Nurse Ratched arrives and discovers that Bibbit and Starr have had sex. Bibbit blames Starr, the other patients for teasing him and, finally, McMurphy for his actions. Ratched threatens to tell Bibbit's mother and sends him to wait in Doctor Spivey's office where he commits suicide by cutting his neck.
Ratched blames McMurphy for the suicides of Bibbit and Cheswick, and he responds by physically attacking her after smashing through a glass door. He tears her uniform, exposing her ample bosom, and chokes her before being stopped by a group of aides, doctors, and nurses. He is sent to Disturbed, where he receives a lobotomy.
Several of the patients check themselves out before McMurphy is returned to the ward. When he does return, his friends deny that the lobotomized individual is McMurphy. Knowing that it is indeed McMurphy, Chief suffocates him and picks up the control panel to push out the screened window. Chief escapes, following the same path he saw the dog chase the geese. He takes a ride with a Mexican hauling sheep and decides to head back to visit the dam where his tribe once lived.
Bibbit's betrayal of McMurphy and subsequent suicide has literary antecedents in the story of Judas, the apostle who betrayed Jesus Christ to the Roman soldiers and then hung himself. McMurphy's love for Bibbit induces him to attack Ratched after she accuses him of responsibility for his death. In his attack, McMurphy rips her uniform and exposes her large breasts. By exposing her as a human woman beneath her air of authority and starched uniforms, he robs her of her mechanical power, a symbolic act that frees the remaining patients to leave the hospital.
Because he is a Chronic and not free to leave the hospital at will, Chief escapes from the hospital. The path he takes, however, is the same path that he saw the dog chase the geese earlier in the novel. In the first scene, the dog runs toward the headlights of an oncoming car, which may be interpreted as a battle between animal and machine that the animal cannot possibly win. The reader is left wondering if Chief remains outside the hospital, or returns where he writes down his memories of McMurphy.
hallucinate to perceive sights, sounds, and so on that are not actually present.
lobotomy a surgical operation in which a lobe of the brain, especially the frontal lobe of the cerebrum, is cut into or across as a treatment for psychosis.
ramshackle loose and rickety; likely to fall to pieces; shaky.