The opening scene of Patricia D. Cornwell's fourth novel, "Cruel & Unusual," is memorably macabre. Dr. Kay Scarpetta, Virginia's chief medical examiner, is getting ready to do an autopsy -- labeling blood tubes, donning her plastic apron and rubber gloves. What distinguishes these particular preparations is that her subject is still alive.
Dr. Scarpetta is awaiting the arrival of Ronnie Joe Waddell, who is about to be put to death in the electric chair. A decade ago, Waddell murdered Robyn Naismith, a beautiful television anchorwoman; after exhausting his appeals, only a call from the governor can spare his life. The phone doesn't ring, so the execution takes place as planned.
Just as Waddell is being electrocuted, a young boy is abducted and murdered on his way home from a Richmond convenience store. The boy's injuries bear an uncanny similarity to those sustained by Robyn Naismith. Shortly thereafter, another murder takes place, and the fingerprints found on the scene are a perfect match for Ronnie Waddell's. Could the wrong man have been executed, allowing the "real" Waddell to embark on a grisly killing spree?
As Dr. Scarpetta searches for the answers, she discovers that one of her co-workers may have participated in the switch; somebody in her office was searching through her computer files, which should have been secure. To help find the culprit, Dr. Scarpetta enlists her 17-year-old niece, Lucy, who's a whiz at computers but somewhat lacking in tact and social graces.
"Cruel & Unusual" marks something of a departure for Ms. Cornwell, whose previous Scarpetta novels have been best sellers. This one, with its Hannibal Lecter-like villain capable of making miraculous escapes, is her boldest, darkest work yet. In past books, Dr. Scarpetta almost lost her life in encounters with killers. Here, the ambitious, hard-driving medical examiner again faces mortal danger, and much more -- she loses her longtime boyfriend, and she comes close to losing her job.
The boyfriend, Mark James, was a rather unwelcome presence in the earlier books, as he never seemed to be a convincing match for Dr. Scarpetta. Mark meets his end in London, where he is slain by a terrorist's bomb; Scarpetta, in mourning, grows ever more detached from her friends and colleagues, and that aloofness almost leads to her professional downfall.
"You've had about a hundred walls up ever since Mark got killed," her friend, police Lt. Pete Marino, tells her. "For those of us around you, it's like being in a room that was once seventy degrees and suddenly the temperature's down to about fifty-five. So nobody's feeling all that attached to you right now."
Even Lucy, who surfaced as a precocious 10-year-old in Ms. Cornwell's first novel, keeps her emotional distance from her aunt -- "Why are men always more important than me?" she pouts. Her memories of the horrifying confrontation with a murderer she endured while visiting Dr. Scarpetta seven years ago lead her to ask for shooting lessons, which Marino reluctantly provides.
Once again, Ms. Cornwell furnishes all sorts of gory details, which will fascinate some readers and repel others. ("Susan started the Stryker saw and no one competed with its loud buzzing as she cut through the skull. . . . I placed the stomach on the cutting board.") The author spent several years working in a medical examiner's office, so her recountings are undoubtedly authentic. Still, people with a low tolerance for blood and guts would do well to look elsewhere for their entertainment.
For those who can stomach the autopsy scenes, however, "Cruel & Unusual" is another first-rate thriller from Ms. Cornwell, as taut and terrifying as "The Silence of the Lambs." The personal and professional difficulties faced by Dr. Scarpetta add a rich dimension to the book, making it far more than just another serial-killer saga.
Title: "Cruel & Unusual"
Author: Patricia D. Cornwell
Length, price: 356 pages, $21