The Hardest Part is the eighteenth episode of the fourth season and the 72nd overall episode of Private Practice.

Short SummaryEdit

When Pete's brother, Adam, brings their sick mother for a consult, Pete discovers her illness may be his brother's fault. Meanwhile, in the wake of her book's success, Violets walks in on Sheldon just as he's about to take her archenemy on a date, and Cooper treats a young musical prodigy whose brain tumor could prevent him from ever playing the piano again.

Full SummaryEdit

Episode in detail.


  • Pete Wilder
  • Cooper Freedman
  • Charlotte King
  • Sheldon Wallace
  • Amelia Shepherd
  • Sam Bennett
  • Violet Turner
  • Frances Wilder
  • Marla Thomkins
  • Dennis Hoffman
  • Adam Wilder
  • Casey
  • Lisa
  • Patrick Hoffman
  • Terri
  • Pam
  • Ricky
  • Jamie
  • Paramedic Rodriguez

Main CastEdit

Guest StarsEdit


Medical NotesEdit

Frances WilderEdit

  • Diagnosis:
    • Arrhythmia
    • AV dissociation
    • Third-degree heart block
    • Congestive heart failure
    • Digoxin overdose
  • Treatment:
    • Atropine
    • Temporary pacemaker
    • Drug reversal

Frances was brought into the ER with an arrhythmia. They stabilized her in the ER and Sam put in a temporary pacemaker. She'd developed congestive heart failure in prison and because the doctors there couldn't handle it, they released her. Her son, Adam, admitted that he had bribed a guard to give her digoxin, which made her worse so that she could be released. Sam later reviewed more scans and said that she was going to die and it wouldn't be much longer. Adam and Pete both sat with her while she died.

Ricky, Pam, and TerriEdit

  • Diagnosis:
  • Treatment:
    • Talk therapy

Ricky, Pam, and Terri came to talk to Sheldon and Violet because their daughters made a pact to become pregnant together in high school.

Casey, Jamie, and LisaEdit

  • Diagnosis:
    • Pregnancy
  • Treatment:
    • Talk therapy

Casey, Jamie, and Lisa came in because they had all made a pact to become pregnant together in high school. Violet and Sheldon took Casey and Lisa on a tour of the maternity ward. While they were there, Casey went into labor. After seeing what happened to Casey, Jamie decided to give her baby up for adoption. Lisa came to Violet and said that her mom didn't deserve having another kid dropped on her when she was already raising three on her own. She said she wasn't sure if she wanted to keep the baby or not, but she wasn't sure how to talk to her mom about it. Violet said they could talk to her together.

Patrick HoffmanEdit

  • Diagnosis:
    • Pilocytic astrocytoma
    • Brain hemorrhage
    • Hematoma
  • Treatment:
    • Awake craniotomy

Patrick, 14, came to see Cooper for numbness. When he held out his hands, one of them drooped, so Cooper ordered an MRI. Amelia reviewed the MRI and diagnosed a pilocytic astrocytoma. She recommended surgery to remove the tumor. The safest way to do it had a high potential to paralyze his hand. Because he's a pianist, he asked about other solutions. She said she could do an awake craniotomy, but it was much riskier and could paralyze his leg. He wanted to do it despite the risks because he said he can't live without playing piano. His grandfather instead decided on the safer option. Patrick said he wanted the riskier one because he felt like his grandfather only loved him because of the music. Amelia spoke to his grandfather, who said that he does love him, but said to let Patrick have the surgery he wanted. They had Patrick play while Amelia operated, so she'd know where it was safe to cut and where it wasn't. During the surgery, Patrick's grandfather was brought into the OR by Cooper, where he told his grandson he loves him. He started bleeding, so Amelia had to repair the damage. She said they wouldn't know if he'd walk again until after the swelling went down, but she got the whole tumor and he would be able to play.


  • Diagnosis:
    • Pregnancy
    • Placental abruption
  • Doctors:
    • OB/GYN
  • Treatment:
    • C-section delivery

Casey had a placental abruption while touring the maternity ward and had to have an emergency c-section. After delivery, Casey decided to name her baby Ben.


Song Performer Scene
"Whole New Way" Scissor Sisters
  • Sheldon and Marla talk in bed.
"Nocturne Op. Post in C Sharp Minor" Simone Sala
  • Patrick plays piano for Cooper.
"This Time Tomorrow" Trent Dabbs
  • Patrick hears his grandfather say he loves him just as Patrick starts bleeding.
  • His grandfather says he can't lose Patrick.
  • Pete sits by his mom's bedside. Adam comes in and feels guilty.
  • They both sit with her as she dies.
"Bring on the Wonder" Sarah McLachlan
  • Charlotte and Cooper kiss.
  • Marla and Sheldon disagree over Violet.
  • Pete picks up the living room. Violet comes in and he tells her about his mom.
  • Pete starts to cry and hugs Violet.

Notes and TriviaEdit

Private Practice 4x18 "The Hardest Part" promo

Private Practice 4x18 "The Hardest Part" promo

  • This episode scored 7.35 million viewers.
  • This is the second out of two episodes in the entire series that don't feature Kate Walsh as Addison Forbes Montgomery
  • Sam says to Pete that Addison is in Seattle, delivering a baby. This baby is Sofia Robbin Sloan Torres, whom Addison had to deliver early because her mothers, Callie Torres and Arizona Robbins, were in a car accident while Callie was pregnant.
  • This episode runs parallel to the Grey's Anatomy episode Song Beneath the Song, as proven by Addison being absent in this episode to deliver a baby in Seattle and the air dates of both episodes (March 31, 2011).
  • This is the first episode to be directed by Paul Adelstein, who portrays Cooper.
  • This episode shows that Cooper can play the piano.


Episode StillsEdit


See AlsoEdit

A complete overview of this episode's crew can be found here.

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