Excision (2012) Plot Summary Explained

Pauline fixates on becoming a surgeon as a way to gain her mother's approval and control over life and death. Throughout the film, surgery represents power to her - the ability to open bodies, manipulate organs, and play God. Her mother Phyllis is controlling and religious, constantly rejecting Pauline's ambitions, making Pauline seek validation through the one thing she believes she can master: cutting people open and saving them.

Foreshadowing: Her disturbing dreams of mutilation and blood establish this fascination with internal bodies from the start.

• surgeon ambition
• mother approval
• power over life death

Pauline's violent fantasies stem from her deep-seated psychological issues and her suppressed desires. The film presents these dreams as manifestations of her craving for control, her obsession with blood, and her distorted view of sexuality. She wakes from these dreams in an aroused state, indicating her fantasies blur the lines between violence, sexuality, and power for her.

Foreshadowing: The opening scene establishes her vivid dreams of mutilation as a recurring pattern that will escalate into reality.

• psychosis
• dreams
• fantasies
• psychological breakdown

Pauline chooses to have sex during her period because of her intense fascination with blood. During intercourse, she imagines herself choking Adam while the bed fills with blood during her orgasm. This blood obsession is central to her psychology - it represents power, vitality, and the control she craves. She also asks Adam to perform oral sex on her while she's menstruating, which disgusts him.

Foreshadowing: Her blood fixation is foreshadowed by her dreams of blood and the scene where she examines her own blood under a microscope in class.

• blood obsession
• virginity
• period
• sexual fantasies

Pauline attacks Adam and Natalie after Natalie vandalized Pauline's house with toilet paper and spray paint profanities. The vandalism was Natalie's retaliation when Pauline approached Adam while he was with Natalie and alludes to their sexual encounter, causing Natalie to break up with Adam. Feeling persecuted and isolated, Pauline's psychological state escalates to physical violence, resulting in her expulsion from school.

Foreshadowing: The buildup begins with Pauline's calculated hint about the encounter, which triggers the chain of retaliatory events.

• assault
• expulsion
• school violence
• retaliation

Pauline kidnaps a neighbor girl to harvest her healthy lungs for her sister Grace, who suffers from cystic fibrosis. After overhearing that Grace will be placed on a lung transplant waiting list and witnessing Grace have a severe coughing fit that night, Pauline decides to take matters into her own hands. She sees herself as a surgeon who can save her sister immediately rather than waiting for a donor.

Foreshadowing: The discussion about Grace's need for a transplant and her severe coughing fit directly precede Pauline's decision to act.

• kidnapping
• lung transplant
• sister
• cystic fibrosis

Pauline drugs her father Bob with drugged tea and ties him up to prevent interference. She lures the neighbor girl to her backyard using chemicals to knock her unconscious. She then drugs her sister Grace, shaves her own head, and performs the crude transplant in her garage. She removes Grace's diseased lungs, places the healthy girl's lungs into Grace, places the diseased lungs on ice, and stitches both girls up. The procedure is depicted as a grotesque, amateur attempt at surgery.

Foreshadowing: Pauline's earlier scene taking her own blood sample under a microscope hints at her willingness to experiment with bodies.

• surgery
• garage
• transplant
• amateur operation

Phyllis initially screams in horror when she discovers Pauline in the garage with the bodies. However, after Pauline tells her it was her first surgery and urges her to look closer, Phyllis moves toward a terrified acceptance and even embraces Pauline. This shocking reaction suggests Phyllis has been so conditioned to accommodate Pauline's disturbances and so desperate to maintain family bonds that she cannot fully reject her daughter, even after such a horrific act.

Foreshadowing: The family's pattern of enabling Pauline's behavior and the controlling Christian mother's struggle to maintain control set up this disturbing acceptance.

• mother reaction
• acceptance
• family collapse
• psychological horror

Pauline initially smiles with pride at what she believes is her successful first surgery - she saved her sister like a real surgeon. However, she quickly begins wailing as she suddenly realizes the full gravity and horror of what she has done. This moment represents the collision between her delusional self-image and the reality of her actions, suggesting she briefly breaks from her psychosis to comprehend the atrocity she committed.

Foreshadowing: The entire film has been building toward this moment of reckoning, where her delusions finally crack.

• realization
• remorse
• psychological break
• ending

Pauline drugs Bob's tea and binds him to ensure he cannot stop her from kidnapping the neighbor girl and performing the transplant. By incapacitating her father, she eliminates the only person who might physically intervene in her plan. This act demonstrates how far Pauline is willing to go and shows her complete disregard for family boundaries in pursuit of her surgical goal.

Foreshadowing: Her earlier dream sequences establish her willingness to harm those close to her.

• father
• restraint
• drugging
• family betrayal

Blood represents power, life, sexuality, and control for Pauline. Her dreams are filled with blood, she is fascinated by menstruating during sex, she examines her own blood under a microscope, and the transplant itself revolves around blood and organs. For Pauline, blood is not just a fluid but a symbol of her desire to dominate life and death, to be the one who controls who lives and dies - the ultimate surgeon's power.

Foreshadowing: The recurring blood-soaked dreams establish this central obsession from the opening of the film.

• blood symbolism
• obsession
• surgery
• power

Grace's cystic fibrosis serves as the catalyst for the film's horrific climax. Her chronic illness creates tension in the family and becomes the justification for Pauline's extreme action. When Pauline learns Grace will need a lung transplant and witnesses her sister suffer a severe coughing fit, she uses this as the motivation to kidnap a healthy girl and perform the transplant herself. Grace's illness is the thread that connects Pauline's delusion of saving her sister with the actual violence she commits.

Foreshadowing: Grace's illness and the discussion about the transplant waiting list directly precede Pauline's decision to act.

• cystic fibrosis
• lung disease
• sister
• transplant waiting list