Keough has been at his job in the mayor's office for a year and he's not happy. He's been involved in more political functions and fund-raisers than investigations. But when bodies of pregnant women begin to pile up on the Illinois side of the Mississippi, the mayor of East St. Louis asks for help. Now out on loan, Keough heads up the search for a serial killer with only a Mark Twain-quoting sidekick and a young female clerk as his "task force." At the worst possible time his ex-girlfriend Valerie comes back into his life with a problem - the little boy, Brady, who tracked bloody footprints into Keough's life in In the Shadow of the Arch, is in trouble. And as if all this weren't enough, Keough is still trying to adjust to the fact that he has diabetes. When an offer to leave St. Louis to join a special statewide serial killer squad comes his way, Keough has to make a decision that could change his personal and professional life forever. Throughout all this turmoil, Keough works frantically to discover the perpetrator of these increasingly sick and twisted crimes, before another young woman and her unborn baby are killed.