8 'This Is Us' Tissue Moments Ranked: Everyone Blows Up as Kate Undergoes Emergency Surgery

Stress brings out the worst in everyone, and that was on full display in an uncomfortably raw bottle episode of "This Is Us."

Bottle episodes take place primarily in a single location and were designed as cost-saving character pieces. They've had mixed results over the years, and this episode is a mixed result all by itself. At times, it dragged a bit, but at the same time, it revealed so much about the cast.

Once again, Miguel was treated as an outsider by the narcissistic Big Three -- represented here by Kevin and Randall, going at it like they're little kids again. And Kevin, unfortunately, is sliding right back into all those traits that made him the least-liked character on the show.

Plus, while relapse is a very real thing that addicts deal with, it doesn't feel we're far enough removed from his last bout with addiction to really appreciate this as a new exploration. On top of that, essentially nothing new has happened with the character, as the entire Vietnam/Nicky arc was more about Jack than Kevin, and the end result was Kevin in the bottle ... again.

And now he's lying to everyone and proving right here and right now that he's absolutely no better than he was the day before when he was too drunk to drive Kate to the hospital. Sure, he fessed up to that one, but what about the fact his water bottle is full of vodka ... and yes, that was obvious from the moment he showed back up with it.

And Kevin was cruel, to boot, lashing out at Madison unfairly. But the hardest thing about that scene was watching Madison get awkwardly upset and leave and not a single member of the Pearson extended family stood up for her or said anything. They just let Kevin's abhorrent behavior and this hurt girl happen right in front of them.

And that's what made this episode compelling. It was ugly in so many ways and that's what made it feel authentic and real. People aren't always at their best, and this is the family on way too little sleep for way too long. They were catty and snippy and mean-spirited, but they were all there and united for Kate, warts and all.

As we do every week, we're going to single out the show's most powerful moments, scoring them by how many tissues we tore through just to watch them. Believe us, these are happy tears of anguish.

Not exactly their finest moment, but one of the most telling of the entire hour. Kevin totally and unfairly lashed out at Madison -- after she brought donuts, no less -- and no one came to Madison's defense. Madison has now been a part of this show for awhile now, with her and Kate striking up an unlikely friendship.

And for all her flighty goofiness, Madison is kind of a sweetheart. Certainly her heart is in the right place. And she didn't deserve to be treated like that by Kevin, or the whole family.

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Meanwhile, Rebeccca is proudly proclaiming the strength of the family in telling the doctor that they intend to stay, no matter how long it takes. And that's what Miguel has been representing all along. This is a very tight-knit group of people, so long as you are on the inside. For the most part, that leaves out all of the spouses, but none so much as Miguel, who is being unfairly compared to Jack on a daily basis.

So yes, this familial bond is something to be proud of, but it's also arrogantly exclusive -- as evidenced by their disregard for Madison as a person and treatment of Miguel of the years. That's something they need to work on, letting others into their inner circle.

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Poor Zoe is such a sweet girl and she's made such a monumental change in who she is for Kevin. This statement alone is huge, and proves just how much he means to her. But does she have any real idea what she's in for should she choose to say? Now Zoe said this before she discovered vodka in his water bottle, but nevertheless, Kevin is the biggest pain in the ass on the show. And he's still lying to her.

This is not how you build a foundation of trust, and it's so unfair to Zoe who's unpacked so much of her own baggage with Kevin and opened herself up so much only have him immediately start dumping his b.s. all over her.

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Rebecca was lost in thought through most of the hour, but snapped out of it long enough to yell at her boys for making this day about their issues over what Kate was going through -- big surprise there! She also kind of made it about her just a little by sharing how vivid her recall is of the waiting room she was in when she took Jack to the hospital for his burns and smoke inhalation where he died. Granted, that would be a very vivid recall.

At least she wasn't yelling at anybody and trying to make them care more about her grief than what was going on with Kate. And it was a telling reminder of just how vividly Jack still lives in her heart, which has to be at least a little awkward for Miguel. He's living in the shadow of his best friend with his stepchildren and his wife.

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Rebecca, at least, has some understanding of Miguel's position. And while we're still waiting for a deeper dive into his world on the outside of the Pearson family unit, it was nice to see her acknowledge her appreciation for him standing by her side and never giving up on her kids.

And then he extended that same message to Madison in a beautiful shared moment between them. The Pearsons are a lot to put up with. They're loud, arrogant know-it-alls and yet they are at the same time compassionate and likable. But they are not easy to be in orbit around.

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Chris Sullivan just knocked it out of the park this week, appearing haggard and shell-shocked as he explained to the family that his son had been born at 28 weeks, extremely premature. You could hear the fear and terror in his voice, and later when he was with Kate, you could see how much he's struggling with all of it.

None of it quite seems real for him, and while we don't yet know exactly what has him in such a state, it's easy to imagine. Everything has gone wrong with what he envisioned for him and Kate as new parents. And this child is definitely not out of the woods yet. It's all more than just a little overwhelming.

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Even after she was shunned out of the waiting room, Madison stuck around because she is that good of a friend for Kate. She was a part of Kate's birth plan and her presence in the hospital was her trying to hang on to whatever part of that plan she could for her friend. But it was her gesture of breaking into Kate's apartment to get her RBG doll -- so the baby could see a strong, female influence from the start -- that solidified her as best friend goals.

Madison is everything Kate isn't, and the old Kate would have hated her on sight. Hell, she did hate her on sight. But new Kate is able to see that underneath all of her quirks is a genuinely kind-hearted person who cares about her. Madison deserved better this week, but she showed her true colors.

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While Toby was struggling to process everything, Kate was calling to a higher power. Of course she would name her baby boy Jack. Even her brothers knew that out in the waiting room. And Toby had no hesitation in agreeing to the name, because he probably knew it, too. There is no bigger male presence in Kate's life, even in his absence, than her father. And so she reached out to him in heartfelt prayer that he do what he can to keep her baby alive.

But what scares us the most is that this is "This Is Us." Pain and heartache are what the show is about, so we can imagine this baby either dying or suffering serious complications from being born so early and we're kind of freaking out, too. And the latter might be a lot of what is weighing on Toby. Nobody gets a totally happy result on this show.

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