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Sweet Home, Oregon. Detective Lacey James needs to solve her marriage problems. But with her focus on a culprit escaping after a robbery call, she’s alarmed when she discovers his getaway car hides a chilling collection of rope, gloves, zip ties, and a gun. But her success in hunting him down turns into horror when the man grabs a firearm, killing a fellow officer before himself.

On a hot July afternoon, a worker at an Antietam Creek construction site drives the blade of his backhoe into a layer of soil - and strikes a 5,000-year-old human skull. The discovery draws plenty of attention and a lot of controversy. It also changes the life of one woman in ways she never expected.

Convicted serial killer Carrie Grethen has escaped from a psychiatric hospital with plans for revenge. Wary and shaken, Scarpetta also has to investigate the death by fire of an unknown woman. The post mortem reveals that the woman was stabbed before the fire was started, and soon Scarpetta and her colleagues are called out to the scene of another fire and another murder.