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.

Assaulted by the bitter cold of a Montreal winter, the American-born Dr. Temperance Breman, Forensic Anthropologist for the Province of Quebec, digs for a corpse where Sister Elisabeth Nicolet, dead over a century and now a candidate for sainthood, should lie in her grave. A strange, small coffin, buried in the recesses of a decaying church, holds the first clue to the cloistered nun's fate.

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.

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.

There's a killer on the loose in San Francisco, and he's stalking newlyweds. When the usual procedures to stop him don't work, four women, each holding a piece of the puzzle, form a Women's Murder Club to collaborate outside the box and pursue the case. 1st to Die is the start of a new series of crime thrillers from James Patterson.