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Annie says Sam is doing well. Gene's sure this is Sam at his worst, only his plonk is too blind to see.
No, maybe she does see it, and knows that by voicing her concerns, she'll condemn Sam the way Sam had condemned Tony Crane.
It runs through him like an electric pulse, his madness, the lunatic mutterings: how it was supposed to be better now, not worse, the cracks in the world are growing, the reflections of a fractured mind, and now he's lashing out at every little thing.
Whatever ends up happening, it's done for Sam's own good.