After returning to her former position as Virginia's Chief Medical Examiner, renowned forensic pathologist Dr. Kay Scarpetta investigates a sinister and mysterious murder that eerily resembles her first big case from 28 years prior.

Present Scarpetta and Marino visit Matt Petersen at his Compound while Lucy and Officer Blaise Fruge team up to search for the murder victim's boyfriend. The past investigation takes a turn when Scarpetta is called into the Health Commissioner's office regarding leaks to the press.