The chapter begins with a letter Liz writes to Ma after her death. Liz explains that Ma’s death prevented Liz from telling her all the things she wanted to say.
At the time of her mother’s death, Liz still has many conflicted feelings: tragically, she never gets a chance to express those feelings out loud.
Liz compares her relationship with Ma to “how pearls are made.” A pearl begins with a small, painful grain of sand that an oyster turns into a beautiful gem in order to protect itself. Liz has done a similar thing: she’s buried her painful memories of her family under layers of happiness. Even when Ma died, Liz was far away, enjoying herself.
Liz has enough self-awareness to acknowledge that she’s been trying to run away from her problems. Liz is plainly struggling with her guilt at having been far away during her mother’s death.
Liz feels guilty for being absent when Ma died. She wonders if Ma was afraid as she approached the end of her life: being in a strange place, surrounded by strange people, must have been terrifying.
Liz’s deep compassion for her mother is plain: she imagines herself in her mother’s position, and seems to understand the kind of fear and confusion Ma must have experienced.
Liz tells Ma that Daddy kissed her on the mouth just before Ma’s death—then, the nurses scolded him for doing so, since Ma posed a “health hazard.” Liz notes that people have always been treated Ma “like something they needed to back away from.”
Where other people see Ma as “just another addict” or “just another AIDS victim,” Liz sees her as a gentle, lovable human being—albeit one for whom Liz had other, more complex feelings as well.
The family buries Ma the day after Christmas. At the funeral, Liz sees Lisa and realizes that her sister has grown into a beautiful woman, just like their mother. Liz wishes that she and Lisa were closer, so that Liz could hug Lisa. And she wishes she could hold Ma.
In the aftermath of her mother’s death, Liz realizes that she’s missed out on having a good relationship with her sister, and expresses a desire to strengthen their connection.