The novel is a coming-of-age story about a young girl named Ellen Foster who, after her mother's suicide and father's subsequent neglect and abuse, is shuffled between family members and foster homes. Despite the hardships she faces, including poverty and racism in the South, Ellen's remarkable resilience and determination help her to overcome her circumstances. Ultimately, she finds a loving home with a foster mother and begins to heal from her traumatic past.

The novel centers around the life of a woman named Kate Vaiden, who at the age of 11, loses her parents in a murder-suicide. Kate is then raised by her aunt and uncle in North Carolina. At the age of 17, she becomes pregnant and, after giving birth, abandons her son, choosing to live a life of solitude. The story is told by Kate at the age of 57, as she reflects on her life and the decisions she's made, while also contemplating the possibility of reuniting with her abandoned son.