She peers into the lens at the contraction bands in the pink-stained tissue shaved from a section of Charlotte Dard's heart at autopsy. Some fibers are missing their nuclei, indicating necrosis, or the death of tissue, and other slides reveal pink-and-blue-stained inflammation and old scarring, and narrowing of the coronary arteries. The Louisiana woman was only thirty-two when she dropped dead at the door of a motel room in Baton Rouge, dressed to go out, keys in hand.

It was suspected eight years ago, at the time of her death, that her family pharmacist illegally gave her the powerful pain medication OxyCon-tin, found in her pocketbook. She didn't have a prescription for the drug. In a letter to Scarpetta, Dr. Lanier suggests that this pharmacist might have fled to Palm Desert, California. Dr. Lanier doesn't indicate what he bases this possibility on or offer further details for his reopening Charlotte Dard's case.

It is a mess for multiple reasons: The case is old; there is no evidence the drug came from the pharmacist, and even if it did, unless he premeditated killing her with OxyContin, he is not guilty of first-degree murder; at the time of Charlotte Dard's death, he would not talk to the police but through his attorney claimed that a family friend with a ruptured disk must have given Charlotte Dard OxyContin, and she accidentally overdosed on it.

Several copies of letters sent eight years ago to Dr. Lanier are from the pharmacist's attorney, Rocco Caggiano.

BEYOND THE WINDOW IN FRONT of Scarpetta's desk, shadows crawl over sand dunes as the sun moves.

Palm fronds rattle lightly, and a man walking his yellow lab on the beach leans into a headwind. Far off on the hazy blue horizon, a container ship forges south, probably to Miami. If Scarpetta is too caught up in her work, she will forget the time and where she is and soon will miss another flight to New York.

Dr. Lanier answers his phone and is hoarse as he says, "Hello."

"You sound terrible," Scarpetta says sympathetically.

"I don't know what I caught, but I feel like hell. Thanks for getting back to me."

"What meds are you taking? I hope it's decongestants and a cough suppressant with an expectorant, and that you're staying away from anti-histamines. Try the daytime or nondrowsy formulas that don't list antihistamines or doxylamine succinate on the label-unless you want to dry yourself out and get a bacterial infection. And stay away from alcohol. It lowers your immunities."

He blows his nose. "I'm a real medical doctor, just so you know. And an addictionologist, meaning I do know a thing or two about drugs." He says this without a trace of defensiveness. "Thought you might be relieved to hear that."

Scarpetta is embarrassed for making assumptions. Coroners are elected officials and unfortunately, nationwide, many of them are not physicians.

"I didn't mean to insult you, Dr. Lanier."

"You didn't. By the way, your sidekick Pete Marino thinks you walk on water."

"You checked me out." She is nonplussed. "Good. Now hopefully we can get down to business. I've been through Charlotte Dards case."

"An oldie but goodie, and I don't mean that literally. There's nothing good about it. Hold on. Let me get something to write with. Unquestionably, there's a Bermuda Triangle for pens, and in my home it's my beloved wife. All right."

"Mrs. Dard's case is definitely perplexing," Scarpetta begins. "As you know from her tox reports, oxymorphone-the metabolite of OxyContin-is only four milligrams per liter of blood, which puts her in the low lethal range. Her gastric is negative, and the level in her liver's no higher than the level in her blood. In other words, death from an overdose of OxyContin is equivocal. Clearly, her drug level isn't as critical as her clinical findings."

"I agree. My thought all along. If you interpret her tox in light of the histological findings, it's possible she didn't need as high a level for an accidental overdose. Although her reports and body diagrams don't indicate any cutaneous stigmata of past intravenous drug abuse," he adds. "So I'm guessing she was a pill-popper but didn't shoot up."

"Certainly she was a chronic drug abuser," Scarpetta says. "Her heart tells us that. Patchy necrosis and fibrosis of varying age, and chronic ischemia, plus an absence of coronary artery disease or cardiomegaly. Basically, a coke heart."

It is a catch-all phrase that does not necessarily mean the person was a cocaine addict. Drugs such as narcotics, synthetic narcotics, OxyContin, hydrocodone, Percocet, Percodan and whatever else the addict can get his or her hands on will destroy the heart just as completely as cocaine will. Elvis Presley is a sad example.

"I need to ask you about blackouts," Dr. Lanier says, after a pause.

"What about them?" This must be what he so urgently wanted to talk to her about. "I saw nothing in the case file you sent me that mentions blackouts."

She checks her irritation. As a private consultant, she is limited by the medicolegal information presented to her, and the absence of pertinent findings-or the presence of incorrect findings-is intolerable. Until she gave up working her own cases or supervising those worked by her other forensic pathologists throughout the Commonwealth of Virginia, she did not have to rely on the competence or veracity of virtual strangers.

"Charlotte Dard suffered occasional blackouts," Dr. Lanier explains. "Or at least this is what I was told at the time."

"Who told you?"

"Her sister. It appears," he goes on, "or let me qualify this by saying it is alleged, that she suffered from retrograde amnesia…"

"I certainly would think her family would know that, unless no one was ever home."

"Problem is, her husband Jason Dard's a rather shady character. Nobody around here knows much, maybe nothing about him, except he's rich as hell and lives on an old plantation. I wouldn't call Mrs. Guidon a reliable witness. Although she certainly could be telling the truth about her sisters condition prior to her death."

"I've read the police narrative, which is brief. Tell me what you know," Scarpetta says.

After a coughing bout, Dr. Lanier replies, "The hotel where she died is in a not-so-nice part of the city, in my jurisdiction. A housekeeper found her body."

"What about blood tests? In the paperwork you sent me, all I got were postmortem levels. So I don't know whether she might have had the elevated GGTP or CDT associated with alcohol abuse."

"Since I first contacted you, I have managed to track down premortem blood test results, because she was in the hospital about two weeks before her death. Misfiled, I'm embarrassed to say. I've got a particular clerk I'd pay heaven and earth to get rid of. But she's the sort to sue for one thing or another. The answer to your question is no-no elevated GGTP or CDT."

"In the hospital for what?"

"Tests after her most recent blackout. So, obviously, she had one of these blackouts two weeks before she died. Again, I say allegedly"

"Well, if she didn't have elevated GGTP or CDT, it would seem to me that we can rule out alcohol as the cause of her blackouts," Scarpetta replies. "And Dr. Lanier, I can't offer you a second opinion if I'm not supplied with all of the information."

"Be nice if I was supplied all the information, too. Don't get me started on the police down here."

"What was Mrs. Dard s behavior during her blackouts?"

"Supposedly violent, throwing things, trashing the house or wherever she was staying. On one occasion, she vandalized her Maserati by smashing the windows, doors and hood with a hammer. She poured bleach all over the leather seats."

"A record of this with a body shop?"