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It makes a little more sense with context. lol. Sarah was fisting herself, partially because she has a size queen fetish but mostly because she wants to be with her sister Carol again despite swearing off the relationship years ago and feel guilty about it and this was a manifestation of that. But like you said it's a deliberately fucked up image to show how screwed up Sarah's headspace is at that moment.
It's the same with writing more edgy characters. Having a character in a book describe in detail how much they hate everything and image how they'll kill people around them, is nowhere near as scary as a normal enough person having a normal conversation and then suddenly snapping and attacking someone without warning.
That's why I was laughing a little. 4 years at the very least, more like 8 just to be a highschool teacher. Don't know how this country has nearly as many teachers as it does.
Don't even get me started on surgeons or some of the more specialized doctors. It's like twelve or fifteen years if you count the residency. No wonder that profession has some of the highest number of seventy and above year old's working in it. Takes that long to pay off the student loans.
Well a surgeon is literally cutting you open, you would hope they know what they are doing. lol. But yeah the amount of schooling's insane. I remember when I was in high school thinking about becoming a nurse and that's what really turned me off of it.
Reminds me of a idea Hitler had in Mein Kampf that actually sounded pretty good to me, and that was instead of the 4 years of schooling to get the certificates to start your residency, it would instead be more like an apprenticeship program with the junior doctors taking some of the role and responsibilities of nurses as they are learning to see if they can handle being a doctor.
Before they've invested all this time in it and to see if they have the right temperament to even be a doctor. Since it goes without saying, that's a very stressful job.
During high school, I had an English teacher who showed us bits of it while we were reading Anne Frank's diary. We basically had these big projects each semester where we would read as a class together these different historical books and we would have side projects that went along with it, one of those being the afro mentioned discussion on Mein Kampf and its history.