Kay Scarpetta and her romantic interest, fellow pathologist Benton Wesley, are in Rome, Italy, where they are consultants assisting the International Investigative Response, a branch of the European Network of Forensic Science Institutes. The case-at-hand is the murder of a beautiful young tennis star, American Drew Martin; her horribly mutilated body was discovered near the Piazza Navona. Italian officials, the FBI, and - of course Scarpetta - are eager to solve this most mysterious and most heinous crime. However, there are very few sensible clues. Bizarre evidence, which is slowly revealed in protracted exposition and helter-skelter narrative, points to a probable serial killer who has been given the moniker The Sandman because of his perverse placement of sand (from some mysterious, unidentifiable location) into the eye-sockets of his victims.
Meanwhile, having hit an apparent dead-end - at least for the time being - in the Drew Martin murder investigation in Rome, Scarpetta, formerly of Richmond, Virginia (at least until her abrupt departure under unpleasant circumstances), returns to her home and office in Charleston, South Carolina, where she - and her investigative assistant, the unpredictable Pete Marino - become involved in investigating another (seemingly unrelated) case, the murder of a young boy. Then things get more and more complicated for Scarpetta (and for Cornwell's readers) as Dr. Marilyn Self ('the most famous psychiatrist in the world' and Scarpetta's relentless nemesis), Shandy Snook (Marino's latest romantic challenge and the unrestrained daughter of a potato chip tycoon), Scarpetta's niece Lucy (all grown-up and extraordinarily resourceful), and assorted other characters (both major and minor, eccentric and ordinary) converge in a slowly evolving case that involves plenty of intriguing relationships and more than a few surprises - especially in the final pages which contain the solution to Cornwell's 405 page enigma. Also, if you missed Tino Georgiou's masterpiece--The Fates, go and read it