Aza Holmes’s OCD and anxiety

Aza Holmes’s OCD and anxiety shape how she experiences her body, her thoughts, and even the possibility of choosing who she is. The novel makes their force tangible through recurring fears of infection, repeated checking and wound care, and spirals of research that intensify rather than settle uncertainty. These episodes are not simply eccentric habits: they form a distressing cycle that can briefly ease through compulsive action, then return with renewed force, while putting Aza’s health and relationships under strain.

Symptoms and the cycle of fear

At lunch in the White River High School cafeteria, the noise of Aza’s stomach draws her attention away from Daisy Ramirez and Mychal Turner. She searches online for information about the human microbiome and Clostridioides difficile, fixating on the possibility that unusual abdominal sounds could signal a fatal infection. Although she finds that she lacks the other symptoms on a list, one reported case of a patient with few symptoms gives her fear another foothold. Reassurance does not close the question: her mind immediately turns the absence of a fever into a new reason to fear that one may develop.

The same movement from sensation to catastrophe appears in her care of the Bandage on the finger. Since childhood, Aza has pressed her thumbnail into the pad of her middle finger, leaving a callus that can split open. Fear that the crack is infected leads her to reopen it and press out blood; attempts to cover it with a bandage are then followed by doubts about whether infection is already present. The behavior is difficult for her to resist: once the possibility of splitting the skin takes hold, she describes herself as unable not to do it. At the cafeteria, she removes the old bandage and digs her thumbnail into the callus beneath the table.

A later episode shows how checking can become a self-reinforcing routine. Remembering that her wounded finger might have encountered water in a river, Aza worries that moisture on the bandage could be evidence of infection. She inspects it under the bathroom’s yellow light, applies Hand sanitizer, washes for the recommended twenty seconds while singing the alphabet, dries her hands, and reopens the crack until it bleeds. Rebandaging the wound brings a brief release of tension, but the relief lasts only minutes or hours before she wonders whether she has removed all the pus, or whether there was pus at all. The action meant to settle uncertainty instead creates new details to examine.

Intrusive thoughts and bodily selfhood

Aza understands some of her thoughts through Dr. Karen Singh’s term for them, though she initially hears it as invasives. The alternate word appeals to her because the thoughts seem like organisms that enter from elsewhere and spread through her mental landscape. She recognizes that other people can have sudden disturbing thoughts and dismiss them; for her, one thought can crowd out the rest, leaving her either caught in it or trying to distract herself from it. Telling herself that she is not her thoughts offers a possible distance, but does not resolve her uncertainty about what the self is.

That uncertainty is intensified by Aza’s attention to microbes. Thinking about the many organisms living in and on the human body, she wonders whether a person can be a single, self-contained individual at all. The fear is not only that microbes might make her ill, but that the boundary between her and them is unstable—that there may be no uncontaminated inner self to locate. Dr. Singh observes that Aza repeatedly explains consciousness through metaphors, including a demon, a bus, a prison cell, a spiral, a whirlpool, and a loop. These images convey how she experiences thought as something that can contain or carry her, rather than as something she can simply direct.

The spiral is especially apt because following it inward does not produce an endpoint: it tightens without finishing. Aza’s internet searches reproduce that pattern. Each search offers information, but she reads it through the possibility of danger, finds another uncertain detail, and searches again. Dr. Singh has advised her not to repeatedly consult her phone about the same fears, yet at lunch Aza retrieves it and rereads an article about human microbiota. Her difficulty is not a lack of information; it is that information becomes material for the next turn of the fear.

Treatment and ambivalence

Dr. Singh discusses exposure response therapy with Aza, a treatment she has tried before. Its exercises require her to touch a dirty surface with her callused finger and then refrain from cleaning it or covering it with a bandage. Aza remembers that the approach helped for a time, but also how frightened it made her, and she cannot bear to try it again when Dr. Singh raises it. Her refusal shows the gap between understanding what a treatment asks of her and being able to endure the distress involved.

Medication brings a related conflict. Aza admits that she does not take Lexapro every day because the idea of a pill changing her makes her question who gets to define her identity. She wants the distressing part of her experience gone, but is unsettled by the thought that medication might alter the self she is trying to recover. Dr. Singh proposes a plan for taking the medicine consistently, including discussion of when to take it and whether a different medication might be considered during a less stressful period. Later, after Aza has experienced severe consequences, Dr. Singh points out that she has not taken her medication as prescribed and recommends finding another medication that she can tolerate and will take. The care plan is therefore presented as adjustment and persistence, not a single instruction that instantly resolves the problem.

Escalation and consequences

Aza’s fear of microbial exchange also intrudes on intimacy. After kissing Davis Pickett, she pulls away and searches online for whether bacteria from a person one kisses remain in the body. Reading that a kiss exchanges, on average, around eighty million microbes, and that gut microbiomes can remain modestly but consistently altered at a six-month follow-up, she imagines those organisms staying and growing inside her. When Davis touches her shoulder, she recoils, caught in an escalating rush of fear. The episode makes clear that the obsession can interrupt closeness even when Aza wants to be with another person.

The most dangerous escalation occurs when Aza’s attention returns to the possibility of infection and cleanliness. One night, after quietly changing the bandage and scrutinizing the blood on it, she opens the medicine cabinet and swallows aloe-scented Hand sanitizer. The action follows the internal logic of trying to become clean, but it is physically dangerous. Aza becomes dizzy and has stomach pain; she later spends eight days in hospital, where she lies in pain with a lacerated liver. At first, hospital staff assume she drank the sanitizer because she was desperate for alcohol. Dr. Singh is contacted, and Aza eventually explains that she had felt medication was making her worse. Dr. Singh rejects the idea that ingesting Hand sanitizer represents progress and stresses both the danger of the chemicals and the need to address Aza’s treatment.

Ongoing care and narrative significance

Dr. Singh also recognizes the hospital experience as serious trauma and tells Aza that it would challenge anyone. When Aza insists that no medication has worked, Dr. Singh reframes the conclusion: none has worked yet. The distinction preserves the possibility of change without denying the repeated difficulty Aza has faced. In a later conversation, Dr. Singh separates thought from action, telling Aza that a frightening thought is not itself an act. That reassurance addresses a central source of her distress: the fear that having a thought means being governed by it or made responsible for its imagined consequences.

The portrayal keeps symptoms connected to daily life rather than treating them as a puzzle solved by willpower. Aza can recognize that a fear is disproportionate and still feel compelled to check, search, clean, or withdraw. Temporary relief can reinforce the very behaviors that keep the next round of fear in motion, while inconsistent medication and reluctance to resume exposure therapy complicate treatment. Her OCD and anxiety also shape questions of identity: if thoughts can feel alien, if microbes blur the body’s boundaries, and if medication may change how she feels, what makes a self her own? The story does not offer a clean break from those questions. It presents continued care and the possibility of adjustment as necessary precisely because insight alone does not make the spiral stop.