PROLOGUE: JUNE 1987

I am a very old woman now. My great-grandchildren—who call me Docky, a name my youngest patients gave me years ago—ask me to tell them stories, and I make up tales about talking pigs with pink hair ribbons on their curly tails, or monkeys who wear vests and carry canes. I am as good at foolishness as I once was in the operating room.

If I tried to tell them this story, the one I am about to set down here, their parents would send me warning looks over the heads of the children. Don't, the looks would say. Stop.

Meaning, too depressing. Too complicated. Too long ago.

So when they come to me—young Austin, named for his great-grandfather; the twins, Sam and Zoe; merry-eyed Lily, adopted from China; and solemn Katharine, who has my name but insists on it whole, never Katy, as I once was, or Kate, as I am now—when they come and ask me to tell them stories, I never tell them this one.

It is not really a story for children, though it is about a child.

But someday one of them will point from a car window toward a huge stone building with boarded windows set in an empty, unlandscaped field at the west side of town and ask, "What's that?" Perhaps they will see, through untrimmed ivy on the stone wall surrounding the field, the carved word in the post to which an iron gate, long gone, was once attached. ASYLUM. A strange word, and a great-grandchild will likely mispronounce it at first, as I remember I did when I was learning to read.

"What's that?What was it for?"

I will write it down here, and this is what they will read, as an answer.

But where to begin?

I will begin with myself. Katy Thatcher. Here I am, thirteen, wearing a sailor dress in this old photograph, looking solemn (but proud, too; the dress was a new one, and I felt grown up). I was, I think, a solemn girl: Henry and Caroline Thatcher's oldest child, and for eight years their only.

Our house on Orchard Street was large, and to the side of the big shingled house, its entrance approached from a pebbled walk through the yard (the walk was between oak trees, and Levi, the stable boy who tended the horses and did odd jobs, spent many days in fall raking it bare), was my father's office. A small sign at the side gate read Henry Thatcher, M.D. From my bedroom window above the porch roof, I could see patients unlatch the gate and make their way to that door, bringing their babies, their arthritis, their small aches and larger sufferings, to my father.

By thirteen I already knew that I wanted to be a doctor, too. I read accounts in the news of the war that was raging in Europe, and I could not wrap my mind around the reasons for it or the terrible logistics of battles far away. I listened to my parents talking to their friends, our next-door neighbors, Mr. and Mrs. Bishop, as they fretted over their oldest boy, Paul, who was just finishing Princeton then and should have been looking ahead to law school and to joining his father's firm one day. But Paul was already yearning to enlist in a war that had not yet, in 1915, begun to take American boys.

But at thirteen, when I read the war news, I thought only of the wounded and how if I were a doctor I could set their bones and heal their burns. I had watched my father do so many times.

I was not yet four when San Francisco toppled in an earthquake and burned. Even so young, I heard talk of it.

At eight, I had heard of the terrible fire in New York, of the factory girls, scores of them, leaping from the windows, their clothes aflame, and dying, burned and mangled, on the sidewalk while people watched in horror. My mother had said "Shhh" to Father when she saw me listening, but he, seeing that my interest was real and not just a child's curiosity, spoke to me of it later. Though I was still a child, we talked of the ways in which death comes, and how perhaps, not always, but sometimes, a doctor could push death away, could hold it back, or at the very least make it come easily.

By thirteen, by the time I had the sailor dress of which I was so proud, many of those moments were past. San Francisco had been rebuilt. The Triangle Shirtwaist Company fire had brought about new laws to protect factory workers.

And on the edge of town, when I was thirteen, stood the stone building called the Asylum. It still stands there today, though newspaper editorials call it the Eyesore in an attempt at wit, and there is talk of tearing it down to make room for a housing development. Its windows are boarded over now, and the grounds are littered with debris. Sometimes, in my growing-up years, when Austin was my beau, we would walk out that way, holding hands. Sometimes I found myself glancing at the ground, wondering if I would spot the gleam and flicker of a cat's-eye marble dropped by a boy. I wondered, then, as I still do, about the boy who had once given me a kitten and changed my life forever. His name was Jacob Stoltz.

His is the story I mean to write down now.

1. SEPTEMBER 1908

My friend Austin Bishop lived next door and was to be invited to my sixth birthday party the next month. Austin was already six and said that he could read. I thought it was true because he showed me a book with a story in it and told me the story—it was about a mouse—and then he told me the story again, and the words were exactly the same. Reading, I knew, was what made the words always, always be the same.

Jessie Wood was to come to my party, too, and had told me a secret, that she was bringing me a tea set with pink flowers as a birthday present. She had promised her mother that she would not tell. A promise was a very important, very grownup thing, and if I promised not to tell something, I would never ever tell. But Jessie was often naughty. She disobeyed. She told me that the pink flowers were roses and the tea set was real china.

