Wow, is she mad! Her dumbass husband didn't load the dishwasher properly! In fact, she's so mad, the sound effects seem to be emanating from her, not her actions! And look at the dust motes of indignation over her head in the second dialogue panel!
Others have commented on the way John seems to be giving Elly the Heimlich maneuver in the penultimate panel. Or maybe they're about to go roadside. But what I really don't understand is why their silhouettes, in the panel before that, are gradations from violet to blue, as if they're being beamed up.
It is a nice touch, though, how John's talk balloon bridges the last two panels, bringing them to a reconciliation. However, this is what, the fiftieth variation on this punchline? "We have everything, so why are we griping about trivia?" The Pattersons must be slow learners.
And for the record, I don't think it makes a whit of difference if the utensils are handle-up or handle-down, as far as getting them clean. I do know, though, that one can, and I have, cut the bejezus out of one's arm on a knife that's turned handle-down.