The Narrator shows up at Marla’s hotel; Marla has called him there. Marla is calm, despite the fact that she recently found out what Tyler was doing with her collagen. She says she’ll forgive the Narrator for the collagen incident if he investigates the lump on her breast—she’s afraid it’s cancer. The incident reminds the Narrator of how, long ago, he went to a medical school to have a wart removed from his penis. During his time there, the doctors noticed the birthmark on his ankle—a birthmark that they at first thought was a new, lethal form of cancer. Disappointed, the doctors removed the wart and let the Narrator go.
Marla seems to treat the Narrator as a close confidant, and yet, based on the novel’s depiction of Marla so far, her request for a “breast examination” seems more like a sexual flirtation. To reinforce such an ambiguity, the passage mentions another instances in which sex and death are closely tied (the wart on the Narrator’s penis). The Narrator’s birthmark further reiterates the constant presence of death in his life: to a doctor, it appears that the Narrator is going to die of cancer soon. The doctors’ vague disappointment that the Narrator doesn’t have cancer again suggests the coldness and dehumanization of modern society.
The Narrator continues to examine Marla’s breasts; as he does, he tries to make Marla laugh. He tells her a story about a woman who married a mortician; the mortician forced her to soak herself in ice water and lie perfectly still immediately before he had sex with her. As he tells the story, The Narrator thinks about the birthmark on his foot—a birthmark that could have been cancer. He also notices that Marla has “Tyler’s kiss” on the back of her hand.
The Narrator is genuinely trying to cheer Marla up, since he’s afraid that she’s actually going to die of cancer (and even the Narrator’s jokes underscore the close connection between sex and dying. The passage also contrasts two different marks: Tyler’s kiss and the birthmark. The former is a symbol of loyalty to fight club, acceptance of pain and sacrifice, and collectivism (since, now, other people have the same “kiss”), while the latter is a symbol of the Narrator’s individuality and uniqueness.