Natalie March is a respected surgeon enjoying a busy life in Washington, DC. As her demanding career has left little time for friends or romance, her deepest relationship is with her mother, Vera March, a Russian immigrant and MS patient confined to a rehab. Vera is still haunted by the fact that her Ukrainian parents were sent to the gulag, Stalin's notorious network of labor camps, when she was just a baby. All her life she has presumed that they perished there along with millions of other Russian citizens. Natalie would do anything to heal her mother's psychic pain: it's the one wound that she, a doctor, cannot mend.

When a young Russian dancer named Saldana Tarasova comes to Natalie's office claiming to be her cousin, and providing details about her grandmother that no stranger could know, Natalie must face a surprising truth: her grandmother, Katarina Melnikova, is still very much alive. Natalie is thrilled to think that her Russian family is reaching out and that Vera may be able to reunite with her mother after so many years. In fact, Saldana has a darker motive for making contact. Suggesting that her family is in grave danger from Putin's government, she pleads for Natalie's help to defect. Unwilling to break the law, Natalie puts her off.

Then the unthinkable happens, and Natalie finds herself drawn into a web of dangerous family secrets that will ultimately pit her against both the Russian FSB and people within the CIA.