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  • Author's Saving Throw:
    • Several people applaud that Casey is able to talk back to people who act rude towards them such as Dr. Ramsey, Aurora Emery, and Landry Olsen, as opposed to previous books which forced the player to be polite.
      • This gets subverted in Chapter 15, when Casey can tell Aurora to suck it up for her antagonistic behavior and choosing to push everyone away when they find her crying in the supply closet, yet ends up helping Landry by default even if the player chooses to not help him in the first place. Many players criticize how selective this has become, especially when they're still angry at Landry for betraying Casey.
      • This ends up double subverted in the Book 1 finale, when Landry walks away if players leave him as the last person to talk to. Players applaud this move because they consider Landry unworthy of forgiveness and redemption. Alternatively, if you *do* talk to him before he leaves, you have the option to rub salt in the wound and say you *really* have something to celebrate now after learning he's leaving Edenbrook.
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    • Introducing Dr. Elijah Greene, the first Choices character to be wheelchair-bound, and giving him a job at a prestigious hospital.
    • Players also applaud the choice to have either Bryce Lahela or Jackie Varma (and later on Rafael Aveiro) to be the person present during certain scenes, giving them the opportunity to pick which love interest to hang out with.
    • After numerous complains about numerous Choices books where the player can be either gender but there is no acknowledgement in the dialogue, even in Premium sex scenes, the Premium sex scene with Ethan Ramsey in Chapter 15 and the Premium sex scenes in the final chapter have notably different writing for Casey depending on whether they are male or female.
  • Base-Breaking Character:
    • To his supporters, Dr. Ethan Ramsey is a genius and a Jerk with a Heart of Gold who shows tough love to Casey given that he's their boss. To his detractors, he's a condescending jerk who takes every opportunity to bully and belittle the interns, doesn't understand that they clearly feel stressed and overwhelmed, and acts unprofessionally towards patients as well. His romance route is either adored for being a proper slow-burn romance or hated for making him similar to a Dirty Old Man who abuses his position to get Casey.
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    • Dr. Jackie Varma is either viewed as a Glory Hound who wants to get ahead, or someone who is showing Casey how to stand up for themselves. She becomes more divisive after Casey decides to enter the competition. She initially states that she won't take the competition personally, but later starts to treat Casey differently after she drops in the rankings, which turned many readers against her either as a romantic interest or a friend. Her supporters, on the other hand, pointed out that it's not her job to help her fellow competitors. She won back a lot of support when she agreed without hesitation to participate in Casey's plan to help Mrs. Martinez, and then backed them up when they confronted Landry about sabotaging them in the competition and snitching on them to Mrs. Martinez's family, stating that she'd rather win the competition fair and square than resort to cheating.
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    • Dr. Aurora Emery is either liked for her intriguing desire to step out of her aunt's shadow and strictly professional behavior towards both patients and co-workers or disliked for her cold, aloof behavior towards her co-workers, particularly Casey, and favoring "interesting" cases.
      • Chapter 4 is a controversial moment for her. While everyone agrees that her dismissal of Dolores’ case was unacceptable, given that Dolores was a pregnant woman admitted for “smoke inhalation” and later died from childbirth, the real debate comes from her character and the context surrounding her actions and motivations, especially after it's revealed that her dismissal is part of her plan to no longer be on the top of the list. While a few people think she crossed the Moral Event Horizon, many people view this as proof that she needs Character Development, given her complex motivations and interactions with her aunt, co-workers, and patients, while continuing to characterize her as initially aloof, as they've noted her softness towards Annie and Tommy Liu. They also express their anger at being forced to hate her.
    • Rafael Aveiro. One side sees him as a selfless hero who easily gets along with others and is willing to risk his life to save lives even when he's not in the position to do so. Another side sees him as a reckless idiot who needlessly wastes hospital resources, such as using a paramedic plane for a joyride if the premium option to fly with him is chosen and disregarding safety protocols during the train derailment accident.
    • Even Casey is subject to this during the situation with Mrs. Martinez. Their supporters praise them for being a dedicated intern who cares for their patients, courage and perseverance in the midst of despair-inducing moments, and standing up to a Corrupt Corporate Executive. Their detractors condemn them as a Designated Hero and think their license should have been revoked for reckless and entitled behavior, deluding themselves into thinking they're serving their patients' best interests, stealing a medication with a mortality rate, administering it without documenting it, and not informing their senior residents or attending.
  • Broken Base:
    • As a profession-based story, the ability to choose Casey's gender has sparked some debate. Some players believe Casey should've been exclusively female because women have a tougher time in the medical field, like with most professions, compared to men, such as underappreciation and being taken advantage of by men. It would also make certain moments in the plot involving white men more emotional, such as Casey's relationship with Ethan that can cause people to question Casey's credibility even more and Landry sabotaging Casey. Other players think the story is already fine with gender options because they point out that men also suffer from discrimination inside the medical environment, like male nurses or LGBT doctors, and genderlocking the book would have been pointless and sexist towards players who want to play as a male protagonist.
    • Players are split on Casey's Ship Tease with Kyra Santana until Chapter 11, when a premium scene where the gang goes skydiving pretty much revealed that she is not a love interestnote . One group approves of this and express their disappointment that she's not an official love interest because they find it refreshing to encounter a cancer patient with a cheerful and optimistic outlook on life. Another group disapproves of this because they think it's unethical for a doctor to pursue a relationship with a patient.
    • Similar to the above case, people are split on whether or not Aurora Emery should be a love interest in Book 2. One group thinks she should be because she stood up for Casey receiving an unfair treatment from Declan Nash as well as the potential of her becoming the gang's new roommate after Landry moves out. Another group is against the idea because they simply dislike her antagonistic attitude towards Casey throughout the first half of Book 1. At the very least, people can agree that her rooming with the gang should be a choice and nobody should be forced to live with her.
