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The title is a direct reference to plot elements. ''[http://en.wikipedia.org/wiki/The_Metamorphosis The Metamorphosis]'' is a novel by Frank Franz Kafka about a man whoa wakes one day to find himself transformed into a giant cockroach, and the conflict this causes with his family. In this episode the character [[Jack Montgomery]] goes through a transformation into a [[rugaru]], and Sam and Dean clash over Sam's continued struggle with the [[demon blood]] he was fed by [[Azazel]] and how it has affected him.