Directed by Deran Sarafian
A flu-stricken Buffy, reluctant to stay at home, patrols the cemetery. Xander, Willow and Cordelia surprise her and she nearly stakes Xander. They try to convince her to go home, but the damage that Angelus has done so far continues to fuel her fire. Angelus appears behind her and attacks Cordelia. Buffy and Angelus fight until Angelus pins Buffy down. Willow throws a burlap sack over his head, and he is scared off by crosses that they all carry. Buffy faints and the gang rush her to the hospital. After being stabilized, she is admitted to the hospital for a few days against her will. Her mother reveals that Buffy has always hated hospitals ever since her cousin died in one while Buffy was there with her.
Joyce brings up the topic of Ms. Calendar's death to Giles, and unknowingly brings up a topic Giles would much rather forget. Meanwhile, Xander, Willow and Cordelia wait to protect a very sick Buffy from the harms of Angelus. That night, Buffy has a dream where she sees a small boy standing in her doorway (this is Ryan, whom we see later). He leaves. A strange-looking man, not quite human, follows after him, glancing into Buffy's room as he goes. As she follows the man down the hall, flashbacks of her cousin's time spent in the hospital are brought to mind. She awakes suddenly in the middle of the night and takes a walk down the hall. Two men exit the children's ward with a child that died that night. At the door she overhears a conversation between Dr. Backer and Dr. Wilkinson about the doctors' experimental treatments on the kids. As she begins to leave, she encounters two children that tell her about "Death" and how he comes at night.
That night, Angelus comes to visit Buffy but Xander stands guard. They stand face to face and exchange many harsh words until Angelus finally leaves discouraged by the fact that he may not make it to Buffy's room with all the security. The next morning Buffy's friends visit bearing gifts to cheer her up — all but Cordelia, that is. They all take a walk and Buffy tells them all about the conversation she overheard. The doctor was trying experimental treatments on the kids in the children's ward that Dr. Wilkinson didn't exactly agree with. Since forced to stay at the hospital she plans to find out what the doctor is up to and Xander volunteers everyone's help. Cordelia and Xander sneak into the hospital's record room and search for records on the girl that died that night. Meanwhile, Giles and Willow search for information at the school library. While looking through the records, Cordelia is caught by the security guard. She flirts with him until Xander can escape with the records, then leaves herself. Xander expresses his feelings towards her flirting with him and Cordelia expresses her anger about Xander's behavior around Buffy. Jealously she leaves to take the records to Giles and Xander "watches her back" as she goes.
Buffy takes a walk and finds the little boy. He is drawing a picture of the man she saw in her dream. Willow digs up information on Dr. Backer at the library with Giles. She finds that he has a large past of experimental treatments and investigations into his practices. Meanwhile, Dr. Backer is working on trying to cure the children's illnesses. After finding a solution that he thinks will work, he takes it to the children's ward to try it out. Before he can do anything, the evil creature attacks him and slashes him up. Buffy tries to stop him but is thrown aside unable to see the creature as its invisible.
The next morning Buffy informs everyone that Dr. Backer is not the suspect and shows them the drawing that Ryan drew of the creature. Xander, Giles and Cordelia leave her alone and come up with a plan. Giles and Cordelia head back to the library while Xander stands guard against the threat of Angelus. At the library, Cordelia annoys Giles with constant questions. Finally, she finds a picture of the monster on the cover of a book and they research it. After searching they find that it is called Der Kindestod. After Cordelia squeamishly describes what is going on Giles takes over and then tells Buffy about how it sucks the life out of a child. Buffy flashes back to her time at the hospital as a child again. She sees her cousin freaking out while she helplessly watches. Buffy goes silent over the phone and then after several minutes, Willow takes it from her and hangs up. Buffy then realizes that Der Kindestod was the killer of her cousin.
