Pine relates growing up poor in New York City's Little Italy, attending medical school, and establishing successful practice until his illegal distribution of prescription medicines led to the loss of his license.
A self-proclaimed "survivor" type, he bitterly whiles away the time by using a logbook as his diary, detailing his rise and fall in the medical profession and his determination to survive this ordeal, get even with the people that "screwed him over", and return to prosperity.
Over time, the diary entries become more and more disjointed and raving, revealing Pine's slow mental decay and eventual insanity caused by starvation, isolation, and drug use.
His last few diary entries, barely comprehensible, indicate that Pine has sliced off and eaten both legs, as well as his earlobes, and drools uncontrollably as he ponders which body part to consume next.
In the Notes section of the 1985 short fiction collection Skeleton Crew, Stephen King wrote about the topic of arriving at the story's premise: "I got to thinking about cannibalism one day .
Hesitant to write anything down, King gained the assurance for the story after speaking with his neighbor, Ralph Drews, a retired doctor who confirmed that "a guy could subsist on himself for quite a while - like everything else which is material, the human body is just stored energy."