Christa Parravani was 40 years old, in a troubled marriage and in bad financial straits when she learned she was pregnant with her third child. Six weeks into the pregnancy, she requested an abortion. And in the weeks and months that followed, nurses and doctors became unavailable to provide Christa with reproductive choice. By the time she understood that she would need to leave West Virginia to obtain a safe, legal abortion, Christa had run out of time. So she gave birth to a beautiful baby boy named Keats. And another frightening education began: available healthcare was dangerously inadequate to her newborn son’s needs. Indeed, environmental degradations and poor health care endangered Christa’s older children as well.

Christa Parravani and her identical twin, Cara, were linked by a bond that went beyond sisterhood or friendship. But haunted by childhood experiences with father figures and further damaged by being raped as a young adult, Cara descended into depression, drugs and a shocking early death. A few years later, Christa read that when an identical twin dies, 50 percent of the time the surviving twin dies within two years. First, Christa fought to stop her sister's downward spiral; suddenly, she was struggling to keep herself alive.