Brilliant Dr. Spencer Truman comes to Llanview, Pennsylvania, in 2005; his younger brotherDavid Vickers and ex-wife Dr. Paige Miller are inexplicably furious to have him back in their lives. In some way "wronged" by Spencer in the past, they are determined to find a way to keep him away from those they love and get him out of town. The somewhat sinister Spencer makes it clear he is not going anywhere. Spencer performs an operation on young Jack Manning that saves the boy's life; Spencer befriends Jack's mother Blair Cramer, and the two soon become romantically involved. Blair, however, is still emotionally wrapped up with her ex-husband, Todd Manning. Obsessed with winning Blair's love for himself, Spencer frames Todd for the murder of Margaret Cochran. Throughout Todd's grueling murder trial, Spencer finally makes Blair question Todd's innocence and seduces her. Todd is convicted of murder and sent to death row; he is actually executed and declared dead when Police Detective John McBain appears with the very much alive Margaret. Spencer manages to revive Todd. In addition to faking Margaret's death, Spencer had secretly delivered her son, whose biological father is Todd. Spencer blackmails Paige into helping him and keeping the secret. Spencer had murdered John and Dr. Michael McBain's father, Thomas McBain, 25 years earlier and had managed to convince both David and Paige that they had been complicit. Spencer puts Todd and Margaret's baby up for adoption, and the boy ends up with Michael McBain and his wife Marcie Walsh, who are unaware of his origins. Spencer's true motivation for returning to Llanview is revealed to be a vendetta against Asa Buchanan. David and Spencer's mother Emma Bradley-Truman had been one of Asa's wife Renee Divine's bordello girls, and on her deathbed had told Spencer that Asa is his biological father. Spencer vows destroy Asa's family piece by piece. Eventually, Blair catches on to Spencer's crimes, and after Todd's failed execution becomes determined to redeem herself in Todd's eyes and stop Spencer once and for all. She spies on Spencer, drugging him and recording their conversations in hopes that he will slip up and incriminate himself. Ultimately, Blair and John McBain succeed in getting Spencer jailed; he confronts Asa about his paternity, but the results of a DNA test showed that he is not Asa's son. Spencer seems to suffer a psychological breakdown. He makes an insanity plea, fooling court-appointed psychiatristMarty Saybrooke into believing he is unfit to stand trial. A vengeful Todd abducts Spencer, determined to torture him to death, but ends up sending Spencer and Blair off a building rooftop by accident. While recuperating in the hospital in early 2007, Spencer descends deeper and deeper into his own private obsession, obsessing over Blair. One night he sneaks into Blair's nearby hospital room, drugging her and preparing to marry her, but is murdered during the attempt on January 26, 2007. The killer is ultimately revealed to be Lindsay Rappaport, who had killed Spencer to protect Marcie McBain, whom she loved like a daughter, from losing her adopted son Tommy should the truth come out that he is actually Todd's son. After Spencer's death, Miles Laurence — younger brother of villain Mitch Laurence — comes to town in February 2007. Miles had been a longtime patient of Spencer's, whose surgical genius had fixed Miles' grotesquely deformed facial features. The sheltered Miles, having lived his entire life in hospitals and institutions, believed Spencer to be his only friend. He listened to Spencer's posthumous messages and followed Spencer's instructions to take revenge on all of Spencer's enemies themselves. Miles has Todd assaulted and abducted, and he keeps the secret of Tommy McBain's paternity. After Miles' scheme to force Marty to become his wife falls apart, a remorseful Miles realizes the extent of Spencer's misdeeds and gives up Spencer's final secret, revealing to Blair that Tommy is Todd and Margaret's missing son.
