All That Matters is the Ending: The Patient

Just like House of the Dragon, I almost gave The Patient a miss but for a friend of mine recommending it. First, I was so disgusted after watching You turn a psychopath into a romantic figure, I didn’t want to watch another show about a sympathetic serial killer. Second, I see Steve Carrell’s face and my mind immediately remembers him in The Office, and even though I’ve seen him in good dramatic roles since, I just couldn’t envision him in this role.

For those that don’t know, The Patient is the story of a serial killer who wants to stop killing and kidnaps a therapist, hoping that they’ll cure him of the desire to kill, with Steve Carrell starring as the therapist.

I watched it expecting a run-of-the-mill, cat-and-mouse style thriller. What I got instead was a profound look at personal trauma, family dysfunction, and the sometimes horrifying, sometimes beautiful, exploration of self. I cried multiple times, and it features what is probably Steve Carrell’s strongest performance, he fully becomes the character in a way I didn’t think possible.

And that’s as much as I can talk about without spoiling it. If you like genuinely emotional explorations of character, then you need to check this one out, and I guarantee it will be more impactful unspoiled. But if you don’t want to watch it or have already watched it, allow me to lay out why this show was so spectacular.

All That Matters is the Ending: The Patient

As always I’ll be focusing on the writing and narrative in review, but I wanted to take a few moments to praise the cinematography and the absolutely outstanding acting. First of all the camera work, lighting, and the understated music, does such a great job of immersing you in the claustrophobic horror of being a captive. Watching this show I felt trapped, confined, and it got my skin crawling just enough to put you in Alan’s shoes.

Second of all if the actors don’t win some kind of award for this, then there is no justice. I came in in here prepared to heap praise on Steve Carrell, and I still do because he gives such a powerful performance, and then praise the absolute noob actor I’d never seen before for playing off Steve so well…

Only to realize that “noob” was freaking Domhnall Gleeson himself! I’ve been a huge fan of his work since About Time and Ex Machina, though his most famous role is probably Bill Weasley in Harry Potter, or (unfortunately) General Hux in the newest Star Wars trilogy. Domhnall sank himself so completely into this role that he was utterly unrecognizable to me, I didn’t realize it was him until I was doing the research for this article.

But let’s talk about the writing, and outstanding story, starting with the characters:

The Characters and Themes

Though this show features a serial killer, it is not about murder or crime scene investigation. There are no cuts to a hardnosed detective tracking clues and no final showdowns or race-against-the-clock manhunts. Instead the show uses its unique premise to provide a deep dive into personal trauma, family dysfunction, and the importance of acceptance, of both self and others. It is essentially a show about therapy, the difficulties of it, the pain it came bring up, but ultimately the peace and acceptance it can bring.

Alan is a therapist with a glowing professional reputation, who has published books on family relationships and resolving familial dysfunction… who himself is struggling to keep together his own dysfunctional family. His wife recently died of cancer, and his son has become an Orthodox Jew, and through a series of rather tragic events, the son refuses to be at his mother’s side when she dies. This has left a huge rift in the family, and the two are barely on speaking terms, leaving the poor sister to basically act as an intermediary. It’s then that he starts seeing his new patient, Sam, who soon after abducts him.

Sam is a serial killer that hates who he is. He doesn’t want to kill, unlike most serial killers he gets no pleasure from the act, he simply feels an unstoppable desire to kill those that anger him. He abducts Alan hoping that this therapist can cure him of his affliction. Sam came from a home where his father physically abused him, mercilessly, and his mother did nothing to stop it. He had one relationship in his life, an ex-wife, but his inability to connect on an emotional level caused it to fall apart. But the important part is, he wants to get better.

