Leaving behind her forensic pathology practice in South Carolina, Kay Scarpetta takes up an assignment in New York City, where the NYPD has asked her to examine an injured patient in a psychiatric ward. The handcuffed and chained patient, Oscar Bane, has specifically asked for her, and when she literally has her gloved hands on him, he begins to talk - and the story he has to tell turns out to be one of the most bizarre she has ever heard.
In Richmond, Virginia, young lovers are dying. So far, four couples in the area have disappeared, only to be found months later as mutilated corpses. When the daughter of the president's newest drug czar vanishes along with her boyfriend, Dr Kay Scarpetta knows time is short. Following a macabre trail of evidence that ties the present homicides to a grisly crime in the past, Kay must draw upon her own personal resources...