Grace, a 54-year-old mother of three, was battling ovarian cancer. The disease had taken a steady toll on her body, so much so that when she faced the camera that day and endorsed her brother’s opponent, she worried that the remainder of her life would be measured in months rather than years.

“I couldn’t be quiet any longer, nor should any of us be,” she said in the ad, which cut to another one of her siblings and then another and another and another and another, all imploring voters to cast aside their brother.

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The Gosar sibling spots were played and replayed millions of times online this past fall, a symbol to many Americans of the turmoil in their own families and the myriad ways in which their country had never seemed more divided, angry and irreconcilable than during the Trump era.

Nine-hundred miles away in Arizona, Grace’s brother, Rep. Paul A. Gosar, won his race by a whopping 38-point margin. Now, like so many Americans whose lives had been shaken by the country’s dysfunctional politics, Grace was wrestling with what came next. What did it mean to be a good daughter, mother, sister and citizen at a moment when her health and her country seemed to be unraveling? Some version of that question was still bedeviling all her siblings.

Grace’s answer came on a frigid December day when she headed off to see patients at the Downtown Clinic, which offered free health care to anyone without insurance. She rubbed her head and neck, which throbbed with pain.

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She had spent 25 years as a rural physician until her disease forced her to give up her medical practice. She had decided to spend what she knew could be her last months attending to the indigent and undocumented in Laramie — some of the very people targeted by Paul’s uncompromising policies and harsh rhetoric.

Her younger brother Pete, 50, served as the clinic’s executive director and needed the extra help to cover a growing patient load. Grace needed something to distract her from the country’s poisonous politics and the steady advance of her cancer.

So she spent the day seeing patients who had no place else to go. It was approaching 9 p.m. — two hours past the clinic’s official closing time — and a couple of patients were finishing up with one of the clinic’s other physicians. A half-eaten chicken potpie, donated by some women from the local Methodist church for the staff and patients, was growing cold in the clinic’s break room.

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“How’s your head?” Pete asked.

“The same,” Grace said. “It’s not great.”

She slipped on her coat and pulled a scarf tight over her face.

“Holler if you need to skip work tomorrow,” he said.

“What am I going to do, sit at home?” she asked.

She pushed open the clinic’s heavy metal door and strode into the windy, snowy Wyoming night.

It was difficult to pinpoint exactly when the Gosars’ political disagreements with their brother Paul became something larger and unbridgeable. Each of the siblings — seven have publicly rebuked him — seemed to have their own breaking point.

The 10 Gosar children — Paul was the eldest of seven boys and three girls — were raised in Pinedale, Wyo., a small town dominated by the oil industry on the eastern edge of the Rockies. Their parents were devoted Republicans who attended the national conventions for former presidents Richard M. Nixon and Gerald Ford.

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Back then, the Gosars’ lives were dominated by sports more than politics. Four of Grace’s brothers played on the University of Wyoming football or basketball teams. Thirty years later, the Gosar Family Walk-On Award is still bestowed upon the university’s top non-scholarship football player. Grace was a track star, running 800 meters and the mile at the university.

Most of the children settled within a few hours’ drive of Pinedale. Paul, attracted by the warm climate, started a dental practice in Arizona. But they all gathered for summer reunions at their parents’ home, a modest one-story house that sits on a lot scattered with broken-down campers, a rusted tractor and dilapidated snowmobiles.

Dave, an attorney and the best man at Paul’s wedding, was the first to cut ties with his brother following one of Paul’s 2010 fundraising visits to Wyoming. Just before Paul left town, he mentioned that President Barack Obama probably wouldn’t be eligible for a second term because he wasn’t born in the United States.

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Dave was already peeved at his brother for ignoring him during the visit. Now he was furious.

“My exact quote to him was, ‘You’re a f---ing birther?’ ” Dave recalled saying. “ ‘You have got to be kidding me!’ ”

A few months later, Paul, part of the tea party backlash to Obama, won his first election by promising to repeal the Affordable Care Act, cut government spending and crack down on illegal immigration.

Grace accompanied their father to Washington for Paul’s swearing-in as a congressional representative. Paul was more conservative politically than she had expected. But she held her tongue. “It wasn’t about me,” she said.

Over time, though, political arguments began to dominate the siblings’ summer gatherings. In the fall of 2015, Paul boycotted Pope Francis’s historic speech to Congress because the pontiff planned to discuss the dangers posed by a rapidly warming planet. “When the Pope chooses to act and talk like a leftist politician,” Paul wrote, “then he can be expected to be treated like one.”

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Paul’s siblings drafted a letter condemning their brother but didn’t send it after his eldest daughter, their niece, warned them that it would tear the family apart.

