Burke Harris opens the Bayview Childhood Health Center, aiming to reduce disproportionately high illness rates in this under-resourced San Francisco community.

Burke Harris treats Diego, a seven-year-old whose bones and growth pattern match those of a four-year-old child.

Diego's mother reveals he was sexually abused at age four, prompting Burke Harris to suspect childhood trauma drives health disparities.

A clinic therapist directs Burke Harris to Felitti's 1998 study linking childhood adversity to leading causes of adult death.

Burke Harris witnesses a drive-by shooting near her clinic and experiences the acute stress response firsthand.

Burke Harris diagnoses Trinity with Graves' disease rather than ADHD, applying her new understanding of toxic stress on the immune system.

Burke Harris calls Child Protective Services when infant Nia repeatedly fails to thrive under her emotionally disconnected mother Charlene's care.

Burke Harris presents her ACE research to the Hospital Council of Northern California and fails to motivate any action.

Kamala Harris, then a San Francisco district attorney, convinces Burke Harris that opening a dedicated research center is essential to changing medicine.

Burke Harris and collaborators raise $4.3 million in start-up funds, and she becomes CEO of the Center for Youth Wellness.

Community supporters flood the zoning commission meeting and secure approval for the Center for Youth Wellness expansion.

The Center for Youth Wellness posts its ACE screening tool online, where clinicians worldwide download it in large numbers.

Burke Harris delivers a widely viewed TED talk on ACEs and toxic stress, significantly raising her public profile.

Burke Harris reveals that her brother Evan's stroke was connected to the hidden risk factor of their mother's untreated paranoid schizophrenia.

Burke Harris imagines a 2040 world where universal childhood ACE screening and intervention have dramatically reduced long-term health disparities.

Burke Harris opens a pediatric clinic in San Francisco's Bayview neighborhood hoping to reduce health disparities, but realizes that access to healthcare alone does not improve her patients' outcomes. A young patient named Diego, whose growth stopped the year he was abused, leads Burke Harris to suspect that childhood trauma is the hidden driver of the health problems she sees. After discovering Felitti's landmark ACE study, Burke Harris builds a biological framework linking stress responses to poor health and begins reshaping her clinical practice. Repeated setbacks—including a failed presentation to the Hospital Council and fierce community resistance—push her to open the Center for Youth Wellness with millions in fundraising support. The center develops a universal screening tool, and Burke Harris's TED talk brings the message of ACEs to a global audience. The book closes with a personal revelation about her brother's stroke and a hopeful vision of a future where universal ACE screening transforms public health.

The key milestones of Burke Harris's decade-long fight to bring ACE science to medicine.

Burke Harris recalls learning in Tyrone Hayes's tadpole lab that the timing of stress hormone exposure determines whether an organism fully recovers.

Burke Harris is shocked to discover that Felitti's 1998 ACE study was never included in her medical school education.

Burke Harris observes that her Bayview patients show unusually high rates of obesity, learning difficulties, and autoimmune conditions.

Burke Harris discovers rat pup research showing that a mother's nurturing licking behavior blunts the stress response across generations.

A hotel worker named Marjorie tells Burke Harris after her Hospital Council presentation that she recognized her own life story in it.

Burke Harris adds integrated behavioral health therapists directly into her clinic to address the root causes of patients' health problems.

Charlene works with a clinic psychologist trained in parent-child therapy and gradually becomes a more nurturing and present parent to Nia.

Burke Harris launches an obesity intervention program at the clinic combining nutrition counseling, exercise, mindfulness, and ACE screening.

Burke Harris learns how physician Robert Guthrie's universal newborn PKU screening campaign offers a practical model for early ACE intervention.

Treating baby Lila, Burke Harris discovers that sharing an ACE score alone guides effective care without forcing difficult disclosures from parents.

Through fundraising work, Burke Harris befriends Caroline, whose story of surviving an abusive marriage reveals that ACEs cross class lines.

Pamela Cantor introduces Burke Harris to how ACEs disrupt educational outcomes, using research from schools affected by the September 11 attacks.

