After their trip to see Madame, things are not the same between Tommy and Kathy. They continue to care for each other and still sleep together. However, it is clear that things are changing. When Kathy goes to see Tommy, he is more likely to identify with the other donors at the recovery center. At first these differences are small. One time, Kathy arrives at the center and finds Tommy talking to some of the other donors. Although he sees her, he does not immediately come over to her, though he claims afterward to have invited her over to him.

Tommy is about to make his fourth donation, and it is rare for donors not to complete before this. There is a great deal of respect for donors who make it to their fourth donation. The other donors look up to these donors, and the doctors will shake their hands. There is also some speculation as to what will happen afterward. However, at this point, Tommy tells Kathy that he has been thinking about getting a new carer. At first they argue about it, and Kathy explains that this is what Ruth wanted: that she would care for Tommy through to the end. However, Tommy argues that what Kathy wanted was for them to get a deferral together. Furthermore, Ruth would understand Tommy’s desire whether she agreed with it or not. As a donor, she would agree.

Kathy is hurt and feels excluded, particularly the way that Tommy has now excluded her from him and Ruth. However, she gives in and Tommy has a new carer. It is odd that Kathy has managed to be a carer for so many years, and Tommy questions whether she does not wish to receive notice that her time for donation has arrived. When the novel ends, Kathy has received notice that her time as a carer will soon end.

After Tommy completes, Kathy allows her only indulgence. She drives to Norfolk. She sees a stand of trees and walks toward them. She imagines Tommy walking toward her from a distance. However, she does not allow the fantasy to continue any further. She explains:

Though the tears rolled down my face, I wasn’t sobbing or out of control. I just waited a bit, then turned back to the car, to drive off to wherever it was I was supposed to be.