Four young women have been found murdered—tortured and strangled in their own beds—all victims of the same brilliant monster. Using a skilled hand and the latest technology in forensic medicine, Kay Scarpetta begins the process of gathering the microscopic clues the latest battered body has to give.

Assaulted by the bitter cold of a Montreal winter, the American-born Dr. Temperance Breman, Forensic Anthropologist for the Province of Quebec, digs for a corpse where Sister Elisabeth Nicolet, dead over a century and now a candidate for sainthood, should lie in her grave. A strange, small coffin, buried in the recesses of a decaying church, holds the first clue to the cloistered nun's fate.

Relentless phone calls interrupt the peace of a warm August morning in Three Pines. Though the tiny Québec village is impossible to find on any map, someone has managed to track down Armand Gamache, head of homicide at the Sûreté, as he sits with his wife in their back garden. Reine-Marie watches with increasing unease as her husband refuses to pick up, though he clearly knows who is on the other end. When he finally answers, his rage shatters the calm of their quiet Sunday morning.

Forensic pathologist Dr. Kay Scarpetta has come almost full circle, returning to Virginia, the state where she launched her storied career, as the chief medical examiner. Finding herself the new girl in town once again after being away for many years, she’s inherited both an overbearing secretary and a legacy of neglect and potential corruption.

Tory Brennan, niece of acclaimed forensic anthropologist Temperance Brennan (of the Bones novels and hit TV show), is the leader of a ragtag band of teenage "sci-philes" who live on a secluded island off the coast of South Carolina. When the group rescues a dog caged for medical testing on a nearby island, they are exposed to an experimental strain of canine parvovirus that changes their lives forever.