It began with a discarded snakeskin --a sign, a portent, a harbinger of change --and with a spouse's midlife crisis. One spring the author's husband awoke to his midlife discontent, and ten months later, despite her resistance, the couple had left their comfortable home on a mountain in western North Carolina, and were living in Accra, a bustling African city known for its poverty, pollution, and congestion. Outside My Skin tells the story of the author's detour year in Ghana, as the "trailing spouse," to her husband who had taken a job with the US Peace Corps. She arrived dragging her feet, still attached to the life she had left behind and anxious about losing her professional identity as a pediatrician. In the course of that year she grappled with one of the crucial tasks of midlife development--that of learning to let go, and she discovered a rhythm, a spiral path for midlife personal growth: Molt, Stretch, Breathe, Repeat... The phases of that spiral rhythm provide the organizing themes for the four parts of this memoir. In Part One, Molt, the author shares her reluctance to embark on the journey, her growing insight into the spiritual challenges of attachment and detachment, and her discovery of her own need to break out of the confines of her comfortable midlife. Part Two, Stretch, reveals the challenges she encountered in Ghana, including an ill-fitting role in her marriage, a new cultural setting; her complex status within that post-colonial culture; the poverty and pollution of Accra's urban environment as the setting for her new home; an obscure process for obtaining a Ghanaian medical license; and the resource-limited settings where she eventually practiced pediatrics. Part Three, Breathe, describes a restorative retreat, the months the author spent away from her husband, alone at her North Carolina mountain home, coming to a gradual awareness of her readiness to move on to a new stage of life, and to a freer form of marriage. In the Afterward, Repeat, the author provides a brief look ahead at the spiral cycles of molting, stretching, and breathing that have continued to expand her life. The detour year was a gateway year that led to further journeys, to be told in further books--about Ethiopia and Moldova, and about her eventual retirement from the practice of medicine.