Vital Signs: What we Know by Heart, is the story of Michael Rocco, a small-town outcast who spends a lifetime in search of authenticity. Michael was born to Latin American parents and raised by an Anglo family in a small conservative town in the northeastern US. He comes of age as a criminal offender, alcoholic, and high school dropout lacking direction and purpose. We find Michael alone, even as he is surrounded by others. He sets out from his hometown to recreate himself by embracing his ethnic identity and starting life anew without the weight of past transgressions. In his travels, he finds himself homeless in Richmond, divorced in Chicago, struggling for work in Palm Beach, and testing the possibilities of corporate life in Baltimore, all the while immersed in counterculture, scholarship and music. Despite many obstacles, he earns a doctorate and eventually develops expertise in the social determinants of health and becomes a professor in a major university. After decades of effort, it seemed Michael may have finally transcended his early life struggles. But, when he and his second wife bring their newborn home, Michael’s symptoms of undiagnosed PTSD worsen as his drinking spirals out of control. His health rapidly declines until he is hospitalized in an intensive care unit. As he lie there dying, he has an epiphany that will both save his life and make it worth living. He returns home to heal and contemplate his new self-understanding, situating his life and his health and illness within the broader research literature on abandoned children. Vital Signs uses Michael's Rocco's life story to model many common experiences of relinquished and abandoned children as well as those struggling with racism, ethnic or racial identity, mental health and addiction. The book is intended for a general audience, but may be of special interest to adoptees and their families, former foster youth, prospective adoptive parents, trauma-informed clinicians, social workers, child welfare policymakers and social scientists.