Medicine River can be read as a Bildungsroman, or coming-of-age novel, at two levels. Will recounts his childhood, youth, and early adulthood, as he grows from the son of a single Blackfoot mother into a fledgling photographer. In the present narrative, Will undergoes another developmental journey, establishing himself back in his home community, reconnecting with his Blackfoot heritage, and reconciling his questions about his paternity. This dual narrative structure is symbolic and reflects other dualities: his dual heritage as the son of an indigenous mother and white man; his two brother figures, James and Harlen; and his two phases of self-discovery, the first when he is living in Toronto and the second after he moves back to Medicine River.

The novel is notable for its mundane texture and lack of a clear central plot. King depicts the everyday occurrences and small-town gossip that define Medicine River, humanizing his characters and allowing them to become familiar. The community of Medicine River experiences births, deaths, abusive relationships, alcoholism, sports triumphs, weddings, and game nights. Though the prose of the novel is simple, the complexity of being human arises in the imperfect relationships among the characters.

King’s novel works to undermine stereotypes about indigenous peoples by emphasizing the normalcy of Medicine River. Bertha wants to date; Louise does Harlen and Will’s taxes; the community gathers at a local bar; friends become enemies. Rather than fetishize and “other” an indigenous community, King deliberately portrays them as ordinary people living ordinary lives. In chapter 12, Lionel James’s character is a clear literary device meant to address common misconceptions about indigienous people. He comments, “Lots of white people seem real interested in knowing about Indians. Crazy world.” But when he tries to tell stories about people currently living on the reservation, his white audiences “don’t want to hear those stories. They want to hear stories about how Indians used to be. I got some real good stories, funny ones, about how things are now, but those people say, no, tell us about the olden days.” Westernized audiences cling to their stereotypical conceptions rather than accept that modern indigenous communities are more similar to them than they are different. 

Connection to the land is a key motif throughout the novel. A geographic description of Medicine River opens the novel, acting as a literal grounding point. When the basketball team loses a game, Harlen pulls the team van over on the side of the road and makes the men get out before saying to them, “Where are you? What are you standing on? . . . You don’t know where you are.” His belief that maintaining a connection to the land suggests a deep spirituality that is embedded in indigenous culture. Will travels across Canada, from Medicine Rover to Calgary to Toronto and back, before finally gaining a clearer understanding of who he is. Being on the land of his birthplace enables him to finally reflect on his life, grapple with his past, and resolve to live in a way that will bring him happiness. James’s nomadic lifestyle stands in direct opposition to Will’s: his flight from his hometown and his constant movement to a new place indicates his restlessness and his disconnection. Many indigenous communities believe that a core part of their cultural identity and their ancestral history is rooted in the land. Rather than adopt the more Westernized mindset that land is meant to be owned by people, indigenous cultures believe that they are stewards of the land, there to protect and care for it. Abandoning the land means abandoning home, culture, and tribal history. 

Medicine River is filled with strong female characters. Louise is adamant that she doesn’t want to get married and takes on the burden of being a single parent as she raises South Wing. Rose works night shifts as a cleaner to provide for her sons after being exiled from the reservation for marrying a white man. Bertha takes control of her love life when she comes to Will asking for a photograph for her dating profile. January Pretty Weasel, tired of being trapped in an abusive relationship, arranges a scenario that causes people to assume her husband committed suicide rather than suspecting her. Though the novel’s protagonist is a man, women are equally present and are portrayed as active agents in control of their own lives.

That the novel ends on the day after Christmas, with Will’s relationship with James rekindled and Louise’s having turned down Harold’s proposal, indicates that Will’s future will contain yet another “rebirth.” South Wing is just starting to learn how to say Will’s name, and Will wraps his father’s top, first given as a gift to him, to give to South Wing. The novel suggests that Will will more formally step into his role as a father and continue to evolve in his identity and character. Ultimately, the book acknowledges that humans are constant works in progress, always responding to their circumstances and always capable of growth and change in the endless pursuit of human connection.