Kupfer (Before and After Zachariah) illustrates the trials encountered during the second half of her life: surviving both the loss of a child and the end of her marriage, and making the difficult choice of whether to pre-emptively operate after testing positive for a genetic disorder—the BRCA gene for hereditary breast and ovarian cancer. The curse of the BRCA gene endemic to Ashkenazi Jews leaves several options: surveillance, chemoprevention, or preventative surgery, namely the removal of her healthy ovaries and fallopian tubes as well as a prophylactic bilateral mastectomy. The author weaves her history into the story, painting family portraits and writing in a compassionate tone that often reads like a journal. Readers will find themselves rooting for Kupfer—and there is plenty of hope to keep her going; she remarries and has the full support of her family and close friends. This sincere memoir will resonate particularly with women undergoing similar procedures and health concerns.