Dr Kay Scarpetta, Virginia Chief Medical Examiner and consulting pathologist for the federal law enforcement agency ATF, is called out to a farmhouse in Virginia that has been destroyed by fire. In the ruins of the house she finds a body that tells a story of a violent and grisly murder. The fire has come at the same time as Carrie Grethen, a killer who nearly destroyed the lives of Scarpetta and those closest to her, has escaped from a forensic psychiatric hospital. Her whereabouts is unknown, but her ultimate destination is not, for Carrie has begun to communicate with Scarpetta, conveying her deadly—if cryptic—plans for revenge. Carrie has linked up with a new companion, willing to end his life of sadistic slayings for her pursuit of Scarpetta.