Mrs. Sigsby, responding to Maureen Alvorson’s suicide in a West Wing room, calls Trevor Stackhouse from the Institute’s village and orders Doctors Hendricks and Evans to leave their tests on C-Level and report immediately. Stackhouse arrives first, with the doctors close behind, and quickly directs Evans to lift Alvorson so he can loosen the noose.

Jim Evans supports the body while Stackhouse works the knot and removes the rope, then carries Alvorson to the mattress. The mark of the noose is visible on her neck, and the group silently surveys the scene. Dr. Hendricks examines a brown pill bottle on the bedside table and identifies it as oxycodone, forty milligrams, originally ninety tablets with only three remaining.

Hendricks concludes that Alvorson likely ingested most of the pills before hanging herself, and Evans notes that the dosage would have been lethal for someone of her small size. They agree she must have decided to end her life, with Evans suggesting her stated sciatica was not the primary issue. Stackhouse reflects on the message “Hell is waiting” as a declaration of guilt, including that of the Institute.

Mrs. Sigsby rejects Stackhouse’s implication with a curt rebuttal. She senses a tone of triumph in Alvorson’s final message beyond guilt. Janitor Fred Clark, still present, volunteers that Alvorson had a recent week off in Vermont, implying a likely source for the pills. Stackhouse brusquely dismisses him, and Mrs. Sigsby orders him to remain silent and attend to maintenance tasks, including cleaning camera housings.

With Fred gone, Stackhouse proposes cremation and timing the removal during residents’ lunch to avoid exposure. Mrs. Sigsby agrees and stresses the need to keep the event from the residents. Stackhouse asks if there is a larger problem, noting Mrs. Sigsby’s demeanor, but she turns to Hendricks and Evans and orders them out so she can speak privately with Stackhouse.