The major conflict at this stage is between Matilda and her mother – the age-old struggle between parent and child for authority and identity.
Matilda is being confronted for this first time with illness, and what's more, with death. She is also being forced away from her mother and the city she loves – into the country.
Matilda and Grandfather get a taste of the cruelty of others when the farmer and his family leave them for dead (more or less) in the countryside. Things keep getting worse, it would seem, when Matilda herself becomes ill and blacks out.
Talk about trauma! If she wasn't before, Matilda is definitely feeling like a victim of the horrors of the fever epidemic now. She watches her grandfather get in a fight with a thief looting their home, and then, horror of horrors, she witnesses her grandfather's death. Though she's there to give him comfort as he dies, the event brings her deep pain and anger.
This section of the novel sees a turning point for Matilda. She is no longer a victim of the fever, rather she's the one giving help to others. She takes responsibility for the orphan Nell and starts working with Eliza at the Free African Society. The suspense builds, however, when Nell and Eliza's nephews becomes sick. Eliza and Matilda must nurse the children back to health – but will they survive?
The frost comes, and the children survive! The fever epidemic is over and life returns to the city. The marketplace is filled once again with food and the people who fled to the country return to the Philadelphia. The coffeehouse is set to reopen.
As the novel ends, the family is re-formed: Matilda asks Eliza to be her business partner, Nell stays on at the coffeehouse with Matilda, Nathaniel shows up, and Mother returns at last. Though things have changed, everyone is back together. Matilda is a survivor and is stronger than ever, running the coffeehouse. Her journey into adulthood is complete.