After his divorce and a year of traveling the world with Doctors Without Borders, Orville Rose returns to his home town of Columbia, New York upon learning of his mother's death. He discovers upon his return that in order to receive the benefits of his mother's will he must stay in this "Hudson River town plagued by breakage" for one year and 13 days. What transpires over that time is the heart of this novel which includes Orville's love story with a single mom (who has her own physical breakage), a renewed relationship with his mentor, Dr. Bill Starbuck (the inventor of the cure-all Starbusol who leaves Orville to travel the world with his wife Babette, before returning to town to receive Orville's care as he dies), and the often hilarious account of Orville trying to care for the citizens of Columbia. Thrown into this mix of new and old relationships is the floating presence of his dead mother as well as the in-his-face presence of Orville's boyhood arch-nemesis who now is riding high in Reagan's "Morning in America" as Columbia's candidate for congress.