Trump’s rise led Paul to sharpen his positions, particularly regarding immigrants. He cited erroneous statistics to argue that recipients of the Obama-era Deferred Action for Childhood Arrivals program, also known as “dreamers,” were prone to crime and accounted for 30 percent of all kidnappings in Arizona.

He asked the Capitol police to deport any dreamers attending the State of the Union as guests of Democratic lawmakers.

“Of all the places where the Rule of Law needs to be enforced, it should be in the hallowed halls of Congress,” Gosar wrote. “Any illegal aliens attempting to go through security, under any pretext of invitation or otherwise, should be arrested and deported.”

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For Grace and her siblings, the final break came in the summer of 2017, when white supremacists descended on Charlottesville, provoking a violent backlash that, police said, led to the death of a 32-year-old woman. Without evidence, Paul suggested in an interview with Vice News that George Soros, a billionaire investor and liberal donor, had funded the riots. He then falsely accused Soros, who is Jewish, of turning in his own people to the Nazis during World War II.

“This is a matter of right and wrong,” Paul’s siblings wrote in a letter published in the Kingman Daily Miner, a newspaper in the congressman’s district. “Our parents are 87 and 83 and we would be outraged if some sleaze did to them what Paul shamelessly did to Mr. Soros.”

Through his chief of staff, Paul cast his brothers and sisters as “hate filled” and urged them to return to the “once-accepted norm that families, neighbors and countrymen can disagree without questioning the other’s character, integrity and motives.”

For now that seems unlikely. A few days before his siblings sent the Soros letter, Dave started a Twitter account for the sole purpose of denouncing his brother. “If you had any guts or decency you would apologize for your despicable, anti-Semitic, loony tunes allegations,” he wrote in his first tweet.

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As the months passed, Dave’s tweets grew angrier and more personal. Within a matter of weeks, he began referring to Paul as “Weasel,” a hated high school nickname.

“He really loves the name and it fits perfectly,” Dave tweeted in December 2017. “Your family despises you, Weasel.”

Some days, Dave relished the pain he imagined that he was inflicting on Paul, who he believed was hurting so many others. And some days Dave wondered if he was becoming a bully himself.

“I know from being a lawyer that when you are angry — and you present that — it’s not effective,” he said. “It’s destructive to me.” By this point, he had logged nearly 1,700 angry tweets.

Grace knew a different version of Dave, and she was reluctant to criticize him for his tweets. Dave was the brother who had taken off work and traveled with her to Houston’s MD Anderson Cancer Center when her tumors had stopped responding to chemotherapy and she was hoping for a spot in a clinical trial that might save her life. He helped her apply for disability.

It was a few days before Christmas, and Dave was home in Jackson, Wyo., reading the news and tweeting. A federal judge in Texas had just struck down the Affordable Care Act. “C’mon, Weasel,” he wrote. “Be happy that this decision might deprive your sisters of coverage for serious health conditions.”

Where Dave railed publicly against his brother, Grace headed off to the clinic to treat those who she believed were most hurt by Paul’s policies. And where her brother told Paul everything he thought of him, she had decided to tell him nothing about her worsening condition.

On a recent Thursday, the waiting room at the Downtown Clinic was filling with people waiting to see Grace.

Pete was waiting by the front door, where he greeted each of the patients by name — a small way he sought to remove some of the stigma associated with charity care.

Before Pete was hired as the clinic’s executive director in 2015, he had been a social studies teacher, a commuter airline pilot and the chair of the state’s Democratic Party. In 2014, he ran unsuccessfully for governor. Paul had never asked to see the clinic, and neither Grace nor Pete had invited him to visit it. They weren’t sure Paul even knew they worked there.

“How is the sleep apnea?” Pete asked Nick Beumer, 42, who came to the clinic four years ago with untreated diabetes and depression.

“Better,” Nick replied.

“You look great,” Pete said. “Grace is going to be so pumped to see you.”

About half of the clinic’s patients, like Nick, worked part time and were battling severe and chronic health conditions. The sleep-apnea program, which had helped Nick shed 50 pounds, was Grace’s innovation, clinic staffers said. Through calls to hospices, she found families willing to donate sleep-apnea masks of deceased loved ones. Pete secured donations from a nonprofit organization, and one of the clinic’s nurses recruited a volunteer respiratory therapist from her church to help treat the patients.

In its best moments, the clinic demanded a creativity that was more rewarding than a traditional practice. “It’s like solving a medical Rubik’s Cube,” Grace said.

In its worst moments, the clinic revealed inequities that seemed absurd and even cruel. In the waiting room, a clinic staff member was helping a 36-year-old man fill out his intake form. The man, who had come in with his dog, had been a clinic patient for several years, but his background was hazy. He struggled to speak or read. His parents, he said, had been killed in a car accident.

