‘The Patient’ Ending, Explained: How Does Alan And Sam’s Story Come To An End?

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FX’s psychological thriller drama series “The Patient” finally winds itself up this week with a comparatively long episode that keeps the spirit of the show intact, which is not the most positive fate for the characters. It has been clear for quite some time that the focus of “The Patient” is not really on the physical or mortal consequences of the characters but rather on their mental and emotional sides. It was, therefore, always about how certain emotions and unsaid thoughts might be expressed, and the series finale stresses exactly this to bring in a sad but memorable and wholesome end.

Spoilers Ahead


Story So Far

“The Patient” began with Dr. Alan Strauss still mourning the loss of his wife Beth even after a few months. As a practicing psychotherapist, Alan’s days passed listening to and advising his patients about how to live with mental stress and other such worries. It was in this way that he met Sam Fortner for the first time when the young man consulted Alan about his problems with childhood trauma. Throughout the few months that Alan had listened to and advised Sam, the patient kept claiming that he was terribly affected by his father’s regular beating of him when he was a child but would always skip any details. Finally, Alan was done with Sam, as he gave up and asked Sam to discontinue therapy with him since he felt that Sam was not able to open up to him. However, what followed was bizarre and horrific for Alan, as one night, he was abducted from his house and brought to Sam’s cabin in the woods, where the therapist had been kept since then, with a thick chain tied to his foot and the floor. Sam now revealed that he was a serial killer with an obsession to kill, but seriously wanted help with it, for which he had taken Alan hostage. With his limited mobility, Alan tries to help Sam day after day, trying to understand his problems and suggesting methods to curb his desire to kill. But Sam’s addiction keeps growing, as he even kills a young man in front of Alan as well.

On the other hand, Alan spends his hours either fearing what might happen to him or thinking about his family. He has always had a good relationship with his daughter Shoshana, but his son Ezra had grown differences with him and his wife. Having become an Orthodox Jew, Ezra had wanted to live his life on his terms, but Alan and Beth had great objections to it. With all the time that he gets, Alan gradually realizes how he, too, has been blind to his son’s feelings and wishes and is gravely ashamed of the fact that he has been more understanding and consoling to a psychopathic serial killer than he has ever been to his son. While Alan now dearly wishes to get the chance to see his children again, it still seems like a far-fetched dream, as Sam has expressed no desire to let Alan go just yet. Meanwhile, in a desperate attempt to stop his murder spree, Sam decides to kill the source of all his childhood angst and worries; he decides to kill his father.

‘The Patient’ Episode 10: Recap

The new episode once again begins right after the events of “The Patient” Episode 9, in which Sam had taken Alan’s words in his usual twisted understanding and had decided to kill his father to bring an end to his thirst for murder. Back at the house, Alan now frantically calls out to Candace and informs her of what her son is about to do. The woman still has one of the most bizarrely relaxed responses, as she refuses to do anything to stop Sam from killing his father. The father, whom we see for the first time shortly after this scene, had been abusive not just towards his son but also towards his wife, and Candace now wishes only ill for him. It is now very clear to Alan that the thought of one not deserving death by murder, no matter how bad they are, is an idea very foreign to both the son and the mother. Instead, Candace pulls her armchair down to the basement, brings in some beer, and drinks it in front of Alan, saying that this is exactly how she copes with the nervous situation every time her son goes out. She shows sympathy for the families that her son has destroyed by now by killing their sons or husbands, but when Alan questions why she does not inform the police to potentially save more families, Candace just replies that she cannot. Although from every sane perspective, she is somewhat of an accomplice in her son’s crimes, to Candace’s interpretation, she needs to remain a faithful mother first and cannot turn her own son in. Alan seems quite disturbed by this exchange with the mother, but he still provides some sympathy and offers her some tissues when she starts to weep.

Sam arrives at his father’s house, and the man is finally seen, although there is nothing remarkable about him. The father, who seems to be living alone, makes a sandwich for his son and looks rather distraught and lost in life throughout the entire scene. Sam brings up their past and asks his father why he used to always physically hit him when he was a child, and the man replies that he simply did not know. He says that Sam was always a strange kid with very stunted social skills, and he then offers a half-hearted apology as well, which looks totally unacceptable while admitting guilt of assaulting one’s child. This perhaps enrages Sam, and he picks this moment to strike, choking his father down to the ground. But when he is almost about to kill him, Sam stops and lets him leave. He quickly returns to his house and informs Alan about this new success. Sam reports that even though he had all his hatred and apathy towards his father intact, he just could not go ahead with the killing this time. Alan congratulates him and then explains how this could have been because the man was, after all, Sam’s father, and patricide is perhaps not as easy as any murder. Alan now makes use of this situation and tries to convince Sam that his work is done since Sam does not need therapy anymore. He says that just like the young man had had a confrontation with his father, which led to positive results, he himself had to go through with a confrontation with his son, Ezra, because he had realized how much he had hurt his son and asks Sam to let him leave.

