Kate and Toby try to navigate their long-distance relationship while Kevin and Madison’s might be too close after she left him hanging at the altar.

For the last time this season, we’ve opened a fresh case of tissue boxes to try and navigate these final 18 installments of TV’s most beautifully heartbreaking family saga, “This Is Us.”

The NBC drama held back a fall premiere to give us a relatively uninterrupted run this winter and spring, which just means the tears are probably going to compound with very little time for healing between episodes.

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Surprisingly, the Season 6 premiere didn’t offer any tantalizing or epic flash-forwards to give us any further glimpses into Kate’s future — SPOILER ALERT if you haven’t been watching (but then, what are you doing here?) — wedding to her arrogant boss, Phillip, or the deeper future where Rebecca appears to be lying on her death bed.

Instead, we picked up the nearly immediate aftermath of Madison having just left Kevin at the altar to see how those events have impacted that pair (we’ve been shipping) as the Big 3 prepare to celebrate their 41st birthdays.

There are moments sweet and bittersweet. In particular, every moment with Toby and Kate is going to be so different to take in, knowing (or thinking we know) where it’s all going for them. There’s a tinge of bittersweet sadness in their scenes now no matter what’s happening.

As for Madison and Kevin, we’re not yet ready to give up hope, just as the Pearsons aren’t quite ready to give up hope on a brighter future for Rebecca. Her own flash-forward, though, tells us there are going to be some very tough episodes in our future.

We’re less certain where Randall’s journey is going to take him, but we’re hopeful that there is at least satisfaction and contentment in his future. As long as he has Beth by his side, he’ll be a winner in our book!

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.

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“I Would’ve Chose Door Number Beth”

Did we mention how much we love Beth? She was in rare form tonight, clearly feeling herself and in a good place. We’re a little scared that she may yet have more challenges ahead of her, even as she’s navigated some tough ones already. Susan Kelechi Watson has never looked more stunning or in command of herself and her marriage. We love that she gets Randall and his unique way of obsessing — or should that be that she doesn’t quite get him completely? — but she accepts him and loves him anyway. We’d have chosen door number Beth, too. Just saying.

0 tissues (but damn, we love us some Beth!)

“You Are a Condescending Prick”

Just as scenes with Kate and Toby have a new weight, so do moments with Phillip, now that we know her arrogant jerk of a boss will somehow transform into her dashing beau by series end. Here, we saw him callously dumping his woman and giving her reason to hate him along the way by calling her dull. It’s just that shortly following that, using the same condescending attitude, he brings Kate out to find her students singing “Time After Time” to her for her birthday. And seeing Kate’s tear-filled joy appears to soften him a bit. We’ve got some work to do to get the audience on board with a shift of this magnitude, but at least we see he has a heart. We already knew Kate’s was huge.

1 tissue (Kate brings out the softer side)

“Life Is Too Short”

Coming off of bad news about her health regarding plaque building up in her brain, Rebecca has had enough of Nicky pining after the girl that got away umpteen gazillion years ago. She knows how short life really is because she’s now looking at her own expiration date in a way most of us can’t fully fathom. And so, we applaud her saying enough is enough and pushing Jack’s brother into facing the unknown now before later becomes never. There is some value in facing your own mortality because it recontextualizes all the road bumps we tend to put in front of ourselves in life.

2 tissues (it’s so real for her right now)

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“Thought Maybe It Came from a Good Part of My Life”

Seeking something to explain two years of nightmares and terror, Randall chose to confront the burglar he caught in his house rather than “Door Number Beth,” only to have that moment not live up to his expectations. Life almost never does. Instead of a monster he could confront, he found a broken addict who didn’t even remember breaking into their house, or how he wound up with one of their wedding pictures. And so, as he does, Randall sought to make lemonade out of a drug addict on an individual basis by trying to help David out (it went about as well as you might expect) and recommitting himself to his district. At least Beth reopened the options because she acknowledged that Randall is truly one of the rare good ones out there. Amen, sister. He’s good, but you’re still better!

