In Richmond, Dr. Kay Scarpetta, chief medical examiner of Virginia and consultant for the FBI, is in the midst of a late-night autopsy at the morgue when the call comes: Gault, the sadistic psychopath who has eluded capture for years, has struck again. For Scarpetta, her worst nightmare returns.

While Scarpetta sorts through strange forensic evidence, including an uncommon tread pattern and extremely rare gold dental restorations, Gault kills again. But the prey he ultimately seeks is Scarpetta, for it becomes increasingly apparent that he is as focused on her as she is on him.