conductor, but no one can open the door. Miles takes charge, and they find the conductor hurt and unconscious.
He informs everyone on the train that there is a gas leak and they need to get out. When no one is listening, Miles becomes desperate, and that's when he sees Miguel, a former Friend Suggestion who was about to commit suicide when Miles stepped in. He vouches for Miles, and the people on the train follow his lead.
He makes it to the hospital, but Ali has already gone into surgery. He thought he was supposed to stop the surgery from happening since Ali has a heart defect that increases the risks, but that wasn't the case since the defect would always be an issue but the cancer needed to be removed immediately.
The surgery is long, but everyone waits patiently. Miles get a message from the God Account with a verse to Jeremih 29:11. When he opens the Bible, he finds a letter from Ali written in case she doesn't wake up.
When Dr. Chang informs them that there have been complications with Ali's surgery, Miles blames himself. His father tells him to find faith in prayer, and Miles realizes he needs to go to the church. With his last few Friend Suggestions, the God Account has wanted him to find his way back to his faith.
After going to the church, things take a good turn, and Ali's condition improves. Everyone rejoices.
Cara's mother, her husband, Paul, and Liv, say goodbye before leaving to Ohio to start a new life.
She tells her to be honest with Miles about her feelings, so Cara tells him the truth. They remain friends.
However, the episode begins catching up to that one-year flashforward with Miles revealing that he and Cara rekindled their romance.
Ali found her Calling and became a preacher, and Rakesh and Jaya got engaged. And this time, she said yes.
Of course, Miles always wondered where or not Ali's health turnaround was a coincidence or a byproduct of something bigger.
The answer was right in front of him. He said the God Account left him a clue in the Bible passage. A year after the surgery, he got a message from the God Account to come to this mountain, which brings us back to where the episode started with Miles standing atop one of nature's wonders.
A young child dressed as a Tibetan monk calls out to Miles to "follow" him.
"She's been waiting for you," the child says as Miles follows.
And that's the last ever scene of God Friended Me.