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The novel follows Tchaikovsky's life from his youth, through his rise to become one of the greatest composers of the 19th century, and until his death. Mann portrays Tchaikovsky as an extremely sensitive and complex personality, torn between social expectations, his own feelings, and his quest for artistic perfection.

The novel deals in detail with his homosexuality, which he was forced to hide in Russian society at the time. The author shows how this repression leaves a deep mark on the composer's psyche and affects his work and relationships. Through emotionally charged descriptions of Tchaikovsky's relationships with men, friends, and family, Mann explores themes of identity, shame, art, and death.

A special place in the novel is occupied by the creation of his last symphony, the Sixth Symphony in B minor, also known as the "Pathétique." This symphony, deeply personal and tragic, becomes a symbol of the composer's inner pain and premonition of death.