Misty Marie Wilmot, a former art student turned waitress, narrates her life in the form of a coma diary addressed to her husband, Peter Wilmot, a building contractor in a persistent vegetative state after a suicide attempt. Peter's body lies curled and skeletal in a hospital bed, sustained by a respirator and feeding tubes. His mother, Grace Wilmot, suggested the diary as a seafaring tradition: Spouses keep records during separations to share when reunited. Instead, Misty uses the diary to rage at Peter and piece together a mystery that consumes her summer on Waytansea Island.
Misty grew up poor in a trailer park in Tecumseh Lake, Georgia, drawing pictures of an island she had never seen: stone houses, rose gardens, stained-glass church windows. Every detail matched Waytansea Island exactly, though she had no way of knowing that. Waytansea is a small, fish-shaped island off the coast. Peter brought her there after they married, and Misty believed she had found paradise, abandoning her painting ambitions to settle into life as a wife and mother to their daughter, Tabbi. Then the money ran out, Peter attempted suicide, and homeowners began calling to report that he had sealed off entire rooms in their summer houses, hiding hateful graffiti inside the walls.
Misty visits one of these houses with Angel Delaporte, a summer homeowner who practices graphology, the study of handwriting. Peter's messages spiral across the hidden walls: threats against outsiders, insults about Misty, and warnings that the island's people will kill anyone who comes there. Angel begins accompanying Misty to other sealed rooms, photographing the graffiti and having her trace Peter's words to feel the emotion behind them. In the hotel dining room and the island library, Misty discovers hidden messages from Maura Kincaid and Constance Burton, two previous Waytansea Island painters: "Don't let them trick you again," "We are their bait and their trap," "Leave this island before you can't."
Through flashbacks, Misty recounts meeting Peter at an art school gallery, where she stood before a painting of a house she believed she had invented. Peter claimed the house was real and proposed on the spot, then revealed that a rhinestone brooch was pinned through his nipple. His friends had warned Misty away, but Peter won her over with his belief in her talent. He told her that the greatest artists were always invalids, citing Frida Kahlo's spina bifida and Michelangelo's depression. Suffering, Peter insisted, was the source of divine inspiration.
Grace's behavior grows increasingly controlling. She reads from a red leather diary that accurately predicts Misty's future actions, claiming she is reading the diary rather than writing it. Tabbi reveals that Grace told her Peter never loved Misty; he only pretended love to bring her to the island. On Tabbi's 13th birthday, Grace and Tabbi strand Misty on Waytansea Point, the forested southern tip of the island, with art supplies and chicken salad that makes her violently ill. Sick and hallucinating, Misty closes her eyes and draws automatically, producing a sketch of an antique chair she has never seen. Angel tests her subsequent drawings and discovers that every angle and circle is mathematically perfect, impossible to achieve freehand.
Detective Clark Stilton, a hate crimes investigator, arrives to question Misty about Peter's vandalism. He reveals that no death certificate exists for Peter's supposedly dead father, Harrow Wilmot, and that Peter's blood contained sodium phenobarbital, a sleeping pill for which Peter had no prescription. Someone drugged Peter before his supposed suicide. Meanwhile, a group calling itself the Ocean Alliance for Freedom (OAFF) has been burning down the mainland houses where Peter sealed his warning messages.
After Misty falls at work, Dr. Touchet, the island doctor, immobilizes her leg in a fiberglass cast and confines her to her attic room. Grace removes the telephone, Touchet sedates her with injections, and Tabbi tapes Misty's eyes shut with masking tape. Blind and immobilized, Misty paints compulsively, producing picture after numbered picture. The green capsules Touchet has been prescribing contain powdered lead laced with arsenic and mercury, systematically poisoning Misty to suppress her rational mind and open what the doctor describes as a channel to the universal subconscious. Days later, Misty removes her blindfold and discovers she has drawn a girl floating facedown in the ocean. From her window, she watches people carry Tabbi's body from the water.
Angel pulls the hotel fire alarm and rescues Misty, revealing two truths: the pills are poison, and he was Peter's romantic partner. Peter, who was bisexual, told Angel about the island legend. Every four generations, island sons are sent to art schools wearing repulsive junk jewelry to find a woman inexplicably drawn to the old gems. That woman is fated to marry an islander, be brought to Waytansea, and produce art that will save the community. Peter sealed warning messages inside houses to alert outsiders and planned to flee with Angel rather than sacrifice Misty. The islanders drugged Peter and staged his suicide when he tried to escape. Before Angel can get Misty out, Grace and the village council intercept them and reclaim her.
Misty's inspiration vanishes after 99 paintings. Released from her blindfold, she spots Tabbi alive on the beach; the drowning was staged. Misty hacks free from the cast with a steak knife and learns from Stilton that Angel has been murdered, stabbed in his sleep. In room 313 of the hotel, she peels away wallpaper to reveal Peter's final message: He loved Angel, refused to die for the island's cause, and recognized the tradition as ritual mass murder. Grace's red leather diary proves to be not her own journal but the diary of Constance Burton, whose life a century ago mirrored Misty's in every detail. The islanders use each artist's diary to script the next one's suffering.
On the evening of the art show, Harrow Wilmot appears alive and explains the full legend. Misty's soul has been reincarnated every four generations as the world's greatest artist; she has been Giotto, Michelangelo, Vermeer, Maura Kincaid, Constance Burton, and now Misty Wilmot. Each time, the islanders torture her into producing paintings that, when unveiled as a mural, trigger Stendhal syndrome, a phenomenon where overwhelming art causes collapse or death. The mass casualties drive outsiders from the island and generate enormous insurance payoffs. Grace confirms: "We've just found a way to harvest rich people."
Misty tries to stop the catastrophe, calling police, fire departments, and television crews. At the art show, she screams for everyone to flee, but Stilton handcuffs her and arrests her for Peter's attempted murder and Angel's death. In her cell, she finds a message on the wall: "If you're here, you've failed again," signed Constance. Through the window, Misty watches the hotel burn. One hundred and thirty-two people die, including Grace, Harrow, and Stilton. News footage shows victims crawling toward the mural, not away from it.
In the aftermath, Tabbi, now calling herself Tabitha, reveals she set the fire as her grandparents taught her, and that when Peter tried to convince her to run away with him, she reported him to Grace, condemning her own father. Insurance payoffs make Waytansea wealthy again, and the island seals itself from outsiders. Misty visits a mausoleum on Waytansea Point and finds the skeletons of Kincaid and Burton, her previous incarnations. Recognizing the cyclical trap, she resolves to break it by publishing her diary as a novel. The book closes with a letter from "Nora Adams," Misty's legally changed name, to Chuck Palahniuk, asking him to publish the manuscript so that one day a girl who picks up a crayon and draws houses she has never seen might read it and save herself. The novel itself is the diary, Misty's warning hidden in plain sight.