Warning: There are spoilers ahead for From season 4, episode 6, “The Heart Is a Lonely Hunter.”From star Elizabeth Saunders reveals the real reason behind Donna’s near-death experience.

During From season 4, episode 6, Donna collapses from a heart attack, and there is a moment where she appears to be dead after Kristi Miller (Chloe Van Landschoot), Marielle Sinclair (Kaelen Ohm), and Boyd Stevens (Harold Perrineau) were seemingly unable to resuscitate her. The episode does not directly explain whether the heart attack happened because of Donna’s health, being overwhelmed after encountering the doll monsters, or something else entirely.

In an interview with ScreenRant‘s Tatiana Hullender for From season 4, Saunders was asked about what she believes was the final straw that led to the heart attack. The actor explains that she thinks it is from the strain of caring deeply for the Matthews family and many other characters, the physical toll from the doll monster attack, and potentially even the Town itself hurting her. Check out Saunders’ comments below:

I think it’s a combination, but I’m going to tie it to the Matthews family mostly, even though it’s also happening elsewhere. Because the ties of love are getting greater, the potential loss is greater, and I think that’s putting more strain on Donna. Her feeling of needing to be there for everybody is so deeply embedded in her that she feels she has to do right by everybody else, so the stakes are getting higher.

Then we have the dolls, and that attack on her, even though she survives it, takes its toll on her physically. So, I think it’s a combination of things that made even a simple disagreement about everything that’s going on too much for her. I think that’s why it happened there.

Although, could the Town have done it to her? Maybe! I don’t know that it isn’t my version of them getting under my skin, you know? The [writers] never secretly tell me anything, other than John [Griffin] warning me that I was going to have a heart attack and make it through, which I was very grateful for. Because if I had read it? I would have had a heart attack while I read it, because I am terrified of having one. I was like, “I don’t want to do this scene!” But that’s my job, so I did.

As the de facto leader of Colony House, Donna is used to caring for many people at once. However, protecting all of them is not the same now that she knows about the dead’s nightmares becoming a reality, which is far worse than just contending with From‘s nocturnal monsters. She now has to worry about any nightmare from the dead endangering them at any time.

On top of that, as Saunders mentions, Donna is closer with the Matthews family than ever before. After the death of Jim Matthews (Eion Bailey), Donna looks after Julie (Hannah Cheramy) and Ethan (Simon Webster). She also gives Tabitha (Catalina Sandino Moreno) the strength to keep going, and she has particularly been a source of stability for Ethan. This makes it all the more difficult for Donna to see Tabitha and Ethan nearly hurt by the doll monsters and to know she cannot protect the family against all the nightmares.

As for whether the Town caused the heart attack, it is possible, as almost killing Donna is one of the worst things that could happen given how she keeps things under control and is connected to practically all the residents. If she died, Boyd may have unraveled completely, Colony House may have descended into chaos, and the Matthews family would have lost another loved one while still grieving for Jim. The Town likes to torment the residents, and almost having Donna die, but not quite, fits the bill for sadistic torture.

If this is the case, the Man in Yellow (Douglas E. Hughes) does not seem to have been involved, though. Disguised as Sophia (Julia Doyle), the villain instead spends the episode getting close to Henry Kavanaugh (Robert Joy) and secretly getting him to consume the Man in Yellow’s blood.

With Donna having survived, the From characters have survived the latest catastrophe, but it likely won’t be long until the next disaster strikes. Consequences are sure to come from the Man in Yellow’s blood being inside Henry and the plan to go into the Town’s tunnels and remove the dead children’s bones is poised to bring plenty of other complications with it as well.

From season 4 releases new episodes on Sundays on MGM+.