The novel/memoir begins with the narrator putting his pants back on and returning to his mother, who is sitting on the couch. He says he was cutting his hair, he lies about cleaning up the cuttings, but his mother can’t check because she can’t move from the couch.

Over the past couple of months she has been leaving the couch less and less, finally not leaving at all and spitting green fluid into a handy half-moon plastic receptacle. Her stomach cancer is explained as a sort of alien colony of podules, cranky and disgusting, malevolently resistant even after having the entire stomach removed.

The narrator and his mother take turns pinching her nose shut because of a nosebleed while watching American Gladiator. The narrator doesn’t seem to be disturbed by his mother’s condition, but rather inured to the humiliating, pungent march of death. He sucks on a popsicle.

After the break on page 5, Beth wakes up early for no particular reason and finds the front door open and her father kneeling at the end of the driveway. The narration breaks again on page 6 with a description of his family’s “inconsistent” taste.

The house is wallpapered with slogans like “Right On” and “Outta Sight,” and while the living room is surprisingly classy, the family room is a truer representation of the family. The furniture is loud and competing, “overwhelmingly brown and squat, like the furniture of a family of bears” (7). There is a fish tank fitted into the fire place, randomly chosen by his father that ended up fitting perfectly. The house is generally in a state of apathetic decay, but not described in a depressing way—more lovingly.

The break on page 8 sends us back to the narrator pinching his mother’s nose. He’s on break from college for Christmas, joining Beth who has deferred law school “to be here for the fun.” The narrator switches back to American Gladiator, completely absorbed with the show’s tension. He remarks Beth and his mother prefer a dating show.

The page breaks again on 10 with the narrator staring at the fish tank, empty of fish for weeks now, dirty and hazy. He wonders what the water would taste like—“nutritional shake? Sewage?”—but knows his mother won’t find the question amusing. He’s still holding her nose, pausing a moment to check the blood flow, then pinching it closed again. Her blood count is low, hence the lack of clotting, and he remembers making a failed joke to the doctor—the humor in their lives is very low right now. Toph appears from the basement, complaining that his Sega won’t work. The narrator tells him to “Turn it off and on again.”

A brief paragraph is interjected on page 12 of his father kneeling in the driveway, on his way to work, and Beth looking though the screen door, waiting for him to get up.

Back to the story, the narrator addresses the reader conversationally: “You should see the area where her stomach was. It’s grown like a pumpkin” (12). Her nose has been bleeding for 10 minutes, but she has made her children promise to not take her back to the hospital. There’s a broken sentence that implies she doesn’t want to die there, but the concept is too painful to complete. He goes into a fantasy of strangling, decapitating, and running over the inquisitive, healthy neighbors. Even mentally attacking the family walking by outside.

After a break on page 15, the narrator reminisces about his mother’s past health, how the neighborhood kids loved her. She directed school plays and gave everyone hugs—except Dean Borris who would flip her off when he drove by. She has an “inner hardness that under no circumstances did you want to trifle with.”

Following another break on page 16 is a further description of the house. There’s a picture of the narrator, Bill, and Beth in an orange dinghy on Lake Michigan. The mother asks about his classes and his girlfriend, both of which he lies about. They all know she’s dying, but seem unprepared even after this slow decline.

After the break on page 17, he removes the towel and thinks the blood has stopped flowing from his mother’s nose. But it hasn’t. Toph, the 7-year-old, appears from the basement, wanting food but the narrator says he’ll feed him later. They bicker slightly as brothers do, and his mother thinks Toph is scared of her. She agrees to let her son call the nurse about the nosebleed, who she suggests ice. He awkwardly applies pressure to the nose and ice to the bridge, while sitting on the arm of the couch watching TV. He tries a few different positions, while his mother rolls her eyes.

Another brief paragraph on page 20 segues back to his father kneeling in the driveway. He had gone to get the newspaper. His head tilts back for a second—his first movement, I thought he was dead—to look at the tree in the neighbor’s yard.

Back to his mother. Her plastic receptacle is full now: green fluid, thin red blood, and black, which is “probably bile.” Beth comes home from a workout, and is angry that the nosebleed has lasted 40 minutes. Apparently, ice didn’t work last time either.

A break on page 21 flashes back six months before; the father is talking to the narrator and Beth. He remembers the blatant statement, “Your mother’s going to die,” without any warm-up or introduction.

Back to the nosebleed. Beth takes the narrator’s place while the narrator asks Toph if he’s still hungry. He gives Toph the pair of sneakers that have been rattling around in the drier. Beth makes him empty the receptacle, which spills on his pants. He expects it to burn through his pants, but it doesn’t. He thinks he should change them anyway, but never does.

