The Patient co-creators break down the show's tragic finale

[Editor’s note: This interview contains spoilers for the series finale of FX’s The Patient, which dropped on October 25.]

The Patient was never going to have a happy ending. The riveting limited series about a serial killer, Sam (Domhnall Gleeson), abducting his therapist, Dr. Alan (Steve Carell), couldn’t close out its 10-episode run with a neat and tidy bow. That’s simply not how co-creators Joel Fields and Joe Weisberg operate. The duo, who also helmed FX’s The Americans, knows how to craft a series finale that builds tension, delivering a satisfying and tragic payoff at the same time. And they tell The A.V. Club that despite considering other options, The Patient’s heartbreaking end was the only way out.

In its last episode, titled “The Cantor’s Husband,” Sam makes a breakthrough when he doesn’t murder his abusive father. As Alan correctly deduced earlier, he has been substituting his dad for his other victims. Sam is glad that therapy is finally working, so instead of letting the good doctor leave (as Alan demands after making a treatment plan), he makes long-term plans to keep him chained in the basement. Alan, refusing to accept his fate, threatens Sam’s mother knowing it could get him killed. And that’s exactly what happens. As Sam chokes the life out of his therapist, Carell and Gleeson deliver a wrenching performance that stays with you way after the credits roll.

The A.V. Club spoke to Fields and Weisberg about the quiet brutality of this moment, why it was the only end that appealed to them, and their time making The Americans.

Joel Fields: I think there’s a multi-part answer to that. The first is this was our first instinct. Not with this exact order or detail of scenes, but the general ending. It was in the summary of the show as we first laid it out. And from there, over the course of writing it, we considered, talked about, experimented with, and wrote every iteration we could conceive of. That was a lot of versions. But ultimately we found ourselves returning to the first one.

Joe Weisberg: It comes down to the fact that it felt true. We just believed it. Any ending where Alan escaped felt not true. Television sometimes tries to pull a happy ending out of something that wouldn’t happen in the real world. In general, even with The Americans, we try to get as close to real as we can. I don’t want to say this ending was a no-brainer, but it was the right way to go.

AVC: The reveal that Sam is actually killing Alan, and then seeing him die, it’s brutal to watch. How’d you feel the first time seeing it?

JF: As I recall, we were around the day before they filmed it for the rehearsal. We were able not to suffer the brutality in person.

JW: That’s an interesting question because we had to see it hundreds of times in the editing process. We were feeling all these painful things, especially when we saw the scene for the first time, but it’s also relief because that means it came out right. And then we had to see it many more times. At least for me, you think it’d get easier with each time. But it didn’t. It almost got worse. I remember getting to the point where I thought, “I can’t watch this scene anymore, it’s a tough one.”

JF: I felt the same way.

AVC: Let’s talk about the letter Alan writes to his children. Why was it necessary for him to be able to have such an emotional goodbye?

JF: In part of our experimentation, as we landed upon this ending, that letter presented itself as a way for Alan to do what he needed to do, knowing he couldn’t do it in person. Again, it felt authentic to us. The truth is, I recall the letter coming out in a fairly simple chunk. We wrote it as he would’ve and didn’t up rewriting it. We didn’t want to refine it too much because it comes out of his heart in one blast on his final night.

AVC: Do you think Alan would’ve ever come to those realizations about his relationship with Ezra if he wasn’t trapped in Sam’s basement?

JW: You know, it’s a good question for us in terms of what we’re doing as storytellers. Our answer is he would not. Of course, we don’t know. But part of the idea of constructing this story is to have it feel like this was the only way Alan was going to get there.

AVC: True, but it’s just so dark and tragic.

JW: Oh, absolutely. It’s very dark.

JF: I can give you another angle of the same crystal, though, which is that this is his story. As with all of our lives, we have one path through our lives, and that’s the path through which we will or won’t find peace or reconciliation. In this story, he was able to. You can say that’s dark, but it’s also a beautiful thing.

AVC: Dark and beautiful is a good way to describe both The Patient and The Americans. Another similar device in those two series finales is the use of a dream sequence, like Elizabeth visualizing Gregory while on the plane. Does the scene here suggest what Alan is thinking about in his last moments?

JW: We always don’t want to interpret too much to let the audience experience it and have their own takeaways. But generally, yes, we asked ourselves what his mind would conjure in his dying moments. I think we don’t want to answer too much about what it is. Is it a conscious daydream or something else? Under duress in that basement, his mind is producing images of Auschwitz. It seemed true to who he is.

AVC: Well, it’s also such a well-crafted bait-and-switch.

JW: Absolutely, that was meant to be a total misdirect.

AVC: What’s appealing about this storytelling format?

JF: To us, obviously there are technical and structural aspects to it, and how it works as a moving piece. We can deconstruct it, and sometimes we do it while we’re constructing a scene, but at the end of the day we’re following an emotional feeling inside ourselves. It’s just what we’re responding to and what feels right to us. I feel like Joe will have a smarter answer.

JW: No, no. I agree with that. It’s not like we automatically or immediately come up with what makes us feel that way. It’s a lot of trial and error. On this one, while figuring out our various versions, if any of us would go, “That’s just touching our bases,” it would mean we felt the need, for example, to wrap up Candace’s story, then we’d write that part. So that’s how we came up with what felt true and emotional even with that Alan scene.

AVC: After six seasons of The Americans, what was it like working on The Patient knowing it’s mostly half-hour episodes and has an end in sight?

JF: I almost said it was less stressful, but that’s not true. It was a stressful, hard-working process. There was still something lovely in seeing all of the story at all times and to work in that sort of a singular way.

AVC: Do you know what kind of project you’d want to tackle next?

JF: We’re developing some projects that we are producing but in terms of what we’re going to write and create, we’re excited to find it now that we’re on the other side of The Patient.

AVC: I must go back to The Americans, which is in my top five TV shows of all time. In hindsight, how do you reflect on your time with it and how the show’s popularity grew season after season?

JW: Even this one-line history you just gave, we think about it like that. We talked about it at the time too. We started as an unnoticed, under-the-radar show, and then the critics loved it, so we got more popular. And so many things in the journey were like that. I could never predict it because I had never experienced anything like it before. It was perfect. It’s so crazy, I don’t think I have anything in my life I can look back on and say, “It was perfect,” except for this. It’s not that I loved every minute of it, but I loved the totality of it.

JF: I second, third, and fourth that. We worked on The Americans with a dear friend, Joshua Brand, who was a consulting producer and wrote for the show from the beginning. He walked into the office Joe and I shared, which was part of the many wonderful things about it, we chose to share an office. So he walked in and said, “I know how stressed you are and how intense this is, but don’t forget to enjoy this. It will end.” Every season he would say this. And it really helped both of us. As hard as it was, it was a reminder to appreciate the incredibly special group of people, the creative experience, and the relationship with the audience and with the critics. I will say, it was a blessed time that gave many gifts, not the least of which is here we are today with another show and more to come.