This thoughtful novel brings up a problem all of us have to deal with in the course of our lives, unless we're lucky enough to sneak through existence without encountering misfortune of any kind. We all like to think that we're decent people, surrounded by people of equally good character. We're fond of telling those in trouble, "Remember, I'm here for you." Or, "If there's anything I can do . . ." We say these things and hear them all the time, and yet the world is full of folks who can't or won't be there for us. And we don't find that out until we look to them for help and all we see is a big empty space. Worse yet, sometimes those missing persons turn out to be us.

"Pictures of You" focuses on two families that manage to meet in the worst possible way - through a fatal car crash. April and Isabelle, two wives in their 30s, who live six blocks away from each other, happen to choose this particular day to run away from their marriages. Isabelle is justified in her decisive departure; her husband's girlfriend has just called her up and announced that she's pregnant. But April's story is a little more murky. Her son, Sam, who is 9 and has severe asthma, is in the car with her at the time of the accident. She brought a suitcase for her but not for him. And after the accident, Sam won't talk about what happened on the morning before his mother died.

The day was foggy, the road deserted, and April's car was stopped and pointed in the wrong direction when Isabelle ran into it. But their small-town newspaper has a field day describing the event, and Isabelle is portrayed as the next-best thing to a murderess. Isabelle finds herself back in her Cape Cod home town, while Luke - that philandering husband of hers - has it both ways, keeping up relationships with his girlfriend and his wife.

Isabelle is traumatized. She's terrified to go out in public because of the contemptuous looks she gets. She can't bear to get into a car. Above all, she can't come to terms with the fact that she's taken a human life, however inadvertently. Then, as the weeks and months slowly pass, she finds herself more or less stalking the remnants of the family she has accidentally destroyed - April's husband, Charlie Nash, and Sam, his young asthmatic son.

Asthma - and the complications of that or any other childhood disability - is a central theme here. Asthma has already taken a terrible toll on Sam's family. He's has been in and out of hospitals all his life; he's been in oxygen tents; he's been mercilessly bullied in school. April had been a devoted - if difficult - mom, doing everything she can to keep him happy and healthy.

Isabelle feels drawn to grief-stricken Sam, who somehow gets the impression that she might be an angel sent by God to reunite him with his mother. Charlie, his dad, is an extremely believable portrait of a man utterly paralyzed by life. He sleeps with Isabelle but won't say he loves her. When Isabelle gets a little cranky about the situation, he presents her with an untenable set of demands: He wants her to stay in town and be available to him, but he wants to keep their affair a secret. His excuse? Sam's illness. "How can I promise you anything? I just have to take things moment by moment right now. Please - we need you here. I need you." Like Isabelle's philandering husband, Luke, he's trying to have everything, without giving anything of his own away. The fact that he keeps his affection for Isabelle a secret from Sam (who's crazy about her already) is madness, but people do crazy things all the time. (And the plot hasn't even started yet.)

Leavitt had asthma as a child, and "Pictures of You" revolves around the trials that childhood illness presents to the adult world. What can be done? How can people help? The pages here are full of professionals who don't do their jobs, classmates who behave like monsters, and even Charlie, who's so afraid to do anything about his son that he may ruin Sam's life. But of course we know people try to do the right thing all the time, but often fail. This is a novel that invites us to look at our own imperfections, not the dramatic crimes, but the niggling little sins of omission that so often render our lives tragically undernourished and small.

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By Caroline Leavitt

Algonquin. 335 pp. Paperback, $13.95