I would just like to make a prediction.
I am currently reading The Cider House Rules by John Irving and I am sure I can see the big cathartic moment in the novel, even though I am only on chapter 5.
To be fair, I have seen snippets of the movie version, but not the whole thing. So I know that Homer Wells will ultimately assume Dr. Larch's responsibilities at the orphanage. However, I just got to the part where Homer declares that while he respects Dr. Larch's decision to perform abortions, he will never perform one himself.
So here's my prediction: Homer will leave the orphanage and go to school or work or something and meet and fall in love with a girl. The girl loves Homer -- but only as a friend. They are inseparable until the girl meets some rich guy who she loves, but he's really a jerk. So the girl ends up pregnant and begs Homer for an abortion and Homer has a huge internal conflict. He doesn't want to perform and abortion, but he does for the girl he loves, even though she rejects him. He is devastated and heads back to St. Cloud's and takes over for Dr. Larch.
We'll see if I'm right....