It's April 2024, and a quiet evening at Dr. Phineas Mann's dinner table is interrupted by a mysterious visit from FBI agents.

As worsening climate change leads to more difficult asthma cases, Phineas has been tasked with investigating a novel treatment in a Phase 3 trial with SynMedical's Dr. Marie Porter. Marie has just returned to North Carolina 26 years after her single mother abruptly extracted her from the sixth grade to disappear into the rural Northwest.

Meanwhile, the Republican U.S. President, in the final year of his second term, develops alpha gal syndrome, a life-threatening allergic condition from Lone Star ticks that find their way north as the planet warms.

Then a surprising assignment sends Phineas and Marie, against their wills, into intrigue at the highest levels in a hotter, dirtier, and more polarized country.