The Second Life of Mirielle West is a work of historical fiction by American author Amanda Skenandore set at what was initially named the “Louisiana Leper Home” in Carville, Louisiana. Carville lasted from 1894 into the 1970s and was a completely quarantined community. Skenandore uses her knowledge as a registered nurse along with research about Carville to explore the medical challenges and social stigma that accompanied the disease of leprosy for most of the 20th century. Set in the “Roaring 20s,” the novel contrasts protagonist Mirielle West’s glamourous Hollywood life with the isolation she faces as a leprosy patient at Carville. Skenandore is the author of three additional historical fiction novels, including Between Earth and Sky (2013), which was awarded the Reading List Award for Best Historical Fiction by the American Library Association.

This guide is based on the 2021 paperback edition by Kensington Publishing Corporation.

Content Warning: At times, the guide cites terms—such as “leper”—that are considered offensive to those infected with leprosy, also known as Hansen’s disease. This guide also contains references to death by suicide.

Plot Summary

Mirielle West, wife of silent film star Charlie West, is examined by a doctor after burning her hand on a hair-curling iron. Lesions on Mirielle’s skin concern the doctor, and Mirielle is diagnosed with leprosy. She is then sent to Carville, a quarantined facility for patients affected by leprosy in Louisiana. At first, Mirielle, who is wealthy and enjoying a prominent social life, denies the diagnosis because she sees herself above the other patients, who come from lower socioeconomic backgrounds. When testing at the leprosy facility confirms the LA dermatologist’s findings, however, Mirielle is required to spend a year there. She will undergo a skin test each month to test for the bacteria that causes the disease. After 12 consecutive negative tests, she will be discharged home to Los Angeles.

Mirielle is appalled to be living among other patients, whom she fears are contagious and with whom she has no desire to associate. Within the first few days, she speaks with a patient named Samuel Hatch, who explains how she can escape through a gap in the barbed wire fence. Hearing this, Mirielle packs three suitcases and prepares to leave. Upon failing to locate the gap, she attempts to climb the fence, which results in her breaking an arm and being captured. Afterward, Mirielle is forced to reside in Carville’s jail. As her tenure begins, she is advised by the facility’s head physician, Dr. Ross, to take on a job so she can become part of the community. Mirielle has never worked in the past and has little desire to do so, but she recalls a letter she received from Charlie in which he accused her of having little drive. Dr. Ross informs her that research is being conducted at Carville to cure the disease, and this intrigues Mirielle. Certain that she can be instrumental in the endeavor and determined to prove her husband wrong, Mirielle takes Dr. Ross’s advice.

Mirielle is assigned to a rotation that includes the ladies’ infirmary, the pharmacy, and the shot clinic. Frustrated by the menial tasks and unconvinced that they will help find a cure, Mirielle works halfheartedly. She is under the supervision of Sister Verena, the facility’s head nurse, whose no-nonsense approach to her job often conflicts with Mirielle’s lackadaisical attitude. However, Mirielle is determined to rid herself of the disease so that she may return home to her daughters and husband. This goal motivates her, and she soon becomes a skilled, reliable worker.

In the months that follow, Mirielle develops friendships with several other patients: She becomes closest to Irene, the head orderly of house 18, where they both reside; Jean, a nine-year-old girl whose family abandoned her; and Frank, a jovial Louisiana native whose hands have been physically affected by the disease. She becomes active in the What Cheer Club, an organization that organizes holiday parties and sponsors social events at Carville. Mirielle finds her work and social life fulfilling, however, she remains focused on being discharged from Carville and returning to her old life. She participates in the fever trial, an experimental treatment, but it is stopped due to its negative effects on one of the patients.

Despite her intention to return home, Mirielle’s relationship with her husband declines. The accidental death of their son, Felix, and Mirielle’s subsequent depression and alcohol misuse have strained their marriage; meanwhile, the family nanny has become a replacement mother for Mirielle’s two daughters, Evie and Helen. These challenges, coupled with the gossip about Mirielle’s whereabouts in a Hollywood tabloid, create tensions that Mirielle must reconcile. All the while, sadness and guilt concerning her son’s accidental death plague her.

Mirielle finds herself growing closer to Frank, despite her initial disdain for his rough mannerisms and her horror at how leprosy has physically affected his hands. Ultimately, Frank fills the absence left by Charlie, comforting Mirielle in times of distress, such as after Irene’s death by suicide. Their friendship proves a rocky one, however, as Mirielle and Frank’s differing approaches to life with the disease cause friction.

The novel’s turning point comes when Mirielle, after a string of negative skin tests, receives a positive test. This means she must spend at least another year at Carville, and her optimism for conquering the disease is crushed. Mirielle takes to her bed, angrily turning away everyone—even Jean—who tries to rally her. Eventually, Sister Verena goads Mirielle into returning to her activities at Carville. Mirielle does so, just in time to learn that Helen has been hospitalized with scarlet fever and that Jean has run away.

Adamant that she must go to her daughter, Mirielle escapes with assistance from Sister Verena. Mirielle realizes that she can infect her daughters and subject them to the disease’s stigma, so, at a train station, she decides to search for Jean instead.

Mirielle’s search of the area around Jean’s hometown is not easy. She relies on what little information she knows of Jean’s father—that he works as a boatwright—to lead her search. Mirielle is saddened to learn that he sent Jean away when she returned home, desperate to spare his business from stigma and protect Jean’s half-siblings from infection. Mirielle’s search ends when she finds a weak and feverish Jean, hiding among crates at a shipyard. Mirielle cares for Jean as the two journey back to Carville.

Along the way, Mirielle contacts Charlie, who lets her know that Helen has recovered. He hints about a decision he’s made and has written to Mirielle about in a letter, stressing that he does not hold Mirielle responsible for their son’s death. Mirielle presumes correctly that Charlie wants to divorce her. Finally, she and Jean arrive at the train station, expecting Sister Verena to have received Mirielle’s message and be waiting for them, but a storm has delayed her. Frank is there instead and takes them back as the residents from nearby towns are evacuating in anticipation of a flood.

Back at Carville, Jean is given the treatment she needs, and the facility prepares for evacuation. Mirielle and Frank lead the process, alerting the residents and helping them board a river barge. Luckily, Carville is spared from the storm, and Jean slowly regains her health.

The novel’s Epilogue is set more than 10 years after the flood. Mirielle continues to work alongside the nurses at Carville, having married Frank. Certain that she will never return to California, she thrives in the meaningful life she has carved out there. The novel ends as her grown daughters visit Mirielle for the first time.