A plastic surgery patient is dead and Shawn and Gus suspect a local surgeon who, inconveniently or otherwise, happens to be someone whom Henry used to date.

Shawn and Gus track down playwright madman named Z, who six years earlier was deemed criminally insane after locking a critic in a back room of the theater that he burned to the ground, and who has been locked in a mental institution since. Shawn and Gus are forced to consult with the one person Z confided in while in the institution, a dangerous villain from Shawn's past.