Agts. Mulder and Scully were called upon to investigate the case of Dr. Harrison Lloyd, a surgeon in the Aesthetic Surgery Unit (ASU) at Greenwood Memorial Hospital in Chicago, Illinois. Dr. Lloyd had deliberately eviscerated a patient for whom a scalp reduction had been ordered, killing the patient. He now claimed to have been possessed by demons.
Agts. Mulder and Scully interviewed Dr. Lloyd in the presence of his attorney. Dr. Lloyd was cooperative. He described himself as having been taken over by a force beyond his control. He expressed horror at the crime he had committed. When Agt. Scully asked Dr. Lloyd if he were taking medication, Dr. Lloyd responded that he had been taking sleeping pills; when asked by Agt. Scully how much sleep he had had the night before the killing, he could not recall. Dr. Lloyd’s attorney, who had advised his client not to answer the agents’ questions, then ended the interview.
At Greenwood Memorial Hospital, Agts. Mulder and Scully proceeded to the operating bay where the murder had taken place. As they walked to the operating room, Agt. Scully checked Dr. Lloyd’s medical records, which revealed that he was addicted to sleeping pills. In the operating bay, Agt. Mulder discovered five round marks on the floor near the body, which appeared to have been deliberately burned or scorched into the floor. Agt. Mulder connected the dots, using the patient’s blood, to draw a pentagram, a symbol of magic and witchcraft. Agt. Scully urged Agt. Mulder to focus on the most probable explanation, iatrogenic death, which in this case would have been brought on by exhaustion. Agt. Scully suggested that given the financial importance of an ASU to any hospital, Dr. Lloyd likely had been extremely overworked. Agt. Mulder countered by pointing out that it would be unlikely for the doctor to have confused a scalp reduction patient with the liposuction patient also scheduled for that day, or to have confused the plainly marked numbers of the two operating rooms.
Outside the operating bay, Agts. Mulder and Scully viewed on a video monitor a rhinoplasty in progress. They then interviewed Nurse Rebecca Waite, who had been attending but had not been in the operating room during the killing under investigation. Nurse Waite appeared somewhat reluctant to give information. When informed by Agt. Mulder that Dr. Lloyd was claiming demonic possession, Nurse Waite suggested that such possession is cheaper than malpractice insurance. Dr. Theresa Shannon, emerging from surgery, interrupted the interview and sent Nurse Waite back to work. Claiming to have a patient requiring urgent care, Dr. Shannon refused to answer the agents’ questions.
In the hospital conference room, ASU doctors Shannon, Jack Franklyn, Eric Ilaqua, and Mitchell Kaplan met to discuss the difficulty of their situation. Dr. Kaplan urged that there be no change in procedure. Dr. Ilaqua pressed for some action. Dr. Shannon feared an exposé. Dr. Franklyn expressed his confidence in their own innocence. In reference to the agents’ interrogation of Nurse Waite, Dr. Franklyn pointed out that Nurse Waite knew nothing.
In the operating room, Nurse Waite attended to a patient responding to the anaesthetic she had been given preceding a scheduled skin peel. As the patient lost consciousness, Nurse Waite peeled away from the patient’s belly five leeches that she had placed there. The leeches were engorged with blood; each had left a bruise-like mark at a point on a pentagram.
In Agt. Mulder’s motel room, Agt. Mulder played for Agt. Scully the videotape of Dr. Lloyd in the process of killing his patient. Agt. Mulder pointed out that the five marks had been on the operating room floor before the patient’s death. He added that the violence of Lloyd’s actions indicated that Lloyd was not acting of his own volition. He also reminded Agt. Scully that the pentagram is a positive and protective symbol. He gave Agt. Scully the Physicians Desk Reference and asked her to read the ingredients of the pills that Dr. Lloyd had been prescribed, one of which was belladonna. According to Agt. Mulder, belladonna is also known as witch’s berry; it is commonly used in witchcraft hexing rituals. Agt. Scully replied that many pharmaceuticals contain belladonna. Agt. Mulder suggested that if the killing were part of a ritual, the ritual might continue.
