For Mailhot, the hospital symbolizes the expectations of Western culture, and her ability to fit into it. She goes there to reconnect with the world and finds no representation of her culture within its White walls. She is a problem that needs fixing in the hospital.

While Mailhot is in the hospital, Casey abandons her because she does not fit his expectations of what a good woman should be; her inability to follow the rules of White culture is a perpetual problem in their relationship. She recalls her stay in the hospital throughout the book, as proof of her inability to meet the cultural norms of her chosen life as the partner of a White man. She writes on this: “You should have thought before you made a crazy Indian woman your lover” (14), as if being with her is a mistake or a punishment.

The hospital returns again and again as both a balancing point for Mailhot and a reminder of her failure to comply with the cultural standards of the world around her. 

For Mailhot, the squaw is symbol of self-hatred. It represents her internalized racism against Indian women, which manifests as a hatred of herself.