Yanagihara stated that her book was in part inspired by Daniel Carleton Gajdusek, who was revered in the scientific community before being accused of child molestation.

Norton writes of his childhood in the small town of Lindon, Indiana, where his interest in science was piqued by his paternal aunt Sybil, a doctor.

While attending medical school, Norton attracts the attention of Gregory Smythe, and is hired to work in his lab.

Shortly before graduation, however, Norton is approached to be the medical doctor on an anthropological mission to U'ivu, led by a man named Paul Tallent.

When they arrive in U'ivu, they meet the other member of the team, a woman named Esme Duff, whom Norton immediately dislikes.

Shortly after, they discover a woman who is devoid of language, completely nude and seemingly unable to function as a regular human being.

Norton quickly realizes that there is a link between eating the turtle, the seeming immortality, and the brain damage exhibited by the dreamers.

Norton continues to visit the island, and begins to adopt local abandoned children in great numbers.

In 1980, he sees a decrepit man he believes was the boy he had the sexual encounter with when he first came to Ivu'ivu, who foists his son on Norton.