Dr Kay Scarpetta, Chief Medical Examiner and consulting pathologist for the federal law enforcement agency ATF, is called out to a farmhouse in Virginia which has been destroyed by fire. In the ruins of the house she finds a body which tells a story of a violent and grisly murder.

The fire has come at the same time as another even more incendiary horror: 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.