The unborn child
Smarsh discusses an unborn child which becomes a symbol for the missed opportunities that she wasn't able to have in life because of her circumstances. This missed opportunity is a weighty burden in her emotions, because she struggles to overcome those feelings of disappointment, embarrassment, and panic. She feels that her life could have been more important than it was, but that dilemma isn't an easy problem to solve. The child is a symbol for her existential confusion and dread.
Kansas as a symbol
To Smarsh, Kansas is a place where dreams go to die. She knows it isn't like that for everyone; in the city there are rich people who live in a completely different kind of Kansas from hers, but she doesn't have those advantages. She is lonely, living on a big farm in the middle of nowhere with only her family around her (which is often a challenge of its own), and there isn't a lot of options for her to escape. She feels trapped in the purgatory of Kansas.
The father's poisoning
The father once was poisoned, we learn, and although this comes as a situational circumstance in her real life, it is still symbolic. Firstly, it belongs to the motif that defines her father's life. Her father often toxifies himself in other ways, usually with strong drink. Also, the poisoning represents the father's mortality, and it symbolizes the ways that their station in life makes them more subject to random harm. Life is dangerous for this family.
Industrial accidents
The industrial accidents are a bitter reminder that many people don't escape the life they are handed in rural Kansas. Some people die farming, so to speak. These industrial accidents are also evidence that there are systemic issues around healthcare, because they were much less likely to survive once injured—they are very far from help. The injuries and accidents are horrifying reminders that everything is not quaint and easy in agricultural midlands.
Poverty and welfare
Toward the end of the story, Smarsh decides to explore what this memoir means to her. She takes a stance on welfare, explaining that although people with money and social mobility may not understand it or see it, many families are on welfare because they are trapped in poverty. Those people might not be obvious, so it is easy to get a wrong idea about welfare. She explains how the government's assistance helped her family in a way that was not exploitative.
