In flashbacks, Campbell recalls more scenes from his high-school relationship with Julia. Campbell’s friends teased him about Julia, but he would not defend her. Campbell also avoided telling his parents about Julia, which Julia suspected. When he finally took her to meet them, his parents behaved rudely and refused to invite her to a party the rest of the family was attending. Afterward, Campbell began ignoring Julia. One day they met at the cemetery, and Campbell told Julia their relationship was over.
In the present, Campbell goes to the hospital to speak to Dr. Bergen, the head of the ethics committee. Dr. Bergen says the committee never met to discuss Anna, despite the fact that Anna had been a patient at the hospital eight times. After his meeting, Campbell runs into Julia. He convinces her to talk with him about the case, and they go to an Italian restaurant. Campbell avoids answering questions about his service dog and why he took the case. He receives a phone call from Anna asking him to meet her at the police station. When he and Julia arrive, Anna tells them Jesse has been arrested for stealing a judge’s car. She asks for Campbell’s help. Reluctantly, he manages to get Jesse released on probation. In the car on the way home, Campbell tries to get Anna to tell him what she really wants. She explodes in anger and says she’s sick but never sick enough for her family. Campbell is pleased at her anger but also worried that she will sound unsympathetic on the witness stand.
Campbell arrives at the firehouse with Anna. When he and Brian talk alone, Brian admits he agrees with Anna and says he is willing to say so to the judge. Brian remembers an incident from the night before in which he shouted at a kid whose girlfriend overdosed on drugs. Another firefighter told Brian he could take time off, but Brian says that means he would have to be at home instead. Back in the present, as Campbell leaves he mentions Jesse’s arrest.
In 1997, Sara finds Kate with blood streaming down her legs. Kate has relapsed and needs a bone marrow transplant. The family’s insurance company refuses to cover the transplant. To prepare Anna for the bone marrow donation, Sara gives her growth-factor shots. Six-year-old Anna tells Sara she hates her. Sara’s sister, Zanne, offers to pay for the transplant, but Brian tells Sara the men at the fire-station raised enough money. Sara takes Kate to the hospital to begin her pre-transplant regimen of chemotherapy. Before she leaves the house, Kate cleans her room in case she doesn’t come back. Again, the chemo makes Kate violently ill. The time arrives for Anna’s bone-marrow extraction, and Sara tells her she doesn’t have to do it but that everyone is counting on her. Sara goes to be with Kate. Brian arrives after Anna’s procedure and says Anna has been asking for Sara. Sara feels torn but goes to see Anna. Anna says she hurts, so Sara finds a nurse to give her medication. When Sara goes back to Anna’s room, she sees Brian putting the locket on Anna’s neck.
A few weeks later, Brian takes Sara out to dinner. They have nothing to talk about other than Kate and feel like strangers. When it’s time to take Kate home from the hospital, Sara notices how different Kate looks. Later, Sara learns that Brian lied about the firefighters having raised enough money to cover Kate’s bone marrow transplant. When Sara confronts him, he says he used the money from Kate’s college fund to help pay for it, because Kate won’t live long enough for college. Time passes and Sara tries to get Kate to leave the house, but Kate feels self-conscious about her appearance. Sara shaves her own head, and then Anna asks to have her head shaved, too. All bald, they go to the mall.
The section makes reference to the novel’s major ethical debate, about whether Anna has the right to stop acting as a donor to Kate. In Sara’s flashback to 1997, we see that Kate might have died without a bone marrow transplant. Anna, of course, served as the donor. In her memory of the time, Sara recalls Anna suggesting that she might not want to go through with the painful bone marrow extraction that Kate needs to survive. Sara tells Anna she doesn’t have to do it if she doesn’t want, but immediately reminds her that she and Brian and Kate are counting on her, essentially leaving Anna no room to make her own decision. For Sara, the matter does not require any deliberation. Better Anna experience some pain and Kate survive than have the alternative scenario take place. But Anna, who will be the one to experience the pain, has no say in the matter.