The Clinic

“You know the work we do. Relationships leave you vulnerable. That’s the end of it. At the poker table, all emotions are tilt, right? Good or bad, they affect your play. Relationships are the tilt of life.”

Meg uses poker metaphors throughout the novel. Here, she uses the poker slang “tilt” to describe the type of emotional volatility she hopes to avoid not only in her work as undercover casino security but in life broadly. This philosophy, one of The Lasting Effects of Trauma, keeps Meg from connecting meaningfully with her ex-boyfriend, Harry, until the end of the novel.

“A hard nugget of pain and regret is nestled far back in my head like an unexploded bomb. I retreat from it fast, in case it explodes.”

This passage reflects the novel’s thematic interest in the lingering effects of childhood trauma. Although Meg has repressed memories of her mother’s near death by suicide, the trauma of those events stays with her. Here, her simile compares the trauma to a threat to her physical safety, laying the groundwork for the novel’s exploration of trauma as a bodily experience.

“His constant sardonic expression is bothering me. Yes, I’m a klutz. No, I’m not a PhD graduate or whatever he is. But I’ve got a right to work here, same as him.”

Cara’s insecurity is an essential part of her character in the first half of the novel. Here, she compares herself unfavorably to Max, the Clinic’s star psychologist, who is ultimately revealed to be a criminal. Cara’s growing confidence drives her character arc and ultimately allows her to take down Dr. Lutz and take over the Clinic.

“‘Would have been embarrassing if I could remember it, Meggy.’

‘It’s Meg.’ I say it a little too sharply, but only Haley calls me Meggy.”

This is one of several passages foreshadowing that Jade is actually Haley in disguise. The fact that Meg does not recognize her sister despite her investigative skills reflects the distance between the sisters.

“There’s something else too. I dismiss it right away, but it pops back up. A tiny part of me thinks Max might be jealous.”

The Clinic combines genre elements of both mystery and romance, creating multiple layers of tension for the central characters. This passage reflects the romance trope of the jealous lover: Max’s intense reaction to Cara’s conversation with Dex leads her to suspect that her crush might be reciprocated. The fact that Cara is also trying to uncover a murder at the Clinic complicates and ultimately derails this romantic subplot.

“I get the strangest sensation looking at those [thank-you] cards. Like my body is having a feeling it doesn’t want to tell me about.”

Meg is initially in denial about her substance use, although her body seems to be aware of her addiction. This reflects the novel’s characterization of addiction as an artifact of repressed trauma, which remains in the body.

“I don’t usually showboat my knowledge, but something about Max’s supercilious manner goads me. ‘The latest thinking is that trauma is a memory, trapped in a primitive part of the brain,’ I say.”

Cara’s initial lack of confidence is central to her characterization and prevents her from engaging directly with Lutz or Max. In this passage, however, she reveals that she has been studying the trauma and addiction recovery industry. The use of the word “supercilious” further suggests that Cara knows more than she admits.

“Fat beams of curved oak mark corridor intersections, as though you’re walking beneath the skeletal keel of a half-built Nordic long boat.”

The architecture of the Clinic is repeatedly compared to boats, and the interior décor is designed to resemble the inside of a ship. This echoes the Clinic’s role as the start of patients’ journey toward sobriety. It also reflects Meg’s sense that she is trapped in an isolated place with no clear means of escape.

“You were expecting good, old clean-cut Tom Abrams. Nice guy, right? Sorry to disappoint you, Dr. Max. I’m a dirtbag. Keeping that from the public is my agent’s full-time job.”

In this passage, Tom Abrams tells his psychologist that the polished movie star persona he portrays to the public is a façade. While Tom is a secondary character, the dialogue reflects the novel’s broader interest in fame and the way it can mask celebrities’ true natures—an extreme example of The Difficulty of Discerning Character.

“A bubble of alcohol deprivation surges through me, shredding my thoughts. And suddenly, I can’t be sure it wasn’t me who drew that extra picture. I can’t be sure of anything at all.”

Meg’s unsettling experience at the Clinic is compounded by the fact that she is in active alcohol withdrawal. As Max explains, alcohol withdrawal can lead to paranoia, brain fog, and even hallucinations. Here, it causes Meg to question her grip on reality, complicating her search for answers about Haley.

“The moment I look into his eyes, I feel that familiar jolt in my chest I’ve grown used to categorizing. The unblinking eyes, something about the pupils. He reminds me of the mob bosses we deal with in the casino. The bad ones.”

This passage suggests that Meg’s experience working undercover security in casinos offers her a unique ability to read strangers. Here, she compares the Clinic’s mysterious founder to the mob bosses she has worked to take down. This comparison foreshadows both Lutz’s true nature and Meg’s involvement in his downfall.

“My body can’t be relied upon to relay messages to my limbs, and I’m moving like a puppet. I have the strangest sense that my head is about to wobble off my shoulders and smash like a melon on the floor.”

When Meg finally flushes the last of her oxycodone, she begins to have severe physical withdrawal. In this passage, she describes her body as if it were an entirely separate entity. The simile comparing her “unreliable” body to a puppet reflects the fact that she is no longer in control of her situation.

“‘Why would you want me to stay?’ The question sounds more loaded than I mean it to be. There’s a tense pause, while a reason I had never even considered insinuates itself into the silence.”

