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Aza is tired the next day from sleepless nights and drinking too much hand sanitizer, but she had already made plans to take Daisy to Applebee’s. In the car, Aza confronts Daisy about writing about her in her fanfiction stories. Daisy apologizes for writing something negative but explains that it is her way of coping since Aza is a lot to deal with. She tells Aza that she is too selfish to get out of her own head, read Daisy’s stories, or know anything about Daisy’s life. Aza yells back at Daisy and accidentally hits the car in front of her. Aza, injured, gets out of the car and tries to pull her dad’s phone out of the trunk but falls over in pain. People around her try to calm her down thinking that she is upset because she believes her parents will be mad at her. She eventually collapses in pain. Aza wakes up in the hospital with her mom there and thinks her ribs are broken. She asks if she will be put on antibiotics.
A doctor tells Aza that she has a mild liver laceration and will need to stay in the hospital for a couple days. She will not need antibiotics because the laceration is mild. Aza is concerned about the increased risk of C. diff from staying in the hospital. Her mom stays there with her. Aza wakes up in the night consumed with thoughts of bacteria, in her finger, in her body, or in the air of the hospital. Aza texts Daisy to apologize again. Daisy responds back with an apology and concern for her friend. Still consumed with thoughts about C. diff, Aza gets out of bed and begins drinking the hand sanitizer from the dispenser on the wall. Aza’s mom wakes up and sees Aza drinking the hand sanitizer and then vomit. Her mom calls in a nurse.
After drinking the hand sanitizer from the dispenser in the hospital, Aza wakes up in a fog. She reflects on the pain she feels and notices the things around her like the bowl of Cheerios her mom made her and the flowers Davis sent. She still has nagging thoughts about bacteria that scare her, so she tells her mom she is in trouble.
Aza begins to reach her lowest point in Chapter 18. Her decision to end therapy after five years signifies that she doesn’t believe that seeking help is worth the energy. This conclusion can only quicken and amplify her spirals as she recedes further into herself without help from others. As Aza loses herself, all she can see and focus on is that Ayala reflects everything the people closest to her dislike about her. The scene in which Aza snaps at Daisy just before the car crash shows how trapped she feels inside her mind. It is notable that she loses control of her own words in a rant where she struggles to convey clearly and thoughtfully what it is like to be inside her mind, and this loss of control is coupled with her losing control of the car.
The scenes surrounding and including Aza’s car crash serve two narrative purposes. First, the argument with Daisy beforehand illustrates how Aza is perceived by others who do not have access to the thought patterns in her head. While Daisy may think Aza is self-centered, she has no idea what the chaos in her mind is truly like. Second, it is a traumatic accident that results in Aza having to confront her bacterial fear. Aza knows that C. diff. is often the result of a hospital stay. While she succeeds in hiding her downward spiral from her mom in the hospital, Aza’s struggle to control her thoughts worsens due to her belief that she can feel the bacteria floating in the air. C. diff. is now metaphorically a part of her and symbolizes the illness which has already consumed her. Aza’s distress becomes more palpable than ever following the events of the car accident that put her in the hospital.
Chapter 20 shifts into Aza’s second-person point of view as Aza wakes up in a fog and attempts to create distance between herself and her illness. Addressing herself, Aza’s narration shifts into a mix of italics, all caps, and more conventional text to show that she is fighting for control. She is in the worst of her thought spirals, and the visual change to the text paints a vivid image of the storm inside her head before she drinks from the hand sanitizer dispenser. The stylistic shift also gives Aza enough distance from her illness to actually speak for herself and verbalize what she needs. In effect, this scene serves as the novel’s climax. Earlier in the novel the plot suggested that the central climax would involve the mystery of Russell Pickett, but this proves to be a red herring. The true climax centers on Aza’s anxiety, and the novel’s stylistic shift signals this change in focus.