Fictional elements that Alcott uses include dialogue, plot elements, and the persona of a narrator. As the narrator, Alcott adopts the persona of "Nurse Periwinkle," sometimes talking about herself in the thired person. Plot elements include the arrangement of the events of the night in a plot curve, with John's death as the climax. In another plot element, a flashback tells about her first meeting with john. The most prominent fictional element is dialogue. Their dialogue helps to characterize the patients, the doctor, and Alcott herself. Ther dialogue also helps to move the story along.