Edgar Freemantle, a Minneapolis contractor, barely survives a horrific on-site accident where his truck was crushed by a crane. Freemantle's right arm is amputated, and severe injuries to his head cause Edgar to have problems with speech, vision, and memory. As a result, Edgar also has violent mood swings and thoughts of suicide. During one of those mood swings, he attacks his wife, who later claims that as a main reason why she divorced him.
On the advice of his psychologist, Dr. Kamen, Edgar takes "a geographical" - a year long vacation meant for rest and further recovery. He decides to rent a beach house on Duma Key, a small island off the west coast of Florida, after reading about it in a travel brochure. Edgar's beach house is located on a part of the island called Salmon Point; Edgar nicknames the house "Big Pink", because of its rich pink color. On the advice of Dr. Kamen, Edgar revives his old hobby of sketching after he moves into Big Pink. He settles in with the help of Jack Cantori, a local college student.
Edgar becomes obsessively involved in his art, painting with a furious energy and in a daze. Edgar brings up psychic images in his paintings; he learns that his younger daughter, Ilse, is engaged to a choir singer and that his ex-wife is having an affair with his former accountant by painting these situations. While exploring the island with a visiting Ilse, Edgar drives past an elderly woman, Elizabeth Eastlake. Ilse becomes violently ill as they drive into an overgrown part of the island. Elizabeth later calls Edgar, warning him that Duma Key "has never been a lucky place for daughters". Edgar initially disregards the message, since Eastlake has Alzheimer's disease.
Edgar slowly recuperates helped in part by taking longer and longer walks along the beach. He slowly approaches and eventually meets and befriends a man in his late 40's whom Freemantle had seen sitting under an umbrella off in the distance. This character, Jerome Wireman, to whom Edgar becomes quite close, is a hired companion for Eastlake. As it turns out during the conversation, Miss Eastlake is very wealthy and owns half of the island, while the other half is a subject of dispute.
The way Edgar paints becomes systematic: he gets a phantom-limb sensation and he paints a psychic image. He eventually compiles a large catalog of artwork and is convinced by his friends to try to sell it to an art gallery; he does and the gallery plans to exhibit his work. While the exhibition is being planned, Edgar gradually begins to understand that his paintings have a paranormal power that allow him to manipulate events, places and people. But nobody outside of Edgar's close family and friends will ever know this. It is evidenced when one of his paintings removes a bullet that was lodged in Wireman's brain from a previous suicide attempt, and another causes Candy Brown, a man accused of raping and murdering a young girl in a highly publicized case, to die suddenly in his prison cell. Elizabeth advises Edgar that due to the power they possess his paintings should be removed from the Island after the exhibition.
Elizabeth makes a surprise appearance at the exhibition, and after seeing the paintings herself for the first time becomes distressed and tells Edgar a number of things, including that the "table is leaking". Elizabeth suffers a violent seizure as she is trying to tell Edgar this and dies in the hospital soon after. Edgar suspects that the entity, Perse, silenced Elizabeth. When Edgar returns to Duma the next day he discovers that Big Pink was broken into and finds a canvas with "Where our sister?" sprawled on it, left in the house along with the footprints of an adult and two children. He soon discovers that those in possession of his paintings either die, or become possessed by "Perse" and carry out her deeds, which mainly include killing people close to Edgar. Most notably, Mary Ire, who had purchased one of a series of "Girl and Ship" paintings, breaks into Ilse's apartment and kills her by drowning her in her bathtub (just minutes after Ilse burns "The End of The Game" at Edgar's request). Mary Ire commits suicide almost instantly thereafter.
Edgar begins to realize that his paintings are connected to tragic events in Miss Eastlake's childhood. Edgar discovers, through both his paintings and the drawings done by a young Elizabeth after she had suffered a head injury and began drawing herself, that Elizabeth had inadvertently used her paintings to discover a figurine off of the coast of Duma Key. This figurine, of a red-cowled woman, used the young Elizabeth to begin changing the reality around her. Elizabeth tried to use her power to destroy the figurine by drawing it and then erasing it. This only enraged the entity Persephone, which then killed Elizabeth's twin sisters by leading them into the surf and drowning them. A young Elizabeth, with the help of her Nanny, eventually discovered that the entity could be neutralized by drowning her in freshwater, and Elizabeth was able to do this by placing the figurine in a cask that is sealed in a cistern under the original house on Duma Key.
