“‘Take care of my daughter,’ she said. But she was not looking at him. She was looking at me. She fell asleep. Two weeks later, she was gone.”

From an early age, Miranda has been expected to care for Lucia. As Lucia gets married, the sisters’ mother reminds Miranda of this responsibility. She is telling Miranda that Lucia will always be her responsibility, even if she is married and has a family of her own. This sets up the dynamic of Balancing Self-Care and Family Obligations.

“My sister was officially a newlywed. A wife. It came to me suddenly, as a blunt ache inside - I’d never felt more alone.”

Miranda contemplates her own happiness as she watches her sister celebrate. She realizes that she has always placed her sister’s needs above her own, devoting herself to familial obligation rather than pursuing self-care. With someone else around who can care for Lucia, Miranda is at a loss for what to do with her own life.

“That night I learned Yonah had trained as a marksman, that he’d lost his arm when he tried to remove a Palestinian boy’s body from the path of an IDF tank. In the morning, I sat on the front porch in my Adirondack chair, reading a book, while he and Lucia panted and groaned upstairs. I wished to be glad for their happiness.”

The theme of Perception Versus Reality comes into play as Miranda adjusts her view of Yonah. Miranda’s perception of Yonah as a loud, silly, and unintelligent man is altered by her discovery that Yonah is actually a brave hero. This changes her outlook on Lucia and Yonah’s relationship, leading to her acceptance of Yonah. It also puts her own life into perspective; Lucia has found a good man who makes her happy, and Miranda, unmoored by the new family dynamic, must reexamine her assumptions of the future.

“That’s not her. That’s her illness. And did you hear that social worker? She didn’t even give a shit. What the fuck are they thinking, giving her Risperdal?”

Miranda struggles against The Stigmatization of Mental Health Conditions even among healthcare workers. In this case, the health care workers do not listen to Miranda about which medications have worked well for Lucia in the past, and they continue with a treatment that Miranda knows from experience will not work. Miranda must fight for Lucia to get the proper care she needs, and she must continuously defy stereotypes and assumptions about Lucia that arise from her condition.

“I did not know what to say. That I was cold? Unnatural? Perhaps I was selfish? That any maternal instinct I possessed did not come naturally, though responsibility had been sown in me from an early age?”

When Stefan asks Miranda if she wants to have children in the future, she finds herself at a loss for words. This quote explores the complexity of “parentification,” which occurs when a child is forced to become the caretaker for another member of their family. Miranda’s upbringing, and the way in which she was required to care for Lucia, has altered her personal desire for her own family.

“Our mother always said this: that immigrants are the strongest, that we leave our homes behind and rebuild. Everywhere we go, we rebuild.”

Many of the characters within the novel are immigrants or come from immigrant families. This plays a major role in how characters, particularly the Bok sisters, perceive and navigate the world. Here, Miranda thinks back on her mother’s words and applies them to Yonah, who is trying to move on, to rebuild, after Lucia leaves him.

“In Mami’s eyes it was our only family’s only ticket. Fredy’s ticket. Marriage to an Americana.”

Manny, like Miranda, must deal with deciding whether to prioritize his own life and personal happiness or his duty to their family. Manny is obligated to consider marrying Lucia because his brother needs life-saving treatment that he can get in America. His love for his family clashes with his lack of interest in marrying Lucia.

“I no longer worried about Lucia, lying with her banana plants just two floors above, or Esperanza, sleeping miraculously through my cries. I closed my eyes and saw Sheetrock crumbling, collapsing pipes, the splintering of marble tiles.”

Throughout the novel, imagery of the condition of the home symbolizes the state of the characters’ mental health. Manny contemplates his relationship to Lucia and his duty to Essy as he has sexual intercourse with another woman, and he imagines the house collapsing as he does. Manny is unhappy, and he feels like his life is falling apart. This imagery also foreshadows the crumbling of Manny and Lucia’s relationship.

