The film's structure is built on the tension of Otto's suicide attempts, each failing due to comedic interruptions. However, the twist is that Otto does not die by his own hand. He eventually reveals he has a condition called hypertrophic cardiomyopathy ('too big a heart').
In the end, Otto accepts his life and stops trying to end it. He helps defeat the real estate developers and accepts Malcolm and Marisol's family as his own. The film flashes forward a few years: Tommy notices Otto hasn't shoveled his snow. Marisol enters to find Otto has passed away peacefully in his sleep from his heart condition. He leaves a letter giving them his house, money, and his car (to Malcolm), ensuring their financial stability. The ending recontextualizes his death not as a tragedy or an escape, but as a natural conclusion to a life finally lived fully.