Quirke is a pathologist in a Dublin hospital who stumbles upon a wide-ranging conspiracy after coming across the dead body of a girl named Christine Falls. The novel begins when Quirke, drunk from a party, sees obstetrician Malachy (who is also Quirke's brother by adoption) falsifying details on the girl's death certificate. Quirke later passes out in the basement morgue.
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When he awakens, the body is gone. But Quirke is able to track it down, and his autopsy reveals that Christine died in childbirth, and not from a heart attack as her death certificate states. This is the same manner in which Quirke's wife Delia died years ago, and his sorrow over Delia's death haunts him as he tries to find out what happened to Christine's missing baby.
At first, Quirke suspects Malachy was having an affair with the girl and changed the documents to cover his tracks. Perhaps Quirke secretly hopes this is what happened, because he has always harbored a secret love for Malachy's wife Sarah, who is also Delia's sister.
But Quirke soon discovers the truth: the baby is now dead, but it was going to be taken by the Knights of St. Patrick, a shadowy Catholic group, and shipped to Boston for adoption. The group has been at work for decades, taking the children of poor or unwed mothers and moving them across the ocean to be adopted away.
Christine Falls had been working as a housemaid in the home of Judge Garret Griffin, Malachy's father and Quirke's adoptive father. Now an old man, Griffin was rejuvenated by his affair with Christine. When she became pregnant, he planned to send the child to Boston like the others, but the men he'd hired to handle it killed the baby. The novel ends with Quirke planning to reveal the crimes.
Best part of story, including ending:
The plot does not go where one would expect it to when faced with the dead body of a recently pregnant woman. Usually you'd think someone connected to the child committed the crime, and while that is what happened, it also turned out to be so much more, and the story is strengthened by Quirke's meditations on adoption, family, and lost love.
Best scene in story:
Quirke walks away from the judge, his own adoptive father, after confronting him with his crimes. Neither man gives an inch in their conversation; both are committed to the rightness of their cause, and both believe that they will "win" the showdown.
Opinion about the main character:
Quirke is very clever and indefatigable in his investigation, but he is also extremely depressing, because his thoughts constantly return to his own dead wife and the circumstances of his upbringing as an orphan. It wears you down after a while, but given what he has been through, can you really blame him?