The Acutes and the aides are watching Nurse Ratched after her outburst while she sits in the nurse’s station. Bromden notes that the fog has disappeared. He remembers he’s supposed to clean the staff room during the staff meeting, but he’s worried after raising his hand on the vote they’ll suspect he’s not deaf and has been listening in. Bromden still goes, aware now that Nurse Ratched suspects him of lying about his capabilities.
The fog has disappeared with McMurphy’s victory; he has momentarily defeated the Combine. Even though Bromden raised his hand, no one mentions the possibility that perhaps he can hear, showing how little Nurse Ratched and the aides are willing to re-evaluate diagnoses let alone allow change on the ward.
Dr. Spivey begins a staff meeting to discuss McMurphy and the other residents (i.e. doctors in training) are all present. Nurse Ratched sits quietly at the meeting, and the residents take her silence as approval of their discussion throughout the meeting that McMurphy should be sent to the Disturbed ward. When she finally speaks, she disagrees with all of them and says that McMurphy is just a normal man, not an “extraordinary psychopath,” who they should pass off to another ward. She believes they should keep him in the ward, and no one disagrees with her. She continues by saying his small rebellion will soon fade out and he’ll lose respect amongst the men. She says they have plenty of time to get him under control.
Dr. Spivey and the other residents are trying to impress Nurse Ratched by saying they believe McMurphy deserves electroshock therapy, because they believe she will take the punitive route. Nurse Ratched, though, doesn’t want to give McMurphy the satisfaction of being labeled some kind of psychopath or extraordinary, when he’s just an ordinary man causing trouble. She believes she can cut him down and expose him for who he is.
Nurse Ratched immediately assigns McMurphy to latrine duty after the staff meeting, i.e. cleaning the communal bathroom. Despite her attempts to assert her power, McMurphy continues to toy with her and the aides as much as he can over the next week. McMurphy hardly cleans the toilets at all, and Bromden notes there really wasn’t that much cleaning going on by the patients anywhere that week. Instead, they gathered around the TV every day that wasn’t on until dinner.
Ratched sees latrine duty as one of the more undesirable chores, and something that will cause McMurphy to act out in some sort of petulant way. Instead, he doesn’t really do the chore at all and this inspires others not to do their chores too because they’re joining McMurphy to “watch” the game.
Bromden feels comforted by McMurphy’s ease, and feels as though the Combine doesn’t have the power over McMurphy that it does over everyone else. He says that for the first time in years the fog isn’t persistent, and he’s seeing people clearly. One night, for the first time in a long time, he can even see out of the window. He sees that the hospital is in the middle of the Oregon countryside. He sees a stray dog and a flock of geese. The dog runs out towards the highway, and he can see the headlights of passing cars. An aide guides him back to bed.
Group meetings have changed; the men even begin to question the logic behind the rules on the ward, like having to take seven people with you to the latrine. McMurphy is satisfied with how things have changed, but is surprised that Nurse Ratched isn’t putting up more of a visible fight. He muses that perhaps she just needed to be put in line, but still feels unsettled by how she acts like she “still holds all the cards up that white sleeve of hers.”
Though McMurphy is happy with the way the men have begun to stand up for themselves with dignity. Notice how McMurphy thinks that Ratched has tricks hidden in her uniform sleeve—it is the uniform that makes her part of The Combine, some non-human force. Her uniform comes to symbolize her power.
McMurphy learns why Ratched is so calm when, that Wednesday, the ward is taken on a mandatory trip to the swimming pool. There, McMurphy learns from the lifeguard, a former football player who has been committed to the hospital for eight years, that it’s only possible to be released from the ward if you have the head nurse’s permission. McMurphy had been under the impression that once he served his court appointed sentence, he could leave—which is how it worked on the work farm. Startled by this news, McMurphy ceases to be confrontational. The next morning, he cleans the latrine perfectly. In the afternoon meeting Cheswick complains that withholding cigarettes from the men isn’t fair and he looks to McMurphy for backing, but McMurphy remains silent. The aides take Cheswick up to the Disturbed ward.
