Clayton Beresford Jr. (Hayden Christensen) has a lot going for him. He's the heir to a powerful business empire, is obscenely rich, and is engaged to a beautiful, loving woman named Sam (Jessica Alba). However, he has two major problems. The first is that, despite being engaged for six months, he hasn't worked up the nerve to tell his mother that he has been dating her personal assistant behind her back. The second problem is that he has a bad heart... and without a transplant, he could die from a heart attack at any moment.
In one fateful evening, his fortune seems to turn. After finally breaking the news to his none-too-pleased mother, he and Sam elope that night. And then, while the newlywed couple prepare to spend their first night together as husband and wife, his pager goes off... and Clayton finds out that a matching heart has just arrived at the hospital. After they noticeably take their time getting to the hospital, Clayton says goodbye to his new bride and his terrified mother as he's wheeled off to the surgical table.
As the anesthesia sets in, Clayton thinks of Sam as he prepares to drift off to sleep, confident that he's in the capable hands of his surgeon and best friend Dr. Jack Harper (Terrence Howard). As the minutes go by, he jokingly comments the cocktail his stand-in anesthesiologist gave him doesn't seem to be working, but none of the surgical team pays any attention to him. He starts to realize that something has gone horribly wrong when he can feel them prepping the incision area, and his fears are confirmed when Dr. Harper slices his chest open and begins cracking his ribcage. Clayton is still awake. He can see and feel everything. But no one can hear him.
Then, just when he begins to push through the excruciating pain, Clayton hears something that chills him to his very core: his doctors are discussing their plans to kill him by making it look like he received a faulty donor heart. Trapped in his own mind, Clayton futilely screams for help, but to no avail. He's going to die, and there's nothing he can do to stop it.
Awake contains examples of the following:
- Abusive Parents: Clay's father.
- Adventures In Coma Land: While Clayton's doctors perform the surgery and plot his death unaware that he can hear them, Clayton can do nothing but relive his memories that led up to this point, scrutinizing every detail to try to understand what's going on. After the transplant "fails" while he remains hooked to the bypass machine, everything in his dream world grows dimmer and dimmer, until finally fading to pitch black.
- And I Must Scream: While the anesthetic keeps Clayton totally paralyzed, he can hear every word spoken by his doctors and can feel every cut of Dr. Harper's scalpel... and the saw used to cut open his sternum.
- Anti-Villain: Jack Harper is the only participant in the murder plot who is genuinely regretful about the whole thing and is reluctant to go through with it in the first place. He turns on Sam at the end.
- Artistic License Medicine: While the caption card that opens the film isn't a complete misrepresentation of the truth, the statistics that it cites include those who feel any degree of Anesthesia Awareness, including those who merely wake up for a second or two and then quickly fall asleep again, and those who have a vague sensation of feeling the doctors operate on them. The number of people who experience the kind of Anesthesia Awareness that Clayton does here is thought to only number a couple of hundred people, worldwide, every year.
- Big Bad Friend: Dr. Jack Harper, Clayton Best Friend plotted with Sam to kill him.
- Billy Needs an Organ: The story is centered around Clayton's need for a new heart, and the plot of his doctors to make it look as though the transplant was a failure. In the end, his mother (who was previously established as a match for his rare blood type), kills herself so that she can give her heart to her son.
- Bitch in Sheep's Clothing: Sam who's plotting to have Clayton killed.
- Bittersweet Ending: Clay survives thanks to his mother's Heroic Sacrifice and everyone involved in the murder plot is arrested, with strong implications that justice will be served in the future. On the other hand, Clay has lost his mother, and the love of his life was not only not who he thought she was, she also conspired to have him killed.
- Chekhov's Gun: In a brief scene near the beginning of the film, Sam grabs her mail and sticks it in her purse as she and Clayton are on their way out of her apartment. This becomes important later on when Clayton's mother goes through her purse after finding out that the transplant failed, and finds out that not only was Sam living under an assumed identity... but that she used to be a nurse, who worked with Jack Harper in the past.
