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Dr. Spaulding was a man who worked 18 hours a day helping the poor and downtrodden
in a Hub City Hospital. He gained a reputation over the years as a saint who cared about the people he helped. The pain and suffering he saw on a daily basis created a deep psychosis and decided it was time for justice to be dealt for those that had caused this suffering.
He took the name Mikado from Gilbert and Sullivan's comedic operetta The Mikado His mask was of Japanese design, and like the character the Lord High Executioner he began to deal out swift justice to those that caused pain. He exacted revenge in the forms of torturing people in the ways they had inflicted pain on others. For example he cut all of the fat off of a man who was starving his children.
After questioning some of the victims, Sage finds that they were all treated at Central Medical and deduces out there must be a connection with that place. He narrows it down to Dr. Spaulding as he was the only one there with the motive and skill to carry out the killings.
Sage confronts Mikado as The Question and is subdued with a tranquilizer dart. He then confronts Mikado with the fact that he is not innocent and has wronged people in the past but he has changed and is trying to help people now. When he asks if he deserves to die the Mikado realizes he almost killed a good person and plunges a needle into his back with the poison that was meant for Sage. Sage leaves the room and when he comes back Mikado's body is gone. He has not been seen since.