The Patient Episode 5 Recap and Ending, Explained

Image Credit: Suzanne Tenner/FX

The fifth episode of FX on Hulu’s thriller series ‘The Patient,’ titled ‘Pastitsio,’ follows the aftermath of Alan Strauss’ instruction to Sam Fortner to see the latter’s wife Mary. Sam accepts the same and meets Mary. Alan talks to Elias Petraki about his family and asks the “restaurant guy” to pass a message to his daughter and son if he escapes from the horrors of Sam before the therapist. Alan also talks about how his son Ezra did grow distant from him and his wife Beth Strauss. The engrossing episode ends with Sam making a decision concerning Elias’s fate and here’s everything you need to know about the same! SPOILERS AHEAD.

The Patient Episode 5 Recap

‘Pastitsio’ begins with Sam meeting Mary, who gets surprised to see her ex-husband unexpectedly. Sam enquires about their adoptive daughter Yara and asks whether she knows about their past to Mary, who replies that it is “against the rules.” Mary tells him that she had adopted another girl as well. She reminds him that he never took a chair belonging to him from her house and they both carry the same to Sam’s truck. Elias asks Alan to conduct a therapy session with him involved so that they both can try to hurt Sam and escape from the serial killer’s custody. Alan asks Elias to pass a message to his daughter and son in case he escapes before the therapist.

Image Credit: Suzanne Tenner/FX

Alan thinks about Ezra’s childhood and how close he was with him and Beth. Sam returns to his home from Mary’s place with his homicidal urges burning inside him. He sets out to kill Elias, only for the former’s mother Candace Fortner to intervene. Candace reminds Sam of the need to protect her by not killing anyone anymore. Sam agrees with Candace and decides against killing Elias for the time being. Alan tells Sam that he is killing people randomly because he misunderstands that people are offending him just because of the simmering anger, the by-product of his troubled childhood, inside him.

The Patient Episode 5 Ending: Is Elias Dead? Will Sam Kill Again?

After Sam’s return, Alan tries to follow the plan he devices with Elias and forces the serial killer to bring Elias to the session. Alan thinks that making Sam realize how good a person Elias is will put an end to the serial killer’s urge to kill the latter. However, Alan’s method not only doesn’t work but turns out to be a mistake as Sam kills Elias. Sam’s motive to kill others is his belief that they are condemnable human beings who have offended him. In the serial killer’s eyes, they all deserve to die, which makes him think that he isn’t doing anything wrong by killing them.

Image Credit: Suzanne Tenner/FX

Although Alan realizes the same, he fails to foresee the consequence of exposing the shallowness of such a motive. When Elias attempts to prove how good a man he is and how he doesn’t deserve anything that happens to him, Sam’s belief gets threatened. Sam will not be able to handle the realization that none of his victims and potential victims, including Elias, deserve to die. If he is forced to confront such a realization, he will be drowning in a sea of guilt, which may make him hate himself. To avoid the confrontation with such a truth, he kills Elias so that he will never know whether he is a good man.

In addition, Elias’ death is expected, especially considering the lack of resources Alan has as a therapist to change Sam’s mind and homicidal impulses. Alan, without a safe environment, cannot transform Sam into a non-murderous being and it becomes evident when the serial killer kills Elias. Alan also doesn’t get enough time and sessions to bring a change in Sam, which explains his failure. However, Elias’ death can be the missing piece of Alan’s puzzle to change Sam. The murder, which Sam commits right before understanding that Elias doesn’t deserve to die, may make him question his own actions and motives.

Elias’ death can be a cathartic occasion for Sam and he may finally release the anger he has been repressing in him as Alan has explained to him. He may regret killing Elias and start to dive deep into his emotions to perceive that the source of his homicidal urges is nothing but his unreleased anger and disappointment. After killing Elias, it is evident that Sam is suffering rather than rejoicing, which can be an indication of how much he is starting to realize the true reasons behind his murderous impulses. If that’s the case, he may not be keen to kill anyone again.

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