Content Warning: This section of the guide contains discussion of mental illness.

Gather initial thoughts and broad opinions about the book.

1. How effectively does Ward D balance its medical authenticity with its thriller elements? Compare this to other medical thrillers like Robin Cook’s Coma. How does MacFadden’s insider perspective as a physician influence the storytelling?

2. What was your initial reaction to the revelation that Amy still sees the young girl in the epilogue? How did this change your understanding of everything that came before?

3. Discuss your emotional response to the way mental health conditions are portrayed in the novel. What aspects felt authentic or problematic to you, and why?

Encourage readers to connect the book’s themes and characters with their personal experiences.

1. Have you ever been in a situation where you had to question whether to trust your own perceptions? How does this relate to Amy’s experiences throughout the night?

2. The novel explores how childhood friendships can evolve or deteriorate over time. Reflect on a friendship from your past that underwent a significant change. What parallels do you see with Amy and Jade’s relationship?

3. Amy struggles with maintaining a “perfect” persona while hiding her fears about her mental health.