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In the past, after he and Sam argue, the narrator takes to following Nurse Ella around the hospital, helping her with her rounds. Ella finally has enough of Sam constantly following at her heels and takes him to Sam’s room, where she makes them talk about their problems. The narrator, who breaks the rules of reality, does not understand what love is. This upsets Sam, who only wants to hear that the narrator loves him the same way he loves the narrator. The boys make up, but Sam’s condition deteriorates—he tells the narrator not to lose hope.
Hikari grieves the death of her friends by collapsing in on herself. She goes to the places they spent time together—Neo’s room, the garden, specific hallways—to talk to them as if they are still physically with her. Sam follows her each time. Hikari both welcomes his presence and resents him; she accepts his comfort but resents that he reminds her of her pain and the friends she’s lost. When she goes to Neo’s room, she finds his parents there. Neo’s clears out Neo’s papers and plans to burn them. She fights to keep the papers, but his father refuses.
Neo’s mom stands up to Neo’s dad and refuses to let him take all the papers—she returns their hit list and some of Neo’s writing to Sam. He takes the papers to Hikari in her room, where he finds her standing in the bathroom holding the plastic knife. He convinces her to let it go, but she gives up her will to continue living.
Sam sits with Eric and asks if this empty feeling he feels now is the same that Eric felt when Sony was dying. At first, Eric doesn’t answer. Then, he tells Sam that he’s angry that kids must go through these difficulties, and he can’t save them. Sam cannot save them either, but he gives them hope.
Eric goes to take care of a new bunch of kids and Sam reads the hit list he, Neo, C, and Sony put together. At the end of the list, where the pages should be blank, Sam finds pictures and writing. Before Neo died, he gathered the memories they made together—C trying Sony’s breathing therapy, the quintet on the roof, Sam and Hikari kissing on the beach—and added them to the notebook with a note for Sam thanking him for helping them have good times that they otherwise might not have had.
Sam, the narrator’s love, recovers from his illness physically, but mentally and emotionally he continues to feel the strain. He no longer smiles like he used to, and does not want to take part in any activities that he enjoyed. Any time the narrator asks him to enact their escape, he responds “maybe tomorrow.” The disease seems like a part of him, and though he loves the narrator, love alone is no longer enough of an impetus to continue fighting. Sam lets go of life and crosses the symbolic bridge as seen in the Prologue.
Hikari leaves the hospital and goes to the bridge. Sam chases her there, knowing what will happen. The shadows entice Hikari to cross the bridge, and she almost does until Sam stops her. She believes she cannot live with the pain of losing her friends; she sobs and wants to give up on life because it is easier than living with the pain. Sam begs her to stay. He pleads that it will get better because life isn’t only about being good; it’s about experiencing love, loss, happiness, and hope. As Sam makes his way to her, Hikari stumbles into the road where a car nearly hits her. Then, Sam rescues her the way she rescued him. They hold each other in the snow, hope and despair embracing until the shadows leave them both.
Hikari’s condition improves. She sees a therapist with her parents, makes friends with other patients in the hospital, and slowly begins to have fewer depressive days. Sam knows there will still be bad days ahead for Hikari, but there will be more days of joy. In one final act, Sam takes Hikari to the rooftop garden for a final picnic before telling her their big secret—he does not exist. “Sam” is the embodiment of hope, of an unfulfilled wish, and of a dream. He is only corporeal because others make him so; he has no description and yet every description, because he is what a person needs. The soul he attached himself to—Sam’s and now Hikari’s, who are the same soul—no longer need his. Sam disperses into the hospital itself, waiting for the day Hikari returns to him one last time.
Hikari concludes the book by recapping who “Sam” is for the audience. Sam wandered the halls of the hospital without a body from the moment they built the hospital. “Sam’s” goal was to heal people; soon, disease appeared and started to take people. The purpose of the hospital shifted and became about maintaining hope and a dream of living beyond illness. It meant more than just minor scrapes—it became a home for the hopeless who needed a place to be. One day, “Sam” met a soul who made him want to live, and so he became real. He fell in love with Sam, and then Hikari, and then whoever Hikari would go on to become, and Hikari fell in love with him—Sam and Hikari’s soul fell in love with hope.
The narrative comes full circle: Hikari returns to the bridge where the narrator’s love Sam died by suicide. The narrator arrives in time to stop her, just like he did before. This time he is changed. With his love Sam, he was immature and ill-prepared to face life and death. Now, he is mature. He knows that time is what a person makes of it, that disease is only as powerful as a person lets it be, and that death does not have to be the end because a person’s spirit and memory can live on. The friends’ motto is fulfilled: Time ceases to have influence. Now, Sam lives for the present. He sees people for who they are rather than their diseases; therefore, illness no longer controls the narrative. Sam now knows there are things that live beyond death, as connections and memories don’t die when a person does. All of this, everything that Sam learned throughout the novel, comes together, fulfilling Sam’s final wish to save Hikari.
Sam, the symbolic reflection of hopes and dreams, can now provide hope to Hikari. When she looks into Sam’s eyes, she sees that life will get better. She knows that she can live a happier, more fulfilling existence where depression doesn’t control her narrative. Neither she nor Sam are hopeless when they look at the future now. The dullness that took over Hikari fades as yellow returns in full strength to Hikari’s yellow-flared eyes. They are the sun that Sam sees in them.
When Sam gazes into his love Sam or Hikari’s eyes, he sees a reflection of himself and the light that he spreads to others. When Hikari’s hair and eyes dull, it symbolizes her and Sam’s fading hope. The return of the yellow-flared eyes in the final chapters conveys Sam’s growth and Hikari’s ability to see a brighter future. Sam has a new perspective on what the hospital can be and how people can interact with it; he once again hopes that people leave the hospital healed, rather than dead. Likewise, Hikari can see a life where her depression and chronic mental illness don’t control her. The hospital is no longer her entire existence, and she can live, love, and have experiences that were previously unavailable. In hoping for the future, the color yellow reignites for both Sam and Hikari.
Sam’s function in the narrative is complete. He has learned lessons that he has helped pass on to Hikari. He teaches his final lesson—that people and souls live beyond death, even if they don’t remember. When Sam successfully reaches Hikari and fulfills his dream of saving her, he achieves peace and allows himself to become part of the hospital again. Hikari leaves and does not return for many years, as she no longer needs the safety of the hospital to keep her alive. She will not leave her hopes and dreams unfulfilled because she will not disappoint Sam again.