McCarthy's second novel to feature London Medical Examiner Harry Kent concerns the apparent suicide of 34-year-old heart surgeon Susan Bayliss, who worked at the Belgrave Hospital for Sick Children. Susan's girlfriend, Teodora Guzman, found her in a chair with wounds incised on her wrists and upper arms. Harry, one of the first officials to arrive on the scene, is convinced that the cause of death is hemorrhage. Susan had recently gained media notoriety for leaking the deaths of four children. She was recently suspended from Belgrave after committing the cardinal sin: blowing the whistle on her colleagues. She paid for it with her job, and now perhaps her life.

Long accepting that life is something fragile, Harry finds himself back working with acting DCI Francis Noble. In happier times--just six months ago--they were a loving couple, until Noble's incessant drinking forced Harry to kick her out of his apartment one final time. Harry hadn't expected his first rendezvous with Noble to be the in the middle of the night with a dead woman lying upstairs. Putting aside their differences, Harry and Noble try to piece together the scene before them. It looks planned; from the open windows to the cut along Susan's elbow, Noble thinks the scene doesn't "look entirely right." Amid the pills and the chaos of all the blood, Harry sees signs of a struggle. Perhaps the killer has attempted to cover his or her tracks.

Frankie Noble pleads with Harry to go above the call of duty in a case that appears politically toxic. At first, he doesn't want to go near the story of a successful doctor who tried to do the right thing. It's tragic enough without the specter of murder, yet Harry feels swelled by the amphetamine pills. Though he knows it's just "chemical trickery," Harry is deluded into thinking that he has more energy than he actually does. Sensing Bayliss was wronged, Harry continues to be distracted by the identity of the girl with the pink hair, found outside Clapham Junction, and by Beth, his girlfriend who loves Harry despite his obsessions.

While Teodora Guzman lies crying and grieving in a Brixton police cell, Harry and Noble interview the hospital staff at Belgrave--in particular lead cardiac doctor Elyas Mohamed, who blames Bayliss for dragging his reputation through the mud. Noble is convinced the Belgrave hospital is attempting to control the information flow of everyone they can. Bayliss was the perfect scapegoat for a hospital coverup: she was stressed, she was struggling to cope. Bayliss was brave to blow the whistle and go to the parents, yet nothing Harry has seen so far incriminates Mohamed for the children's deaths. While much is built on hunch and suspicion, it is from this well of muted, suppressed bitterness that a portrait of Susan Bayliff's killer is finally forged.

The images of the last few days flash in the slideshow of Harry's memories: Wilson with his chest open, Bayliss in a pool of blood, Beth's face twisted in anger. The killer's actions are becoming less rational, limiting an investigation light on forensic evidence and heavy on motive. The focus turns to Mohamed's feeble attempts to deceive Harry and Noble, and to a support group led by Michelle Roberts. She tells Harry that after their children's deaths, the parents "sort of split up" but met in secret with Bayliss. There's no obvious prime suspect, though Noble works on a matrix of names, a bunch of doctors whose careers Susan almost ruined, as well as Guzman's made-up alibi and her history of mental illness, and also Belgrave Hospital, which painted Bayliss as crazy as she attempted to give voice to four forgotten children.

While the descriptions of Harry's forensic techniques are sometimes a bit tedious, McCarthy is better when he focuses on the minutiae of Harry's addiction. Harry is blinded to his intoxicating chemicals, obliterating any ability to do his job properly. Beth, a caring partner, is torn between her loyalty and her inability to say nothing. Noble wants nothing more than the bliss of vodka. Her sponsor knows everything about her, yet she doesn't know about the reasons that started Noble on the road to oblivion and the nights when she put away two or three bottles. Noble knows about Harry Kent and the first murder investigation (detailed in The Hollow Men), that brought them together and the long nights of vodka-fueled rows that drove them apart. Neither Harry nor Francis seems able to accept that there are things beyond their control. Alone in his locker room, Harry's guilt unfolds as he pops two pills from his blister pack. It's not really guilt about addiction, but a culpability that he is enjoying finally reconnecting with Noble.

McCarthy makes good use of his medical background to lend unvarnished reality to the brutality of murder. Balancing Noble's sardonic efficiency with her passion for damaged, headstrong Harry, McCarthy throws us into his spinning jigsaw: a slice of an addict's life, a shakily traced killing, and Harry and Noble's initial frustration that they can't get a handle on the twisted, brutal identity of Susan Bayliss's executioner.