Dr Kaye Scarpetta has made a place for herself in Charleston, South Carolina. Now in private practice, her skills as a forensic pathologist are for hire, though often misconstrued by the residents of the town. She is not alone, with her consultancy offering a holistic approach from three others who made the trip across from Florida with her. A former behavioural profiler with the F.B.I., Benton Wesley offers his psychological insight, former Detective Pete Marino is on the on-ground investigator and Scarpetta's niece Lucy, a brilliant and wealthy woman, provides the technology of examination and electronic records access. It has been a year and was supposed to be a new start for Scarpetta, recovering from an encounter with a Florida psychopath. Some old wounds have not quite healed, and the disintegration in the people dearest to her may this time not be something she can prevent.
An American tennis star has been slain while taking a respite in Italy. It was odd that it was her choice to take a break, right before she was expected to play in a Grand Slam tournament. The killer, calling himself the Sandman, makes contact with Scarpetta's old nemesis, Dr Marilyn Self, drawing the two women together again in reluctant contact after their last painful encounter. The young tennis champion is not the only victim needing Scarpetta's assistance. A young boy who has lain unclaimed for sometime in Scarpetta's morgue troubles her, not only because of the agony she knows he suffered in his short life but also because no one has come forward for him. The worry Scarpetta constantly carries for Marino has not lessened with the move away from their old life; it has become a greater burden as she watches him step further out into a life so far from healthy that it seems inevitable he will harm himself, distancing himself not only from her but from Lucy, whom he has loved and taught so much. Scarpetta knows from experience that killers can cross shores to find new hunting grounds, and it appears that the circle of death, from motive to discovery to reason, again leads straight back to her own doorstep.