Blue Sisters

Fiction | Novel | Adult | Published in 2024

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Summary

Background

Chapter Summaries & Analyses

Prologue-Chapter 3

Chapters 4-6

Chapters 7-9

Chapter 10-Epilogue

Character Analysis

Themes

Symbols & Motifs

Important Quotes

Essay Topics

Tools

Beta

Discussion Questions

Background

Cultural Context: Fentanyl Crisis

Fentanyl is a highly potent opioid developed for pain management (it is significantly more potent than heroin or morphine). Fentanyl was first approved for medical use in America in 1968 and has become a widely prescribed drug. However, fentanyl has become a major contributor to the epidemic of opioid drug overdose deaths in the United States; most research suggests that as of 2018, fentanyl was responsible for the majority of drug overdose deaths in America (surpassing heroin). Because of its potency, a relatively small amount of fentanyl can result in overdose, and higher doses of lifesaving drugs such as Naloxone may be needed to counteract an overdose.

Prescription opioids were initially not recommended for chronic pain and were intended to manage acute pain for individuals suffering from terminal illness; however, in the 1980s and 1990s, advocacy and promotional efforts from pharmaceutical companies (some of whom made misleading claims that individuals could not become addicted to opioids) led to opioids being prescribed more widely in the United States, including in response to chronic, non-life-threatening conditions. Opioids are now known to be highly addictive, and this characteristic plays a significant role in dependency and the risks of overdose. Consistent use of opioids can contribute to increased tolerance to the drugs, forcing users to take higher and higher doses to manage their pain, and thus raising overdose risks. The opioid overdose crisis results from both prescription and illegally obtained drugs; fentanyl is also regularly introduced into other drugs such as heroin or cocaine, and this also contributes to overdose and death. In Blue Sisters, Nicky’s dependence on prescription narcotics for pain management leads directly to her death from a fentanyl overdose. When she is unable to obtain the prescription drugs she normally uses, she turns in desperation to street opioids that turn out to be laced with fentanyl, causing her death.

Cultural Context: Endometriosis and the Medical Response to Women’s Pain

Endometriosis is a painful chronic condition that can impact individuals with a uterus. Endometriosis occurs when the tissue that normally grows as the lining of the uterus (the endometrium) grows outside of the uterus instead. Common symptoms of endometriosis include pelvic pain, pain during menstruation and/or sexual intercourse, and fertility problems. Endometriosis is difficult to diagnose conclusively, and most studies indicate that it is chronically underdiagnosed. Patients experiencing endometriosis often see multiple doctors over several years before receiving a diagnosis. The underdiagnosis of the condition is important given that the disease is not rare: According to the World Health Organization, endometriosis affects roughly 10% of individuals of reproductive age who have uteruses (“Endometriosis.” World Health Organization. 24 Mar. 2023). Unfortunately, there is no cure for the condition, but pain management can help provide relief from symptoms and hormonal birth control methods may also lead to symptom improvement for some. Minimal surgical interventions can remove endometriosis tissue while leaving the uterus and ovaries intact, but pain sometimes returns over time. Hysterectomy (the removal of the uterus) can permanently resolve the condition, but such a surgery has significant impacts, including the loss of fertility.

The challenges many women experience when reporting pain and seeking a diagnosis for endometriosis reflects a broader problem in which it has increasingly been documented that many medical professionals underestimate and under-treat women’s reports of physical pain. While women are statistically more likely to experience chronic pain, studies indicate they may wait longer when reporting pain, receive less pain medication, and be more likely to have their reports of pain dismissed or treated as an exaggeration (“Gendered Pain: A Call for Recognition and Health Equity.” eClinical Medicine. 6 Mar. 2024). In conditions like endometriosis, both ongoing social stigma around menstruation and reproductive health, and skepticism about women’s experiences of pain may impact the chances of women receiving prompt treatment. Nicky’s experiences in Blue Sisters exemplify these problems. Nicky sees numerous doctors for many years as she seeks treatment for her endometriosis, but the only effective treatment she is offered is a hysterectomy, which would deprive her of the chance to have biological children—her most cherished goal. Eventually, she develops a dependence on narcotic painkillers that leads to her death.