Juliet sits on a beach, staring out into the ocean, flipping a small pouch in her hands. Heading inside a bleakly lit corridor, she passes Ethan. She enters a room where a girl lies in bed, hooked up to oxygen canisters and with a cloth wrapped around her head. It seems she is ill, and this becomes more apparent when Juliet injects her stomach with some sort of vaccine. This is Juliet's sister, but we don't know what's wrong with her as of yet. It is also revealed that this scene takes place in Miami.
We return to the present, where Jack is holding the clinic hostage with Ben's life in the balance. He has just ordered Kate to run to safety, so she and Sawyer turn the tables on Pickett and his goon buddy. It's not enough for Sawyer to just knock Pickett out, not after all the torture he has put him through. Instead, Sawyer rams a dazed Pickett's head into the fish biscuit button three times, sending an electric shock through Pickett. The Others subdued, Kate and Sawyer close and lock the cage, then flee into the jungle. It seems like a temporary victory, because Juliet sends one of the Others in the clinic after them, and to kill them if necessary. Jack tries to buy his friends a little more time:
Jack: No, you do that and Ben dies.
Juliet: (to the Other man) Go.
Jack: You think I'm lying, you think this is a bluff? I will let him die!
Juliet: No Jack, you won't!
It seems that Juliet once again has Jack's character pegged. In another flashback, Juliet enters a Medical Research Lab in Miami. As she walks through the corridor, she receives a cell phone call that identifies her as "Dr. Burk" while confirming an appointment she has for the next day. She ends the call and enters the laboratory, where she quickly swipes a couple vials of the vaccine she was giving to her sister. Suddenly, a man shows up in the lab, forcing Juliet to hide. This guy is taking advantage of the late hour to show off the lab to his new girlfriend, and score a bit of alone time with her. Juliet's cell phone begins to chirp, revealing that she's in the room. The man finds her, and we learn that this is Edmund, Juliet's ex-husband, and the girl he is with is Sherry.
Back in the standoff in the clinic, Juliet informs Jack that there is no escape for Kate and Sawyer, because they are on an island just off the coast of the main island, so it would best to reach a peaceful resolution. Undaunted, Jack reveals Juliet's plot to kill Ben during the operation. Tom orders Juliet out of the room, but Juliet doesn't go silently. "Don't let [Jack] fool you," she warns Tom. "He'll never let a patient just die."
Meanwhile, Pickett wakes up and starts screaming for help. Another Other guard races out of the jungle and releases him from the cage. Kate and Sawyer reach the shoreline, where Kate realizes that Sawyer was telling the truth about their stranded situation. Kate calls Jack on the radio, but her frantic call is interrupted by Pickett's arrival. He shoots the radio out of her hand, destroying it, and the duo are forced back into the jungle. Sawyer fires at Pickett, but quickly runs out of rounds. The Other guard aims in on Kate, but is knocked out by a slung rock. Alex has shown up just in the nick of time, slingshot in hand, and leads Kate and Sawyer away before Pickett realizes what's happened. The escapees duck into a concealed foxhole, and the Others wander off into the jungle in search of them.
Back at the clinic, Tom and Jack confer, and Jack insists that he's telling the truth about Juliet's duplicity. To their surprise, Ben reveals that he's been awake for some time, and he tells them to bring Juliet to him. In Juliet's flashback of her time in Miami, she is summoned to Edmund's office by Sherry, who reveals that she's the new research assistant. Edmund tells Juliet that he wants in on whatever project she's got going on, because he thinks that whatever it is will work. He's sure that with Juliet working on it, it has to be genius research, although her theft of the vaccine raises some ethical issues. He also has determined that the guinea pig for this groundbreaking research has to be Rachel, Juliet's ailing sister.
In the present, Alex reveals to Kate and Sawyer that she has a boat, but in order to use it, they'll have to rescue Alex's boyfriend, Carl. At the clinic, Jack and Ben talk about Jack's betrayal. Ben admits that he "should have seen it coming". Juliet comes in, and Ben tells Jack to give him three minutes alone with her. After all, with his kidney sac cut and him slowly bleeding to death, he only has 27 minutes left, anyway. Whatever they say is secret for now, but it causes Juliet to break down in tears. "They've got history," Tom explains to Jack as they look on from the upper deck window. Juliet exits the room and tells Jack that he has to help Ben, because she is going to help Kate and Sawyer escape. Tom is stunned.
