Dean wakes up at Sioux Falls General Hospital in the ER as the doctors work on his broken leg and tell him what happened. He passes out and sometime later, pulls out the IV and tries to get out of bed only to discover that he has a cast on his leg. Bobby comes in, wearing a suit, and Dean is surprised to see that he's alive. Once he gets Dean up off the floor, Bobby says that they have to go and leaves to find Sam.
The Leviathans possessing Dr. Gaines and the head nurse get a call that the Winchesters are at the hospital. Meanwhile, Bobby finds Sam on a stretcher and wheels him out of the hospital and into an ambulance. When Gaines comes out after them, Dean manages to get in just in time and they drive off. Gaines and the head nurse make a call.
Three weeks later in Whitefish, Montana, the brothers hole up in a cabin belonging to Rufus and Dean watches Spanish soap operas. Bobby comes in and Dean brings him up to speed, and they compare notes on what the Leviathans have been doing. Hunters have encountered them and determined that they bleed black goo and are indestructible, and that the ones at the hospital have disappeared. Sam spaces out briefly as he hears Lucifer's voce but then manages to regain his self-control. Bobby goes to get copies of all the ancient tomes that were burned along with his house and Dean suggests that Sam make a run to get some food. Once he leaves, Dean asks Bobby for his opinion. Bobby figures that he'll get over it and that for now they need to focus on the Leviathans.
At the store, Sam pays for the food with a bogus credit card and notices a newspaper article on a local ice pick killer. When he pays for the food, a Leviathan duplicating a credit card accountant tracks the charge, identifies it, and calls Edgar. Edgar tells him to deal with the Winchesters.
Sam returns to the cabin and Dean asks him how he's doing. Sam admits that he's still seeing things but he's managing it. Later, Dean dozes off and Sam looks at the newspaper article on the ice pick killer.
Lincoln, Nebraska, 1998
Young Sam calls Dean to say that he's located a kitsune. John gets on the line and Sam assures him that he's heading to the library to research the killer.
Sam leaves a note for the sleeping Dean and leaves.
A drug dealer is making a deal but is interrupted when a police siren goes off nearby. His customer runs and the drug dealer takes off. Something grabs him and kills him, drilling a hole in his skull.
When Dean wakes up and discovers that Sam has gone, he calls splitting Bobby. Bobby figures that they should give it a couple of days until Dean gets the cast off. Dean then gets out a saw and starts cutting off the cast.
Sam poses as a FBI agent and talks to a cop who says that losing a drug dealer is no big loss. He claims that he dealt with a similar case and asks if the brains were missing. As Sam goes to check it out, he gets a call from Sam and ignores it.
Dean stops in at the grocery store and confirms that Sam bought a newspaper. He checks out the day-old copy and spots the icepick killer ad.
At the morgue, the coroner tells Sam that a big chunk of the victim's brain was removed, including their pituitaries. Sam remembers reading about same deaths when he was a child.
Young Sam tracks the murders and confirms there was one death per town, each one in a park off the highway, and that the killer was moving along the highway in Montana.
Sam tracks the pattern of killings and realizes where the next one will occur. He drives to the park outside of the next town.
In Montana, Young Sam buys a coffee and spots a woman going into the library. He goes back inside and notices her going through the books, and she notices him as well.
Sam sees someone pull up and go into the park.
Young Sam goes to get a book and sees the girl in the next aisle, looking at him. He then calls Dean and tells him the way to kill the kitsune is to stab it in the heart. Once he's finished his report, he asks his brother how he can talk to girls. Young Sam then approaches the girl and notices a moon necklace. He tries to make conversation and she tells him to go away. When he hesitates, she says that she's not supposed to talk to boys and he goes outside. However, he sees the girl walk away and notices two boys following her. Young Sam watches and sees them harassing her. He intervenes and quickly takes them down, and the girl introduces herself as Amy.
Sam sees a woman approaching a man whose car has broken down on the road. He grabs her, sees the moon necklace, and greets her as Amy. Amy recognizes him and admits that she never thought she'd see him again. He holds a knife to her and walks her away, and asks why she's doing the same thing again. Amy insists that she has a life and a family.
Amy takes Young Sam to her home and treats his injuries. She talks about how her mother is often on the road and Young Sam admits that he goes through the same thing with his father. They commiserate over their lives and when Sam admits that he's a freak. Amy agrees, but says that she's a freak and all the coolest people are freaks. Sam leans forward and kisses her.