In the ASU scrub room, Dr. Shannon asked Dr. Ilaqua if he was finished working for the day. As Dr. Shannon proceeded to the operating room to perform a skin peel, she witnessed on the video monitor Dr. Ilaqua attacking her patient in the operating room. Dr. Shannon tried to enter the operating room, which was locked. She called for help and beat on the door. Other hospital staff ran to the scene. Dr. Ilaqua, apparently in a trance-like state, used a laser scalpel to burn through the patient’s head, killing the patient.
Under questioning by Agt. Scully, Dr. Ilaqua said that he had not been aware of his actions when he killed the patient. Agt. Scully noted a vial of pills in the pocket of Dr. Ilaqua’s scrubs and read its prescription. In the ASU consultation room, Agt. Mulder replayed the videotape of Dr. Ilaqua killing the skin-peel patient. On looking at the vial of pills Agt. Scully handed to him, Agt. Mulder also concluded that Dr. Ilaqua and Dr. Lloyd had the same prescription for sleeping pills. Agt. Mulder noted the five bruise-like marks on the patient’s belly. The agents decided to interrupt a meeting of ASU doctors.
At that meeting, Dr. Franklyn told Agts. Mulder and Scully that the ASU was committed to resolving the case. He also admitted to the agents that ten years earlier, patients had died in the hospital; those deaths had been ruled accidental. He revealed that Nurse Waite had been on the ward where those deaths had occurred and had only recently been transferred to ASU.
That night, Agts. Mulder and Scully drove to Nurse Waite’s home. Before they arrived, Nurse Waite, partially clothed, had begun performing a ritual in which she spoke an unknown language and burned her hair in candle flames. On Nurse Waite’s porch, Agts. Mulder and Scully noted a pentagram. Entering the house with guns drawn and flashlights lit, they discovered the ritual paraphernalia, but Nurse Waite was not in the house.
Meanwhile, Dr. Franklyn arrived at his home in Winnetka, Illinois. Upon entering, he discovered that his lights were not working. He proceeded upstairs. On a bathroom mirror he discovered the words "vanitas vanitatum" (Latin: "vanity of vanities"), written as a single word in what appeared to be blood. He approached the bathtub, which was full of what appeared to be blood and water. Nurse Waite emerged from beneath the surface of the liquid in the bathtub and attacked Dr. Franklyn with a knife, stunning him. Then Nurse Waite disappeared. Dr. Franklyn proceeded downstairs. While he was calling 911, Nurse Waite again attacked him, cutting his head.
When Agts. Mulder and Scully arrived at Dr. Franklyn’s home, Nurse Waite was being removed from the scene by the police. She spoke to Agt. Mulder, urging him incoherently to help "stop it." Nurse Waite then began gagging and vomiting. Agt. Scully called for paramedics; she diagnosed Nurse Waite as suffering from internal bleeding. Nurse Waite vomited hundreds of straight pins. Agt. Scully accompanied Nurse Waite to the emergency room.
In Dr. Franklyn’s home, Agt. Mulder interviewed Dr. Franklyn while Dr. Shannon treated Dr. Franklyn’s cut. Dr. Franklyn suggested that Nurse Waite had attacked him because he had raised suspicions regarding her involvement in patient deaths; Agt. Mulder pointed out that Nurse Waite could not have been aware of those suspicions. When Agt. Mulder mentioned witchcraft, the doctors appeared bewildered. After Agt. Mulder and Dr. Shannon left Dr. Franklyn’s home, Dr. Franklyn lay on his bed and levitated.
Later that night, Agt. Scully returned from the emergency room and met with Agt. Mulder in his motel room. Agt. Scully reported that Nurse Waite had died twenty minutes earlier of massive hemorrhaging caused by vomiting the straight pins. Agt. Scully referred to pica, a psychiatric disorder characterized by a craving for non-food objects, but Agt. Scully and Agt. Mulder agreed that had Nurse Waite swallowed the pins, she would have died before she vomited. Agt. Mulder suggested that Nurse Waite was suffering from allotriophagy, the spontaneous disgorgement of strange or foul objects, associated with demonic possession and referred to in a book on witchcraft that Agt. Mulder had removed from Nurse Waite’s home. Agt. Scully countered with the simple biological fact that what comes out of a person must have gone in. Agt. Mulder also showed Agt. Scully Nurse Waite’s calendar, in which pentagrams had marked the victims birth dates. Each of those birth dates corresponded to a witch’s Sabbath. Agt. Mulder’s theory was that Nurse Waite had been trying to protect the victims.
