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How much do we really know about those we love? Kate is visiting Albania with her husband, Paul, a much needed break from Paul's stressful website business. 'Hold still,' says Kate, taking a picture as Paul steps onto the hotel room balcony. 'We'll always be together,' Paul responds. Suddenly there is screaming below and a blaring car horn. Kate stares down from the balcony at the broken body of her husband lying lifeless in the street.

Deep in the muddy fields of the Lincolnshire Fens, a teenage girl is found wandering, delirious, claiming to have been drugged at a party. Metres away, the drowned body of another girl is found on an isolated beach. And all this on a small stretch of land where, nearly 10 years ago, the shocking disappearance of a young girl remains an open case.

It is the week before Christmas. A tanking economy has prompted Dr. Kay Scarpetta - despite her busy schedule and her continuing work as the senior forensic analyst for CNN - to offer her services pro bono to New York City's Office of the Chief Medical Examiner. In no time at all, her increased visibility seems to precipitate a string of unexpected and unsettling events.

The body of an elderly woman is found dismembered in a Virginia landfill. Scarpetta initially believes the clues mirror that of a serial killer she's tracked before. But upon further investigation, she discovers puzzling pox-like erruptions on the woman's body that, perhaps, point in another direction.