Lincoln Rhyme is in North Carolina with his aide Thom and his companion and partner Amelia Sachs in order to receive experimental spine surgery, which may improve or further worsen his C4 quadriplegic disability.

After Rhyme cunningly outwits Garret, he is arrested and Sachs is allowed to question him in order to find out where Mary-Beth is being hidden.

Eventually they reach Garret's safe house, where he reveals that he was lying about the man in the tan overalls, but he never meant to hurt Mary-Beth.

Rhyme is curious and thinks things do not fit into place correctly, and eventually confides in Bell that he believes the murders in the town are accountable to a local businessman manufacturing an illegal pesticide.

Lucy, the deputy who helped shoot the gun nuts earlier, is listening and they run in and restrain Bell, who is frustrated to see that Rhyme has tricked him and the sample of the pesticide was merely 'moonshine'.

She is about to be sentenced when Rhyme bursts in with evidence that the deputy she shot was in on the murders, allowing Sachs to be freed on the grounds that her victim was a criminal engaged in pursuit of an officer and thus legitimately making her 'crime' self-defence.

As he is going under anesthesia she reveals to him that she was the sheriff's mistress, and had been reporting who in the town had developed cancer due to pesticide poisoning so that those people could be silenced.

Rhyme does not have the surgery and is now back on the ventilator, after going into shock as Lydia attempted to stop his oxygen flow, requiring another year to regain his original physical status until he is fit to have the operation again.

In the novel, Sachs uses it on Garret despite not being a trained therapist, and as a result learns several valuable clues to the ultimate solution to the case.