After dealing with Crowley, Sam and Dean drive off into the night in the Impala. Sam is checking the Internet and discover that everyone believes that the falling angels in the sky were a meteor storm. Dean finally tells Sam that it's none of their business, but Sam figures that they'll have to deal with it. Noticing that Dean is unusually quiet, he asks what the real problem is and his brother tells him that he's dying. Sam doesn't believe it and turns away...
At the Glenwood Memorial Hospital in Randolph, New York, Dean sits at his brother's side. Sam is in a coma and the doctor tells Dean that he's in bad shape and will likely die. Dean insists that it wasn't supposed to happen, but the doctor tells him that it's in God's hands now. Furious, Dean tells him that God has nothing to do it with. He then walks out and goes to the hospital chapel. He prays to Castiel, hoping that his friend will come, but gets no answer. Desperate, Dean then makes a general prayer to any angel that can hear him, promising that he'll pay any price they ask if they can help Sam.
Angels across the country hear Dean's prayer as he says where and Sam are. They drop what they're doing and head for New York.
As "Dean" drives the Impala, he tells Sam that he's got a plan and tells him to hang on. When Sam wonders what's going on, Dean admits that they're in Sam's head and that he's in a coma, and insists that they need to focus on saving Sam. Sam asks for details but Dean doesn't have anything definite, and Sam wonders if that means that it's his subconscious telling him not to fight. Bobby appears behind them on the back seat and tells Sam that he might be right.
In Longmont, Colorado, Castiel hears angels screaming in his head. Distracted, he doesn't notice an oncoming truck and it almost hits him. Castiel lands on the side of the road and scratches his hand, and stares at the blood in amazement. The driver comes over and Castiel says that he heard angels in his head, and then asks the man if he has a phone. The man says that there's no signal in the mountains and offers Castiel a ride to a phone, and the former angel accepts.
The imaginary Dean and Bobby argue, and Bobby points out that even if the real Dean worked out a way to keep Sam alive, he'd probably end up doing something stupid like selling his soul. When dean points out that he's driving because Sam's subconscious wants him in control, Bobby instantly appears in the front seat. Before Dean can argue further, Bobby teleports Sam away to a quiet forest.
When the truck driver arrives at a gas station, he lets Castiel out and offers him some money. Castiel reluctantly accepts and goes around to the side... unaware that a woman is watching him carefully. A biker is using the pay phone and Castiel orders him to leave. The biker dares him to do something about it and Castiel tries to smite him, only to discover that his powers are gone. The woman comes over and tells Castiel that they know each other: they meet in Heaven and her name is Hael.
A woman comes into Sam's room and Dean assumes that she's an angel. She explains that she's the hospital grief counselor, Kim Shortz, and suggests that Dean should prepare to accept the inevitable. Dean insists that nothing is inevitable, but Kim says that Sam's condition appears helpless. A they talk, Dean remembers that he has Crowley in the trunk of the Impala. He goes down to the parking garage and knocks on the hood to get Crowley's attention. Before he can take the demon out, a male angel grabs Dean from behind and demands to know where he can find Castiel. Dean says that he doesn't know and the angel starts beating Dean.
Another angel, Ezekiel arrives and tries to convince the male angel to let Dean go. The angel attacks him again and Ezekiel fights back, disarming his opponent. Dean manages to grab the angel blade and kills his attacker, who disappears in a burst of light. Ezekiel says that he's there to help but then collapses from his injuries.
Hael tells Castiel that she's worried about what lies ahead and he tells her that she has nothing to be afraid of. He believes that now that the angels have been locked out of Heaven, they can do whatever they like instead of follow orders. Castiel asks what Hael would like to do and she says that she made the Grand Canyon, and wouldn't mind seeing it again. Together they set off to go see it.
Dean surrounds Ezekiel with a circle of burning holy oil. When the angel wakes up, Dean demands answers. Ezekiel warns that the other angels are on the way, homing in on Dean's pray to them. However, some angels still consider themselves friends to Castiel despite what he did and believe in their holy mission. Ezekiel admits that he was injured in the fall and his vessel was further damaged in the earlier fight. However, he offers to do what he can for Sam.
In the forest, Bobby tells Sam that he needs to let go of fighting and surrender to death. Sam is disappointed but Bobby tells him that he's done more to save the world than most people can ever claim.
Ezekiel tries to heal Sam but discovers that Sam is too weak for his angelic efforts to do any good. While they try to work out what to do next, Castiel calls Dean and tells him how he was tricked into locking away Heaven. Dean tells him about Sam and asks if he can help, but Castiel says that Metatron took his angelic grace. Castiel confirms that Ezekiel can be trusted and says that he's on the way, but Dean tells him to lie low and worry about himself now that he's human and defenseless. Castiel refuses to abandon the angels, Hael in particular, and tells Dean that he'll be fine. As they talk, the hospital starts shaking. Dean runs to Sam's room and Ezekiel tells him that more angels are coming. The angel says that they have to warn Sam, but Dean points out that his brother won't survive the shock. Working against time, Dean draws anti-angel wards on the walls.