Again I hate to keep shitting on You (that’s a lie actually, I love shitting on that show) but this how to properly show a sympathetic killer. No one is on Twitter asking Domnhall Gleeson to marry them and him having to patiently explain that his character is a serial killer. No, Sam is deeply disturbed, there’s no attempt to romanticize his actions or portray them as funny and charming. Yet he’s sympathetic because he comes across as so profoundly human. Beneath his monstrous actions, we see he’s just as wounded and lost as any of us. He’s doing the best he can against an overwhelming anger and urge to kill that he doesn’t want to give into, and wants to stop.

And Alan works miracles around this, and when he successfully talks Sam into going to work rather than killing his latest victim, I felt so god damn proud of Sam. I was rooting for this kid to stop killing, to find the peace that evaded him for so long. But as fascinating as Sam’s journey was, it’s really just a vehicle to tell Alan’s story.

The basic premise is can Alan cure Sam before Sam decides to kill Alan, and yet through that lens we get a much more profound journey through Alan’s mind. Exploring Sam’s psyche is fascinating, but it really is the B-story in this show, and Alan’s inner journey is the main course.

Facing what he knows is probably the end of his life, Alan begins to reflect on his life. A truly well-written story is one that can put you into the shoes of a character and let you see the world through their eyes, and The Patient does exactly that. For the first few episodes, we see flashbacks into Alan’s relationship with his son.

The first time we see Ezra is when Alan brings him his mother’s guitar, because she loved music and Ezra is now the only musician left in the family, but Ezra callously rejects it. Immediately I hated this guy, here was his dad trying to do something nice, bridge the gap and bury the hatchet, and Ezra dismisses it out of hand. This is followed up by revelations about Ezra humiliating his own mom at his wedding, because she wanted to sing a song for him, and his Orthodox beliefs don’t allow women to sing in front of men. And then, when she got cancer and found she was dying, she wanted to given a morphine drip so she could fade off peacefully rather than face a few weeks of excruciating pain. Ezra refuses to take part, again, citing his moral code.

Seeing this strictly from Alan’s point of view, Ezra looks like the world’s biggest dick, and I hated him way more than I hated Sam. And I love this because it means I had the exact same journey as Alan in this story.

As his isolation and fear grows, Alan begins to have imaginary conversations with his long dead professor from school, his own internal therapy sessions.

As he goes through these sessions, we get to see Ezra in a slightly different light. Alan describes his son as “obstinate” even as a young boy, and dismisses Ezra as becoming Orthodox just as a way to spite him. He claims to be understanding, that he once complimented Ezra’s wife for cooking the best “kosher” steak he’d ever eaten, a backhanded compliment that for the longest time he doesn’t even acknowledge as backhanded. And when Ezra undergoes a spiritual pilgrimage, crucial to his faith, he asks his father to donate. Which he does: a mere thousand dollars. By comparison, Alan paid for his daughter’s medical schooling, averaging about 40k a year for 8+ years.

At one point Alan’s imaginary therapist asks him what he would say to Ezra if he were there. And just before he speaks, Alan’s upper lip and part of his nose starts to twitch in one of the most subtle and yet blatant displays of contempt I’ve ever seen. He then rails against his son, that Ezra was selfish, and self-righteous, convinced that his way was the only way. It’s only on further reflection that he realizes… his son got those traits from him.

I have been more understanding, more compassionate, to a fucking serial killer than I was to my own son.

– Alan to Charlie, his invisible therapist.

Alan never accepted, or even tried accepting, Ezra. Even as a child, he was artistic, not great in school, and not interested in medicine or even any higher education. He was a disappointment to Alan, unlike his daughter who followed in his footsteps. And when Ezra became Orthodox, Alan treated him like, as he says in his own words, like Ezra was a scientologist. Like he’d fallen into a cult. Even worse, regarding Alan regarded it as an act of personal rebellion rather, refusing to accept that his son might just truly find that kind of spirituality fulfilling.

He finally realizes he’s held his son in contempt for almost his entire life, and his only goal from then on is escape… so he can tell Ezra in person that he was wrong.

