But for Fortune follows a Kentucky medical student whose search for the truth about her institutionalized grandmother exposes the betrayals, medical injustices, and enduring music that bind their lives across generations. What was the inspiration for the setup of your story?

The story stems from my own experience as a medical student doing a month-long psychiatry rotation at Eastern State Hospital, where my grandmother had been a patient from the 1950s-1990s. Like Corinth in the novel, I couldn’t help but wonder what life had been like for my grandmother in that place, and I was struck by the coincidence that both my grandmother and I had arrived at the same place at roughly the same age, but for very different reasons.

Though the story is rooted in a real-life experience, I feel more adept at finding truth through fiction rather than nonfiction. When writing, I am more comfortable making up a story than sticking to a story, so choosing to write a novel with fictional characters in fictional situations was straightforward.

How did you balance the clinical realities of depression and medical hierarchy with the novel’s more lyrical elements, particularly music, nature, and faith?

As a physician and a writer, the clinical and the lyrical are a daily reality and are equally important to me. In fact, I relish moments when I can blend the two rather than hold them in counterbalance. I see beauty in physiology and anatomy and metaphor in disease. Nature is aesthetically beautiful, but also innately scientific. Music is not only an essential form of human expression but also relies on concepts found in math and physics, and faith, whether its faith in a higher power or faith in a shared humanity, is simply a fact of being human. To me, it’s the yin and yang between the clinical and lyrical that breed interest and complexity and lead me to explore a character’s motivations and experiences on a deeper level.

Mary Esther uses numbers, trees, piano music, and scripture to make sense of her world. How did you develop these recurring motifs as expressions of her interior life?

Mary Esther’s character is based on my own grandmother. Unfortunately, I only know snippets of my grandmother’s past. By the time I was born, her brain had been addled by years of institutionalization and outdated psychiatric drugs and treatments. She was unable to tell me about herself. That lack of knowledge gave me a lot of freedom to create the character of Mary Esther without being tempted to include too much of my non-fictional grandmother in the character. However, there are a few things I knew about my grandmother that I wanted to include as a way to honor her history. She played piano and she was an excellent student (hence the fascination with numbers). She was also devout in her faith, and, I imagine when she was well, my grandmother would have recited scripture from memory as Mary Esther does throughout the book.

Trees act as characters in the novel: They’re studied, they’re revered, and, in some instances, they speak. My admiration for trees made their inclusion in the story a natural, unquestioned choice. Trees fascinate me. They offer shelter, shade, and food. They are beautiful to look at, from exposed roots to the ragged bark of their trunks to their variegated leaves and flowering blooms. They are also wise. I like to imagine all that a towering, aged tree has witnessed, what it could tell me if it spoke in a language I understood.

What do you hope readers will reconsider about inherited trauma, family silence, and the act of witnessing after finishing your book?

My novel centers honesty as a virtue. Honesty is necessary. Honesty leads to understanding. It fosters empathy. When we inherit and then perpetuate secrets, we only limit the ability to process traumatic experiences. The act of sharing our stories, the secrets, through fiction or nonfiction is an act of bearing witness, and by bearing witness, we open the door to discernment, connection, and appreciation for the inherited histories that have formed us.

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