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TEASER: Grand Junction, Colorado
Two teenaged boys sneak into an abandoned mental hospital (Dr. A Meadows Mental Health Center) at night. Apparently, the place has a reputation for being haunted by the spirit of the doctor who ran the facility – the rumor is that he used to cut open his patients’ brains. The boys have video cameras and plan to post their excursion on social media. One boy (Sean Rader) is clearly more afraid than the other (Evan) and reluctant to continue with their plan, but both of them enter the building.
Upstairs, they find the doctor’s office. There are several antique plague masks on a bookcase, and Sean reluctantly takes one at the urging of his friend. He puts the mask in his backpack.
As the boys are looking around, they start hearing noises. They get scared and run out. But before they can both get out, a ghost appears. He is dressed in a lab coat, wearing one of the plague masks, and he has a power drill in his hand. He attacks the boys. Sean runs out of the building, but we can see that he’s bleeding from a wound on the side of his head. As Sean runs away, we see Evan lying on the floor screaming as the doctor drills a hole into his head.
It is morning at the bunker. Sam enters the kitchen to find Dean making a peanut butter and jelly sandwich for breakfast. At first, Sam teases Dean about his breakfast, but then Dean is pleasantly surprised when Sam offers him a beer with it.
As Dean continues making his sandwich and wondering aloud why Sam is behaving differently, Sam tells him about a case. A teenager (Sean Rader ) was found walking by the side of a road near Grand Junction, Colorado three days earlier. The boy was bleeding from his head, and the only word he has uttered since being found is “monster”. His friend is still missing.
Sam suggests that they take the case – just the two of them – and leave Jack at the bunker, explaining to Dean that Jack is binge watching Sam’s DVDs, so he thinks Jack will be ok if they put up some extra warding on the bunker and leave to work a case. Dean is dubious at first, but agrees to Sam’s plan.
Later, they arrive in Grand Junction at the home of Sean Rader.
Posing as feds, they speak to Sean’s mother, who tells them that her son hasn’t spoken to anyone since he was found, due to the psychological trauma he suffered. Dean and Sam split up – Dean goes to Sean’s room to talk to him, while Sam talks to Sean’s mother.
Dean finds the boy in his room repeatedly drawing the plague masks he saw at the abandoned hospital. Dean tries to get the boy to talk, explaining that he has also seen monsters, that he understands how they can haunt someone, and that he might be able to stop the monster if Sean is willing to tell him what happened.
Meanwhile, Sam talks to Mrs. Rader in the kitchen. She tells him that Sean and Evan (the missing boy) were best friends. Mrs. Rader suggests that a third boy, Mike Ramos, who is friends with Sean and Evan likely knows where the missing boy is, but he’s denying that he knows anything.
Later, night has fallen and the Winchesters are arriving at a hotel. As they’re talking, Dean tells Sam that Sean didn’t say a word, and Sam suggests that they talk to the third boy, Mike, first thing in the morning for more information. Realizing that they are likely done working for the night, Sam suggests they go to a strip club. Dean is surprised and demands to know why Sam is being so nice to him – offering him beer for breakfast, chili fries for lunch, a night at a strip club, etc. After a brief exchange, Sam reluctantly admits that he knows Dean is in trouble and he’s trying to help. Dean insists that he’s fine and tries to convince Sam that he doesn’t need to worry.
Back as Sean Rader’s house, the boy wakes up screaming from a nightmare. His mother rushes in to him, and after she leaves he tries to go back to sleep. When Sean is alone in his room again, the doctor’s ghost appears with his drill. He rushes at Sean, and the scene fades to black.
The next morning, Sam wakes up to find Dean passed out on the floor. He has a pink, lacy bra around his neck, his tie around his head, and some sort of flagellation device in his hand. Shaking his head in amused annoyance, Sam leaves Dean asleep on the floor, dresses in his fed suit, and leaves to go talk to Mike.
Sam finds Mike working at a farm, unloading hay. Apparently, Mike told the police that he doesn’t know where Sean went the night Evan disappeared. At first, Sam tells Mike that he’s just rechecking the facts, but Mike’s twitchy behavior leads Sam to believe that the boy is lying. Reluctantly, Mike admits that his friends had planned to go to the Meadows' hospital because Evan dared them to go. Mike didn’t go because he was afraid, but he tells Sam that Sean and Evan went.