“There was no reason to think these statements were false. Lucia was able to count backwards from ten, correctly name several ordinary objects, including a pen, a bracelet, a pillow. She identified a watch as ‘a speedometer,’ a trash bin as ‘a velociraptor.’ Tangential, but clever, in a way.”

Upon her admittance into Crote Six, the psychiatric ward in her local hospital, the doctors begin to evaluate Lucia’s mental state. This quote depicts the ways in which mental health is not treated as seriously as other kinds of illnesses by medical professionals. While some of the questions Lucia is asked are clearly meant as a way of gauging her perception of reality, others cast doubt on her intelligence, which hints at implicit bias against those with mental health conditions.

“Nurse Bob liked Miranda Bok. He liked that she still had the fight. Too many family members came through their ward already wrung out by the system, slumped in their chairs, panning the room with dull eyes. No opinions, no hope, no fight.”

Nurse Bob reflects on the impact of serious mental illness on caretakers and loved ones. In a country with a medical system that often fails to provide adequate support for and education around mental health, families find themselves under immense amounts of stress as they try to figure out effective treatment plans. Since Miranda has dedicated her life to Lucia’s care, she puts all of her energy into finding the appropriate treatment for Lucia, which Nurse Bob appreciates—however, it comes at the cost of herself.

“‘That may be our opinion, but what if she doesn’t see it that way?’ Bob could see Miranda Bok struggling, still confused.”

Nurse Bob tries to explain to Miranda the complexity of schizophrenia. He describes the way that Lucia’s perception of reality is her reality. He provides an empathetic insight into the difficulty of treating mental illness; a patient may believe they do not need treatment, and medical professionals must balance that reality with the potential risk of harm.

“Schizophrenia doesn’t define me. It’s not who I am. We learned that in Group today, didn’t you hear?”

Lucia, desperate to be discharged from Crote Six, tries to explain to Nurse Bob that she is a person, not just a mental health condition. This moment is ironic because the same people who taught her that idea are the ones that only seem to care about treating her illness. Lucia feels unheard and unseen by the very people who have told her that she deserves to be herself.

“You can’t keep fighting your sister’s illness all by yourself.”

Miranda constantly fights Lucia’s care team, demanding that they treat Lucia in a specific manner—sometimes against Lucia’s wishes. Nurse Bob reminds Miranda that she can’t help Lucia on her own; she needs to work with them, not against them. Additionally, he stresses that some of the desire to receive treatment has to come from Lucia herself. This is difficult for Miranda, as Lucia repeatedly insists that she does not need medication and does not belong in a hospital.

“This is not some fairy tale. Things don’t turn out okay just because you want them to.”

Miranda reminds Stefan that mental illness is more complicated than just taking medication and becoming better. Caring for Lucia is a lifelong process, involving constant monitoring and frequent adjustments to maximize Lucia’s happiness and safety. Miranda also knows that no matter how hard she is fighting for her sister, things may not turn out well. This moment foreshadows the ending of the novel, in which Lucia tragically passes away.

“In Crote Six, they said I ‘suffer’ from schizoaffective disorder. That’s like a sampler plate of diagnoses, Best of Everything. But I don’t want to suffer. I want to live.”

Lucia offers her perspective on The Stigmatization of Mental Health Conditions in society. Like before, Lucia describes how she does not want to be defined by her illness; this time, she provides further insight into how people view those with mental health conditions. Lucia’s words reflect real-life recommendations for anti-bias language from organizations like the National Institutes of Health, which suggest person-first language and emphasize the importance of acknowledging that people with mental health conditions can enjoy life just like anyone else.

“‘It’s weird,’ she says, ‘In all these years, no one’s ever told me I suffered from cancer. I’m a fighter. A survivor, you know.’ [...] It occurs to me that no condition covered in the DSM-IV is ever followed by the word ‘survivor,’ but I don’t mention this.”

