The protagonist of the novel is Civil Townsend, 23 years old and 66 years old, respectively, in the novel’s two timelines. She is the narrator—using first-person past tense in the chapters from 1973 and first-person present tense in the chapters from 2016. She often uses second-person address, as the text speaks directly to her daughter Anne. Civil’s narrative voices in the present and the past are similar until the end of the novel when Civil finds peace.

In the early years, Civil is a newly graduated nurse and works at a community health clinic that primarily serves poor Black women and their families. The older Civil is a practicing OB/GYN, who can make a difference in her patients’ lives.

Civil’s character arc involves becoming aware of her privilege and then learning to use that privilege in a way that does not place her in a savior role. At first, she does not understand her fellow nurses’ fear of losing their jobs, and that she takes for granted the multitude of choices she enjoys with parents and family friends who are successful, educated professionals. By the end of the novel, she realizes that the privilege she enjoys does not make her different from or better than those she wants to help.