Dr. Kroger leaves for a psychology convention in Germany, leaving Monk even worse off than usual. He and Natalie catch a flight to follow Dr. Kroger, and while there, Monk comes to suspect that a set of local homicides are murder — possibly tied to a six-fingered man like the one who killed Trudy.
This episode includes examples of the following tropes:
- Autocannibalism: Monk's upstairs neighbor, a former climber, once got stuck on a mountain and cut off and eat one of his own legs to survive. Naturally, Monk finds this anecdote horrifying rather than inspiring and develops an obsession with having a "cannibal" living upstairs.
- Beware the Nice Ones: Despite her usual friendliness, Natalie's reaction to Dr. Kroger's apparent betrayal of Monk is to break his nose and try to attack him.
- Bilingual Bonus: Lohr's Stottlemeyer and Disher equivalents are named Hauptkriminalkommisar Stoffmacher and Kommissar Geshir, names clearly picked for sounding phonetically similar. Stoffmacher's name goes a few steps further: the proper English translation of Hauptkriminalkommisar is "Main forensics commissioner". Stoffmacher translates as German for material maker or fabric maker. As for Kommissar Geshir, his name translates to "plates", "dishes" or "cookware".
- Blackmail: Natalie talks Monk into stopping off at Paris for a few days by showing him a picture of himself in an absolutely filthy state (taken when he was on Dioxinyl) and threatening to send it to Stottlemeyer, Disher, and Julie.
- A Day in the Limelight: This is the second case of Monk material to give Dr. Kroger the limelight, the first one having been season 5's "Mr. Monk Gets a New Shrink".
- Disproportionate Retribution: Monk orders a whole police investigation into a missing sock.
- Heroic BSoD:
- Monk becomes absolutely worthless at his job when Dr. Kroger leaves, once causing an investigation to grind to a halt because he's lost track of how many times he blinked.
- When he thinks that Dr. Kroger is involved with the people responsible for Trudy's death, he runs from the scene. When Natalie finds him, he's questioning everything in his life.
- Let Me at Him!: Natalie lunges at Dr. Kroger and throttles him, thinking he's in a conspiracy with Trudy's killer, and has to be held back by the onlookers.
- Pillow Silencer: The killer of the week turns out to have fired a shot through a pillow. Ironically, he didn't mean to kill the victim, only scare him, but the victim was so scared he died of a heart attack.
- Right for the Wrong Reasons: The six-fingered man, Dr. Martin Rahner, turns out to have not killed Trudy. However, he is guilty of accidentally killing a journalist who was investigating a Ponzi scheme he was running by scaring him into having a fatal heart attack during an intimidation attempt, and the neighbor he accidentally killed by said gunshot.
- Shout-Out: The book opens with Natalie in a detective-sidekick support group that meets for coffee. Natalie mentions that they even have guests in their sessions, including one person who works for a gifted detective who solves crimes by pretending to be a psychic.
- Shown Their Work: A lot of research was done on Lohr, Germany, the main setting, for information on the hotel that the psychiatric conference is held at, and also nods to "Snow White".
- What the Hell, Hero?: Dr. Kroger makes very clear to Natalie how unpleased he is with her for enabling Monk to stalk him to Germany.
