At the start of the novel, Lucy, who is temporarily hospitalized, received visits from her mother. Lucy is grateful for the visits and grateful for the doctor who seems to genuinely care for her.
Underneath the mother's kindness, however, there is an undercurrent of cruelty. Lucy is the only one who has successful escaped her humble beginnings in Amgash, IL.
Lucy has gone to college and become a writer but she still experiences loneliness and disconnection. Once after Lucy has her first baby, she calls her mother. Her mother, however, refuses to accept the charges for the collect phone call.
This novel is set in the 1980s before cell phones and smart phones. Another crucial part of the novel is the AIDS epidemic; Lucy feels a connection with outcasts and with the neighbor who is dying.
The brothers and sisters she left behind in Amgash feel some resentment for Lucy, who made it out of the rural community. Those themes are explored in Strout's award-winning short story collection, Anything is Possible.
Lucy discovers she will always be connected to her family even though she has left them and started life anew elsewhere.
The Chrysler building on the cover makes sense.
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