Two of nine children born to abolitionist, Protestant dissenters in Bristol England, Elizabeth and Emily Blackwell were the recipients of a strict moral upbringing. While successful in instilling the values of education and hard work, their childhood also left them socially awkward and with the sense that they were both morally and intellectually superior to those outside of their family. When the Blackwells emigrated to New York City in 1832 and then on to Cincinnati in 1838, their social circles were confined to religious and abolitionist advocacy. Yet soon after the family arrived in Cincinnati their lives were upended by the passing of their father, Samuel Blackwell. With their mother and six siblings to support, the three eldest Blackwell daughters-- Anna, Marian, and Elizabeth-- took up teaching until their younger brothers were old enough to support the family.               

Elizabeth, morally principled to a fault, studious, and determined to succeed intellectually, found teaching to be an unfulfilling means of channeling her energies. Having forsworn marriage at the age of 17, she longed for something challenging and admirable upon which to focus her formidable intelligence. When a dying friend suggested that she become a physician, because she herself would have appreciated a female doctor tending to her disease, Elizabeth’s interest was piqued. Yet her attraction to medicine was rooted not in a desire to help the ailing (indeed she viewed illness as a form of weakness), but in an ideological quest to prove that women were capable of achieving the same distinctions as any man. She saw herself as a moral crusader with the goal of uplifting all of womankind.              

Beginning in 1844, Elizabeth leveraged her teaching connections to gain the backing of several prominent male physicians. Yet the all-male world of medicine remained stubbornly closed to her, and it wasn’t until 1847 that she was admitted to the Geneva Medical College in upstate New York, an event that caused a stir in the medical community and beyond. Isolated both from her male classmates and from laypeople, who viewed her at best as an oddity and at worst as a dangerous anomaly,  Elizabeth nonetheless became a figure equally admired and reviled by the public.  Her reputation as the first “lady doctor” preceded her, even as she gained the respect and admiration of the faculty at Geneva College and distinguished herself with additional training in Europe.                    

Meanwhile, the trials of Emily Blackwell, whom Elizabeth encouraged to follow in her footsteps, illustrated that far from breaking down the doors that barred women from medicine, Elizabeth’s admittance may only have served to seal them more tightly. Elizabeth was viewed as a notable exception to the general rule that women were unfit to practice medicine, and her male colleagues were uneasy at the thought of being replaced. But after a prolonged struggle, Emily succeeded in obtaining her medical degree from Cleveland Medical College and joined Elizabeth to hang up her shingle in New York City.              

Increasingly frustrated by the difficulty in recruiting private patients to be seen by female physicians and by the dearth of clinical opportunities for the growing number of women in the field, Elizabeth and Emily opened their own hospital and medical school with the help of female philanthropists. Elizabeth’s philosophical zeal combined with Emily’s true love and aptitude for medicine proved to be a dynamic combination. Their contributions to the field not only changed the way that medicine is practiced, but also paved the way for generations of female physicians. Today, just over fifty percent of the nation’s medical students can trace their acceptance into the profession to the dogged determination of these two extraordinary women.   

Transcendent Kingdom opens with a reminder that the past rarely stays put. Gifty, a sixth year PhD candidate in neuroscience at Stanford University School of Medicine, is reckoning with a relapse of her mother’s depression. After years of remission, Gifty’s mother is unable to get out of bed, and Gifty decides that she should come stay with her in California. With her mother lying in her bed at home, Gifty’s work in the neuroscience lab is charged with a weight beyond that of a typical student trying to publish papers and make it to graduation. Her study of the neural circuits that underlie reward seeking behavior and addiction in mice not only applies to her mother’s disease, but also to the impetus for her mother’s first depressive episode—her cherished older brother Nana’s long struggle with opioid addiction and death by heroin overdose. As Gifty, long accustomed to keeping her emotions to herself and clutching her past close to the chest struggles to keep her mother afloat, she reflects on how her past continues to hold power and relevance.           

The daughter of Ghanaian immigrants, Gifty grew up in the predominantly white community of Huntsville, Alabama. Homesick and miserable amid a climate of overt racism and everyday micro-aggressions, Gifty’s father abandoned the family to return to Ghana, leaving four-year-old Gifty and 10-year-old Nana to be raised by their mother. Wryly referred to as “The Black Mamba” by Gifty, their mother, an enigmatic mix of deep tenderness and removed resolve, works long hours as a home health aide to make ends meet. A deeply religious woman, she finds solace in The First Assemblies of God Church, a Pentecostal congregation that, at times, seems to be the only thing keeping her afloat. Gifty, too, is deeply pious as a child. Continuously striving to be good and consumed by questions about God, she writes to God in her journal in an attempt to find religion in the everyday.            

