10 This Is Us Premiere Tissue Moments Ranked: 2020 Hits Hard -- Plus, the Gasp Heard 'Round the World

After watching the two-hour premiere of "This Is Us," it's easy to see why the creative team wanted to air both episodes back-to-back.

There was a lot to unpack, as the show took 2020 head on from the pandemic to the Black Lives Matter movement and protests. The death of George Floyd and subsequent protests informed Randall's entire arc across these two hours, and will surely be felt for a long time to come.

At the same time, the pandemic immediately derailed any thoughts of Rebecca going into a clinical trial in St. Louis to deal with her early onset dementia. At the same time, it was all seamlessly woven into the fabric of what we've seen before, as this was the birthday party that saw her get lost while trying to pick up a cake for her kids.

We also quickly realized that as heavy as 2020 has been, the weight of what went down between Randall and Kevin is weighing heavily on both men, as well. And it's not something that can be or should be resolved quickly, as both said some pretty awful things to one another.

The result was a 40th birthday unlike the previous three Big 3 birthdays. While Kate and Kevin joined Rebecca and Miguel down at the cabin, where the latter have been quarantining since the pandemic began, Randall's focus was on family.

Actually, his focus throughout has been on the years and years of systemic racism he's witnessed -- and experienced -- but never really felt free to talk about. Those realizations informed a difficult conversation with Kate and a huge therapeutic change.

The reality is that there is no easy way to talk about these issues, but we applaud "This Is Us" for tackling them head on in all their messy uncertainties. Kate doesn't know what to say to Randall, and Randall isn't sure what to say back. In this blended family, that's absolute truth.

It's painful and it's hard, but so is what's going on in the world around us. It would have been disingenuous for the show to skirt this reality to paint a fiction that ignores it when it's been so direct already in dealing with issues of racism, and in particular, Randall's complicated relationship with his own Blackness and his white family.

But this is also "This Is Us," which means it has its own twists, turns and emotional heartbreak to lob at us. Flashbacks took us to the births of the Big 3 -- with Randall acknowledging he's not even sure when his birthday is exactly -- from the points of view of Rebecca and Jack as well as William and Laurel.

Plus, it wouldn't be a new season of "This Is Us" without a new shocking twist and reveal. This one takes us all the way back to the beginning and in some major ways changes everything -- while raising so many more questions.

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.

We started to get hints of this late last season, but the more we sit with it, the more we're convinced that Kevin and Madison are strangely perfect for one another. We love that Kate has come to accept their odd relationship, as well, as it looks like it's going to the next level. How Kevin to propose while she's scared one of their unborn babies is gone, but at the same time, he showed some Jack-like prowess in sharing his faith and positive thinking that the babies were going to be fine.

It's a shame he's not quite there completely and botched his chance to have a meaningful exchange with Randall. We're not sure Randall was in the headspace to have had that talk anyway, but Kevin made it all about himself and didn't even try to bridge that gap. In all honesty, both men failed there, but there's time yet.

1 tissue

This was definitely the night's biggest shocker, but it wasn't exactly a tear-jerking moment. Nevertheless, our hearts break all over again for William, who went to his grave convinced that he had given Randall's mother the fatal overdose that killed her -- because in the final moments of this episode, she gasped.

Yes, Randall's mother did not die the night after he was born. But William apparently never knew that (unless there are even more secrets) as he fled from the paramedics saying they were going to call family services. He dropped Randall off at the firehouse and the rest is history. But now, so many more questions rise up.

If Laurel survived her overdose, where did she go? Why did she never seek out William or try to find her baby? Is she still alive today? Does she know about Randall? Does Rebecca know about her (hey, she knew about William!)?

1 tissue

On any normal episode, this might have risen much higher, but there were such bigger things going on, it was hard to get too worked up about Toby and Kate getting word that they've matched with an expectant mother for adoption. We're happy for them and look forward to their journey, but we're not, like, crying over it or anything.

1 tissue

We loved the weaving of Jack and William in the hospital as Rebecca was delivering her babies and Randall was already there. Even better, they locked eyes and saw one another coming in and out of the chapel. Our hearts were breaking for William, convinced he had killed Laurel and then given up their son (we can't even imagine the weight of this).

