The story follows Samuel Carter, a young man whose life becomes bound to the grim corridors of a state asylum after his elder brother Daniel descends into violent madness. Out of loyalty and guilt, Samuel refuses to abandon Daniel, volunteering to remain close as caregiver in Ward C, the ward of chains where the most disturbed and dangerous patients are kept.At first, Samuel is treated as little more than a servant-untrained, mocked by hardened orderlies, burdened with humiliating chores. He cleans filth, carries buckets, and suffers bites, scratches, and jeers. Yet his quiet persistence earns him the role of caregiver in truth. Samuel forms fragile connections with the ward's inmates: Old Thomas, the hymn-singing veteran; Ruthie May, feral and vicious; and Isaiah "Bones" Johnson, cunning and obsessed with escape. Above all, Samuel clings to Daniel, searching for fleeting moments of clarity amid his brother's rages.As months pass, Samuel begins to sense something uncanny in the asylum. A night when a patient dies.