Dexter's world has become a cage. Sergeant James Doakes, convinced that "something is wrong" with Dexter, has become his shadow, following him 24/7. This constant surveillance forces Dexter into a performance of ultimate normalcy: he even joins a bowling team with Angel Batista just to maintain his "suburban stepdad" facade.

Still reeling from her near-death experience with the Ice Truck Killer, Debra returns to work far too soon. Her trauma manifests as hyper-vigilance and a hair-trigger temper, evidenced when she punches a man in a bar for merely touching her shoulder.

Caught in a psychological tug-of-war, Rita is pressured by her imprisoned ex-husband, Paul, who insists Dexter framed him. Rita chooses to believe Dexter, but her world is shattered when Paul is killed in a prison fight shortly after she ignores his pleas for help.

A massive gang leader and Dexter’s next intended target, Chino proves to be a formidable physical threat, escaping Dexter's table when the ritual fails. "It's Alive": The Heartbeat Returns

While Dexter struggles with his "impotence," the women in his life are facing their own demons:

The episode title, " It's Alive! ", refers to both Dexter’s resurfacing humanity and the literal discovery of his victims. Flashbacks show a young Dexter standing on a rooftop, not because he was suicidal, but because he wanted to feel his own heart beat—to feel "alive".