The Surgeon: a Rizzoli and Isles Novel

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NEW YORK TIMES BESTSELLER * “A briskly paced, terrifically suspenseful work that steadily builds toward a tense and terrifying climax.”–People (Page-turner of the week)

He slips into homes at night and walks silently into bedrooms where women lie sleeping, about to awaken to a living nightmare. The precision of his methods suggests that he is a deranged man of medicine, prompting the Boston newspapers to dub him “The Surgeon.” Led by Detectives Thomas Moore and Jane Rizzoli, the cops must consult the victim of a nearly identical crime: Two years ago, Dr. Catherine Cordell fought back and filled an attacker before he could complete his assault. Now this new killer is re-creating, with chilling accuracy, the details of Cordell’s ordeal. With every new murder he seems to be taunting her, cutting ever closer, from her hospital to her home. And neither Moore nor Rizzoli can protect Cordell from a ruthless hunter who somehow understands–and savors–the secret fears of every woman he kills.
“[A] top-grade thriller . . . Sharp characters stitch your eye to the page. An all-nighter.”–Kirkus Reviews (starred review)

“Creepy . . . will exert a powerful grip on readers.”–Chicago Tribune



One year later

Detective Thomas Moore disliked the smell of latex, and as he snapped on the gloves, releasing a puff of talcum, he felt the usual twinge of anticipatory nausea. The odor was linked to the most unpleasant aspects of his job, and like one of Pavlov’s dogs, trained to salivate on cue, he’d come to associate that rubbery scent with the inevitable accompaniment of blood and body fluids. An olfactory warning to brace himself.

And so he did, as he stood outside the autopsy room. He had walked in straight from the heat, and already sweat was chilling on his skin. It was July 12, a humid and hazy Friday afternoon. Across the city of Boston, air conditioners rattled and dripped, and tempers were flaring. On the Tobin Bridge, cars would already be backed up, fleeing north to the cool forests of Maine. But Moore would not be among them. He had been called back from his vacation, to view a horror he had no wish to confront.

He was already garbed in a surgical gown, which he’d pulled from the morgue linen cart. Now he put on a paper cap to catch stray hairs and pulled paper booties over his shoes, because he had seen what sometimes spilled from the table onto the floor. The blood, the clumps of tissue. He was by no means a tidy man, but he had no wish to bring any trace of the autopsy room home on his shoes. He paused for a few seconds outside the door and took a deep breath. Then, resigning himself to the ordeal, he pushed into the room.

The draped corpse lay on the table—a woman, by the shape of it. Moore avoided looking too long at the victim and focused instead on the living people in the room. Dr. Ashford Tierney, the Medical Examiner, and a morgue attendant were assembling instruments on a tray. Across the table from Moore stood Jane Rizzoli, also from the Boston Homicide Unit. Thirty-three years old, Rizzoli was a small and square-jawed woman. Her untamable curls were hidden beneath the paper O.R. cap, and without her black hair to soften her features, her face seemed to be all hard angles, her dark eyes probing and intense. She had transferred to Homicide from Vice and Narcotics six months ago. She was the only woman in the homicide unit, and already there had been problems between her and another detective, charges of sexual harassment, countercharges of unrelenting bitchiness. Moore was not sure he liked Rizzoli, or she him. So far they had kept their interactions strictly business, and he thought she preferred it that way.

Standing beside Rizzoli was her partner, Barry Frost, a relentlessly cheerful cop whose bland and beardless face made him seem much younger than his thirty years. Frost had worked with Rizzoli for two months now without complaint, the only man in the unit placid enough to endure her foul moods.

As Moore approached the table, Rizzoli said, “We wondered when you’d show up.”

“I was on the Maine Turnpike when you beeped me.”

“We’ve been waiting here since five.”

