You have to deliver your tried and true BB's corpse to the incinerator, a poetic end to how you started your journey.
At the last second before the doors of the incinerator shuts, he snatches Lou's pod and remembers Deadman's words that there is a 70% chance of catastrophic failure when removing a BB from its pod. Sam reconnects his cord with Lou one last time and sees a flashback of the scene where Cliff is fleeing the room.
Soon after learning the President's intentions, Clifford attempted to flee with the baby but was shot during the escape. After being found and confronted, Clifford was fatally shot by John McClane and President Strand, accidentally killing the BB in the process.
Sam is the perfect legacy for him, a bridge who brought people together. Cliff gives Sam BB, who we now know is Sam as a baby. The trio embrace. and then saved him when he was lost on the beach.
Louise is particularly a female name, however, as well as the name Sam gave to his unborn daughter. ^ Deadman incorrectly surmises that Sam's unborn child was a boy. Lucy confirmed in her ninth report that their child was in fact a girl.
Nothing is confirmed, but the film certainly seems to suggest that Lou could be alive. Still, Hannah and Vee are (presumably) safe going forward, which is at least some sort of a happy ending after all.
Sometime through their marriage, Lucy became pregnant with Sam's daughter, planning to name her Louise. However, around her seventh month of pregnancy, Lucy began suffering DOOMS nightmares, a result of Sam's condition being passed down to Lou.
Having a lower level of DOOMS allows Sam to sense BTs but doesn't allow him to see them without the aid of a Bridge Baby (BB). Sam's second unique trait that is revealed early on is that he is a repatriate, meaning he can come back from the world of the dead.
The handprints arrayed across Sam's body are said to be the amount of times he has repatriated, with a new handprint showing on him after each repatriation. Sam has never been able to visit his Beach of his own volition. Sam's aphenphosmphobia is mainly used to refer to Sam's aversion to physical contact.
Aphenphosmphobia – Sam's phobia that causes human contact to permanently mark his skin, hence the handprint scars all over his body.
In practice, the date hardly matters in-game and doesn't affect how your character plays. It does, however, unlock a fourth wall breaking birthday message for players.
The only known documented repatriate is Sam Porter Bridges, a result of Amelie bringing a neonatal Sam back to life after he was shot to death. This violation of the normal order of life and death made his Ha reject The Beach, resulting in his bodily fluids, thus his Ka, reject beings from The Beach.
The implication being that if have (pick) a birthday in one of these constellations you'll have a stronger DOOMs ability. What that actually means isn't clear. The general consensus is that it doesn't really do anything meaningful so you won't have a better or worse experience whatever date you pick.
Repatriation. Beached Things (BTs) are entities whose souls are stranded in the world of the living following the events of the Death Stranding. BTs are considered extremely dangerous and are almost invariably hostile toward living beings.
Sam is the Original BB All Grown Up
In a panic, having certainly not intended on killing BB, Amelie rushes to Sam's beach and revives BB, thereby giving renewed life to what eventually becomes Sam, and explains his ability to repatriate from death.
Her death caused a voidout in the satellite town of UCA-01-0C, leaving Sam, a repatriate, as the sole survivor in the area and the primary suspect of the incident. Due to public pressure and guilt, he left Bridges and became a freelance porter, isolating himself from society and cutting himself off from the living.
Our protagonist Sam' Porter' Bridges, in addition to an array of other characters such as Fragile, Mama and Higgs, all suffer a kind of allergic response to the presence of Chiralium due to a rare condition known as DOOMS. Much like actual allergies, these can manifest in a number of ways.
Frequent blood drawing is linked to anaemia. Anaemia is linked to going grey early because oxygen is not supplied to the scalp. Sam has his blood drawn in excess during the game and undoubtedly afterwards as well."
Aphenphosmphobia is a phobia, or extreme and irrational fear, of intimacy. That includes physical touch, which is why Sam reels from hugs or even simple handshakes in Death Stranding.
Causing a Voidout
Once Sam dies, he enters the Seam and will have to find his body to return to life. However, providing Sam gets eaten by a giant BT, which can be summoned by getting dragged off by a BT in the world, he can cause a Voidout.
Sam possesses a DOOMS level of two, enabling him to sense BTs, but he is unable to see them without connecting to a bridge baby. He also has aphenphosmphobia for much of his life, a fear of touch and an affliction causing him to have an allergic reaction upon being touched.
By all accounts, Death Stranding has just one ending, which is essentially a feature-length cutscene. Kojima wanted to tell the story in a very specific way, so unless some intrepid explorer discovers some ultra-secret hidden ending, assume that there's only one way for the game to end.
As players learn in the game, Lou is Sam's unborn child.
The true identity of Cliff is something of a mystery throughout the game. By the end of the game, however, we learn that Cliff is Sam's biological father, and the mysterious cutscenes of Cliff talking to a bridge baby are shown from a first person perspective as these are Sam's memories.
The story presented was Amelie suffering from locked-in syndrome, causing her extended isolation. In reality, the young woman is Bridget's Ka, or soul, and Bridget is the Ha, or body, of the same consciousness. Because she lives on the Beach, Amelie does not age.