I can't believe they spent only 1/4 of an episode on Sayuri confession! The explaination was seriously lacking. Some first time viewers will be confused by the whole flashback.
Some explainations
1. Sayuri was really strict on her brother. The game went on great length to tell us how cruel she got. Think how the kid shivered when Sayuri pulled the trigger.
2. The main reason why her brother fall ill was because of his sister- Their parents were not exactly caring. Therefore he looked upon Sayuri as a guide. However, due to Sayuri's strict teaching, he thought that his own sister, his cloest person, despises him. He thought that if even his own sister hates him this much , other people are much worse. This made him fearful towards all beings (especially Sayuri). All this stress, along with his already weak body, made him fall ill.
3. They also cut out some stuff from the hostpital and the subsequent grave scenes. IIRC, Sayuri had only seen her brother smiled once in her entire lifetime.
Also KyoAni decided to skip on how their parents are inconsiderate (not due to indifference, just not understand) of Sayuri after her brother's death. She thought she was responsibe for his death...
I guess that's the compromise KyoAni came in terms with. Afterall, you can't have someone slashing their wrist on TV...
I guess I am being too harsh on KyoAni- showing all these materials in one single episode makes the pacing and the mood of episode 14 fantastic. We see the conflicts, the explaination, and the resolution all in one episode. We, the viewers, underwent all sorts of emotion throughout the episode. I guess KyoAni decided that this effect outweights slashing Sayuri's flashback.
Those asides- Tamura Yukari did a fabulous job on voicing Mai's breakdown scene. I couldn't recognize Mai's voice with all her emotion flying high.
PS- That's a lot more blood than I thought it would be coming from Sayuri...