The two head to Dr. Backer's office in search of answers. They find out that Dr. Backer was giving the children injections of the disease they already have in order to inoculate them against it. Buffy realizes that only sick people can see the demon, so decides to infect her self with the vials of disease the doctor was using on the children. Willow stops her, warning her that the vials are 100% pure and would kill Buffy instantly if she drinks them. Willow then dilutes the disease in some water so Buffy can drink it "safely". Buffy's fever rushes to a near 107 degrees as she stumbles to the children's ward. She finds all the children are gone. They have headed down to the basement in hopes of escaping from the Kindestod. After a few moments, Buffy sees the Kindestod in the room and watches as he heads down to the basement. The door is locked so Buffy and Willow rush to find access to the basement. Dr. Wilkinson tries to stop them, but Buffy shoves her aside. When security guards stop the two, Willow takes on the blame as Buffy makes her escape.
Buffy works her way to Xander, and he helps her down to the basement. The children wait quietly in hopes of not being found, but then the Kindestod picks up Ryan. He screams, along with all the other children. Buffy arrives just in time and fights off the Kindestod. Just as he is about to kill her, she snaps his neck, and then leaves while leaning on Xander. Buffy finishes her rehabilitation at home with her friends. Her mother reluctantly waits on them all. Joyce then hands Buffy a letter from Ryan, which is revealed to be a drawing of her hailing over a dead Kindestod.
- Artistic Licence Medicine: Buffy reinfects herself with the same flu strain she already had, in order to get a fever that allows her to see the demon. After her immune system got rid of her flu infection earlier, she would be forever immune against that particular strain, and it would take at least a day to kick in anyway. This plot point would have made a lot more sense if Willow had figured out which drug from the hospital pharmacy to use to artificially raise Buffy's temperature.
- Also, the doctor's strategy of curing the kids by increasing their viral load and so making their fever spike is complete nonsense. Raising the body's temperature higher and higher in a futile effort to "kill" the virus is exactly why and how some rare strains of the flu (such as the famously deadly Spanish flu) kill especially young people with active immune systems — it's their own fever reaction that kills them, not harm done directly by the virus.note (The fever defense strategy of the human body only really works against organisms that really are alive and have a metabolism to disrupt through the heat, like bacteria.) Short of actual antiviral medication, the most sensible way to treat a viral infection like the flu is to keep the body's fever defense mechanism in check, so that the body doesn't cook its own cells, and to try and ward off additional bacterial infections, thus giving the immune system enough time to produce antibodies specifically designed to bond and catch the virus particles. It really is mostly just a matter of waiting it out.
- Bald of Evil: Der Kindestod, of course.
- Beneficial Disease: Buffy's flu makes her sick, but also allows her to see Der Kindestod.
- Big Damn Heroes:
- When Angelus has the better of a weakened Slayer, the Scoobies all pile in to drive him off.
- Ryan is about to have his energy sucked out when Buffy hits the demon on the back of the head.
- Blatant Lies: Buffy has never tried Playing Doctor.Cordelia: (looking skeptical) Ahem.
- Bread, Eggs, Breaded Eggs: A collaborative example when Xander, Willow, and Cordy take an unconscious Buffy into the Hospital Emergency room:Intern: What happened?Willow: The flu.Xander: She fell.Cordy: She fainted.Xander: The flu, fainted and fell. She's sick, make it better!
- Oddly enough, none of those were lies. Buffy did have the flu, which caused her to faint and fall down. It just sounded like a lie.
- Breather Episode: Only in BtVS could an episode about a hideous anti-semitic stereotype stalking and murdering children be a break between more horrific nightmares, but it follows the murder of fan-favorite Jenny Calendar and precedes the season finale.
- Brutal HonestyCordelia: So this isn't about you being afraid of hospitals 'cause your friend died and you wanna conjure up a monster that you can fight so you can save everybody and not feel so helpless?Giles: Cordelia, have you actually ever heard of tact?Cordelia: Tact is just not saying true stuff. I'll pass.
- Buffy Speak: Xander says a child dying of the flu "doesn't exactly sound monsterrific".Buffy: "I feel all oogy."Xander: "Increased ooginess. That's a danger signal."
- Busman's Holiday: Buffy can't even take time off to recover from an illness without running into demons.
- Captain Obvious: A delirious Buffy tries to get off the gurney, while the nurses restrain her.Buffy: No! No! Let me go!
Cordelia: I think she wants to go.
- Call-Back: To Willow's "frog fear" in What's My Line, Part 2.
