“ILLC is a state-run nursing facility for adolescent youth through age twenty-one. It’s just like a regular nursing home, but instead of locking up old people they lock up young people.”

Joanne’s tone of condemnation is clear from the outset of the book. Her use of phrases like “locking up” imply a sense of imprisonment and punishment related to the disabled population. Rather than being cared for, they are marginalized and made to be invisible outcasts.

“Most of the kids are chair users, but they have manual chairs. Quite a few are too gimpy for manual chairs and should have power chairs so they could get around on their own, but it’s against the rules. That’s unofficial. The official practice is that everyone who needs a power chair gets one. But just the other day I asked why this one girl, Mia, didn’t have a power chair, and Mrs. Phoebe said Mia wasn’t ready for a power chair. But I’m looking at her, she’s planted in this one spot all by herself, can’t move an inch on her own, can’t talk to the other kids, has to wait for a staff person or one of the kids who can walk to notice her so she can get a push. Mia looks about as ready for a power chair as anyone I’ve ever seen.”

The symbol of the wheelchair is a prominent tool used by the author to signify a character’s social status. If a person can move by themselves, they are more likely to have power. For Mia, her lack of mobility is representative of how little she—and others like her—are able to pursue their ambitions. She is voiceless and disregarded as an inanimate object left for others to push.

“It used to be that places like ILLC were state-run, but the state made a mess of it and now they pay our company—which, unlike the state, knows how to run a business—to do everything.”

The dangers of mixing corporate capitalism with healthcare is an important theme in this novel. Instead of properly caring for the outcomes of patients, companies like Whitney-Palm become profit oriented and begin to treat patients like a business. The allusion to how states have abandoned the care of these patients is also symbolic of how our society has largely lost interest in supporting the disabled population.