This Is Us threw me right back into my fat-girl insecurities during last night’s episode. In a flashback scene at the beginning, the Pearson family is getting ready for Christmas, and Kate complains about a stomachache. Rebecca brings up the cookies that Kate ate earlier as a possible cause. It turns out that Kate’s appendix has burst, and she has to have emergency surgery.Not only is this scene reminiscent of how everyone — family, friends, and even doctors — blames any ailment that overweight people have on their weight or eating habits. It was also a reminder of the shame that many plus-size people feel about their food, especially when others are constantly scrutinizing everything we put in our mouths. Adult Kate relives this shame during her gastric bypass consultation. Rebecca tags along, and Kate has to reveal that she still binges.Speaking of Rebecca, her propensity to be the human version of Pinterest is cute but slightly annoying. While adolescent Kate is being wheeled into surgery for her burst appendix, Rebecca gets the idea to pluck a branch from some of the hospital’s Christmas garnish and convince Kate that it has the magic to ensure that “nothing bad happens on Christmas Eve.” No one’s mom can enchant their family through this much drama.Still in the flashback, Jack and Rebecca spot another patient at the hospital who turns out to be Dr. K, the man who delivered Kevin and Kate and inspired the couple to adopt Randall. He has just been in a car accident and needs a lifesaving operation. The couple looks after both him and Kate as they push through their health issues. The episode includes shots of a patient on an operating room table, but both Kate and Dr. K pull through.On another high note, Jack's push-ups from last week paid off. Young Randall is feeling more grateful than ever to be part of the Pearson family. He buys Dr. K a snow globe from the hospital gift shop to show his gratitude that Dr. K convinced his parents to adopt him. Randall is the gracious child I can only hope to have one day.He is also the friend that some of us need. Randall’s coworker sells him a boat, which Beth is not happy about when she finds out. But the coworker was actually unloading his possessions because of suicidal feelings, and Randall has to talk him down from killing himself during their office Christmas party. Randall deserves some peace.One of the biggest shockers of the night comes from William. After a Narcotics Anonymous meeting, a man named Jesse approaches him. They know each other…well. Jesse wants to know why William chose not to disclose the severity of his cancer status, and why he ghosted Jesse in their relationship. Yes, William is queer. And his former lover Jesse is ready to forgive and wants them to spend William’s last living days together. It’s all too much, and there aren’t enough tissues.With all of the close calls, the episode still leans heavily toward a happy ending. Toby shows up to New Jersey to spend Christmas with Kate, and they have sex. Kevin falls for Sloane and decides to undertake a new play with her. Randall warms up to Rebecca following her betrayal. Even my wish that Kevin’s fling, Olivia , would disappear comes true. So being a self-sabotager, I secretly hoped, against Rebecca’s wishes, that something bad would happen on Christmas Eve. And it does. After they’ve finished dinner, Toby collapses from an assumed heart attack. It becomes clear that he, and not young Kate or Dr. K, was on the operating table. We won’t know if he survives until the series returns on January 10.Life continually serves the Pearson’s lemons. They’ve made themselves a batch of lemonade, but no one said it had to taste great.