After Sylvia helps deliver her first baby as an apprentice midwife, Meda, the mother, leaves believing the baby died at the request of the father, her wealthy, white employer. Meda tends to her grief by volunteering at an orphanage, where she takes on the care of two babies and helps raise them. Sylvia assuages her guilt by throwing herself into nursing, obtaining a post at Lazaretto, the first quarantine hospital in the U.S. Though from different socio-economic levels, Sylvia and Meda’s lives brush upon each other slightly throughout the years, though both women are unaware. A wedding party composed of black employees at the Lazaretto is quarantined due to a yellow fever scare. Sylvia must take charge of the ensuing chaos of racial terrorism upon the group on the boat over to the island and deal with white policemen whose purpose is unknown, but who are also quarantined with the wedding party. Meda’s boys end up in the middle and learn the truth of their mother.

McKinney-Whetstone deftly portrays the precarious position of characters in a society that considers them invisible at best, and how they must carefully balance dignity with always a thought toward self-preservation. Though the characters hold their integrity through actions, the dialogue alternates between formal, stiff language without contractions and colloquial dialect, seemingly randomly, and can be distracting from the story. Systemic racism is nearly its own character in the tale, as even refined, strong-willed Sylvia deems it important to pamper the stranded detectives based on their color. Readers of historical fiction, lovers of secrets, and fans of flawed, complex characters will appreciate this novel.