This novel tells the story of Dr. Wilbur Larch—saint and obstetrician, founder and director of the orphanage in the town of St. Cloud's, Maine, and a man of rare compassion and an addiction to ether. Dr. Larch loves all his orphans, especially Homer Wells, who is never adopted and becomes his invaluable apprentice. As Homer comes of age, he must leave the only home he's ever known to explore the world outside, a world filled with temptations and moral dilemmas, from the struggle over abortion to the question of what constitutes a family.

This novel follows the poignant journey of two teenagers, both cancer patients, who meet in a support group and fall in love. Their shared experiences and unique outlook on life and death bring them closer together, and they embark on a trip to Amsterdam to meet a reclusive author they both admire. Through their journey, they explore the harsh realities of living with a terminal illness while also experiencing the beautiful and tragic aspects of first love.

The novel follows the life of twin brothers born from a secret union between an Indian nun and a British surgeon in Ethiopia. Their mother dies during childbirth and their father disappears, leaving them to be raised by two doctors at the mission hospital where they were born. The story spans several decades and continents, and explores themes of love, betrayal, medicine, and the complexity of family ties. One of the brothers, a gifted surgeon, flees to America after a political revolution in Ethiopia, while the other remains and struggles with the challenges of practicing medicine in a developing country.