READERS GUIDE

Questions and Topics for Discussion

1. Each sister responds differently to the pressures of their upbringing. Which sister did you relate to most, and why?

2. What other books, movies, and TV shows does this novel remind you of?

3. Mercy Hill functions almost like a fifth sister in the novel. How does growing up on the hospital grounds shape each of the Cross sisters differently?

4. Lisa Cross is both a devoted doctor and a formidable mother. Did you view her more as a hero, a villain, or something in between? How did your perception of her evolve over the course of the book?

5. The sisters start out with a shared mission: to save Mercy Hill. How does that sense of duty unite them—and how does it divide them?

6. How does Denise’s position as the youngest sister influence the way she tells the story?

7. The novel is set during a period when many state mental hospitals were closing. How does the broader crisis in American mental healthcare mirror what’s happening within the Cross family?

8. The sisters grow up surrounded by patients in crisis. How does that proximity to mental illness shape their understanding of “normalcy,” safety, and responsibility?

9. Looking at the novel through a modern lens, how does Mercy Hill’s struggle compare to today’s mental health crisis in the United States—particularly around underfunded services, overcrowding, and the lack of long-term care options?