On a snowy late-winter night in Lexington, Kentucky in March 1964, a doctor's wife unexpectedly goes into labor, and he has to perform the delivery himself in his own office. Twins are delivered - a healthy boy, and a girl who clearly exhibits Down's syndrome. Believing that it's in everyone's best interests, the doctor asks his nurse to bring the baby girl to a home for the mentally impaired. She complies, but can't go through with leaving the baby there once she sees the institution - instead, she keeps the baby herself and moves away to raise her. Meanwhile, the doctor tells his wife that she delivered twins, but one was stillborn. The Memory Keeper's Daughter is the story of what happens to these characters over the subsequent 25 years.
This is a story founded on deceptions and secrets - one that sets the stage, and another hinted at but not revealed until much later. The central one wouldn't even be possible now, but in 1964, prior to natural-childbirth practices and "mainstreaming" of the developmentally disabled, it was entirely possible to tell a woman her mentally-retarded baby was stillborn and send it away without her knowledge. Dr. David Henry asks his nurse, Caroline Gill, to deliver baby Phoebe to an institution in an attempt to shield his wife Norah and allow her to concentrate on the "surviving" twin, Paul, but this lie and Norah's grief for her "lost" daughter are the first steps down a road that will fracture the remaining family. Meanwhile, Caroline raises Phoebe mostly on her own in Pittsburgh, fighting for opportunities for her "daughter" to participate in life as fully as she can, and periodically corresponding with David and receiving money for his daughter's support without actually letting him know where they are.
Intimacy and honesty, and how lack of one can inhibit the growth of the other, are central themes in this novel. Because David has lied to Norah about their daughter's "death," he cannot fully empathize with her grieving that loss, and Norah's feelings about that loss complicate her relationship to her remaining child, Paul. As time passes, the Henrys become a family that travels in divergent directions and cannot talk to each other; David has his work and a serious photography hobby, Norah finds work of her own and eventually owns a successful travel agency, and Paul's youthful anger and restlessness are channelled into his music and a budding career as a classical guitarist. On the other hand, Caroline's relationship with her husband Al is one of more physical than emotional distance - eventually she tells him everything about how she came to be raising Phoebe, but he's a truck driver and just not around much except on weekends.
This is a novel definitely more driven by character than by plot. The secrets the characters in this novel hold are the only real elements of suspense, and they keep them at arm's length from each other. While I felt that the story was very moving, with real and sympathetic characters, I felt a bit distanced from them myself as a reader, and that was a little frustrating. But it was well-written, and I liked the narrative structure as chapters moved among the major characters at five-year intervals.