As Cara becomes closer to Max, they begin to acknowledge their mutually growing feelings. However, Cara’s relationship with Max causes her to question her own instincts and to avoid reporting things to the police that might harm him, suggesting that his influence may not be healthy. Ultimately, the novel ends with Cara rejecting a future with Max.

“‘Stress hormones supercharge your memory, right?’ I’m quoting his research. ‘Trying to protect you from making the same mistake twice.’”

Discussions about the source and mechanics of trauma appear throughout the novel. Here, Cara quotes Max’s research showing that traumatic memories are embedded into the brain on a hormonal level. This conception of stress aligns with Max’s larger argument that trauma is a physical and mental problem.

“They’re all my characters, I realize fuzzily. The roles I play at the casino. Different outfits and attitudes. Angry Little Rich Girl, Hustler Francine, Pro Patty with the coke problem. Small Town Susie. Underneath them all is the lady.”

Although Meg entered the Clinic to search for answers about her sister, she ultimately realizes that she cannot proceed without addressing her own trauma. In this passage, she realizes that the identities she takes on while undercover are all tied to her childhood trauma. Uncovering these memories is essential to her character development in the final section of the novel.

“I cannot have important decisions made by softheaded sentimentalists who let their personal feelings cloud their logic.”

The Clinic’s primary psychologist, Max, serves as a foil to the Clinic’s founder, Lutz. Lutz sees Max as weak and emotional, as opposed to what he believes is his own logical perspective. Ultimately, Max’s emotions lead him to help Cara uncover the Clinic’s mysteries, which he is criminally involved in and ultimately imprisoned for—thus ironically vindicating Lutz’s argument.

“‘Please, Cara,’ Max’s face shows utter devastation. ‘They could find you complicit. My dream of saving addicts is over. I couldn’t live with myself if you were brought down with this too. Importing blowfish carries up to a ten-year prison sentence.’”

Immediately after admitting to smuggling fugu for Lutz, Max urges Cara not to report him to the police. Cara trusts that his concern for her well-being is genuine, although the novel ultimately suggests that he is self-serving. As a potential therapeutic that is at the heart of the novel’s corrupt dealings, the fugu itself also symbolizes Problems in the Addiction Treatment Industry.

“Matthew Priest was here. He was a visitor. 

The idea that he can get inside this building gives me a sensation I can’t explain. Like my body is trying to tell me something I don’t understand.”

Throughout her time at the Clinic, Meg experiences physical reactions to trauma that she does not fully understand. In this passage, she suggests that her body is aware of traumas that her conscious mind cannot identify. Ultimately, her trauma is not directly related to Mr. Priest; however, because she did not understand what was happening at the time, her body still formed a traumatic memory, which manifests physically.

“‘Well, sir,’ says Hanson finally. ‘Seems to me that ethics are the luxury of folk with options. And right now, those folks don’t include you.’”

Police Captain Hanson’s diction helps characterize him as a down-to-earth, working-class alternative to the slick luxury of the Clinic. His use of the phrase “seems to me” and the repeated use of the word “folk” distinguish him from Lutz and Max, whose speech is more formal and polished. The fact that Hanson is able to see through Lutz’s lies suggests that he is more intelligent than they assume, hinting at their elitism and class bias.

“Could he have been sending the messages from Haley? I push the thought away. I can trust Harry. Can’t I? Suddenly I’m not so sure. Can I believe anything he says?”

Meg’s withdrawal symptoms include visual and auditory hallucinations, making it hard for her to distinguish what is real and what is not. As a result, she becomes an unreliable narrator, leaving the reader unsure of whether she is actually any closer to solving the mystery. Meg’s loss of touch with reality destabilizes readers as it does Meg herself.

“Have you any idea how many unidentified drug overdose victims are removed from Seattle every day? More than I would ever have a use for. Empathetic people, for all their talk of family and love, are rather careless with one another. Particularly when drug addiction is concerned. Commonly, they would rather not ever engage with the troublesome addict again.”

Although Lutz claims that antisocial personality disorder enables him to commit crimes more efficiently, this passage suggests that he also relies also the apathy of people who can empathize but prefer not to. Lutz exploits the societal contempt for people with addictions to provide bodies for his fugu project. This passage reflects the novel’s thematic interest in issues in the addiction treatment industry.

“The facts are he was obsessed with some drug treatment so he could be the big man changing the world. He put everyone at risk and allied with a really shady criminal to do it. If you take away how you feel about his tragic past and look at what he does, Max is kind of a douchebag.”

Cara and Meg only interact a few times, at the beginning and end of the novel, but their meetings are informative for both. In this passage, Meg offers Cara a fresh take on Max, arguing that Cara is too preoccupied with her feelings for Max to see his crimes clearly. This indicates that, like Meg, Cara might not be an entirely reliable narrator.

“Remember, Meg, antisocial personality disorder is a coping mechanism. A way of dealing with unbearable events in childhood. Many relentless traumas that forced you to adapt. You learned that love was unreliable, that adults were cruel and unpredictable, that healthy emotions only led to pain and suffering.”

When Lutz tells Meg that she has been diagnosed as a “sociopath,” he treats the diagnosis as evidence that she should embrace callousness and selfishness as core aspects of her identity. In this passage, another therapist tells Meg that she developed antisocial personality disorder—the preferred term—as a response to severe trauma. This more empathetic perspective on her diagnosis allows Meg to begin the healing process without shame.