Content Warning: This summary contains depictions of racially motivated prejudice and forced sterilization.

In Memphis, Tennessee, in 2016, 67-year-old Civil Townsend recounts her experiences from 1973 as a nurse in Montgomery, Alabama, to her 23-year-old adopted daughter, Anne, who has just graduated from college. She narrates in the first-person present tense.

Civil hopes Anne will gain a greater understanding of why Civil never married or gave birth and what led her to adopt Anne. She is “telling it in order to lay these ghosts to rest” (3).

The novel switches time and location to Montgomery, Alabama, in 1973 as Civil begins telling her story, using first-person past tense. Civil is 23 years old and has just landed her first nursing job at a family planning clinic where she works with seven other nurses. Their supervisor, Mrs. Seager, is strict and sees everything. She is white, the nurses are all Black, and the clinic primarily serves poor Black women.

The nurses only have one week of training, but they feel ready. Civil meets and talks with Alicia, who becomes her best friend and confidante. She and Alicia compare cases: Civil is to give birth control shots to 11- and 13-year-old sisters, India and Erica Williams.