Dr. Kay Scarpetta, the chief medical examiner of the Commonwealth of Virginia, is called to the scene of a gruesome strangling, the latest in a string of unsolved murders in Richmond.

Scarpetta and Pete Marino, a detective with the Richmond police, work with FBI profiler Benton Wesley to attempt to piece together the pathology of the killer.

Meanwhile, in her personal life, Scarpetta must deal with the presence of her extremely precocious ten-year-old niece, Lucy, as well as an uncertain romantic relationship with the local Commonwealth's attorney.

As she attempts to reach for a gun, Marino bursts into her bedroom and shoots the intruder, having realized that the news article would make Scarpetta a likely target.

[citation needed] Patricia Cornwell received the Edgar, Creasey, Anthony and Macavity Awards and the French Prix du Roman d'Adventure for Postmortem.