Rachel flashes back to Beth’s infancy. When Beth is two months old, their mother tells the neighbor, Mrs. Stein, that she’s worried. The doctors squeezed Beth’s head with forceps during her delivery, and Beth isn’t as vigilant or reactive as other babies. She just stares emptily into space—she barely moves and never cries. Mrs. Stein says not to worry, but Beth doesn’t improve.
Throughout the book, Rachel intersperses stories from her year riding the buses with Beth with flashbacks to her and Beth’s childhood. These flashbacks give context to Rachel and Beth’s strained relationship with each other and their family as a whole. In particular, Beth’s infancy shows that she has always been different—and that this difference has always made it challenging for her family to care for her.
The family doctor examines Beth several times but doesn’t realize that something is wrong for many months. When Beth is seven months old, the Simons take her to a renowned Philadelphia children’s hospital. After a month’s worth of tests, the doctor confirms that Beth is developmentally disabled—but he doesn’t know why, or how severely. The Simons are devastated.
While Rachel implies that Beth’s disability may stem from the way her doctors squeezed her head during delivery, she also admits that the family will never get a definitive answer about why Beth didn’t develop the same way as other children. She conveys the family’s sense of powerlessness and confusion at realizing that they were totally alone in determining how to raise Beth: there was no clear formula to follow and no guarantee that Beth would ever live the fulfilling life that she has today.