Not since Jack the Ripper terrorized the London slums has there been such a gruesome crime scene. By all accounts, acid-tongued Vita Berlin hadn't a friend in the world, but whom did she cross so badly as to end up arranged in such a grotesque tableau? One look at her apartment-turned-charnel house prompts hard-bitten LAPD detective Milo Sturgis to summon his go-to expert in hunting homicidal maniacs, Alex Delaware. But even Alex is stymied when more slayings occur in the same ghastly fashion. And the only clue left behind a blank page bearing a question mark seems to be both a menacing taunt and a cry for help from a killer baffled by his own lethal urges. Under pressure to end the bloody spree and prevent a citywide panic, Milo redoubles his efforts to discover a link between the disparate victims. Meanwhile, Alex navigates the secretive world of mental health treatment. As each jagged piece of the puzzle fits into place, an ever more horrific portrait emerges of a sinister mind at its most unimaginable. "This one was different," Alex observes at the start of the case. This one will haunt his waking life, and his darkest dreams, long after its end.