54 pages • 1-hour read
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Content Warning: This section of the guide includes discussion of substance use, addiction, graphic violence, mental illness, death, and death by suicide.
Max grows angry when he learns that Lutz has begun treatment on Meg, insisting that it’s too soon. Cara finds articles online about Lutz’s involvement in a disgraced former rehab in Florida. Lutz, who was then using the name Abhaya Lutzheimer, was not prosecuted.
As Meg remembers Haley telling her a secret, Lutz pulls her out of the treatment so that her body won’t go into organ failure. She overhears Max insisting that Lutz stop treatment. Max warns Meg that she may disassociate as a result of the treatment.
Meg searches the spa and pool for Haley’s phone, finding nothing. She calls Haley’s number and is shocked to hear a phone ringing in the women’s dorm. Before she can reach it, she is intercepted by Madeline, who accuses her of being undercover police.
In therapy with Max, Meg reveals that she has felt unsafe since childhood and that she began using drugs and alcohol at age 13. Max suggests that she has repressed a traumatic childhood event. Meg sneaks a look at Max’s notes and deduces that he suspects that Jade murdered Haley.
Through online research, Cara learns that Lutzheimer and Pro Lab Florida were involved in an insurance scam, charging insurers thousands of dollars for simple but unnecessary tests. Cara realizes that the Clinic was charging Haley’s insurer $22,000 per day.
Meg returns to the women’s dormitory to find it trashed, as if someone were searching for something. She accuses Jade of giving Haley drugs, but Dex and Madeline intervene, explaining that Jade checked in after Haley left. Harry calls with news: The fingerprints on the note are Haley’s.
Harry insists that the notes were left by someone who knew Haley had touched the paper, not Haley herself. He urges Meg to engage honestly with therapy to earn the other patients’ trust. When Meg admits to using oxycodone, Harry insists on picking her up in two days.
Meg decides to flush what is left of her oxycodone to begin the process of healing so that she can learn more about Haley. However, she is terrified about what she might discover.
Based on what she has learned, Cara threatens to quit, but Lutz insists that he was not complicit in the Florida rehab scheme. He explains that insurers are unwilling to pay for new treatments and says that the Clinic upcharges tests to supplement their research. Cara decides to stay, deeming Lutz’s actions unethical but not illegal.
Meg immediately begins to feel the physical effects of opioid withdrawal. She offers to read an honesty statement in group therapy to progress to the next treatment with Lutz. Max warns her that the treatment may bring up difficult memories.
In a group therapy session, Meg reveals her near-death experience, including the fact that she nearly killed one of her assailants. Tom looks excited by the retelling. Suddenly, Meg has a seizure and hallucinates a woman wearing vintage lingerie whom Meg calls the queen of hearts.
Make wakes from her seizure but continues to hallucinate the woman in vintage lingerie; she has a memory of the woman stopping her from leaving some place. She reveals the truth of her prior oxycodone use to Max and the other patients, who encourage and care for her through her detox.
When confronted by Cara, Max explains that he overlooked Lutz overcharging insurers for simple tests because he truly believes that their fugu treatment works. As Max is beginning to offer Cara advice, he is called away. Max invites Cara to dinner to continue their discussion.
At dinner, Max reveals that Lutz left Switzerland when his clinic was investigated for criminal connections but insists that he genuinely cares about his patients. Max urges Cara to stay at the Clinic, and she agrees to stay for another week. She senses a romantic moment but accidentally squashes it.
Meg wakes to find a man wearing a fedora next to her bed. The man starts to strangle her but disappears when Meg loudly fights back. The others dismiss it as a nightmare, but Meg finds a fedora, which Jade then claims is hers. Madeline reveals that Haley had nightmares about a man in a fedora before she died.
Cara discovers the door to the medicine room open, suggesting that a patient accessed drugs. Max comes to her room with whiskey to comfort her. When she questions Lutz’s ethics, Max tells her to leave if she doesn’t trust him. Cara pushes back, and they share a kiss. Cara insists it’s just a rehab romance, and Max leaves.
Jade takes Meg to the salt room, where the other patients are waiting. They urge Meg to delay her next treatment with Lutz, explaining that she isn’t physically strong enough. Meg insists on the treatment, knowing that Harry is coming for her soon. After everyone else leaves, Tom corners Meg and threatens her subtly.
Cara searches for an alternate route to the medicine room through the anger room. Finding nothing, she smashes a computer with a baseball bat, breaking down in tears. Suddenly, the lights go off, and a stranger enters, trying to attack Cara. A voice that Cara recognizes shouts that she never wanted to kill Haley and begs to be left alone.
In her next treatment with Lutz, Meg uncovers a memory of seeing Haley trapped in a bathroom with Mr. Priest, who chased Meg away by throwing playing cards at her. She realizes that her undercover personas are all based on the lady in vintage lingerie. As Meg recovers, she realizes that she may know the password to locate Haley’s phone.
Cara turns on the light and finds Sierra wearing noise-cancelling headphones. Sierra explains that she has compulsive thoughts of hurting others, even though she doesn’t want to, and that Max encourages her to verbalize and then smash those thoughts. She reveals that Haley was intimate with both Tom and Dex.
Meg goes to an empty gym designed for low-oxygen workouts. She uses her birthday as the passcode to access Haley’s phone location and discovers that the phone is nearby. Suddenly, she grows lightheaded; she suspects the oxygen levels in the room have been hacked. As she passes out, she sees a message on the glass, ostensibly from Haley, warning her to stop treatments.
While studying Haley’s file, Cara discovers that the Clinic never charged her a supplemental fee. She cannot make sense of this. Tom calls her from the treatment room, claiming to know who killed Haley. Before he can explain, the line dies.
