Truly Plaice knows what it is like to be an outsider - gargantuan since birth, in contrast to her lovely and petite older sister, she grew up on the fringes of society and family. Her mother died giving birth to her, something her father never recovered from, passing away when Truly was 12. While Serena Jane, Truly's sister was snapped up by the local minister and his wife, Truly was taken in by the Dyerson's, a poverty-stricken family who resided outside of town.
The girls grew up very differently. Serena Jane was doted on at school by Miss Sparrow, the town's teacher, while she barely tolerated Truly's presence. Serena Jane had all the lates fashions, her clothes neatly pressed, while Truly wore men's clothes because she could not fit into girls' or even women's clothing. Serena Jane was surrounded by her disciples wherever she went, while Truly had only 2 friends - Amelia, the Dyerson's quiet daughter and Marcus, who loved Truly despite what everyone else thought. Serena Jane was raised as a young lady, Truly helped out August Dyerson with the horses and learned how to throw races to her benefit.
As Truly enters adulthood, she leaves the Dyersons to move in with Serena Jane's husband, Robert Morgan, the town doctor, and her nephew Bobbie after Serena Jane abandons them. While Robert continues the cruel behavior he showed Truly as a child, she stays on due to her love of her nephew. Throughout it all, Truly continues to grow, which Robert gleefully points out to her during her checkups. While Truly tends to her nephew, she also discovers that a family heirloom quilt holds more than just traditional stitches - it is a record previously only rumored to exist - a guide to potions handed down from generation to generation of medicinal herbs and potions from the first Mrs. Robert Morgan, Tabitha. Truly begins experimenting with various mixtures on the sly.
This is a story of dichotomies - Truly vs. Serena Jane, pretty vs. ugly, love vs. hate, big vs. small, mercy vs. murder, forgiveness vs. revenge, etc. and how they may not be as opposite as we sometimes think. Through all of her trials, Truly remains true to herself - although she entertains and sometimes acts on her feelings of revenge, in the end, her compassion and love shine through. She endures the tragic loss of a friend as well as her sister but gains the everlasting love of her nephew and eventually, the respect of her small town. This is a heartwarming story of sorrow and joy, and Truly is "truly" larger than life.