Jack is sixteen and crap keeps rolling into his life. Many teens will say that, however, Jack's mother has just died and that leaves traitorous older sister Emma in charge. Because aside from momma, only Jack's friend Elliot accepts him living his life as a boy; Jack is biologically female. But neither El nor his mother see Jack as male or even a male who likes other males. When Emma drives Jack to suicide and he survives, she has him committed to a mental institution where (this is 1971 Georgia) they will CURE him to see herself.
The parts at the mental institution are rough; that Jack and Noah are the only two underage patients in a population of dangerous or delusional much older people is a nightmare. (I had to skip to the end to make sure they both got out or I wouldn't have finished). In Noah, Jack finally finds someone who sees him the same way he sees himself and someone to fight for besides himself. When opportunity at just the right moment strikes and they make their escape, I cheered, even if it was a bit pat. And which Lake Lucerne did they end up at? I assumed Wisconsin but it's probably Florida, is that really far enough away?
The author states the book began as YA and then she changed the classification; I think it is still YA. It reminded me of Never Promised You a Rose Garden
and one other book I read in high school about two brothers in Forest Hills where one becomes involved in drugs (I can't remember the title and that's really bugging me now). The things that Jack does to protect Noah and himself, what they endure are horrific, but I don't know the rules for YA, that's a genre I haven't read in 30+ years. Still, I enjoyed it and would love a sequel.