Meg is awoken by Sierra, who explains that the oxygen settings in the gym were altered. She does not seem to believe that Meg didn’t adjust them. Sierra reveals that she recovered a memory of meeting Meg at a party with Haley, but Meg denies this happened.
Alerting Max of what’s happening, Cara rushes to the treatment room but finds it empty. Inside a drawer, she finds surgical tools and a collection of glass eyeballs. Max arrives and discovers that a box of medical-grade heroin has been taken from the medical closet. Cara rushes to help him find Tom before he relapses.
Meg texts Harry about her fears that someone is trying to murder her. She finds Haley’s cellphone hidden in one of the spa rooms. On the phone, she finds the code to the medicine room and a text from Madeline.
Cara overhears an argument in which Lutz seems to accuse Max of disobeying his orders and giving Meg a smaller dose of fugu than ordered. Lutz threatens to fire Max. Later, Max and Cara find Tom dead in the treatment room.
Haley’s phone reveals that she was in contact with Madeline for weeks before Haley came to the Clinic and that Madeline introduced Haley to a man. Suddenly, Meg is attacked and pushed underwater. She is rescued by Jade, who insists that no one else was in the room when she arrived. Jade is shocked to see the phone, now destroyed in the pool.
Max argues that Tom is unlikely to have died by suicide and that heroin was not his drug of choice. He expresses frustration that patients are dying on his watch. Cara offers to call the police, but Max asks her to wait until he can explain something to her.
Meg accuses Madeline of working with Lutz. Madeline admits that she was paid to bring patients to the Clinic and then encourage them to relapse afterward, the same scam that Lutz perpetrated in Florida. She describes Haley as a special case.
Max admits that he has been helping Lutz smuggle in fugu, which is a controlled substance in the United States. He suggests that Lutz plans to manipulate his treatment to sell the fugu-derived medication to criminals. Horrified, Cara decides to call Captain Hanson.
As Meg and Cara dig deeper into the mystery surrounding Haley’s death and Dr. Lutz’s work at the Clinic, they uncover proof of Problems in the Addiction Treatment Industry. Cara discovers that Dr. Lutz is involved in a scam known commonly as the Florida shuffle, in which rehabilitation clinics “shuffle” patients through a series of clinics and safe houses, encouraging relapses to secure bigger insurance payouts. This plotline alludes to a real-life scam that emerged after the 2020 Affordable Care Act required insurers to pay for rehabilitation as a necessary health benefit. Cara realizes that Lutz has continued this practice at the Clinic and that Haley’s wealth and celebrity made her particularly valuable. Madeline confirms this suspicion, telling Meg that she recruits famous people with addictions to enroll at the Clinic and then encourages them to relapse: “[I] see if I can get them to party [and] get them checked back into rehab” (323). This cycle suggests that there is true corruption within the addiction treatment industry, which can treat people with addictions like merchandise rather than patients.
The process contrasts particularly starkly with Lutz’s empathetic hippie exterior, suggesting that he is not what he seems and thus exploring one of the novel’s themes: The Difficulty of Discerning Character. Max’s characterization further develops this idea, as it suggests that the corruption in the addiction treatment industry stretches even to the most genuine of practitioners. Max defends Lutz’s practice of overcharging insurers for simple tests, explaining that “the companies that play fair with insurers, that don’t mark up the tests and push for extra time…their addicts don’t stand a chance” (263). This suggests that Max knows that the practice is unethical but believes that it serves a larger ethical goal: to treat patients with addiction. Similarly, Max admits that he has been illegally importing fugu but rationalizes his actions by arguing that the fugu-based medicine could be life-saving. Here again, Max argues that the ends justify the means in addiction treatment. Beyond complicating Max’s character, such rationalizations suggest that navigating a corrupt system itself demands corruption, contributing to the novel’s overall moral ambiguity.
Meanwhile, the novel further unpacks The Lasting Effects of Trauma through Meg’s recovered memories. Cards continue to feature heavily in these memories, foreshadowing the reveal that Matthew Priest taught Meg to play poker to distract her from her mother’s attempted death by suicide. The woman Meg identifies as the “queen of hearts” emerges as a particular focus of her trauma (257), at one point blocking Meg from approaching her sister. However, the novel has previously associated the queen of hearts with Haley herself; the card pops into Meg’s head while she is thinking about how Haley “always won” games, and its symbolism evokes Haley’s charisma and star power. This foreshadows the role Haley played in sheltering Meg from the truth of what happened to their mother while also implying that Meg’s resentment of Haley stems principally from that day—not her sister’s celebrity. The card motif thus illustrates the complex ways in which trauma is repressed, sublimated, and projected.
Author Cate Quinn builds tension in this section of the novel by offering a series of red herrings designed to mislead the reader about the identity of Haley’s killer. In Chapter 55, Meg discovers a comment in Max’s therapy notes about “Jade transferring codependence to Haley” (232). Meg misunderstands the note, and the chapter ends on a cliffhanger, as she mistakenly guesses that Max believes Jade murdered Haley. This theory is immediately disproven in Meg’s next chapter, however, when it is revealed that Jade checked into the Clinic the day after Haley died. Something similar occurs in Chapter 69, when Cara overhears a woman in the anger room shouting, “I never wanted to kill you, Haley” (287). Cara’s next chapter begins with her identifying Sierra as the speaker. However, Sierra soon explains that her apparent confession was simply a form of therapy. The use of Sierra and Jade as red herrings diverts attention away from the truth about Haley and adds tension as both Meg and Cara pursue useless threads.



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