The next day, Dr. Shannon informed Dr. Franklyn and Dr. Kaplan , who were preparing for surgery, that Agts. Mulder and Scully were investigating patient’s birthdays. Dr. Kaplan complained about the difficulties the investigation was posing the ASU. Noting Dr. Franklyn’s exhaustion, Dr. Kaplan also offered to take over Dr. Franklyn’s surgery. Dr. Franklyn resisted; Dr. Kaplan insisted Dr. Franklyn leave work. Driving to the hospital, Agts. Mulder and Scully learned by cell phone that a skin-peel patient whose birth date corresponded to a witches’ Sabbath was then in pre-op and that Dr. Kaplan had taken over that surgery for Dr. Franklyn.
When Dr. Kaplan’s patient had lost consciousness, Dr. Kaplan, in an apparent trance, poured acid over the woman’s face. Agts. Mulder and Scully entered the hospital and discovered Dr. Shannon screaming. Looking into the operating bay, they saw the acid-destroyed face and cranium of the patient, and an apparently bewildered Dr. Kaplan.
Immediately afterward, Dr. Shannon confessed to Agts. Mulder and Scully that with the hospital’s tacit approval, the ASU doctors had covered up the patient deaths which had occurred ten years earlier. She also revealed that at that same time, a Dr. Clifford Cox had died of a drug overdose. Agt. Mulder requested files on Dr. Cox. Those files revealed that Dr. Cox’s birth date was not a witches’ Sabbath. Dr. Shannon used the cosmetic surgery imaging software to alter Dr. Cox’s picture. Under Agt. Mulder’s instructions, altering the images of Dr. Cox’s eyes and forehead beyond surgical capabilities, Dr. Shannon arrived at a picture of Dr. Franklyn.
In his home, Dr. Franklyn began carving a pentagram into the floor. Meanwhile, Agt. Scully and Dr. Shannon failed to reach Dr. Franklyn by telephone. As Agts. Mulder and Scully proceeded toward Dr. Franklyn’s home, Agt. Mulder suggested that Dr. Cox had committed the patient murders as sacrifice in order to improve his own looks supernaturally. According to Agt. Mulder, Dr. Cox had become Dr. Franklyn. Meanwhile, Dr. Franklyn arrived at the hospital. In an operating room, he began arranging on a table dozens of surgical instruments. Dr. Shannon entered the operating room. The surgical tools disappeared, and Dr. Shannon collapsed, bleeding from the mouth.
Agts. Mulder and Scully entered Dr. Franklyn’s home with guns drawn. Agt. Mulder noted an inverted pentagram carved into the floor. The names of the murdered patients were carved at points of the pentagram; Dr. Shannon’s name appeared there as well. At the hospital, Dr. Shannon was wheeled into the emergency room for an exploratory laparotomy. Dr. Shannon weakly begged the doctors not to operate. In another operating room, Dr. Franklyn began cutting off his own face. Agts. Mulder and Scully found Dr. Shannon in the emergency room. Agt. Mulder instructed Agt. Scully to stop the operation; he searched for Dr. Franklyn. Agt. Scully attempted to interrupt surgery, but the doctors heatedly refused to desist. Agt. Mulder found Dr. Franklyn’s face but failed to find Dr. Franklyn. He returned to the emergency room to discover that the surgeons had extracted dozens of surgical tools from Dr. Shannon’s stomach. Dr. Shannon, however, was alive.
As Agts. Mulder and Scully concluded that Dr. Franklyn had failed in his plan to kill another patient, they were interrupted by screams from down the hall. A doctor had killed a patient. That patient’s birthdate was October 31st, Samhain, the fourth witches’ Sabbath.
Dr. Franklyn, now a handsome doctor named Hartman, joined an ASU team at a hospital in Los Angeles.