The fourth and final section of this novel depicts the final showdown between Randle Patrick McMurphy and Nurse Ratched. This part begins with Chief telling the reader that Ratched began planning a counterattack on McMurphy while he and the group were on their fishing excursion. Chief somewhat omnisciently relates that Ratched knows that people eventually grow suspicious of individuals who seemingly operate selflessly on behalf of others.
She plants the seeds of dissent in the group while McMurphy takes a phone call. She prompts the group to question McMurphy's motive when she tells them he has won more than $300 from the other patients. While the patients enjoy the additional benefits that McMurphy has provided, they suspect that he may be motivated by more than philanthropic impulses.
Ratched manipulates the conversation by asking if any member of the group considers McMurphy a "martyr or a saint." She continues that McMurphy is taking credit for giving the patients items and freedoms that were not his to give. She climaxes her attack on McMurphy by revealing to the patients that McMurphy made money off the patients when he arranged the fishing trip. Ratched tells Billy Bibbit, McMurphy's most staunch defender, that she doesn't disapprove of McMurphy's actions, but that she feels the patients shouldn't delude themselves that McMurphy's actions are selfless.
