As the book opens Dr. Kay Scarpetta, Virginia's Chief Medical Examiner, has maimed the deformed serial killer Jean-Baptiste Chandonne ('the werewolf') in self-defense. Kay believes Chandonne killed the corrupt former police chief Diane Bray but - in a twist - Kay herself is being investigated for Bray's death.
As usual in the Scarpetta novels Kay is the target of various malevolent individuals who wish her harm (in Cornwell's books being a medical examiner is a very high risk job). Kay is more depressed and fed-up than usual for a number of reasons: she's still in deep mourning after the murder (in a previous book) of her boyfriend FBI profiler Benton Wesley; she's upset about her niece, Lucy, being suspended from her job at ATF; her 'sidekick', detective Pete Marino, is being more obnoxious than usual; and she's thinking of quitting her job as Chief Medical Examiner.
Part of the book is devoted to Kay examining her life in talks with her psychiatrist/friend Anna Zenner and much of this self-examination comes off as whiny and complaining. The book's best parts revolve around the investigation of a couple of bizarre torture murders that are labeled hate crimes and, towards the end, a young boy's suicide.
As usual the scenes of autopsies conducted in the morgue are graphic and the forensic analyses of evidence is interesting. The book is okay but not one of the best in the series.