Chapter 22: Summary, Analysis, and Key Themes

⚠️ 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 in a flashback to a summer when Jamie was five years old and Willa was not yet two. The narrator and her husband Nick are on their way home from an ultrasound appointment and stop at a pharmacy. The doctor has called in a prescription for misoprostol, a medication used to terminate a pregnancy. The narrator goes to the pickup window to sign for the prescription while still crying intermittently, with Nick's arm around her waist for support.

The pharmacist asks whether she has questions about the medication and then, looking at his computer screen, observes that she has taken it before—specifically in September of the previous year. The narrator automatically denies this, insisting it must be a computer error, and signs for the prescription. She cannot tell whether Nick is paying attention to the exchange.

Back in the car, Nick remarks that one would expect better record-keeping from a pharmacy. The narrator nods in agreement, swallows the pills with the end of somebody's coffee, and waits for what she knows is coming—the physical effects of the medication and, implicitly, the emotional weight of the moment.

Key Events

The narrator and Nick stop at a pharmacy on the way home from an ultrasound appointment
The narrator signs for a misoprostol prescription while crying, with Nick's arm around her waist
The pharmacist notes from his computer records that she has taken the medication before, in September of the previous year
The narrator automatically denies the prior prescription, calling it a computer error
Nick comments on the supposed record-keeping failure
The narrator takes the medication and waits for its effects

Character Development

The narrator reveals a pattern of concealment that runs deeper than the immediate situation. Her automatic denial—before she has even processed the pharmacist's words—suggests a reflexive need to protect a secret she has kept even from her husband. The fact that she cannot tell whether Nick is paying attention during the exchange underscores the isolation of her secret: she is alone with it even while standing beside him.

Nick appears in this scene as a supportive but possibly oblivious presence. His arm around the narrator's waist shows care, but his comment about record-keeping suggests he either accepts the computer-error explanation at face value or chooses not to probe further. The ambiguity leaves open whether he suspects the truth.

The pharmacist is a minor but pivotal figure. His routine observation—reading the computer screen and noting the prior prescription—is what forces the narrator's secret to the surface, however briefly. He functions as an unwitting catalyst.

Themes, Symbols, or Motifs

Concealed past abortion: The chapter's central revelation is that the narrator has undergone a medical abortion before, in September of the previous year, and has not told Nick. The scene dramatizes the weight of carrying this secret.

Marital secrecy: The narrator's inability to share this part of her history with Nick—even in a moment of shared grief after an ultrasound—speaks to the boundaries that can exist within even close relationships.

Grief after ultrasound: The narrator's intermittent crying and Nick's supportive arm suggest the ultrasound appointment was emotionally difficult, likely confirming a pregnancy that cannot continue. The scene captures grief in a mundane setting.

Denial of past events: The narrator's automatic denial is a reflexive response that reveals how deeply she has buried this memory. Her insistence on the computer error is both a lie and a form of self-protection.

Hidden past resurfacing: The pharmacist's computer record is a small, mechanical reminder that the past does not stay buried. A routine errand becomes a moment of exposure.

Why This Chapter Matters

This brief chapter carries significant weight in the narrative. It reveals a concealed abortion in the narrator's past—a secret she has kept from Nick—and shows how a mundane errand can become a moment of crisis when the past resurfaces. The scene also establishes the emotional context of the narrator's relationship with her body, her pregnancies, and her marriage. The fact that she takes the medication with the end of somebody's coffee underscores the ordinary, almost dismissive way she must move through this experience, even as it is anything but ordinary.

The chapter also raises questions that may resonate later in the book: Does Nick know more than he lets on? What does this concealed history mean for the narrator's present? The scene's placement—as a flashback within the larger narrative—suggests that this memory is surfacing for a reason, perhaps connected to the narrator's current circumstances.

Study Questions and Answers

1. Why does the narrator automatically deny having taken misoprostol before?

The narrator's denial is reflexive rather than considered. She has clearly kept this prior abortion a secret from Nick, and the pharmacist's observation threatens to expose it. Her automatic response suggests a deeply ingrained habit of concealment—she does not pause to think before lying, which indicates how central this secret is to her sense of self and her marriage. The denial also protects her from having to explain, in that moment, why she has taken the medication before.

2. What does Nick's comment about record-keeping reveal about his awareness of the situation?

Nick's remark—that one would expect better record-keeping—is ambiguous. On one level, he may genuinely accept the computer-error explanation and is simply commenting on the pharmacy's apparent incompetence. On another, his comment could be a deliberate deflection: a way of acknowledging the awkwardness of the moment without forcing the issue. The narrator cannot tell whether he was paying attention during the exchange, which leaves his awareness deliberately unclear. This ambiguity may be significant for the larger narrative.

3. How does the setting—a pharmacy, a routine errand—contrast with the emotional weight of the scene?

The pharmacy is an ordinary, functional space—a place for picking up prescriptions and running errands. The narrator's experience, by contrast, is anything but ordinary: she is terminating a pregnancy, grieving after an ultrasound, and concealing a past abortion from her husband. The contrast between the mundane setting and the profound emotional stakes highlights the way profound experiences often unfold in unremarkable places. The detail of swallowing the pills with the end of somebody's coffee reinforces this—a moment of deep personal significance is handled with the casualness of a routine chore.