During a Kentucky winter storm in 1964, Caroline assists in a home birth for Dr. David Henry and his wife Norah. She delivers twins, one healthy boy named Paul, and a baby girl with Down Syndrome. David wants to spare Norah the pain of raising an ill child, so he tells her the baby died and asks Caroline to take the baby to an institution.
After seeing the terrible conditions at the institution, Caroline decides to raise the baby herself in Pittsburgh and names her Phoebe. David continues to lie to Norah while Caroline sends him letters and pictures of Phoebe throughout the years.