Community activists at a national conference accuse Burke Harris of medicalizing what is fundamentally a social and political problem.

Burke Harris loses a baby at six months of pregnancy and falls into a severe depression that leaves her unable to cope.

Burke Harris's brother Evan runs past her parked car by chance while she sits inside at her lowest point after the pregnancy loss.

Burke Harris's path to understanding toxic stress runs through her undergraduate tadpole research, her shock at discovering what her medical education omitted, and her careful observations of patterns among Bayview patients. Patient stories—from Charlene and Nia's difficult journey toward an effective parenting relationship to baby Lila's revealing ACE score—show how the toxic stress framework changes clinical practice in concrete ways. Research breakthroughs, including the rat pup nurturing study and Robert Guthrie's PKU screening model, give Burke Harris both scientific grounding and a practical blueprint for universal ACE intervention. As her work grows, Burke Harris encounters resistance from conference activists who see her framework as medicalization, while collaborators like Pamela Cantor expand her vision into education. Her personal life intersects with her professional mission when a pregnancy loss sends her into depression, and a chance encounter with her brother helps her begin to recover.

The research discoveries, patient stories, and collaborations that built the case for ACE intervention.

Burke Harris reflects on John Snow's discovery that a contaminated well—not miasma—caused cholera, framing her own search for what drives health disparities.

Burke Harris connects her father's biochemistry lessons and tadpole lab research to suspect that stress hormones are stunting Diego's development.

Burke Harris realizes that documented side effects of synthetic cortisol treatment in children already prove what long-term stress hormones do to developing bodies.

Burke Harris's supervisor recommends hiring a therapist for Diego, a seemingly routine decision that accidentally leads Burke Harris to the Felitti ACE study.

Felitti discovers by chance that patients dropping out of his obesity program are frequently survivors of childhood sexual abuse, revealing the ACE-health link.

Burke Harris learns that telomeres shorten in response to childhood adversity specifically, unlike in adults who first experienced adversity only as adults.

Burke Harris discovers that epigenetic changes allow parents who experienced ACEs to pass a maladaptive stress response to children through gene expression.

Burke Harris learns about Alicia Lieberman's parent-child therapy model and begins integrating it into the clinic to help parents buffer children from stress.

Charlene's ex-boyfriend assaults her while she holds Nia, threatening her recovery but ultimately not derailing her progress toward becoming a nurturing parent.

An activist named Sister J circulates fliers falsely claiming Burke Harris is experimenting on Bayview's children, threatening the clinic's zoning approval.

The Center for Youth Wellness develops a de-identified ACE screening process that any clinic can complete in three minutes.

Burke Harris learns that Turnaround for Children's school programs improved test scores only after adding attachment, stress management, and self-regulation support.

A speaker at a national conference argues that people actually living with ACEs are never present in the rooms where researchers discuss their experiences.

Burke Harris reverts to childhood patois at a conference to declare that ACEs and toxic stress are universal, not unique to poor or marginalized communities.

Burke Harris reveals that her brother Louis, who developed untreated paranoid schizophrenia like their mother, disappeared at seventeen and was never found.

From the outset, Burke Harris's thinking is shaped by paradigm-shifting models—John Snow's contaminated well and the stress hormone research she encountered as an undergraduate—that teach her to look for hidden causes beneath visible suffering. A series of accidental discoveries, including a supervisor's offhand recommendation to hire a therapist and Felitti's serendipitous obesity clinic finding, reveal how ACEs connect to health in ways the medical establishment had long ignored. The science of epigenetics and telomere damage deepens the picture, showing that childhood adversity leaves biological marks that can span generations and that a nurturing caretaker is a powerful countermeasure. On the ground, confrontations with community activists over the Center for Youth Wellness and heated debates at national conferences force Burke Harris to continually refine both her tools and her arguments. Personal losses and the long-ago disappearance of her brother Louis give the book's final chapters an emotional gravity that underscores what is at stake when ACEs go unrecognized and untreated.

The pivotal discoveries, confrontations, and personal revelations that transformed Burke Harris's understanding of ACEs.