Intent on putting a stop to Perse following the death of his beloved daughter, Edgar, along with Wireman and Jack, travels to the house Elizabeth lived in as a child, which is now overgrown by thick, unnatural vegetation. They manage to find the figurine, and are able to contain it in freshwater inside one of their flashlights. Later, Edgar takes the flashlight back to Big Pink, where his daughter Ilse begins to form out of the sand and seashells under the house. The entity offers Edgar immortality and forgetfulness in exchange for the flashlight. Edgar, however, has a different flashlight and tricks the entity masquerading as his daughter to get close enough to him that he can destroy it. Later, Edgar drops the figurine into one of the freshwater lakes of Minnesota.
The book ends with Edgar starting his final painting; a storm destroying Duma Key.
The novel contains an expansive cast of minor characters while maintaining a rather small circle of central players.
- Edgar Freemantle: is the central character in the book, which focuses on his struggles and he eventually takes the lead in the climatic fight against Perse.
- Jerome Wireman: is a former lawyer from Omaha who moved down to Florida after losing his wife and daughter, surviving a suicide attempt, and being fired from his law firm.
- Elizabeth Eastlake: a wealthy heiress and former art patron suffering from Alzheimers, she plays a major role in background of the story and in leading the protagonists to stopping the evil force present on the island.
- Pam Freemantle: Edgar's wife who divorces him at the beginning of the novel. During the novel she has several affairs, but gradually reconciles with him until the events of the climax begin.
- Ilse Freemantle: Edgar's younger daughter who remains the only person from his "past life" to stay close to him and who is the person he loves most in the world.
- Jack Cantori: local college student who serves as Edgar's chauffer and handyman, keeping the house stocked with groceries and picking up whatever odds and ends he needs. It is his quick thinking that allows them to trap Perse at the end of the novel.
- Perse: the evil force manifested on Duma Key, she first reached out through young Elizabeth Eastlake to get back to the surface from the ocean before being trapped in freshwater (she is left powerless by it), until the present day. She commands a ship of damned souls, and while not human is said to have something distinctly feminine about her, and she is manifest in an old china doll with a red cloak. She is again put back to sleep at the end of the novel though the characters fear she will eventually escape again. Her full name, Persephone and her description and place are all generally influenced and taken from the Greek Goddess Persephone, the Queen of the Underworld (although, like many of King's entities, she is also decidedly similar to some of H.P. Lovecraft's characters.)
There are a large number of minor characters in the book who have only passing significance to the main characters or to the plot of the book, including large numbers of friends and family from Edgar's "other life" as well as Wireman's family and boss, a number of characters with loose association to the two, and the various people who rent houses on Duma Key during the tourism season.
Critical reception was generally positive, with some negative criticism being outweighed on the whole by the positive, a fact noted by USA Today and declared by King in that article as a byproduct of the fact that "[...]a lot of today's reviewers grew up reading my fiction. Most of the old critics who panned anything I wrote are either dead or retired".
The New York Times printed a fairly positive review by Janet Maslin which called the novel "frank and well grounded" and lauded the brevity and imagery of the novel, as well as the furious pace of the last third, while a somewhat less enthusiastic but still positive review by Mark Rahner was published by the Seattle Times that while criticizing King for a little unoriginality and long-windedness, ultimately praises King's characters and the terror of the novel.
Richard Rayner, in a review published by the Los Angeles Times called the novel a "beautiful, scary idea" and lauds it for its gritty down to earth characters. However while also praising the writing itself, "He, (King), writes as always with energy and drive and a wit and grace for which critics often fail to give him credit", criticizes it for losing its originality and believability towards the conclusion, stating "The creepy and largely interior terror of the first two-thirds of the story dissipates somewhat when demon sailors come clanking out of the ocean." Similarly, the Boston Globe review, writing by Erica Noonan, called the novel a "welcome return" to a similar style of some King's better novels.