Anna WAS alive and Deacon WAS a serial killer according to director
According to an interview with the director as shown on the film's DVD, Anna was alive, and there are many clues throughout that point to this. Just before Anna's accident, she is being tailgated by a white van that we later learn belongs to Deacon. About 60 minutes into the movie, Anna is in a room with Deacon with a mirror. She admits that she looks like a corpse, closes her eyes, and exhales. Her breath fogs up the mirror, which Deacon wipes away before she reopens her eyes. When Paul is at the police station, one of the cops mentions that a drug exists that could slow heartbeat to almost nothing and cause paralysis. When we see Deacon giving Anna an injection shortly after, the vial has the same name on it. Note that it is pointless to inject a corpse with anything because there is no blood flow and therefore no way to circulate a drug through the body. There is also the scene between Anna and Deacon where she sees her breath condensation on the handheld mirror and panics, screaming "You lied to me!" Deacon is in fact a psychopath, who takes it upon himself to decide who gets to live. The final clue is when Deacon puts Anna's picture on his wall, and we pan out to see all of the pictures. Some of the people have eyes open, other eyes closed. Wojtowicz-Vosloo says that those whose eyes were open were, like Anna, ones who were not really dead.
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