This novel features medical examiner Laurie Montgomery and her husband, pathologist Jack Stapleton, who travel to a small town in New York's Adirondack Mountains to assist a local physician and coroner with a series of unexplained medical cases. While investigating the sudden death of a young worker and a cluster of rapidly progressive neurological illnesses, Jack and Laurie become involved in a complex forensic inquiry. Set against the backdrop of a community experiencing economic and social decline, the story combines elements of medical investigation, forensic science, and suspense as the protagonists work to uncover the cause of the deaths.