Kennedy grounds Denny and Theo’s experiences in two real and medically distinct conditions. When the main character was born, his “umbilical cord […] got wrapped around [his] neck” and he “didn’t get enough oxygen” (11). The medical term for this is nuchal cord, and the National Institute of Health estimates this condition occurs “in about 10–29% of fetuses” (Meyers, Talya. “Nuchal Cord and Its Implications.” National Library of Medicine, 4 Dec. 2017). Although nuchal cord is usually not fatal, it can result in Hypoxic-Ischemic Encephalopathy (HIE), in which the infant doesn’t receive enough oxygen. Individuals born with HIE may experience lifelong effects, such as cerebral palsy, vision impairments, or respiratory conditions. Others may have intellectual or developmental disabilities, as is the case for Denny. Denny’s difficulties with abstraction, his slowed processing, and his “sideways,” associative way of navigating the world are consistent with the aftereffects of HIE. 

In the novel, Theo has Tourette syndrome (TS), a neurodevelopmental disorder characterized by involuntary motor and vocal tics that typically emerge in childhood and often wax and wane in response to stress, excitement, or fatigue. Tourette’s frequently co-occurs with ADHD, OCD, and anxiety. In keeping with Theo’s struggles with his peers, the CDC notes that “[c]hildren with TS experience more bullying than children without TS” (“Tourette Syndrome and Bullying,” CDC, 24 Jul. 2025). Tics, though involuntary, are commonly misread by strangers as deliberate provocation or aggression. In law-enforcement encounters especially, sudden vocalizations or repetitive movements can escalate an already precarious situation. Kennedy draws on both conditions to critique how society in general, and the justice system in particular, mistreat people with disabilities.