Block’s contemporary debut novel will probably appeal more to young adult readers and to those concerned with the harm caused by prescription drugs. Exposing various secrets and lies in the life of Zoe Goldman, a newly minted doctor in Buffalo, Block fills her thriller with a number of twist and turns that build to a shocking denouement this reader didn’t coming. Returning to an unresolved drama between her adopted mother who is suffering from late-stage dementia, Zoe is asked to attend to the psychiatric ward’s newest inmate, Sofia Vallano, who murdered her own mother when she was a teenager. Sofia--with her shiny black hair and royal blue eyes--was once considered a psycho but is now a model patient.

As Zoe gets ever closer to Sofia, she’s haunted by her inability to give closure to the death of her birthmother, leading her to reveal that she has built her current persona on a flimsy network of memories that have denied her any chance at happiness. For Zoe, the nightmare is always the same: bloodstains on her hands “red as finger paint” and the memories of a fire over twenty years ago. As the “finest gossamer of a thought sticks to her brain like a burr,” and with Adderall tweaking “to keep her thoughts from flying too far,” Zoë turns to her psychiatrist, Sam, whom she tells about the fire that killed her birth mother.

Together with her half-brother, Scotty, Zoe works to put the pieces of the puzzle of her past together. When she’s not on the psych ward, she’s plying her birth mother for information about the all-important picture: a dog-eared photo of a woman with dark hair and brown eyes. Though stressed, Zoe is determined to get to the root of the problem, seared by the recollection that there were just the two of them the house when the fire happened.

Meanwhile, the story of Sofia’s violent past spreads throughout the hospital. The half-punctured nightmare of what she did to her mother is made all too real by her brother, Jack, who visits from Chicago and quickly blames his sister for taking everything he had. As Zoe sits silent, as though waiting for the next victim, Sofia remembers getting high and feeling unbelievably full of rage. She also remembers her brother being stabbed and seeing blood, but she still doesn’t remember killing her mother.

From a girl huddled by the dryer in a blue frilly nightgown, trembling and clinging to a big blue bear with one eye, to the moonlight lying in the crisscross shadow of the windowpane, Zoe is frustrated by her terrible nightmares and her inability to see into her past. But not everything is difficult for Zoe. She suddenly finds herself in a romantic relationship with the beautiful Jean-Luc while also fielding the attentions of hunky Mark. Unfortunately, even Mark’s bittersweet attentions are short-lived when the threat to Zoe’s life lands at her front door. Gathering information about her birth mother, Zoe discovers the dirty black lies she’s been told, lies that begin to parallel the ugly pieces of Sofia’s true persona. Zoe’s life might be a blank slate dotted with broken memories, but Sofia holds the surprising keys to her denouement.

In fast moving chapters that sometimes seem a bit fragmented and cobbled together, Block manipulates Zoe and her drug-addled inner conflicts with the day-to-day workings of the psych ward and how so many of these damaged patients go directly into suicide precautions because their brains have convinced them that it is not worth living without drugs.

Although I was frequently appalled at Block’s portrayal of her heroine swallowing down pharmaceutical drugs like candy, I liked the way she got inside the heads of her characters, from the patients to Zoe’s co-workers, from Jack and Scotty to the elusive Sofia. She brings them all to life in a surprising a finale that culminates in the warped mind of a psycho who has no option but to go ahead and bask in all the swirling craziness she has created.