Barker explores the nexus between art and war against the landscape of London during World War One. In Queen Mary’s Hospital, Sidcup, medical officers attempt to undertake facial reconstruction surgery on damaged, scarred soldiers. Barker writes of three characters--Elinor Brooke and her fellow artist friends Kit Neville and Paul Tarrant--who, in attempting to retake their shattered lives, have been influenced in various ways by Toby, Elinor’s enigmatic brother who fought with Kit on the Western Front.

Barker’s theme is the ache of regret as she attempts to humanize Elinor, Kit and Paul, who first met at London’s Slade School of Art. The early sections of the novel belong to Elinor as she tries to piece together events from a scrap of a letter left by Toby. The letter opens up the reader to the nature of Toby’s shadowy presence: an enigmatic and beguiling figure who was drawn to his sister from an early age.

In prose that is both fascinating and repellent, Baker portrays the emotions and motivations that lie under the surface of Elinor and Toby’s childhood: a fantastic, sweeping collage of contradictory, conflicting elements of love, duty, reserve, and propriety. For Elinor, in particular, there’s a constant sense of change and of gears shifting as her life begins to take on new shapes. Balancing Elinor’s first few "spindly shoots" of independence in London, Baker does an astonishing job of comparing her heroine’s existence to the horrors of Paul, Toby and Kit’s time at the Front, where they endured mustard gas, constant bombardment of the German guns, and the sheer misery of the physical conditions.

Contrasting the sights, sounds and smells of Slades’ dissecting room with descriptions of the still peaceful English countryside, Barker shows us that war's stunning losses are just beginning to be felt. Death lurks around every corner, fear and heartbreaking loss are daily companions, and preserving Toby's honor becomes paramount. Through Elinor, Paul and Kit's points of view, the author is able to evoke the minute details of the damaged soldiers who have fallen into the capable hands of the surgeons at Queen Mary’s who work on those with severe facial injuries and devote their expertise to restoring the men’s faces. While war has often served to accelerate the development of surgical procedures, no other injuries have ever posed challenges as technically difficult or as heart-rending as those affecting the human face.

Arriving at the hospital ostensibly to help sketch a record of their grossly altered faces--these young men with gouged-out eyes, blown off jaws, and gaping holes where their noses had been--Elinor connects with monstrously wounded Kit, whose poetic good looks were blasted away forever. In constant denial about the severity of his wounds, Kit’s account of the mystery behind Toby’s actions on the battlefield becomes the driving force behind both the positive and negative aspects the novel. The smell of Toby’s garments breaks the taboo Elinor has imposed on herself: the war is not to be “acknowledged” and that memory and desire are to be “swept away.”

Barker strikes the perfect balance of dialog and description also employs a technique that uses Elinor’s diary to depict the narrative from her perspective as a burgeoning artist who needs exoneration. From London’s hysteria over zeppelin raids and the "spurious sense of excitement and even glamor" that seems to cling to it all, to Elinor’s thoughts when she visits a hot and sweltering Lewes to her need for her brother’s love, we see her and Paul becoming lovers in the doomed city just as the nightly bombardment begins. Barker unravels their intersecting stories with a powerful delicacy that one might never expect to find within such a potentially grotesque theme.

While Kit and Paul’s exhaustion from pain and war ground the later sections of the novel, Barker effectively time-tunnels back to post-WWI Britain with such a degree of authenticity that the emotional and medical come together as her characters grapple with lives forever transformed. It's left to Kit to shoulder the ultimate burdens of war when he realizes that nothing will ostracize a human being faster than the sight of a destroyed face.