We survive by remembering....but sometimes we survive by forgetting
The movie begins with a young girl Anna and a male lying on the beach at a party. After he tells her he loves her (and subsequently produces a condom) she gets up to leave. As she goes, her sister Alex asks if everything is all right. On her way through the woods to her house, Anna encounters three white garbage bags. When she goes to open them, the corpse of a redheaded girl falls out. As Anna recoils, the girl's head snaps around and speaks. Anna runs home, and upon getting there she hears the bell that her mother, who is terminally ill, rings when she needs something. Anna is concerned because her mother is not supposed to be alone. However, after she leaves the boathouse her mother is in, it explodes into flames. All of a sudden a piece of debris comes flying towards her, burning her. It is then revealed that this is a dream.....
She has been in a mental hospital since the death of her mother ten months earlier, but her psychiatrist believes she is ready to leave and as Anna packs, another patient enters, asking who she will tell her stories to now that Anna is leaving. Anna's father takes her home, where she is joyfully reunited with her sister, Alex, who is angry that Anna never responded to the letters she wrote. Once Anna tells her that she never received any letters, Alex yells at their father for not sending them. Anna also sees Rachel, her mother's former nurse who is now dating Anna's father. Later that night, Anna overhears Rachel and her father having sex, so she turns up her music to a louder volume.
The next day, Anna meets with Matt, a friend. Matt tells Anna he knows what happened the night of the fire. However, Rachel comes before he can say anything more and sends him away. That night, Anna wonders to herself if the fire that killed their mother was not an accident, and the following day she and Rachel go into town so Anna can talk to Rachel. Rachel discusses her former patients with Anna, telling her that the only way she got through it was by reminding herself that the people she was caring for would be dead soon. She also showed Anna her pearls, saying they were a gift from one of her patients. Anna sees the little girl from her dream along with two little boys, but this vision quickly evaporates.
When Anna meets up with Matt, he tells her he will meet her at "the rock" that night to tell her what he saw. Anna and Alex wait on the rock, but he does not show up. Later that night she goes home and goes upstairs to her bedroom, when Matt comes in her window, saying he hurt his back. They speak for a few minutes and then begin to kiss, but when she touches his back it is twisted and broken. He grabs her arms as she recoils in horror. The next day they find out that Matt died of a broken back on his way to see Anna. Anna shows Alex that there are bruises on her arms where Matt grabbed her and Alex becomes scared for them both.
Later that night, Anna and Alex start researching and learn that Rachel lied about her name. Anna confronts Rachel, who becomes angry and tells Anna if she says anything, she'll be sent back to the mental hospital. That night, Rachel has a dinner party that Anna inadvertently ruins after the red-haired girl comes out from under the stove, telling Anna that "she's next." The girls' father goes for a business trip on the day of Matt's funeral, and the redheaded girl shows Anna to the gravestones of a family of five. Later that day, she researches the children of the family. The suspected killer was a woman named Mildred Kemp, who was the nanny of the three children after their mother had died in a car accident a year before. The killer had heavily sedated the children before stabbing them repeatedly. In a picture Anna sees the mother wearing a pearl necklace just like Rachel's. The two sisters begin to think that Rachel and Mildred are one and the same.
Alex and Anna try to get to the pearls as evidence for a case against their father's girlfriend. A struggle ensues between Anna and Rachel, but Anna manages to get the pearls. When she goes upstairs to check if Alex is okay, she finds that Rachel has heavily drugged her with the needles Anna and Alex found earlier, and she must leave Alex behind. Anna finds Rachel's car keys and tries to drive away, but the car stalls and Rachel catches up to her, only to be dragged to the ground once Anna manages to start the car again and drive off.
At the police station Anna explains everything, begging the police officer to hurry because Alex is still at the house. He leaves, and while he is gone Anna falls asleep and dreams about her mother, but as she gets closer to her, the dream ends, replacing her mother with Rachel, who, with the police officer's help, sedates Anna and takes her back to the house where she suspects Rachel will kill her. As Rachel prepares to dress Anna in her pajamas, Anna reaches for a knife, but can't grasp it. As the drugs are taking over, Anna sees Alex creeping up behind Rachel before she finally blacks out. Once Anna wakes up once more, she sees a trail of blood that leads to the body of Rachel outside in a trashcan. Alex steps out from the woods covered in blood, holding the knife and exclaiming that she had to do it. They hug and clasp hands when their father pulls up into the driveway. Anna and Alex begin explaining what happened when Anna's father grasps her and tells her that Alex is dead; she had died in the fire one year ago.
Anna looks around for Alex, but realizes she is alone. Suddenly, she notices Alex standing in the shadows. As Anna slowly walks toward her, she sees that it's her reflection in a mirror instead of Alex.
It is revealed that the night of the party, once Anna had come home, she had seen Rachel and her father having sex. Disgusted, she went to the boathouse to fill a watering can with gasoline so she could burn down the house. She did not shut off the faucet all the way, and when she slammed the door, Alex accidentally knocked over a lantern. Once the gasoline reached the lantern the boathouse exploded, killing her mother and Alex. Through a series of flashbacks, we see that Alex had never really been there, that Anna had been the one who killed Matt and Rachel, and that Rachel was not truly evil. Anna is arrested and institutionalized once again.
While Anna is at the institution she says to her psychologist that she did what he had told her to, she had "finished what she started." It is also revealed that the institutionalized woman at the beginning was "Mildred Kemp."
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