The episode hits the ground running with Sam and Dean fighting off a couple of monsters in a cabin in the woods. But, before they destroy them, one of the monsters shoots Sam in the chest, taking him down instantly.
The next scene takes us back 48 hours prior.
The boys are the bunker, where Sam suggests a case for them: two missing hikers he suspects were taken by werewolves. Dean’s not interested; he’s worried about getting Cas back. Sam says they need to clear their heads and take the case.
We pop back to the present, where Dean immediately springs into action to remove the bullet. The two hikers are there -- Corbin and Michelle -- as well. Dean gets the bullet out and starts to cut down the captives while Sam attempts to bandage the wound. Dean explains to the captives that they were werewolves. With no landline or cell service, Sam decides to leave to call an ambulance. The captives tell the boys that there are more werewolves out there, so they all head out.
Back to 48 hours earlier: Sam and Dean are in a bar after running into no leads. The bartender suggest they check some old hunting cabins out in the woods.
Back to present: Sam, Dean, and the honeymooning captives are making their way through the woods looking for cell service and come across another cabin with no phone. Sam appears to not be doing so good, and neither does the honeymooning wife. The husband suggests they move on without Sam because he’s just holding them back. When Dean is outside, the honeymooner -- knowing full well Dean isn't leaving without him -- suffocates Sam. To death.
Dean discovers Sam and teary-eyed, says his goodbyes, and moves on to get the couple to safety (not knowing, of course. that the man is responsible for killing Sam).
They flag down a sheriff, who Dean punches when he tries to leave to go back to Sam. The Sheriff tases Dean, and he wakes up later in the hospital. The couple try to explain the what happened to the sheriff. He downplays the “werewolf” aspect, angering his wife, who is still holding some ill will toward him for killing Sam (which she saw). At the hospital, a doctor forces the man to let her examine him, as they are all in bad shape. But things get weird when she discovers a bite mark on his arm.
The woman sneaks into Dean’s hospital room to apologize and somehow ends up escorting Dean to find something he can kill himself with, in an attempt to talk to death.
Meanwhile, at the cabin, Sam wakes up, apparently not actually having died … only to find the werewolves (which include the bartender from the beginning) have arrived. As Sam makes his way to hide in the basement, he falls down the stairs, still not in great shape … meanwhile, Dean feels the effects of his overdose and collapses on the hospital floor.
Back in his hospital room, our honeymooning captive has healed completely and begins to werewolf up. Like we didn’t see THAT coming.
Sam continues to hide out in the basement, bleeding out, as the werewolf tries to sniff him out.
Dean’s spirit leaves his body and everything freezes, as Billie the Reaper shows up. Dean tries to make a deal with Billie, who says no and tells him that the answer will always be no. Dean begs Billie to save Sam, to which she reveals Sam’s not dead -- she’s there to reap Dean and only Dean. At the last moment, the doctor revives Dean and brings him back.
Back at the cabin, Sam manages to get away and back to the Impala. He attempts to call Dean but doesn’t have much of a conversation with the crappy cell service. Sam is able to find out where Dean is and take off in the car.
Back to the hospital: the Doctor discovers the werewolf, who kills her and the sheriff right off the bat. He, of course, tells his wife he doesn't want to kill but, instead, turn her so they can be together. Before he can bite her, Dean swoops him, giving her the chance to run. As he pins down Dean, a shot rings out, killing the werewolf. Sam has arrived, bloodied and injured, but in time.
After things settle, Dean tells the woman that Sam is hurt but is going to be okay. As the boys leave the hospital, Sam asks Dean what he did when he thought Sam was dead. Dean cracks a joke and tells Sam he never believed he was dead -- not telling Sam about his visit with Billie.