The Surgeon (2001) by Tess Gerritsen is a medical crime thriller and the first installment in the best-selling Rizzoli and Isles series of novels. Boston Homicide Detectives Jane Rizzoli and Thomas Moore are tasked with investigating a series of murders of women who have had their throats cut and their uteruses removed a few weeks after they were sexually assaulted. Their investigation leads them to a Boston ER doctor Catherine Cordell who killed a serial killer with the same MO two years ago in Savannah, Georgia. As the new killer targets Dr. Cordell, Rizzoli and Moore race to find the culprit before it is too late. The novel touches on themes of Misogyny and the Prevalence of Gender-Based Violence, The Tension Between Professional Identity and Personal Vulnerability, and The Psychology of Serial Killers.

The Surgeon won an award from Romance Writers of America for Best Romantic Suspense Novel in 2002. In 2010, the Rizzoli and Isles series was adapted for television by TNT, with Angie Harmon starring as Detective Jane Rizzoli and Sasha Alexander starring as medical examiner Maura Isles, who does not appear in The Surgeon.

This guide is based on the 2022 Penguin paperback edition of The Surgeon.

Content Warning: The source material and this guide feature depictions of bullying, racism, gender and transgender discrimination, sexual violence, rape, suicidal ideation, graphic violence, graphic medical procedures, cursing, and sexual content.

Plot Summary

The narrative of The Surgeon is told from the shifting first-person perspective of the killer, Warren Hoyt, and the limited third-person perspectives of Detective Jane Rizzoli, Detective Thomas Moore, and Dr. Catherine Cordell.

In the Prologue, the killer Warren Hoyt revels in his fantasy of the police finding the body of Diana Sterling, the woman he has just tortured and killed after removing her uterus.

One year later, Detective Thomas Moore of the Boston Police Department attends the autopsy of Elena Ortiz, a woman who has similarly had her uterus removed and her throat cut. He is joined by Detective Jane Rizzoli. They suspect the same person committed the murders of Sterling and Ortiz. Rizzoli discovers that the MO is the same as a series of murders that were committed years ago by Andrew Capra in Atlanta and Savannah, Georgia. Andrew Capra was killed two years ago by his sole surviving victim, Dr. Catherine Cordell, who is currently working in the ER of a Boston hospital. Moore and Rizzoli question Dr. Cordell, who was recently featured in a Boston Globe article about female surgeons. She does not recognize either of the women murdered in Boston. Rizzoli learns from a forensic scientist that one of the killer’s hairs found on the body of Elena Ortiz has little nodules on it caused by a rare disease called “bamboo hair.”

Rizzoli and Moore meet with the rest of the investigative team, which includes consulting criminal psychologist Dr. Lawrence Zucker. Zucker tells them that the killer is motivated by his hatred for women. The team contemplates whether the killer is a copycat or if somehow he had been in communication with Andrew Capra before his death. They cannot figure out what the connection is between the two victims.

Dr. Cordell goes to the victim Elena Ortiz’s house and sees her car with the vanity plate “POSEY5” parked outside. She meets with Detective Moore and tells him that she recognizes the phrase Posey Five from her online chatroom for women who have PTSD from sexual assault. She had searched for Ortiz’s patient records in the hospital database and discovered that Ortiz had been sexually assaulted about two months before her death. Ortiz had accepted STD testing, but she had refused a rape kit, so they do not know the identity of her rapist.

Rizzoli interviews Ortiz’s sister, Anna. Anna tells her that she does not recognize the gold necklace Ortiz was wearing when she was brought to the morgue. She also says that a charm bracelet her sister always wore has gone missing. Rizzoli realizes that the necklace had been taken from the first victim Diana Sterling and she suspects Ortiz’s bracelet will be found on the next victim. This confirms that the murder victims were killed by the same murderer.

That night, Dr. Cordell goes home from work to get ready for her birthday dinner with her colleague, Dr. Peter Falco. Before she leaves, she checks her emails and finds an email from an unknown sender with an attachment labeled as lab results. When she opens the attachment, she is horrified to see the photo of an unidentified bloody woman. She calls the detectives and they go to the hospital to investigate. The detectives learn that the killer has broken into Cordell’s office and sent the email from her work computer. He has also stolen Cordell’s spare keys. The Boston PD “techno-wiz” analyzes the photo, and he identifies Ortiz’s charm bracelet in the image. He also finds a library book in the background, which leads them to identifying the woman as Nina Peyton.

