Aza Holmes’s obsessive-compulsive disorder

Aza Holmes’s obsessive-compulsive disorder is portrayed not as a quirk of caution but as a cycle that can seize her attention, dictate painful rituals, and make the boundary between her thoughts and her self feel uncertain. Fears of infection and microbial contamination give that cycle its recurring imagery: a rumbling stomach, a damp bandage, or a kiss can become evidence in an internal emergency that no amount of checking can conclusively settle.

Identity and Pattern

Aza’s obsessive thoughts are sometimes called intrusives by Dr. Karen Singh. Aza prefers the misheard term invasives: the thoughts seem to arrive from elsewhere and spread through her mind until they crowd out other concerns. The metaphor captures both their unwanted quality and the way they can take over her attention. Aza understands that such thoughts do not necessarily express a wish or intention, but recognizing them as intrusive does not make them easy to dismiss. She has had cognitive behavioral therapy and tries to separate herself from her thoughts, yet remains unsure what that separation means for her identity.

Contamination fears give the spirals a tangible focus. In the White River High School cafeteria, excessive stomach noises lead Aza to search online for information about the human microbiome and Clostridioides difficile. She finds that the illness can be fatal and that abdominal noise is an uncommon but possible presenting symptom. Although she has none of the other symptoms listed, and reminds herself that she has no fever, the reassurance immediately becomes unstable: her mind turns the absence of a fever into the possibility that one might develop. Information intended to resolve uncertainty instead supplies the next threat to examine.

The fear is bound up with questions about bodily identity. Aza worries that the microorganisms living inside her help make her what she is, while also seeming foreign and impossible to remove. She describes herself as unable to find a pure or untouched inner self beneath the microbial life. In this way, contamination is not only a fear of illness; it becomes a crisis about whether there is a distinct, uncontaminated self at all.

Checking, Cleaning, and Brief Relief

A longstanding habit gives these fears a repeated physical target. Since childhood, Aza has pressed her right thumbnail into the pad of her middle finger, leaving a callus over her fingerprint. The skin can crack open, and she covers it with a Band-Aid to prevent infection. But the bandage can itself become a source of uncertainty: she worries that infection may already be present and feels compelled to reopen the skin and press out blood. Once the urge takes hold, she describes being unable not to act on it.

After remembering a boy holding her hand and looking at the finger, Aza becomes preoccupied with whether the wound is infected. She wonders whether river water might have reached it, then removes the Band-Aid and examines a damp patch on its pad. The moisture might be sweat, but she also fears it could be water or drainage that signals infection. She uses hand sanitizer, washes for the length of the alphabet song, reopens the crack with her thumbnail until it bleeds, squeezes out blood, and applies a fresh Band-Aid. The ritual briefly eases the tension. Soon, however, she is questioning whether pus remained or whether the dampness was ever pus at all. The apparent answer does not close the investigation; it gives the next round of doubt a new starting point.

The novel’s narration makes this recurrence part of the experience. In one extended account, it shifts into second-person address as Aza retraces the thought, checks the wound, and gives in to the urge. The shift presents the spiral as a sequence that can engulf consciousness rather than as detached reflection after the fact. Even when Aza can name the pattern, that insight does not automatically interrupt it.

Treatment, Intimacy, and the Problem of Selfhood

Dr. Singh proposes exposure response therapy, which Aza has tried before. The exercises involved touching her callused finger to a dirty surface and then refraining from cleaning it or covering it with a Band-Aid. Although the treatment helped for a time, Aza remembers how frightened it made her and cannot face trying it again when Dr. Singh raises it. Her response shows the gap between understanding a treatment and being able to tolerate the distress it asks her to withstand.

