49 pages • 1 hour read
Abby JimenezA modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Dr. Briana Ortiz talks to a nurse about the new emergency room doctor at Royaume Northwestern Hospital, Dr. Jacob Maddox. All six of the patients he has treated that day have died, causing the other staff members to dub him “Dr. Death.” Briana defends him by pointing out that all patients were terminal before they arrived in the emergency room, but the nurse also complains that Jacob is rude and unfriendly. As they speak, Briana gets a text from former emergency department head Alexis Grant, who is also her best friend. Alexis wants to visit Briana on the day that her divorce is scheduled to be finalized. Briana calls Alexis, assuring her she’s fine, but Alexis insists on coming.
Dr. Gibson, the current head of the emergency department, calls Briana to his office. She expects him to tell her that he wants her to take over the position once he retires, but instead, Gibson tells her that he has decided to put off his retirement. Gibson feels it is only fair that Jacob be given a fair chance to compete for the job as well, and he wants to give him time to get to know the staff. When Briana leaves Gibson’s office, she calls Alexis to complain about Gibson’s decision and Jacob.
Jacob meets his brother, Jeremiah, and former girlfriend, Amy, at a local bar. The noise and chaos of the bar overwhelm him, compounding his anxiety from his difficult first day at Royaume. This is the first time Jacob has seen Amy and Jeremiah together since they began dating three months after he and Amy broke up. Amy announces that she and Jeremiah are getting married. Jacob congratulates them and quickly leaves, even though he knows it will give the impression that he’s hurt by their choices.
The following day, Jacob’s sister Jewel calls to tell Jacob that she; her wife, Gwen; and the rest of Jacob’s family will boycott the wedding if that’s what Jacob wants, but Jacob lies and tells his family that he’s dating a woman he works with at Royaume. He adds that he took the job at Royaume to be closer to his new girlfriend, not to escape Amy and Jeremiah.
Jacob leaves the storeroom where he went to take the call and runs into Briana, causing his phone to fly from his hand and break. Jacob chases Briana to an exam room and watches as she chastises the patient for not calling her sooner. When Briana notices Jacob, he freezes because he finds her attractive. When she confronts him and insists on knowing why he’s in the room, Jacob calls her out for running in the hall and making the workplace dangerous. Jacob is angry with himself because he knows the staff already dislikes him and he’s only made the situation worse.
Briana’s patient is Benny, her brother. He has renal failure and has been on the transplant list for a while, but he has a rare blood type that makes it difficult to find a match. Benny is depressed and struggling with his circumstances. He came to the emergency room because the catheter through which he gets his dialysis treatments is infected. Briana goes to the supply closet she refers to as her “sob closet” to cry alone, but when she arrives, Jacob is already there. They introduce themselves to each other and joke about having designated places for emotional breakdowns. Jacob asks about Benny, and Briana confesses that he is her brother and that he went into renal failure after being diagnosed with an autoimmune disorder. Jacob says that people can live for years on dialysis, and Briana calls him insensitive. She also accuses him of trying to take her job, which she assures him he will never get because the staff likes her better.
Dr. Zander Reese, a nephrologist, finds Jacob in the hall and invites him to drinks. Jacob and Zander were once roommates, and Jacob knows Gibson through his previous job. Jacob confronts Gibson about pitting him against Briana to take Gibson’s job when he retires. Gibson says that he doesn’t want Briana to get the job by default because then her subordinates won’t respect her as much.
Zander asks Jacob about his anxiety. Jacob reflects on how difficult some situations can be, especially when he is in an unfamiliar place and around people with high levels of energy. He often struggled with his anxiety when he was with Amy because she constantly pushed him into uncomfortable situations.
They talk briefly about Briana, and Zander suggests that Jacob ask Briana what she did when she learned her ex-husband, Nick, was having an affair with their friend, Kelly. Jacob asks Zander about Benny and learns about his struggle to find a donor. Jacob volunteers to be tested since his blood type makes him a universal donor. Jacob’s mother experienced renal failure when Jacob was a child, and her friend made a directed donation, which Jacob admires. He has always wanted to pay it forward by donating himself.
Briana visits Benny’s apartment only to discover he hasn’t bothered to clean in a long time, and he is about to be evicted. Briana decides to move Benny into their childhood home, where she is also living. The next morning, Briana has coffee with a coworker, Jessica, and announces she has sworn off men. Briana asks Jessica about Jacob. Jessica, who dislikes most people, declares Jacob to be a “wonderful man.”
