It takes place in New York City in the 1990s and revisits some characters of the original, including Yossarian, Milo Minderbinder, and Chaplain Tappman.

The book has two stories that are interwoven throughout: that of Yossarian in the last stages of his life, and that of Sammy Singer and Lew Rabinowitz, two men from Coney Island who also fought in World War II (the Sammy Singer character makes a brief appearance in Catch-22 as the tailgunner aboard Yossarian's bomber who kept waking up and fainting when he saw Yossarian trying to attend to the wounds of Snowden).

As with Catch-22, the topic of death is omnipresent, only in this case from usually age-related illnesses, in particular cancer rather than dying in battle, as with its predecessor.

When asked about the inconsistency in an interview with The New York Times, Heller replied, "I know, but I decided to ignore it.

A character named Joey Heller is also mentioned who, like the author, was a bombardier during the Second World War and suffers from Guillain–Barré syndrome.