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A serial killer is turning New Orleans into his personal playground. The victims are killed in pairs - no connection, no apparent motive, no real clues. It's a very sick game, and it's only just begun. Abby Chastain left New Orleans long ago and for good reason. Now she's back where she feels watched, as if the devil himself is scraping a fingernail along her spine. It doesn't help that Detective Reuben Montoya is convinced she's somehow the key to unlocking the murders -- a mystery that has something to do with Our Lady of Virtues Mental Hospital, a decaying old asylum where unspeakable crimes were once committed and a human predator may still wait. As more bodies are found in gruesome, staged scenarios, Montoya and Abby are in a desperate race to stop a killer whose terrifying crimes are bringing them ever nearer to a shocking revelation.