Minneapolis construction company owner Edgar Freemantle is injured in an accident at a job site when his truck is crushed by a crane. His right arm is amputated and he has severe head injuries that affect his speech, vision and causes violent mood swings and depression. His wife Pam asks him for a divorce after he attacks her twice. Edgar has no memory of these attacks due to his injuries. His psychologist, Dr. Kamen, advises him to get away from everything for a year to aid in his recovery. Edgar decides to move to an island off the west coast of Florida called Duma Key for the year. He rents a house which he nicknames "Big Pink" because of its color. He hires a local college student named Jack Cantori to help him get set up.
On the advise of Dr. Kamen, Edgar picks up his old hobby of painting. He quickly becomes obessed with painting and sometimes can feel his phantom right arm when he is painting. He begins to take long walks along the beach and eventually meets Jerome Wireman, a former lawyer from Nebraska, who takes care of Mrs. Eastlake, the wealthy heiress who owns most of the land on Duma Key including "Big Pink". Edgar soon realizes there is a supernatural element to the paintings he does when he feels his phantom arm and is in a dazed state. His painting have shown him things that were happening in Minnesota, his daughters new boyfriend who he hadn't met, allowed him to kill a pedophile by removing his nose and mouth in a painting and remove a bullet from Wireman's head.
Mrs. Eastlake convinces Edgar that the paintings are dangerous and that he should sell them and get them away from the island. She says that his "Girl and Ship" series are especially dangerous. The "Girl and Ship" series depict a haunted pirate ship named Perse and a little girl who looks just like Edgar's daughter Ilse. He holds an exhibition of his work at a local art gallery which his family and many of his friends travel from Minnesota to attend. Elizabeth Eastlake makes a suprise appearance at the exhibition and warns that "the table is leaking" before she dies of a seizure.
All of the friends and family members who buy Edgar's paintings begin to die that night or be possessed by Perse to kill for her. Ilse Freemantle is killed by an art critic from Duma Key named Mary Ire who did a story on Edgar's art. After drowning Ilse in her bathtub Mary commits suicide.
Edgar soon learns his paintings are related to events from Elizabth Eastlake's childhood. Perse had killed Elizabeth's twin sisters by luring them into the ocean and drowning them. Elizabeth had neutralized Perse by drowning her in fresh water. In the years since then the cask that held the fresh water had cracked and the water had leaked out allowing Perse to influence the world again. Edgar, Wireman, and Jack Cantori find the cask and take out the figurine of a red cowled woman that Perse possesses. They seal it in a silver container filled with fresh water and drop it in the middle of one of Minnesota's fresh water lakes.