Serenity Valley. Aftermath. Nurse Wretched casually drags Dean in from the hall while Sam dribbles blood onto his hand. "GOOOOOOOOOOOOOOORE!" Pestilence wryly observes that they're not looking so hot, and sardonically surmises that their current wrecked appearance might be due to the scarlet fever, meningitis, and syphilis with which he just dosed them. Unfortunately, Pestilence then rather tediously lectures Our Dear Boys at length regarding the nature of disease and its relationship to God, and because this episode was going so well up until this point, I'll just pretend this minute-long bout of blathering on The Horseman's part never happened and skip ahead to the bit where My Sweet Baboo arrives to save the day. Hooray! "How'd you get here?" Pestilence demands once Castiel's slammed his way in from the hall. "I took a bus," Castiel growls and then, because the poor thing's more human than angel at this point, he immediately drops to his knees to barf up part of his esophagus. "EEEEEEEEEEEEE!" Pestilence taunts at him, unwisely pissing off the nerd angel, so it's little surprise when Castiel snatches up The Knife That Can Kill Anything Except When It Usually Can't from where it landed on the floor and lurches to his feet to...hack off Pestilence's ring finger! "VIOLENCE!" howls Raoul, practically piddling himself with glee over this sensationally gruesome turn of events. "WANTON ACTS OF UNREPENTANT DIGIT-CHOPPING VIOLENCE AND GOOOOOOOOOOOOOOORE!" Pestilence spins off bellowing as his amputated ring finger -- with bonus pinkie! -- rolls around in a puddle of its own blood. Meanwhile, Nurse Wretched emits a caterwauling banshee wail as she leaps upon My Badass Baboo, and that's a very bad move on Nurse Wretched's part, indeed, for Castiel's still clutching The Knife That Can Kill Anything Except When It Usually Can't, so it takes little effort for him to jam the thing between Nurse Wretched's ribs, and Pestilence's comely assistant zots and zaps and shivers and dies.
Of course, Our Intrepid Heroes instantly recovered from their paralyzing illnesses the second Castiel lopped off Pestilence's fingers, and Dean now hustles to retrieve The Horseman's ring. "Doesn't matter," Pestilence calls out with an oddly triumphant smile on his face even as the blood continues to spurt from his mangled hand. "EEEEEEEEEEEEE!" I'm so happy you're happy, Raoul. "EEEEEEEEEEEEE!" In any event, having thus captured Our Intrepid Heroes' attention, Pestilence mysteriously asserts, "It's too late!" before vanishing in a swirl of something I'm certain would have been impressive to see, had they not chosen to have him dematerialize off camera.