In the past, Juliet is interviewed by a genetics company called Mittelos BioScience, who are interested in utilizing her talents in a project centered around a 27-year-old woman's womb, which for some reason decayed in the same way that an older woman's would. The company is in Portland, and Juliet is reluctant to take the position, partly because of her sister, but also because her ex-husband wouldn't allow it. She jokingly tells the headhunter that she wishes he would just get hit by a bus, and then tells him, "Whatever you think I am, I'm not. I'm not a leader, Mr. Alpert, I'm a mess." In the Swan hatch, Juliet checks the security cameras and finds Kate, Sawyer, and Alex outside the DHARMA facility where Carl is being held captive.
Alex pretends that she is ushering Kate and Sawyer into the facility as captives, claiming they escaped from their cages. The guard (Aldo) doesn't quite believe it, and says that her dad is going to be furious if he finds out she's there. Too late, he realizes it's a trick, and Sawyer is not tied up at all. He knocks the hapless guard to the ground, and they learn that Carl is being held in room 23. They race inside, and find room 23 is a room where detainees are shown some sort of subliminal message DHARMA reel. Carl is strapped into a chair with an IV pumping drugs into his arm and his eyes fixated on the screen with some sort of wacky goggles that keep his eyes open. Sawyer drags Carl out of the facility and demands that Alex produce the boat. Shortly after they leave, Pickett shows up and returns Aldo to consciousness. Before Pickett can give chase to his prey, Juliet shows up and tells him that Ben has ordered the captives to be let go. Pickett doesn't believe her and gives chase anyway.
In Miami, Juliet's sister asks about the interview, and Juliet informs her that she turn the position down. Rachel tells her that her research was a success, and that Rachel is now pregnant. Juliet is pleased and confronts Edmund about it. Edmund is delighted as well, and says that they should publish the findings immediately. Juliet is again reluctant, since the research subject in question is her sister, but their argument is cut short when Edmund is run over by a bus.
In the present, Jack is finishing up his surgery. He asks Tom why they didn't just take Ben to a hospital, a question that's been plaguing many a Lost fan. Tom is about to reveal something about when the "sky turned purple," when Jack accidentally nicks an artery, and Ben's vitals start to spiral. Meanwhile, the escapees reach Alex's boat, but Pickett is right on their heels. Sawyer takes a dramatic stand against his nemesis and Kate rushes to his defense. Juliet appears from the jungle and shoots Pickett, killing him.
Jack works desperately to save Ben with Tom's assistance. Juliet tells Kate and Sawyer that they can leave, but Alex has to stay, or else Ben will get incredibly angry. Alex reluctantly agrees, and then Juliet has Kate call Jack on the walkie-talkie. Jack gets Kate to repeat the story he told her the first day on the beach, about the operation he botched in which the little girl almost died because he cut the spinal sac. As she tells the story about how he didn't let fear take control of him, Jack regains his concentration and finishes patching Ben up. "Promise me that you'll never come back here for me, Kate," Jack demands. Kate and Sawyer flee the island with Carl.
In a Miami flashback, Juliet is in a morgue, and she breaks down and cries as she signs paperwork for Edmund's body. In the present, Jack tells her the operation was a success, although they'll have to do a biopsy to ensure the tumor is not malignant. Unfortunately, Jack will have to return to his cell until "they" – as Juliet calls the Others – decide what to do with him. Jack demands to know what Ben said to Juliet
In the Miami morgue, Juliet is approached by Ethan and Mr. Alpert, who expresses his condolences for the horrible accident with her ex-husband. Juliet quickly suspects that they had something to do with this tragedy.
"We came because we're that serious about you working for us," Mr. Alpert insists, and reveals that they also know about Rachel's pregnancy. They tell Juliet that if she comes to work for them, she can be back in six months time, long before Rachel gives birth. Unfortunately, Rachel can't come to Portland with Juliet, because the site is actually pretty remote. "Well, actually, we're not quite in Portland," Mr. Alpert says.
In the present, Juliet reveals that she has been on the island for three years, two months, and 28 days, and Ben had told her that if he lived, and she helped Jack, Juliet could finally go home.