Back at the hotel, Sam finds Dean at the hotel’s buffet breakfast, helping himself to a Dean-Winchester-sized portion of bacon, eggs, and other items piled high on a plate. Dean is clearly hungover, but he and Sam talk about the case. Sam has learned that Dr. Avery Meadows worked at a mental hospital in town back in the 1960s. It seems that the doctor performed lobotomies on patients, regardless of the medical problem they were seeking help for. Patients who survived the procedure were kept at the hospital, and the doctor experimented on them. Sam tells Dean that the hospital is the same place where Sean and Even went that night. He also tells Dean that once the authorities discovered what Meadows was doing, the doctor was tried, executed, and cremated. As they’re talking, Dean notices a picture of a plague mask in the file Sam has compiled. He recognizes the object as matching Sean’s drawings. Sam explains the plague mask (how it was once believed to help reduce the spread of disease) and that the doctor was wearing one when he was arrested. The police had to forcibly rip it off of him.
As they’re talking, Sam gets a phone call from Mrs. Rader. She tells him about Sean’s nightmare and that he is missing now. The Winchesters suspect a ghost; since Meadows was cremated, they think his spirit could be attached to an object, and Mrs. Rader noticed that Sean’s room was cold. Wondering if Sean and Evan might both still be alive and at the Meadows hospital, Dean and Sam decide to check the place out.
By the time they arrive at the hospital, night has fallen. When they get inside, they detect EMF. Meadows’ ghost appears and attacks them, but they ward the ghost off before it can drill holes into their heads or otherwise harm them. Dean and Sam eventually search the building and find the doctor’s office and his collection of masks. They decide to burn the masks, thinking the doctor could be attaching himself to them. Sam creates salt lines to secure the room while Dean gathers the masks into a waste basket to burn them. Seconds later, the doctor appears and tries to attack them again, but burning the masks dispatches the ghost.
At first, the Winchesters think the ghost situation is resolved, and continue searching the building for Sean. But the building suddenly gets cool, and furniture starts flying around as light bulbs explode. The Winchesters quickly realize that the other ghosts -- apparently patients who were killed by the doctor – are still trapped and attacking them. They surmise that the bodies of the patients must be buried in the house or on the property somewhere, but they don’t have time to figure out where.
Realizing that they are out of time, Dean says they need to ask the ghosts where their bodies are buried, and he comes up with a drastic plan for doing that.
Dean removes a small kit from his bag – it contains two large syringes. He tells Sam that one syringe contains a solution that will stop his heart, and the other one contains a medication that will bring him back after he dies. Sam tries unsuccessfully to talk Dean out of what he’s thinking, but before Sam can say very much, Dean tells Sam to give him three minutes before giving the second injection, stabs himself in the heart with the first syringe and falls over dead.
Sam, still somewhat shocked. Looks at his watch and begins timing three minutes. He also creates a salt circle around Dean’s body and guards it, with the second syringe in his hand, counting down the three minutes.
Dean – now a spirit – can see the ghosts and starts trying to talk to one of them, asking where the doctor buried their bodies. He quickly runs into a reaper, who tried to tell Dean to come with her. Dean brushes her off and keeps chasing the ghost he was talking to. The reaper, realizing what just happened, is suddenly in a room that looks like a large library. We can’t tell who else is there, but she announces to someone that Dean Winchester is in the veil.
Dean continues chasing one of the ghosts, but comes across Sean’s ghost instead. Sean recognizes Dean as the FBI agent who came to his house, and asks Dean if he’s dead, too. Dean tells Sean that he’s dead and asks what happened to him. Sean tells him about his nightmare, and describes being possessed by Dr. Meadows’ ghost. In his possessed state, Sean walked back to the hospital to return the mask he’d taken. Still under the ghost’s control, Sean was forced to drill a hole into his own head and kill himself. Dean apologizes to Sean for not being able to save him. Sean tells him that Evan is also stuck and can’t leave the building. Dean tells Sean that he can’t get him back home, but he can help him and Evan escape the building and go to a better place if Sean will tell him where his body is.
We don’t hear Sean’s reply, but in the next scene we see spirit-Dean racing back to Sam to tell him that he has the information they need. Of course, Sam can't hear Dean, but by that time, three minutes have passed and Sam gives the second injection. They both wait, but nothing happens – the injection seems not to have worked. Sam begins frantically shaking Dean to revive him while Dean looks on, unable to help.
Suddenly Dean turns around and Billie the reaper is standing there.