Medication raises a related difficulty. Aza admits that she does not take Lexapro every day because the idea that a pill might change her makes her uneasy. She wonders whether the resulting version of herself would still be her, or whether that self would be determined by the people who make the medication. At a later appointment, she says that she still takes it inconsistently; Dr. Singh stresses that medication only works when taken consistently and with care. Aza’s resistance is not simply a refusal of help: she also hates the condition she describes as a demon, but finds the prospect of removing it through a pill unsettling. She also says that she did not bring Ativan to Davis Pickett’s house.

Intimacy can activate the same contamination fears. After kissing Davis, Aza searches for information about whether bacteria pass between people during a kiss. One study reports an average exchange of around eighty million microbes and modest but consistent changes to gut microbiomes at a six-month follow-up. Aza fixates on the possibility that Davis’s microbes will remain inside her permanently. When Dr. Singh asks about intrusive thoughts, Aza explains that she had to stop making out with him because she could not stop thinking about the microbial exchange. What might otherwise be a moment of closeness becomes, in her mind, an irreversible alteration of her body. Dr. Singh suggests that anxiety can accompany a change in circumstances, including the development of a new relationship, while also asking what Aza may be afraid to say.

Crisis and Continuing Care

The most dangerous escalation occurs when contamination fears intersect with Aza’s research about microbes. Late at night, after reading about the gut-brain informational cycle, she worries that bacteria may influence her thinking and that her thoughts might therefore not be her own. She changes the Band-Aid on her finger, sees blood, and becomes caught between explanations: the wound may bleed because it has not healed, but it may also be infected. She drinks aloe-scented hand sanitizer, then continues despite recognizing that it could make her sick. The act does not settle the fear. Her stomach hurts and rumbles, feeding the very anxieties about microbes and Clostridioides difficile that had helped precipitate the episode.

Aza subsequently spends eight days in the hospital with pain from a lacerated liver and other injuries. At first, hospital staff assume she drank the sanitizer because she wanted alcohol. Dr. Singh comes to her bedside and identifies two concerns: Aza has not been taking her medication as prescribed, and the accident has caused serious trauma. Aza says she felt the medication was making her worse; Dr. Singh rejects drinking sanitizer while hospitalized for a liver laceration as evidence of progress and explains the danger of ingesting it. Rather than treating the current medication as a settled solution, she proposes finding a different one that Aza can tolerate and take consistently. When Aza says that none of the medications have worked, Dr. Singh answers that none have worked yet. The distinction leaves treatment open without promising an immediate cure.

Dr. Singh also asks whether Aza feels like a threat to herself. Aza cannot easily separate the threat from the self: the question becomes tangled in uncertainty about which thoughts are hers and who, if anyone, is directing them. Dr. Singh tells her that a thought is not an action, a distinction Aza needs even though it cannot by itself stop the thoughts. The episode makes plain that the danger lies not in every feared thought becoming an intention, but in the distress and behavior that can gather around it.

Narrative and Thematic Significance

The novel presents Aza’s disorder as a lived constraint on attention, intimacy, and agency rather than as a clue that makes her a more effective investigator. Its creator describes the character’s obsessive concerns as distinct from the creator’s own and explains that the writing aimed to convey how obsessive thought spirals can consume consciousness. That approach resists the familiar idea that obsessiveness necessarily sharpens observation: Aza’s condition can instead make it difficult to attend accurately to the world outside herself, or to interpret what is happening within her.

Microbes deepen the conflict between bodily fact and catastrophic interpretation. Aza is right that human bodies contain extensive microbial life and that microbes can affect health; the novel’s account of the gut-brain relationship gives her fears a factual point of departure. But a real connection does not confirm the conclusion that every thought is infected or that she has lost control of herself. Her spirals repeatedly turn partial knowledge into an impossible demand for certainty. The resulting question of selfhood is not a detached philosophical puzzle: Aza experiences it as a threat to her ability to know what she thinks and to act as a coherent person. Treatment and reassurance do not erase that struggle, and the narrative does not present a sudden cure; instead, it shows the continuing work of distinguishing a frightening thought from an action and seeking care that Aza can actually sustain.