Sam points out that she's spiked three guys in the last week, but Amy insists that she just had to do it. She can't explain further and attacks Sam when he doesn't believe her. Amy knocks him out and runs. As he falls, Sam grabs something from her coat pocket.
The coroner tells Dean that Sam was there and confirmed that the pituitary glands were missing. He calls Bobby to tell him that Sam is tracking a kitsune. Bobby wonders what Dean is going to do when he catches up, and Dean says that he has a few ideas.
Amy goes to her suburban home and packs, but discovers Sam in her bedroom. He's traced her from the note he grabbed from her pocket. When he spots fresh blood on her hands and demands to know what she's been doing. Amy still refuses to explain and says that Sam know the kind of person that she is.
Once they get done kissing, Young Sam knocks over his beer. Amy says that her mother has a temper and starts to clean it up, and explains that her mother isn't a good person. She wonders if she's a good person and Sam says that he knows good when he sees it. He takes her hand and Amy explains that her mother has a plan. They both admit that neither one of them want to be like their parents.
Sam asks for an explanation and refuses to drop his knife until she does. Amy finally relents and opens the bedroom door, revealing her son Jacob in the next room. She explains that she works as a mortician and she's been feeding on the dead, taking what she and Jacob need. Jacob was dying and needed fresh meat, but now that he's been fed, he's recovering. Amy says that Sam could just walk away, and reminds her of what she did for him.
Amy's mother arrives and Amy hides Young Sam in the closet. She says that two men in an Impala have caught up to them, and they need to move. Amy hesitates until her mother starts toward the closet, and then agrees to start packing. Her mother goes to get gas and Amy realizes that something's wrong. Young Sam says that he has to go but then notices a jar with a brain inside of it. He explains that his dad and brother are in the Impala and accuses Amy of being a monster. She realizes that he's a hunter and she wonders if they're supposed to kill each other. Young Sam advances on her with the knife and Amy admits that she hasn't killed anyone and doesn't want to hurt him. She asks if he wants to hurt her and Young Sam admits that he doesn't. She tells him to run and he puts away the knife and leaves.
Sam returns to his hotel room but Dean ambushes him and punches him. Once they get inside, Dean complains that Sam left him. Sam insists that he had a job and he wanted to take care of it, and Dean asks to see the body. His brother finally admits that he let the kitsune go.
As Sam tries to leave, Amy's mother comes back, realizing that something was up when Amy agreed to leave town so easily. She condemns Amy for letting Young Sam into his life and slaps her daughter aside when she tries to interfere. The kitsune grows claws and prepares to eat Sam's brain, but Amy stabs her in the chest and kills her.
Sam finishes telling Dean what happens. He doesn't believe that Amy committed the murders but Dean insists that they have to drop her now no matter what she did as a kid. When Dean says that it's sample, Sam points out that nothing in their lives is simple.
Young Sam tells Amy to get out of town on the bus while he takes care of the body. She asks him to come with her so that they can be freaks together, but he says that he can't.
Dean dismisses Amy as a freak and Sam prepares to leave. He explains that he figures that Dean considers him a freak as well and he agrees, but he insists that he's not dangerous. Sam explains that Amy works in a funeral home and has figured out how to deal, and says that they'd do the same thing if someone close to them were dying. He asks Dean to trust him, not Amy, and Dean agrees. Sam is surprised and Dean says that he has to start sometime.
The next day, Dean calls Bobby and confirms that they'll meet him the next day. He lets Sam drive and they go to Spokane to hole up. Sam checks in and Dean claims that he's going to get medication. Instead he goes to the hotel where Amy has holed up and explains who he is. Dean warns that she's a killer and eventually she'll kill again no matter what she claims. He stabs her and apologizes, and then sets her down on the bed. As he turns to go, he sees Jacob in the door, watching him. Dean asks if he's ever killed anyone. When Jacob says that he hasn't, Dean promises to come back for him if he does. The boy says that the only person he plans to kill is Dean and Dean tells him to look him up in a few years.
At the grocery store in Whitefish, Chet the Leviathan calls his superiors to report that he's on Sam's trail. He then ties up the owner and pours hot cheese sauce on him as he eats him.