Twelve years ago, Adrian and Trudy Monk are celebrating Christmas and come back from caroling. He thanks her for getting him out of the house. Monk is preparing to go to the midlife clinic where a missing woman, Wendy Stroud, worked. He notices that Trudy is upset and she admits she has a lot on her mind. As he goes, Monk notices a new present under the tree and suspects that it’s a digital watch. Trudy tells him not to open it until they’re together on Christmas. They share a last hug before Monk leaves.
Later, Trudy goes to her car in the parking garage. A man with six fingers on one hand chases after her and she runs to her car. The man disappears and Trudy starts her car… and it explodes.
Monk and Stottlemeyer are talking to Wendy’s boss, Dr. Malcolm Nash, who can’t help them. Stottlemeyer gets the call about Trudy’s death and has to break the news to his friend.
Now, Monk dreams that Trudy is sitting on his bed. She tells him that he can lay on the entire bed, but Monk insists that he can’t sleep on her side and that she’s still there as far as he concerned. When Trudy tells him that it’s time to say goodbye, Monk says that he can’t, but Trudy says it won’t be much longer. Monk reaches for her hand and wakes up.
The next morning, Monk and Natalie are called in to investigate a murder. Dr. Nash has been found dead at the same mid-life clinic where Monk learned of Trudy’s death 12 years ago. As they walk, Monk tells Natalie about his dream and Natalie thinks that it’s an omen. They arrive at the clinic and Monk examines the scene while Disher talks about his mysterious two-week vacation. Natalie hadn’t noticed she was gone, but spots the New York airline tickets in his pocket. Monk makes two discoveries: none of the medicine was stolen despite the fact Nash was apparently killed by a robber, and the killer accessed the computer and used his left hand.
The MO of the left-handed killer matches up with Joe Kazarinski, and they find his fingerprints on the scene. Stottlemeyer and the others go to see Judge Ethan Rickover to get a warrant to search Kazarinski’s apartment. Rickover is entertaining and informs Stottlemeyer that he has been appointed to the State Supreme Court.
Kazarinski lives with his ex-wife Edie, and Stottlemeyer has his men toss the apartment to intimidate her. Unfortunately, Monk is busy cleaning up after them. Edie claims that Kazarinski comes and goes whenever he wants and she doesn’t know where he is. While she gets a photo, Stottlemeyer wonders where Natalie is and Monk explains he gave her the day off to be with her boyfriend.
Kazarinski is on the streets and receives a call from a mysterious figure, who warns him that he screwed up and the police have connected him to Nash’s murder. The figure informs Kazarinski that Monk is investigating the crime, and tells him to kill Monk. He admits to Kazarinski that 12 years ago, he killed Monk’s wife.
Trudy and her boyfriend, Lt. Steven Albright, are shopping at the grocery store. Natalie has to use two carts: one for her and one for Monk. Kazarinski is following them. When Natalie steps away for a moment, Kazarinski starts to wheel Monk’s cart away. She stops him after a few seconds and he claims he made a mistake, and then leaves.
That night, Natalie and Albright meet for supper at Monk’s and bring Julie along. As they discuss Julie’s college plans, Albright asks Monk about the case. Monk chokes on his artichokes and then starts seeing spots. He goes into convulsions and they take him to the hospital, where the nurse has to call in a dozen staff members to hold down Monk so she can get a blood sample. Dr. Matthew Shuler, a hematologist, determines that Monk has been poisoned with a synthetic toxin, and the prognosis isn’t good.
Shuler sends a hazmat team to check out Monk’s apartment while he checks Natalie and the others. They show no signs of the toxin and they can’t identify the toxin that was given to Monk. If they can’t determine what it is, they can’t prepare an antidote and he’ll die in two or three days. Natalie sees a newspaper article about Kazarinski and realizes he was at the supermarket and briefly had Monk’s cart.
At the police station, Stottlemeyer reviews the case with a team of volunteer officers. He has them split up to investigate Nash and determine his connection to Kazarinski, while the others try to find the killer. Stottlemeyer warns them that they have to capture Kazarinski alive so they can learn what poison he used on Monk. He then talks with Ronnie, who sells fake IDs. When Ronnie refuses to talk, Stottlemeyer beats him with Disher’s laptop computer until the crook gives up Kazarinski, who is leaving town by train. Stottlemeyer sets up surveillance at the train station but they fail to see Kazarinski, who is wearing a blonde wig. When Stottlemeyer and Disher realize the next train doesn’t have an announcement, Disher goes to the control tower and discovers the controller is dead. He inadvertently announces the man’s death over the loudspeaker, sending everyone into a panic. Stottlemeyer spots Kazarinski and chases him out across the railyard, but the killer is struck by a train and killed.
Monk goes to his appointment with Dr. Bell and tells him that they weren’t able to find anything at Kazarinski’s hotel room. All of the food on Natalie’s shopping list has also tested negative. Monk bemoans the fact that he’s wasted the last 12 years of his life as a virtual prisoner, and that despite all the criminals he’s brought to justice, it means nothing if he doesn’t find Trudy’s killer. Bell tries to reassure him but Monk says goodbye and leaves.
Disher gives Stottlemeyer an update on the lab’s lack of progress and the two share a drink in the captain’s office. Stottlemeyer admits that he once thought that Monk wasn’t human, but he’s come to realize that Monk sees and feels so much that he’s all too human.
Monk goes to the cemetery to say a brief goodbye to Trudy, assuring Natalie he’ll be with his wife in a day. They return to Monk’s apartment and he decides to open the present that he’s been waiting 12 years. Inside is a videotape with a message from Trudy. She warns Monk that she had a secret from before they met something terrible…
(to be continued…) Share this article with your friends