Jack needs an emergency appendectomy, and Juliet is forced to perform it. In the jungle, Miles notices something odd about Claire just before she sees a startling sight.

Written by Edward Kitsis & Adam Horowitz
Directed by Stephen Williams

Flashforward

After Kate’s trial in the future, Jack had a change of heart and decided to take her up on the offer to become part of Aaron’s life. So he moved in with Kate and everything was coming up roses, even to the point that he proposed marriage to her and she accepted. But their happiness didn’t last. Jack began to emotionally unravel after seeing visions of his father.

Jack was called in to consult by a doctor at Santa Rosa Mental Hospital about Hurley, who had descended into a form of dementia where he questioned everything about the reality around him. He told Jack that he had been getting visits from Charlie often, who told him about things that would happen in the future. Charlie’s latest visit was to pass a message along to Jack: “You’re not supposed to raise him, Jack,” a statement clearly referring to Aaron. Charlie also told Hurley that Jack would be receiving a similar visit himself, and soon.

Jack went through with his plans to get engaged to an overjoyed Kate, even though he was troubled by Hurley’s warning. Things got worse when he saw another glimpse of his dead father at his medical practice late one night. Immediately after, he asked a colleague to write him his first prescription for the same potent drug he would later become addicted to. When he got home, he found Kate talking on the phone with someone she lied to him about.

His sudden paranoia over Kate’s secret grew until he confronted her one night while he was drunk, because she had been gone for several hours. She begged him to let the matter drop, saying it had nothing to do with the two of them, but it was a secret she needed to honor. When he pushed her, she admitted that she was doing something that Sawyer had asked her to do shortly before the Oceanic 6 escaped the island. Jack was outraged, pointing out that Sawyer chose to stay on the island, but Jack was here with her and he deserved her trust and loyalty more. He blew up in about how she’s not actually related to Aaron, and the two of them suddenly spotted Aaron standing nearby, having heard the whole thing. Kate rushed to Aaron’s side but with a single look between them, Kate and Jack both knew that things had just ended between them. Jack left the house, and never went back.

Now

    Jack’s abdominal illness worsens, and he passes out after breaking up an argument between the survivors and Daniel & Charlotte. He later tries to play it off as food poisoning, but Juliet has enough experience as a doctor to know appendicitis when she sees it. And it’s in danger of rupturing. So Juliet will have to take it out.

    Jack can’t be moved, so Juliet makes plans to send Sun to the Staff station for surgical supplies. But when Sun says she doesn’t know how to recognize most of the stuff on Juliet’s shopping list, Daniel volunteers to help. He manages to convince Juliet of his sincerity, but Charlotte and Jin will both go as well, and Juliet gives Jin her pistol with orders to shoot them in the leg if either of them tries to run.

    As Sawyer, Claire, and Miles trek through the jungle on their way back to the beach, they come upon the place where Karl and Danielle were killed, and Miles’ abilities as a medium lead them to a pair of shallow graves where the two have been buried. Sawyer angrily points out that it was Miles’ “buddies” from the freighter who must’ve done this, but Miles replies that Keamy and his men are not his friends, and slaughter is not what he signed up for.

    Miles keeps a curious eye on Claire, observing her from nearby. A suspicious Sawyer notices and gives him a “restraining order” of not getting within twenty feet of Claire. Later, Frank comes running out of the jungle straight at them, and he’s shocked to see them there. He quickly tells them that Keamy is right behind him, and he warns Sawyer, Claire, and Miles to hide before Keamy gets there. They do so, and Keamy comes running in with what’s left of his team, who are still smarting from their encounter with the smoke monster. Frank wards them off back toward the helicopter before they can discover the castaways, reminding them that the plan is to get off the island and back to the freighter before dark.

    Rose expresses great concern to Bernard about Jack’s illness, reminding him that people on the island don’t usually get sick. She finds it remarkably coincidental that Jack has come down with a life-threatening problem immediately before all of the survivors are about to get rescued.

    Jack asks Juliet to use a local anesthetic so he can remain conscious during the surgery, because he wants to talk her through it. Juliet argues that there’s no way he can see what she’s doing, but he says to get Kate to be there to hold a mirror up so he can see — and he wants Kate to do this, and no one else. This action sends sparks through the love triangle between Jack, Kate, and Juliet, since Jack seems to be choosing Kate over Juliet for the first time in a long time.

    Sun’s group arrives at the Staff station and she and Jin notice that Daniel has feelings for Charlotte. They confer with one another in Korean on the subject, but Charlotte seems to notice what they say, and Jin picks up on this. That night, when they get back to camp, Jin confronts Charlotte and gets her to confess that she really can speak Korean. He asks her to ensure that Sun makes it onto the helicopter when it comes back for her and Daniel, and he threatens Dan to ensure she’ll cooperate.

