The book appeared briefly on the New York Times bestseller list and became a word-of-mouth sleeper hit, especially in the Southern United States.
Much of his life has been defined by an event from his childhood: at age four he witnessed his mother's murder during a terrible snowstorm.
As Clay tries to find out the truth about how and why his mother was killed, he falls into a situation that reveals we all have the capability to be violent, and that we can all choose not to be.
Clay's Quilt gives insight into a misunderstood region, and is one of the few books set in Appalachia that is contemporary to the time in which it was written.
House has said this is one of the main reasons he wrote the book, to make up for the lack of literature that shows a nuanced and modern look at Appalachia and the rural South.