One of the "black boys" boasts to another that he can order Chief — who is "big enough to eat apples off my head" — to do his bidding, establishing Chief, the narrator of the story, as a large, passive, half-Indian. Chief can hear the men talking, which they do freely in his presence because they believe Chief is deaf. Not only does Chief hear the employees, he describes their conversation as the "hum of black machinery, humming hate and death and other hospital secrets."
Big Nurse Ratched enters the ward, and Chief describes her as carrying a wicker basket that contains the wheels and cogs she'll need to maintain the machinery of the Combine. He relates that her basket contains none of the feminine accoutrements one normally would imagine in a woman's purse.
Big Nurse catches the black boys' conversation, and Chief describes her resulting anger as a powerful force that inflates her size to as "big as a tractor," enabling him to "smell the machinery." She reverts to her original physical shape, however, when other patients enter the hall. She tells the employees to quit talking and go back to work, addressing them in an authoritative yet patronizing tone.
Chief describes Big Nurse's large breasts as a source of bitterness for her, because he believes she would have been a perfect machine without a woman's physical attributes to remind her that she is human. The rest of his description of Big Nurse refers to her less-than-human characteristics: a "smooth, calculated, and precision-made" face "like an expensive baby doll" and her "flesh-colored enamel" skin.