Briana goes to the emergency room and finds the nurses watching Jacob sew up the toy of a little girl who was attacked by a dog to distract her while a resident sews up the girl’s wounds. This act of kindness combined with Jessica’s high opinion of Jacob inspires Briana to tell him that he should bring cupcakes to win over the nurses.
At home, Jacob ignores phone calls from his mother, Joy, only to receive text messages asking about a girlfriend who doesn’t exist. Jacob has a habit of journaling his thoughts and emotions, but today he decides to write a letter to Briana instead.
Briana convinces Benny to move in with her by telling him she can arrange for him to do daily dialysis at home. By doing dialysis so often, Benny will be able to reintroduce certain foods to his diet. Briana reflects that neither she nor Benny is living the life she imagined they would. Briana is frustrated with her life and disappointed at the end of her marriage. Because her father abandoned the family when her mother was pregnant with Benny and her own husband cheated on her before leaving to be with his lover, she decides she can no longer trust men.
At work, Briana discovers that someone left her a custom cupcake with a letter attached. She goes into the storeroom and reads the letter. It’s from Jacob. He explains that he confronted her about running in the hall because she broke his phone. He told her that Benny could live for years on dialysis because he found this fact comforting as a child when his mother was in renal failure. He also explains that he has no interest in taking the job as head of emergency medicine. Briana is touched by the letter and decides to write back.
Jacob finds a letter from Briana taped to his locker. The letter causes him anxiety because he imagines all the worst things it might say, so he doesn’t read it until he gets home. However, it is the opposite of what he imagined: Briana apologizes for not being kinder to him and for assuming the worst of him. Jacob reads the letter multiple times and then writes back.
Briana finds another letter from Jacob taped to the inside of the sob closet door. She finds it amusing and quickly writes back, leaving her letter on Jacob’s charting computer. An hour later, she finds another note on her own charting computer. Briana is so charmed by the letters that she goes to a stationery store and buys proper paper to write on.
Jacob is excited that Briana bought special paper just to write to him. They discuss his dog, Lieutenant Dan, and her brother’s cat, Cooter, as well as a funny story about a travel blogger who received a Shetland pony as a gift from an earl after he accidentally locked her in a drafty tower in Ireland. Jacob enthusiastically writes her back.
These first few chapters introduce the protagonists of the novel, Briana Ortiz and Jacob Maddox. The first chapter reveals Briana’s troubles in her personal life, including the finalization of her divorce after 10 years of marriage. These insights into Briana’s personal life illustrate her struggle to trust people, especially men, introducing what will be a central conflict in the novel. Likewise, the shift to Jacob’s point of view in the second chapter gives insight into his standoffish behavior in the emergency room. Jacob has an anxiety disorder that causes him to act in certain ways in social settings, especially those where he doesn’t feel in control of the outcome. Sometimes Jacob seems aloof, and other times he can appear confrontational, as in his interactions with Briana. Just as Briana struggles with issues in her personal life, Jacob struggles as well. Not only has he just started a new job in order to place distance between himself and his former girlfriend, Amy, but he also learns that Amy is engaged to his little brother. This discovery creates a conflict between Jacob and his family that he must resolve.
The introduction of Benny gives another dimension to the problems Briana is facing. Briana’s reaction to seeing Benny in the emergency room reveals her role in his life as not just a sister but as a caregiver. Initially, this role can be put down to Benny’s health situation, but when Briana later reflects on their childhood, it becomes clear that she has always taken responsibility for Benny because their father abandoned the family. The experiences of being abandoned by two of the most important men in her life have shaped the way Briana reacts to other men, including Jacob, foreshadowing the conflict that will plague their relationship.
Briana and Jacob’s first face-to-face encounter in the emergency room is filled with tension despite an undercurrent of attraction. Jacob’s anxiety plays a role in this first meeting, causing him to act out in a way that is unintentional and more confrontational than intended. Later, when Jacob attempts to make up for his behavior, he makes things worse by making Briana feel as though he is dismissing the seriousness of Benny’s situation. Jacob’s meaning is once again misconstrued, and this is illustrated when he later volunteers to be tested as a donor for Benny. Jacob’s own family connection to renal failure and kidney transplants is revealed, and this again shows that Jacob’s intentions and his delivery are mismatched, in part due to his anxiety disorder.
The letters that Briana and Jacob begin to exchange symbolize the theme of Anxiety Within Relationships. Jacob’s anxiety makes it difficult for him to connect to his new coworkers in person, but in writing letters to Briana, he is able to move past his anxiety and be vulnerable with her, revealing a part of his personality that might not have been apparent in other circumstances. It is through these letters that the possibility of romance begins to appear.
By Abby Jimenez