This personal journey through Alan’s mind, his family, and recognizing the twisted thinking that we all fall prey to, was the most startlingly beautiful things about this show. And none of it would have been possible at it all not felt so wonderfully, horribly, real.

It All Felt Real

When I read the blurb about The Patient my mind went to a Saw-like scenario: with our therapist hero in some dark basement, filled with cage doors, devious traps, and dark, blood-stained concrete walls. Instead when Alan wakes up in captivity, he’s in an unassuming downstairs living room, a chain bolted to the floor attached to his ankle. There’s no bomb on his neck, no long torture sequences, and no over-the-top murders.

This grounds the entire story, giving it the authenticity needed to properly explore its characters and themes. Compared to You, where our killer had convenient access to a secret basement featuring a hermetically sealed chamber, this scenario actually feels believable.

The fact that Alan isn’t fighting for his life, at least not in a literal sense, allows for the quiet moments of introspection that not only allow the characters to process their situation, but also me, as the audience. Giving the audience some moments of stillness and peace, to contemplate and fully embrace the emotions of a scene, is quickly becoming a lost art. So many shows, movies, and games these days seem to underestimate people, that if they’re not constantly being spoon-fed explosions or witty banter, that they’ll get bored. Modern storytelling is in such a rush to reach the point it often ends up ploughing past it.

That’s not the case with The Patient. We get quiet moments spent following Alan’s family, or Sam’s work life. Not only do these moments allow for the characters and audience to reflect on what’s happening, they also give us a profound glimpse into the mindset of the characters. One of the most powerful examples of this is following Alan’s son around as he goes about his day.

When it starts Ezra is seen going to his place of worship and the praying. This scene made me so irrationally angry, because the writing so well done that I was seeing everything from Alan’s point of view. I was totally on his side, his son was a fundamentalist who’d embarrassed and humiliated his mother, and refused to be there when she died. So seeing him then praying while his father is still missing? Wow, this kid just really doesn’t care.

And then he finishes praying, and he spends an entire day papering the city with missing posters with his father’s face prominently displayed. A lesser show would have had him speaking to his father while he was passing them around, or even worse, going out and buying a gun preparing for a bloody quest for revenge. Instead, not a single line of dialogue is spoken for most of the scene, it’s conveyed entirely through the body language of the actor. His hunched appearance, the grim determination in his walk, the slightly hopeless shrug of his shoulders.

I know this feeling well.

His hand lingering on the portrait of his father on the missing poster. I could feel the grief in that moment, I knew that grief, and seeing it replayed on screen destroyed me. This show excels at inflicting some emotional distress.

Speaking of, I mentioned earlier that there no over-the-top murders. What I meant was there were no lovingly crafted and shot murder scenes a la Saw, Hostel, or even the murders on most cop procedurals. There’s no dramatic close ups of knives stabbing or blood spurting. But there are still murders, exactly three of them. Sam, our serial killer prefers to strangle his victims, and the first time he does it I was actually shocked at how… violent it felt. In my years of consuming stories, I’ve seen, read, or heard victims killed in all kinds of horrific and terrible ways, but rarely has it evoked the feeling of shock, and horror, that Sam’s killings did. Most of this is created by the look of bestial fury on Sam’s face (again Domnhall Gleeson is a fantastic actor), he’s deriving no sadistic pleasure from the act, it’s an act of unbridled hatred. To see that look on the face of a character that is otherwise soft spoken and sensitive is deeply disturbing.

To drive that horror home is the fact that Alan is there to witness it, and this is again where I have to call out some outstanding acting. Listening to Alan’s screams of horror, and his pleading for Sam to stop, actually made me nauseous to listen to. Alan begins sobbing as he watches another human being murdered before his eyes, and again it struck me as absolutely real. And that’s exactly why it was so disturbing, it made me feel as though I were actually watching a murder.

And, when the ending comes, that feeling is truly driven home…

The Ending Was Inevitable and Beautiful

He may not be in jail… but he’s not free.

