Medical examiner Kay Scarpetta and her friends investigate two bizarre murders in the 18th thriller to feature America’s favorite medical examiner. Training at Dover Air Force Base’s Port Mortuary, Scarpetta gets tapped to solve the seemingly straightforward case of the sudden death of a man walking his dog near her home in Cambridge, Mass. He dies at the scene of an apparent heart attack, but an inspection at the morgue suggests he was still alive while put in the body bag. Further examination reveals unusual internal injuries.

At the same time, her husband, FBI agent Benton Wesley, seeks her help in an open-and-shut case involving the death of a little boy and the man who confessed to the crime. Wesley thinks the confession is bogus, though all the evidence points to his guilt. These two disparate cases will test her in ways she never imagined.