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 ago.

Scarpetta and Marino ask Lucy to find Matt Petersen, their old suspect from 28 years prior, due to a case connection. In flashbacks, they investigate his possible role in his wife's death.

Scarpetta and Marino find disturbing parallels between their current murder case and a jogger's "accidental" death from six months ago. Meanwhile, Scarpetta believes a colleague is undermining her work and makes a major breakthrough.

In the present, Scarpetta and Benton's marriage is tested when Kay is called in by the FBI to perform autopsies on two dead astronauts found at a crash site. 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 killer out of hiding. In the present, Scarpetta orders the exhumation of the dead jogger's body. At home, Kay and Benton's mounting secrets 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.

Scarpetta and Marino grapple with a lie binding them forever. Now, with her family, career, and marriage in ruins, Scarpetta stands alone as a killer remains at large.