  • Catharsis Factor:
    • The premium choice to help Sienna break up with Wayne is this, primarily because of his dismissal of her job as a doctor and selfishly demanding that she cater to him even after she just saved patients from a subway crash.
    • Chapter 15 has Casey pointing out to Aurora that despite her own issues with her family name and how others try to suck up to her, she has been pushing people away, including Casey when she could've given them a chance. This happens regardless of whether the player chooses to console her or tell her off. Players felt that this is the issue that needs to be addressed to Aurora as part of her storyline.
    • Chapter 17 has Casey being able to give Declan Nash a punch in the face after their hearing.
  • Crowning Moment of Awesome:
    • The premium choice in Chapter 14 for both Casey and Sienna to lay a "The Reason You Suck" Speech to Wayne as she finally breaks up with him.
    • The very free choice in Chapter 17 to punch Declan Nash in the face after the hearing.
  • Die for Our Ship: Harper Emery often receives this from players pursuing Ethan as a love interest since it was revealed that they were in a relationship. They assume Harper is trying to steal Ethan from Casey by having them fired from Edenbrook.
  • Ensemble Dark Horse:
    • Dr. Sienna Trinh already has several fans for rescuing Casey from Dr. Ramsey's scolding, standing up to a rude frat boy at a bar, and suggesting that her, Casey, Jackie, Landry, and Elijah all rent an apartment together after they bemoan their current living conditions. A number of players were openly disappointed by the revelation that she has a boyfriend, seemingly indicating that she will not be a love interest. Even more so with the Ship Tease between her and a nurse named Danny.
    • Kyra Santana instantly gained fans upon her introduction, both for her cheerfulness and determination in the face of being treated for cancer, as well as her beauty and flirty personality. She gained even more admirers for her determination to go through chemotherapy so she could have a chance to live.
    • Despite their minimal screentime, the fanbase absolutely adore Dr. Zaid Mirani and Ines Delarosa for their dynamic together and concern for the interns.
    • Dr. Elijah Greene is popular among players for his witty comments, friendliness, loyalty to his friends, and dedication to saving lives previously thought hopeless.
  • Fan-Preferred Couple:
    • Zaid/Ines is universally supported by the fandom due to their individual popularity and interaction together when they counsel Casey regarding Mrs. Martinez's situation and when they celebrate after Casey wins their ethics hearing.
    • Fans have been very vocal about wanting to romance Aurora, Elijah, Sienna, and (after the reveal that she is not a Love Interest) Kyra.
  • Memetic Mutation:
    • Before the story premiered, many fans were making jokes along the lines of "Well I guess all my patients are going to die because I'm not going to spend diamonds to save them," referring to Choices' tendency to put favorable outcomes behind paywalls (and other Choices stories have forced the player to spend diamonds to save someone's life). The jokes gradually died down once it became apparent that saving lives was not going to be paywalled.
    • “Dr. (Name). I like the sound of that.” It involves people abusing the Hello, [Insert Name Here] feature and giving their character names of other famous or fictional doctors or scientists, such as Dr. Pepper, Frankenstein, Doom, Feelgood, and Heinz Doofenshmirtz.
    • "Dr. Ramsey has no diamonds." - The joke is mostly about how the romantic moment between Casey and Dr. Ramsey seems to be separated from the rest of your friends, as well as the fact that his romance proceeds much more slowly than the other Love Interests even when you pick the Premium scenes, which led many to the conclusion that he has no Diamonds to spend time with Casey.
  • Moral Event Horizon: Landry crosses this by sabotaging Casey's pager and messing with their charts out of petty jealousy, disrupting their ability to treat patients in the process.
  • Narm: Avid Choices players have noted that the Patient of the Week gets very distracting because many of the portraits are recycled from other stories, even from stories that are still updating (like Willow having Yvette’s face despite AME All-Stars still ongoing when Willow appeared).
  • The Scrappy:
    • Sienna’s boyfriend Wayne instantly became hated due to his condescending and dismissive attitude towards his girlfriend and her co-workers, refusing to acknowledge that doctors have stressful and demanding jobs. Many chose the premium option to help Sienna break up with him, as it allowed them to blow off steam at his callous attitude.
    • Landry Olsen quickly became hated after the reveal that he sabotaged Casey's job as an intern by turning off their pager, hiding their charts, and spreading malicious rumors about them, all because he was jealous of Casey getting to spend time with Ethan. Even more so when he didn't apologize for his actions. Many players are glad he got Put on a Bus at the Book 1 finale.
  • Scrappy Mechanic: The 3:1 ratio of male to female love interests has been heavily criticized, especially since the book is not gender-locked.
  • Strawman Has a Point: Harper Emery may be a huge stickler for the rules, but she has a point that having Ethan testify on Casey's behalf isn't a smart move because of his bias in Casey's favor, and biased witnesses have clouded judgements that weaken their reasoning and credibility.
  • Tear Jerker:
    • Dolores Hudson dying in childbirth, leaving her son, Ethan, without either of his parents. Many agree that it's one of the saddest scenes, if not the saddest, in all of the Choices stories.
    • Mrs. Martinez dying a week after receiving an experimental treatment for her condition.
  • They Wasted a Perfectly Good Character:
  • Unintentionally Unsympathetic: In Chapter 15, Aurora expresses her frustration at everyone trying to use her because of her connection to Harper Emery, as a means to give her character more depth. However, Casey can call her out on her attitude, because the treatment she gets is not a justification to push other people away through her antisocial and overly guarded behavior, including towards people who might even want to be genuinely friendly with her.
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