3.0 out of 5 stars - It is a rainy and stormy season in Philadelphia. A man is found with a railroad spike driven into his head in Priory Park, close to the old shut down Delaware Valley State Hospital at Cold River which used to hold many insane and homeless patients. It closed its doors forever more than twenty years ago but a man who was perhaps a patient there, Luther Wade, never left, and roams the catacombs, sewer and storm drainage tunnels beneath the city, and now commits horrific crimes. He seems to be targeting people who once were associated with that old hospital. Why them? Why now? And is there a connection to a toddler found in the middle of the street one night? Detectives Kevin Byrne and Jessica Balzano, long time partners with the PDD, are assigned to the case. This book was creepy and quite hard to follow at times with the jumps back and forth in time and the characters and their relationships to each other both past and present. I found it confusing but the excellent writing kept me glued to the pages trying to see what would happen next. To tell you the truth, I am still not quite sure I understand completely who did what and all that went on from the asylum to the current murders. The last couple of chapters helped tie it up a bit, but the end of the investigation still didn't completely explain everything to my satisfaction -- or maybe I need to reread with the ending still fresh in my mind. I found the description of Cold River and the practice of psychiatric "care" there quite unnerving and mostly unbelievable, even for fiction. I know that conditions at some of those homes for the insane bordered on inhumane and bedlam, but I'd like to think that perhaps there were one or two good staff who had an idea of patients who were dying in hallways, giving birth in corridors, and escaping regularly. I did like the book, but feel that the non-linear narrative made it hard to completely grasp all the motivations of the criminal(s) and their history. I liked the partnership of Jessica and Kevin and wonder how the author will handle that in the future. I loved the police procedural details as well. I'd read another by this author. *Part of a series that I have not read previously. This seemed to stand alone but perhaps the book was a bit confusing to me because I didn't know all the previous history of the main characters. The ending of this one seems to leave room for yet another installment in the series. Thank you to NetGalley and Mulholland Books for the eBook ARC to review.