World-renowned forensic pathologist Kay Scarpetta and her husband Benton, a psychologist with the US Secret Service, have returned to Virginia. They are headquartered five miles from the Pentagon in a post-pandemic world that's been torn by civil and political unrest.

Just weeks into the job, Scarpetta is called to a railway track where a woman's body has been shockingly displayed, her throat cut down to the spine. But the trail of clues will lead Scarpetta back to her own neighbourhood. At the same time, a catastrophe occurs in a top-secret lab in outer space, endangering the scientists aboard. Scarpetta is summoned to the White House to find out what happened. As she starts the new investigation, an apparent serial killer strikes again, this time dangerously close to home.