Darling Sammy's Lucifer-related insomnia has worsened considerably since last we saw him, and it leads directly to a pre-credits car accident that lands him in an insane asylum after the emergency room doctors determine the dear boy's suffered a psychotic break. Of course, Sam's Lucifer hallucination comes along for the ride, and the foul fiend quickly devises a series of nuthouse-related torments designed to run Our Intrepid Hero into an early grave. Darling Sammy does his valiant best to ignore the torture, however, and he even finds time to gallantly help a fellow inmate rid herself of the pesky ghost that had been plaguing her for the better part of the last year, so that was pretty nice of him, I guess.
Meanwhile, Dashing El Deano uses Darling Sammy's hospitalization as an excuse to freak the fuck out, and he begins dialing his way through Dead Bobby's lengthy list of contacts until one of them calls back with news of an actual, honest-to-God faith healer named Emanuel, who just might be able to cure Sam. Dean tracks Emanuel down to the latter's tastefully-appointed home deep within the lush coastal rainforests of central Colorado, and is shocked and appalled to discover that Emanuel is actually an amnesia-afflicted Castiel. My Sweet Baboo, you see, emerged from that municipal reservoir all those many months ago with no recollection at all of the last several years -- no comment -- whereupon his adorable self was quickly adopted by some random who is now his wife, and he's been spending his time since then curing his various friends and neighbors of their various ills and ailments. You know, more or less.
Luckily enough for Dashing El Deano, Emanuel is more than amenable to the idea of a road trip to go restore Darling Sammy to the latter's typical levels of mental health, but naturally, there's a problem: Crowley's cancelled the moratorium he placed on all Winchester-related demonic activity, and so on top of everything else, Dean finds himself under repeated attack by Hell's many minions. Fortunately, Meg shows up just in time to offer Our Intrepid Hero a crucial assist, and she promptly invites herself along as a sort of bodyguard for both Dean and Castiel on the rest of the journey to the asylum.
Eventually, everyone ends up in the same place and, after My Sweet Baboo's memories come rushing back in the middle of an especially dull run-in with a quartet of Crowley's goons outside Sam's hospital, Castiel decides to sacrifice himself so Darling Sammy might live, because the only way he can cure Sam is by trading places with him. Just go with it.
And in the end, as Sam and Dean board this week's crapped-out piece of trash to motor on off towards their next wacky adventure, My Sweet Baboo gets himself fitted for a straitjacket while Meg gets herself hired as one of Castiel's nurses. I have no clue where they're going with all of this, but to be honest with you, I don't particularly care, either.
Rattle, Rattle STILL NOT GIVING A SHIT NOW! The NOW! creeps forward into complete and utter blackness, as is its occasional wont, and silence reigns for one very long second until the sounds of heavy, labored breathing emerge from the dark to usher us into the episode proper. The panting is joined by a series of plodding footfalls before the camera finally opens up to offer us all a lingering shot of Darling Sammy's denim-clad derriere, which is currently making its tantalizing way down a set of dimly-lit railroad tracks somewhere ominous and remote. Our Intrepid Hero's ridiculously oversized feet eventually hop over one of the rails to bounce their owner up onto an adjacent asphalt walkway, and the shaky, hand-held, Ginormomope-POV InsomniaCam propels us forward until Darling Sammy slams right into some mouthy midnight dirtbag who'd been ambling along in the opposite direction...or does he? For you see, by the time Darling Sammy spins around to apologize to the dirtbag he's just so brusquely jostled, the dirtbag in question has disappeared. DUN!
The mysterious disappearance of the mouthy dirtbag doesn't seem to bother Darling Sammy too much, though, and he continues tumbling forward in a woozy haze until he reaches a dank and forbidding alleyway, where he finds a diminutive drug dealer finalizing a transaction with an even tinier Goth girl...or does he? Just kidding -- the diminutive drug dealer's real, and he greets Darling Sammy like so: "Dude, get the hell away from me!" Charming. The camera finally focuses in on Somnolent Sammy's face and, as one would expect, he's sporting a set of puffy-yet-photogenic bags under his eyes, and there's several days' worth of stubble sprouting from his chin. "You speak friggin' English?" the diminutive drug dealer demands when Somnolent Sammy makes no move to leave. "Go away!" "It's okay -- there's no one after me," Sam attempts to assure him, but the diminutive drug dealer's not having it, and as Sam slowly slumps down to squat in the alleyway filth, the diminutive drug dealer shouts, "Why you running up in here like that? What the hell did you take, anyway?" "Nothing," Sam wearily sighs. "Bullshit," the dealer basically replies, and it's up to the just-appearing Lucifer to defend what's left of Our Intrepid Hero's honor, which the foul fiend does by too-casually insisting, "No, he's telling the truth -- burned through that last beer hours ago, right around the time Dean passed out." Somnolent Sammy rolls his eyes before burying his face in his hands as Lucifer exposits, "Come on, tell the nice tweaker -- you'd be sleeping by now if the devil would just leave you alone for five seconds." "Stupid Satan," Lucifer teases, placing a pair of sassy hands on his hips as he continues, "chasing you all the way to...where the hell are we?"