Victoria Alexander, . . Permanent, $24 (208pp) ISBN 978-1-57962-078-3

Alexander (Smoking Hopes) takes on a gut-wrenching topic in this ambitious but uneven second novel, which tells the story of a Texas woman who returns home to care for her dying father and faces a profound dilemma when he asks her to help him commit suicide. Hali is helping her father, Dave, in his battle against throat cancer, a fight that seems winnable when his chemotherapy works and the cancer goes into remission. But Dave's respite proves brief, and when the cancer begins to advance again, Hali knows the request her father will soon make. At first, the plan seems simple: Hali and Thomas, one of the two nurses who provide round-the-clock home care, will administer a lethal but painless mix of morphine, alcohol and other painkillers. But the first hit of morphine fails due to Dave's tremendous resistance to the drug, the other nurse begins to suspect euthanasia, and their plans go dangerously awry. Alexander writes eloquently about the family's daily emotional pain, but the flashbacks describing Dave's alcoholism and violent treatment of his children are overfamiliar. The major flaw here is the lurid, macabre ending, which involves the attraction between Thomas and Hali, a climax that seems barely believable given Alexander's portrayal of Hali's satisfying marriage to Seth, a sensitive artist who, like Hali's two older sisters, remains an undeveloped character. This unsatisfying conclusion overshadows the book's strengths. (Dec.)