- The Cape: Buffy playing as a child. Power Girl to the rescue! Buffy the Potential Slayer has a subconscious urge to play the superhero.
- Cassandra Truth: The Scoobies are quietly (with the exception of Cordelia) skeptical that Buffy did see something in the hospital, wondering if she is using this as a coping mechanism for her cousin dying.
- Chess with Death: Lampshaded by Xander.Ooo, if he asks you to play chess, don't even do it. The guy's, like, a whiz.
- Child Eater / Names to Run Away from Really FastCordelia: It's called Der Kindestod. The name means "child death". This book says he feeds off of children by sucking the life out of them.
- Comically Missing the Point: Giles and Cordelia are researching demons.Cordelia: Eww, what does this do?Giles: It extracts vital organs to replenish its own mutating cells.Cordelia: Wow! What does this one do?Giles: It elongates its mouth to engulf its victim's head with its incisors.Cordelia: Ouch! Wait, what does this one do?Giles: (incredibly irritated) It asks endless questions of those with whom it's supposed to be working so that nothing is getting done!Cordelia: Boy. There's a demon for everything!
- Comfort Food: Buffy is disappointed that no one brought her chocolate in hospital. Then she discovers that Willow did all her homework. "Chocolate means nothing to me!"
- Creepy Basement: The final battle takes place in the service areas under the hospital.
- Don't Explain the Joke: Cordelia snarks that she's seen Xander "watching Buffy's back". He doesn't get it.Cordelia: Oh, right. Your obsession with protecting Buffy. Have I told you how attractive that's not?Xander: Cordelia, someone's gotta watch her back.Cordelia: Yeah, well, I've seen you watch her back.Xander: What is that supposed to mean?Cordelia: Well, I was using the phrase "watch her back" as a euphemism for looking at her butt. You know, sort of a pun.Xander: Oh! Right. [beat] Hey!
- Evil Gloating: Angelus taunting Xander.Angelus: Buffy's White Knight. You still love her. (leans in close) It must just eat you up that I got there first.
- Expy: Der Kindestod is sometimes referred to by fans as Der Krugerstod.
- Eye Scream: Der Kindestod has stalked mouths that come out of its eye sockets for easy access to the victim's peepers.
- Faux Affably Evil: Upon realizing Buffy can see him, Der Kindestod chuckles and tips his hat to her.
- The Xander/Angelus confrontation lays the groundwork for Xander's attempt to ensure Angelus' demise with his lie to Buffy in "Becoming, Part II".
- Joyce thanking Giles for looking after Buffy, and giving her sympathies over the death of Jenny Calender, is Ship Tease for Season 3.
- Illness and death being things Buffy can't fight, and her need to find something with an ass to kick, will come back in a major way in season 5.
- Getting Sick Deliberately: Buffy deliberately infects herself with the flu in order to kill the Monster of the Week, as it is only visible to someone who is running a high fever.
- Gory Discretion Shot: A verbal version. Cordelia is on the phone to Buffy.Giles: I found a picture of how it kills. Let me talk to her.
Cordelia: (takes the book and looks) Oh! Eww!
Cordelia: Oh! Uh, you should see this thing! The way it does its thing...I mean, eww! Why do I let you guys drag me into this stuff? (hands Giles the phone and leaves)
Giles: (into the phone) Uh, uh, Buffy? Are you, are you still there?
Buffy: Hanging on every 'eww'.
- Go Through Me: For once, this works for Xander.Angelus: If I decide to walk into Buffy's room, do you think for one microsecond that you could stop me?
Xander: Maybe not. Maybe that security guard couldn't either. Or those cops... or the orderlies... But I'm kinda curious to find out. You game?
- Gratuitous German: "Der Kindestod". At least it's grammatically correct German for once.
- Healing Factor: Dr. Wilkinson is surprised by how quickly Buffy recovers. This causes problems as she can no longer see the invisible demon.
- Hospital Gurney Scene: Buffy gets strapped to one during her flu episode.
- Ignored Confession: Delirious Buffy babbling to Joyce and the hospital staff that she has to kill the vampires. Given the circumstances the Scoobies are easily able to pass it off as being due to the fever.
