Rose's vengeful spirit kills two men, Steve and Dave, before going after Johnny. Sam is able to save Johnny from her attack, and Johnny admits that he and some of his workmates bullied Rose by leading her to believe she had a secret admirer at the factory. When she arrived at an apartment for a supposed date, they revealed the prank, and, as she went to leave, Steve grabbed her and she fell, hitting her head on a coffee table and dying. Sam finds out where they buried the body and heads off to salt and burn Rose's corpse. He calls Johnny, telling him the haunting is over, but he is mistaken. That night Johnny returns to his apartment and explains to his Real Doll that he is going to leave town, but she becomes animated by Rose's ghost and kills him.
At a loss, Sam speaks to Rose's sister, Isabel, and she reveals that she had one of Rose's kidneys transplanted into her when she was 16. As a result, Rose's spirit can move around, able to go wherever Isabel does. As Sam and Dean try to figure out a way to put Rose's spirit to rest, Rose possesses the Impala and tries to run Dean over. He manages to maneuver it into a wall, but Isabel is fatally injured in the resulting crash. As she dies, the spirit of Rose appears and apologizes before disappearing in flames.