Contains spoilers for this episode and earlier episodes.
Jack collapses at the beach, and Juliet diagnoses appendicitis. Sun, Jin, Daniel and Charlotte collect surgical supplies from the medical station. Noticing Charlotte understands Korean, Jin privately threatens Daniel unless she ensures Sun leaves the island. Jack insists on remaining awake for the operation, with Kate holding a mirror so he can direct Juliet. His interference makes that impossible, and Bernard administers chloroform. Juliet completes the surgery successfully and later tells Kate that Jack loves her.
Sawyer escorts Claire, Aaron and Miles toward the beach. Miles locates the buried bodies of Rousseau and Karl, and Frank warns the group to hide as Keamy’s surviving mercenaries pass. That night, Claire sees her father Christian holding Aaron. By morning, she has vanished. Miles tells Sawyer that she left with a man she called her father. Sawyer finds Aaron alone beneath a tree and calls for Claire, but receives no answer.
Flashforwards show Jack living with Kate and helping raise Aaron. He proposes, and Kate accepts, but his unease grows after visiting Hurley at Santa Rosa. Hurley passes on Charlie’s warning that Jack should not raise the boy. Jack then sees Christian at work and seeks medication for sleeplessness. Suspicious of Kate’s telephone call and absence, he demands an explanation. She says she was fulfilling a promise to Sawyer. Their argument escalates until Aaron appears and Kate turns to comfort him.