A nurse at the Baltimore State Hospital for the Criminally Insane is murdered by a patient, Dr. Abel Gideon (Eddie Izzard), who begins taking credit for a series of murders perpetrated by the "Chesapeake Ripper", who hasn't committed a murder in two years, the same number of years Gideon has been incarcerated. While Graham tries to discover whether Gideon truly is the Ripper, Crawford receives a phone call, apparently from the real Ripper, which plays the recorded voice of Miriam Lass (Anna Chlumsky), a trainee Crawford had consulting on the Chesapeake Ripper case two years previously when she suddenly disappeared. Bloom and Crawford make a deal with Freddie Lounds to write a story about Gideon, hoping to provoke the real Ripper to make himself visible. During a dinner with Bloom and Lecter, Dr. Frederick Chilton (Raúl Esparza), the administrator of the Baltimore hospital, already suspected Gideon of being the ripper and had unintentionally planted the thought in Gideon's mind during a session, implying that Gideon is not the Ripper but believes himself to be. Later, Crawford receives another phone call, which they trace to an old observatory, where they find Miriam's cell phone clutched in the hand of a severed arm. A final flashback reveals Miriam's fate: she visits Dr. Lecter to ask about an old patient, Jeremy Olmstead, whom he had come into contact with when working as an ER attendant, who has turned up as the latest Ripper victim. While Lecter excuses himself, Miriam finds one of his sketches of the Wound Man, which precisely matches the manner in which Olmstead was murdered. Lecter sneaks up on her from behind and knocks her unconscious. Dr. Hannibal Lecter is revealed as the real Chesapeake Ripper.