Yet Gifty’s faith starts to fracture in early adolescence. Her brother Nana, a basketball star and hometown hero, becomes addicted to prescription opioids following an injury on the court. The ensuing years of conflict overwhelm Gifty with feelings of shame, and sometimes even hatred towards her brother. This, combined with increasing recognition that her religious community—so reverent of Nana when he was healthy and so quick to give up on him when he became ill—is not the bastion of morality she once idealized it to be, prompts Gifty to reevaluate her upbringing. When Nana dies and her mother sinks into a depression that culminates in a suicide attempt, Gifty gives up on religion altogether.              

As a college student at Harvard, Gifty continues to eschew overt religious affiliation. Still, she can’t shake the feeling that there’s more to be understood about the human experience. Call it the soul, call it the mind, call it the sub-conscious, Gifty longs to understand the neurologic underpinnings of the behavioral choices that make us who we are. She ultimately chooses to study neuroscience because its rigor appeals to her—if she can decipher which neurons control the behaviors that led to her brother’s addiction, then maybe those behaviors can be changed and controlled. But the more experiments she conducts the more she is forced to grapple with the fact that science can only take her so far. Reconciling her prior absolute belief in God with her current scientific practice isn’t as easy as switching one for the other. Maybe, transcending to a higher level of understanding requires a merging of the two, a recognition that understanding ourselves takes, and is in it of itself, an act of faith.      

In Blue Ticket, Sophie Mackintosh constructs a dystopian vision of modern life for women. Ambiguously set in space and time (given the technology presented we know it takes place around the present day, and not much else), Mackintosh’s universe is one in which a girl’s destiny is set at the time of her first period, when she receives either a white ticket or a blue ticket from the government. These designations are supposedly based on intense scrutiny from the State, and they determine the path each woman will lead. White ticket women, as they’re called, are destined for motherhood, having been deemed worthy of childrearing. Blue ticket women, implanted with a permanent intrauterine device and forbidden from getting pregnant, are bound for the working world, bound for a "free" life that "could change at any time." Each girl must leave her family to start a new life after her ticket is drawn, and the white tickets and blue tickets immediately diverge. The white ticket girls are ferried safely to their destination cities, while the blue ticket girls must brave the open road on foot and alone, fighting for survival and the privilege of an adult life.            

We meet Calla, the narrator, as she teeters on the brink of menarche. One by one her female classmates have disappeared from around her, and she is one of only three girls left in school when her period finally arrives. She draws a blue ticket, and embarks on a new life as a chemist, initially living the free and unencumbered life that blue ticket women are supposed to lead. Yet desire for a child smolders inside her, a “dark” feeling that crawls under her skin until it is impossible to ignore. Desperate, Calla removes her IUD and finds a man, known only as R, to unwittingly father her child. When R learns what she has done he turns his back on her, disgusted by her aberrant behavior.            

Calla’s illicit pregnancy is communicated to the government by her doctor, known as Doctor A. In this world, citizens are required to meet with their doctor regularly, and the doctors, who act as a hybrid between therapist and primary care provider, report their patients’ thoughts and behaviors to the government. Doctor A offers to terminate the pregnancy with no consequences, but Calla refuses, a decision from which there is no coming back. Calla is provided with a backpack of basic survival tools and a map, and told that she must be prepared to flee to the border at any moment—the government will give her a head start to reward her years of loyal service, but even so, they’re sure to find her before she can cross.                  

The question of what will happen if she is caught haunts Calla as her pregnancy progresses and she awaits the signal to flee. When it finally arrives, in the form of government emissaries on her doorstep, Calla’s final view of her old life as she speeds away is of her neighbors destroying her home. On the road, Calla is once again alone and vulnerable. Strangers, eager to take advantage of a lone woman, pose a more immediate threat than the government. Yet Calla’s outlook takes a turn for the better when she meets Marisol, a self-assured blue ticket woman who is also pregnant and headed for the border. The two protect each other, and as time goes on they are joined by other blue ticket women on the run, and one white ticket woman, who fears returning to her husband after an illegal abortion. Determined to escape the lives chosen for them, their freedom rests not only on their individual tenacity, but also on their ability to help each other. Yet the question of who to trust looms large, and casts a shadow as they flee towards a new life.