The book is set in Detroit, Michigan, where Small spent his childhood.

Small's family—on the surface a model of 1950's-style middle class contentment and success—was a tinderbox of closeted feelings and mental repression.

Years after the diagnosis, Small awoke from this supposedly harmless operation to discover that he had been transformed into a virtual mute—one of his vocal cords had been removed along with the growth.

From there things began to stack up as his parents' hidden distress and anger started to seep through in fits of sadness and rage directed towards him.

[2] It was a #1 New York Times Best Seller,[3] and was named one of the ten best books of 2009 by Publishers Weekly and Amazon.com.