One question that I find myself answering a lot these days is, How did you come to write this story? I’ll answer it again, here. Some years ago, when I was working for Outside magazine, I went to Hawaii to write about Daryl Haley, a six-foot-five, 300-pound former offensive lineman for the New England Patriots, who was attempting to become the largest man ever to complete the Hawaiian Ironman triathlon. (Did he? You can find out here.) During one of the inter-island flights I took, the small prop plane navigated along the northern coast of Molokai, which is a solid green wall of towering cliffs. Midway along this rugged coastline emerged a small triangle of land, which the pilot announced was the site of a former leprosy colony. Everyone moved to the window for a glimpse, but the plane sped past too quickly.

I later went hiking along this same coast, and soon reached an overlook from which the entire peninsula was visible. The morning was cool and misty, and far down on the plain a wisp of smoke snaked upward from a cottage—one of the remaining residents was cooking breakfast. I watched for a time, until the mists closed in and suddenly sealed off the view. The moment was powerfully poignant, and I carried it back to the mainland.

At Outside I worked as an editor on all manner of survival and adventure narratives, including Jon Krakauer’s Into Thin Air, and I soon recognized that the story of the colony was, foremost, a survival tale—complete with shipwrecks, tsunamis, murders, thrilling escapes, heartbreaking loss, and enduring love. Leprosy simply happened to be what set this story in motion.

At the time what I knew about leprosy was almost nothing, gleaned mostly from several viewings of Papillon. In the film, Steve McQueen—playing the French criminal Henri Charriere, who has been sent to the French prison on Devil’s Island—hopes to escape by securing a boat from the leader of a leprosy colony which occupies the opposite side of the island. The leader of the community, played by Anthony Zerbe, emerges from his cave of a hut, his disfigured face partially hidden behind a cloud of cigar smoke. Testing McQueen’s character, he offers him the cigar, which McQueen takes and smokes. “How did you know I had dry leprosy?” he asks, using an antiquated term for the non-communicable form of the disease. “I didn’t,” McQueen replies, puffing away.

The intense shorthand of the scene—McQueen’s apparently suicidal leap of faith, Zerbe’s wearied attempt to gain simple respect—stayed with me, and at the outset of my research for the book I suppose I expected the colony on Molokai to be not unlike that from the movies: a grim, frightening, otherworldly place of single dimension. But as I learned more about the community and the people who comprise its remarkable history, both good and bad, I came to realize that the truth was something much greater, and more affecting. The colony is unique in American history, a dark stain that has not been fully addressed even today. Perhaps the only vaguely similar episode in the country’s past is the treatment of Japanese-Americans in the days after March 21, 1942, when the concentration camp at Manzanar, California, opened in response to wartime hysteria. The impetus behind its creation—prejudice, fear, and a lack of understanding—certainly echoes the factors that birthed Molokai some eight decades earlier. But while the treatment of the innocents incarcerated in these camps is abhorrent, their months of hardship pale beside the century of torment suffered on Molokai. And while the nation has, at times, attempted to reconcile its conscience over the wartime internment camps, it has yet to even acknowledge the lives lost and damaged unnecessarily in the colony. Several years ago, the Japanese government agreed to pay $15 million to 127 persons exiled to a leprosy colony that was modeled after Kalaupapa, but in America the more than 8,000 people who lived and died in the colony had been mostly forgotten. Their story remained largely untold. I decided to try and tell it.