Claire races to discover the source of an epidemic aboard a disease-stricken ship before hundreds of sailors die. And as Jamie locks horns with Captain Raines, Fergus finds himself torn between loyalty and love.
Heaven & Earth opens onboard the Artemis as Jamie wait for Claire’s returned only to be shocked when the Porpoise’s sails unfurl and they sail away. Jamie attempt to get kick the crew into high gear to go after the Porpoise by Captain Raines prevents him. Raines explains the Porpoise needs a surgeon and they promised to find accommodations for Claire when they arrive in Jamaica ahead of the Artemis. Jamie is not okay with this arrangement and wants to take over the ship but Raines has him locked up below decks.
On the Porpoise, Claire comes up against opposition as many of the crew have never heard of a lady doctor. However, Captain Leonard gave her an assistant in Mr. Pound who informs all crew the Captain’s orders are to obey Mistress Fraser. Claire turns all the men’s grog into distilled alcohol making everyone aboard use the alcohol to clean their hands when carrying for the sick. As Pound helps Claire tend the sick he finds his friend Jim has succumb to typhoid.
Despite best efforts the disease continues to claim the lives of the Porpoise crew. Claire seeks out the Captain for information as to who came down with the sickness first. Claire realizes only one of the men from the original group who’d been infected survived without ever showing symptoms and he’s now working in the galley.
Claire and the Captain go to the galley where Claire insists the man is quarantined and makes an enemy of the cook who looks out our Typhoid Mary and sees a healthy man. Captain Leonard doesn’t understand how a man cannot show the illness and yet give it to people but he trusts Claire and quarantines the man in the brig.
Back on the Artemis, Jamie is seasick as being locked in the brig means Willoughby (Yi Tien Cho) cannot give him acupuncture treatments. Fergus is the only person allowed to visit Jamie and Jamie tries to convince Fergus to steal the keys to his cell so they can take the ship. Fergus is reluctant to help with such a crazy scheme but in Jamie’s desperation not to lose his only remaining connection to the life he always believed he’d live; he bribes Fergus with marriage to Marsali. Fergus questions the plan and Jamie tells Fergus he doesn’t know what loves is. Love is moving heaven and earth, risking everything to rescue the woman you love.
On the Porpoise, Claire looks on as Jim is sewn into his hammock. Elias Pound finishes stitching Jim into his hammock by putting the final stitch through the dead man’s nose to ensure death which is said to usually be done by a friend.
Later, the crew of the Porpoise gather on the deck as the send the bodies of the dead into the ocean for burial. The cooks sneers at Claire but Elias sends him back to his work before wondering if there is a secret to remaining calm in the face of so much death. Claire explains that she compartmentalizes things but it is easier as Jim wasn’t a friend of hers. She goes on to tell him with luck they’ll get through this remaining voyage. Elias gives her his lucky rabbit’s foot which his mother gave him when he went to sea.
Claire continues to nurse the sick but is called away when Mistress Johansen’s (who tends the ship’s goat which are keeping the men alive) husband, falls ill. Claire goes to tend him but discovers the man isn’t sick with typhoid by with alcohol poisoning as he drank some of the distilled liquid. Claire goes to leave when she encounters a Portuguese flag. Instead of returning to her work, Claire seeks out the Captain and asks about the name of the Portuguese ship. However, the Captain is not in his office but undeterred, Claire searches his log book and discovers the ship wasn’t the Bruja. However, she also notices Jamie’s name in the book. Claire reads the passage and discovers a Mr. Harry Tompkins recognized Jamie and told Captain Leonard he is a seditionist. The logs indicate that Jamie will be arrested upon arrival in Jamaica and will hang for his crimes.
Claire is interrupted by the cook who is there to retrieve the Captain’s pipe but has a few words for her. Claire isn’t happy to see the man who menacingly approaches her. To quickly extricate herself from him she threatens to tell the Captain he attempted to violate her which takes the man aback. She threatens to scream if he will not let her pass and the cook steps aside.
