The book takes its title from the Velvet Underground song "Heroin",[5] and concerns the exploits of several addicts living in rural America, as they engage in drug use, petty crime, and murder. The stories are linked by shared locations (such as a dive bar in small-town Iowa) and repeated imagery. They are all narrated by a troubled young man identified only as "Fuckhead" ("Emergency").[6]
The book is known for its seemingly chaotic narrative style, which mirrors the mental state of its narrator and the disjointed perception of an addicted, drug-addled mind.[7][8][9]
In "Car Crash While Hitchhiking" Fuckhead seems to have extra-sensory perception, which allows him to experience in the present a deadly car crash that won't happen until much later in the narrative. Despite his foreknowledge, he enters the car he claims to know will inevitably crash. "Emergency" picks up with Fuckhead while he's working a job as a hospital janitor and driving around under the influence of batches of prescription medications that he's stolen from the hospital. The orderly, with whom he takes a drug-fueled, bunny-killing trip, helps to save a man who's been stabbed in the eye by his wife (this character, Georgie, is also the one who reveals the nickname of the narrator). The book ends on a more hopeful note as the final narrator enters a recovery program and begins to hold down a stable job writing a newsletter for the residents of a nursing home.
