Andrew's already severe depression aggravates further at the news about the car crash — more exactly, at the news of how it happened. When he comes back to Moscow, Sofia tells him what she couldn't afford to break to him over the phone: the tragedy was caused by Nathalie's father who drove under influence after his birthday party, way too excited about giving his daughter and granddaughter a ride home in his brand-new luxury SUV. Nathalie herself was no less drunk to allow him to do so at the cost of her kid's safety. After running a red light and a side collision with a heavy truck totalling the car, her father is dead on ambulance's arrival. Nathalie suffered a few fractures and burns but was out of danger currently. Ann, who was on the driver's side without a child's seat and seatbelt, was severely injured by the impact and brought into emergency room in critical condition. As Andrew's mind is torn apart between anger and pain, he spends a few hours with Sofia in the overcrowded public hospital before learning that his daughter now has absolute indication for blood transfusion. However, it cannot be administered immediately: the hospital has trouble finding compatible blood in their bank because of the girl's rare blood type. The whole thing sounds dreadful to Sofia, but to Andrew it has another meaning his mother-in-law is not aware of. He knows his own and Nathalie's blood type and, as a doctor, he is aware of blood type inheritance patterns. He realizes that given Ann's blood type, she cannot be his biological daughter. He remembers that shortly after the girl's birth Nathalie's father apprised him of the possibility of her cheating on him. At first, he refuses to believe it and thinks that doctors in the hospital misidentified the girl's blood type. Forcing his way in the ICU saying that he's a fellow professional, he gets to test his daughter's blood himself and sees that the result was right. He tests it a few times again, only to see the same result. He realizes that his daughter, who was the main reason keeping him from divorce and emigration for years, is in fact not his. He feels betrayed by the last intact piece of his reality, and it drowns him further in desperation.
However, he realizes there is a small chance that Ann's mismatched blood type might be a result of her spontaneous genetic mutation rather than his wife's infidelity. In order to definitively assess his paternity, a full-DNA genetic test is required, so he steals the girl's blood sample from the hospital. His mind is obscured by delusions of self-blame and self-hate: he believes that the paternity of his daughter being taken away from him is a God-sent visitation for him having been a bad husband who didn't love and accept his wife the way she was. He doesn't say a word to Sofia about his discovery and brings the girl's blood to a private genetic lab. The full test takes one week to be performed, so beginning from the next day he starts making attempts to fix their marital relationship as Nathalie recovers from her injuries. He hopes to make God change His mind and to receive the positive result of his paternity test which he knows is barely probable. His thinking is totally disfigured by his mental illness. Blaming himself for all bad things happening to him, Andrew completely dismisses the fact that Nathalie's recklessness caused the car crash in the first place.
Fortunately, despite Ann's critical condition on admission, after the blood transfusion she is stabilized and steadily improves in the following days. Both she and Nathalie are discharged from the hospital within a week. Andrew receives the genetic test result in the lab but dreads to think about opening it. Unwilling to confront what he believes can become the most momentous heartbreak in his life, he cannot muster inner strength. He feels like he sorely needs to pray before doing that, and he feels like he is unable to pray. After that day when he first prayed in Barcelona's cathedral about his and Pablo's better future, faith has become a crucial part of his life. But now he feels like he can no longer exercise it. He feels like there's an impenetrable, unscalable wall between him and God, and God doesn't hear him. He feels like his soul is completely silenced by his illness. He feels like he is unworthy of being heard by God after all the sins and offenses he committed in his life. He feels like God shut His heart against him. It is lost on him that all these feelings are symptoms of his clinical depression itself, indicative of its severity. Instead, he puts off facing the test result until he gets better and regains his "ability to pray". He hopes to get better by "redeeming his sins", "being a good husband to Nathalie", and thus "earning God's pardon". He doesn't see that the remaining excruciating vulnerability about the issue that is so emotionally significant to him only exacerbates his disease further.
As fate would have it, other circumstances contributing to his worsening condition emerge. Deep down, under his depression-dictated resolve to settle for the misery of his professional reality in Russia, he dreads to think about returning to work in his academic hospital. He is ashamed of his impaired memory and concentration and probably compromised manual skills. He hates the thought that he will again work on a risible salary, making most of his earnings in the form of crumpled bills stealthily shoved by patients into the pockets of his surgical gown. However, on top of that, the hospital holds a far more distressing experience for him. On his first work day, he learns about recent suicides of two young residents in the aftermath of what he realizes was homophobic bullying. He knew one of the guys from his previous years of working there, and he remembers him as a bright and promising resident and a straightforward person, who, just like Andrew and unlike the majority of their colleagues, was not okay with the corrupt realities of the industry including institutionalized bribery and widespread malpractice. As Andrew learns later from talking to his father, being his only relative now doomed to a lifelong grief, the guy suffered from major depression during the last year. Without even understanding it, Andrew projects the entire story upon himself. He observes the hate and cruelty with which the majority of his colleagues, including hospital administration being collective authors of bullying, speak about dead guys. Depression voices in his mind tell Andrew that all homosexual people are deviant and thus doomed to misery and suicide, so sooner or later he will end up the same way.
