Indiana University North Hospital

Indiana University North Hospital is the large Carmel medical center where Aza Holmes attends an appointment with her therapist, Dr. Karen Singh. Its windowless office, with a single unremarkable picture on the wall, provides the setting for a clinical conversation that makes the novel’s abstract concerns tangible: Aza’s fear of contamination, the struggle to describe psychic pain, and the uncertainty of managing treatment while feeling estranged from her own thoughts.

Setting and Office

After school, Aza drives north to the hospital in Harold, her car, choosing time alone with him over a ride offered by her mother. The journey is quiet because Aza cannot think and listen to the radio at the same time; the rumble of Harold’s mechanical heart is the only sound she notes. She anticipates telling Dr. Singh that she is getting better, while recognizing the pressure to narrate illness as a hurdle overcome or a battle won.

Dr. Singh’s office is windowless. Its walls are bare except for a small picture of a fisherman standing on a beach with a net over his shoulder, an image Aza regards as generic; Dr. Singh has not put up diplomas. The sparse room is not presented as a dramatic clinical environment. Instead, its stillness and plainness frame the effort to give language to an experience Aza finds difficult to control or explain.

Aza’s Appointment

When Dr. Singh asks how she is, Aza describes feeling as though she might not be driving the bus of her consciousness. The therapist restates this as a problem of control, inviting Aza to elaborate. Aza explains that thoughts about the microorganisms living inside her can make her feel less like an individual than a teeming mass of bacteria. Her fear is not limited to germs on the body’s surface: she cannot locate a pure inner self, or a soul untouched by contamination.

Dr. Singh proposes trying exposure response therapy again. Aza has previously touched a dirty surface with a callused finger and resisted cleaning it or covering it with a Band-Aid; although the treatment helped for a time, the fear it provoked now makes her unwilling to repeat it. Asked about Lexapro, she admits she does not take it every day because taking it frightens her. Dr. Singh discusses a plan for consistent use, including whether mornings or evenings might work better, and raises the possibility of changing medication during a less stressful period such as summer vacation.

Pain, Language, and Care

Dr. Singh observes that Aza often understands her experience through metaphors, including a demon, a bus, a prison cell, a spiral, a whirlpool, and a loop. She argues that physical and psychic pain can be approached only indirectly through metaphor, because pain cannot be represented like an ordinary object. To explain the difficulty, she shares Virginia Woolf’s writing about how language can express literary thought and tragedy yet fail to describe a headache. Dr. Singh also warns that labels such as “crazy” and “chronic pain” can minimize or ostracize rather than convey the fear, persistence, and courage involved in suffering.

As the appointment continues, Aza feels a stomach twinge and connects it to her fear of Clostridioides difficile, imagining a progression from stomach pain to a fatal infection. She searches her memory for details of a case study and becomes increasingly anxious. Dr. Singh guides her through a breathing exercise, asking her to inhale deeply and exhale as if flickering, rather than extinguishing, a candle. Aza later checks the case report and finds that the woman in it also had a fever. The discovery briefly reassures her, but the gnawing ache resumes its power over her interpretation of her body.

Narrative Significance

The hospital scene places Aza’s attempts to describe her distress beside Dr. Singh’s effort to listen, name patterns, and offer care. Aza’s metaphors make an experience that resists direct description communicable, but they also reveal how thoroughly fear can organize her sense of self: even a bodily twinge becomes evidence in a feared medical story. Dr. Singh’s discussion of language recognizes what clinical labels leave out, while her questions about therapy and medication bring the conversation back to practical treatment.

The appointment does not resolve Aza’s symptoms. Dr. Singh asks to see her again in ten days, a much shorter interval than the eight-week appointments Aza had received for a time the previous year. Aza reads the change as a measure of how unwell she might be. The return visit and temporary reassurance therefore sit alongside continuing fear, making the hospital a place of care without an easy narrative of recovery.