Vital Records is a record of a family, place, and other relationships in the deep South, seen from the speaker's point of view. The speaker recalls family events and experiences, some about her parents before she was born, and others directly experienced and related from her point of view. From the beginning poem about how her parents met to what it was like to grow up with them as parents, the poems capture emotional moments with considerable license and imagination rather than literal episodes. A key event in the family's life is the birth of a disabled child and its effects on especially the mother and her relationship with her husband and with other children. Anyone who has had a disabled family member will understand the power of the grief that colored everything that came after. After deciding to place the child, severely disabled, in a residential home, the mother lived all her life preoccupied with that grief, affecting everything and everyone. Another significant dynamic was the cultural differences in the parents' backgrounds, including religious differences, that set the stage for conflict and compromise. One other highly significant event was the murder of the speaker's paternal grandmother, which is the focus of the final poem in the book.