I believe the best way to describe this partly autobiographical story is as an illness travelogue. Alexie prepares his reader for a strange journey by making the first stop his discovery of a dead cockroach in his suitcase. This allusion to The Metamorphosis works wonderfully well for the Kafkaesque remainder of the journey. His bodily journey moves from loss of hearing to possible meningioma to his doctor's proclamation that his "brain is beautiful." His existential/psychological/cultural journey, triggered by his bodily suffering, moves in multiple directions: to time spent with his dying father, his own experience with hydrocephalus, his grandfather's death in WWII, and his loving relationships with his children, wife and brother-in-law.
Twenty-one stanzas of couplets spin out stereotypes of Native Americans promulgated by white American culture. Among those stereotypes that Alexie develops: the tragic Indian; Indian women as sexual objects for white men; Indian men as secretly desirable to white women; Indians as violent, alcoholic, childlike, mystical, and members of a "horse culture." But in addition, Alexie emphasizes how American whites have co-opted Indian culture: "white people must carry an Indian deep inside themselves" until finally, "all of the white people will be Indians and all of the Indians will be ghosts."
