Fresh from her bruising battle with a psychopath in Florida, Scarpetta decides it's time for a change of pace. Moving to Charleston, South Carolina, she opens a unique private forensic pathology practice, one in which she and her colleagues, including Pete Marino and her niece, Lucy, offer expert crime-scene investigation and autopsy services to communities lacking local access to competent death investigation and modern technology.
It seems like an ideal situation, until the new battles start: with local politicians, with entrenched interests, with someone whose covert attempts at sabotage are clearly meant to run her out of town. And that's before the murders and other violent deaths even begin.
A 16-year-old tennis star, fresh from a tourament win in Charleston, is found nude and mutilated near Piazza Navona in Rome. The body of an abused young boy is discovered dumped in a desolate marsh. A woman is found ritualistically murdered in her multimillion-dollar beach home. Meanwhile, in distant New England, problems with a prominent patient at a Harvard-affiliated psychiatric hospital begin to hint at interconnections that are as hard to imagine as they are horrible.
Scarpetta has dealt with many brutal and unusual crimes before, but never any as baffling, or as terrifying, as the ones confronting her now. Before she is through, that book of the dead will contain many names - and the pen may be poised to write in her own.