The Patient season 1, episode 5 recap – “Pastitsio”

By Jonathon Wilson
Published: September 20, 2022 (Last updated: 4 weeks ago)
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The Patient season 1, episode 5 recap - "Pastitsio"


A bleak episode once again builds to a powerful climax, suggesting that perhaps Sam’s therapy isn’t going especially well.

This recap of The Patient season 1, episode 5, “Pastitsio”, contains spoilers.

The big dramatic device in this week’s episode of The Patient is nothing new – in fact, it’s the exact same one it employed last week. The entirety of “Pastitsio” rests on whether or not Alan can prevent Sam from killing Elias, and it takes us the whole half-hour to realize that he can’t.  

The Patient season 1, episode 5 recap

But to the show’s credit, it’s unclear all the way up until that point. Sam even seems to try – at least until he doesn’t. He begins by visiting his ex-wife, Mary (Emily Davis), which you’ll recall Alan advised him to do in order to shock his psyche into a less murderous mood. It doesn’t quite have the desired effect, though. Sam and Mary share an awkward catch-up, discuss their adopted Bangladeshi children, and then carry Sam’s old La-Z-Boy back to his truck. When Sam returns to his latest session, he dementedly rocks in it, seemingly in just as much of a bad mood. 

Meanwhile, Alan and Elias continue to bond. Elias has a plan for them to go down swinging since they’re both probably going to die anyway. If Alan finds a therapeutic excuse to involve Elias in the sessions, they can jump Sam together. While they wait for Sam to return, Alan tells half a story about his son Ezra’s difficult transition to Orthodox Judaism.  

If there’s a theme of this episode, it’s revealing Sam as much more of a garden-variety nutcase than we first suspected, perhaps one less willing to curb his impulses than he has been letting on. After returning from Mary’s, he tries to kill Elias, but Alan shouts for Candace, who comes downstairs and straight-up sends him to his room. There, he dances like a weirdo, messages in some forums, and scrolls PornHub (even his search terms are mundane, though the camera makes a note of highlighting some of the edgier stuff he’s contemplating watching, so perhaps he is trying to change after all.) 

Eventually, the desire to kill Elias becomes too overwhelming and Sam heads downstairs in the middle of the night to talk to Alan. Maybe it’s the hour, but this struck me as the most honest therapizing in the show thus far. Alan doesn’t buy Sam’s claims that everyone he kills deserves it; that they were all mean and unpleasant in some way. Alan thinks Sam is perpetuating a legacy of arbitrary violence begun by his father, and that Sam is looking for an excuse to kill people in the same way his dad found ways to justify beating him. Sam doesn’t like this theory, presumably because it gives him too much personal responsibility. If his victims aren’t really as terrible as he claims, maybe he is.  

This is where Alan makes his move, suggesting that they incorporate Elias into the session. Alan thinks he can convince Sam that he’s just a nice young restaurant manager. But he’s wrong. Midway through the session, Sam tips Elias’s chair over and strangles him right there on the floor. The camera backgrounds the killing, with Alan’s horrified face in the foreground, probably wondering how much responsibility he has for this latest development. 

Further reading

Our recap of The Patient episode 6.

5 reasons to watch The Patient.

5 shows like The Patient.

You can stream The Patient season 1, episode 5, “Pastitsio”, exclusively on FX on Hulu.

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