The Patient’s Shocking Ending Sealed One Character’s Fate

FX’s The Patient proved that therapy isn’t always easy. For 10 episodes, therapist Alan Strauss (Steve Carell) has attempted to convince serial killer, Sam Fortner (Domhnall Gleeson), to refrain from his killing spree. The Oct. 25 season finale proved that helping someone change is harder than just reasoning with them, and despite our best efforts, we’re at the grim mercy of both our urges and fates. Alan’s final episode in captivity proved to be as much of a breakthrough for himself as it was for Sam.

The finale begins with Alan still chained to his basement bed while Sam sets out to kill his abusive father. Alan uses Sam’s absence to press Sam’s mother Candace (Linda Emond) about her complicity in her son’s murders. While his words have an effect on Candace, she refuses to turn in her son to the authorities. Meanwhile, Sam’s attempt to murder his father fails, as the killer finds he can’t do it and says to his father, “my therapist said not to kill you.” When Sam returns to Alan, the therapist calls Sam’s decision a “major breakthrough.” Sam’s usual feelings of hate culminated in mercy instead of rage. Ultimately, Sam subconsciously realized that killing his abusive father would make him the same monster he saw in his dad.

Alan then asks to be set free, eager to return to his family and mend their strained relationship. He assures Sam that he’s both legally and ethically incapable of going to the police and reiterates that he thinks Sam’s behavioral change is permanent. “Therapy takes time, years, you said, sometimes,” Sam tells Alan before promising to furnish the basement with a stocked fridge and a television.

As he has throughout the season, Alan once again hallucinates his therapist Charlie (David Alan Grier) and comes to the conclusion that he can’t spend the next 10 years locked in Sam’s basement. He then begins writing a secret letter on a notepad and pleads with Sam once more, “You brought me down here, and you asked me to treat you, and I did, and I can’t do it anymore.” He tells Sam that the only way to curb his homicidal tendencies is to be physically stopped. Alan commends Sam on his efforts before delivering an ultimatum: either Sam releases Alan, or he kills him.

Sam refuses both choices, which forces Alan’s hand. He plays on Candace’s vulnerability and accuses her of not protecting Sam against his abusive father. He takes the opportunity to ambush her with the sharp edge of a tube. Alan gives him another choice. Either Sam turns himself in, or Alan will kill his mother. Despite Sam’s doubts, Alan digs the sharp edge into Candace’s neck before the scene cuts to black.

Alan awakens on a couch, surrounded by his loving family, but his relief is short-lived. It’s all an illusion, the scene cuts back to the basement as Sam chokes Alan to death. He then drags Alan’s lifeless body into a cellar, where he buries him in a grave. Sam finds Alan’s notebook and sends the pages to his children, Ezra (Andrew Leeds) and Shoshana (Renata Friedman). It’s revealed that the notes Alan had been writing were his final apologies and tributes to his children.

Thinking he’s changed, Sam returns to the basement and sees a hallucination of Alan, who tells him that he hasn’t changed at all. So, Sam chains himself to the bed and gives the key to his mother to end his cycle of killing.

Will The Patient Have A Season 2?

It’s unlikely that The Patient will return for Season 2. The crux of the show was the dynamic between Alan and Sam, and with Alan dead at the season’s end, it’s hard to imagine the show continuing without him. According to Deadline, The Patient was initially acquired by FX in October 2021 as a limited series. Moreover, FX only ordered 10 episodes from showrunners Joe Weisberg and Joel Fields. That means the network likely only ever intended for The Patient to run for a singular season. Conventional wisdom might dictate that one never say never, but given the show’s definitive ending, it’s safe to say that Sam’s sessions are over for good.