It is mid-October, 1997, harvest time in the Columbia Basin of central Washington state, a rich apple- and pear-growing region. Ben Givens, recently widowed, is a retired heart surgeon, once admired for his steadiness of hand, his precision, his endurance. He has terminal colon cancer. While Ben does not readily accept defeat, he is determined to avoid suffering rather than engage it.

And so, accompanied by his two hunting dogs, he sets out through the mythic American West - sage deserts, yawning canyons, dusty ranches, vast orchards - on his last hunt.

The main issues for Ben as a doctor had been tactical and so it would be with his death. But he hadn't considered the persuasiveness of memory - the promise he made to his wife Rachel, the love of his life, during World War II. Or life's mystery.

On his journey he meets a young couple who are "forever", a drifter offering left-handed advice that might lessen the pain, a veterinarian with a touch only a heart surgeon would recognize, a rancher bent on destruction, a migrant worker who tests Ben's ability to understand. And just when he thinks there is no turning back, nothing to lose that wasn't lost, his power of intervention is called upon and his very identity tested.