But I did not get to sleep long. At several minutes past four A.M., my phone rang again. It was Dr. Hoyt this time, a family practitioner in Norfolk, where he had served as a state-appointed medical examiner for the last twenty years. He was pushing seventy, but spry and as lucid as new glass. I’d never known him to be alarmed by anything, and I was instantly unnerved by his tone.

“Dr. Scarpetta, I’m sorry,” he said, and he was talking very fast. “I’m on Tangier Island.”

All I could think of, oddly, were crab cakes. “What in the world are you doing there?”

I arranged pillows behind me, reaching for call sheets and pen.

“I got called late yesterday, been out here half the night. The Coast Guard had to bring me in one of their cutters, and I don’t like boats worth a damn, beaten and whipped around worse than eggs. Plus it was cold as hell.”

I had no idea what he was talking about.

“The last time I saw anything like this was Texas, 1949,” he went on, talking fast, “when I was doing my residency and about to get married . . .”

I had to cut him off. “Slow down, Fred,” I said. “Tell me what’s happened.”

“A fifty-two-year-old Tangier lady. Probably been dead at least twenty-four hours in her bedroom. She’s got severe skin eruptions in crops, just covered with them, including the palms of her hands and the bottoms of her feet. Crazy as it sounds, it looks like smallpox.”

“You’re right. That’s crazy,” I said as my mouth got dry. “What about chicken pox? Any way this woman was immunosuppressed?”

“I don’t know anything about her, but I’ve never seen chicken pox look like this. These eruptions follow the smallpox pattern. They’re in crops, like I said, all about the same age, and the farther away from the center of the body, the denser they get. So they’re confluent, on the face, the extremities.”

I was thinking of the torso, of the small area of eruptions that I had assumed were shingles, my heart filled with dread. I did not know where that victim had died, but I believed it was somewhere in Virginia. Tangier Island was also in Virginia, a tiny barrier island in the Chesapeake Bay where the economy was based on crabbing.

“There are a lot of strange viruses out there these days,” he was saying.

“Yes, there are,” I agreed. “But Hanta, Ebola, HIV, dengue, et al., do not cause the symptoms you have described. That doesn’t mean there isn’t something else we don’t know about.”

“I know smallpox. I’m old enough to have seen it with my own two eyes. But I’m not an expert in infectious diseases, Kay. And I sure as hell don’t know the things that you do. But whatever it might be in this case, the fact is, the woman’s dead and some type of poxvirus killed her.”

“Obviously, she lived alone.”