The Cider House Rules revolves around the life of Homer Wells, an orphan who grew up in St. Cloud’s orphanage under the care and eventually, the tutelage of Dr. Wilbur Larch. The novel has three main parts, the first being an account of Homer’s youth, growing up in the orphanage serving as a medical assistant to Dr. Larch. Dr. Larch’s past is recounted as flashbacks that explain his emotional distance with women. As a young man, Wilbur Larch experienced a deeply distressing incident with a prostitute and this causes him to completely shun sex and relationships with women. In response to this trauma he instead chooses to help women as a doctor, assisting them especially with unwanted pregnancies ---the result of rape or incest in many cases--- by caring for the women as they give birth then caring for the infants in an orphanage that he put up.
The same aloofness that Dr. Larch displays around women is applied to the orphans under the his care. He reasons that keeping emotional distance with the orphans helps them shift to their adoptive families with greater ease. Over the years that pass however, it becomes evident that Homer, out of all the other orphans on St. Cloud’s, seems to be destined to stay. Dr. Larch grooms Homer from medical assistant to obstetrician and eventually grows to love the young orphan like a the son he never had. Their relationship is strained however by Dr. Larch’s dark secret; apart from doing work as an obstetrician, he also performs abortions. He argues that he came into this line of work aversely but was motivated to do it after having seen the aftermath of the “operations” that unlicensed and unqualified “doctors” carry out. Homer is horrified to learn of his secret because he considers it morally reprehensible.
The second part of the novel focuses on Homer’s life as a young man. He befriends a young couple, Wally Worthington and Candy Kendall that came to St. Cloud’s to have an abortion. After performing the abortion Homer leaves St. Cloud with the couple to join them at Ocean View Orchards. Homer becomes very good friends with Wally and over time, grows to love Candy, which he keeps to himself of course. Time passes and Wally is drafted to fight in World War II as a fighter pilot and his plane is unfortunately gunned down over Burma. Homer and Candy assume that he has been killed in action and pursue a romantic relationship. Subsequently Candy becomes pregnant and they return to St. Cloud’s to give birth to their son whom they name Angel. In a surprising twist of fate however, Wally is discovered in Burma, alive but injured, paralyzed from the waist down. He returns home and is reunited with Candy and they marry not too long after. Despite his paralysis Wally is still able to perform sexually, but is incapable of fathering children due to a disease he contracted as a P.O.W. in Burma. Homer and Candy lie about Angel’s descent, stating that he was conceived before Wally was drafted and that Homer decided to adopt him out of love for them both. Candy and Homer however maintain a discreet affair that lasted about 15 years.
The third portion of the novel focuses on the now teenaged Angel. He falls in love with the daughter of foreman of the migrant workers who are employed at Ocean View Orchard. Rose has become pregnant, the result of an incestuous rape. They turn to Homer to perform an abortion on her. The novel comes to a full circle with Homer Wells taking the role of director of St. Cloud’s Orphanage; he assumed the mantle of leadership after Dr. Larch’s passing, taking on the identity and credentials of a fake doctor persona that Dr. Larch created as homage to one of the orphans who died: Fuzzy Stone.
Like his predecessor he too carries out abortions, despite finding the practice morally distasteful. He carries them out to respect for the choice of his patients and, like Dr. Larch before him, out of a sense of care for the marginalized who come to him for medical assistance without fear of being judged or paying exorbitant fees.