The Twist: The 'twist' is that the solution Ruben sacrifices everything for—the cochlear implants—is a failure. Instead of restoring his hearing to normal, they provide a harsh, distorted, digital signal that makes music sound unbearable and conversations difficult.
The Ending: Ruben realizes that he cannot return to his old life with Lou; she has moved on and healed, and his presence brings back her anxiety. He leaves her while she sleeps. Sitting alone on a park bench in Paris, surrounded by the unbearable digital screeching of the city through his implants, he makes a choice. He removes the processors. The sound cuts out instantly. In the profound silence, he looks around at the trees and people, finally finding the 'moment of stillness' Joe spoke of. He has stopped fighting.