This is a tough book to rate/review. I thoroughly enjoyed most of it, but was really put off by the ending. After thinking it through some more, I think I have a decent sense of what happened, but if you are not a fan of ambiguity, you'll probably want to avoid this. 
 Ishiguro is a great author, probably known most for Remains of the Day and Never Let Me Go (two nearly perfect novels). A Pale View of the Hills is his first novel, and I think his inexperience shows a bit. The first-person account of Etsuko, a Japanese woman living in England, is very poignant at times, even on a surface level. But Ishiguro is weaving multiple timelines and story threads together, and a seemingly simple story becomes dizzying and complex before long. Spoilers below. 
 (view spoiler)[So the story remains pretty straightforward up until the last chapter or two, where Ishiguro seems to reveal a BIG TWIST. When I read this, I had no idea what to think. Then I read some comments online, and still had no idea of what really happens here. Some people theorize that Etsuko is a child murderer or that she and Sachiko are the same person. Both of these twists would be pretty cheap if they were literally the case. But I don't think they are. 
 Most of the novel consists of matter-of-fact scenes where Etsuko interacts with people from her past or present. Most of these scenes are fairly mundane, but have the weight of both the past and the future to give them added emotional depth. To think that the whole sub-plot with Ogata-San, for example, would be part of the same story where Etsuko is a child murderer is completely absurd. If this is a twist, it trivializes about 90% of the story. 
 Instead, I think that Ishiguro is using the fact of Keiko's suicide and the unreliability of Etsuko's memory and narration, to create a dream-like version of the past. In this past, Sachiko and Mariko's story is so heavily colored by Etsuko's own experiences of leaving her husband and Japan, that we are unable to distinguish what really happened to either woman. Furthermore, Etsuko's self-inflicted guilt over having caused Keiko's suicide (by moving from Japan and leaving Jiro) manifests itself literally in this dream-narrative-remembrance as the rope which tangles around her ankle. So every time she approaches Mariko and tries to help her, the child runs away in fright. In the remembrance, she carries the physical burden of the murderer, because her actions, in her mind at least, are leading to Keiko's eventual suicide. 
 So this is a fascinating concept in theory, but in actual practice it's far too ambiguous to be very satisfying to the reader. I think that Ishiguro was a little over-ambitious for a first-time novelist, so he didn't quite pull this off as well as he might have (and as he has admitted in interviews). But it makes a compelling novel and source of discussion nonetheless. (hide spoiler)]