"Real Americans" begins with a prologue and is divided into three novella-length sections, each from a different character's perspective, illustrating complex narrative techniques.
The characters in the book explore their personal and familial identities, grappling with their relationships and past connections that shape their present.
The novel delves into philosophical questions about free will, genetic engineering, and the ethics of altering genomes, reflecting contemporary societal issues.
The third part of the book, largely from the perspective of May, Nick's grandmother, is particularly rich in cultural and historical detail, including her experiences during the Cultural Revolution in China.
The story incorporates elements of magical realism, particularly through the family’s ability to "keep time still," which adds a layer of fantasy and metaphor to the narrative.
The novel poses significant questions about scientific advancements and their moral implications, particularly in the context of polygenic screenings and life extension.