Jack & Alana are contacted by a former colleague, Dr. Chilton, who believes he has The Chesapeake Ripper in custody, but then one of his patients commits a murder that matches The Ripper's profile. The team determines the Ripper was a surgeon and is still at large when Jack's former protégé Miriam becomes the next victim. Jack copes with her loss and the prospect of losing his wife by opening-up to Hannibal.