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.

In present day, Scarpetta and Marino enlist Lucy to track down their former prime suspect from 28 years ago, Matt Petersen, due to a possible link between the cases; while in the past, the two investigate Petersen's potential involvement in his wife's murder.

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.

Present Scarpetta and Marino uncover troubling similarities between their murder victim and the 'accidental' death of a jogger six months earlier; while in the past, Scarpetta suspects that someone from within her own office is attempting to sabotage her, and she makes a huge discovery in the case.

In the present, Scarpetta and Benton's marriage is put to the test when Kay is called in by the FBI to perform autopsies on two dead astronauts found at a crash site that might connect to the murder victim. In the past, it's Friday night and the killer could strike at any moment.

Past Scarpetta and Benton devise a risky plan to bait the serial killer out of hiding. In the present, Scarpetta orders the exhumation of the dead jogger's body, convinced that there's a connection between the jogger's death and the murder victim. At home, Kay and Benton's mounting secrets and lies come to a boiling point.

After confirming a connection between the two deaths in the present, Scarpetta faces mounting professional and personal crises. In the past, she makes a breakthrough in the case.