Re-occurring themes include growth, understanding, wisdom and love that shows that beauty and friendship can be found inside the simplest things.

Devastated, Sarah and her husband spend two years and enormous sums of money going to doctors, but each tells them to send Petey to an institution.

The Corbins decide to send him to a psychiatric hospital, although called an insane asylum (in 1922), in Warm Springs, Montana.

Petey and Calvin meet many people in the Warm Springs Insane Asylum including Joe, Cassie, and Owen, however they all leave them at different points in time.

Joel Shoemaker of the School Library Journal wrote Mikaelsen "successfully conveys Petey's strangled attempts to communicate", "captures the slow passage of time, the historical landscape encompassed" and "brings emotions to the surface and tears to readers' eyes as time and again Petey suffers the loss of friends he has grown to love.

"[2] Kirkus Reviews wrote that "despite some overly sentimentalized passages, the message comes through that every being deserves care, respect, and a chance to make a difference.

"[3] Publishers Weekly criticised the characterisation, writing that the characters "never really come to life beyond their roles as symbols", and wrote that the novel "never meets the promise of its compelling premise.