[1] The story is set in a psychiatric hospital, where the protagonist Francis Petrel has been confined by his family after his erratic behavior culminated in a terrifying outburst.

[3] Francis Petrel, nicknamed C-bird, was just over twenty years old when his family confined him to the Western State Hospital psychiatric facility after his erratic behavior culminated in a terrifying outburst.

The book describes a scene of abandonment, sadness, rejection, and indifference from Francis' family and the society he lives in, leaving the character in an unfamiliar place.

[3][4] Recently released from the Western State Hospital, Francis faces his own inner demons as he recounts his memories of the murderer of a young nurse, whose mutilated body was found one night after the lights went out.

[2][8] Washington Post reviewer Patrick Anderson wrote that the novel could be "sometimes over the top" however was "a tour de force, superior storytelling designed to scare your pants off and likely to succeed".