Austin's brother, Paul, was not invited because he was too big. Paul was almost fifteen years old and had his own desk, many pencils, and a book with maps. He had a pocketknife that was very sharp and we were not to touch it, ever. He tried to smoke his father's pipe but he was too young, and it made him sick. We saw him being sick out by the barn. It was yellow and splattered on his shoes.

Austin's father was named Mr. Bishop, and he was a lawyer, but at home he spent a lot of time out in the barn, pounding and sawing. He liked tools and steam engines and wheels and anything that moved its parts and made noise. Sometimes he said he wished he could be a train engineer. During the summer, when Austin's birthday was coming, Mr. Bishop and Paul worked many days out in the barn. It was a secret. No one could peek. They made a lot of noise, and it was a surprise for Austin's birthday.

My mother said, when she saw what they had made, that it was a mazing. I had never seen a mazing before. It had wheels, but it was not a velocipede. Everyone had a velocipede, even me. I was allowed to ride mine to the mailbox, but then I was always to turn around and come back.

Austin could sit in his mazing. He pushed with his feet on the pedals and he traveled down the walk. I supposed he could go to town in the mazing if he wished. Perhaps he could go to his father's office. Or to the library, or Whittaker's Dry Goods! A mazing could go anywhere.

I hoped that someone was building me a mazing for my birthday, but I didn't think that anyone was because there was no noise coming from the Bishops' barn or from our stable, except the plain old noise of the horses snorting and stamping their feet as Levi cleaned their stalls.

Our horses were named Jed and Dahlia, and they were brown but their manes and tails were black. Our cook was named Naomi, and she was also brown. Everything has a color, I remember thinking. I could not think of a single thing that had no color, except the water in my bath. You could see through water, I realized—could see your own hand when you tried to hold water in it, but then it ran away, right through your fingers, no matter how hard you tried to keep it there.

Austin had one more thing besides the mazing, onemorethingthatIwishedIhad.Hehadababy sister! She had horrid black hair and cried a lot and her name was Laura Paisley Bishop.

How they got Laura Paisley was very, very interesting to me. Austin's Nana took him on the train to Philadelphia for a whole day. How I wished my grandmother would do that for me! My own Gram lived in Cincinnati and came by train in the summers to visit, but she never took me with her on the train. Austin said it was noisy and clattery and you could look through the windows and see trees go by as fast as anything. Sometimes, when the train was going around a curve, you could look ahead and see the engine and know that you were part of it, still attached. It was hard to imagine.

They rode to Philadelphia and went to a museum, where they saw stuffed creatures, like bears, posing as if they were alive, and then they had lunch in a restaurant, with strawberry ice cream for dessert. Then they went back to the train station and came all the way home on the train again. When they arrived at our town, Austin's Nana used the telephone at the railroad station to call his home and see if anything exciting had happened while they were away.

"My goodness!" she said to Austin, then. "There will be quite a surprise at your house when we get there."

So they walked all the way home from the station, and when they got to Austin's house, he saw the surprise. It was a baby sister!

They had found her out in the garden. That's what they told Austin: that his mother had gone outside to pick some tomatoes for lunch, and when she looked down, she saw a lovely baby girl there.

"Fibber!" I said to Austin.

I did not believe him because I had been playing in my own backyard almost all day, and never once heard a baby, and did not see Mrs. Bishop go out with her tomato basket at all. In fact, my mother had told me to play quietly because Mrs. Bishop had a headache and was lying down most of the day.

So I called Austin a fibber and he was angry and threw some dirt at me and said I could never hold his baby. But I asked my mother later and she said it was true that Mrs. Bishop had found the baby in the garden. Mother said that she hoped someday we would find one in ours.

So I decided I would look carefully each day. But it seemed a very strange thing, that babies appeared in gardens, because it might be raining. Or it might even be winter! I hoped that the babies were bundled up in thick blankets then!

I had to apologize to Austin for calling him a fibber. His big brother, Paul, was there when I did, and Paul laughed and said I shouldn't bother. Paul said I was the smartest child on the street. (It was not true, because I couldn't read yet, no matter how I tried.) But his mother, who was sitting in a rocking chair holding Laura Paisley, said, "Shhhhh," so Paul shushed and went away and slammed the screen door behind him, which startled the baby, so that her eyes opened wide for a second and then closed again.

I hoped her hair would improve because it really was horrid to look at. It was exactly like Jed and Dahlia's manes.

2. SEPTEMBER 1910

Father took me with him to the country to get the new hired girl. It was a Sunday afternoon in late September; I had just started second grade, and I would very soon be eight. My teacher's name was Miss Dunbar, and I loved her desperately, but the stories that we read in the classroom, filled with children who were helpful and kind and had very nice clothes, didn't hold my interest. I wanted to know more about people who needed things. My mother, sympathetic with my impatience, had been reading books to me at home. I had loved listening to Little Women because of the missing father, the shortness of money, and the death of Beth, which I felt quite certain Father could have prevented if he had only been called in soon enough.