Soon after relocating to Charleston, S.C., to launch a private forensics lab, Scarpetta is asked to consult on the murder of U.S. tennis star Drew Martin, whose mutilated body was found in Rome. Contradictory evidence leaves Scarpetta, the Italian carabinieri and Scarpetta's lover, forensic psychologist Benton Wesley, stumped.

But when she discovers unsettling connections between Martin's murder, the body of an unidentified South Carolina boy and her old nemesis, the maniacal psychiatrist Dr. Marilyn Self, Scarpetta encounters a killer as deadly as any she's ever faced.