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Dr. Jim Bob Brady is attempting a difficult knee reconstruction on Melvin Brown, Houston philanthropist and University Hospital board member, when Doc is notified that his wife Mary Louise has been involved in a near-fatal hit-and-run. When Brady arrives at his wife’s bedside, he sees the horrific aftermath of the crash, including the worst, a brain injury. He calls for help from all his colleagues, and most importantly from his long-term friend—and son-in-law of Doc’s philanthropist patient—Dr. Frank James, a stellar neurosurgeon.

But Doc soon learns James’s wife, the daughter of the philanthropist patient, has been murdered, and Doc’s friend is in mourning, unable to care for Doc’s wife. Mary Louise’s critical care is left to an extremely unpleasant neurosurgeon that Doc just doesn’t trust.

While Mary Louise remains in a coma, Doc and his investigator son, J. J. Brady, join forces with the police in working out the mysteries of both the crash and the murder. Who killed Meredith Brown James, and why? Who was driving the car that careened into Mary Louise’s car? And was Mary Louise’s crash somehow tied to the James murder, or was it just an act of fate?