“And I’m just starting the internal exam,” Dr. Tierney said. “So I’d say Detective Moore got here right on time.” One man coming to the defense of another. He slammed the cabinet door shut, setting off a reverberating clang. It was one of the rare occasions he allowed his irritation to show. Dr. Tierney was a native Georgian, a courtly gentleman who believed ladies should behave like ladies. He did not enjoy working with the prickly Jane Rizzoli.

The morgue attendant wheeled a tray of instruments to the table, and his gaze briefly met Moore’s with a look of, Can you believe this bitch?

“Sorry about your fishing trip,” Tierney said to Moore. “It looks like your vacation’s canceled.”

“You’re sure it’s our boy again?”

In answer, Tierney reached for the drape and pulled it back, revealing the corpse. “Her name is Elena Ortiz.”

Though Moore had been braced for this sight, his first glimpse of the victim had the impact of a physical blow. The woman’s black hair, matted stiff with blood, stuck out like porcupine quills from a face the color of blue-veined marble. Her lips were parted, as though frozen in mid-utterance. The blood had already been washed off the body, and her wounds gaped in purplish rents on the gray canvas of skin. There were two visible wounds. One was a deep slash across the throat, extending from beneath the left ear, transecting the left carotid artery, and laying open the laryngeal cartilage. The coup de grace. The second slash was low on the abdomen. This wound had not been meant to kill; it had served an entirely different purpose.

Moore swallowed hard. “I see why you called me back from vacation.”

“I’m the lead on this one,” said Rizzoli.

He heard the note of warning in her statement; she was protecting her turf. He understood where it came from, how the constant taunts and skepticism that women cops faced could make them quick to take offense. In truth he had no wish to challenge her. They would have to work together on this, and it was too early in the game to be battling for dominance.

He was careful to maintain a respectful tone. “Could you fill me in on the circumstances?”

Rizzoli gave a curt nod. “The victim was found at nine this morning, in her apartment on Worcester Street, in the South End. She usually gets to work around six A.M. at Celebration Florists, a few blocks from her residence. It’s a family business, owned by her parents. When she didn’t show up, they got worried. Her brother went to check on her. He found her in the bedroom. Dr. Tierney estimates the time of death was somewhere between midnight and four this morning. According to the family, she had no current boyfriend, and no one in her apartment building recalls seeing any male visitors. She’s just a hardworking Catholic girl.”

Moore looked at the victim’s wrists. “She was immobilized.”

“Yes. Duct tape on the wrists and ankles. She was found nude. Wearing only a few items of jewelry.”

“What jewelry?”

“A necklace. A ring. Ear studs. The jewelry box in the bedroom was untouched. Robbery was not the motive.”

Moore looked at the horizontal band of bruising across the victim’s hips. “The torso was immobilized as well.”

“Duct tape across the waist and the upper thighs. And across her mouth.”

Moore released a deep breath. “Jesus.” Staring at Elena Ortiz, Moore had a disorienting flash of another young woman. Another corpse—a blonde, with meat-red slashes across her throat and abdomen.

“Diana Sterling,” he murmured.

“I’ve already pulled Sterling’s autopsy report,” said Tierney. “In case you need to review it.”

But Moore did not; the Sterling case, on which he had been lead detective, had never strayed far from his mind.

A year ago, thirty-year-old Diana Sterling, an employee at the Kendall and Lord Travel Agency, had been discovered nude and strapped to her bed with duct tape. Her throat and lower abdomen were slashed. The murder remained unsolved.

Dr. Tierney directed the exam light onto Elena Ortiz’s abdomen. The blood had been rinsed off earlier, and the edges of the incision were a pale pink.

“Trace evidence?” asked Moore.

“We picked off a few fibers before we washed her off. And there was a strand of hair, adhering to the wound margin.”

Moore looked up with sudden interest. “The victim’s?”

“Much shorter. A light brown.”

Elena Ortiz’s hair was black.

Rizzoli said, “We’ve already requested hair samples from everyone who came into contact with the body.”