- I'll Kill You!: Xander can hardly make this threat to Angelus, but knows Buffy can, stating, "You're gonna die. And I'm gonna be there." He'll make two separate attempts to ensure this, in "Becoming" and "Revelations".
- Improvised Weapon: Willow throws Xander's jacket over Angelus's head, whereupon Xander grabs the blinded vampire and delivers some Percussive Therapy of his own.
- Innocent Innuendo: Willow mentions that she and Xander used to play doctor. She would get out medical books and diagnose him with things. Xander didn't have the heart to tell her she was doing it wrong.
- Innocuously Important Episode: Buffy is sick and ends up in hospital — a place she hates since her cousin died in a hospital when they were children. While the Monster of the Week in the episode (which was also responsible for her cousin's death) is dealt with, Sunnydale General ends up playing a big role in Season Five — not only does Buffy's mother Joyce end up with a brain tumor and spends a few episodes there, but we're also, at the same time, introduced to the character Ben Wilkinson, a young medical intern who serves as a possible Love Interest to Buffy and who turns out to be the mortal, human shell of Glory, the Big Bad of Season Five — Glory's plans, in turn, result in Buffy's death in the Season Five finale.
- Invisible Monsters/By the Eyes of the Blind: The demon can only be seen by sick people.
- Invisible to Adults: What Buffy thinks she's up against at first.
- It's Personal:
- After Giles describes its method of killing, Buffy realises the Monster of the Week is what killed her cousin.
- When the Scoobies are fighting Angelus, Xander is the one whaling on him the most. Not just over their long-standing Buffy rivalry, but because Angelus had made a direct attempt to kill Cordelia moments before.
- Long-Lost Uncle Aesop: Buffy exhibits a phobic reaction to being in the hospital, and we learn that it's because of her cousin Celia's death when they were kids. They were close, and Buffy was traumatized as a result of watching her die. While some of this trauma is legitimately resolved in the episode, the lack of mention of Celia before or after makes the whole thing seem to come out of nowhere. It is particularly jarring because Buffy spends a great deal of time visiting the hospital in Season Five, and shows no phobia beyond an appropriate reaction to the immediate circumstances. Then again understanding (and killing) the cause of her trauma would've allowed Buffy to get over it.
- Monster of the Week: Der Kindestod
- Mundangerous: Buffy laid low by a virus — for the first and only time in the whole show. Joyce mentions that Buffy's never sick, and it's implied that the stress of dealing with Angelus has weakened her supernormally stellar immune system.
- Must Be Invited: Angel can walk into the hospital as it's a public building.
- My Life Flashed Before My Eyes: Xander after Buffy nearly stakes him.Man, Buffy! My whole life just flashed before my eyes! [Beat] I gotta get me a life!
- Neck Snap: Yep, violence does work.Xander: He's dead, right? I heard something snap.Buffy: That would be his neck.
- Nightmare Fuel Coloring Book: Ryan draws a creepy picture of Der Kindestod. He thanks Buffy for killing the demon by drawing a not-much-less creepy picture of Buffy in the act.
- Non-AnswerXander: You don't know how to kill this thing.
Buffy: I thought I might try violence.
Xander: Solid call.
- Non-Indicative Name: "Killed By Death" sounds like it would be a parody episode — but it's played dead seriously. The title comes from a song title — and also how the children describe the Monster of the Week as Death.
- Not So Invincible After All: The Slayer is brought down by the flu. The cause is implied to be partially psychosomatic, due to Buffy's guilt and stress over everything Angelus has done.
- Oblivious Guilt Slinging: The Scoobies are discussing the Monster of the Week when Joyce walks in to visit her daughter. Everyone quickly shuts up, causing Joyce to quip that she's interrupted a secret meeting. Cue unconvincing laughs.
- Pietà Plagiarism: Xander carrying Buffy into the hospital.
- Percussive Therapy: For both parties.Angelus: Not feeling well, lover?Buffy: (knocking him down) That helps.Angelus: You know, you being off your game's kinda takin' the fun out of all this. (punches Buffy in the face) Nope, still fun.
- Safety in Muggles: Angelus decides not to risk taking on the entire hospital staff.