Then Jack, who didn't have a huge role this week, showed again why his heart is so big when it comes to his family, effectively threatening God, begging, praying and demanding that Rebecca make it through this delivery. Life had always been difficult for Jack, he said, and Rebecca was the only good thing that had ever happened to him. So of course he was willing to trade his life for hers.

2 tissues

As Randall found himself immersed in the emotional turmoil of Black Lives Matter, this small moment from Tess perfectly painted just how monumentally huge it is. It's not that she's wanting to deny it or step away, she just needs to step back and take a moment.

To live in that pain and sadness, as Randall described it later, is totally overwhelming for him as an adult. As Tess is still trying to make sense of the world around her, it's easy to see that it could be a pure sensory overload at times, requiring a breather and disconnects to be able to process the enormity of the movement and the horrific history that precedes it.

3 tissues

This was a moment of tremendous growth and self-awareness. It also felt inevitable from the moment we first saw Randall having a session with Dr. Leigh over Zoom. He's never had an easy time opening up about the biggest things in his life, and this may be the biggest thing he's never fully unpacked.

Already a champion of normalizing and championing mental health care and therapy for men (and Black men), we can totally support Randall realizing that he is going to need a Black therapist for this next chapter in his mental health journey. We also applaud the writers for recognizing how real that can be for him, and taking that step with his character.

3 tissues

Look, finding out later that a bad combination of medications made this a more serious episode than we might otherwise have to deal with at this stage doesn't take away from how hard it was to watch Rebecca repeat this question to Randall in the span of a few minutes. And that's because this day is coming.

We've seen how far her dementia takes her in the future, and we know it's a tough road ahead for her, for her kids and her husband. We're thrilled that it's pushed a little further down the road, but this is the kind of sneak peek that breaks your heart and definitely sits with you.

4 tissues

Toby came through in a huge way for Miguel, struggling with looking down the tunnel at that very future with Rebecca. Miguel's love is absolute and pure, but he's afraid for her and not sure how to be there for her in the best way possible.

Toby came up with a great comparison to his own realization that his anti-depressant medication was a forever thing. You can dwell on that facet of the future, or you can simply focus on one day at a time, making the best of those moments. Cherish each one and don't short-change the future.

Miguel took this to heart when he suggested they plant apple tree seeds rather than a sapling. Rebecca, fearful of how much time she has left, was ready to take that shortcut to fruit in two years, but Miguel reminded her that six to ten years isn't so bad. "I've got all the time in the world."

4 tissues

Easily one of the most complicated and beautifully played conversations on this show, Kate was shown early on being an activist, going to protests and genuinely having her heart in the right place. But then Randall challenged her, why not before now? It's not different this time.

We may never know why now, but it's an absolutely fair question for him to ask her. Kate has a big heart and it is in the right place, but that doesn't change Randall's reality or the reality that he and his Black brothers and sisters have lived in for generations.

And so, even as her tears fell, he knew he could not console her and try to make it easier for her. Because what does that do for him? And later, as Kate could only sit with her thoughts and think them, that was also the right thing to do.

She doesn't get an easy pass for her emotions, just as he doesn't for his. There isn't an answer to why now, why not then? And none of it lessens the pain that Black people have been feeling for longer than white people have been paying attention to it.

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As always, it's Beth who comes through in the clutch, sitting with Randall on his birthday surrounded by his loving family and still overwhelmed by a sadness inflicted by the world outside his window. In a way, it's like the advice Toby gave Miguel, but it sings differently.

First, Beth told him to go ahead and acknowledge the tragedy of it all. He can also acknowledge that he was born of multiple tragedies (the believed death of Laurel and death of one of Rebecca's triplets). "Look right in front of you, right here in this room," she challenged him, looking at their daughters. "Look what you did with all of that."

And yet, that's why the call isn't to live life and move on, but rather to "fight on." Yes, you have to live your life, and yes you are still allowed to find joy in it but this fight is not over and it won't be for a long time. Don't lose sight of your life for the fight, but don't lose sight of the fight, either.

6 tissues

"This Is Us" returns in two weeks at 9 p.m. ET on Tuesday, November 10.

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