Harry Cunningham investigates when a car accident reveals two bodies inside one coffin. The coffin contained the body of 80-year-old Ethel Mortimer, who was supposed to be there and also that of James Featherton, a high tech sales rep who also had a heavy cocaine habit. Leo Dalton and Nikki Alexander have to deal with the death of a young child who died post-operatively. The pediatric surgeon in the case, Alice Huston, is well known in her field but may be prone to undertaking aggressive surgeries. The pathologists find a connection between the two cases when Featherton's girlfriend is found to be a nurse on Huston's surgical team.

With Claire Kowalski missing and Nikki Alexander unconscious from a blow to the head, Harry and Leo investigate exactly what is going on at the hospital. Harry discovers that a member of Huston's surgical team is not who they claim to be and has actually stolen the identity of someone who died six years before. Blackmail is at the center of it all and it turns out Alice Huston is hiding a secret. However, the killer is identified only by looking to old friendships and the calling in of an old debt.