Chapter 14 (Thirteen) — 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

Civil's growing unease about her work at the family planning clinic reaches a turning point in this chapter. After learning about the Tuskegee syphilis study and reviewing Miss Pope's materials, she becomes worried that she might be repeating the mistakes of Eunice Rivers, the nurse who facilitated that study's abuses. She decides to search Mrs. Seager's patient files to find out whether the clinic is knowingly administering a dangerous drug to underage patients and whether proper records are being kept.

Her plan is complicated by the fact that Mrs. Seager stores all patient files in a locked cabinet in her office, and only the receptionist Lori is normally allowed access. Civil waits for an opportunity during clinic hours, when Mrs. Seager is occupied in the exam room counseling a mother of six about getting a tubal ligation. She finds the cabinet key beneath a porcelain bell on Mrs. Seager's desk and opens the cabinet.

Inside, Civil finds files for several young patients receiving Depo-Provera: Mary, age thirteen; Patsy, age sixteen; and Yolanda, age fourteen, who is epileptic. She searches for parental signatures and consent forms but finds none. The nurse notes in the charts document side effects like excessive bleeding, amenorrhea, headaches, abdominal cramps, and vaginal discharge, but one nurse's notes are unsigned and punctuated with exclamation points, noting patients who were late for injections, didn't understand the reason for the shot, or had swelling at the injection site. Other notes use vague, judgmental language such as