The book was named after the 1987 single "Girlfriend in a Coma" by The Smiths. Additionally, Coupland uses other Smith lyrics and song titles within the book such as "Bigmouth Strikes Again," "Hand in Glove," and "The Queen is Dead."
The first part of the book covers the next 17 years in the lives of the friends, after Karen’s lapse into a coma. Richard has to cope with losing Karen but gaining a daughter (Megan), as fatherhood is thrust upon him: the outcome of their mutual loss of virginity just hours before Karen fell into her coma. Wendy throws herself into work and Linus loses himself, looking for that which is lost. Pamela becomes a supermodel and Hamilton a demolition expert, but none of the friends’ lives turn out how they imagined. Broken and lacking, they return to the suburbs of their youth to try to pull themselves together until one day, almost two decades after she fell asleep, Karen regains consciousness.
The first part of the book is briefly narrated by Jared, a ghost of a friend of the characters that died tragically of leukemia at a young age. The rest is narrated by Richard, in the first person, as he tells the story of what happened in the 17 years.
The second part of the book deals with Karen's return to the world. It also begins, as Karen remembers, to explain where she had been all those years and the reality she had hoped to escape. Then, suddenly, the future is upon her, upon them all, and the world ends. This section is narrated in the third person, with insight into all the characters' minds.
The final part of the book details life after this end: after everyone except these seven people have fallen asleep and not reawakened. This section is again narrated by Jared. The characters’ have to deal with the end of the world as predicted by Karen in her coma.
Thrust into a coma after having a glimpse of the future, Karen is the tragic figure in this novel. She has a vision of the future she can’t quite understand, before or after her coma. Upon returning from her coma, she has the mind of a seventeen year old, and a daughter, Megan, physically the same age as she is mentally. She constantly wonders what the future and technology has really given humanity.
The boyfriend of the comatose girlfriend, and the father of her child, Richard’s struggle through life is one of the primary focuses of the first part of the novel. He was a close friend to Jared. Jared’s death and Karen’s coma cause Richard’s mental state to be quite weak. A frequent alcoholic, Richard struggles with addiction while waiting for Karen to possibly walk up.
The smart one of the group, Wendy moves on to become a doctor working in the Emergency Room of the hospital. While the other characters seem to disappear into addiction or misery, Wendy gives herself to her schooling and work. She later gets together with Linus, though her heart still bares feelings for Jared.
Shortly after high school, Linus leaves to travel the world, in a quest to find himself. He spent quite a stay in Las Vegas. What Linus finds does not give him the closure that he searches for. Instead, it leaves him feeling emptier then when he left. Linus later marries Wendy.
Pamela is the supermodel of the group. She leaves the group to enter into the decadent lifestyle of the rich and famous. Pamela constantly name drops different celebrity names in conversation, and hints at many drug induced exploits. She has a problem with Heroin. She later marries Hamilton, whom she indulges with in her Heroin frenzy.
Hamilton is an eclectic member of the group. He, too, has a problem with Heroin. He later marries Pamela.
Born to Karen while in her coma, Megan is raised by Karen’s parents. She is a rebellious child, finding solace in the thought of death. Her father, Richard, leads a tertiary life as her father, distant yet there when needed. She dates a very low class man named Skitter. She later becomes pregnant by Skitter.
A high school friend of the main cast, Jared was very promiscuous. He was also a jock. At the beginning of the novel, he has already died of leukemia, and exists as a ghost. The leukemia was very fast acting, giving him little time after learning of his disease. He is the only other presence to visit the main cast after the End of the World.
The novel is set in Vancouver "because [his] brain was so incapacitated [he] decided [it] had to be set in [his] own neighbourhood".
Comas were also an inspiration for him. "Comas really are peculiar only to the late 20th century. Before, say, 1960, people who might have gone into a coma simply died. Comas are more modern than plastics or TV. I like the notion that comas can allow a person to radically reinvent themselves upon awakening. I think we all want to do that -- radically reinvent ourselves -- I think it's our deepest need."
The title, a Smith’s song title, was chosen because “It's clearly descriptive of the book, but it's also a little salute to those points in my life when I was melting down to soundtracks provided by British gloom rockers”
It is considered one of Coupland's finest novels, with a stronger narrative than some of his earlier books but still providing relevant cultural criticism and commentary. In the UK, The Guardian described the book as Coupland "becoming extraordinary" (25 April 1998) and The Times as "a disturbing, thought-provoking and moving novel. Girlfriend in a Coma has something of the quality of a fairytale, but it contains a sharp realism that makes the book scarily contemporary" (15 May 1999). -->
BBC Radio 3 broadcast an adaptation of the novel as part of its "Drama on 3" strand on 24 February 2008. It was adapted by Dan Rebellato who has previously adapted The Midwich Cuckoos for BBC Radio 4.