This was a beautifully written book that was heartbreaking in some moments, hard to read in others, and poignant throughout.
I was under the impression that this was nonfiction but it's actually fiction. I read it as more of a lyric essay with some parts prose, other parts poetry, and parts that still feel very true even after knowing some parts are fictional. All of these parts were connected through a process that seemed to appear on paper even when I know that the words only sound the way they do through a lot of editing.
This is essentially an exploration of identity, of an intense parent-child relationship, of the opioid epidemic through the eyes of someone who's friends keep dying, and of an ever present grief caused by trauma from wars of multiple varieties. Ocean Vuong does these explorations well by reflecting in a way that feels true. 
The reason why this book falls just short of a 4 for me is hard to explain except it's probably mostly because of the end. The very end started to feel... looser to me than the rest of the book. The connections not as clear to me, the meaning of the table metaphor (was it a metaphor?) just out of reach, and the ending lines not clicking with me. This might've just been me - maybe if I read this again down the line I'd understand that part better. There were also parts of this that were hard to read. This isn't necessarily what made it not a 4 stars or above because these parts felt necessary, no matter how painful or cringe worthy. It's just worth noting to check triggers if you need to.
Overall this was a well written book that wants to make you think about important aspects of the American experience that many hate to acknowledge exists and Vuong succeeds in this mission.