An unnamed man floats in a haze of semi-consciousness, experiencing great a great cyclical pain that reminds him of the ebb and flow of tide. The man remembers his name is Paul. When he regains full consciousness, Paul meets his caretaker: an unsettling woman named Annie Wilkes, who tends to him in her guest room. Paul is immobilized—his legs have been shattered. Annie regularly brings Paul an opioid painkiller called Novril, which brings the tide of relief in over his ever-present pain.
Annie claims to have rescued Paul from a terrible car crash and taken him to her home in Sidewinder, Colorado. Paul recalls his own hazy version of events. He is a well-known fiction writer. On the night of his accident, Paul had just finished his latest book—a contemporary novel called Fast Cars—in a hotel in Boulder. In drunken celebration, Paul drove through a heavy snowstorm, flipping his car. He calculates that he has been unconscious for nearly two weeks. Based on her drug supply and caretaking skills, Paul assumes Annie is a former nurse. Annie claims to be Paul’s “number-one fan”—she loves his Misery books, a series of pulpy historical romance novels.
Annie is moody and quick to anger. Furious at Paul’s use of profanity in the Fast Cars manuscript (which she persuades him to let her read) Annie throws a bowl of soup at the wall. As punishment for upsetting her, she delays his medication until she has cleaned the mess, then forces him to swallow the pills with rinse water. Addicted to the painkillers, Paul does so willingly. Soon after, Annie finishes the latest Misery book and discovers Paul has killed off the beloved titular character, Misery. Truthfully, Paul was glad to kill off Misery, as he now hopes to focus on more “serious work.” Enraged at this betrayal, Annie leaves Paul alone in her house—unfed and unmedicated—for 51 hours.
When Annie returns, she manipulates Paul into burning the Fast Cars manuscript by withholding his medication. Ruminating on her offhand remark about being on trial in Denver, Paul assumes that Annie’s psychosis has led her to commit some previous crime. Paul believes Annie will kill him whenever the police find his car, and he thinks of himself as a trapped, exotic bird from Africa.
Annie buys two presents for Paul: a wheelchair and an old Royal typewriter. She insists he use the machine to write a new novel—Misery’s Return—to thank her for nursing him back to health. Resigned to the task of resurrecting Misery, Paul asks Annie for some better paper, which she takes as an insult. She punishes him by slamming a fist into his already-shattered knee before leaving for town. Driven to desperation by extreme pain, Paul uses one of Annie’s fallen bobby pins to pick the lock on his door and wheels himself to the downstairs bathroom, where he steals several cartons of Novril. He makes it back to his room just as Annie returns with the paper.
Paul begins to write. Annie is dissatisfied with Paul’s first attempt at resurrecting Misery. She claims that simply erasing Misery’s death is unfair, revealing a strong desire for “justice,” fictional or otherwise. Paul is surprised to find he agrees with Annie. He tries again, slipping back into the familiar process of overcoming writer’s block. Finally, he writes several chapters, in which Geoffrey—Misery’s friend and occasional lover—discovers she has been buried alive. Annie deems this revision fair and seems to appreciate its dark tone.
Paul notices his wheelchair has left scuffmarks on the doorframe and fears Annie will realize he has been out of his room. A man from town (Mr. Rancho Grande) visits to notify Annie she has missed a tax payment. Paul offers to cover the payment, hoping to get into Annie’s good graces. When she leaves for town, he cleans the scuffmarks off the doorframe. Paul continues writing, which becomes a distraction from his tense and painful circumstances.
In the spring, Annie becomes depressed. Her behavior becomes increasingly erratic: she binges sweets and hurts herself. Annie decides to go to her cabin in the hills—her “Laughing Place”—to protect Paul from her low mood. After she leaves, Paul sneaks out of his room but is unable to escape the locked house. In the parlor, he flips through a scrapbook filled with newspaper clippings (many of which are obituaries). From these, Paul reconstructs the trajectory of Annie’s life, and he realizes she killed many patients during her time as a nurse. Annie’s crimes went undetected until she began killing infants, at which point she stood trial in Denver, where she was acquitted based on lack of evidence. The town’s hatred of Annie and her self-imposed isolation now make sense to Paul: everyone knows she got away with murder. At the end of the book is an article about Paul’s disappearance, and he knows he will have to kill Annie to escape. He hides a butcher knife under his mattress.
When Annie returns, she drugs Paul before waking him. In much better spirits, she tells Paul that his car has washed away with the spring runoff. Annie knows Paul has been out of his room, and she has found the hidden butcher knife. To punish him, Annie uses an axe to chop off Paul’s left foot before cauterizing the wound with a blow torch.
In the weeks afterward, Paul continues his work on Misery’s Return, trying not to upset Annie. Annie, he knows, will not kill him until she knows how the story ends. One day, a young officer (Duane Kushner) pulls into the drive while Annie is mowing the lawn. Paul yells for help, but Annie brutally kills the officer. She locks Paul in the dark basement while she hides the car and the corpse. Paul steals Annie’s lighter fluid and hides it in his room when she returns.
Soon after Kushner’s death, two state policemen (David and Goliath) arrive and question Annie about his disappearance. Paul stays silent during their visit, wanting to kill Annie himself. Reporters and hecklers drive by Annie’s house, harassing her like they did during her trial. Knowing that Annie will kill the officers and Paul himself if they return with a warrant, Paul hastens to finish the book. When he is done, Paul calls Annie into his room, where he has covered the manuscript in lighter fluid. He lights the pile on fire. Horrified, Annie throws herself at the flaming pages and Paul hits her with the typewriter. He shoves hot paper down her throat, choking her. Annie hits her head and falls unconscious. Paul locks her in the guest room, but he feels certain Annie is not yet dead. Hearing an approaching car, Paul calls for help. David and Goliath break into the house to find Paul, emaciated and babbling. The guest room is empty.
Nine months later, Paul has published Misery’s Return and is slowly healing from his ordeal in Annie’s house. Although she was ultimately found dead in her barn, Paul still hallucinates Annie terrorizing him in his daily life. Returning to his new apartment, Paul has an idea for a story and begins to write for the first time in months, weeping.