Balm in Gilead takes place in 1966 in Frank's café, an all-night coffee shop on Manhattan's Upper West Side peopled by a makeshift community of dealers, junkies, hustlers, prostitutes, dreamers and runaways. The plot loosely centers on Joe, a cynical drug dealer, and Darlene, a naive new arrival to the big city, over the course of three days. Joe seduces Darlene hours after they meet, but Joe's relative inexperience in the dangerous world he does business in and his debt to a local kingpin named Chuckles hangs over his head, provoking him to push her away. Darlene, meanwhile, finds herself completely ill-equipped to handle life in a New York slum, and she becomes increasingly vulnerable to the attentions of the various low-rent men who hang around the café looking for an easy target. Joe, seeing in Darlene a chance for a fresh start, briefly considers giving up dealing, but just as he is about to return Chuckles' money, he is killed by one of the dealer's thugs. The play ends with all the principal characters droning their lines from the first scene over and over again in a circle, suggesting that their lives are stuck in a demoralizing rut.