- Security Cling: After defeating Der Kinderstod, a still-sick Buffy collapses on Xander, who helps her out of the basement."You're not going to yurk on me, are you?"
- Shadow Discretion Shot: Dr Barker's death.
- Shaking the Rump: Cordelia is jealous of the way Xander is obsessed with Buffy. Xander says he's just watching Buffy's back, which Cordelia turns round on him by claiming Xander is always checking out Buffy's butt. When Xander denies this, she says, "Fine, watch my back" and walks off. Xander obediently checks out her behind.
- The design of Der Kinderstod. As said in one of the DVD extras, "There's sort of a Freddy Krueger in there, there's sort of a Nosferatu..."
- The murky visual treatment of some scenes is very similar to Riget.
- Xander warns Buffy to not play chess with Death.
- Young!Buffy apparently was a fan of Power Girl.
- Show Some Leg: Cordelia is caught in the record office by a security guard. A Description Cut later and he's preening under her charms while Xander sneaks out with the required files. Xander is not happy afterwards.
- Sick Episode: Buffy passes out while fighting due to a flu, and she goes to the hospital, where she fights a monster that preys on sick children.
- Sinister Silhouettes: Der Kinderstod in the basement.
- Slasher Smile: Der Kindestod, who eats up kids' life force by pinning them down, extending horrible little pipes from his eyes and sucking the energy out of their foreheads, while they screamed helplessly under him.
- Staring Down Cthulhu: Xander stares down Angelus and dares him to try something. Angelus backs down.
- Stealth Insult:Cordelia: Nobody told me I was supposed to bring a gift. I was out of the loop on gifts.
Giles: It's tradition among... people.
- Stereo Fibbing: Played With. Xander, Willow, and Cordy take an unconscious Buffy into the Hospital Emergency room (oddly, none of these are lies, just not the whole story).Intern: What happened?Willow: The flu.Xander: She fell.Cordy: She fainted.Xander: The flu, fainted and fell. She's sick, make it better!
- Suspect Existence Failure: The Scoobies become convinced that the villain killing the sick children in the hospital is the creepy (and, it turns out, criminally negligent to the point of malpractice lawsuits) Doctor Backer... until Backer himself is killed by the invisible demon that is actually killing the children.
- Tempting Fate: Ryan and the other children have fled to the basement.Ryan: We're gonna be safe in here. (Kinderstod grabs him from behind)
- They Really Do Love Each Other: A subtle version where Cordelia stalks off after arguing with Xander, then returns with coffee and donuts.
- This Is the Part Where...:Xander: So, is this the part where we say, what can we do to help?(Answer Cut to Xander and Cordelia breaking into the hospital records room)Cordelia: (whispers) You had to ask that, didn't you?
- Also Angelus pinning Buffy and saying, "Uh-oh. This does not look good for our heroine."
- Time-Shifted Actor: Mimi Paley plays Buffy as a child.
- Titled After the Song: "Killed by Death", by Motörhead.
- Took a Level in Badass: Xander stands up to Angelus. Angelus. After trading snarks Angelus, despite his confidence he could get to Buffy, walks away at the threat to kill him. Xander's balls dropped about a foot here, and tripled in size.
- Troubled Backstory Flashback: Buffy remembers playing superhero games with her cousin, then later witnessing her horrible death in hospital.
- Verbal Backspace: Giles grudgingly accepts Cordelia's assistance with his research.Giles: Why do I have to have...good thinking. I could do with a research...assistant.Cordelia: Let's go, Tact Guy.
- We Need a Distraction: Willow acts hysterical to make it appear she's the violent patient the security guards have been told to intercept, giving Buffy a chance to get away.
- Walk-In Chime-InBuffy: I'm still the Slayer. And as long as I am, Angel's not gonna kill anybody else.
Angelus: (behind her) Aw, c'mon. Just one more. (charges at Cordelia)
- We Will Meet Again: After being driven off by cross-wielding Scoobies, Angelus snarls that they'll have to do this again sometime.
- With Friends Like These...: At the end of the episode, Buffy, Xander and Willow are lying in Buffy's bed, making Joyce fetch them sandwiches and chips.