The novel opens with a letter from the father of protagonist Will, addressed to his mother, and sent from Edmonton, Alberta when Will was a child. Will’s father expresses how he misses Rose, Will’s mother, and his two sons, Will and James. Will does not remember his father, and views him as a selfish person who abandoned his family when Will was very young. While in the Will developing some photographs in his studio, when his friend Harlen Bigbear comes in and invites Will to lunch. Having recently moved back to Medicine River, Alberta, a town that sits below the Rocky Mountains and beside a Blackfoot reservation, Will is confronted with his past regularly. He describes the weather of Medicine River as never good, but worst in the winters and summers.

At the restaurant, Harlen gives Will a stack of old letters from his father, noting how he got them through a long chain of townspeople. Will and Harlen discuss the past, and Harlen recalls how Will’s mother, Rose, was treated poorly by her family when she married Will’s father, who was white. In addition, because of the Indian Act, Rose was forced to leave the Blackfoot reservation permanently, and so she settled in nearby Medicine River.