Did Sarah know that it would come to this? Maybe not. Did she care if it had? Definitely not. Sarah McMillan was a cold-hearted bitch, after all.
With all the wish-induced consequences piled upon Joan and Karyn, it could have only gone this way and yes, it was tragic. But sometimes life could be this way, and definitely could be this way if someone's weight exceeded 700 pounds, as it did with Karyn less than a week later. She grew so fat that she died. Joan had lost the love of her life and it was all Sarah's fault.
Well, Sarah was going to regret that decision. The first thing Joan was going to do when she got the stone back was to punish Sarah. The second thing she was going to do was wish her big beautiful girlfriend Karyn back. She loved the fact that Karyn was fat, but she decided that when she wished her back, she intended on making her only around 400 pounds. She didn't need to be severely obese for Joan to love her.
So, right after Karyn's funeral, Joan (and yes, she was Joan now and not Jon, since her period hadn't come around yet) headed to Sarah's house.