The novel follows the life of Daisy Goodwill Flett, a seemingly ordinary woman, from her birth in Canada in 1905 to her death. It explores her experiences as a mother, wife, and widow, as well as her work as a gardener and her later years as a columnist. The book is unique in that it is written in a variety of styles including letters, diary entries, and third-person narrative, and it explores themes of identity, love, and the often overlooked lives of women.

The novel centers around Rachel Cameron, a 34-year-old spinster schoolteacher living in a small Canadian town, who confronts her solitary existence and the constraints of her conservative environment. Through a summer romance with a former childhood acquaintance, she experiences an awakening of her long-suppressed desires and emotions. This personal journey is marked by moments of introspection and the challenge of breaking free from the expectations imposed by her overbearing mother and the community. As Rachel grapples with the complexities of adulthood, love, and identity, she embarks on a path of self-discovery that promises to transform her life.

All My Puny Sorrows is a poignant exploration of the complex relationship between two sisters, one a successful concert pianist battling severe depression and the other a struggling writer trying to support her. The narrative delves into themes of mental illness, suicide, love, and the power of familial bonds. It grapples with the moral and ethical questions surrounding assisted suicide, the struggle to understand a loved one's pain, and the lengths to which one might go to help them find peace.