    As Juliet preps for surgery, Bernard injects Jack with an anesthetic to numb the incision spot. Juliet tries to abide by Jack’s wishes to stay conscious, but the pain becomes overwhelming for him, and he’s unable to remain still enough for her to perform the surgery. So she has Bernard knock him out, and she orders Kate out of the tent.

    Kate goes back inside the tent once the surgery is complete, and Juliet reports that it was a complete success and Jack will be fine. After the two of them have a friendly moment, Juliet confesses to Kate that Jack kissed her a few days ago. She says it was nice, but he didn’t do it for her; she sure he was trying to prove to himself that he wasn’t still in love with Kate. But Juliet’s explanation makes it clear that Jack was unsuccessful, and he is indeed still deeply in love with Kate. Kate thanks Juliet and leaves, after which Juliet tells Jack that she knows he’s really awake even though he’s pretending to still be asleep. He opens his eyes, having heard Juliet and Kate’s entire conversation.

    Claire is alarmed to wake up in the jungle in the middle of the night and find that Aaron is missing. But she finds him nearby being held by her dead father, Christian Shephard. When morning comes, Sawyer is shocked to hear from Miles that he watched Claire get up in the middle of the night and walk off into the jungle with someone she called “Dad.” He says he didn’t follow her because of his “restraining order.” Sawyer hears baby Aaron crying in the distance and runs toward the sound, and finds Aaron alone, laying in his blanket at the base of a tree. But Claire’s gone.

    • Jack and Kate came close to achieving domestic bliss, even getting engaged and planning to raise Aaron together. But Jack ruined the whole thing by refusing to trust Kate when she wouldn’t confide in him a secret task that Sawyer had asked her to perform before she left the island.
      Question: What happened between Jack and Kate in the future that they wound up on such bad terms? [3.23]

    • Why was Miles so interested in Claire? Did something about her set off his abilities as a medium? Could Claire possibly be dead, having not survived the explosion of her house at the Barracks after all?
    • Is Rose right about Jack having done something to cause the island to make him sick? If so, what did he do? Is it his relentless plans for escaping the island? Could the island be trying to keep him from leaving?
    • Is Hurley really seeing visions of dead people, or is it all in his head?
    • What was the favor Sawyer asked of Kate?
    • Why did Sawyer “make his choice” to stay on the island?
    • What’s become of Claire? Where did she go with her father Christian? Why did she leave her child behind?

    

    I suppose this is the episode where the Jack/Juliet relationship was officially scuttled, as the two of them never really had any further romantic overtones after this.

    Jack/Kate shippers got everything they ever wanted between the two characters — sex, a marriage proposal, domestic bliss — and then saw all that happiness utterly destroyed, all in a single episode. It was quite the emotional rollercoaster, and ultimately, it was a tragedy. The two of them clearly are still madly in love, but they both have issues — Jack in particular — that need sorting out before they can achieve genuine contentment. Not the least of which is finding their destinies on the island.

    Of all the Jack/Kate action in this episode, my favorite scene between them was actually the little moment after Kate finds out she’s going to help during the surgery by holding Jack’s mirror, and the two of them quietly walk down the beach together arm in arm. So much more goes unsaid than said in this brief moment, so much history between the two of them, and it perfectly underscores their entire relationship.

    Dead Charlie’s message that Jack isn’t supposed to raise Aaron is a nice bit of continuity that goes all the way back to Season 1, when Claire learned that “danger surrounds” her child, and that she alone must be the one to raise him. Could there be more to this? Could Aaron somehow be at the heart of every major mystery related to the island?

    So what really caused Jack’s mental breakdown? Was it his own control freak tendencies and trust issues? Or was it his stubborn refusal to listen to the island when it wanted him to come back? He definitely knew that the island wanted him back, but not listening to it caused him tremendous anguish, as we saw in “Through the Looking Glass.”

    Going back to our ongoing discussion about Jacob’s nemesis, and my theory that it can take the shape of dead people like Yemi and Christian Shephard… If the Christian we saw in this episode — as well as the Charlie that appeared to Hurley in the Season 4 premiere — was a manifestation of Jacob’s nemesis, then wouldn’t that mean that it was Jacob’s enemy and not Jacob himself that wanted the Oceanic 6 to return to the island? This notion is validated throughout Season 5 when “unLocke” was seen as the one instigating this notion that the Oceanic 6 all had to come back to the island together, in order to save it. We still don’t know what they were supposed to have saved it from, and I’m wondering if this was just a lie on the part of Jacob’s nemesis in order to get them back to the island for some other purpose that’s yet to be revealed. By that same token, it would mean that Jacob’s nemesis was ultimately responsible for Jack’s mental breakdown, and the end of Jack’s relationship with Kate — all for the purpose of getting the Oceanic 6 back to the island.