HBO’s I Know This Much is True is a gripping adaptation of Wally Lamb’s bestselling novel. Starring Mark Ruffalo as tortured twins Dominick and Thomas Birdsey, the limited series takes us to the emotional brink, showing us the heartache caused by mental illness, grief, and generational trauma. However, I Know This Much is True‘s final episode, which premiered tonight on HBO, leaves the audience with a glimmer of hope. The only problem? The ending of HBO’s I Know This Much is True is different than the ending of Wally Lamb’s book. Here’s why…
I Know This Much is True opens on Dominick Birdsey narrating a tragic episode for his paranoid schizophrenic brother, Thomas. Convinced that the only way to atone for America’s sins is a blood sacrifice, Thomas attempts to hack off his own hand in the middle of a public library. This shocking opening sequence sets up a tale of profound sorrow, and eventually, hard-earned reconciliation. By the end of both Lamb’s novel and the show, Dominick Birdsey has learned the power of owning up to his own failings and forgiving those who have wronged him.
However, Wally Lamb’s novel takes a slightly different path. Dominick gets something of a happily ever after, though it comes at a heavy cost. HBO’s version ends with just the suggestion that Dominick might reunite with his ex-wife and start a new family with her.
Here’s how the ending of HBO’s I Know This Much is True is different from the book, and why.

I KNOW THIS MUCH IS TRUE ENDING EXPLAINED: HOW THE SHOW IS DIFFERENT FROM THE BOOK
I Know This Much is True‘s final episode opens with Dominick Birdsey successfully managing to transfer his brother Thomas out of an abusive mental hospital and into his home. However, Thomas immediately commits suicide. This loss forces all of the pent-up anger in Dominick to boil over at the funeral. Most of this rage is directed at his stepfather, Ray (John Procaccino). Over the course of the episode, Dominick must reckon with his grief and anger through therapy. He also learns to let go of certain hurts and to reach out to both Ray and ex-wife Dessa (Kathryn Hahn). By episode’s end, Dominick has found a measure of peace in his life and his relationships. He also learns the true identity of his father: Henry Drinkwater. This means that the deceased Penny Ann and still alive Ralph Drinkwater (Michael Greyeyes) are his cousins.
The final shot of the miniseries sees Dominick joining Dessa in the infants ward at the local hospital. Dessa is volunteering with the children’s wing of the hospital, which is how the two reconnect after Thomas’s funeral. It should be pointed out that Dessa and Dominick’s marriage fell apart only after the sudden death of their infant daughter, Angela. This final moment suggests that despite Dominick’s vasectomy, the two might be parents yet in the future.
While all this basically happens in the book, a big swerve is what doesn’t happen to Dominick’s much younger girlfriend Joy (Imogen Poots). While Dominick is able to figure out that she’s been cheating on him — thanks to the fact that she’s pregnant and he had the aforementioned vasectomy — in the book, Joy’s fate is darker. Through her affair, she has contracted HIV, and ultimately dies of AIDS. Her daughter is adopted by Dominick and Dessa. Also Dominick wins the lottery. It’s a lot.

WHY HBO’S I KNOW THIS MUCH IS TRUE‘S ENDING IS DIFFERENT FROM THE BOOK
To understand why I Know This Much is True ends on a much more ambiguous final shot, Decider went to the man himself: writer and director Derek Cianfrance. The Blue Valentine auteur adapted Lamb’s sprawling novel for the screen and explained to us why he chose not to end the series with Dominick and Dessa adopting Joy’s baby.
“It’s very satisfying in a novel to wrap everything up and have a sense of closure, but, to me, my favorite movies are the ones that have open endings, that allow the audience to generate their own kind of projections on what happens,” Cianfrance said. “In some ways, the story of Joy having a kid, becoming Dominick’s adopted kid, and Dominick becoming a millionaire…there became too many conveniences.”“I wanted his growth in the end to become more minute, right?” Cianfrance said. “I wanted it to be more of a glimmer of hope so that you could see the possibilities of his future but not heal it completely. And I think that’s more redemptive and more real.”
Cianfrance went on to say that while he loves the way the book ends, he felt he had to change it onscreen thanks to the differences between the two storytelling mediums.
Cianfrance said, “The way the book ends is perfect for the book. You have more time in a book. You can put the book down, you can walk away and go have dinner. You can come back to it later, but there’s this linear idea of cinema and shows that it just keeps on going and it’s almost too much to take at one time.”
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'I Know This Much is True' Ending Explained: Here's Why it's Different from the Book - Decider
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