2 tissues (life is always messy and unpredictable)

“I Don’t Like That He Calls You Maddy”

It’s like Rachel and Ross from “Friends” all over again, with the new “will they”/”won’t they” relationship of Kevin and Madison. She may have dumped him at the altar, but their chemistry remains incredible. Kevin moved into her garage to stay close to the babies because of course he did — we’re still not sure about the fantasy of them being scantily clad women, dude! But it was too close for comfort when Madison started growing closer to one of her book club guys. Even though he couldn’t say he loved her on their wedding day, Kevin made it clear that he has feelings of some sort. He just needs to figure them out. We’re still rooting for these kids to figure it out for themselves, but Kevin needs to get out of his head, out of his own fantasy worlds and be ready to face the real world head on. It was telling when the Challenger explosion flashback had that moment where he said it wasn’t real and instead was on TV. He echoed a similar sentiment today, when he decided to take “The Manny” reboot so he could stay close to home. But he’s got to step out of these fantasy worlds and face the truth about his own feelings, his relationship with Madison — and what’s happening with Rebecca.

3 tissues (feeling some kind of way)

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“We Have Found the Light Before”

We love that these three have spent these past five years mostly strengthening their own sibling relationships through all the trials and tribulations they’ve faced. Five years ago, when we first met them, Kate and Kevin were both at extreme lows in their lives, and it was through their support of one another that they got through. And as both face new challenges now, it’s again hard to see the light. Kate’s metaphor was beautiful, and even more meaningful for those of us who know there is joy for both of them in the future. They’ve achieved their dreams of finding happiness — even if it wasn’t perhaps in the form they saw for themselves, or even that we saw for them and wanted for them. In the end, if it’s earned, we’ll be happy that they’re happy.

3 tissues (sibling support at its finest)

“Maybe You Can Send Them Macaroni & Cheese?”

Randall’s heart has been bigger than his chest since he was a wee lad, and even as his chest has broadened impressively (we remember the video!) his heart has only grown more so. That he turned a confrontation into trying to help the man who terrorized his family is evidence of that. And it’s just an innate part of him, as he immediately worried about the kids of Christa McAuliffe after her tragic death in the Challenger, asking his mom to maybe send dinner to them so they could be sure someone had made them dinner. Randall wants to save the world, leading Rebecca to worry he’ll face a “beautiful but perpetually disappointing” life. So far, there’s been some truth to that. But his journey isn’t over yet.

4 tissues (the biggest heart in the world)

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“Happy Birthday”

Toby’s grand gestures are almost Jack-worthy in so many ways, and we’ve adored him and Kate since they started dating. Now, though, with him working from San Francisco three nights a week, the strain of distance is already starting to form. His remote grand gesture was eclipsed by him showing up to surprise her at the tail end of the day and episode, but again, we can’t look at these sweet moments the same way. We know how this ends, and while Kate seems to find her happily ever after in someone else’s arms, it doesn’t look quite so joyful for Toby. Here’s hoping it’s all a future misdirect, because he deserves joy, too.

4 tissues (such sweetness, now bittersweet)

“The Little Red–“

The through line for the entire episode, and the nagging problem that overshadowed Rebecca’s ability to be present for or enjoy the birthday dinner with Kate and Kevin was that she lost the word for “caboose.” Refusing to allow anyone to help her, she spent almost the entire day chasing the elusive word through memories of walking the train’s length with her father to the last car, and even reading the children’s book to the Big 3 every night. It took her forever, and she did finally find it with a sigh of relief. But it was a tragically sad triumph, because these struggles will only become more frequent and the lost words and fragments will get larger and become more important. It was particularly poignant watching the her in her memory’s fail to remember, as that visualizes the idea that her memories themselves will change and falter and fail. It is losing herself a piece at a time, and she can see it coming and there’s nothing she can do about it. It’s going to impact the whole family, as Rebecca has been the constant in every era from start to finish. In many ways, “This Is Us” is the story of her and all those she’s impacted by being in their lives. And it looks like, when she goes, so will we go and the story will be over.

5 tissues (fighting to hang on to everything)

“This Is Us” airs new episodes every Tuesday at 9 p.m. ET on NBC.

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