Elizabeth Strout, author of four previous novels, including the Pulitzer-winning "Olive Kitteridge," moves entirely away from New England to place "My Name Is Lucy Barton" in New York City, with flashbacks to small-town Illinois and a writers' conference in Arizona.

The pivot around which the novel turns is a hospital room, its seclusion serving both as a type of limbo and a place of reckoning for Lucy Barton. When we meet her it is the 1980s; she is in her mid-30s, a wife and mother of two little girls, and is now confined to a New York hospital with a lingering illness. Three weeks into her stay, her estranged mother arrives from Illinois and the result is a five-day, daughter-mother excavation of what would have been a shared history if memory didn't obfuscate as much as it chronicled.

Lucy grew up with her parents and two siblings in dire poverty, despised by the townspeople and beset by the destructive behavior of a mercurial father traumatized by war. Her story, told in her voice, is built on an architecture of memory, episodes from her past incorporated as they occur to her.

As Lucy assembles key elements of her life, we are put on notice that what we are reading is a story she's writing many years hence and that she is being selective. She will not — she says — talk about aspects of her marriage, though at the same time she keeps bringing them up.

The novel wobbles toward a meditation on the nature of fiction, most especially in addressing the problem that afflicts writing, as it often does life: the inclination to hold back or cover up things to protect others or oneself.

The baldest, one might even say dogmatic, expression of these ideas comes from a writer, Sarah Payne, with whom Lucy has taken a seminar. Payne takes up the role of instructor in this book, not only for Lucy but intrusively for the reader, even going so far as to tell Lucy — and us — what the story we are reading, is "about." This self-conscious, metafictional element dissolves the life from the novel, as does Lucy's isolation from the world by virtue of her confinement in a hospital room. The events she describes, parceled out as memories and presented from a retrospective, writerly distance, take on the character of exhibits and grist for the mill. Gathered together, they never achieve the integrity of a story.

Katherine A. Powers reviews widely and is the editor of "Suitable Accommodations: The Letters of J.F. Powers, 1942-1963."