The novel's narrator, Peggy Cort, tells the story of James's life, his growing up, and her relationship with him. She herself is estranged from her family, lonely, and depressed, although she handles this with a biting and self-deprecating wit. Readers should not be put off by this--in the end, Peggy does find connection and peace in spite of James's death.

This quirky Flannery O'Connor-esque love story provides a window for considering conceptions of normalcy and how society at large--and medicine as well--copes with those with "freakish" conditions. One chapter toward the end of the novel ("His Heart Shares in His Proportions") offers a disturbing portrait of a doctor who visits to study James's case, and whose subsequent article in JAMA [Journal of the American Medical Association] diminishes James with its dehumanizing, insensitive, and critical language: "Dr. Calloway described James physically piece by piece. . . not liking a single detail. . . . Here was a catalogue of his every part by a man who would not know a metaphor from a semaphor, and it was so ugly I could barely read it."