One of the preoccupations of a memoir -- and one of the form's strengths -- is its attempt to account for the narrative self: whence the "I" on this page? For Mary Jane Nealon, who takes up this project quite directly in "Beautiful Unbroken: One Nurse's Life," the question is interrogated across the full span of life and the full range of this country, from early childhood to the almost-present, from New York to Hawaii, as the author eventually embraces who she is -- and what she can and can't do.

Inspired by stories of saints from an early age, Nealon writes, "I started to imagine that I was uniquely qualified to save the world." She follows this calling to nursing school, but during her first year there her brother learns that he has a rare abdominal tumor. His body is pulverized by chemotherapy and radiation. When, after a brief remission, the cancer returns, Nealon faces what will prove a defining choice: "I tried to hold on to the heroic fantasy that had sustained me most of my life. After all, I was a graduate nurse now, waiting for my license. Maybe I could find a way to save him. Maybe. But I also felt the need to flee."

Deciding to "flee" to a nursing job in Virginia as her parents and sister cared for her dying brother becomes the source of the immense guilt that will plague Nealon.

The story follows her through a series of nursing positions -- most significantly, with early AIDS patients in New York -- and a lifetime of intimate relationships. No matter where she goes, though, or who she cares for, or who she bonds with, the guilt inside her lingers. And even as she writes, "I might be able to undo the sin, the great sin of having abandoned the person I loved the most, when he needed me the most," Nealon knows there's no undoing the past. And so she proceeds, caring for her patients and, when the time comes, each of her dying parents. Parallel to the deaths that pile up around Nealon is the poetry that helps sustain her. "I knew there were people all over the world who lived without poetry, but I didn't know how."

In fact, it's for her poetic sensibility as much as for her story (which will be thematically familiar to most memoir readers) that "Beautiful Unbroken" succeeds. The lyrical flourishes occasionally overreach, but when they hit their mark they hit it true: "The ocean's waves mirrored our breathing, ceaselessly in and out, unconsciously in and out, and yet within its powerful life, as in our own bodies, death was in every wave."

Scott F. Parker is co-editor of "Coffee: Grounds for Debate." He lives in Minneapolis.