Castiel tells Hael that his friend Sam needs help, but she begs him to stay and help her. He refuses and starts to walk away, and Hael knocks him out with a piece of lumber.
Once he completes the wards, Dean tells Ezekiel to save Sam however he can and goes out to delay the angels. All of the glass in the hallways explodes as Dean runs to the fire alarm and pulls it, telling everyone to get out.
Castiel wakes up in the truck and realizes that Hael is driving... and she has an angel-killing blade in her lap. She says that she couldn't let Castiel leave and blames him for everything that happened. As they drive, Hael tells Castiel that the two of them are going to merge and become one, because her body is wearing out the strain of containing an angel. She says that she thinks that she'll like being on Earth once the two of them are together.
Dean finds Kim sprawled on the floor. As an angel in a farmer's body arrives, Dean gets ready to fight but Kim--an angel--grabs him and holds him up in the air.
Bobby leads Sam to a cabin in the woods and tells him to go in and accept his death. However, Dean appears and stabs Bobby from behind, killing him. As the imaginary Bobby fades away, Dean tells Sam that their friend had to go. Sam tells him that it over and asks what kind of plan he has to save him. Dean punches him and says that he'll keep fighting no matter what. Sam tells him that what he's hoping for is in the cabin, and a desperate Dean tells Sam that he can't fight for him if he won't fight for himself. Sam says that it's okay and "Dean" freezes, and then fades away. Satisfied, Sam turns and enters the cabin.
Kim and the farmer angel drag Dean to the warded hospital room and demand to know where they can find Castiel. The farmer grabs a fire axe and prepares to break down the door while Kim tries to beat the information out of Dean.
When Sam enters the cabin, he finds Death waiting for him.
As the angels break into Sam's room, Dean lies hunched over on the floor, bleeding. He finally yells at them to stop, saying that he'll tell them where they can find Castiel. When they hesitate, Dean completes the angel banishment ward that he drew with his blood. They disappear back to a Heaven locked away to them, and Sam goes into the room. Sam has flatlined and Ezekiel says that he was weak to help him. He says that there's no good way to save Sam, and Dean asks what others one there are because they're out of time. The angel reluctantly tells Dean that he can enter Sam and heal his body from the inside out. Dean refuses, insisting that Sam would rather die than be possessed by anyone, angel or demon. Ezekiel understands and starts to leave, but Dean tells him to wait. He asks for proof of how bad a condition Sam is in before agreeing, and Ezekiel touches both Winchesters, letting Dean hear what is going on in Sam's mind.
Death tells Sam that he is deeply honored to come and collect Sam's soul, and tells Sam "Well played." Sam says that he needs Death to promise him one thing: that if he's dead, he stays dead and no one else will get hurt because of him. Death assures Sam that he will.
Dean recoils in horror from Sam and wonders what he's doing.
As Hael drives, Castiel notices that she isn't wearing her seatbelt. He covertly puts his on and then grabs the wheel and swerves the truck into a pile of concrete barriers.
Ezekiel tells Dean that once he merges and heals Sam, he can then leave. He believes that Sam would agree to do it... if Dean asked him to.
Castiel wakes up, bloody and bruised and finds Hael on the grass in front of the truck, her legs shattered. He picks up the angel blade and goes over to her, and insists that he only wants to help the angels. Disgusted, Hael tells him that most of the angels want him dead for banishing them from Heaven, and warns him that she can only protect him if she allows her to use his body as her vessel. Castiel refuses and starts to walk away, and Hael yells that she'll broadcast to all the other angels where Castiel can be found. He turns around and tells her to stop, but she refuses and he has no choice but to use the blade to kill her.
Death tells Sam that it's time and starts to go. Dean appears and tells Sam that he can fix it... if his brother doesn't shut him out. Death says that it's up to Sam to decide if it's his time, and Dean reminds Sam that he promised him that it would be the two of them, together forever. Sam considers and then asks what he should do. Dean touches him... and transforms into Ezekiel, glowing with light.
As the staff clean up the hospital, the doctor visits Sam's room and finds Ezekiel's vessel lying on Sam's bed. There's no sign of Dean, and the vessel has no idea what happened.
Outside, Dean and Sam/Ezekiel walk away. Ezekiel admits that there is a lot of damage for him to repair. When Dean wonders what happens when Sam wakes up, Ezekiel says that Sam won't know that he's inside of him. The angel warns that Sam can eject him at any time if he doesn't accept him, but if he does then he will die. Dean realizes that they have to keep Ezekiel's presence a secret for the time being. Ezekiel offers to erase all of Sam's memories of what happened and Dean considers.
Castiel goes to a Laundromat, covered in blood, strips to his boxers, and starts to wash his clothing. He sees a vending machine nearby. After a moment, he steals some clothing, buys himself a bottle of water, and enjoys drinking for the first time.
That night, Sam wakes up in the Impala. Dean pretends that nothing happened since the church and confirms that Sam doesn't remember anything since the angels fell. He says that he's doing better and Dean reminds Sam that he said he was capable of anything. Sam considers and says that they've got work to do.