Fergus goes to Marsali and tells him of Jamie’s harebrained scheme clearly wanting assurances that it would work. Marsali is not impressed by Jamie’s plot either but Fergus is determined to win Jamie’s approval.
Claire asks Elias Pound if he knows who Tompkins is but Elias tells her he doesn’t know everyone aboard. Claire lies to Elias telling him the man may also be a carrier for the disease.
Fergus sneaks to the Captain’s quarters but overhears the captain and some crew speaking of putting him in the brig and having their way with Marsali. Knowing he can’t risk being imprisoned Fergus abandons they plan to steal the keys.
Elias took the threat of another disease carrier seriously and brings a man to Claire who has everyone leave him alone with her. Claire realizes it is the exciseman who attacked Young Ian in the print shop and considers way to make him talk. Eventually, Claire grabs a sharp surgical tool as if to threaten the man and tells him, “Now, you’re going to tell me exactly what you know about my husband.”
Tompkins doesn’t seem phased and instead hopes she’ll kill him as he’s been disfigured from the print shop fight and then was pressed into serving on a disease riddled ship. However, he does tell her about the warrant out on Jamie for treason and murder because they did find the other exciseman in the cask of Crème de Menthe.
Claire doesn’t know what to do about Tompkins but has him locked up in the brig in another cell telling the Master-at-arms that he is another source of the fever. She then warns Tompkins not to get too close to Howard as he actually is the source of the fever.
Claire realizes there is no way for her to warn Jamie and goes to Annekje Johansen for a friendly ear and to check on Annekje’s husband. Annekje thanks Claire with some goat cheese and has an idea about helping Claire. Her goats need grass which doesn’t make any sense to Claire.
Fergus goes to Jamie and tells him he did not steal the keys and that he can’t risk leaving Marsali. Fergus informs Jamie he does understand love and loves too much because he won’t risk leaving Marsali alone and he will not risk sending Jamie to his death for mutiny. Fergus informs Jamie he would do anything to save Marsali even if it means he can never have her.
Claire is feeding the sick when Jones asks if it is a pleasant sound. Claire realizes it is silent as the sick mean are improving and there are no death groans and moans. She realizes they are over the worst of the illness and she pulls out the rabbit’s foot wanting to tell Elias it worked.
Claire goes above deck to find Elias who she sent to rest but when she finds him he is ill and calls out for his mother. Claire comes to him and lets him believe she is his mother telling him it is time to come home. Elias dies and later we see his body being sewn into his hammock. Claire put his rabbit’s foot in his hand before making the last stitch through his nose.
Claire tells Captain Leonard she missed the signs in Elias but he assures her that all her efforts have been heroic says they only had the one death and no new cases which wasn’t the case the day before.
Season Jones comes by to tell Claire they have come to land which is Grand Turk where they will stop for water.
Annekje appears to remind Claire her goats needed grass and Claire realizes their stop could be her attempt to escape.
The next day, Claire assists Annekje on the beach of Grand Turn with her goats before Annekje encourages her to run to the other side of the island where the town is. Claire sets off but is intercepted by Captain Leonard who tells her he can’t let her warn her husband.
Back on the Artemis, Jamie is in his cell looking at picture of Brianna and Claire and the small portrait of Willie when Captain Raines comes in with Marsali. Marsali has told Raines that if he can get Jamie to give his word he won’t stir up trouble Jamie will keep it. Raines needs the man power so is willing to gain Jamie’s word.
Marsali asks Jamie if he can’t see what Fergus has done for him but Jamie believes Fergus’s actions were for her. Marsali tells him if that is what he believes he doesn’t deserve his freedom.
Jamie comes on deck (we must assume he gave his word) and gives Marsali and Fergus his blessing as long as they are married by a priest after they find Claire and Ian.
On the Porpoise, Claire meets Annekje at the gunwale. Annekje tells Claire to jump and swim to the island town they are now leaving but Claire is reluctant as she thinks she’ll drown. Annekje produces two empty casks that have been tied together. Claire is stunned but Annekje assures her the water will move her and hands her a bag of coins. Claire thanks her and strips down to her undergarments and jumps in after the makeshift raft.
