Flash back to six months ago. A drunken Sam enters his motel room and is ambushed by a male demon with a wicked left hook. A blonde, female demon (not Cassidy; she can act and her voice doesn't make the hair on the back of my neck stand at attention) attacks him from the front. She takes the Knife That Might Kill Some Things, Who Knows and thanks Sam for keeping it warm for her. He says, "Ruby." She says she was in a nasty corner of Hell, and Lilith only let her come topside to kill Sam. He dares her. She raises her arm and plunges the knife right into... the male demon. Excellent choice, Blonde Ruby II. She tells him to get his car keys. They have to go now.
Sam and Ruby drive through the night. In Metallicar. Ack! It's a wonder Dean didn't rise out of Hell right then and there. I wonder if that's what he had to watch, over and over, as part of his (not so, as it turns out) eternal torment. Can't you hear him? "Remove the unclean thing. The seat on which sits the Abomination is a holy seat." He picked up that accent in Hell. And what's up with Baby, huh? Why didn't she just stall out, and refuse to move? Okay, I'll cut Baby some slack. She was hurt and confused. She just wanted to feel alive again. She just wanted to feel, at all. Blonde Ruby II wants French Fries. She says, "I just escaped Hell, I deserve a treat." When Sam is unresponsive, she launches a massive guilt trip about being a fugitive for his sake -- she came back for him. Sam and I say, "Who asked you to save me?" I'm just trying to help. Blah blah blah. Can you save Dean? Blee blee blee. No, nothing's that powerful, bloo bloo bloo. Sam gets angrier, and Metallicar's tires squeal as he pulls her up too short on the side of the road. If she can't save Dean, Sam has no use for her -- he orders her out of the car. She tries to talk, but he interrupts. "Whose body are you riding, Ruby?" She doesn't understand why Sam cares, but finally says, "Some secretary." Sam tells Ruby to let her go, "Or I send you right back to Hell." Blonde Ruby II sighs.
On the foot of a hospital bed there's a sticker that reads, "Doe, Jane 45-098-R3." Genevieve Cortese lies comatose, with a respirator down her throat. One doctor tells another (or a nurse, or a someone), "All right, pull it," and he removes the contraption. We hear the monitor's telltale flat line sound. Seven seconds after the respirator was removed (yes, I counted), the girl springs to life and sits up in her bed, gasping for breath. "Who do I have to kill to get some French Fries around here?" Hee.