New incidents indicative of corruption in the clinic do not take long to appear and worsen Andrew's condition. One of the professors offers Andrew to participate in another scientific fabrication with the end of pocketing money from the university grant fund. He watches as under-the-table cash continues to be extorted from patients for insurance-covered treatment in an increasingly undisguised way, while inadequate diagnosis and treatment practices become normalized. He watches as professionally illiterate people get promoted by virtue of corruption and nepotism. He realizes that these very things increasing over the years were what made him want to emigrate. He realizes that these very things were what made his career prospects in Spain so different. But depression keeps unrelenting stronghold on his mind and bullies him into believing he is no longer capable to affect change in his life.
The reality is different, though. Pablo remains present in his life through email correspondence and, without Andrew having to tell him what he lives through at work, Pablo encourages him to immediately quit it. Now as he processes Andrew's story while being sane, unlike Andrew he realizes that working in this soul-sucking job has been the source of Andrew's frustration for years and now it cannot but fuel his clinical condition. Pablo remains strong in his choice, and over and over again he expresses his willingness to be open about their relationship as soon as Andrew moves to Spain. At the same time, Andrew never shares with him his discovery of his daughter's blood type. He doesn't make Pablo aware of this entire delusional theory that God punished him with taking away his paternity for being a bad husband and a bad father, in which their relationship with Pablo is, of course, the root of his transgression. Without this knowledge, Pablo remains unable to run an evidence-based interception to this story. Given that Andrew's condition only gets worse instead of improving (why would it improve?), he still cannot summon courage and faith to pray and confront the genetic test results. Staying blind to the real root causes of his mental affliction, he tries to alleviate it with physical exercise and religious practices in church, but to no avail. Despite what Pablo tells him after making himself familiar with mental health issues in these months following the news about Andrew's diagnosis, Andrew refuses to consider medical treatment, holding internalized stigma against psychoactive drugs. As a result, with the passage of time his mental health deteriorates while Nathalie, rather than giving him empathy and support, is completely focused on the litigation over her father's multi-million-dollar legacy.
Over weeks and months of autumn, Pablo tries to drag Andrew out from his delusions back to reality, but he fails. As Andrew's mental impairment progresses, so does Pablo's guilt about his betrayal that caused Andrew trauma in the first place. His guilt is even more painful because his own publicity and career problems following the dope scandal resolve smoothly and fortuitously, just like the legal proceedings of his divorce. Now fully understanding what a privileged life he has, he is willing to use his power and resources to make Andrew's life by his side as secure and happy and fulfilling as Andrew has always deserved it. He is devastated realizing that now Andrew's mental illness stands in the way of his better future and their common happiness. On his part, Andrew stubbornly refuses to seek for professional treatment in Russia. Aside from the mental health stigma widespread in his society, he holds tight to the belief that he deserves his suffering, that he is a lifelong sinner, a loser, and a failure, and his illness is God's will that he has no right to interfere with. Pablo's attempts to controvert his delusions are not successful, but he urges him to find a psychiatrist in private. By mid-November 2009, when Andrew's non-medical approach of "religious purification" fails to improve his condition, he finally listens to Pablo's words and sees a psychiatrist, who immediately puts him on medical therapy.
Needless to say, Andrew doesn't tell his real story to the psychiatrist. He just seeks symptomatic relief. He starts feeling the adverse effects of the drug almost immediately, but therapeutic effects do not manifest in the least after days and weeks of treatment. The doctor switches him to another antidepressant, then to combined therapy, but nothing works. In the severity of his condition, Andrew remains blind to the truth that the root causes of his mental disorder persist in his outer reality, and their impact cannot be outweighed by the therapeutic power of his medications. Instead, the failure of multiple medical treatments makes him yet more convinced that his illness is God's immutable will and he is destined to burn in the hell of his mental agony forever. So he starts thinking about the hell of the afterlife as an alternative. In December, after a month of failed medical therapy, his suicidal ideation becomes constant. He sees no other way to try to stop the suffering — he thinks it may work just in case God, hell, and afterlife don't exist. Even if they do, he feels like he has already nothing to lose. He never verbalizes it overtly in his ongoing correspondence with Pablo, but Pablo starts feeling the threat in his heart.