However, Sam’s expressions change, and within some time, he brings a couch and a mini fridge into the basement room, saying that he would fill the latter with any drink Alan wanted. Sam now repeats Alan’s own words about therapy taking time to work, sometimes even years. He says that he intends to keep Alan hostage in the basement for some more time, if not years, but would make sure that he lives in comfort. This is, of course, not what Alan wants, and the man now sits down to write a long, heartfelt message for someone, which is revealed later on. That evening, when he is done with the message and has carefully left it on the bedside table, the therapist calls Sam in for one more session and now makes a more truthful analysis of the situation. He firmly believes that Sam does need some external force to help him with his addiction to murder, for he will start doing it again. In order to stop himself, Sam must call the police and inform them of their crimes if he is to accept Alan’s therapy at all. If not, then he should either let Alan go or end this once and for all by killing him. Sam refuses to take either of the choices and says that he does not feel ready to make a choice. The next morning, when he is out of the house, Sam does drive close to the police station, perhaps contemplating Alan’s advice, but his first priority still remains his own protection. He returns home and has breakfast with his mother, following which Candace goes down to the basement to give Alan his food. Alan now honestly confronts Candace about her actions, or rather inactions, both when her husband used to hit her son many years back and also now when her son goes out to kill. Alan maintains a respectful and sympathetic tone, though, and Candace breaks down, perhaps thinking of her own inability to do right. Once more, Alan offers her some tissues, and as soon as she gets close to him, the therapist grabs hold of her from behind, with the sharpened foot cream tube held menacingly at her throat. He cries out to Sam, and when the young man comes in, shocked at the scene, Alan tells him again to make a choice.


‘The Patient’ Ending Explained: What Is The Fate Of Alan Strauss And Sam Fortner?

Sam still insists that he does not want to make any choice yet, and he also believes that his therapist is only playing out the role of a violent man intending to harm his mother but will not actually do it. He even tells Alan that he does not believe Alan is the kind of man to hurt someone, but to Alan, this is his only way out of captivity. Based on his long-handwritten message from the previous day, it is clear that Alan just does not want to remain Sam’s captive, like a pet, he says, any longer. If death would let him escape this fate, so be it. In a swift moment, Alan pierces Candace’s neck with the metal tube, and blood oozes out from the wound. The next scene is confusing at first, for Alan is seen inside a gas chamber where he looks at Beth while the toxic gas fills the room, and he is then woken up from a daydream inside Ezra’s house. Here he spends loving time with his entire family—Ezra, Shoshana, their in-laws, and their children, and Alan even sits and sings religious songs with them. Such warm and loving scenes do not last long, though.

It soon becomes clear that Alan was thinking of all this inside his head while Sam had leaped on him and was now strangling him to death. As this happens, Alan’s face remains remarkably calm and still, though, as he has his family in his memory, and the man is finally killed by Sam. Taking the chains off, Sam drags the body into the adjacent room where he had earlier dug a hole to bury Elias and prepares to bury Alan in that same hole. However, better judgments prevail, and it is now that it looks like Alan’s therapy has finally had some effect on Sam, no matter how little it is. We see Shoshana walk into Alan’s empty house, perhaps a day or two later, and the woman is still perplexed and worried about her father, who is still missing. She goes through all the mail that has been collecting in these few days, and among it, she finds an envelope with a letter inside. This letter, written by Sam (he does not mention his name, of course), says that Alan had indeed helped Sam a lot, and he had also made him aware of the Jewish ritual of mourning requiring the dead body. Therefore, he had hidden Sam’s body in a public place and now revealed the location in the letter to Alan’s children. Along with this letter, he has also attached Alan’s own handwritten message, which the latter had left for his children. In this, he thanks Shoshana for always being an easy child to deal with and professes his love for her. Next, he addresses Ezra and expresses a genuine apology for always being biased against him and for never supporting him as he should have. Every realization that Alan had during his captivity is beautifully expressed through his words, and the two siblings have to find support in each other during such an emotional time. Although Ezra did have his grievances against his parents, perhaps, especially against Alan, the father makes sure to wipe clean these complaints and any remorse, even though he is unable to do so in flesh and blood. Like Alan himself mentions in the note, he did not want his relationship with his son to be remembered only as a failed misunderstood tussle between a father and son, and truly he makes sure that Ezra forgives him after his death.

Sam returns to his house, possibly after dropping off the letter, and he visits the now-empty basement where Alan had been living for so long. He questions himself about his actions in the future, and now he seems to have dissociations of his own, as the dead Alan appears to him and says that Sam will actually not stop his murder spree, no matter how he feels at the moment. Once more, Sam listens to his therapist’s advice and decides to work on it. Sitting down on the same bed, which was given to Alan, Sam now places the lock around his own leg and chains himself to the floor. He then calls out to his mother, and once Candace comes down; he hands over the keys to her. Although the mother is rather surprised, none of them say anything, and it is felt that the mother acknowledges the step her son was finally taking to protect others and also himself. It is true that this self-captivity is not the best or most effective way to stop Sam in the long run, but at least it is a step that he takes. Whether or how long he can stick to this plan, we won’t know for sure since there is no mention of ‘The Patient’ returning for a second season. It is also worth noting that “The Patient” does not really leave any scope for a second season either, as the matters of the first season are well settled.

“The Patient” finally ends with a scene of Ezra, as the man sits down with his own therapist and tries to talk about the recent struggles of his life. He tells his therapist that he worries less about himself than the effect of this event on the lives of his children, wife, and sister. The therapist then asks Ezra to tell him some more about himself, and just as Ezra is about to do so, the episode cuts to black, and “The Patient” comes to its end. Ezra would perhaps anyway need a therapist in his life, owing to how his relationship with his parents had been. The kidnapping and subsequent death of his father perhaps gives him the starting point.


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Sourya Sur Roy
Sourya Sur Roy
Sourya keeps an avid interest in all sorts of films, history, sports, videogames and everything related to New Media. Holding a Master of Arts degree in Film Studies, he is currently working as a teacher of Film Studies at a private school and also remotely as a Research Assistant and Translator on a postdoctoral project at UdK Berlin.

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