By Kim Edwards

Viking. 401 pp. $24.95

My first daughter was born lifeless and gray-blue. "Like a seal," I remember thinking as the room went bright white and the doctor started suctioning her mouth. I pushed my wife's head back onto the pillow so she wouldn't be able to see the slick form down below. The oxygen tank hissed angrily. In the minutes that followed, as we waited and waited for my daughter to cry, all the hopes we'd stored up were suffocated under the weight of our new future that filled the room with fear.

Mercifully, few parents experience the shattering birth moment we did, and it may be that memories of my daughter's birth magnified the emotional impact of Kim Edwards's debut novel. But I think anyone would be struck by the extraordinary power and sympathy of The Memory Keeper's Daughter. The book opens during a snowstorm in Lexington, Ky., in 1964, when Norah Henry realizes that she's going into labor. The weather keeps her doctor from making it to the office in time, but her husband, David, is an orthopedic surgeon with enough experience to handle the situation. Under the partial influence of gas, Norah gives birth to a healthy baby boy, but as David tells her the happy news, another series of contractions begins. He quickly sedates his wife again, and she gives birth to another child, a girl with Down syndrome.

"Later," Edwards writes, "when he considered this night -- and he would think of it often, in the months and years to come: the turning point of his life, the moments around which everything else would always gather -- what he remembered was the silence in the room and the snow falling outside." In that quiet, terrifying moment, the grief and resentment caused by his sister's death at the age of 12 washes back over him, and he acts to preserve their vision of a happy future. He hands the baby to his nurse and asks her to take it to a home outside the city for handicapped children. When Norah awakens a few minutes later, he tells her their second baby was stillborn. "He had wanted to spare her," Edwards writes, "to protect her from loss and pain; he had not understood that loss would follow her regardless, as persistent and life-shaping as a stream of water. Nor had he anticipated his own grief, woven with the dark threads of his past."

Edwards has trouble maintaining the electrifying atmosphere of this long opening scene, but David's fateful decision that night is enough to power the novel through the next 25 years. The story runs along parallel tracks that don't converge until the very end: The first follows the picture-perfect Henry family, three healthy, talented people separated from one another by the secret that only David knows. The other track follows David's nurse, Caroline, who couldn't bring herself to follow his instructions that night. Instead, she left town with his baby, struggled through a series of part-time jobs, battled an unresponsive school system and managed to hammer out a joyful life.

As a single mother at a time when special-needs accommodations are unheard of or considered naively radical, Caroline would seem to have a far more difficult path to travel. Edwards does nothing to minimize or romanticize that struggle, but Caroline makes her humble way in the world through sheer determination and with the help of like-minded activist parents who are beginning to argue that children with disabilities should be raised at home and attend regular schools.

Those two sets of lives make for a thought-provoking contrast, a study in what really determines a family's happiness. With a successful, lucrative career, David can give his wife and son everything, except candor. As Edwards points out -- probably too many times -- the effort to conceal what he's done with their daughter poisons the atmosphere of their home with a colorless, odorless gas of deception. David throws himself into photography, a poignant attempt to freeze perfect moments and crop life just as he wants it. Barred from her husband's heart, Norah turns to alcohol, then to a series of affairs, trying to deaden or distract herself from a sense of loss she can't fully understand.

Some ominously saccharine moments indicate that Edwards can slip into the treacly trade -- "The love was within her all the time, and its only renewal came from giving it away" -- but these gaffes are relatively infrequent, especially considering the presence of a handicapped character, who would, in less disciplined hands, be used to generate a waterfall of sentimental tears.

The episodic structure allows Edwards to survey these two families through the '60s, '70s and '80s, but frankly she's best when she moves slowly. The middle section skips through the years, obscuring the characters behind Significant Historical Moments: Women's Lib, Vietnam, Disability Rights. The novel begins to look as though it's been planned by a divorced dad: Every alternating weekend encounter has to be packed with a major activity. This structural tendency may be the effect of Edwards's experience as a short story writer. We drop in on these characters only on important days -- separated by years that included all the minutiae of real life. They're reduced to saying things like, "The last few years have meant so much to me." I kept thinking, No, show the true nature of these people on a few ordinary days.

Edwards is entirely capable of doing that, as the opening and closing sections of her novel show. This tragedy of a man who thinks he can control how lives are redirected is as moving as the story of his nurse, who knows that her love can bless a damaged life. In the end, it's not just that David made a mistake in a moment of crisis; it's that he never realized that parenthood is an infinite series of opportunities for redemption. Years after the choice he could never forgive himself, for, as Caroline tells him, "You missed a lot of heartache, sure. But David, you missed a lot of joy." Readers of The Memory Keeper's Daughter will find ample stores of both. *

Ron Charles is a senior editor of Book World.