Where It All Goes Down
Three Rivers, Connecticut, 1950-1992
Three Rivers is a fictional Connecticut town, although there is a real-life Three Rivers Community College. Notable attractions in Three Rivers include the Hatch Institute, a state mental hospital; a large cemetery; and a river with a waterfall, creatively named The Falls.
Escape Hatch
Thomas is accustomed to being treated at the state hospital's Settle building, but after chopping off his hand in public, he's deemed a danger to the public, so he is court ordered to the Hatch Institute, which is a little more serious than Settle. According to Dominick, it smells like "Human rot. […] Human decay" (4.41), so the hospital must have exceeded its Febreeze budget for the year.
We're also told that "there's never been an escape from Hatch" (4.2) making this place like the Alcatraz of mental hospitals. There are strict regulations around personal property (even Thomas's Bible has to be approved) and a generally higher level of security.
From an objective perspective, this is a good thing. Clearly Thomas's previous treatment wasn't working because someone receiving the treatment they need is unlikely to chop off their hand in the middle of the library. So maybe a more serious setting will do him good.
Dominick doesn't think so, though, and does everything and anything he can to get Thomas out. Sadly, the officials at Hatch bend as many rules as they set, and they're trying to cover up an HIV epidemic in the facility. When Dominick uncovers it, and blackmails the doctor in charge, Thomas is set free and the facility is closed.
Don't Go Chasing Waterfalls
The Falls of Three Rivers factor into Dominick's life often, in both good ways and bad. Dominick often goes there for peaceful reflection and for a literal perspective change. For instance, he goes there after his baby dies and tries to get a "high-up perspective—[a] long view of things" (14.20). Dude's looking for the bigger picture, which makes sense since his kid just died in her sleep.
The Falls are damaging, too, though. Both Ralph Drinkwater's twin sister and Thomas, Dominick's twin brother, die at the Falls. This reminds us of Dr. Patel's "Life is a river" (36.110) analogy. Part of life is death and tragedy, too—but for more on this, hop on over to the "Symbols" section.
Cha-ching
Throughout the novel, we're given updates on the fictional Wequonnoc Native American tribe's fight for federal recognition. This loosely ties into Dominick's story, as he deals with guilt he feels for Ralph Drinkwater, a Wequonnoc Indian, who has been dealt a tough hand by life—dead sister, sexually molested, dropped out of college, to name a few.
Ralph's story seems to represent the greater struggles of Native Americans, whose lands were taken from them by white settlers and were left with nothing for years. But as the tribe gains recognition—and builds a casino—their fortunes begin to change.
Strangely, Dominick finds out that he, too, is Wequonnoc at the end of the novel, and he gets a share of the money they rake in from the casino. Is Lamb trying to equate Dominick's struggles with those of the Native Americans? Or did he just want to give Dominick the happiest ending he could? We'll let you chew on that one for yourselves.