Tierney directed their attention to the wound. “What we have here is a transverse cut. Surgeons call this a Maylard incision. The abdominal wall was incised layer by layer. First the skin, then the superficial fascia, then the muscle, and finally the pelvic peritoneum.”

“Like Sterling,” said Moore.

“Yes. Like Sterling. But there are differences.”

“What differences?”

“On Diana Sterling, there were a few jags in the incision, indicating hesitation, or uncertainty. You don’t see that here. Notice how cleanly this skin has been incised? There are no jags at all. He did this with absolute confidence.” Tierney’s gaze met Moore’s. “Our unsub is learning. He’s improved his technique.”

“If it’s the same unknown subject,” Rizzoli said.

“There are other similarities. See the squared-off margin at this end of the wound? It indicates the track moves from right to left. Like Sterling. The blade used in this wound is single-edged, nonserrated. Like the blade used on Sterling.”

“A scalpel?”

“It’s consistent with a scalpel. The clean incision tells me there was no twisting of the blade. The victim was either unconscious, or so tightly restrained she couldn’t move, couldn’t struggle. She couldn’t cause the blade to divert from its linear path.”

Barry Frost looked like he wanted to throw up. “Aw, jeez. Please tell me she was already dead when he did this.”

“I’m afraid this is not a postmortem wound.” Only Tierney’s green eyes showed above the surgical mask, and they were angry.

“There was antemortem bleeding?” asked Moore.

“Pooling in the pelvic cavity. Which means her heart was still pumping. She was still alive when this . . . procedure was done.”

Moore looked at the wrists, encircled by bruises. There were similar bruises around both ankles, and a band of petechiae—pinpoint skin hemorrhages—stretched across her hips. Elena Ortiz had struggled against her bonds.

“There’s other evidence she was alive during the cutting,” said Tierney. “Put your hand inside the wound, Thomas. I think you know what you’re going to find.”

Reluctantly Moore inserted his gloved hand into the wound. The flesh was cool, chilled from several hours of refrigeration. It reminded him of how it felt to thrust his hand into a turkey carcass and root around for the package of giblets. He reached in up to his wrist, his fingers exploring the margins of the wound. It was an intimate violation, this burrowing into the most private part of a woman’s anatomy. He avoided looking at Elena Ortiz’s face. It was the only way he could regard her mortal remains with detachment, the only way he could focus on the cold mechanics of what had been done to her body.

“The uterus is missing.” Moore looked at Tierney.

The M.E. nodded. “It’s been removed.”

Moore withdrew his hand from the body and stared down at the wound, gaping like an open mouth. Now Rizzoli thrust her gloved hand in, her short fingers straining to explore the cavity.

“Nothing else was removed?” she asked.

“Just the uterus,” said Tierney. “He left the bladder and bowel intact.”

“What’s this thing I’m feeling here? This hard little knot, on the left side,” she said.

“It’s suture. He used it to tie off blood vessels.”

Rizzoli looked up, startled. “This is a surgical knot?”

“Two-oh plain catgut,” ventured Moore, looking at Tierney for confirmation.

Tierney nodded. “The same suture we found in Diana Sterling.”

“Two-oh catgut?” asked Frost in a weak voice. He had retreated from the table and now stood in a corner of the room, ready to bolt for the sink. “Is that like a—a brand name or something?”

“Not a brand name,” said Tierney. “Catgut is a type of surgical thread made from the intestines of cows or sheep.”

“So why do they call it catgut?” asked Rizzoli.

“It goes back to the Middle Ages, when gut strings were used on musical instruments. The musicians referred to their instruments as their kit, and the strings were called kitgut. The word eventually became catgut. In surgery, this sort of suture is used to sew together deep layers of connective tissue. The body eventually breaks down the suture material and absorbs it.”

“And where would he get this catgut suture?” Rizzoli looked at Moore. “Did you trace a source for it on Sterling?”

