The episode succeeds when it focuses on Joyce and it fails when it focuses on the semi-lame demon from space. I say 'semi' because in the sequence at Buffy's house the creature is pretty effective in its creepiness being in the midst of the sadness that is looming all over that home. Another problem I see is a pace that is just a bit too slow. This one's a mixed bag, although more excellent acting all around causes it to get its point across successfully.
Even though Joyce is out of it most of the time, she's really the focus of everyone's concerns here. I can understand her not wanting to wait around in a hospital for her operation. That'd drive me crazy too. Willow getting the Summers' family individual presents to help cheer them up is both sweet and kind. I especially like the beer hat for Joyce and the homework with yoyo for Buffy. Joyce's sudden snap into abrasive words is pretty jarring. Later on she says, "No reason to get upset? Oh, right, sorry, I must just think there is because of my brain tumor!," which is also very abrupt and scary to hear her say, especially in front of Dawn as I'm so used to Joyce being so soft-spoken and kind. I have to say that I'm a bit surprised by how fast Joyce's symptoms manifested. I guess the writers didn't want to drag out the "Joyce is ill" subplot for too long, and I have to say I think it was a wise decision.
I also found Joyce's randomness in speech back at the house later to be really effective. It's creepy in a realistic way that really hits home for me. I've gone through losing someone to a disease, and I've seen that person do a lot of weird and random stuff. I really appreciated seeing Joyce unaware of what she's saying, randomly thinking it's breakfast time and insulting Buffy. Joyce's rambling upstairs, when there's actually the demon right above her, is really sad to see. I have memories of being in Dawn's position of hearing a sick loved one through the wall having lots of pain and confusion in a room adjacent to mine, it's scary and not at all easy.
The emotion-filled final scene with Joyce asking Buffy to promise to protect and take care of Dawn in case she doesn't make it is really tough to see. Buffy's expression when she hugs her mom is one of sadness and fright that this might be it; she really might lose her mom. The very final shot of the doctors taking Joyce away into surgery is obviously intended to make us think that was really her farewell. I now, in retrospect, love the way Whedon handled this plot thread. We get all the goodbyes, tears, and promises early on in the season. Then Joyce seems fine again only to suddenly die later from a complication of the surgery taking place now. This way we get all the goodbye talk out of the way and can simply experience the shock of an unexpected death without feeling completely cheated from losing a beloved character.
All throughout the episode Buffy is trying to hold herself together. She turns on the radio while washing dishing to drown out her mom's loud rantings from upstairs. Unfortunately the sound of a crazy happy radio song combined with the mundane task of washing dishes that undoubtedly her mom would usually take care of, are the things that finally work to make Buffy emotionally break down all the way. SMG is heart-breaking in this scene. I so feel for her, and she makes me want to be there to offer some comfort because she looks so genuinely scared and sad; an excellent, realistic scene. In classic Buffy fashion, she faces her pain alone.
There's some other interesting bits to talk about besides Joyce and Buffy though. The gang's patrol without Buffy and Willow's giddiness after staking two vamps in the intro is highly amusing. I'm sure Buffy expected Riley to be there helping out, but instead he's started the vamp suck jobs, sulking over Buffy not wanting him every second of the day. It's at this point where I lose my sympathy for Riley -- he's gone too far here, although I still understand why he's doing it.
The Willow/Tara scene on the rooftop is really sweet. She says that looking at the stars is supposed to make you feel all insignificant, but that instead they make her feel like she's a part of them and therefore significant. I can't help but see this as a bit of a commentary on Willow. Before she had many friends, or many self-confident ones, she essentially viewed herself as an insignificant nerd. Just remember back to how she reacted when Buffy said, "Uh, Hi! Willow, right? ," and she replied "Why? I-I mean, hi! Uh, did you want me to move?" in "Welcome to the Hellmouth". Now, over the years of becoming part of the Scooby family, she's much more secure with herself and feels much more significant.
The major fault of this episode is the space demon, which is silly even before we find out what it is. How is it that no one can see this huge thing crawling around the ceiling? It's called 'peripheral vision' people! However, the demon's a lot more effective when in Buffy's house, mostly because you can't really see it very well. It actually becomes a bit creepy during this sequence. Overall, though, I feel this episode does its job well of showing us the very icky horrors of illness and its affect on the people around it. It's also a lot better than I originally thought. Flawed, but nonetheless good.