A serial killer named the Surgeon once tried to kill Boston Detective Jane Rizzoli. Still serving time, his 'signature' killings recur. Rizzoli, together with Medical Examiner Dr. Isles, pursue them, while the Surgeon escapes from prison.

Rizzoli pursues strangling deaths, suspense-fully reminiscent of the now long dead Boston Strangler, who a retired cop believes to be alive. Her new Boss, a childhood tease, is unbelieving. Clinically inclined Dr. Isles ruins a date.

After a student is gunned down in broad daylight, the investigation reveals she had more than a few secrets. Meanwhile, Jane's mother Angela gets into a spat with her father over the car.

Rizzoli and Dr. Isles look at the death of the head of the rich, Brahmin Fairfield family. Dr. Isles once dated the dead man's brother and Rizzoli feels that this is hampering work. Rizzoli's mother peddles juices with dubious benefits.

Rizzoli and Dr. Isles run the Massachusetts Marathon and find a dead runner at Mile 3 and Mile 12 marks. Impossible to get back-up, and fearing more deaths from panic and stampede, they silently endeavor to solve the crimes as the race continues.

The actions of Hoyt, alias the Surgeon, and Rizzoli's nemesis, from inside solitary confinement spook her. While Rizzoli is off the Hoyt case, Dr. Isles does facial analysis of Hoyt for clues on murder/ disappearance of a married couple.

An unknown man is killed with an ice pick pierced into his ear. Police find that he is Colin Doyle, son of the Irish mob enforcer, Patrick Doyle, the actual target of gang rivals. Dr. Isles is in an emotional upheaval about the dead man.