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.
Sara’s flashbacks to 1997 additionally reveal how torn between her two daughters she feels at times, although those memories also show that, if Sara must decide which daughter to help, she will always choose Kate first. For instance, Anna goes to the hospital to give bone marrow for Kate’s transplant at the same time that Kate receives chemotherapy, putting the two girls in the hospital together. Sara prefers to stay by Kate’s side, and she even hesitates to leave Kate when Brian tells her that Anna, who has just gone through a bone-marrow extraction, has asked for Sara. Even as Sara speaks to Anna, who says she is in pain, Sara expresses her desire to get back to Kate, prompting Anna to cry out that she is in the hospital, too. The incident serves as a prime example of Sara’s single-minded focus on Kate causing Anna to feel neglected and to demand attention. Anna’s feelings about this incident and others like it surface when she shouts at Campbell that she is never sick enough for her family.
Sara’s overriding concern for Kate obviously stems from the fact that Kate repeatedly verges on death, whereas the problems the other children experience, though serious, are not fatal. Sara has great difficulty admitting that Kate might die, even as Kate herself seems to recognize the fact. Most notably, before Kate leaves for the hospital to receive chemotherapy, she cleans and organizes her room in case she doesn’t return. Sara, however, deliberately avoids the prospect of Kate’s death. For instance, when Brian admits he took the money for Kate’s bone-marrow transplant out of Kate’s college fund because he doesn’t think Kate will live long enough to go to college, Sara reacts by literally running away. She locks herself in the bathroom and pretends not to have heard him. In many ways, such as this refusal to discuss the matter with Brian and her constant care and concern for Kate, Sara has built her entire life around avoiding Kate’s death.
Throughout the story, and particularly in this section, Brian appears to be more understanding and open-minded than Sara, but we also see that he runs away from the family’s situation in a way Sara does not. Specifically, Brian uses work and astronomy as ways to avoid dealing with difficulties at home. Most significantly, when one of his coworkers suggests he take time off, he refuses, saying that if he is not working it means he has to be at home. Although Brian has cared for and supported Kate through her battle with cancer, he hasn’t done so to the degree that Sara has. But the deliberate distance he has created between himself and Kate’s cancer may also be what gives him perspective on his family’s situation, allowing him to see Anna’s and Jesse’s problems in a way Sara cannot. That perspective may also be what allows him to admit to himself that Kate might die, because unlike Sara, his life includes more than the struggle to keep Kate alive.
In addition, throughout this section the reader continues to learn more about Campbell’s and Julia’s romantic history, which provides some hints about the secret Campbell hides. In his flashbacks to high school, Campbell clearly has strong feelings for Julia, but he lacks the strength and maturity to defend her from either his peers at school or his parents. When Campbell admits that he stopped calling Julia just after she met his parents, it appears the reason he broke off communication stemmed from his desire to please his parents and fit in. Certainly Julia believed that to be the reason. But Campbell tells the reader, somewhat cryptically, that Julia doesn’t know the real explanation, suggesting that the secret Campbell has been hiding about himself and his need for a service dog has something to do with why he stopped seeing Julia. What the secret may be, however, remains unclear.