“It’s almost impossible to identify a specific source,” said Moore. “Catgut suture’s manufactured by a dozen different companies, most of them in Asia. It’s still used in a number of foreign hospitals.”

“Only foreign hospitals?”

Tierney said, “There are now better alternatives. Catgut doesn’t have the strength or durability of synthetic sutures. I doubt many surgeons in the U.S. are currently using it.”

“Why would our unsub use it at all?”

“To maintain his visual field. To control the bleeding long enough so he can see what he’s doing. Our unsub is a very neat man.”

Rizzoli pulled her hand from the wound. In her gloved palm was cupped a tiny clot of blood, like a bright red bead. “How skillful is he? Are we dealing with a doctor? Or a butcher?”

“Clearly he has anatomical knowledge,” said Tierney. “I have no doubt he’s done this before.”

Moore took a step backward from the table, recoiling from the thought of what Elena Ortiz must have suffered, yet unable to keep the images at bay. The aftermath lay right in front of him, staring with open eyes.

He turned, startled, as instruments clattered on the metal tray. The morgue attendant had pushed the tray next to Dr. Tierney, in preparation for the Y-incision. Now the attendant leaned forward and stared into the abdominal wound.

“So what happens to it?” he asked. “Once he whacks out the uterus, what does he do with it?”

“We don’t know,” said Tierney. “The organs have never been found.”



Moore stood on the sidewalk in the South End neighborhood where Elena Ortiz had died. Once this had been a street of tired rooming houses, a shabby backwater neighborhood separated by railroad tracks from the more desirable northern half of Boston. But a growing city is a ravening creature, always in search of new land, and railroad tracks are no barrier to the hungry gaze of developers. A new generation of Bostonians had discovered the South End, and the old rooming houses were gradually being converted to apartment buildings.

Elena Ortiz lived in just such a building. Though the views from her second-story apartment were uninspiring—her windows faced a Laundromat across the street—the building did offer a treasured amenity rarely found in the city of Boston: tenant parking, crammed into the adjacent alley.

Moore walked down that alley now, scanning the windows in the apartments above, wondering who at that moment was looking down at him. Nothing moved behind the windows’ glassy eyes. The tenants facing this alley had already been interviewed; none had offered any useful information.

He stopped beneath Elena Ortiz’s bathroom window and stared up at the fire escape leading to it. The ladder was pulled up and latched in the retracted position. On the night Elena Ortiz died, a tenant’s car had been parked just beneath the fire escape. Size 8 1/2 shoe prints were later found on the car’s roof. The unsub had used it as a stepping-stone to reach the fire escape.

He saw that the bathroom window was shut. It had not been shut the night she met her killer.

He left the alley, circled back to the front entrance, and let himself into the building.

Police tape hung in limp streamers across Elena Ortiz’s apartment door. He unlocked the door and fingerprint powder rubbed off like soot on his hand. The loose tape slithered across his shoulders as he stepped into the apartment.

The living room was as he remembered it from his walk-through the day before, with Rizzoli. It had been an unpleasant visit, simmering with undercurrents of rivalry. The Ortiz case had started off with Rizzoli as lead, and she was insecure enough to feel threatened by anyone challenging her authority, especially an older male cop. Though they were now on the same team, a team that had since expanded to five detectives, Moore felt like a trespasser on her turf, and he’d been careful to couch his suggestions in the most diplomatic terms. He had no wish to engage in a battle of egos, yet a battle was what it had become. Yesterday he’d tried to focus on this crime scene, but her resentment kept pricking his bubble of concentration.

Only now, alone, could he completely focus his attention on the apartment where Elena Ortiz had died. In the living room he saw mismatched furniture arranged around a wicker coffee table. A desktop computer in the corner. A beige rug patterned with leafy vines and pink flowers. Since the murder, nothing had been moved, nothing altered, according to Rizzoli. The last light of day was fading in the window, but he did not turn on the lights. He stood for a long time, not even moving his head, waiting for complete stillness to fall across the room. This was the first chance he’d had to visit the scene alone, the first time he’d stood in this room undistracted by the voices, the faces, of the living. He imagined the molecules of air, briefly stirred by his entry, now slowing, drifting. He wanted the room to speak to him.

