Still feeling ill, Pepper receives a confusing phone call from a woman she doesn’t recognize. She eventually realizes it is her daughter, Alice, who is so worried about Pepper’s confusion that she cancels three meetings to come over immediately. When Alice arrives, she confronts her mother about the phone call and questions Pepper about her new relationship with Moth. Alice expresses shock and concern that her mother is having sex at her age and reveals she has scheduled a doctor’s appointment, suspecting the onset of dementia. All of this prompts Pepper to remember that Alice has no desire to be married and care for a man and that Alice adopted her twin boys to raise alone.

At the appointment, Pepper’s primary care physician, Dr. Kim, is kind and attentive. Despite agreeing that Alice may have overreacted, Dr. Kim orders a comprehensive series of medical tests to rule out any serious conditions.

Dr. Kim summons Pepper and her three children to her office to discuss the test results. Dr. Kim announces that Pepper is about six weeks pregnant. Her children react with stunned disbelief, with Alice questioning how a 77-year-old could conceive naturally. Dr. Kim confirms that the pregnancy is unprecedented but real.

Pepper worries that her body is not actually creating a baby. Dr. Kim reassures her that the pregnancy is not viable and that she expects it to terminate quickly, framing the diagnosis as good news, as it eliminates more serious possibilities like dementia or cancer. Pepper is relieved that the strange illness requires no medical intervention and will resolve itself. The chapter ends by noting that time passed, but she was still pregnant.

A week later, Pepper’s pregnancy continues, and her queasiness has progressed to vomiting. She finally tells Moth about the pregnancy. He is initially concerned she is delirious, then relieved that she is not dying from a more serious illness. Pepper also informs her friends Maisie and Dot, who are completely unfazed by the news. Pepper reflects on the García Márquez story “A Very Old Man with Enormous Wings”—which she had taught in class—seeing a parallel between her own unacceptably, uselessly miraculous situation and the story’s shabby, misunderstood angel, and noting that people do not recognize miracles “in the aged or unsavory” (72).

The conversation shifts when Dot casually reveals, amid a running exchange of medical misadventures, that she has been diagnosed with terminal cancer that has spread to her bones. Moth offers support, saying he can help because he cared for his late wife, who had cancer. Pepper reveals to Maisie and Dot that she is a breast cancer survivor. This admission prompts her to remember how hard it was to watch her young children live through her cancer and how her illness destroyed her marriage to Roger. Consequently, Pepper also offers to help Dot, who vows not to tell her son. She declares that Moth, Maisie, and Pepper are her real family.

Dr. Kim assembles a team of specialists for Pepper. Along with Moth and her three children, Pepper attends an appointment with the head of gynecology, Dr. Blankman, who is visibly excited by her unique case. A transvaginal ultrasound reveals that the eight-week pregnancy is healthy and progressing normally.

Realizing she is not losing the pregnancy, Pepper requests an abortion. Alice simultaneously grasps the obstacle, and Dr. Kim confirms it in a word: “Texas.” Dr. Kim explains that under Texas law, termination is not an option. Dr. Blankman states that the law’s exception for the life of the mother does not apply because Pepper is not in immediate, life-threatening danger. Dr. Kim confirms they can only intervene if Pepper is already experiencing a medical emergency, which Alice clarifies means she would have to be “practically dead.” Dr. Blankman invokes divine providence, calling the pregnancy a miracle, and cites the law—not a moral objection—as his stated reason for refusing to help terminate the pregnancy.

With no other options, Pepper goes home and waits, finding herself in the grotesque position of praying to lose her pregnancy. The prayer feels monstrous, especially as she recalls a past pregnancy loss and the fervent prayers she offered for her son Max’s survival during that subsequent pregnancy.

Max visits her, bringing a box of supplies that includes multiple jar openers, jars of pickles and other foods, mittens, a pink stapler, colored pens, a sugar bowl, and a pair of lightning-bolt-shaped earrings. Max recounts a shared family memory of watching storms together, and Pepper reflects on it warmly, remembering how they would watch the storms with Max, so he would not be afraid of them like his sisters. The memory forces Pepper to consider the difference between harmless thunder and lethal lightning. Recognizing the danger her pregnancy poses, she puts on the earrings, acknowledging that she relishes a storm.

At her next appointment, Dr. Kim offers an explanation for the pregnancy. She produces paperwork from Protocol 183, an experimental breast cancer drug trial Pepper participated in from 1980 to 1982. The treatment involved two distinct drugs: a SERM (selective estrogen receptor modulator) that blocked estrogen to fight cancer, and a separate early gene therapy drug designed to repair and strengthen DNA. Dr. Kim explains that SERMs can also stimulate ovulation and are sometimes used in fertility treatments. Their working hypothesis is that the experimental drugs had a lingering, DNA-altering effect that resulted in her pregnancy.

Pepper challenges the hypothesis: She recalls being warned before the trial that chemo might impair her future fertility, and asks why the same treatment would make pregnancy more rather than less possible. Dr. Kim then addresses why Pepper appears to be the only trial participant affected, explaining that Pepper is an outlier; most other participants were older, have since died, had hysterectomies, or are no longer sexually active. Moth suggests that most of the participants have died, and then he slowly gets up and leaves the room. When Pepper asks if this new information provides any more options, Dr. Kim replies no and declares that they must continue to wait.