The author juxtaposes the discussion of cancer survivors and people with mental health conditions within society. The term “suffering” has negative connotations and implies that a person with a specific condition is unhappy or incapable, and that they are defined by their condition. Both physical and mental illnesses can be debilitating and life-altering; however, the treatment of people with mental illness is vastly different than those with a physical ailment.

“I would be told I had a twenty percent chance of maintaining a full-time job, a twenty-five percent chance of living independently, a forty percent chance of attempting suicide, a ten percent chance of succeeding. I was twenty-six years old.”

The helplessness of Lucia’s experience with her mental illness is depicted in great detail. Lucia is expected, by the people who are supposed to help her learn to live successfully with her illness, that it is almost impossible that she will. This sets Lucia up for failure at a young age, giving her little reason to go along with the suggestions of medical professionals afterward.

“Jie always used to be on my side, but now all she sees is my illness. I brace myself for the lecture. I’m sick, I’m reckless, I’m irresponsible. But to hear Jie’s words come from Manny’s mouth, I can’t help it, the tears spill out of my eyes.”

Despite Miranda‘s intentions being good, her treatment of Lucia and her hands-on approach to treating Lucia’s mental illness have altered the sisters’ relationship. Lucia believes that Miranda no longer sees Lucia as her own person due to her mental health condition. As Lucia fears the same treatment from Manny, she begins to cry, displaying just how hurt she is by Miranda’s treatment of her.

“She remembers reading about scientists who conducted experiments where they fed spiders the blood of severely ill mental patients, and the spiders spun cockeyed webs. […] She pricks her left index finger. A red droplet forms. She offers it, but the Spider does not seem interested. It is still too busy, spinning, hopping, pinning its thread.”

This moment in the novel references the scene from the Prologue, in which Lucia describes a spider’s web as “beautiful.” The spider’s web represents Miranda’s love for Lucia, meant to catch anything that may hurt her. The idea of the spider webs becoming “cockeyed” after the spiders receive the blood of people with mental illnesses suggests that caretakers are negatively influenced by the people they care for. Here, Lucia offers the spider a piece of herself, but the spider is too busy caring for the web to notice. This is representative of Miranda’s obsession with treating Lucia’s illness, causing her to ignore Lucia herself.

“At times, he felt its answer was more important to Miranda Bok than her sister’s actual well-being.”

Miranda asks if Lucia is taking her medication when Manny calls her, seeming to not care about how Lucia is doing otherwise. Like Lucia, Manny believes that Miranda no longer sees Lucia for herself, only focusing on Lucia’s condition. Despite her efforts at living her own life, Miranda is too used to dedicating herself to Lucia’s treatment, and she continues to let obligation dictate her behavior until it erodes her relationship with Lucia.

“Later, in hindsight, they would come together on this: to wonder when it had become impossible to distinguish which parts of Lucia fell under her own jurisdiction and which belonged to her illness.”

This moment alludes to the reflections Manny and Miranda will have after Lucia dies in Minnesota. They wonder whether Lucia could’ve been saved if they had made different choices, but it is impossible to know. Lee acknowledges the difficult truth that most caretakers and loved ones encounter: that there is only so much a person can do to keep a person safe without severely restricting their freedom and autonomy.

“Doubts like these had never seized Miranda before. And then, her worst fear: the line between her sister and her illness was becoming irrevocably blurred.”

As Lucia seems to experience another “episode,” Miranda realizes she can no longer distinguish what parts of Lucia’s actions and words are inspired by her illness and which are genuinely things Lucia might say in moments of clarity. This moment serves as the tipping point for Miranda, in which she realizes she may no longer be able to protect her sister from herself.

“In the end they agreed: There should be no blame, yet each would remain tortured in the years to come, unable to fend off their guilt.”

After Lucia dies, both Manny and Miranda deal with immense guilt. They try to navigate their grief and wonder what they could have done better. While they are able to agree that neither of them were at fault, and that they both did their best, both feel as though they failed to uphold their obligations as Lucia’s family members; keeping her safe and well was their responsibility, as impressed upon them by other family members.