Another page break on 23—it’s been an hour and Beth and the narrator argue about whether to let their mother bleed out on the couch, or go against her wishes about bringing her into the hospital. Nearly three pages follow of the narrator’s interior monologue. The writing is rushed with incomplete sentences and run-ons about who to call, which family should be there, if he can stop the nosebleed, running to Kmart for a speakerphone, etc. He finally dumps out the fluid into the drain, and overhears Beth trying to talk her mother into going in. She refuses, even starts crying at the thought of dying in the hospital.

Page 29 has another brief paragraph of their father, still kneeling in the driveway. Beth remembers that he’s been falling a lot recently—the kitchen, the shower—and finally flings open the door and runs to him.

The narrator lays down a blanket and pillow in the backseat of the station wagon. He loads up clothes, snacks, and the IV and tells his mom that he’ll carry her to the car. She’s not as heavy or bony as he expects, but knocks her head on the doorway. He’s still only 21, after all. He envisions what her tumor looks like: a fuzzy black gourd, a spider with eyes, a balloon covered in dirt. He remembers her pregnancy with Toph, how she was 42 then, but he had come out perfect. He places her carefully in the backseat, green fluid spilling out of her mouth. Beth and Toph pile in, cheerfully yelling, “Roadtrip!”

After a lined page break on 33, we are addressed in second person again: “You should have seen my father’s funeral.” The funeral is the third week of November and prematurely freezing. The guests are stricken, expecting the mother to die, not the father. The minister is at a loss since the man was an atheist. A few people come back to the house for the party, and the narrator tries to lighten the mood by suggesting beer, but no one goes for it.

Les, the only friend of their father the family was familiar with, says the man was a good driver, who called Toph “the caboose” of the family. The pry him for more information, hungry for gossip about a strange, secretive man, but he doesn’t seem to know much more.

The narrator remembers the last time he saw his father: in intensive care where he would be getting some tests. He had filled his room with cigarette smoke and was reclining and “grinning like he had won the biggest prize in the world” (36).

After a page break, we are thrown into another hospital room, only this time it’s their mother’s. She’s sleeping in a large room with windows and a fold-out bed—Beth calls it the “death room.” Toph, Beth, and the narrator are stretched out on the fold-out.

After the break on page 37, the narrator and his girlfriend are laying out a blanket in his parents’ bathroom. Apparently, the bed squeaks. They have been dating for “many months,” only getting more serious when they admit they both have a parent with cancer.

Page break: Beth and the narrator wake up at 3:21AM having remembered that tomorrow—today—is their mother’s birthday. They consider flowers and balloons but are worried it’s too gift-shoppy.

Another page break: the narrator is looking at his mother in her hospital bed. Her hair is darker and curlier than it had been before, and it looks more like a wig than the wigs she had actually worn.

Page break: when his father was in intensive care, a priest had come into the room, probably to administer last rites. But in the same way he treated solicitors, his father had said “No thanks” and asked him to leave.

After the break on page 41, Beth and the narrator plan on breaking their mother out by hiding her under a gurney. They then play out a fantasy of getting a 24 hour nurse and hospital bed in the living room. The narrator seems to be detached from reality, hoping that things will turn out like a movie—the nurse is a matronly black woman, or a cold Russian woman, and family friends arrive in furs and lipstick. The pain of her decline is cursory and washed over with morphine that they administer themselves. After her death, Toph will get to meet the Chicago Bulls who will sign his basketball cards. Bill will move from D.C. to L.A. to be closer, the narrator will graduate college (despite the lack of credits), and they’ll all live together in a big house in Berkeley.

Then his mother stirs, half-conscious, and doesn’t hear the narrator wish her happy birthday. He watches Toph sleeping, then imagines taking his hand and flying out to California. The chapter ends on page 45.

Chapter two starts with an angry, forceful narration, demanding the reader watch them hurtling down Highway 1 in a little red car, collecting everything that’s owed to them. They’re driving to a beach 35 minutes south of San Francisco. It’s the narrator and Toph, singing as loudly as they can: “I can do these things because I am an extraordinary singer” (48). The narrator describes Toph as a captive, 24 hour classroom, teaching him about bands, history, “everything I deem worthwhile.” The voice is arrogant and self-aggrandizing, sounding too young and untouchable. Page 50 ends describing the two boys’ importance: “We are dangerous. We are daring and immortal. Fog whips up from under the cliffs and billows over the highway. Blue streaks from beyond the fog and sun suddenly screams from the blue.”

A Heartbreaking Work of Staggering Genius is a fascinating experiment in first person narration. The youth of the narrator is underscored by his recklessness, anger, and ego, given way too much responsibility after the untimely deaths of his parents. Chapter two starts out a bit ambiguous, but it appears that the 21-year-old narrator is given custody of his 7-year-old brother. They are free, but dangerously so with no parameters or rules. The writing is choppy because of all the page breaks, but this emphasizes the overwhelming speed and sadness of losing two parents at once from the perspective of a young adult completely unprepared for real life. The distance and obvious denial of real emotion by the narrator makes this coming of age story poignant and (as per the title) heartbreaking indeed.