Sam's strapped to the bed, looking sick and helpless, while an angry not!Dean circles him, like a creature going in for the kill. “I know why you really drink that blood Sam.” A fatigued Sam pleads with him to leave him alone, but not!Dean keeps going. “It makes you feel strong, invincible, big bad wolf in a world of little pigs.” Sam tells him he’s wrong, but not!Dean keeps going. “It’s more than that isn’t it? It’s because your whole life you felt different, am I right?” Sam weakly tells him to stop. “I hit a little close to home, huh?” Sam starts to struggle against the cuffs to no avail, and must listen to this completely trapped. 
 

 
“You’re not different because you were some a lonely kid or because of your weirdo family.” Not!Dean leans over and delivers the blow. “Because you’re a monster.” Sam yells at him to shut up, and goes crazy yanking at the cuffs now. Not!Dean lays into him more. “Always a monster. And you only feel right when sucking down more poison and more evil!” Sam is on the brink of tears, unable to hear anymore.      
 
Back to the real Bobby and Dean. “I would die for him in a second, but I won’t let him do this to himself. I can’t. I guess I found my line. I won’t let my brother turn into a monster." Back to not!Dean, who bluntly tells Sam “Monster, Sam, you’re a monster. I tried so hard to pretend we were brothers, that you weren’t one of the filthy things that we hunt. We aren’t even the same species. You’re nothing to me.” Sam's falling apart now. "Don't say that to me. Don’t you say that to me!" Sam turns away in agony, and we’re back to the wide shot of Sam alone in the room. Sam realizes it too, and sinks into the cot in exhaustion. That was one intense depiction of him going through his worst nightmare.


 
 
This part here reminds me of one of my favorite scenes in "Yellow Fever." Dean hallucinates an evil Sam, who flings him against the wall and chokes him just before flaring the yellow eyes. That episode revealed Dean's two greatest fears, going back to Hell, and Sam turning into a monster. The latter obviously stuck with him, for that's pretty serious that he'd rather see Sam dead than become that monster.
 
Just when we're catching our breaths over that intense moment, we get another shocker. Stop guys, you're killing me! Sam is seen in the same position later, when it's dark. He's still chained to the bed. He sighs over his sorry predicament and then suddenly, the handcuffs one by one unlock on their own. Then the door opens. A confused Sam calls out, but no one is there. Just like any caged bird longing to be free, Sam in stealth mode goes upstairs. 
 
Then we see Castiel hiding under the stairs. Cas, you bastard! What are you doing??? Cas does his angel mojo thing and closes the door with his mind, locking it tight. Sam gets upstairs grabs his coat, and brushes by a sleeping Bobby and Dean. Time to find his dealer.


 
Castiel is at a harbor, and while I'm no expert when it comes to the state of South Dakota, I imagine being a land locked state its a little short of harbors. Perhaps Castiel flew to Minnesota? Anyway, Anna appears, pretty much saying what we all want to, what the hell have you done you bastard? Sam drinking demon blood is "much worse than we thought." We? Who's we? No time to speculate, for two angel goons come to take her away. "You really shouldn't have come," Castiel tells her, completely riddled by guilt. Aw Cas, they didn't completely ruin you with the ass reaming.   


 
Sam is breaking into a car, and suddenly behind him is the click of a shotgun. Gulp! Oh wait, it's Bobby. Sam, thinking what we all are, tells Bobby he won't shoot him. Bobby tries to appeal to Sam, telling him to get back inside. Sam says no, and damn does he look bad. The makeup people are doing too convincing a job, for the way Sam looks, he should be on his death bed by now.


 
Bobby keeps the gun on him, telling Sam they're only trying to help him. Sam again points out Bobby can't shoot him, Bobby warns him not to test him. Sorry Bobby but even I see that's a flimsy threat. Bobby pushes the shotgun into Sam's middle, so Sam grabs the barrel and moves it slowly up to his heart. "Then shoot," Sam says, getting all teary as he looks Bobby in the eye. Bobby gets teary, I get teary and then Sam ruins the mood by quickly grabbing the shotgun and knocking Bobby out with it. Sam feels guilty about it though, and reacts with a "what am I doing" look before throwing down the shotgun in disgust. He drives away, leaving an unconscious Bobby on the ground. Oh Sam, how could you?


 
Bobby and Sam open the panic room door and inspect, trying to figure out how Sam got out. The devil's traps were broken, so the assumption is Ruby did it, even though she doesn't have the goods to open the door. Dean thinks that's a good enough reason to put killing her first on his to do list, and heads off to find Sam. "I thought you were an angel duty," Bobby says. "I am, in my car, on the way to kill the bitch." Dean is so good at spelling it out. Bobby points out that Sam will be impossible to find, but Dean has ideas. 
 
Okay, this is a rare treat on this show. The next scene is in a nice, tastefully done hotel room. You know the set designers have been chomping at the bit to do one like this for a while. The camera makes sure we get a long look at this cozy room until it gets to Sam waiting on the couch. Yikes! He's a mess. Usually he's prettier than these motel rooms.


 
Sam is pretty jumpy, and obviously very broken by what's happened. He also looks like a powderkeg ready to go off. There's a knock and Sam opens the door, and Ruby is all smiles over the honeymoon suite. Yeah, I want to slap her too. Doesn't she see what she's reduced this poor man to? 
 
Sam asks if she busted him out of the room. “How could I Sam? The whole thing is engineered to bite me in the ass.” Sam wonders who then, Ruby doesn’t care. Funny how no one wants to get to the bottom of that.  Maybe next week. Sam wants to know where's she been for three weeks. She's been out tracking Lilith. Likely story. She's trying to string you along Sam, so you'll need her more than ever and be willing to do anything for your next fix. Dealers do that. Sam stands by the door, looking at her with his gaunt face and super sad puppy dog expression, and I end up picking up my own puppy and giving him a big hug. There's just something about that look that got me in a puppy clutching mood.


 
Ruby lowers her guard a bit. "I'm sorry you're hurting Sam. I had no idea Dean would do that to you." "You and me both," a devastated Sam replies. I guess it's going to take him a while to get past this. Or never.
 
Ruby guesses the honeymoon suite wasn't to impress her. Nope. Dean’s going to come after him and knows all his habits, his aliases, everything. Sam’s willing to do what it takes to shake him. Ruby, who’s standing on a platform near the bed so she can actually be eye-level with freakishly tall Sam, tries to be sympathetic, running her hand through his hair. "It’s sad. That things have gotten this bad between you two."