- Domestic Abuse: Clay's father again.
- Face Death with Dignity: Clay eventually accepts that he's going to die and there's nothing he can do about it, so returns to his apartment in his mind to peacefully wait it out.
- Fan Disservice: Hayden Christensen shirtless? Nice. Hayden Christensen shirtless and having his chest sliced into? Not so nice.
- Foregone Conclusion: Subverted. The film opens with Jack talking about how Clay died during the surgery, so viewers expect the film to have a Downer Ending. As it turns out, Clay survives thanks to his mother.
- Freeze-Frame Bonus: Towards the end, when Clay is in his mind preparing to die, Clay's father, in the Santa suit, can be briefly seen in the foreground before the last light in the room goes out.
- From Bad to Worse: Clay's realization that he's still conscious is horrifying enough. Then he learns that the surgeons are planning to murder him.
- Heroic Sacrifice: Lilith, after figuring everything out, kills herself so her heart can be transplanted to Clay.
- Honey Trap: Sam is revealed to have seduced Clayton in a plot to kill him in surgery to get the insurance money.
- Hospital Hottie: Sam used to be a nurse under Dr. Harper, and to pay off their malpractice lawsuits, she plotted to seduce his rich best friend so they could kill him and get the insurance money.
- Mama Bear: It is eventually revealed that Lilith murdered her violent husband in order to protect Clay.
- Manipulative Bastard: Sam.
- Meaningful Name: One member of Clayton's surgical team is a young British woman named Penny Carver.
- The Mole Larry Lupin, who pretends to be an annoying, incompetent, drunk of a surgeon, but is really an undercover cop. Jack Harper suspects him and wants to end the plot, but Sam talks him into going through with it.
- My Beloved Smother: Clayton's mother Lilith's over-protective nature is the main reason that he is afraid of telling her about his engagement, as he knows she would never accept Sam. She also tries to get him to drop Jack, his best friend, as his heart surgeon in favor of an acquaintance of hers who is at the top of the field. As it turns out, she was right on both counts.
- Oh, Crap!: Although there's no facial expression to show it due to being paralysed, Clay's tone of voice says it all when he realizes he's still conscious. He reacts similarly when he finds out about the murder plot.
- Organ Theft: Clay and his mother joke about this as a solution to having to wait for his turn on the heart transplant list.Lilith: "I'm serious this time. Let's go to China, try out luck on the black market."Clayton: "Why don't we just go outside, grab some random person, drag him in here and, y'know..."Lilith: "Sounds good to me. Drag 'em in and cut 'em open! Hey, whatever it takes, right?"
- Psychological Thriller: Overlapping with Psychological Horror.
- Shirtless Scene: Clay has a few prior to surgery.
- Starts with Their Funeral / How We Got Here: The film opens with Dr. Harper lamenting the fact that while he has lost patients before, Clayton is the only friend he's ever lost on the surgical table. He then ponders whether Clayton was thinking of "her" that day, before the scene switches to Clayton and his fiance Sam together in his apartment several days before the surgery.
- Think Happy Thoughts: Clayton tries to cope with the pain of the surgery by thinking of Sam.
- Token Good Teammate: Dr. Larry Lupin, the anesthesiologist. Although he's an alcoholic, he's the only one who's not in on the plan to kill Clay (as he was brought in after the other anesthesiologist backed out of the plan), he's the only one who checks on Lilith after Clay's death while the others are covering their tracks and upon learning the truth, manages to help bring them to the authorities.
- Toplessness from the Back / Side Boob: Sam when she's brushing her teeth naked at the start of the movie and later sitting up in bed post-sex in Clayton's memories.
- Villainous Breakdown: When the murder plot is foiled, Sam's façade and demeanour rapidly deteriorate.
- What Happened to the Mouse?: The fifth member of the surgical team, an anesthesiologist backs out.