Will lectures on the Chesapeake Ripper killer, saying that he kills in threes. The removal of organs is associated with surgical knowledge. Miriam Lass was investigating the case two years ago and suddenly disappeared. Her severed arm was found just recently, her cell phone still in the hand. The Ripper obviously wanted them to know that he's still out there.
Dr. Lecter enjoys an operatic play live. He is moved to tears by the performance. Someone notices him from the back row. We know him as Franklin, one of Lecter's current patients. Franklin continues to watch Lecter as he stands to provide the first ovation. Franklin approaches Lecter with his friend Tobias while Lecter is talking to another friend.
Back at FBI headquarters, Crawford hears Miriam's phone ring inside the autopsy room. Crawford's own phone rings as well. He doesn't pick it up. When it rings again later into the night, Crawford isn't sure who it is. But it's another crime scene. Crawford picks up Will and they head towards the scene. Will warns that the Ripper is trying to play them again. At the scene, Will finds a man who has been mutilated. Surgery was performed to remove organs, but this time, he was also sutured up as well. Will does his thing and gets into the mind of the killer. He enters the bedroom and sees the large antlered stag moving towards the bathroom, where the man was found. The man came out of deep sedation and tried to attack the killer. After that the killer threw the man in the bathtub, but that sent him into cardiac arrest. The killer then tried to revive the man by pumping the heart manually.
When Will doesn't think it's the Ripper, Brian can't believe it. Crawford eventually believes him however. Meanwhile, Franklin visits Dr. Lecter to talk. Lecter points out that doctor-patient confidentiality prohibits them from being good friends outside of therapy. Franklin doesn't quite understand however and says that they have similar interests. Later, Lecter visits someone, a psychiatrist of his own. This woman characterizes Lecter as someone wearing a persona far different from his real one. She says that she is retired but continues to see him as a favor. Lecter asks why she even bothers. The woman replies that she likes him and thinks she knows just enough of him.
Later, Will meets Lecter for a weekly session. Lecter pours Will some of the wine. Will confesses that the Freddie Lounds tabloid story was fake. The real Chesapeake Ripper is still out there and Crawford is obsessed with catching him.
Lecter recalls an interaction with another doctor from some time ago. The male doctor thinks Lecter is withholding some medical information and is abrupt and somewhat rude to him. Lecter asks for a business card. In the present, quite some time after this meeting, the male doctor notices that his fuel line has been cut when he pulls over to the side of the road. Dr. Lecter shows up behind him in his car. The male doctor does not remember Dr. Lecter, but he won't be remembering much after their encounter.
Jimmy, Beverly, and Brian report that the doctor's body was found severed in two. The kidney and heart have been removed and interspersed with the discussion, we see Lecter slicing and dicing the organs, preparing a meal. Brian doesn't understand how Will can still believe that the Ripper is not involved in the bathtub murder. The team discusses whether there can possibly be two killers. Will still thinks that the real Ripper did not commit the first murder.
Meanwhile, Lecter prepares a different meal with Dr. Alana Bloom now. They talk about Will and how Crawford is obsessed with catching the Ripper. Crawford finds an empty lab and walks over to examine Miriam's arm, but finds it missing. When he turns around he has a vision of Will with a severed arm turning towards him.
Lecter selects a few more recipes and kills three more people. Each one is selected using a business card. He harvests liver from a customer service representative, lungs from a book expert, and brains from an IT consultant. He stores the organs in his freezer. Other organs are missing: spleen, pancreas, and intestines from other bodies. Jimmy says that they are not dealing with someone who does transplants, because no one gets transplanted spleen, it is simply removed in cases of illness. Brian jokes that the Ripper is making sausage, but that's indeed what Lecter is doing. Crawford still thinks the man is at least selling the organs. Will says there are two killers here still and one of them is the Chesapeake Ripper
Franklin meets with Dr. Lecter once again saying that they are both cheese aficionados, another reason why they should be friends. Lecter again points out that this is a small town and he can't break doctor-patient laws. Lecter asks Franklin about Tobias and whether they are involved. Franklin says that Tobias is just a friend, however. The real roots of Franklin's problems is that he doesn't want to be alone. After Franklin leaves, Lecter waits for his next patient, which should be Will, but he is late.
Will has a vision about the girl who was impaled on antlers in the desert (see Episode 2). Lecter interrupts him, saying that he never showed up for his appointment. Lecter says the killer takes the organs away because in his mind, he thinks that the people don't deserve them. When the Ripper killed Miriam, he was really getting at Crawford, however, which was different from the other murders. Will says it was successful. Meanwhile, Beverly has video footage that shows that the person who committed the first murder is a paramedic. When they head over to the city's ambulance bay, the manager says a young man named Devon, an aspiring doctor, is the man they are looking for.
They find Devon near a warehouse in the ambulance. But Devon has messed up trying to remove the kidneys from a would-be victim. Dr. Lecter confirms this and hurries over to take over and stop the bleeding. Devon is quickly arrested. Will watches as Lecter stops the would-be victim's bleeding.
Later on, Dr. Lecter prepares a grand meal. Will laments that he cannot stay for dinner but brought wine. He asks when Dr. Lecter stopped performing surgeries. Lecter laments that he couldn't save everyone and it got too heavy for him. Instead he saves people's minds and no one has died from therapy. Will says he is going back to the lab to work on the Chesapeake Ripper case.
After a grand presentation of food, Dr. Lecter informs his dinner guests that they may eat. He warns, however, that nothing is vegetarian.