In an interview with Lilja's Library, King said:

"...it’s about a construction worker who is involved in a terrible accident. He lives in the northern part of the United States, Minnesota, and he’s hurt very badly and loses an arm, sustains head injuries and is not expected to live but he does and he comes out of a coma and because of the head injuries he has uncontrollable rages and memory lapses. It’s very difficult and his wife divorces him so he decides he’s going to move to Florida but he’s also thinking about suicide just because of his pain and because he doesn’t like being angry all the time and this psychiatrist kind of talks him out of it and one of the things he says is, “Is there anything that you do that you can use as a kind of buffer against this depression? Is there any kind of new life for you besides working on buildings?” and this guy says, “I used to draw, I used to paint a little bit” and the guy says, “Well, try that” and he discovers that, after this injury, that he is really a very talented painter and he moves to Florida and he starts to paint these pictures and then strange things start to happen with the pictures. They have this power so that sometimes if he paints things into the world they kind of appear and if he paints things out they disappear, including people. And there is something going on, on this island, this Duma Key that is actually amping that talent up and making it stronger because there is something wrong there. That’s the real basis of the story."[2]