After throwing around Dean and Bobby, the Leviathan begin to bleed and stagger around, seemingly dying. Dean realizes that the beasts cannot remain within Castiel's body without destroying it. As a result, the Leviathan disperse into the local water supply nearby. Possessing different people and establishing a base at Sioux Falls General to maintain a food supply, the Leviathan hint at further plans and the importance of maintaining discretion to prevent unwanted attention. While Sam, Bobby and Dean attempt to learn of the Leviathan whereabouts, Sam continues to be tortured by visions of Lucifer, slowly believing that the world he sees is not a true reality. This eventually leads to Sam driving off by himself in what could have led to suicide, save for Dean's timely appearance and support in helping Sam overcome his visions through distinguishing the pain of the world from the tortures of Hell. Visions under control, the brothers head to Bobby's. Bobby, in the meantime, was investigating Sioux Falls General at the call of Sheriff Jody Mills, and discovers that the Leviathan are in the hospital. When the brothers arrive at Bobby's house, they find it burnt up, and are confronted by one of the Leviathan, possessing a man named Edgar. Though the brothers manage to crush Edgar under a car, Dean's leg is broken in the process, and Sam is severely wounded after being struck across the head by a pipe. While being driven in an ambulance, both brothers receive a shock: Sam is still seeing Lucifer and starts to seize, and Dean learns that the ambulance is taking them to Sioux Falls General.