In the Arctic, winter goes on for ten months every year. The cold temperatures penetrate every aspect of human life. Existence is a struggle. In the Canadian community of Rankin Inlet, an Inuit woman finds personal tragedy as abundant as the snow. Victoria is diagnosed with tuberculosis (puvaluq) as a child and sent to a sanatorium far south of home. Following treatment with medication and a thoracoplasty, she returns to her town years later. Victoria's experience has changed her view of the world but she quickly discovers that in her absence, the people and locale have transformed too.

She marries an outsider, John Robertson, who is a British businessman. His success and local influence allow him to arrange for a foreign-owned diamond mine to open in the area, and with it, a new hospital for the territory. The couple have three children - a son, Pauloosie, along with two daughters, Justine and Marie.

Victoria seems a magnet for misfortune. At age 16, she has a miscarriage. A fourth child dies during a complicated delivery. Her marriage is increasingly strained beyond repair. Victoria's father suffers a stroke and becomes demented. Her mother dies of lung cancer. Husband John is murdered - someone slits his throat. Marie commits suicide. Pauloosie leaves home and sails to the South Pacific.

The Robertson family frequently interacts with the American primary care physician stationed in the isolated region. Dr. Keith Balthazar is a middle-aged atheist who has toiled in the Arctic for more than 20 years and abuses morphine. He keeps a journal of his experiences and meditations and commiserates with the local priest, Father Bernard.

Escape appears to be the best chance at happiness. For Victoria and most everyone else living in this harsh and beautiful land, survival - both physical and emotional - is hard. Personal choices are confusing. Nature doesn't seem to care one way or another.