Contains spoilers for this episode and earlier episodes.
Juliet's flashbacks show her secretly treating her sister Rachel's infertility while working under her controlling former husband, Edmund. Richard Alpert approaches her with a research job supposedly near Portland. Juliet says Edmund would never let her go unless he were hit by a bus. After Rachel becomes pregnant, Juliet tells Edmund and resists his demand to publish her results. He steps into the road and is killed by a bus, leaving Juliet disturbed by the coincidence.
At the Hydra, Jack continues holding Ben's life hostage while Kate and Sawyer flee. Juliet initially argues that escape is impossible because they are on a separate island. Alex helps the fugitives hide, then offers a boat if they rescue Karl. They enter a guarded building and find him restrained before a screen projecting rapid images and messages. They free him and take him toward the shore, with Pickett and the other guards still pursuing them.
Ben wakes during surgery and speaks privately with Juliet, who then promises Jack that she will help his friends if he completes the operation. She shoots Pickett before he can kill Sawyer and lets Kate, Sawyer and Karl leave in Alex's boat. Kate radios Jack with his counting story, and he makes her promise not to return for him. Juliet later explains that Ben has offered to let her go home if he survives and Jack's friends escape.