Ward D

“‘What if,’ I say quietly, ‘at the end of the night, they get confused and think that I’m one of the patients there and they don’t let me out?’”

Amy asks this question of her roommate, Gabby, and Gabby laughs. This is the first time she openly questions her mental health, and she is brushed off, reinforcing her reluctance to do so again. This quote further foreshadows the reveal of the young girl as a real delusion.

“While I’m standing in the middle of Ricardo’s, trying not to stroke the forbidden sweater, I notice a little girl standing on the other side of the clothing rack. She is about six or seven years old, wearing a pink dress that is the same color as the sweater, and with blond curls around her face. She is adorable, especially when she offers me a gap-toothed smile.”

Amy describes the first appearance of the young girl from her delusions. The girl is nonthreatening, a reflection of Amy’s subconscious that contrasts with her later suggestions to steal and cheat.

“(Yes, I apparently believed our attending physician tonight would be Dr. Sigmund Freud.) But Dr. Beck is not like that. At all. First of all, he’s not old. Certainly not old enough to grow a long white beard. He’s in his thirties, with slightly sun-kissed brown hair, and a hint of dimples in his cheeks when he smiles at us.”

Amy describes Dr. Beck as attractive, but this moment will come back to haunt her when she learns this doctor is an imposter—and that the real Dr. Beck is an older man akin to Dr. Freud. This initial reaction implies his influence over her as both an attractive man and an authority figure, perhaps explaining her reluctance to question him.

“After all, if you meet someone who is truly mentally ill, that’s the only way to know that you’re sane.”

Amy questions her mental health as she considers Will’s diagnosis. She is frightened by the fact that Will reported hearing voices telling him to kill, but decides to see him to “prove” her own mental health. This again foreshadows the reality of the young girl, who later tells Amy to kill Will.

“I hear the noise again, and this time the door to Seclusion One vibrates. And as I stare at the door, it happens again. That loud thud, followed by the door vibrating. And an anguished growl from inside.”

Amy hears many noises from the seclusion rooms as the night progresses, but these are the first she hears. She becomes concerned that Damon, an isolated patient with a penchant for violence, might have freed himself. Jade makes her question whether or not she heard these noises, as Amy is supposedly the only one who hears them. These developments add tension and cast doubt on Amy’s perception of the night’s happenings.

“I can’t believe it when I see them. Ring Dings are like my favorite sweet treat in the entire world. I have a rule that I can’t buy them for myself, since I would just gorge myself.”

Ring Dings are one of Amy’s favorites: She associates peach iced tea with Jade, Ring Dings with Cameron, and later, iced dirty chai tea lattes with Will. She connects with items that she then associates with important people in her life. These particular Ring Dings will be the last Amy eats, as she loses interest in such connections once their associated relationships are severed.

“I dig out my phone and try once again to get some service on it. For a split second, I have a bar. But then it vanishes.”

Amy’s continual struggle to get a signal on her cellphone shows her desire to connect with the outside world. However, her failure to do so adds tension and a sense of isolation. At one point, she considers using the landlines to call, but they are eventually rendered useless.

“She smiles at me. ‘If I’m not real, then what does that mean for you?’”

Amy tells the young girl that she’s not real, and the girl then questions Amy’s mental state. This shows Amy is aware of what is happening to her, and it reinforces her fear of becoming a patient in Ward D. At the same time, it shows how the delusion plays on her self-doubts and self-esteem to manipulate her into acting.

“Mr. Riordan finally gives the student the last test, but there’s a troubled look on his face. It doesn’t matter though. Absolutely anything could have happened to that extra test paper. He has no idea.”

Amy’s math teacher notices a missing test, stolen by Jade, but Amy believes he won’t figure out what happened to it. This is the catalyst, the moment when Jade is pushed over the edge and pursues violence to solve her problems. This is the beginning of the end, but Amy exhibits the innocence and naivety of a teenager.

“She would be in jail right now facing theft charges, except the two of them were armed only with beer bottles that they were pointing at the poor bank clerks like weapons, and they didn’t leave any of the banks with any actual money.”

Touching on the theme of Mental Health Diagnoses and Their Impact on Patients, Jade and Damon’s attempted robberies with beer bottles show they don’t always make the most informed decisions as a result of their diagnoses. This foreshadows their flawed plan to escape Ward D despite the main door being locked. This information is also important to Amy as it helps her figure out which of the patients is Jade’s boyfriend.

“After I punch in the final number of the code, I expect to hear that loud alarm noise and a click as the door unlocks. But instead, all I hear is a soft buzzing noise.”

Amy’s attempt to unlock the main door to Ward D reveals two facts. The first is that the door locks have reset, so no one can leave. The second reminds Amy and the reader that the door emits an alarm when unlocked. This reminder proves Cameron didn’t leave when he went missing because the alarm would have sounded—which Amy doesn’t piece together until the end of the novel.

“‘He came to my room,’ Spider-Dan explains. ‘He was looking for you, but I didn’t tell him where you are. I won’t let him hurt you.’”

Spider-Dan’s words to Amy reveal he knows Dr. Beck is Damon because he identifies the man who threatened her as Damon. This quote also reveals Damon knows who Amy is and is looking for her in particular, foreshadowing his and Jade’s plan to burn down Ward D—killing everyone else in the process. Finally, the quote reveals Spider-Dan’s determination to help Amy. Both Cameron and Will make this same promise, but Spider-Dan is the only one who keeps it.