In a desperate, last-resort attempt to save himself, Andrew decides to go to a church and confess his "mortal sin" of homosexuality because he keeps believing that it is the main cause of God's "righteous rage" against him. He hopes to receive absolution from God and to earn His mercy. After hiding the story of his love from his psychiatrist, now he reveals it to a priest. Despite his expectations, the priest says that God already forgave him and the only thing he needs to do now is to forgive himself. But this is exactly what Andrew is unable to do in his condition, so he leaves the church not relieved, thinking that either the priest was a fraud, or God hates him so much that He doesn't even accept his repentance. In no less desperate attempt to prove to God how sincere his repentance is, he erases all Pablo's emails from his mailbox as soon as he gets home. He erases Pablo's number from his phone's contacts. For the next few days, he ignores Pablo's new emails and his consequent texts and calls. With the awareness about the severity about his condition, Pablo goes desperate as the silence continues. Eventually, he finds the landline number of Andrew's apartment and blows up his home phone there all day long hanging up when Sofia picks up. When Andrew comes home after work and the phone rings again, Sofia makes him to pick up and Andrew is cornered. Taking the receiver to the bedroom before answering, he abruptly tells Pablo that he will go out and call back from mobile shortly. Sofia hears him talk in Spanish nevertheless, which confirms her guess that Andrew has a secret part of his life linked to Spain and someone important to him in this country, which, as she insightfully sees, is the main reason of his suffering. Calling Pablo from the street half an hour later, Andrew is ashamed of the pain he caused Pablo by ignoring him. He tells him about this failed confession enterprise as the "last-resort measure" he tried to save himself. At this point, Pablo understands that his beloved's mental impairment is terminal and his suicide is within an arm's reach.
Although unable to come to Moscow the exact same day since he has no valid Russian visa that takes two weeks to acquire, Pablo is perfectly right. In a few days, Andrew starts making preparations for an overdose suicide, stealing a pack of narcotic drugs from the hospital. He follows Pablo's self-annihilation scenario, except he knows that no one will come to save him. Unexpected circumstances play in favor of his plan — Nathalie wins the litigation over her father's property, and not bothering to discuss it with Andrew she decides to sell their apartment, which she legally owns, and move to the dead man's country house a dozen miles away from the city. Sofia and Ann are supposed to move with her, but Andrew refuses to move to the house of the man he hated under the pretext that it will take much longer time and much bigger traffic jams for him to commute to work. Nathalie continues to pressure him, and eventually simply informs him that their apartment is already sold and all of them have to leave it by the evening of the next day. Andrew responds that he will move into the former apartment of his parents, the one he has been leasing over the years of marriage. As fate would have it, his tenants recently moved away, so the apartment that provided the most of his monthly income for years is now uninhabited. Nathalie wonders how he is going to live alone in his terrible mental condition, and Andrew states that solitude is exactly what he needs. He does not say it out loud that he wants solitude and seclusion because those are necessary to commit an overdose suicide. He is glad that his suffering will be over so soon. He sets the exact timing for offing himself, which is as close as the upcoming Saturday night, the very first night after moving in there.
He doesn't know that two thousand miles away to the southwest, in the flourishing Mediterranean capital where he once felt like belonged and dreamed to live the rest of his life, the heart of another human being who truly loves him feels the brokenness of his own heart despite so many barriers standing between them. Over all these months, Pablo has been praying for Andrew's recovery aside from being willing to take action to change things for him, but now he feels like despite his efforts and his acknowledgement of the pain he caused Andrew, God doesn't hear him and keeps Andrew in the trap of worsening illness. He is crushed as he feels powerless to heal Andrew's wounds. At this juncture, a desperate idea crosses his mind. On another early December morning, when his parents are still asleep, he drives to the church in a small town away from Barcelona, the one where five years before he made his own confession overwhelmed by homophobic shame. It's the selfsame church where he spoke to a mysterious voice in the confessional booth, the voice which, as he came to believe later, was God's voice. Finding himself alone in this church again, he envisions himself to be face-to-face with the all-mighty God. Feeling otherwise important to change anything for Andrew, he offers God a bargain. He asks God to take away his own health as a sacrifice for giving Andrew's sanity back to him. He says he is ready to accept any illness, as severe as Andrew's suffering. This is how he believes he can redeem the harm he caused to the life of his beloved.
Pablo does not feel that God hears him, and he repeats his plea. Still feeling no sign from above, he presses his argument by saying that Andrew deserves happiness far more than he does. He keeps saying this over and over again in different words, and finally his eye is struck by a ray of morning sun breaking through the window. At this moment, he feels a stabbing pain in his chest. This is the kind of pain he felt only once in his life, that morning on the beach when he ran across Andrew after his exhausting three-hour-long marathon. An avalanche of memories about their meeting rushes over him, and he feels truly happy despite the sharpness of his ongoing pain. After a couple of minutes it subdues, and Pablo leaves the church fully convinced — God has heard him and accepted his sacrifice.
