Set in the steel town of Donora, Pa., Shoop's second novel follows hard-drinking, foul-mouthed community nurse Rose Pavlesic as she struggles to maintain control over her family and life. Raised in a "wretched orphanage," Rose compensates for her unfortunate upbringing by excelling as a nurse and encouraging her teenage twins to attend college and escape the mill town. Everything begins to disintegrate, though, when she finds out both children have different plans and her husband loses his job at the mill. Rose's own career is at risk when the new mill superintendent's wife, Mrs. Sebastian, is reluctant to fund the town health clinic. Through her attempts to persuade Mrs. Sebastian by treating her asthmatic daughter, Rose is forced to confront a secret from her own past. Rose's personal drama unfolds as a "killing smog" descends on Donora, forcing her to care for dozens of suffocating townsfolk. As one surprise follows another, each begins to lose its shock value and the novel descends into melodrama. The unexplained smog, an actual event that killed 20 Donora residents and sickened thousands, becomes an afterthought in the background of Rose's family conflicts. Despite its potential, too many twists and subplots crowd the novel, leaving it feeling unfocused.