The fifth episode of the fifth season of Outlander, “Perpetual Adoration,” sees both Jamie (Sam Heughan) and Claire (Caitriona Balfe) losing patients (patience?).

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The action in this episode is split between 1968 Boston and early 1700s North Carolina. As Claire prepares for and then performs tonsillectomies on Josiah and Keziah (both Paul Gorman) using the Penicillin she has successfully manufactured, her thoughts are cast back to a patient she had in Boston after Frank died, Graham Menzies (Stephen McCole, clearly named in honor of Outlander alum Tobias Menzies).

Graham was a Scot with gallstones and an infection, a Catholic widower who’d lived in the US for 20 years without losing any of his accent. Claire had become attached, reminded by him of someone she’d “lost” in Scotland. Although he tested negative for a Penicillin allergy, when she prescribed it to treat his infection before she operated on his gallbladder, it caused fatal anaphylaxis. 

Graham’s death hit her hard. She knew he’d been sitting an Adoration shift every Friday at his church since his wife’s death, so she went in his time slot to pray and contemplate things. The priest approached her, and in their conversation she drew the connection between Frank’s death, this man’s death and her homesickness for the UK. She immediately requested a leave of absence from work and invited Brianna (Sophie Skelton) to go to London with her for the summer… the trip that would ultimately lead her back to Jamie. 

Fortunately for the twins, their tonsillectomy is successful and neither has an adverse reaction to the Penicillin. Now Claire has a resource that will make her a more effective healer. 

While she’s fighting infection at home, Jamie is reporting to Lieutenant Knox (Michael D. Xavier) in Hillsborough with his militia. When he arrives, Knox surprises him with Tryon’s decision to pardon all of the leaders of the Regulators… except one. Tryon’s intention is to make an example of Murtagh (Duncan Lacroix). Now that Knox is only hunting one man, he dismisses Jamie and his men to go home, handing him a stack of pardons to deliver as he travels. 

In addition to the objective being more manageable, Knox is excited to finally have a hot lead. A copy of the Ardsmuir Prison roster from after Culloden is on its way from Scotland, and Knox is confident that he’ll find names of Murtagh’s co-conspirators on the list. He tells Jamie to leave his militia muster book with him and then to go home with good health. 

That evening, when Jamie visits Knox’s hotel room to deliver the muster, he agrees to stay for a game of chess. The poor lieutenant is convinced that he and Jamie are kindred spirits who would have made good battle buddies if they’d really seen any action. Jamie plays along… until a boy delivers the Ardsmuir list. 

When Knox receives his package, Jamie makes the decision to tell Knox himself that his name will be on the list. Knox is in utter disbelief when he confirms it– and when he discovers that Murtagh Fitzgibbons has the surname Fraser. Jamie confesses that their quarry is his godfather, and a horrified Knox leaps up from the chess table and draws his knife.

He expresses his extreme disappointment at Jamie’s betrayal and treason, understanding that his believed-comrade has been working against him all along. He orders Jamie to be calm as he calls for his arrest, but Jamie isn’t having that. He may have sworn an oath to Tryon, but he swore one to his family first. Knox cannot see things his way, nor choose to admit any grey area in the definition of what makes a “good man,” so Jamie gets him in a headlock and suffocates him. 

To cover his tracks, Jamie burns the Ardsmuir roll, drags Knox into bed and removes his shoes (and closes his bewildered eyes), reclaims his muster book, hides the whiskey glass he’d used and then closes the flue on the fireplace to fill the room with toxic fumes and cover his escape. He leaves through the window, climbing down to a discreet place in the alley behind the inn just as others inside raise the alarm for an apparent fire and attempt to rescue the lifeless Knox. 

Jamie finds Fergus (César Domboy) and a kitten outside the inn and leaves in a hurry with both of them. When he gets home, Claire joyfully accepts the gift of the kitten and shares with Jamie about the patient whose death indirectly led her back to him and how much she appreciates that man. Jamie has some news to share with her, but for now he just kisses his wife while their new cat drinks milk from a saucer.

Meanwhile, Roger (Richard Rankin) stumbles across the black diamond Bonnet gave Bree when she visited him in prison. He’d seen it before when Bonnet was cheating at cards on the ship, and he recognizes it at once. When he confronts her about it, Bree breaks down and finally tells him everything about visiting Bonnet in prison, telling him about Jemmie, Mrs. Bug seeing an Irishman paying attention to Jemmie in town, Bonnet still being alive and Bonnet haunting her because he’s been sighted in Wilmington. 

Roger struggles with Brianna’s choice to hide things from him at first, but after a pep talk from Claire about the difficulty of lying to your child all its life about who its father really is, he chooses to get over it and be there for Bree. 

RELATED: Read all of our Outlander Season 5 recaps HERE!