Chicago is like every other American metropolis: built on a foundation of death. Little surprise that when a loving couple in a low-rent apartment cannibalize each other, the police write it off as a bizarre murder-suicide. Cameron-local fixer and addict in recovery-volunteers to take up the case as a favor to their neighborhood, the 49th Ward.

A year ago, Cameron overdosed on a hot new party drug and picked up an extra passenger, an entity that forces them to perform rituals written in blood. Being possessed is Cameron's new normal, but as more cannibalized victims turn up, so does an eldritch doppelganger of Cameron's old dealer, hunting them through nightmares and hallucinations.

Cameron tracks the molding remnants of their dealer from block to block, discovering a malicious growth that promises to spread through Chicago and give it a whole new shape. With a body not quite their own, Cameron faces the question lurking throughout the urban sprawl: who gets devoured, and who gets to feast?