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Dublin, in the late autumn of 1956. City pathologist Quirke - we never get to know his Christian name - stumbles late one night from a party in the nurses' quarters with a view to sleeping off his hangover in his subterranean pathology lab. To his surprise his quiet refuge has been invaded by his adoptive brother, obstetric consultant Malachy Griffin, who is at Quirke's desk completing some paperwork for a recently deceased patient named Christine Falls.

When Quirke returns next morning to find Christine's body gone, he remembers his brother's odd behaviour, and, consumed by curiosity over what Mal was doing, recalls the body and performs a full post mortem.

As he investigates, all the time stirring up a hornets' nest of trouble for himself, Quirke uncovers the truth about a family secret that has remained buried for nearly twenty years, and begins to understand that there are some truths that may be better left untold.