Malignant Ending Explained (Spoilers)

Madison is paralyzed by shocking visions of grisly murders, and her torment worsens as she discovers that these waking dreams are in fact terrifying realities.

Malignant: Spoilers Below

In 1993, Dr. Florence Weaver, John Gregory, and Victor Fields treated psychiatric patient Gabriel at Simion Research Hospital. Gabriel can project his thoughts through speakers and control electricity. Gabriel becomes violent one night and kills several staff members at the hospital.

Twenty-seven years pass. Madison Lake is a woman who lives in Seattle. She returns home to her abusive husband after feeling sick at work due to her pregnancy. Derek smashes Madison's head against the wall during an argument, causing her to bleed out of her head, after which she locks herself safely in her bedroom and falls asleep. Madison dreams of a man entering their house and violently killing Derek; she later wakes up and finds his corpse in reality. Madison tries to escape when she realizes the killer is still in the house; however, he attacks her and renders her unconscious.

Madison wakes up in the hospital the following day. Her sister Sydney lets her know that her unborn child died in the attack. Madison returns home after she is interviewed by police detective Kekoa Shaw and his partner Regina Moss. Madison tells Syndey that she was adopted when she was eight. The killer kidnaps a woman running a tour of the Seattle Underground. Madison experiences a new vision of the unknown murderer killing Dr. Weaver.

During their investigation, Moss and Shaw learn that Dr. Weaver specialized in child reconstructive surgery and find a picture of Madison as a child in her house. Madison experiences another vision, this time of the murder of Dr. Fields, and she and her sister tell the police about it. The killer calls Madison on the phone while she's with her sister, Shaw, and Moss and reveals himself to be Gabriel, Madison's imaginary childhood friend. Sydney and Madison go to their mother Jeanne's house, to find out more. Madison realizes that Gabriel was a real honest person whom she spoke to during her childhood and not an imaginary friend. Shaw links Madison to the doctors, leading him to find Dr. Gregory's corpse.

Shaw and Moss hope to unlock Madison's memories with the help of a psychiatric hypnotherapist. Madison remembers that she was born as Emily May and Gabriel wanted her to murder her unborn sister, an act she came close to committing before she was able to stop herself. The kidnapped woman, who is Serena May and Madison's birth mother, falls from the attic in Madison's house; the police arrest Madison on the suspicion that Gabriel is living in her home. Sydney discovers that Gabriel is Emily's (Madison's) twin brother after she searches through the archives of the now-abandoned Simion hospital. Gabriel lives within her body as an extreme version of a "teratoma," sharing Emily's same brain and spinal cord. During Emily's childhood, Gabriel was a half-formed child living out of her back. Weaver operated on Emily and removed all of the tumors except for the brain. After childhood, he was dormant until Madison suffered a head injury from Derek. Madison's skull now splits open to reveal Gabriel's grotesque face. It operates her body backward when he takes control, explaining the killer's unnatural movements and the upside-down fingerprints at his crime scenes.

Provoked by fellow inmates in the lockup, Gabriel takes full control of Madison's body and slaughters all of her inmates and almost the entire precinct with superhuman agility and strength before eventually leaving. Shaw and Sydney find Gabriel at the hospital where Madison's birth mother, Serena, is still recovering from her captivity. Gabriel attacks the duo. Sydney reveals to Madison that all her miscarriages were caused by Gabriel feeding off her fetuses for sustenance. Angry at the revelation, Madison wakes up, takes control of her body, and transports herself and Gabriel to a black mindscape. In her mind, she locks an enraged Gabriel behind bars and says she will be ready after he promises to escape one day.

Back in the hospital and in complete control of her body, Madison lifts a hospital bed pinning Sydney to the wall. Madison hugs Sydney and affirms that she will always love her as a sister despite not being blood-related. Serena looks on happily as the two embraces, while the electric humming accompanying Gabriel's attacks can be heard faintly.

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