This novel for young adults is mainly a first person narrative of how a middle school graduate comes to terms with the illness of his much loved grandfather. As Jake Moon struggles with the pressures of having to take care of the man who once took care of him, as well as the resentments that come along with those pressures, the narrative also explores themes relating to the necessity for going past surface impressions and the struggle of dealing with change.

The novel begins with a third person description of three teenage boys taunting an old man - or rather, one teenage boy watching two others taunt an old man. At the end of the first chapter, the narrative shifts into first person, as the narrator reveals that he is the third boy ... and that the old man is his grandfather.

The next few chapters are an extended flashback, and narrate how the boy,Jake, and the old man, Skelly, come to be in that initial situation, Jake having been raised by a single mom in his grandfather's home and having been encouraged and supported by him. He also describes how Skelly develops Alzheimer's disease, which slowly destroys a person's memory and ability to function properly. Jake comments on his increasing resentment at having to take more and more time to take care of Skelly and his resulting struggles to have a life outside of home and school. Also in this flashback section, Jake describes how the family is helped with Skelly's care by two nurses - the no-nonsense Lanna, whose own troubles at home are a significant part of why she eventually decides to leave, and the eccentric Mrs. Russell, who clearly cares for Skelly and his family. As the narrative returns to the present with an encounter at the dumpster, the arrival of Mrs. Russell disrupts the taunting of the other boys, and makes Jake feel even worse for standing by and doing nothing.

As Skelly's condition deteriorates, Jake's difficulties in finding a balance between his home and private lives worsen, particularly as the result of his tense relationship with his cousin James and resentment of James' mother, the wealthy Aunt Marguerite who, according to Jake, simply writes checks to pay for Mrs. Russell instead of actually caring. Jake's mom, however, takes him sharply to task for having this opinion, and reminds him that the situation is a struggle for everybody. Shortly afterward, as Jake is preparing for his eighth grade graduation, Skelly goes on an outing with Mrs. Russell and disappears. Jake and his family spend an anxious forty eight hours waiting for him to come home, becoming quite frightened when a cap that Skelly might have been wearing is found near a lake in a park. Shortly after the police reveal that there is no sign of Skelly in the lake, a confrontation between Jake and James makes Jake realize that he is not the only teenage male in the family who worries about his grandfather. That night, Jake and James are sitting outside when Skelly is brought home by a friendly cab driver. Coming so close to losing him, Jake comments, makes him change his mind; he had originally planned to not invite Skelly to his graduation out of fear of any embarrassing situation that might occur. After Skelly comes home, however, Jake arranges for him to attend the graduation.

On the night of graduation, while Jake is sitting with the rest of his graduating class, a misunderstanding between the other members of his family results in Skelly being left on his own, becoming disoriented, making his way to the stage, and being grabbed by security. Jake rushes to help him, and is soon rejoined by the rest of the family, who take Skelly outside while Jake goes through with the ceremony. As soon as he gets his diploma, Jake rejoins his family and they drive home, with Jake imagining that his grandfather is saying the same words of support and affection that he had used when Jake had been little.