From Campbell’s section through Sara’s section
Campbell, while on the phone with his mother, wonders how much people are beholden to their parents. Campbell stops for coffee and gives his waiter a new sarcastic explanation of his service dog, Judge. He returns to his office and finds Anna there. Sara calls while Anna is in the room with Campbell. Sara tells Campbell that Anna has changed her mind, but Anna tells Campbell she has not. Campbell recalls a memory of his father. They competed in a sailing competition, and Campbell ended up embarrassing and disappointing his father. Campbell goes to the courthouse where he meets Sara, who decides to act as counsel for herself and Brian. Sara and Campbell speak with Judge DeSalvo, the judge for the case. They argue about what Anna really wants until Judge DeSalvo decides he needs to speak with Anna.
Anna wonders what her funeral would be like. She doesn’t think many people would come, unlike Kate’s funeral, which would be crowded. At the courthouse, Anna speaks with Judge DeSalvo alone. They discuss the trial, and Anna tries to remain composed. But she recalls a time when she and Kate pulled a prank on a nurse at the hospital and starts to cry. She tells Judge DeSalvo she can’t give a kidney to her sister. He assures her no hospital would take a kidney from an unwilling donor, but she says being a donor has never been her choice. She says she never wanted to stop the lawsuit and only told her mother she would because she loves her. Judge DeSalvo decides to appoint Anna a guardian ad litem who can decide what is best for her. The hearing, he says, will take place the following week.
Anna goes home with her parents, even though Campbell wants to speak with her. Brian pleads with Sara to calm down, but Sara shouts that Anna practically signed Kate’s death sentence. Kate runs upstairs. Anna leaves the house to go to a laundromat, a place she feels safe. She tries to picture a future without Kate but can’t. They are as connected, she thinks, as Siamese twins.
Jesse thinks about when he was a child and would light bath soap on fire to show Anna. He reflects that Anna is the only proof he has that he belongs in the family. While driving down the highway, he imagines crashing his car because he would be worth more dead and used as parts. He meets a homeless man named Dan. Jesse has a deal with Dan where he brings Dan food if Dan will watch Jesse’s things, including stolen acid and sawdust. Jesse goes to an abandoned warehouse and sets a fire. He admits he has done it before. He watches the fire from far away until he sees his father arrive. Jesse goes home to find Sara frantic. Kate is vomiting blood. Jesse drives Kate to the ER.
At the hospital, Dr. Chance tells Sara and Jesse that Kate is in the end stages of kidney failure. Sara asks if a transplant is possible, and Dr. Chance tells her that the odds are not good. Sara asks if they would do the transplant if a donor were available. Jesse offers his kidney, but Dr. Chance tells him it must be an exact match. Jesse wonders why he thought he might suddenly be worth something and why he thought he could save his sister when he can’t save himself. Kate tries to tell Jesse something, but all he can understand is “tell Anna.”
The time is 1990–1991 and Sara is pregnant with Anna. Sara knows everything about the baby, from the sex to the specific combination of genes that will allow Anna to be a donor for Kate. She admits that she has thought of Anna only in terms of what she will be able to do for Kate. Sara reveals that three months after chemo, Kate went into molecular relapse. Sara recalls the television interview she and Brian did. They explain why they went to a geneticist and deny wanting a “designer baby.” They only wanted a child who would save Kate’s life. Sara goes into labor on New Year’s Eve. Anna is born, and the doctors take her umbilical cord to harvest the cord blood. Kate begins a pre-transplant regimen of radiation and chemotherapy, which makes her violently ill. The doctors put her in isolation, then give her Anna’s cord blood.