Set in the small Nevada town of Boulder City, near Hoover Dam and Lake Mead, the novel follows three characters locked in an escalating triangle of desire, possession, and retaliation, told in rotating sections from each of their perspectives.
Terrence "Terry" Tully, a third-year medical resident at County/USC Hospital in Los Angeles, learns of his mother Katie's sudden death from Margaret Berner, an elderly neighbor in Boulder City who found Katie collapsed on her kitchen floor. Terry has no siblings, and his father died five years earlier. He drives to Boulder City to handle funeral arrangements. On his first morning in town, a young woman in a turquoise minidress asks for his newspaper at a café called Doodles, mentioning she needs a rental. That evening, Terry encounters the same woman, Bethany, at a restaurant with live music. They sleep together at his mother's house that night.
Bethany is 24 and works part-time as a receptionist at the Boulder City hospital. She has recently been evicted after breaking up with her boyfriend Jesse, an eighth-grade English teacher who drained her bank accounts. She asks to house-sit and watch his mother's dog, Daisy, a black shepherd mix, but Terry refuses and Bethany walks out. Back in Los Angeles, Terry resumes his residency. He takes Daisy to a memorial for his mother at his aunt Julie's home in San Francisco, but nobody wants the dog; he surrenders Daisy to a shelter and retrieves her the next day. At the hospital, he treats Frances Hayes, a homeless woman leaking cerebrospinal fluid after neurosurgery to remove a pituitary tumor. Frances gives him a small carved figurine of her recently killed dog Chico as a lucky charm.
Weeks later, Margaret calls to report that someone claiming to be Terry's fiancée is living in the house. Terry drives to Boulder City and finds Bethany has moved in, bolted the door, and is driving his mother's Prius. She has shown Margaret an engagement ring and introduced herself as Terry's fiancée. Bethany pleads financial desperation, and despite his fury, Terry agrees to let her stay as house-sitter and caretaker for the dog. That evening at the marina, Bethany spots Jesse and panics, fleeing in Terry's car. Jesse, who has a stiff left arm from a childhood shooting accident, pays their dinner tab, a gesture Terry reads as mockery. The next morning, all four tires on Terry's Audi have been slashed. Despite these disruptions, Terry grows infatuated. Before he returns to L.A., Bethany suggests he could move to Boulder City permanently, noting he has a house, a dog, and her.
Terry plans a surprise visit and arrives after midnight to find Bethany hosting a party for her friend Lutie. Jesse and his friend Thomas show up at the door, and Terry confronts Jesse, letting the dog out to chase him off. The next day, he learns Lutie has been paying Bethany $500 a month for the spare room. He hikes the Bootleg Canyon Trail with Daisy to clear his head. On the trail, two motorcyclists roar toward him. Terry recognizes Jesse and Thomas just before one of them shoves him off the trail, sending him tumbling onto rocks below, where he loses consciousness.
The narrative shifts to Bethany's perspective, revealing her calculating pragmatism alongside genuine feelings for Terry; she acknowledges she is partly motivated by having a rent-free place to live. When Terry fails to return from his hike, Bethany searches for him and, the next morning, follows Daisy up the trail to find Terry unconscious with a head wound. Terry's aunt Julie arrives from San Francisco and takes up residence in the guest room, creating a tense standoff with Bethany. Doctors diagnose a spinal cord injury at the L5 vertebra in the lower spine; the cord is intact, making the prognosis cautiously optimistic, though Terry initially uses a wheelchair. He names Jesse as his attacker. Bethany meets Jesse at a bar, where he admits giving Terry a shove, calling it a prank, and insists he will deny everything. That night, Bethany sleeps with Jesse, then flees in the morning, disgusted with herself. Julie, her friend Sims, and the police investigate, but the case stalls for lack of evidence. Julie eventually leaves, and Bethany assumes full caretaking responsibility as Terry progresses to crutches.
Jesse's perspective reveals his obsession with Bethany and his resentment of Terry. He views the trail shove as instinctive, describing it as "counting coup," a warrior's gesture of striking an enemy without killing. He denies everything to a visiting detective and channels his energy into writing a novel about his great-grandfather, the last person to leave a town submerged by the rising waters of Lake Mead. His former creative writing professor, Lillian Lutece, becomes both literary mentor and sexual partner. Jesse's violence escalates: He sneaks into Bethany's yard and attacks Daisy with a shovel when the dog charges him, costing her an eye. On another visit, Daisy bites Jesse's leg, and Bethany obtains a restraining order. Then, late one night, Jesse enters the house and forces himself on Bethany sexually, an act the narrative frames as rape, though Bethany later resists naming it as such.
Terry returns to L.A. to resume his residency. A process server delivers Jesse's dog-bite lawsuit demanding $250,000. Terry drives to Boulder City, ejects Lutie, and discovers Bethany has been distributing house keys to friends. He stakes out Jesse's school and follows Jesse's motorcycle along the North Shore Road toward the lake, swerving the Prius into Jesse's path. Jesse veers off-road and hits volcanic boulders, sustaining a compound fracture of the femur that severs an artery and a fractured elbow. Terry stops, tears up his own shirt for a tourniquet, and saves Jesse's life. When Jesse threatens to report him, Terry explains his cover story: He is a Good Samaritan who happened upon an accident.
Bethany visits Jesse in the hospital, bringing flowers. After his discharge, she continues visiting his apartment nightly; she has unblocked his number, and the two fall back into easy familiarity. Terry calls to tell Bethany he has tested positive for tuberculosis, contracted from Frances, and she needs testing; her result is negative. On the eve of Halloween, Bethany brings Jesse to Terry's house for margaritas and pumpkin-carving, with Daisy locked in the outdoor pen.
Terry arrives unannounced, carrying champagne, roses, and a jewelry box containing a ring. Finding Bethany and Jesse together by candlelight, he hurls the champagne bottle at Jesse and attacks him. Jesse defends himself with a paring knife, cutting Terry's forearm. Bethany tackles Terry to the floor, shouting at him to leave Jesse alone. Terry storms out, ordering Bethany to leave the house.
In the final section, Terry drinks scotch at Baxter's until last call and sleeps in the same motel he checked into the night his mother died. In the morning, he returns to the house and opens the jewelry box, but the ring is gone; he speculates whether Bethany is wearing it or has already sold it. He packs his mother's souvenir Hoover Dam coffee mug, leashes Daisy, and leaves. Margaret intercepts him on the porch, but he deflects her and drives back to L.A. At the hospital, he learns Frances has died. Terry schedules his board exam, applies for a fellowship, and sinks into solitary routine without having taken any legal steps to evict Bethany. Weeks later, on a wind-lashed Santa Ana night, Bethany calls. After a long silence, Terry answers and says he is there, leaving the future of the relationship, and the house, unresolved.