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.
Julia admits to Izzy that she still has feelings for Campbell. Just then, Campbell arrives and asks Julia out to dinner to discuss Sara’s plea bargain. He takes her out on his boat, and though they’re having a good time, Julia suspects Campbell wants to sway her decision. Julia gets angry and wonders if Campbell ever says anything that isn’t a lie, but Campbell kisses her. She remarks that it feels like the most natural thing in the world.
The novel presents love, whether romantic or familial, as a complex and often contradictory emotion, and no relationships better exemplify this idea than Julia’s and Campbell’s relationship and Sara’s and Anna’s relationship. Julia, for instance, feels simultaneously attracted to and repelled by Campbell, largely because of how he treated her in the past. She asks Izzy if Izzy thinks she likes Campbell “because he’s an asshole or in spite of it.” At one point, Julia and Campbell go from arguing to kissing in a matter of seconds. In a similar manner, Sara can go from being extremely angry at Anna to being tender and caring in a short period. Often the people in both relationships wound each other deeply, as when Campbell stopped calling Julia, or when Anna filed her lawsuit. The characters in these relationships can hurt each other so much specifically because they love each other, not in spite of that fact.
Sara’s and Brian’s relationship reaches a breaking point in these chapters. In Brian’s memories of their trip to Nevada, we see a couple entirely different from the one we have seen throughout the novel. They are young, energetic, and very much in love. Currently, however, much of their relationship revolves around dealing with Kate’s cancer. Brian’s choice to support Anna also puts them for the first time in opposition with each other. Previously, Sara typically took the lead and convinced Brian to follow, as when she convinced him to see the fortune teller with her during their trip to Nevada. Now, however, Brian cannot be convinced. He believes Anna should be allowed to make her own decision about serving as Kate’s donor, leaving Sara feeling even more alone in her struggle to save Kate.
Brian’s wish to bring Kate home to die brings up another conflict in the story. Kate comes near death multiple times in the novel. Each time we see her suffering greatly. She bleeds profusely and slips into a coma, for instance. Because she has a terminal disease, the question does not seem to be whether she will die, but when. The struggle to prolong her life has put a great burden on every member of the family. Jesse and Anna do not have normal childhoods and regularly cannot do the things they want to do. Sara and Brian must care for Kate constantly and their marriage has suffered as a result, The greatest burden, however, falls on Kate herself, who must endure harsh treatments such as chemotherapy and suffers tremendously as the cancer destroys her body. If Sara and Brian bring Kate home, she will certainly die, ending her suffering. If she remains in the hospital, she may be able to go on living temporarily, but her suffering will continue and it remains only a matter of time before she will need to be hospitalized again. No perfect option exists, and we see Brian and Sara struggling to determine what would be best for Kate.
Despite his tough-guy persona, Jesse begins to emerge as one of the most vulnerable characters in the story. Even when he destroys things, he never intends to hurt anyone. When he sets the shack on fire and Dan tells him someone could be inside, Jesse runs in without a thought to his own safety. Although he blows up the school’s septic tank, we learn that he has been donating platelets for Kate. These actions suggest an internal conflict in Jesse’s character between impulses to destroy himself and to save others. Jesse’s self-destructive behavior stems specifically from his desire to be noticed by his parents, specifically Brian. According to Jesse’s description, when Jesse asked Brian to keep his promise and take Jesse to the parking lot to skate, Brian looked at Jesse like Jesse was “made out of smoke.” Jesse says for the first time he thought he might be, just meaning that he felt invisible. Immediately after, he ended up walking into traffic, just hoping to be noticed. Jesse’s desire to save others, meanwhile, appears to stem from his wish to save Kate and also from a wish to be like Brian, his father. When Jesse runs into the burning shack to save the homeless man that lives there, he unconsciously mirrors Brian, the firefighter.