Pearson is the author of the book and its main character. She was raised in a tightly knit, working-class family. Her mother was college educated, but her father was not, which makes him both self-conscious and determined that Pearson receive a college education. Pearson initially wants to be a writer and enrolls in a creative writing program at a university in New York. After spending a summer working in an abortion clinic, her perspective on the nature of stories and their meaning changes. The stories in the clinic feel more real and vital than anything she can create. She decides to attend medical school and enrolls at a university in Texas.

As Pearson progresses through her medical education, she relates stories of her successes, failures, doubts, and fears about both her profession and her own capability as a physician. She also struggles with questions of her identity. She still considers herself a writer, but in her profession, anyone with interests outside of medicine can be seen as someone who is not taking the practice of medicine seriously. Early in the book, she says that studying in medical school obliterates the world. Living only for medicine would have a similar effect on her, so she continues to investigate various medical specialties as potential career paths and never gives up on the idea of writing again.