Edgar Freemantle is a millionaire, having made his fortune in construction. He has a happy marriage and two lovely grown daughters. But his contentment changes in one moment when a 12-story crane crushes his truck, along with himself, at a job site. The accident shatters his hip, breaks his ribs, damages his vision and costs him his right arm. Edgar’s head injury impairs his brain to the point where he doesn't know his own family members, scrambles his speech and is unable to remember what happened. His frustration fuels his rage, and he turns abusive toward those trying to help him, including his wife Pam. His psychiatrist, Dr. Kamen, gives the angry, depressed, drug-addicted patient an unusual treatment: a Lucille Ball look-alike doll for him to vent his fury upon, but the cure is insufficient.
When Pam informs Edgar that she’s leaving him, he retorts, "Get out, you quitting birch." Yet that last pain in a chain of horrors comes close to totally destroying him. He contemplates suicide. But how can he do it without his life insurance company contesting the settlement? Even more importantly, how can he kill himself in a way that won't hurt his daughters, especially his sensitive favorite, Ilse? Dr. Kamen intervenes, suggesting that he move away for at least a year. Although he (and Kamen himself) is skeptical that leaving the area will help his despair, Edgar feels something that almost resembles hope. And when Kamen asks him if anything besides his work and family has ever made him happy, Edgar remembers that he loved to draw when he was a child.
Edgar proceeds to rent a huge pink house on Florida's Duma Key. Before he moves, though, he has an experience in which his (amputated) right arm seems to put a suffering dog out of its misery by choking it to death. Or did it? He also dreams a terrifying nightmare, in which Reba, his anger management doll, grown to the size of a real child and with her mouth smeared with blood, tells him, "The bad frog chased us!" (At this point, the reader experiences a sudden urge to flip on another light or three in a night-darkened house.)
Settled into "Big Pink," Edgar sketches and then paints, sometimes in a frenzy and with the sure knowledge that his missing right arm is, at the very least, guiding him. Those dream-fever art attacks result in incredible paintings, some of which are beautiful while others are ominous. Edgar repeatedly paints a ship he has not physically seen in the ocean outside his window. When Ilse plans to visit him with good news, his right arm tingles and itches until he draws the person he somehow knows is connected with Ilse's coming announcement: a young man in jeans and a Minnesota Twins shirt.
As he sketches, Edgar knows not only that the subject of his portrait has given his daughter a ring, but also where it was bought. When she arrives, he discovers that his drawing is eerily psychic, down to the tiniest details. The story's atmosphere turns darker with foreshadowing as Edgar and Ilse attempt to explore the jungly deserted end of the island. However, they are unable to enter it, partly due to the vegetation but mostly because Ilse becomes deathly ill.
Meanwhile, Edgar meets his neighbors. The elderly Elizabeth Eastlake owns the houses on the island, including Big Pink. Her caretaker, Wireman, is both damaged and wise. Their fates are inextricably linked with Edgar's. A mystery threads through the plot: what exactly happened to Elizabeth'