Contains spoilers for this episode and earlier episodes.
Flashbacks show Kate marrying a policeman, Kevin, under the name Monica. His mother welcomes her and gives her a family locket, but Kate remains afraid of discovery. She telephones Marshal Mars and asks him to stop pursuing her. After a negative pregnancy test, she tells Kevin that she is a fugitive and has been hiding her identity. She drugs him, leaves the locket in his hand and abandons their marriage before he can stop her.
On Hydra Island, Jack refuses to remove Ben's tumor despite its urgency. Juliet takes Kate to see him, telling her that persuading Jack to operate will prevent Pickett from killing Sawyer. Jack rejects the appeal. Kate returns to the cages and breaks into Sawyer's, determined to escape, only to learn that they are on another island. With their options apparently closed, they have sex. On the main island, Locke buries Eko and notices a northward direction on his stick.
Jack finds his cell unlocked and reaches the surveillance room, where he sees Kate and Sawyer together. He agrees to operate in exchange for Ben's promise to send him home. Once surgery begins, Pickett prepares to execute Sawyer, but Jack deliberately creates a dangerous complication and threatens to let Ben die unless Kate and Sawyer are released. He demands radio contact with Kate and orders her to run, asking her to repeat his counting story when she is safe.