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Patrick O'Brien is a young journalism and business student attending college when he publishes an article in the Dartmouth Free Press that catches the eye of a prestigious elder-care facility: The Vine. After watching both his parents and grandparents deteriorate slowly in nursing homes, he wonders at the agonizing slowness of their demise and asks repeatedly, "Is there not a better way to manage this?" This question is the very one that The Vine seeks to address.
Once Patrick is hired at The Vine and becomes embedded in its culture, his worries and concerns are assuaged until his live-in girlfriend, Liv Sullivan, the daughter and niece of the owners of The Vine, begins asking questions: Why do patients at The Vine die so quickly? As the story unfolds, the reader is taken on a journey full of tantalizing questions with few satiating answers. The Vine's mysterious origins, strange practices, and stranger files kept on patients whose families demand investigation leave the reader just as turned around as Liv is.
Pugh's book hints at the classic austerity of Victorian homes and their long histories while combining notes of true crime investigation and a whiff of cult-like mystery. Readers will find themselves turning each page searching for clues to the secretive world of The Vine, but no good mystery is easy to crack. In the final moments of the story, Pugh leaves his readers at the closed gates of an old home with a consoling story and a prevailing question: "Who do you believe?"