Chapter 27: Before – Summary and Analysis
⚠️ Spoiler Warning: This guide contains detailed spoilers for the entire novel. Proceed only if you've finished reading or are comfortable knowing the plot.
Summary
The chapter opens with the narrator admitting they haven't spoken to Sam since Henry died. They follow Nurse Ella like a shadow, helping care for patients—especially infants, whom the narrator watches with a mix of fascination and melancholy. When the narrator asks about Sam, Nurse Ella deduces the two have fallen out and forces a confrontation. She marches into Sam's room, orders them both to sit, and delivers a theatrical scolding about how miserable they are apart. After she leaves, Sam and the narrator are left in silence.
Sam reveals his anger: he is hurt because the narrator cannot say "I love you" and cannot tell Sam who they truly are. The narrator responds by recalling small, intimate details about Sam—the way the sun hits his face, his childhood habits, their shared moments under a willow tree. They explain that they have always been lonely and that Sam was the first person to stay. They confess, "I want to save everyone, as is my purpose," and admit they don't fully understand love but know it exists because of Sam. At last, they say "I love you." Sam embraces and kisses them, and the narrator agrees to leave the hospital with him once he heals.
A time jump follows. Doctors diagnose Sam with a new, serious illness due to his immunocompromised state. The narrator's "butter baby" (a young infant patient) dies at three months old. Sam saves the narrator from running into traffic, then comforts them as they grieve. More patients arrive and die; the narrator returns each time to Sam, whose health deteriorates. The chapter closes with the narrator reflecting on how hope is lost—not misplaced or thrown away, but forgotten, and that forgetting is an essential part of grief.
Key Events
- Nurse Ella forces Sam and the narrator to reconcile.
- Sam confesses he is angry because the narrator can't say "I love you" or reveal their identity.
- The narrator recalls intimate memories and declares their love, promising to search for answers together.
- Sam is diagnosed with a new, serious illness.
- The narrator's infant patient ("butter baby") dies.
- Sam pulls the narrator from traffic and comforts them.
- The cycle of death and grief continues, and the narrator contemplates hope as something that is forgotten.
Character Development
The Narrator: Grows by finally articulating their love and purpose. They move from avoidance to vulnerability, confessing a lifelong loneliness and a desire to save everyone. This marks a turning point in their ability to connect emotionally.
Sam: Softens after hearing the narrator's confession. His anger gives way to understanding and affection. Still physically and emotionally fragile, he takes on a caretaker role when the narrator grieves the baby's death, showing resilience despite his own declining health.
Nurse Ella: Demonstrates tough love and perceptiveness. She refuses to let the rift between Sam and the narrator fester, using a commanding but caring approach to force reconciliation.
Themes, Symbols, or Motifs
Love as Self‑Discovery: The narrator's definition of love is tied to Sam's existence and their own growth. Love becomes a mirror for understanding identity and purpose.
Fragility of Hope: Hope is presented as something that can "break" or be "forgotten." The narrator's repeated losses and Sam's worsening illness test the limits of hope—a finite resource that must be actively remembered.
Grief and Forgetting: The closing lines introduce forgetting as a core part of grief. The narrator wonders if hope is lost because we stop recalling it, linking emotional survival to memory.
The Body as Evidence: Sam's skin patches (pink, raw, scabbed) and his graying complexion serve as outward signs of internal deterioration, mirroring the narrator's emotional wounds.
Why This Chapter Matters
This chapter is a crucial turning point for the central relationship. It resolves the rift that opened after Henry's death, deepens the emotional bond between Sam and the narrator, and sets up Sam's new illness as the primary conflict for the remainder of the novel. The narrator's decision to leave the hospital "once you get better" introduces a fragile promise that will be tested. By examining hope, grief, and forgetting, the chapter also deepens the book's thematic exploration of mortality and the cost of caring—ideas that reverberate through all preceding and subsequent events.
Study Questions and Answers
1. Why is Sam angry at the narrator at the start of the chapter?
Sam is angry because the narrator cannot tell him who they are and cannot say "I love you." He feels that he lives for the narrator, yet they withhold the most basic affirmation of their bond, making him feel invisible and unloved.
2. What definition does the narrator give for love?
The narrator says they do not know what love is, but they would never have tried to understand it if not for Sam. They equate love with wanting Sam to heal, be safe, and be happy—and they realize they have felt this way longer than they can remember.
3. How does the chapter explore the idea of hope?
The chapter presents hope as fragile and finite. The narrator watches Sam's condition worsen while other patients die, and each loss chips away at hope. The final lines suggest hope is lost not through being misplaced but through being forgotten, and forgetting is an essential part of grief.