Carol Efron is a physician and writer. She earned her MD from Johns Hopkins and served on the faculty at Johns Hopkins and Stanford before building a thriving private practice in Silicon Valley. Her medical research—much of it on Huntington’s disease—has been published in leading journals. Witnessing the dilemmas posed by genetic testing inspired the questions at the heart of her debut novel. Efron has spent the past decade studying fiction craft, leading a writers’ critique group, and running a fifteen-year book club. She currently resides in Menlo Park, California.

Baltimore, 1986. Julia and Matt are newlyweds, in love and eager to begin graduate school. Julia longs to leave behind haunting memories of her mother’s devastating decline in Maryland, but she unexpectedly learns the truth her father has hidden: Her mother died of a fatal genetic illness. Julia now faces a 50 percent chance of inheriting the same fate, and every child she longs to have will carry the same risk.

When an unplanned pregnancy rocks their careful plans, Julia and Matt face agonizing uncertainty and impossible choices. Desires and convictions pull them toward starkly different paths, each possibly leading to misery.

As the couple struggles to protect the fragile, fierce love that first bound them together, they face the cost of secrets and the ache of betrayal—but they also discover the hope of forgiveness.