Billie greets him, and we see that she is dressed all in black, holding Death’s scythe and wearing a long, black, leather coat instead of her normal jeans and leather jacket. Billie says “We need to talk”. She waves her hand and freezes time, so Sam is no longer shaking Dean and trying to revive him.
Shocked, Dean questions how Billie is alive, saying that he saw Castiel kill her. Billie tells him that “reality” has rules, and when someone kills one incarnation of Death, the next reaper to die must become Death. She removes one of her black gloves to show Dean that she now wears the Horeseman’s ring. She glibly comments about her promotion and repeats her order to Dean that they need to talk. She turns to walk away, and suddenly Dean has been transported with her and they are both standing in the large library.
Billie refers to the room as her “reading room”. Dean asks Billie if she plans to keep him dead, and her response is evasive. She knows that Dean has been slipping between worlds, and wants to know how he did it. Dean agrees to tell her in exchange for freeing all the ghosts who are trapped in Meadows’ hospital. Billie is surprised that Dean didn’t ask to be resurrected himself, but instantly releases all the trapped souls. (Back in the hospital, the same reaper Dean met reveals herself to the assembled ghosts, and offers to help them. They all evaporate, going to their rest).
Once Billie says the souls have been freed, Dean tells her that events surrounding the birth of Lucifer’s son opened an inter-dimensional rip and that’s how he was able to enter the other world. When Dean asks Billie why she cares about the rip and the other world, she tells him that the complicated multi-verse is like a delicate house of cards, and she doesn’t want Dean and Sam messing anything up. Dean seems satisfied with that answer.
As Dean and Billie are talking, Billie comments that Dean has “changed”. She also asks why when he bargained, he didn’t ask for his own life back. Dean replies that he assumed that (knowing her previous threat about keeping him dead if he ever died again) she wouldn’t bring him back this time. Billie says that it doesn’t seem like Dean to give up on life so easily. She confronts him, telling him that he has indeed changed; that he used to save the world and think he could never lose. She also tells Dean that now he tells people that he can work through his trouble, but he knows he can’t, and that scares him.
Dean refuses to engage her, saying none of what she is saying matters because he doesn’t matter. He feels like he couldn’t save his mother or Castiel, and now he can’t save one scared kid. He admits to Billie that Sam keeps trying to fix things, but he feels like he is dragging Sam down. Dean tells Billie that he refuses to beg, and that if it’s his time, then it is. Billie challenges him, saying that he has a death wish. She then shows him an entire shelf of books in her library that are about him and the potential ways he could die in different realities. But she concludes by telling him that nothing in her books say he’s supposed to die today, and that his eventual death will depend on the choices he makes. She tells him that, since her "promotion", she has access to a much larger picture than before. She realizes that he and Sam still have important work to do, so he needs to go back. She waves her hand to send him back. Before Dean leaves, he tries to ask her about Mary, but it’s too late. He is resurrected. He suddenly sits up and gasps for air. Sam is there and is very relieved that he’s alive.
The next morning, police cars and the coroner’s van are at the hospital. Dean and Sam are leaning against the Impala, watching the officials bring out Sean and Evan’s bodies. Many other skeletal remains have also been uncovered. Sam asks Dean what happened, and says it seemed like the injection didn’t work. At first Dean says that it took a minute for the drug to kick in and that he got lucky. But Sam persists, saying that when he checked his EMF meter for the ghosts, they were all gone, so it can't just be luck. Reluctantly, Dean tells Sam that he saw Billie, that she is the new Death, and that she freed the ghosts. When Sam asks him why she would help them by doing that, Dean recounts what she said about the two of them having important work to do. Neither brother knows what that means.
When Sam asks if Dean is okay, Dean admits that he is not. He tells Sam that throughout his life, he'd always believed that what they do is important, and that no matter what it cost them and who they lost, he’d take the hit and keep fighting because he believed that they were making the world a better place. But now, after losing Cas and Mary, he needs a win. Sam suggests that Dean is saying he doesn’t believe anymore, and Dean doesn’t refute that. Without further discussion they get into the Impala and drive off.
While on the road, Dean’s cell phone rings. He answers it, but seems shocked and doesn’t speak. The next thing we see, Dean and Sam pull into what looks like an alley in an unknown city. When they get out of the car, they see Castiel standing at a pay phone. Clearly, Cas is the one who called Dean. As the scene ends, the camera zooms in on Cas and Dean looking at each other without speaking.