It's June in Montreal, and Dr. Temperance Brennan, who has left a shaky marriage back home in North Carolina to take on the challenging assignment of Director of Forensic Anthropology for the province of Quebec, looks forward to a relaxing weekend in beautiful Quebec City. First, though, she must stop at a newly uncovered burial site in the heart of the city. The remains are probably old and only of archeological interest, but Tempe must make sure they're not a case for the police. One look at the decomposed and decapitated corpse, stored neatly in plastic bags, tells her she'll spend the weekend in the crime lab.

Four young women have been found murdered—tortured and strangled in their own beds—all victims of the same brilliant monster. Using a skilled hand and the latest technology in forensic medicine, Kay Scarpetta begins the process of gathering the microscopic clues the latest battered body has to give.

One look at the decomposed and decapitated corpse, stored neatly in plastic bags, tells Temperance Brennan she'll spend the weekend in the crime lab. Something about the crime scene is familiar to Tempe: the stashing of the body parts; the meticulous dismemberment. As a pattern continues to emerge, Tempe calls upon all her forensic skills, including bone, tooth/dental, and bite mark analysis and x-ray microflourescence to convince the police that the cases are related and to try to stop the killer before he strikes again.

He slips into their homes at night and walks silently into bedrooms where women lie sleeping, unaware of the horrors they soon will endure. The precision of the killer's methods suggests he is a deranged man of medicine, propelling the Boston newspapers and the frightened public to name him "The Surgeon". The cops' only clue rests with another surgeon, the victim of a nearly identical crime. Two years ago, Dr. Catherine Cordell fought back and killed her attacker before he could complete his assault.

Forensic pathologist Dr. Kay Scarpetta has come almost full circle, returning to Virginia, the state where she launched her storied career, as the chief medical examiner. Finding herself the new girl in town once again after being away for many years, she’s inherited both an overbearing secretary and a legacy of neglect and potential corruption.