Jack and Will receive a call about another possible Chesapeake Ripper slaying. A man lies dead in his hotel bathroom, with blood everywhere from dismantled sutures and open wounds. Will closes his eyes and enters the mind of the killer. From the entryway, Will envisions the victim stumbling around, still woozy from failing anesthesia, attempting to open his sutures. When the victim notices Will, he reacts violently in self-defense, and Will forcefully tosses him into the bathtub. When the victim convulses, Will rips open his ribcage and attempts to massage the man's heart from the inside, hoping to keep him alive. He fails. Back in the present, Will tells Jack this wasn't brutal, but clumsy. The surgeon they're looking for tried to keep his victim alive. Did the Chesapeake Ripper ever do that?
Jack and Brian Zeller notice all the similarities between this case and the murders associated with the Chesapeake Ripper, but Will knows better. The last Ripper murder consisted of a bloody tongue lodged in the pages of a church pew Bible. This... isn't that. Jack wants desperately to find and arrest the Ripper before more people die, but Will preaches patience. They'll capture that killer, eventually; but for now, they need to focus on this individual crime.
In a posh art museum, an operatic performance moves Dr. Hannibal Lecter to tears. Following the show, as Hannibal converses with an old friend, Franklyn Froidevaux interrupts, eager to introduce his companion Tobias to Dr. Lecter. Franklyn is one of Hannibal's patients and borderline obsessive about his doctor's genius. At their next therapy session, Franklyn admits his chance encounter with Hannibal at the opera wasn't entirely coincidental. Franklyn thinks he and Dr. Lecter could be great friends outside of his office and laments how he must pay to hang out with him. Hannibal asserts his role as Franklyn's therapist and nothing else. Ushering the man out of his office, Hannibal prepares for his next appointment... with Will Graham.
Will is attempting to recover from the trauma surrounding his role in the orphaning of Abigail Hobbs. Hannibal empathizes with Will and even goes so far as to suggest they're both parents to the girl in a coma. Dr. Lecter tells Will he's heard about the latest "alleged" Chesapeake Ripper killing, but Will insists it's not the same guy. Lecter wonders if any of the killings have been "the same guy." The connection between each crime is the careful extraction and harvesting of organs. Maybe Jack is looking for a lone serial killer that doesn't exist. Will agrees to keep Lecter's theory in mind moving forward.
Eighteen months prior, Andrew Caldwell - an independent medical examiner - draws blood from the arm of Hannibal Lecter and releases it into a vial for later testing. Andrew asks the doctor if he's aware of any other infections in his body at the moment and encourages Lecter to tell the truth, since he'll find out anyway and lying just increases his insurance payments. Hannibal asks for the man's business card. Months later, in the present, Andrew drives along a desolate road when his gas tank leaks, and he's forced to pull over. Suddenly, Hannibal Lecter pulls up beside him and offers assistance. In the days following, Caldwell's severed body shows up in an empty school bus, while Hannibal meticulously files clean-cut red meat into his refrigerator...
Later, in the FBI autopsy room, Will Graham examines the bloodied corpse of Andrew Caldwell; the victim's heart and liver are missing. Whoever is committing these crimes is meticulous about their work and their craft. Beverly Katz sees this psychopath as an artist, though his canvas is obviously unconventional. Will worries, aware that an artist is not only inspired by those before him, but is capable of inspiring the ones who follow...
At Hannibal's apartment, Alana Bloom acts as the doctor's sous-chef as they prepare a multi-course meal. As Alana slices vegetables, Lecter attempts to pry into her relationship with Will Graham, as well as her knowledge regarding the ongoing case to catch the Chesapeake Ripper. Alana is purposefully vague, citing her wish to keep things between Will and her entirely platonic and separate from their work. Alana just wishes everyone would leave Will alone, but as Hannibal ponders the comment, he knows this is easier said than done. Later on, when alone, Hannibal refers to a massive rolodex in his kitchen full of people's business cards, attached to fine meat recipes. With each selected card, Hannibal places another slab of meat into his refrigerator.
As Hannibal Lecter presses an organ through a sausage maker, the autopsy team over at the FBI informs Will and Jack of the variety of missing body parts in each of their recent victims. Whoever this killer is, he's doing something with the organs other than transplants; after all - who gets a spleen transplant? Will's convinced their dealing with two killers - the surgeon who murdered the man in the hotel and the person Will assumes is the Chesapeake Ripper: the one killing the others for their organs. Will knows the killers are aware of each other, either by direct contact or from Freddie Lounds' blog. Their best chance of catching the Ripper... is if the "hotel surgeon" leads them to him.
Elsewhere, Hannibal engages in another therapy session with Franklyn Froidevaux. Franklin mentions how he saw Hannibal again outside of his office, this time at the grocery store, but he chose not to approach him, following Dr. Lecter's reaction to their last informal encounter. Franklyn is worried about being alone in life - he assumes everyone feels the same way. When Franklyn leaves, Lecter opens his door for the next patient, but no one is in the waiting room. Hannibal returns to his desk and looks at his phone, expecting it to ring. Somebody missed their appointment.
Hannibal finds Will Graham in his classroom, steeped in a pile of crime-scene photographs depicting recent murders possibly committed by the Chesapeake Ripper. Lecter offers his help analyzing the information. The first motif he notices is one of intimacy - the killings are personal. Hannibal asks Will about Jack's former trainee, Miriam. Will knows the Ripper killed her. But where's her body? Hannibal wonders if the Ripper is taunting Jack by not displaying the "artwork" of the murdered Miriam. Will knows this is a valid hypothesis, and Dr. Lecter takes the theory one step further by predicting Jack will hear from the Ripper directly, and soon...
Beverly Katz approaches Jack with a major revelation - security cameras from the hotel show a private ambulance pulling away from the scene just as first responders show up. If the killer wanted to perform surgery in his vehicle, an ambulance is the best kind to have, and since it blends in so well with an emergency, no one would think twice when seeing it at the scene. Jack rushes to Will's classroom and requests Graham and Lecter's help with capturing the Ripper.
After contacting the private ambulance company, the FBI team tracks down the missing vehicle using GPS and, together with a SWAT team, approaches the vehicle - which is parked in a remote location. Jack finds Devon Silvestri in the middle of surgery, attempting to extract his latest victim's kidney. Jack orders Devon to put his hands on his head, but the surgeon warns Jack that doing so will kill the victim. Crawford calls Hannibal in to take over the operation and stop the bleeding, which Dr. Lecter seamlessly does. With the victim stabilized, the SWAT team extracts Silvestri from the vehicle and places him under arrest.
Following the arrest, Will pays Hannibal a visit and thanks him for saving the victim's life in that ambulance. Will asks Hannibal why he stopped doing surgeries, and Lecter reveals he lost the passion after losing a patient on the emergency operating table. Ever since, he's committed himself to psychological therapy, where he's never had a patient die. Will excuses himself, as he has a "date with the Chesapeake Ripper." Though catching Silvestri was a success, the true killer's still out there, and Will has become so obsessed, he won't stop until he's caught him.
As Hannibal throws a lavish dinner party with a plethora of non-vegetarian courses, Will Graham returns to his classroom and meticulously examines crime scene photos belonging to the Chesapeake Ripper's "works of art." Will's head is wrapped so tightly around the mind of this killer that he can't think of anything else...