The Heart Goes Last is set in a not-so-distant future in which the economy of the United States has collapsed. In the wake of a major financial meltdown, those rich enough to flee have taken up residence in floating offshore tax havens, leaving the rest of the population to cope with a society ravaged by spiralling unemployment, drug addiction, and crime. The novel’s protagonists, a married couple named Stan and Charmaine, have lost their home and are living in their car, dodging thieves and rapists on a nightly basis. Their only income is the pittance Charmaine earns working in a sleazy bar. Stan’s outlook is so bleak that, against his better judgement, he considers asking his criminal brother Conor for help.

Then an apparent solution to their difficulties presents itself. Charmaine sees an advertisement for the ‘Positron Project’. Applicants accepted into Positron are given a place to live in a safe and wholesome-looking town named Consilience, a gated community that is straight out of the 1950s, right down to its mandatory Doris Day soundtrack. The catch is that admission is a Hobbesian bargain: in return for security, Charmaine and Stan must surrender their freedom. Once they enter they can never leave. They are paired with another couple, known as their ‘Alternates’, with whom they share a house; they must then alternate with their Alternates, spending one month leading comfortable suburban lives in Consilience and the next month locked away in Positron’s private prison system, where they work on morally dubious projects that generate profits for the governing corporation.