It's a lonely voice, but also accusing. He knows about her affair of the heart with the holohunk. Janeway opens the door concealing the voice, only to discover the psychotic knife-wielding face of the holomarm. Imaginary or no, that knife is sharp. A struggle ensues, and Janeway calls Security.
Security is already there.
Tuvok asks Kes if she can see what Janeway sees, and Kes confirms that Janeway's not just wrestling herself. As Janeway comes to her senses, Kes reports that the knife fighter has jumped into Janeway as the little girl did. Jim Kirk might be able to captain a ship when he's bonkers, but Janeway decides she better not. She relinquishes command to Chakotay and he tries to assure her that the crew is up to whatever challenges may be facing them. She checks herself out and heads for the bridge.