Set among the apple orchards of rural Maine, it is a perverse world in which Homer Wells' odyssey begins. As the oldest unadopted offspring at St Cloud's orphanage, he learns about the skills which, one way or another, help young and not-so-young women, from Wilbur larch, the orphanage's founder, a man of rare compassion and with an addiction to ether.

Dr Larch loves all his orphans, especially Homer Wells. It is Homer's story we follow, from his early apprenticeship in the orphanage surgery, to his adult life running a cider-making factory and his strange relationship with the wife of his closest friend