RUNNING TO SAVE his life, William Buckman leaves his job as a physician in Philadelphia and returns to his childhood home in the Old World, an isolated rural community in Canaan, a town in the western hill country of Massachusetts. He is running from Christopher Koenig, a well-known poet with second career as an assassin. Koenig, hired by the administration of Worthington Hospital, owned by the Worthington-America Medical Group, a nationwide health industry business, is terminating underinsured patients as part of a cost-reducing program.

Back in the Old World, where he is known as Billy Buck, Buckman is forced to confront the demons of his childhood in an abusive, incestuous home at the same time he is fighting to live and reclaim his career. His struggle for survival is complicated by: His father's sudden death. His relationships with his brothers. A crazed preacher/policeman. The arrival in the Old World of an old love. Koenig's obsessive pursuit of him.

The story is one of murder in a corrupted and corrupting health care system. It tells of the difficulties an adult has in facing down the problems of growing up in a life he has far outgrown. It also is a story of love in all its forms.