“Sanguinarium” is episode six of season four of The X-Files.
The episode opens at the Aesthetic Surgery Unit at Greenwood Memorial Hospital in Chicago. A woman is waiting for some liposuction and the nurse goes and checks on Dr Lloyd, who will be carrying out the procedure. He’s currently scrubbing up for another patient, and scrubbing so hard he’s making his hands bleed. Lloyd starts performing liposuction on a man, but he’s ramming the suction device so hard the fat being removed quickly turns to blood. The nurse, Waite, goes to see why Lloyd is late and sees what’s happening on the monitor. She goes into the OR and there’s blood everywhere. Lloyds says he thinks the patient is finished.
Lloyd is talking to Mulder and Scully in the presence of his counsel. He says he was in his body and out of it at the same time; he couldn’t control his actions or stop what he was doing. Lloyd thinks he may have been possessed. Mulder tells him that doesn’t hold up well in court. Lloyd is on sleeping tablets and antacids. Scully wants to check the dosage. Lloyd wants to know why he did what he did. When Scully asks Lloyd how much sleep he had the night before, Lloyd’s counsel shakes his head and the doctor says he can’t recall.
At the hospital, Scully tells Mulder the sleeping pill is effective but controversial and addictive, which could affect long-term behaviour. Lloyd was taking it in quantities that Scully thinks indicate addiction. Mulder points out that Lloyd has performed hundreds if not more of these procedures without one fatality. Scully says that plastic surgery is a veritable factory, a booming industry where ASU wards can support an entire hospital. In the OR, Mulder finds five marks on the floor. Burn marks, that he draws together to make a pentagram.
Scully thinks Lloyd was pushing his limits. Mulder thinks it was black magic. They speak to the nurse who spoke to Lloyd, Rebecca Waite. She can’t explain what happened. She prepped the patient. On Lloyd claiming possession, Waite says it’s cheaper than malpractice insurance. Another doctor, Shannon, tells the nurse she wants something doing and that she doesn’t have time to speak to Mulder and Scully.
The doctors who seem to be running the ASU war, which includes Shannon, are discussing the matter and that the FBI is talking to the nurse. One, Dr Franklin, says Waite can’t say anything because she doesn’t know anything. Waite is currently attending a woman waiting for a skin peel. She’s removing leeches from the woman’s stomach that were placed at the points of a pentagram. Scully thinks the only magic is being done with silicone, collagen and a well-placed scalpel.
Mulder and Scully are watching a tape of the operation. Mulder points out the burn marks were there before the operation. Scully says Lloyd stabbed a man to death in his sleep. Mulder says pentagrams are normally used for protection. He wants to know what’s in Lloyd’s antacid. One of the ingredients is belladonna, which Mulder calls the witch’s berry. Scully asks Mulder if he knows how many drugs in the book have belladonna in them. Yes; one. That one.
Dr Shannon is getting ready for her skin peel and Dr Ilaqua is scrubbing up. Shannon is talking to Waite when she notices Ilaqua in the OR with her patient. He’s burned a hole in her face with the laser peel and the door is locked, so no-one manages to stop him before the laser burns a hole right through the patient’s skull. Waite bolts.
Ilaqua, when asked, doesn’t remember anything. He realises what he’s done now. Scully takes a bottle of pills from his pocket and goes to see Mulder. Mulder is watching the recording and points out the pentagram on the dead woman’s stomach. Scully shows him the drugs; they’re the same as Lloyd’s.
Mulder and Scully barge into a meeting of the doctors and one, Franklin, says that 10 years ago there were several deaths at the ASU. All ruled accidental. A nurse, Rebecca Waite, was on the ASU at that time. Six weeks ago, she transferred back. She’s the only person to have had contact with both doctors and patients and she left and hasn’t returned.
Waite is at home performing some sort of ritual, but she’s gone by the time Mulder and Scully arrive. Mulder suggests a broomstick is probable cause. There’s also a pentagram on the door. They find the remains of the ritual. It looks like Waite may be involved, but Mulder did say that pentagrams are normally used for protection. Is she trying, and failing, to protect the patients?
There are pentagrams all over the place, many not immediately obvious, and Mulder spends quite a bit of time staring at himself in mirrors. It seems he’s wondering if he needs plastic surgery.