The ending was beautiful, tragic, and utterly authentic.

Eventually the stress of his confinement, the ever-present threat of death, and his need to reconnect with his son, becomes too much for Alan to bear and he resolves to escape. His plan is to take Sam’s mother, who lives in the same house, as a hostage to force Sam to turn himself into the police. Throughout the show, Alan is haunted by images of Auschwitz, prisoner’s in striped star-bearing prison garb. At one point he has a nightmare of himself dying in a gas chamber. This is accompanied by his internal therapist asking if Alan is simply going to allow himself to die. (This actually, is one of my few gripes about the show, since it continues the myth that Jews allowed themselves to be killed in the concentration camps. In reality there were several uprisings in several camps, and plenty of acts of passive and active resistance both inside and out of the camps during the Holocaust.)

But Alan resolves to escape, better to die in the attempt to escape than be slaughtered like a lamb. Like Alan, I’d also been fantasizing about his eventual escape, the police busting in the door or, even better, Alan choking (Serial Killer) to death with the chain around his ankle. I wanted Alan to survive.

But on some subconscious level, I knew he wouldn’t. As much as his invisible therapist told him he used to be a wrestler, and that he wasn’t helpless, we all knew if it came down to a hand-to-hand fight, Alan wouldn’t win. Armed with only a slightly sharpened corner of an old skin cream tube, he didn’t stand a chance. When Sam calls his bluff, Alan follows through and attempts to cut his mom’s throat, but this was never going to work. The carotid and jugular may be vulnerable vessels in the body due to being located in the neck, but they’re still protected by thick layers of interwoven muscle and sinew. He would have needed time to saw through, or a sharper implement, to reach his target. He didn’t have either.

Goodbye Alan…

And so it ends, as it must, with Alan dying at the hands of his patient. And even as (Serial Killer) was dragging his body, there was a faint hope:

“He’s faking, any moment now he’ll lash out or make a run for it…” But that hope quickly died too. Alan was dead.

Yet in the aftermath, we get a beautiful moment in which Sam finds the goodbye note Alan wrote before attempting his escape. One of Sam’s journeys through the show has been about learning empathy, to see the world through other’s eyes and attempt to feel as they might feel. And Sam, who honestly regrets killing Alan, shows empathy here. After learning from Alan that having a body is important to Jewish burial rituals, Sam leaves his body where it could be found and mails the goodbye note to his children. And when he’s done, he has one last conversation with Alan, swearing to his ghost that he will never hurt anyone again.

We both know that’s not true…

-Alan to Sam

And Sam does know that… so he locks himself to the same ankle chain as he kept Alan locked in, and gives his mother the key. It’s left ambiguous what happens after this, does he then tell his mom to call the police? Will he simply keep himself locked up for the rest of his life? We’ll never know, but I found myself hoping that Sam knew that was where he belonged.

But the emotional high note comes as Ezra reads his father’s goodbye note, the voiceover coming from Steve Carrell so we can hear the Alan’s voice reading it. He tells Ezra everything that he’s kept bottled up for his entire life, how wrong he was to reject his son’s choices, for not respecting him as a man or a son, and how he was more to blame than anyone else. He tells his son that he loves him, that he regrets not saying it more, and that he’s proud of him. And Ezra dissolves into tears, a mixture of joy and relief in finding the affirmation he’d always craved from his dad, and crushing grief that his father was now gone forever. As someone who would have loved to hear those words from his father, I was sobbing right alongside Ezra. And had it ended there I would have still given this ending a 10/10.

But it actually ends, appropriately, in a therapist’s office. Ezra, some time later, seeking to recover from the trauma of the murder of his father… and heal the wounds in his own psyche, the trauma and sadness of his life. Ezra says he doesn’t know where to start, and the therapist tells him anywhere is fine.

The final line is a work of art.

It ends on the most complex idea we express with the simplest word…a single letter:


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