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It's the '90s in a small Canadian prairie town and fourteen-year-old Aaron Gourlay, born a male, asserts that she is female, a claim that no one in her life will accept--except for her single mother, Nadine. After wrestling with the health care system and having her identity invalidated time and time again, Aaron tries to kill herself. Desperate to keep her child alive, Nadine calls on a neighbouring town's outlier and loner, Al Klassen, to perform a radical procedure.

Aaron's attempt to jumpstart her own gender transition with Al's assistance creates shockwaves that throw everyone around them out of orbit--and out of their resigned apathy in the stifling town of Saltus, where nothing new ever seems to happen. Lenore is a M tis woman working at the Harvest Gold Inn & Restaurant who longs for the family she never had. Trish is a young mother who desires nothing more than to flee her husband and son, the family she was never ready for. Roger is the by-the-book police officer investigating Aaron's case. Aaron and Nadine's situation, the talk of the town, forces each townsperson we encounter to look long and hard at themselves, at their own identities, at the traumas and experiences that have shaped them.