1. “But, of course, throughout these treatments, as he’d discovered, the frowning doctors hedged and balked and shat caveats, until the promise of recovery was off the table, out of the room, nowhere near the building.”
“Shat caveats” is the star here, all the more for the way “eat” is buried in “caveats” and unconsciously summons an inverted eat shit power dynamic into the patient/doctor relationship.
2. “A disappointment of trains…”
Not only is it wonderfully strange to think of collective nouns for trains, but it is perfect to think of them in this context of being let-down, of those who leave and fail to arrive.
3. “Even in bed, as she hobbyhorsed on top of him with the focus of a child doing homework…”
What other verbified noun would capture the sad, squeaking lack of intensity? The simile directly amps up the inappropriate contrast — the child/fucking — and pairs it with the frustrated displeasure of homework and double entendre slang of “doing.”
4. “…even though his medication sometimes gave him the cold, dull crotch of a mannequin.”
Impotence amplified through the purchase of one perfect metaphor. Castrated. Plastic. A child’s toy.
5. “…humping one another’s empathy slots…”
Aside from the surface juvenility of “humping” and the crudeness of “slots,” there’s a superb resonance with coin-operated arcade machines— those addictive, bottomless, and at times frustrating quests.
6. “…the perfectly refreshing speed-balls of marrow…”
What makes music in this story is sometimes this great collision of the narrator’s glib tone, the illicit choices, and the deeply visceral/medical. No one in the history of injecting mixtures of cocaine and morphine has quite sold the experience as “refreshing.” And certainly not juxtaposed with naturally harvested bone marrow.
7. “Julian was simply allowed to lick money from his father’s body whenever he wanted to, and his father had pledged never to cry out in pain.”
Lick money. Demeaning to be reduced to the licking, but also cruel to be the parasite. Captures the grim duality of the impoverished dependency of the adult child.
8. “In English, no matter what you said, you sounded like a coddled human mascot with a giant head asking to have his wiener petted.”
“Coddled human mascot with a giant head” immediately renders a kind of pathetic, corporate, nanny-stated object of derision, and the absolute kill-shot lands on “wiener petted,” the double t in petted echoing the double d in coddled, trussing up the sad little ham of it all.
9. “If you could draw a headache, this is what you would draw.”
This refers to the image of a smudge in a brain scan, itself evidence of an unknown malignancy, and there’s a real delicacy in asking the reader’s imagination to draw that which is invisible, a pain, a physical concept utterly impossible to draw. The sentence is a kind of headache, and this is a good thing here.