After a few hours in surgery, Mia is back in ICU. She wishes she could go to sleep. She thinks she will get away. She just needs to figure out how to let go. Willow shows up at Mia’s beside with Mia’s grandparents. Her grandmother combs Mia’s hair with her fingers and fills Mia in on mundane family news, a running stream of commentary. Mia meditates on the sound of gran’s voice. She thinks about how welcome sleep would be; she has heard people speak of death as like sleep without dreams. She wouldn’t mind that. She wonders if her family had to decide whether to stay or go as well. She wishes someone could decide for her. Gran and Willow leave and Gramps arrives. He is crying. He tells Mia it is okay to go if she wants to. He wants her to stay, but he understands if she wants to stop fighting. Mia thanks him.
Mia recalls how, after Teddy’s birth, her father decided to quit his punk band and apply to grad school. This led to a fight between Henry and Mia’s father. Henry didn’t understand until he had a daughter himself. Mia was surprised to learn that her grandfather was most disappointed with Mia’s father’s transformation from rocker to teacher. Gramps had always wanted Mia’s father to become a writer. Mia learned her father wrote lyrics. She checked the liner notes on one of his band’s old CDs and read the lyrics to “Waiting for Vengeance,” and she was surprised by how good they are. While playing checkers, Mia asked her father if he regretted giving up the band. He said he didn’t, explaining that sometimes you make choices in life and sometimes choices make you. This made Mia think about her cello, and how she didn’t understand how she had become so drawn to it.
Mia can’t stop thinking about “Waiting for Vengeance,” singing it to herself, wondering if there is a hidden message in it that can help her decide whether to stay or go. Meanwhile, Willow is lobbying for Adam to be allowed to visit her. Nurse Ramirez takes Adam over. Even though he is fatigued, Adam is beautiful to Mia. He holds her cold hands, and Mia reveals that her hands are always cold. In a low voice, Adam repeats the word "please," imploring her to stay alive.
Mia reflects that she had never expected to fall in love. When she was falling in love with Adam, things were so comfortable that she hardly registered what was going on. But after her Juilliard audition, there was tension between them. He asked her how it went and she downplayed her performance, only to admit later that it went really well. Adam is curious why she hadn’t told him in the first place, but suggests they should go out to dinner to celebrate. However, the dinner is difficult to schedule, since Adam’s band was getting popular and he had to be in the studio that week. With a tightness in her throat, Mia acknowledges that things were getting complicated between them.
From that point on, they stopped speaking about anything that was going to happen more than a few weeks away. However, on the most recent New Year’s Eve, Adam kissed Mia hard and asked her to promise him that she would spend next New Year’s with him. The next day Mia cries to her mother, releasing the tension that had been building. Her mother said that she had sensed their relationship was more than a high school fling, but it was difficult to maintain a serious relationship at seventeen. Her mother says she would support any decision Mia made, whether to go with her love of music if accepted to Juilliard in New York, or to stay in Oregon, choosing her love for Adam. Later, Adam jokes that he would write a blues song about her if she left.
Adam suddenly rushes out of ICU, claiming to the nurse that he forgot something and will be back soon. Kim comes in, looking disheveled. Kim sits next to Mia and asks how she is doing. Kim recounts the day to Mia. Mia knows everything she says, but appreciates how Kim talks to her normally. Mia reflects on how it would hurt for Kim to lose Mia, but she would become a stronger person for the loss. Kim lists everyone who has come to visit Mia at the hospital. Kim says there are about twenty people in the waiting room, some related, some not, but they are all Mia’s family. Kim kisses Mia on the forehead and tells her that she still has family.
Mia remembers the previous summer, when her family hosted a Labor Day party. Adam joins. Mia and Adam wrestle on the lawn, playing in the sprinkler. Later Adam and Mia’s father jam together. With her family and boyfriend enjoying each other’s company, Mia thinks to herself that this is what happiness feels like. After some reluctance, Mia plays her cello, realizing that it could sound amazing alongside the guitar tones.
In the morning, Mia is tired of everything. She can barely blink her eyes. She knows she is delaying the inevitable, but she is waiting for Adam to return. When he does, he is panting, like he has been running. He tells her that there’s no word for what happened to her, but there is something to live for. He knows her life is “fucked up no matter what,” but he can’t imagine her not getting old and having children and getting to play her cello in front of large audiences. He tells her that if she stays, he will do anything: quit the band, follow her to New York; he’ll even go away if that’s what she needs, that maybe it would be easier for her to erase her old life.
The sound of Adam sobbing is replaced by the sound of Yo-Yo Ma. He has put headphones over her ears. She sees her future: visiting a cemetery, lying with Adam on a riverbank, hearing people say orphan, walking through New York with Kim, sitting with her cello. The future vision is interspersed are memories of what her life used to be, coming fast and intense. The future and the past keep coming until everything collides and, in a blinding flash, a pain rips through her body and she realizes how agonizing it will be to stay. But she can feel Adam’s hand. She is back in her body, lying in the hospital bed.
Adam is crying, and Mia is crying internally, feeling the catastrophic pain of everything that she has lost. The only way to survive the feelings is to focus on Adam’s hand grasping hers. She summons her strength to squeeze him back. He grips her back. When he says her name, it is the first time she can truly hear him.
Following her surgery for the burst blood vessel, Mia has made up her mind: she has chosen not to wake from her coma, believing that death is akin to deep slumber. However, she delays the decision, showing she is still uncertain, or perhaps unable to decide for herself. She wonders if her family had to decide, and wishes someone could decide for her.
In a recollection about her father, the motif of parental wisdom arises: Mia asks her father if he regretted giving up his music career to get a stable job that would allow him to spend more time with his children. His response—that sometimes you make choices in life and sometimes choices make you—speaks to the novel’s thematic concern with free will and determinism. Mia is facing a choice whether to struggle to live or succumb to death. She can take her fate in her hands, or go with the flow of existence.
As if answering Mia’s request for someone to help decide whether to stay for her, Adam is finally at Mia’s bedside. He holds her hand and implores her not to die. However, his approach is inadequate: Mia is inspired only to think more about the complications of their love. Adam senses that what he is saying is inadequate, and leaves in a panic. With him gone, Mia is closer to deciding not to live. She considers how Kim will be saddened by the loss, but tells herself that it will make Kim tougher.
Though Mia has made up her mind to die, she delays the inevitable, wanting to see Adam a last time. To her surprise, he places headphones over her ears and plays Yo-Yo Ma. Moved by the music, Mia considers for the first time what her future might look like if she stayed.
In the climactic scene of the book, the power of these visions, mixed with the unbearable pain of the past, collide and combine beyond Mia’s control. The mixed sensations of optimism and grief are strong enough to bring Mia back into her body. The final lines suggest that Mia has woken from the coma, able to squeeze Adam’s hand and listen when he says her name. Mia has chosen to stay.