The narrator is an ICU (intensive care unit) resident. He describes his encounters with three patients: a 23-year-old woman, Kimberley, shot in the head by her fiancé before he killed himself; Mr. Wilson, the alcoholic into whom Kimberley’s liver is transplanted after she has been declared brain dead; and Mr. Griego who, in a failed suicide attempt, has shot off his lower jaw.

In the call room there is a poster that reminds the doctor of a lake in Vermont where his family had vacationed when he was a child. The lake, alive with fishes, had filled the boy and his brother with expectation: "We wanted something to happen, we wanted it to come gliding out to us, miraculous, powerful, full of wonder." (p. 56)

When the resident’s thoughts are interrupted by Mr. Griego, who has leeches attached to the wound where his chin is being constructed, his recollections shift to another lake. Overgrown with algae, it had insufficient oxygen, no fish, and when he and his brother swam in it, they emerged covered with leeches. He recalls the violence with which his brother tried to kill one of the creatures, pounding it with a rock. The lake had become "repugnant" but also "exciting."

These memories are juxtaposed with Mr. Wilson, who has Kimberley’s young liver in its new, "damaged bed." The resident finds himself withdrawing from Mr. Wilson, whom he imagines as a ghost that has haunted Kimberley’s life, drinking it away, or as a kind of monster rising up from beneath the surface of a lake.

The resident is called out a third time, to transfer Mr. Griego to the floor. The leeches have been removed and killed and his chin is healing well, looking both "clean and terrible." His new face will scare his little daughter, the resident thinks.