Pauline is a very, very messed-up teenage girl who dreams of becoming a surgeon, though it would be more appropriate to call them "delusions". She wants to lose her virginity to her classmate Adam, and to help her little sister and only real friend Grace, who is dying of cystic fibrosis. Oh, and she is completely insane, having twisted dreams/fantasies that combine sex, blood, and surgery in dangerous quantities. Her parents Phyllis and Bob have just about given up on her, the entire school thinks she's a weirdo, and she's failing math. It's only a matter of time before she finally loses it.
This film provides examples of:
- Alpha Bitch: Natalie and Abigail.
- Ax-Crazy: Pauline, progressively more so over the course of the film.
- Beauty Inversion: Anybody who's watched 90210 knows that AnnaLynne McCord is a very beautiful woman. Anybody who's watched this film knows that Pauline is not.
- Black Comedy
- Disproportionate Retribution: The jump roping girl who lives across the street is rude to Pauline. At the end of the film, Pauline kills her for the purpose of harvesting her lungs.
- Gorn: Especially in Pauline's fantasy sequences.
- Hemo Erotic
- Ill Girl: Grace, who's dying of cystic fibrosis.
- Important Haircut: Pauline shaves her head before performing surgery on Grace.
- Loners Are Freaks: Pauline.
- Mad Doctor: Pauline has dreams of becoming this, and progresses into it over the course of the film.
- Nice Job Breaking It, Hero!: Pauline's lung transplant for Grace goes about as well as you can expect for a complicated procedure performed by someone with no medical training, little proper equipment, and a garage for an operating room.
- No Periods, Period: Averted. Pauline makes a guy go down on her, not telling him that she's having her period. He is completely, utterly, and appropriately squicked out.
- Roaring Rampage of Revenge: One day, Pauline walks into school and simply starts beating the crap out of everybody who ever pissed her off. This gets her expelled.
- Sliding Scale of Comedy and Horror: It's very bloody, but many scenes are played for sick laughs more than anything.
- Southern Belle: Phyllis, who wants to enroll her daughter Pauline in cotillion classes in order to teach her how to be a "proper" lady.
- There Are No Therapists: It should be obvious to anybody with authority that Pauline has problems that go way beyond simply being antisocial, and yet the only help she ever receives are weekly sessions with the local church pastor who is woefuly inept at dealing with her. Worst part is that Pauline twice asked to attend a real psychiatrist, only to be denied for petty reasons.