Medicine River takes place in a town by the same name next to a Blackfoot reservation in Alberta, Canada. Quickly, readers learn that “Indian politics are complex” (45), and each person who lives within the community must find their own way of navigating these politics formed by centuries of heritage and oppression. Canadian laws have a direct effect on the social politics of Indigenous people, particularly the now-repealed Indian Act, which required women who married non-Indigenous men to renounce their Indigenous status and leave the reservation, bringing shame on them from their family. Additionally, those who are not “fully Indigenous” are not allowed to live on the reservations, creating a source of rivalry and superiority, as those who are not “fully Indigenous” must live in a town on the reservation’s borders, like Medicine River, or otherwise leave altogether.

The novel argues for a more holistic view of identity than blood quantum, which measures the percentile of one’s biological inheritance. The community of Medicine River is made up of many people with a non-Blackfoot parent, and although some of their conflicts do arise due to identity—as in the case of Big John and Eddie—whether or not one is “fully Indigenous” is not the defining feature of the milieu.