Chanel accuses #5 of being the new killer. #5 denies it. #3 suggests that they give in to Hester's demands and get her transferred to the CURE Institute so she can help them solve the case. Munsch arrives and instructs the girls to dispose of the evidence so that the hospital doesn't get shut down. The Chanels and Munsch dispose of Tyler's body in the swamp, where Munsch says it will be preserved.
Chad's friend Randall is cured of his Jumping Frenchman of Maine disease but winds up slaughtered by the Green Meanie immediately after.
Munsch and the Chanels visit Hester in jail. Hester tells the group that the third missing victim (Randall) is dead and that she knows who the killer is. She insists that the killings will only get worse. She refuses to offer up any more information until she gets what she wants, demanding a timeshare in Cabo San Lucas in addition to what she already asked for. Chad texts Munsch telling her that he knows who the killer is. They leave Hester, telling her she'll never get out of the psychiatric hospital, but not before Hester mocks Chanel's dry skin and advises her to use "Esrun" cream."
Chad gathers Munsch, Dr. Holt, and Chanel and claims that Dr. Holt, because of his serial killer hand, is the murderer. Holt denies it and accuses Chad of being the murderer instead. Chanel declares that she chooses neither of the men to date, choosing herself instead. Munsch suggests that they find a new donor hand for Holt, or she'll have to fire him.
Dr. Cascade, Chanel #3 and Munsch meet with a woman who is experiencing multiple spontaneous orgasms per day. Cascade prescribes her with a mega-dose of antidepressants to quell the orgasms.
Cascade and #3 clean up the morgue where Chad was apparently practicing butchering cadavers' hands. #3 confesses that she's never had an orgasm and that, in general, she's alive but not really living and doesn't truly feel anything. Cassidy confesses that he's dead -- he believes he choked to death on his own vomit after a kegger and is now cursed to walk the earth until he fulfills his purpose. Cascade claims that his one purpose might be to help Chanel #3 feel alive again (and experience an orgasm). They kiss.
Zayday and #5 play Scrabble. Zayday realizes that "Esrun" is the word "Nurse" spelled backwards and points it out to the Chanels as a possible clue from Hester.
In the showers, Chad approaches an also-naked Holt with a list of potential "handidates" for his new hand. Holt tells Chad to knock it off. Chad also claims that he will be performing the hand transplant surgery himself.
The Chanels, Zayday, Denise Hemphill, and Munsch travel to visit Lynn Johnstone, a nurse who created Esrun cream. They ask him about Our Lady of Perpetual Sorrow. He explains that he used to work there and that in 1986 on Halloween night he was working on the night when an entire floor of patients and staff was euthanized. He was paid hush money by the hospital not to talk about it. He confesses that he knew who the killer was -- in his months at the hospital, he befriended Nurse Thomas (the nurse who helped the doctor dump the COPD patient's body) who told him about the story.
Lynn attempted to ignore the connection to the 1986 massacre, but he recently received phone calls from someone he was sure was a woman, saying they would rise from the swamp where the bodies were buried, threatening him and to kill again. He thought it was definitely the pregnant woman whose husband was killed.
Back at the CURE Institute, the group discusses the killer. Denise and Zayday don't understand why the killer would just start killing now, when the nurses and doctors who killed the COPD patient were long dead. Munsch believes that the killer is trying to get revenge on the hospital itself by killing the CURE patients and that the killer could be the male child of the dead man and woman, rather than the pregnant woman herself. The group identifies Cassidy Cascade, Chad Radwell, and Chamberlain Jackson as potential suspects, given that they are all males of around age 30.
Chad prepares to saw off a handidate's hand. Holt stops Chad. Munsch storms in to stop Chad as well, telling him that she now knows the killer is a 30 year old male, not the older Holt. Munsch suspects Chad. Holt leaves and when Chad confronts him, Holt claims that he will be proposing to Chanel.
#3 and Cassidy observe Mrs. Baumgartner having an adverse reaction to the antidepressants they prescribed her. The two meet that night and have #3 get into the yoga position that the patient was in when she started experiencing her orgasm condition. Cassidy twists #3's hip while she's in the position, setting off a sensation that makes it feel like he's touching her intimately. Cassidy realizes that he needs to perform surgery on the patient's pudental nerve in order to resolve the issue.
Chanel meets with Chad in the park, after Chad asks her there to take a walk and have a talk. Chanel is suspicious of Chad's motives. They walk and chat. Chad cues up a mariachi band and tells Chanel that he's in love with her. Chad gets down on one knee and asks her to sign a prenup. Chanel is ecstatic, though Chad is very careful to say he'll "consider" marrying her once she signs the prenup. They kiss, and while kissing, Chad spots Holt in the distance, staring at them ominously before vanishing.
Dr. Cascade performs surgery on Baumgartner to resolve her issue. Immediately upon finishing the surgery, #3 and Cassidy start making out (while the patient is still in the room). They move the making out to a bedroom, where #3 keeps getting distracted by the music. Cassidy tells #3 that he's in love with her and prepares to give her an orgasm. #3 stops him, pointing out that he's too cold for her to get fully into it. Cassidy takes his temperature (61 degrees) to prove to #3 that he's so cold because he's dead.
Chad summons Dr. Holt to the locker room and asks Holt to be his best man. He explains that, though he isn't cut out for monogamy, he wants someone to keep him from leaving Chanel at the altar. He wants Chanel's wedding day to be special for her because he "kinda sorta" loves her. Holt ominously ties Chad's bowtie extra tight but agrees to be Chad's best man, noting that he'll be there to comfort Chanel (by having sex with her) once Chad and Chanel break up in six months.
Chanel shows off her giant engagement ring to the Chanels and Zayday. She asks Zayday and #3 to be her bridesmaids. She asks #5 to be her doggy ringbearer. She tells them that the wedding is tomorrow because she needs to get married before Chad changes his mind or forgets.
Mrs. Baumgartner is released from the hospital, cured. She explains that she called the local news to tell them about the great care she received at the hospital. Suddenly, from down the hall, the Green Meanie throws a blade and decapitates Baumgartner before non-fatally stabbing Chamberlain. Zayday is purposely left alive when the Green Meanie suddenly runs off instead of attacking her. Chamberlain is confused about why the killer didn't come after Zayday.
Hester, in Hannibal Lecter-type restraints, is transferred to the bottom floor of the CURE Institute. Zayday and Denise explain to her that she's there because her Esrun tip turned out to be legit. They ask her to tell them who the killer is before they kill again, but Hester says it is too late.
At Chanel's wedding, Chanel walks down the aisle first and Chad doesn't show up. Chanel notices some blood dripping on her from above. Suddenly, Chad falls through the ceiling onto the pulpit, apparently dead via a stab to the throat.