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In Chicago, a pregnant cafeteria worker begins hemorrhaging from her body, while in Boston, a brilliant musician, disfigured by a mysterious illness, spirals into lethal paranoia. In Belinda, West Virginia, a miner's violent outburst leads to a deadly cave-in. These events are linked, and uncovering the connection could be deadly. Five years earlier, internist Matt Rutledge returned to West Virginia to marry his high-school sweetheart and open a practice, driven by a desire for justice after his father's death in a mining accident and his beloved Ginny's battle with cancer. He believes the mine's toxic waste disposal is behind the strange cases he has dubbed the Belinda Syndrome. As he seeks proof, two women, unknown to each other, are drawn to Belinda and into danger. Massachusetts coroner Nikki Solari attends her roommate's violent funeral, while retired schoolteacher Ellen Kroft pursues a relentless killer threatening her family. Each of these three strangers—Rutledge, Solari, and Kroft—holds a vital piece of a dangerous puzzle they must solve quickly, or risk losing far more than their own lives.