He felt nothing. No sense of evil, no lingering tremors of terror.

The unsub had not come in through the door. Nor had he gone wandering through his newly claimed kingdom of death. He had focused all his time, all his attention, on the bedroom.

Moore walked slowly past the tiny kitchen and started up the hallway. He felt the hairs on the back of his neck begin to bristle. At the first doorway he paused and stared into the bathroom. He turned on the light.

Thursday is a warm night. It is so warm that all across the city, windows are left open to catch every stray breeze, every cool breath of air. You crouch on the fire escape, sweating in your dark clothes, staring into this bathroom. There is no sound; the woman is asleep in the bedroom. She has to be up early for her job at the florist’s, and at this hour her sleep cycle is passing into its deepest, most unarousable phase.

She doesn’t hear the scratch of your putty knife as you pry open the screen.

Moore looked at the wallpaper, adorned with tiny red rosebuds. A woman’s pattern, nothing a man would choose. In every way this was a woman’s bathroom, from the strawberry-scented shampoo, to the box of Tampax under the sink, to the medicine cabinet crammed with cosmetics. An aqua-eye-shadow kind of gal.

You climb in the window, and fibers of your navy-blue shirt catch on the frame. Polyester. Your sneakers, size 8 1/2, leave prints coming in on the white linoleum floor. There are traces of sand, mixed with crystals of gypsum. A typical mix picked up from walking the city of Boston.

Maybe you pause, listening in the darkness. Inhaling the sweet foreignness of a woman’s space. Or maybe you waste no time but proceed straight to your goal.

The bedroom.

The air seemed fouler, thicker, as he followed in the intruder’s footsteps. It was more than just an imagined sense of evil; it was the smell.

He came to the bedroom door. By now the hairs on the back of his neck were standing straight out. He already knew what he would see inside the room; he thought he was prepared for it. Yet when he turned on the lights, the horror assailed him once again, as it had the first time he’d seen this room.

The blood was now over two days old. The cleaning service had not yet come in. But even with their detergents and steam cleaners and cans of white paint, they could never fully erase what had happened here, because the air itself was permanently imprinted with terror.

You step through the doorway, into this room. The curtains are thin, only an unlined cotton print, and light from the street lamps shines through the fabric, onto the bed. Onto the sleeping woman. Surely you must linger a moment, studying her. Considering with pleasure the task that lies ahead. Because it is pleasurable for you, isn’t it? You are growing more and more excited. The thrill moves through your bloodstream like a drug, awakening every nerve, until even your fingertips are pulsing with anticipation.

Elena Ortiz did not have time to scream. Or, if she did, no one heard her. Not the family in the unit next door, nor the couple below.

The intruder brought his tools with him. Duct tape. A rag soaked in chloroform. A collection of surgical instruments. He had come fully prepared.

The ordeal would have lasted well over an hour. Elena Ortiz was conscious for at least part of that time. The skin on her wrists and ankles was chafed, indicating she had struggled. In her panic, her agony, she had emptied her bladder, and urine had soaked into the mattress, mingling with her blood. The operation was a delicate one, and he took the time to do it right, to take only what he wanted, nothing more.

He did not rape her; perhaps he was incapable of doing so.

When he’d finished his terrible excision, she was still alive. The pelvic wound continued to bleed, the heart to pump. How long? Dr. Tierney had guessed at least half an hour. Thirty minutes, which must have seemed an eternity to Elena Ortiz.

What were you doing during that time? Putting your tools away? Packing your prize in a jar? Or did you merely stand here, enjoying the view?

