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Eighteen-year-old Lillian Dolan takes a job as a nursing assistant at the New York Cancer Hospital. Determined to make a better life for herself and her younger sister, Marie, who’s sightless and has a cognitive disorder due to the effects of scarlet fever, Lillian aims to prove that she has “a stomach built for nursing,” and she does her best to absorb all she can from her colleagues at the hospital so that she may one day become a nurse herself. But Lillian soon learns that the medical field is rife with questionable ethics, and she even finds herself rethinking her definitions of good and evil. When Lillian takes responsibility for the care of Mrs. Sokolova, a strong-willed Russian immigrant, she must confront a monumental moral challenge that could change her life forever. Along the way, a trio of supporting characters help Lillian grapple with the demands of her job and broaden the straight, White woman’s worldview: Michael Dolan, her caring and generous gay cousin; Jupiter Scott, an earnest Black crematorium worker; and Josephine, a witty lesbian sex worker. Mayo’s novel not only offers a close look at health care at the turn of the 20th century, but also addresses the racial, class, and sexual tensions that existed alongside strict, bigoted Victorian-era standards of morality. Mayo brings her characters and settings to life with deft prose and careful research. Her descriptions of the crowded streets of New York are visceral and authentic; for example, during Lillian’s commute to the hospital, she weaves through throngs of people with “hats, bobbing like corks in the sea. Derbys, Hombergs and flat caps of drab colors mixed with women’s bonnets.” Descriptions of medical procedures are graphic yet graceful; during a surgical procedure, for instance, Lilian observes the “terrain” of “blue veins and yellow clumps of fat and bulges of white and lavender, hills and valleys and rivers.”

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