Choke follows Victor Mancini and his friend Denny through a few months of their lives with frequent flashbacks to the days when Victor was a child Victor grew up while going from one foster home to another. Victor's mother was found to be unfit to raise Victor. Several times throughout his childhood his mother would kidnap him from his foster parents. They would eventually be caught and he would again be remanded over to the government child welfare agency.

In the present day setting of the book, Victor is now a man in his mid-twenties who left medical school in order to find work to support his mother who is now in a nursing home. He cannot afford the care that his mother is receiving so he resorts to being a con man. His "con" is to go to restaurants and midway through his meal, he forces himself to choke on his food.