The final act was swift and businesslike. Elena Ortiz’s tormentor had taken what he wanted, and now it was time to finish things. He’d moved to the head of the bed. With his left hand he’d grasped a handful of her hair, yanking backward so hard he tore out more than two dozen strands. These were found later, scattered on the pillow and floor. The bloodstains shrieked out the final events. With her head immobilized and the neck fully exposed, he’d made a single deep slash starting at the left jaw and moving rightward, across the throat. He had severed the left carotid artery and the trachea. Blood spurted. On the wall to the left of the bed were dense clusters of small circular drops flowing downward, characteristic of arterial spray as well as exhalation of blood from the trachea. The pillow and sheets were saturated from downward dripping. Several cast-off droplets, thrown off as the intruder swung away the blade, had spattered the windowsill.

Elena Ortiz had lived long enough to see her own blood spurt from her neck and hit the wall in a machine-gun spray of red. She had lived long enough to aspirate blood into her severed trachea, to hear it gurgle in her lungs, to cough it out in explosive bursts of crimson phlegm.

She had lived long enough to know she was dying.

And when it was done, when her agonal struggles had ceased, you left us a calling card. You neatly folded the victim’s nightshirt, and you left it on the dresser. Why? Is it some twisted sign of respect for the woman you’ve just slaughtered? Or is it your way of mocking us? Your way of telling us that you are in control?

Moore returned to the living room and sank into an armchair. It was hot and airless in the apartment, but he was shivering. He didn’t know if the chill was physical or emotional. His thighs and shoulders ached, so maybe it was just a virus coming on. A summer flu, the worst kind. He thought of all the places he’d rather be at that moment. Adrift on a Maine lake, his fishing line whicking through the air. Or standing at the seashore, watching the fog roll in. Anywhere but this place of death.

The chirp of his beeper startled him. He shut it off and realized his heart was pounding. He made himself calm down first before he took out the cell phone and punched in the number.

“Rizzoli,” she answered on the first ring, her greeting as direct as a bullet.

“You paged me.”

“You never told me you got a hit on VICAP,” she said.

“What hit?”

“On Diana Sterling. I’m looking at her murder book now.”

VICAP, the Violent Criminals Apprehension Program, was a national database of homicide and assault information gathered from cases across the country. Killers often repeated the same patterns, and with this data investigators could link crimes committed by the same perpetrator. As a matter of routine, Moore and his partner at the time, Rusty Stivack, had initiated a search on VICAP.

“We turned up no matches in New England,” said Moore. “We ran down every homicide involving mutilation, night entry, and duct tape bindings. Nothing fit Sterling’s profile.”

“What about the series in Georgia? Three years ago, four victims. One in Atlanta, three in Savannah. All were in the VICAP database.”

“I reviewed those cases. That perp is not our unsub.”

“Listen to this, Moore. Dora Ciccone, age twenty-two, graduate student at Emory. Victim first subdued with Rohypnol, then restrained to the bed with nylon cord—”

“Our boy here uses chloroform and duct tape.”

“He sliced open her abdomen. Cut out her uterus. Performed a coup de grace—a single slash across the neck. And finally—get this—he folded her nightclothes and left them on a chair by the bed. I’m telling you, it’s too goddamn close.”

“The Georgia cases are closed,” said Moore. “They’ve been closed for two years. That perp is dead.”

“What if Savannah PD blew it? What if he wasn’t their killer?”

“They had DNA to back it up. Fibers, hairs. Plus there was a witness. A victim who survived.”

“Oh yeah. The survivor. Victim number five.” Rizzoli’s voice held a strangely taunting note.

“She confirmed the perp’s identity,” said Moore.

“She also conveniently shot him to death.”

“So what, you want to arrest his ghost?”

“Did you ever talk to that surviving victim?” Rizzoli asked.


“Why not?”

“What would be the point?”

“The point is that you might’ve learned something interesting. Like the fact she left Savannah soon after that attack. And guess where she’s living now?”

On Sale
Mar 29, 2016
Page Count
464 pages