What is the main setting in the novel, All My Puny Sorrows?

The action centers around Elf’s hospital room. The characters are there in their minds even when they are physically elsewhere. The significance of the hospital underlines by the author’s choice to place those scenes alone in the present tense. This is a family in crisis. Elf is mentally ill and her family has rallied around her sickbed in an attempt to save her from herself. Centering the action around the hospital builds an underlying sense of urgency and dread into the story. Though Elf has been saved, she is still ill and as she continues to be held at the hospital it becomes clearer how little help there is available for her.