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  • Alternative Character Interpretation:
    • Does Madeline ever forgive her mother? Or does she permanently cut her off from her life? Or is it more a case of Forgiven, but Not Forgotten? And if Madeline did forgive her, does she even deserve it?
    • Carla admits she suspected Pauline wasn't right in the head, but insists she didn't know Maddy wasn't sick. It's possible she had an inkling of what was going on, but deliberately avoided looking too close or thinking too much about it, since if she questioned anything or encouraged further testing, Dr. Whittier would fire her and replace her. At least if she stuck around, she could protect Maddy as much as she could. She's a nurse, so she might have realized something with Maddy's case wasn't adding up.
  • Ass Pull: Madeline's mother having been delusional about Madeline's illness the whole time really doesn't have any buildup. She acts totally normal for majority of the novel, but the second Maddy learns she might not have SCID, she immediately starts acting unstable and crazy, even before Madeline showed her the email.
  • Broken Base: The Reveal at the climax of the novel has caused a... split in the audience, to say the least. Some are glad it allows for a happy ending, while others think it's a massive cop-out. The movie adaptation though, fared a bit better, leaning on the Earn Your Happy Ending side.
  • Ensemble Dark Horse: Zach only appears for one chapter, but his story of wanting to be an "African-American Freddie Mercury" despite his Fantasy-Forbidding Parents is very memorable and interesting.
  • Nightmare Fuel:
    • Madeline's disease. Even stepping outside for a moment could kill her. When she and Olly go to Hawaii, she gets so sick her heart stops. Yeah, it turns out Madeline never actually had it, but SCID is still a very real condition.
    • Even more terrifying is The Reveal that Madeline was never sick. Her mother had fabricated the whole thing over her delusion that Madeline needed to be "safe," which, in her mind, meant being confined in her house for her entire life. The level of mental instability and desperation that would take elevates Pauline from being a Hate Sink to being genuinely scary.
  • The Woobie: Madeline, due to being unable to leave her house, see anyone besides her mom and her nurse, or have anything resembling a normal life. For most of the book, she's an Iron Woobie, since she knows it's no good being morose about her situation, but once she finds out her mother had fabricated the whole thing, she begins to break down, understandably so.

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