The novel's historical backdrop is the North African and Italian Campaigns of the Second World War. The story is told out of sequence, moving back and forth between the severely burned "English" patient's memories from before his accident and current events at the bomb-damaged Villa San Girolamo (in Fiesole), an Italian monastery, where he is being cared for by Hana, a troubled young Canadian Army nurse. A few chapters are also devoted to Kip, an Indian Sikh, during his time in England training and working as a sapper on unexploded ordnance.
The English patient's only possession is a well-worn and heavily annotated copy of Herodotus's The Histories that has survived the fiery parachute drop.[5] Hearing the book constantly being read aloud to him brings about detailed recollections of his desert explorations, yet he is unable to recall his own name. Instead, he chooses to believe the assumption by others that he is an Englishman based on the sound of his voice. The patient is in fact László de Almásy, a Hungarian Count and desert explorer, one of many members of a British cartography group.
Caravaggio, an Italian-Canadian in the British foreign intelligence service since the late 1930s, is a friend of Hana and Patrick, her mother's lover. He had remained in North Africa to spy when the German forces gain control and then transfers to Italy. He is eventually caught, interrogated, and tortured, resulting in his thumbs being cut off.[6] He is prematurely released and is standing on the Ponte Santa Trinita bridge when it is destroyed. He recovers at a hospital for over four months before he accidentally overhears about the patient and Hana. Caravaggio bears physical and psychological scars from his painful war experience.
During a thunderstorm, Kip and another British soldier arrive at the villa while Hana is playing on the piano. Kip decides to stay at the villa to attempt to clear it of unexploded ordnance. Kip and the English patient become friends due to the latter's extensive knowledge on both Allied and enemy weaponry and a detailed topography of Tuscany. At one point, Hana risks her life while Kip is defusing a bomb telling him later that she had hoped both of them had died. Shortly after, Kip and Hana develop feelings for one another and begin a relationship.
The English patient, sedated by morphine, begins to reveal everything: he fell in love with the Englishwoman Katharine Clifton who, with her husband Geoffrey, accompanied Almásy's desert exploration team. Almásy was mesmerised by Katharine's voice as she read Herodotus' tale of Candaules aloud by the campfire.[7] They soon began a very intense affair, but she cut it short, claiming that Geoffrey would go mad if he were to discover them.
Geoffrey offers to return Almásy to Cairo on his plane since the expedition will break camp with the coming of war. Almásy is unaware that Katharine is aboard the plane as it flies low over him and then crashes. Geoffrey is killed outright. Katharine is injured internally and Almásy leaves her in the Cave of Swimmers. Caravaggio tells Almásy that British Intelligence knew about the affair. Almásy makes a three-day trek to British-controlled El Taj for help. When he arrives, he is detained as a spy because of his name, despite telling them about Katharine's predicament. He later guides German spies across the desert to Cairo. Almásy returns to the cave where he finds Katherine has died years earlier. He retrieves her body from the Cave and, while flying back, the decrepit plane leaks oil onto him and both of them catch fire. He parachutes from the plane and is found severely burned by the Bedouin.
Towards the end of the novel, Kip learns through his headset that the US has bombed Hiroshima and Nagasaki and a situation develops where he nearly shoots the English patient. Hana calms him down and Caravaggio reflects that they would not have dropped that kind of bomb on a white nation. Kip departs from the villa, estranged from his white companions, and returns to India. He marries and has two children though he still thinks of Hana.
