Jacob sings along to the stereo as he drives his car, with Beth in the passenger seat and Rachel in the back. He turns the volume up and down while he sings, and he asks Beth and Rachel to join in—and sing “louder!” They’re heading to the hospital for Beth’s surgery. Last night, Rachel went to Beth’s apartment to make sure everything went smoothly. And when Beth asked, Jacob readily agreed to take her to the hospital. Beth is afraid of surgery, but with Jacob driving and singing, she has forgotten her fears.
Jacob once again affirms that his commitment to Rachel and Beth’s well-being goes far beyond his job: just like he brought them to the beach with his family, he accompanies them on the most stressful day of their year together. This is a prime example of the kind of friendship, love, and support that can help people with disabilities make (and follow through with) better personal decisions.
Rather than giving Beth a corneal transplant, which might not work, the doctor will remove the eyelashes that are growing into her eyes. She’s supposed to spend the following two days at home, icing her eyes, but she wants to keep riding buses instead. Rachel knows she can neither force Beth to follow the recovery procedures nor totally honor her wishes, so she tries her best to remind Beth of the consequences. Rachel is as grateful for Jacob’s support as Beth is. In fact, rather than just dropping them off outside the hospital, Jacob follows them inside.
While Jacob clearly knows how to support Beth and help her make healthy decisions, Rachel worries that she won’t manage to do the same for Beth. Thus, she comes to view Beth’s recovery as a test of their sisterhood. Once again, she is running into the limits of self-determination: Beth’s right to make her own decisions may lead her to put herself in serious danger, because she struggles to understand the consequences of her actions due to her disability.
Beth’s medical caseworker, a nurse named Mary, helps her with the paperwork. Rachel sees that Mary’s other client, an elderly woman with intellectual disabilities, is all alone. She wonders whether the woman has family and what her life has been like. Beth dutifully follows the medical staff’s advice and asks for Rachel to stay with her at every step of her procedure. Right before she goes in for surgery, Beth declares that she needs to go to the bathroom and is planning to run away—but Rachel can tell that she’s not serious. Beth is reluctant to lie down on her gurney and turn over to receive her anesthesia shot, but she eventually agrees.
Mary’s job further shows that there’s no contradiction between self-determination and providing support services for people with disabilities—on the contrary, such services are often necessary in order to help people like Beth truly make autonomous, well-informed decisions. Yet the other elderly woman shows why this kind of formal support isn’t enough on its own: people with developmental disabilities also need connections to loved ones, friends, and broader community networks in order to truly thrive. After all, it’s Rachel’s company—not Mary’s—that convinces Beth to go through with the surgery.
Rachel follows Beth as the nurse wheels her away to surgery, and she notices that Beth’s eyes look blurry and scratched-up. As Beth falls asleep, Rachel feels overwhelmed with love for her. Olivia later tells Rachel that she wouldn’t have forced Beth to go through with the surgery if she really decided to run away. But Rachel feels conflicted: she wants to respect Beth’s wishes, but she knows how important the surgery is.
Rachel still struggles to fully accept the principle of self-determination. Unlike Olivia, whose job requires her to prioritize Beth’s autonomy no matter what and accept the consequences, Rachel knows that she will feel responsible if she lets Beth make poor decisions. Thus, when she gazes over at Beth’s damaged eyes, she asks herself which is really a greater expression of her love: respecting Beth’s autonomy, or violating that autonomy in order to save Beth from a danger that her disability prevents her from fully understanding.
After the surgery, Beth agrees to follow the doctor’s orders. Jacob spends the whole day with her and Rachel. Rodolpho and Rick visit, and after Rachel goes home, Beth finishes her post-op treatment at Jacob’s house. Olivia tells Rachel that “this is how it’s supposed to work”—self-determination is supposed to help people with developmental disabilities form a community that will care for them. Rachel marvels at how lucky Beth has been to find such a community, but she wonders what happened to the other, older woman in the waiting room.
In previous chapters, Rachel has introduced the core members of Beth’s bus-driving community one by one. Here, she shows how they come together to support Beth when she needs them. Again, Olivia emphasizes that autonomy and connection are complements, not opposites: self-determination doesn’t mean living a solitary or totally self-sufficient life, but rather accepting the help and resources necessary to live in line with one’s values and desires. Finally, Rachel’s concern for the older woman shows that she recognizes how many people with developmental disabilities aren’t lucky enough to have the kind of love, community, and effective services that enable Beth to live an autonomous, fulfilling life. She encourages her readers to think of what they can do to help the people who fall through the cracks. Of course, the solution is to build better political and social systems, so that all people with developmental disabilities have a chance to thrive like Beth.