Sam and Dean investigate an abandoned sanitarium and discover that when the hospital was open, the patients held a revolt against the cruel and unusual punishments inflicted by the head doctor. While the brothers search the premises for four lost college students, the tortured spirits cause them to go insane, turning Dean against Sam.

While battling a demon, Dean is electrocuted, resulting in permanent damage to his heart and leaving him with only a couple of months to live. A despondent Sam searches desperately for a way to save his brother and believes he may have found an answer through a preacher who claims to heal the incurable. However, Dean and Sam discover that the preacher is getting help from the Grim Reaper who is trading one life for another he feels is less worthy.