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Jesse steals a dump truck and picks up Dan. In flashbacks, Jesse recalls when he was eleven and received a skateboard as a “guilt gift,” meaning a gift his parents gave him whenever Kate became seriously ill. Brian promised him he would take him to a parking lot where he could ride it, but Kate’s nose started to bleed. When Jesse reminded Brian of his promise, Brian looked at Jesse like he didn’t see him. That day, Jesse walked into the middle of traffic, hoping to get noticed. In the present, Jesse takes Dan to a shed. Jesse lights it on fire and admires his work, until Dan tells him that a homeless man named Rat lives in there. Jesse runs in to the burning shed, saves Rat, and runs away just as the fire trucks arrive.
Anna waits at the hospital with Kate and Sara. Kate feels alert, but Dr. Chance cautions that Kate’s lucid moments will occur less and less frequently because she is in end-stage renal failure. Kate asks Dr. Chance how long it will be before she dies, and he tells her maybe a week. Sara begins crying. When Anna tells her to stop, Sara looks at Anna and tells her to stop. Later at the fire station, Anna talks to Julia about her crush, Kyle, and Julia asks Anna what it will be like when Kate dies. Anna can’t answer. Sara calls to apologize to Anna and say goodnight. On the roof that night, Anna and Brian talks about the stars and celestial navigation.
Brian goes to the hospital to see Sara. He talks to her about a trip they took to Nevada years ago. They saw a fortune teller who told Sara her life wouldn’t be good enough and told Brian to save himself. Sara doesn’t remember the trip and only wants to talk about Anna. Brian tells her he plans to speak on Anna’s behalf. Sara can’t understand this. She asks Brian to remember what it used to be like between them. But Brian knows Sara is not the same woman she used to be. He also knows he is not the same man he used to be, a man who believed Sara when she told him she would always love him.
In 2001, Anna asks for money for goaltender pads. She has started playing ice hockey. Four years have passed since Kate’s bone marrow transplant. One night, the family goes to watch Anna play hockey. Later, Kate wakes up bleeding badly. She has relapsed and her body is failing. Dr. Chance suggests a new and untested arsenic therapy. That night, Sara finds Brian writing Kate’s eulogy. He wants to bring Kate home to die in her own bed. He tells Sara the arsenic will just postpone what is coming. Sara tells him it’s not time.
Kate slips into a coma. Sara receives a call from Jesse’s school. He blew up a septic tank and has been expelled. Sara picks him up from the school and notices needle marks on his arms. She suspects drug use, but Jesse reveals he has been donating platelets for Kate every three days. Anna gets accepted to a prestigious hockey camp, but Sara tells her she won’t be able to go because they might need her for Kate. Anna says the camp is a year away, implying that Kate won’t be alive then anyway. Kate develops an infection and becomes seriously ill. Jesse and Anna say their good-byes to Kate. Brian tells Sara that Kate needs her permission to leave. As Sara tells Kate that it’s okay for her to go, Kate grips her hand and begins to claw her way back to life.
Anna ponders what heaven will be like. She wonders what age people are in heaven, and how anyone recognizes each other. Sara calls a meeting at Campbell’s office. She tells Anna that if Anna gives Kate a kidney she will never ask Anna for anything again. Anna hugs her mother but tells her she can’t do it. Without a word, Sara tries to smile and then leaves.