The story opens with Oscar’s first letter to God. Oscar admits he’s never written to God before because “I don’t even believe you exist” (2). Despite his lack of faith, Oscar decides to write the letter at the suggestion of Granny Rose, an elderly volunteer at the hospital where Oscar lives.

Oscar is 10 years old and lives in a hospital with other sick children. He is dying of cancer, and the mood around him has shifted from happy and hopeful to quiet and sad. After a failed bone marrow transplant, adults are hopeless and uncomfortable with Oscar’s nearing death. Doctors who once praised him as a model patient now approach him with disappointment, making Oscar feel guilty and angry. The mood around Oscar has changed drastically since his surgery, but there is one adult who treats him as she always did: Granny Rose.

Granny Rose isn’t like the other adults at the hospital. She curses, tells wild wrestling stories, and isn’t afraid to talk to Oscar about death. She encourages Oscar to talk to God, so he writes to God to ask a couple of favors and one specific question: “Am I going to get better?” (12) Even though Granny Rose talks with Oscar about death, she remains silent when he asks if his operation worked, which is the closest to a confirmation Oscar has received from an adult so far.