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John Hawkes said Lewin met and read with several disabled actors to take on the role of O'Brien but said "none of them felt quite right" for the character. Lewin explained, "I felt that if I could do on film what he had done to me with his writing, then I could potentially deliver something powerful." While writing the script, Lewin drew from his own experiences with polio and worked closely with Susan Fernbach, O'Brien's partner during the last years of his life, and Cheryl Cohen Greene, the surrogate. He stumbled onto the article while researching sex and the disabled for a semi-autobiographical sitcom project. Writer and director Ben Lewin, a polio survivor himself, first read about O'Brien's experiences with a sex surrogate from O'Brien's article "On Seeing a Sex Surrogate" on the Internet. O'Brien's life was chronicled in the 1996 short documentary Breathing Lessons: The Life and Work of Mark O'Brien, directed by Jessica Yu, which won an Academy Award for Best Documentary Short. The film is based on an article O'Brien published about his experiences with Greene, "On Seeing a Sex Surrogate", which appeared in The Sun magazine in 1990.
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At age 38, he hired sex surrogate Cheryl Cohen-Greene to help him lose his virginity.
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O'Brien breathed with the support of an iron lung for much of his life. O'Brien was a journalist and poet who was paralyzed from the neck down by polio since his childhood. Father Brendan gives the homily and Susan reads the poem he had previously sent Cheryl. The film then cuts to Mark's funeral, held sometime later in 1999, and attended by four of the women he came to know and care for, including Cheryl. However, he survives and meets a young woman named Susan Fernbach. One day sometime later, the power goes out in the building in which Mark lives, causing the iron lung to stop functioning and making it necessary for Mark to be rushed to the hospital. After several attempts, Mark and Cheryl are able to have mutually satisfying sex, but decide to cut the sessions short on account of their burgeoning feelings. Cheryl's husband, who loves her deeply, fights to suppress his jealousy, at first withholding a love poem that Mark has sent by mail to Cheryl, which she eventually finds. They begin their sessions, but soon it is clear that they are developing romantic feelings for each other. She tells him they will have no more than six sessions together.
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After consulting his priest, Father Brendan, he gets in touch with Cheryl Cohen-Greene, a professional sex surrogate. After unsuccessfully proposing to his caretaker Amanda, and sensing he may be near death, he decides he wants to lose his virginity. Due to his condition, he has never had sex. In Berkeley, California, in 1988, Mark O'Brien is a 38 year old poet who is forced to live in an iron lung due to complications from polio.