Alma dies and Shed and Dellwood have to amputate Ida's legs which are badly frostbitten. They help her to heal by giving her the energy of their Moves Moves. By the end of the novel, Shed is content with his identity. The novel offers an alternative picture of healing and medicine. Life is not managed by drugs or surgery but by sexuality and other forces that govern the world.
People can give one another life through sacrifice and caring.
The novel suggests that current disrespect for alternative medicines is the product of racism. Lastly, Shed's sexuality and his alternative family offer a new vision for family values. The book won the Pacific Northwest Booksellers Association Prize.