The episode begins one evening in Baltimore, Maryland, when George Usher, a middle-aged businessman, arrives at his office building to work late. Unbeknownst to him, he is being watched by someone with un-natural yellow eyes from a nearby storm drain. Soon after Usher makes it to his high-rise office, it is shown that someone seems to be climbing the cables in the building's elevator shaft. When Usher leaves his office to make a cup of coffee, the screws in the office's vent begin to unscrew from the inside. When Usher comes back to the office and closes the door, an off-screen struggle insues, and the door is damaged in the process. Usher is killed in the attack, later revealed to have had his liver removed. His unseen killer returns to the ventilation shaft, rescrewing the vent's lid behind him.
The following day in Washington, D.C., Agent Scully has lunch with Tom Colton, a fellow agent and old acquaintance from the FBI academy. Colton tells Scully about his investigation of three mysterious murders in Baltimore, the latest being that of George Usher the previous night. All of the victims had their livers taken out of their bodies, but they were found in rooms locked from the inside, with no obvious points of entry for the killer. With no idea where to go with the investigation, he asks Scully for help. When Scully suggests bringing along Mulder, Colton agrees only reluctantly. Colton, it turns out, seems to be only interested in the case because solving it may give him "a bump up the ladder" and advance his career.
Later Mulder and Scully arrive at 66 Exeter Street, and make their way to Tooms' apartment. Upon entering the room, Mulder senses a feeling of evil. The agents find a hole in the wall behind a mattress, which leads them to a crawl space beneath the room. Down there, they discover a small pile of Tooms' trophies from his previous murders. They also find a large paper-mache-like structure, composed of old rags and newspapers, with a small hole as an entryway. The structure is covered with a slimy substance that Scully deduces to be bile. Mulder theorizes that the structure is a "nest" of sorts that Tooms hibernates in after each murder spree. Upon leaving, Scully seems temporarily snagged by something, but manages to easily pull herself free. It is revealed, however, that Tooms had grabbed her necklace -- as a trophy -- with his arm.
Mulder stops Tooms from killing Scully and he is sent to the mental asylum. A food tray is given to Tooms by way of a slot through the cell door. The episode ends with Tooms grinning calmly at the slot.
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