“How often do you feel down, depressed or hopeless?” the staffer asked him. He looked blankly at her. “Do you feel sad?” she clarified.

He flashed a thumbs-up to indicate that he felt fine and after a few more questions headed back to the exam room, his dog trailing behind him.

Out front, Pete greeted a 62-year-old man who had come to pick up his diabetes medication. Even though the temperatures had plunged into the teens, he was wearing only a Windbreaker and torn gloves. Pete pressed the man to go to the local soup kitchen.

“I only go if I’m desperate,” the man said.

These men would never find jobs with health benefits, Pete and Grace knew. If voters and lawmakers spent a day at the clinic, Pete was sure they would demand a more humane system.

“They haven’t been touched by it,” he said.

By Pete’s reckoning, Paul was one of those who hadn’t been touched.

These days, though, Pete doubted he was reachable. There was a time, only four years ago, when their relationship wasn’t so strained. In 2014, when Pete was making his long-shot run for governor, he joked in the Casper, Wyo., newspaper that his eldest brother was a conservative because he never had to wear hand-me-down clothes.

“We’ll keep working on him,” Pete had said then.

“He is a good man,” Paul had replied, back when their disagreements were merely over policy. “He is my brother!”

Back then, whenever Pete was in Washington, he and Paul would meet for dinner or a drink. Pete didn’t appear in the campaign ad with his other siblings, but he signed the 2017 letter calling on his brother to apologize for the Soros remark. Somewhere along the way — he wasn’t sure when — he and Paul had stopped speaking.

Initially, Pete said it didn’t make sense to invite his eldest brother to the clinic. He didn’t have time for “desperate” acts, he said. But, after stewing overnight on the question, he decided it was his responsibility to do everything he could to advocate for his patients. “There’s nothing to lose,” he said.

He wasn’t sure how Grace, whose anger was rawer, would feel about inviting Paul to the clinic. Maybe, he said, he would try to schedule a visit on a day when she was off. As of mid-January he still hadn’t called Paul.

In one of the ads she made for Paul’s opponent, Grace was sitting in what looks like the hallway of a bustling hospital talking about the random nature of “tragedy and illness” and her own terminal disease.

“When I began in medicine I didn’t believe — I did not believe — health care was a right,” she said in the ad. “I couldn’t be but 180 degrees from where I started.”

A few weeks after the ad aired, Grace and her husband sold their home to pay for her care.

Her insurance company, United Healthcare, had stopped paying for the infusions of the drug Avastin that were keeping her alive. First, they told her, the Food and Drug Administration-

approved drug was “not medically necessary,” she said. Then they insisted that it was “experimental and investigational.” Now the company was saying she owed nearly $200,000 and counting.

Sometimes she berated herself for crying at her fate because she knew that so many of her patients had it worse. There was the mother of three with advanced colon cancer. A few days earlier, Grace had been shopping at Goodwill for ugly Christmas sweaters when she saw a collection jar on the counter for the woman. The woman and her husband earned slightly too much to qualify for Medicaid. So, they took the money from the jar directly to the hospital to pay down their bill, Grace said, “because they know if that goes away, she’s not living.”

She thought of the 49-year-old man who had walked into the clinic one day earlier in torn socks and no shoes. He was several hundred pounds overweight. What he really needed was a surgical specialist to close the wounds on his feet. Without such care, his sores would just get larger and eventually doctors would have to amputate. Grace prescribed antibiotics — the best that she could do for him for now.

It was a Friday afternoon, and the clinic was closed to patients. The staff gathered around a folding table in the clinic’s makeshift pharmacy for its end-of-week meeting. Grace had been hospitalized one week earlier for surgery to open an obstruction in her kidney. She hoped the blockage was just scarring, but “everyone surmises that it’s probably the cancer,” she said.

For now, though, she was healthy enough to work and planning her schedule for January and February. She spent her weekends with her husband and daughter in Buffalo, Wyo. — about a four-hour drive away — and her weekdays in Laramie at the clinic. She took time off for her cancer treatments and her daughter’s high school basketball games.

Her illness, she said, had been a “personal earthquake . . . a seismic event where everything is interrupted and demolished at the same moment.

“You go from problem solver to a problem; from asset to liability; from well to sick; from financially stable to precarious; from a member of the community that is regard-able to someone who is forgettable; from thinking about a life when you’re no longer available for your kids to doing crazy-ass things like driving four hours to work for something that seems like your only opportunity.”

She missed seeing her husband and daughter back home in Buffalo. But she needed the clinic. It was a place where she could still practice medicine, still do good and still fight back against the forces she believed were making the country meaner, angrier and more divided. Those forces included her brother Paul.

“I feel like it’s an affliction,” she said of the alarm she felt for the country and the anger she felt toward her brother. “What can you do but try to hold the line in the best way you can against the awful he represents?”