Rizzoli and Moore race to Peyton’s apartment. She is weak from the blood loss from the hysterectomy the killer performed on her, but she is still alive. They rush her to the hospital where Dr. Cordell treats her injuries and is able to stabilize her. Rizzoli and Moore investigate. They learn that Peyton was sexually assaulted after being drugged two months before she was attacked by the killer. After the assault, Peyton had blood labs done to test for AIDS and other STDs.

The next day, a nurse informs Dr. Cordell that written on Peyton’s leg is the message “Happy birthday. Do you like my gift?” (161). Cordell is horrified and calls Detective Moore to inform him that the killer had targeted Peyton to send a message to her. Detective Rizzoli is growing increasingly suspicious of Dr. Cordell and wonders if she could possibly be involved in the crimes. Detective Moore is falling in love with Cordell and he does not accept Rizzoli’s accusations of her. Suddenly, Cordell receives news that Peyton has regained consciousness. Detective Moore interviews Peyton, who tells them that the killer was wearing a surgical mask, so she cannot describe him in detail. She only knows that he was white, average sized, with pale blue or gray eyes.

Some time later, the killer, Warren Hoyt, who works at a lab attached to the hospital that processes blood tests, looks up Dr. Cordell’s patients. He sees she has a patient in an adjacent hallway to Peyton who is near death. Hoyt sabotages the patient’s IV bag, causing his heart to stop. Cordell rushes to treat her patient, but unfortunately he dies. Immediately after, Cordell hears a scream from Peyton’s room. She rushes to her, but it is too late. The cop guarding Peyton has been shot and killed, and Peyton herself has been stabbed to death. The detectives cannot find the suspect on the surveillance tapes because people ran to the area from all over the hospital when the code was called for Cordell’s patient.

That evening, Cordell receives a piece of interdepartmental mail containing a lock of her hair and a message that reads “Birthday greetings from A.C.,” as in Andrew Capra. Cordell tells the detectives about the note and explains the lock of hair was cut from her head when she was attacked by Capra in Savannah two years prior.

Detective Moore realizes there must be aspects of the night of her attack that Cordell does not remember. He arranges for Cordell to be interviewed by a hypnotist in an attempt for Cordell to recover her memories of that night. Under hypnosis, Cordell remembers hearing Capra talking to another person in the home while she was being attacked.

That night, Rizzoli and Moore get a call that the DNA from Peyton’s rape kit has matched to a man named Karl Pacheco. She rushes to Pacheco’s house. She sees him on the roof of his building and pursues him. Moore follows behind. Pacheco throws a garden trowel at her, injuring her face. In response, Rizzoli tells the suspect to freeze. He has his hands in the air, but he keeps moving toward her. Rizzoli shoots and kills Pacheco. Moore tells her that she has shot an unarmed man who was attempting to surrender. He investigates the scene and determines that Pacheco is not the killer, because his shoe size is too big and he does not have any surgical tools in his apartment. At the morgue, Cordell confirms that she does not recognize Pacheco. After the morgue visit, Moore drives Cordell home and they have sex in her apartment.

The next morning, Moore and Rizzoli’s lieutenant takes Rizzoli off the case and sends Moore to Savannah to investigate the murders that took place there. While reviewing the Georgia murders, Moore notices that a hair with the same “bamboo hair” syndrome was found on the body of the first victim in Atlanta. He realizes that Andrew Capra and his accomplice have known each other since the very first murder. Moore goes to Atlanta to interview staff at Emory Medical School where Capra studied medicine. He learns that Capra had a lab partner named Warren Hoyt who was expelled when he was found masturbating over the mutilated body of a cadaver in the anatomy classroom.

That evening, Hoyt hides in the trunk of Cordell’s car using the keys he stole from her office. Cordell has just returned home when she gets a call that she has to return to the hospital for an urgent meeting. When she gets back in the car, Hoyt uses chloroform to incapacitate her. The hospital calls the police to inform them of Cordell’s disappearance. The detectives, including Rizzoli, despite having been formally removed from the case, race to find Cordell and Hoyt. Rizzoli analyzes Hoyt’s financial records and sees he took money out of an ATM in Lithia, Massachusetts. She also notices that an Asian hair was found in Hoyt’s apartment. She drives to the Lithia ATM and asks the store manager if there are any Asian women in the area. He tells her that there is a woman with dark hair renting out a nearby farm. Rizzoli searches the farm and finds Cordell tied up in the cellar. Before she can help, Rizzoli is attacked by Hoyt. Cordell manages to get Rizzoli’s gun and shoot Hoyt. The police arrive on the scene soon after.

Rizzoli is commended for her bravery. Cordell and Moore get married. Hoyt survives his injuries and is arrested. From prison, he vows he will see Cordell again.