This is a story of curdled bitterness. One of the main characters tears his family in two and creates a gaping wound that doesn't heal until several decades later. A tale of "twins separated at birth", The Memory Keeper's Daughter explores how the secret complications of that separation affect all the members of the two families that raise these twins.
I appreciate her depiction of Down's syndrome in the '60s and '70s, as well as the challenges that parents of children with Down's syndrome faced, particularly in securing education and accommodation for their children. As someone who hasn't had much experience with Down's syndrome, I can't attest to Edwards' accuracy, but I think she got the emotional resonance down.
Often the conflicts in these books seem contrived and forced; that seldom happens in this story. The characters and their motivations seem real--irrational at times, sure, but that's because they're human. The relationships are a realistic, as is most of the plot, which is aided by creative license only when required to keep the story moving. Edwards makes me care about Caroline and her adopted daughter, Phoebe. She makes me resent David's actions and question whether Nora is really devoted to her son, or if every time she looks at him she's reminded of the daughter she "lost".
About two-thirds of the way through the story, another character, Rosalie, is introduced. I disliked this subplot, finding it somewhat random. In hindsight I understand Rosalie's purpose, of course, in that Edwards needed a way for David to become a father again and eventually decide to tell his family about Phoebe. But this is the only part of the book that feels contrived, which was disappointing in light of how good it is otherwise.
A moving story, I'd recommend this to others and read it again.