Excision

Pauline is a troubled high school student who experiences vivid dreams of mutilation and blood. She often wakes panting and unsettled, hinting at a craving for control through violence. The dreams establish a dark, recurring pattern that foreshadows the events to come.

Pauline resolves to lose her virginity to Adam, choosing to do so while she is menstruating because of her fixation with blood. She and Adam have sex, and during her orgasm she imagines choking him as the bed fills with blood. She then asks Adam to perform oral sex on her, intensifying the blood-fantasy.

During sex education, Pauline takes a sample of her blood and places it under a microscope to check for STDs. The act underscores her preoccupation with blood and body fluids as a form of power. The moment foreshadows her later, more extreme experiments.

Pauline approaches Adam while he is with Natalie and alludes to their earlier encounter, provoking tension. The insinuation destabilizes Adam's relationship and angers Natalie, who reacts by ending the relationship. The incident marks a turn toward open retaliation from Pauline.

Natalie and her friend retaliate by throwing toilet paper and spray-painting profanities on Pauline's house. The act demonstrates the volatile social climate around Pauline at school. It heightens Pauline's sense of persecution and isolation.

The next day at school, Pauline assaults both Adam and Natalie, shocking students and staff. The violent outburst leads to her expulsion from school. This event marks a clear escalation in Pauline's behavior.

Pauline overhears her parents discussing Grace's doctor's plans to place her on a waiting list for a lung transplant. The overheard conversation adds to the family tension and raises the stakes of Grace's condition. The moment plants the seeds for Pauline's drastic actions.

That night Grace experiences a severe coughing fit, underscoring the seriousness of her cystic fibrosis. The event intensifies the family's urgency and frames Pauline's later actions as a misguided attempt to 'save' her sister. The scene heightens the sense of impending crisis.

The morning after, Pauline drugs her father Bob's tea and ties him up, preventing interference as she proceeds with her plan. The act demonstrates how far Pauline is willing to go and how she bypasses family boundaries to pursue her goal. The household descends into a dangerous, controlled chaos.

Pauline confronts a neighbor who had rebuffed her, lures the girl to her backyard, and uses chemicals to knock her out. In the same sequence, she drugs Grace, linking the kidnapping with her sister's fragile health. The actions mark a full commitment to her morbid 'surgery' plan.

Pauline shaves her own head and stages the transplant, removing Grace's diseased lungs and attempting to insert the healthy lungs from the abducted girl. She places Grace's lungs on ice as she stitches the patients up. The garage becomes an improvised operating room for a grotesque intervention.

Phyllis arrives home to find Pauline in the garage with the two bodies. She screams in horror as she tries to comprehend what has happened. The moment shatters any remaining sense of normalcy for the family.

Pauline tells Phyllis that the operation was her first surgery and urges her to take a closer look. Phyllis screams in disbelief, then gradually moves toward a conflicted, frightened acceptance. The exchange destabilizes the mother-daughter dynamic and confirms the gravity of the act.

Pauline initially smiles at what she imagines as success, but she quickly wails as she grasps the full consequences of her actions. The scene ends with a chilling mix of pride and despair, leaving the future uncertain for Pauline and her family. The film closes on an ambiguous, unsettling note.