Contains spoilers for this episode and earlier episodes.
Flashbacks show Hurley receiving treatment in a psychiatric hospital after a deck collapse killed two people. He blames his weight for the accident, although the deck was already overcrowded. His friend Dave encourages him to resist treatment and seek more food. A photograph taken by Dr. Brooks shows Hurley with his arm around empty space where Dave should be. The apparent companion is imaginary, confronting Hurley with a relationship that has been undermining his efforts to recover.
On the island, Hurley destroys his hidden food with Libby's encouragement, only to find a new supply pallet has arrived. Dave appears again, and Hurley follows him before questioning whether he is hallucinating. He attacks Sawyer after asking for medication and being mocked. Dave tells Hurley that the island and everyone on it are fantasies, then urges him to jump from a cliff to wake up. Libby finds him and persuades him to step away, kissing him.
At the Swan, the exposed prisoner offers another account of the real Henry Gale before admitting he is an Other. He says that speaking could bring punishment from his own people. Locke asks what happened during the lockdown, and the man claims that he let the timer expire without entering the numbers. His account remains unverified. A final flashback shows Libby as another patient at Hurley's hospital, revealing a connection neither has openly explained on the island.