Campbell Alexander has a service dog named Judge who elicits many questions from strangers. He lies about Judge’s purpose every chance he gets, engaging in a sort of game to see if he can make people believe his stories. However, it is slowly revealed that Campbell hides his seizure disorder behind Judge and these stories. Thus, Judge becomes symbolic of Campbell’s need for secrecy and shame over his disorder—a way for him to control an otherwise uncontrollable situation. Judge speaks to Campbell’s judgement of himself. At the same time, Campbell’s stories speak to the whimsical side of his personality, an expression of optimism in the face of adversity. For him, Judge is a symbol of both support and playfulness in a world that is often too serious.

Twice in the novel, characters discuss a lack of money in relation to Kate. The first time, Anna struggles to save enough money to pay a retainer fee for Campbell Alexander to represent her in her petition for medical emancipation. The second time, Sara discusses how the family medical insurance provider is refusing to pay for Kate’s bone marrow transplant, forcing her and Brian to take on a payment plan to cover it.