“Even though I’m worried about Jade, I do what she asks of me. After all, I’m not going to convince her right now. Eventually, she might realize I’m right.

I only hope she realizes it in time to save her life.”

Amy’s concern for Jade is complicated. Exploring the theme of Friendship Becoming Adversity, she finds herself struggling to let go of their childhood friendship, even in the face of Jade’s current ambiguity and previous threat to kill her. Jade is the root of Amy’s fear of Ward D, yet she continues to treat her like nothing has changed between them.

“I can’t rip my eyes away from the man duct taped to a chair in the middle of this tiny kitchen. His hands and legs are bound with the dull gray tape, and there’s a piece holding his mouth closed.”

Amy reacts to Jade’s capture of their math teacher, Mr. Riordan. For the first time, she sees what Jade is capable of and how her Bipolar I has changed her thought process: In Jade’s mind, torture is the best way to stop Mr. Riordan from reporting them to the principal for stealing a math test. This again foreshadows her plot to burn down Ward D without an escape plan.

“The diagnosis in his chart is paranoid schizophrenia, but he claimed it was a lie. That he was faking it. But in retrospect, everything he has done or said since we’ve been here has been incredibly paranoid. He has created an entire conspiracy theory. When, in fact, he is the most suspicious person of all.”

Amy’s trust in Will fluctuates throughout the novel, coming and going with his words and what others tell her. In this moment, she believes Will hurt Mary, and that he might have hurt Cameron, too. Amy’s inability to trust adds tension and places Will in danger, as it leads her to allow Dr. Beck and Ramona to sedate him with a dangerous amount of Ativan.

“So according to Gabby, who spent a week working with him, Dr. Beck is an old man. And if the attending physician on this unit is an old man, then who the hell was just with me in this room?”

Upon learning the truth about “Dr. Beck,” Amy begins to reevaluate her situation. Previously, she seemed unwilling to do more than hide in Will’s room and read books, but now, she is spurred into action by Gabby’s text.

“I made a terrible mistake. I should have helped my friend, even when she asked me not to. There’s a small part of me that feels like I deserve everything that’s about to happen.”

Amy’s guilt over not helping Jade when they were children, as Jade was abused by her mother, reinforces the theme of Friendship Becoming Adversity. While Amy still cares about her former friend, this regret being a rare show of sympathy from the otherwise insular woman, it doesn’t change Jade’s past manipulation.

“‘You were the one who got all A’s and were the teacher’s pet, and I was the crazy one. You never had any idea what it was like to be me.’

Damon grins. ‘Maybe you should’ve dropped a few more hallucinogens in her peach iced tea.’”

In the novel’s flashbacks, Amy always has a peach iced tea, implying its importance. Here, it is revealed that Jade used to spike Amy’s tea, suggesting her delusions of the young girl were caused by the drug. However, this reveal is subverted in the Epilogue.

“It’s Spider-Dan. He came out of freaking nowhere and dropped a web constructed out of dental floss onto Damon’s face. And now he is tightening the web, cutting off Damon’s airway.”

Spider-Dan proves a true hero when he uses Cameron’s suggested dental floss-web to save Amy from Damon. This moment fulfills Spider-Dan’s promise to protect Amy, his delusion proving mental health conditions are not inherently violent. He truly believes he is Spider-Man and proves it in this moment, offering relief in an otherwise tense moment.

“Mary’s knitting needle! It’s still in your pocket—stab her with it!”

In the heat of her fight with Jade, this thought crosses Amy’s mind, reminding her of the knitting needle in her pocket. This thought is later revealed to have been the words of Amy’s delusion, who has always been with her. However, like with Spider-Dan, this delusion saves Amy.

“At least five people are dead on this unit, including the boy that I used to think I loved. Five lives cut short. And it’s at least partly my fault. I could’ve done more for Jade. How can I call myself a doctor if I can’t even try to heal my best friend in the entire world?”

Amy reflects on the night as she waits for rescue, again stewing in guilt. Reinforcing the theme of Friendship Becoming Adversity, she berates herself for not helping Jade when they were 16, forgetting that she, too, was young and didn’t understand much. Her affection for Jade is confusing given all that has happened, but perhaps shows a softer side to the otherwise intellectual woman.

“He’ll never know the difference. He’ll just think she got discharged. There’s no reason for him to know she’s dead.”

Amy again shows a softer side when she decides against telling Clint Eastwood that Mary died. She picked up on Clint’s crush on Mary earlier, and knows her death would hurt him the way Cameron’s does at the moment—despite her previous anger.

“I pass her one of the two chocolate cake pies as I take a bite of my own. I close my eyes, chewing on the chocolate and cream mixed together. It’s the last Ring Ding I’ll ever eat.”

After leaving Ward D, Amy shares Cameron’s Ring Dings with Gabby without telling her what happened at night. This moment reinforces the symbolism of these cakes as a means of connection. This final meal will forever be associated with Cameron’s death, but it’s also a natural part of Amy’s pattern to stop enjoying foods or drinks when their associated relationship ends.