The latest novel from New York Times list-topper Susan Wiggs was more than 20 years in the making.

The Bainbridge-based author, with more than 50 published novels (even she’s forgotten how many exactly) to her credit, first clipped the article that inspired “Between You & Me” (on sale Tuesday, June 26 from William Morrow) decades — and a bunch of books — ago.

“It was kind of a sad article,” Wiggs said. “It was about a little boy in Amish country in Illinois … he suffered a terrible, devastating accident with a piece of farming equipment and the news story was about how they had to access the modern medical facilities in order to save this boy and this clash of cultures.”

It had a lasting effect on the author, though she remained uncertain what to do with the story for some time.

“I remember in the end I was very moved by it,” Wiggs said. “I sent a check, there was a bank listed that said they were taking donations, and so I sent a check and I got a handwritten note back from the dad and it was in very elementary, Palmer Method handwriting … I always kept that.”

The book utilizes a similar traumatic turn of events to focus on two characters and two very different struggles.

Caleb is bound by a deathbed promise to raise his orphaned niece and nephew in their insular Amish community, despite his long-held doubts about their ways and beliefs.

Reese is poised to join the medical dynasty of her wealthy, renowned parents, but though she thrives on the thrill of saving lives she is ultimately uncertain of her own true goals.

A devastating accident brings them into contact, and the ensuing culture clash and legal and moral tug-of-war that plays out in court and the hospital causes them both to reconsider their lives and priorities.

It’s a book with a clear main theme, according to the author.

“This is a book about choices,” Wiggs said. “The main character, the doctor … she thinks she has made her own choices, but over the course of the book she discovers that she has been kind of living life in her parents’ shadow. They created this medical empire and she’s meant to join a practice and be fabulous and renowned along with them, and she discovers, as much as she wants to want that, your heart wants what it wants.

“Reese’s storyline is about choices and Caleb’s storyline is about responsibility,” she added. “How much do you owe to your family? How much do you abrogate your own desires and your own goals and wants in order to fulfill somebody’s else’s plan?”

In the end, her latest novel surprised even herself, Wiggs said, as it became “very dramatic and very emotional.”

Wiggs published her first novel in 1987, and since then has become known especially for her strong, complicated central characters and strict adherence to realistic, research-gleaned depictions of their professions and specific locales.

“Between You & Me,” coming on the heels of her two previous instant New York Times bestsellers, “Family Tree” and “Map of the Heart,” is no exception.

Despite the years and books now under her belt, Wiggs said she’s still often surprised at the turns her work takes and is yet to tire of the rigors of upholding what is considered one of the most dependable brands in the so-called “women’s fiction” genre.

“It never gets old,” Wiggs said upon seeing an advance copy of her latest book for the first time. “By this time I have a pretty good idea of what I want the book to be, but you always have to stay open and creativity is such a strange thing … you’ll be writing along and suddenly your nature voice comes through and you’re saying something that you hadn’t planned. As I was writing this there were a number of surprises for me as well and that’s kind of fun; it keeps it fresh and emotional.”

About the genre label itself, Wiggs said she doesn’t give the idea of “women’s fiction” much thought.

“It is a category,” she said. “What they mean is usually fiction without a heavily male-dominated thriller component — or mystery component or crime component. It’s basically a story about characters in the middle of their life.

“I’m personally not a huge fan of it,” she added. “It’s just fiction.”

Bainbridge Island’s Eagle Harbor Book Company is offering discounted pre-sale copies of Wiggs’ new book. Order online at www.eagleharborbooks.com and enter coupon code “SUSAN” at checkout to receive 20 percent off a signed first edition copy. According to store officials, you can pick the book up at the shop or opt to have it shipped to you and specific inscription requests are accepted as well.