Lauren and Scott Mason, twins, are brought to Dan by their own individual maladies: Lauren with an unknown illness, while Scott struggles with substance abuse. As the three bond, Dan can't help but wonder if these twins are his own, a serendipitous meeting after he participated in an artificial insemination procedure as a medical intern.

When the house of cards falls, Dan, Lauren and Scott become further intertwined as the Russian mafia hierarchy tightens its grasp. Can the small found-family protect one another and find peace? Or are they destined to lose one another all over again?

In a sequel to Marchetti's Inferno, Douglas Ratner returns to the story of Dan Marchetti once more.