Martin returns from Ontario more in love with Madeline than ever, and they are re-engaged. Twenty minutes later, she is sneering at Clif Clawson, at fishing, and at all schoolteachers.
The junior year of medicine is "a whirlwind." Martin does his first original research in a manner that evokes praise from the meticulous Gottlieb.
Gottlieb sends his assistant to a hospital in Zenith, where he becomes lost and encounters a probationer nurse who is scrubbing the floor. She is Leora Tozer.
Within half an hour, the two are well-enough acquainted for Martin to plan a dinner date for the evening. They dine together twice in two weeks, and only twice in that time does Martin see Madeline. Leora is never critical or corrective, and Martin is at ease with her. She tells him of her home, the tiny sordid village of Wheatsylvania, North Dakota, and of the Tozer family. Soon Martin is engaged to two girls at once.
That evening, Clif and Martin visit a tavern together, and under the influence of liquor Martin telephones both Leora and Madeline late at night to meet him the next day for lunch at College Square. Both accept. By bringing the two girls together, Martin expects to find out which one loves him. Next morning, he wakes sober, "with a crackling skull" and a realization that he is going to face both his fiancées at lunch.
The meal at the Grand Hotel is a painful one. Stylish Madeline patronizes untidy Leora by inquiring about her family, the West, and all the personages of Zenith society whom Leora could not conceivably know and whom Madeline herself knows but little. At last, Martin is forced to blurt out the purpose for which he has brought them together — that he is engaged to them both. Madeline springs up, stares at them, and walks away, wordless. Leora has won, and she vows never to give Martin up.
"I am stupid and ordinary and she isn't. I simply admire you frightfully . . . while she has sense enough to make you admire her and tag after her." This remark made by Leora after Madeline releases her hold on Arrowsmith reveals the diversity of character traits in the two women. One would change and reform the man she marries. The other would submerge her own personality in his.
In this chapter, Lewis deals briefly with romance, giving it some surprising turns, such as the planned meeting of the two fiancées. His first wife, Grace Hegger Lewis, is thought to be the original of Madeline Fox. Evidently Lewis prefers the permissive type of woman, exemplified by Leora, especially for the wife of a character like Arrowsmith, whose first love is science with everything else in the world secondary.