The narrative switches back to Moscow. Andrew is counting minutes down to Saturday night, impatient to put an end to his miserable life. On the morning of the day when his family is supposed to leave what has been their home for years, he gets up early in the morning. Before going to the hospital, he watches each of them sleep and mentally says his last goodbye to them, thinking that he will never see them again. On the way to work, Andrew gets ensnared in dead traffic caused by a closure of the major avenue. He is aware it happens because of the passage of another guarded motorcade of a state official. Just like millions of people commuting by car every day in the city, he knows that it's become a common practice. As he idles for one hour among other blocked vehicles and people who are just like him trapped being late for jobs, meetings, planes, and living their lives, he finds himself thinking whether things are ever going to change for better in this country. He finds it ironic that he gets this typically outrageous experience of contemporary social reality of Russia on what he believes to be the last working day in his life. In the afternoon, along with other physicians of his unit, he is called for a meeting with hospital administration where the staff are ordered to produce their passports. Another practice reflecting the political situation in Russia, it is demanded so that hospital employees' passport data could be used to forge ballots at the hospital's dedicated polling station during Parliament elections this weekend, in order to falsify in the favor of government's party. Andrew refuses to do so, which gets him into an argument with the head of his unit who threatens to lay him off. Andrew doesn't give a shit as he plans to off himself the next day anyway. Leaving the hospital for good, Andrew remembers how much misery it has caused to his life over the years. He notices that his car in the parking lot, perfectly clean in the sunny morning, is now dirty after it rained during the day. It suddenly occurs to him that in Barcelona his own shoes and cars he saw around in the streets remained clean after rain, but in Moscow the air is apparently so polluted that even raindrops absorb dust and dirt as they fall onto the ground. Suddenly, he remembers how much dirt he has seen on city roads for years and decades. He remembers how much dust has been accumulating in their apartment despite air conditioning filters and the fact that Sofia cleaned it every other day. Now he feels like the ubiquitous dirt of pollution in Moscow reflects the intoxication of his own life by multiple, systemic, interrelated emotional traumas that accumulated over the years. He feels that just like the lungs of a forty-year-long smoker are imbued with soot, every cell of his soul is now impregnated with the poison of his pain and the damage is irreversible. Suicide, he concludes, is his only way out.
Before going back to the apartment where he spent his university years struggling with poverty, he drops by the church where he used to pray during all these months of depression and he renders the final prayer to God. Yes, he still feels like he is unable to pray "normally". He still feels like God doesn't hear him and shut His heart against him. But he asks God to forgive him for his inability to bear this suffering anymore and to regard his suicide as the fatal outcome of his disease, not an act of weakness.
When he enters the uninhabited apartment, the apartment where the happiness of his childhood was lost when his parents were killed, he decides to give himself the final blow. Going to put an end to his life the next day, he already has nothing to lose. He takes the paper with the genetic test results that he feared so much to see and reads the truth. As it turns out, he didn't win the lottery. The test proves him to not be the biological father of his daughter, while the DNA from Nathalie's hair sample proves her to be the girl's biological mother. This is the irrefutable evidence of him having been fooled by his wife for years.
And then, all of a sudden, a miracle happens. After months of insomnia and getting no more than a couple of hours of nightmares every night, Andrew now feels healthy sleepiness. It feels like a mountain he was carrying for years now has been lifted off his shoulders, and all he wants is to get a rest. As he slips under the blanket and closes his eyes, instead of dark depression visions, his mind comes back to the bright dreams he once dreamed about Spain. The dreams that he felt were lost forever in the black hole of his illness. The dreams about building a career from scratch. The dreams about being with Pablo. The dreams about taking beach jogs together every morning and watching sunsets every evening together. The story of their love flashes through his mind like a fast-forwarded movie. He remembers the weird rapture of belonging he experienced coming to Barcelona for the first time. He remember how he and Pablo met at the beach. He remembers Pablo's confession and how his conflicting feelings made him walk away instead of saying his truth to Pablo. He remembers three years of silence between them. He remembers their idyllic vacation in Greece. He remembers their reunion in Barcelona and meeting Pablo's parents. He recollects his crazy quest for suicidal Pablo through Spanish countryside. He remembers the ghost-like little girl in the white lace frock who guided him to find Pablo. He remembers Pablo's expression when he left him in ward of a private clinic in Barcelona, and the grasp of Pablo's hug making him promise that he will one day come back. A feeling of joy, completely absent from his life over eight months depression, starts filling his heart again as he watches the pictures of their story, and he does not notice how he slips into a profound, healthy sleep.