Medicine Creek, Kansas, has been slowly dying for the last century. A small, quiet place, the primary occupation is still farming, Main Street is a stretch of old and dusty businesses, and the nearest mall is 200 miles away. In a town where nothing changes, the community is terrified after a series of grisly murders takes place. Even more alarming, the bodies are displayed in bizarre tableaus. With the entire town in shock, FBI Agent Pendergast arrives from New Orleans to investigate.

From the fields to the local caves, Pendergast discovers the remnants of a Prohibition-era moonshine operation and the truth behind one of the town's greatest mysteries: who was behind the Medicine Creek Massacre of 1865. Now, Pendergast must discover the twisted secret hiding within a four-generation Kansas family – before someone else is murdered.