When McMurphy learns that Ratched has actual control over him in ways that matter to him, his immediate instinct is to give in. To get out, he needs to protect himself, to play by Ratched's rules. So he does. But the other men don't know about this change, and Cheswick, the most daring of them, continues to rebel, only to discover that McMurphy, who he thought was his leader, has essentially betrayed him.
Some of the patients suspect that McMurphy is playing a long con against Nurse Ratched, and that’s why he didn’t speak up—but Bromden heard him speaking with the lifeguard and knows the truth. Bromden thinks that McMurphy is doing the smart thing, like the way his own Native American family sold their tribal land to the government—it was inevitable. Bromden thinks it’s safe, “like hiding.”
Bromden can’t blame McMurphy for falling in line like the rest of the patients. He sees the Combine’s power as insurmountable and their victory inevitable, so it’s best to simply hide by being obedient. That's what Bromden's done, after all, in his fog.
However, the other Acutes quickly catch on to why McMurphy is acting differently. None of them act mad or disappointed because they understand why McMurphy has changed his behavior, but they look at him like the wish it wasn’t that way. When Cheswick returns from Disturbed, he tells McMurphy while they are walking to the swimming pool that he understands, though he added that he wished it were different. Cheswick then dives into the water and his fingers get stuck in the grate over the drain. No one can pull him free and he drowns.
Cheswick returns having lost all hope. He had seen McMurphy as the ward’s chance, and his chance, for freedom—and now, in his view, McMurphy has crumbled under the institution’s power. It’s heavily insinuated that Cheswick’s death is a suicide, and that he forced his fingers to get stuck in the grate over the drain.
Soon after, while waiting in the lunch line, Sefelt has an epileptic seizure. Nurse Ratched comes and stands over him saying Sefelt has been refusing his anti-seizure medication. Nurse Ratched pointedly turns to McMurphy and says that Sefelt is an epileptic and this is what it looks like when you “act foolishly.” Fredrickson steps in and asks if Nurse Ratched is just going to let him suffer out of spite. Bromden notes that Nurse Ratched knows, like everyone else on the ward knows, that Sefelt refuses his epilepsy medication. Fredrickson takes both his pills for epilepsy and Sefelt’s. Sefelt’s seizure ends. Fredrickson tells McMurphy that the medication makes your gums rot out and you lose your teeth from grinding them in the seizures. Bromden notes that McMurphy looks “haggard, puzzled,” with a “look of pressure.”
Nurse Ratched tries to use Sefelt as a physical example to McMurphy of what happens when you don’t obey her rule while they wait out Sefelt’s seizure. Note also, though, that Ratched uses Sefelt as an example without making any move to actually help or comfort Sefelt. She just uses him, a man in the midst of an epileptic seizure. The look of puzzlement and pressure on McMurphy's face attests to the bind he finds himself in: controlled by Ratched on one side who holds the one thing he cares about, getting out, but with the fates of the men in the ward hanging on him too, as they see him as their leader.
Harding’s wife comes for a visit to the ward. Harding does not appear in any way affectionate. He calls over McMurphy to introduce him. She mocks Harding for “never having enough” when he doesn’t have an extra cigarette and he questions if this is just literal or also symbolic. She tells him she wishes his limp-wristed friends would stop coming around the house. The conversation is tense. She leaves suddenly, but only after taking McMurphy’s hand and saying she hopes she’ll see him again. Harding asks McMurphy what he thinks of her, and McMurphy says she has great breasts. Harding persists and McMurphy erupts, saying Harding should shut up and that he doesn’t know what to think—“I’ve got worries of my own without getting hooked with yours. So just quit!” Later at dinner, he apologizes to Harding, and Harding shrugs it off—saying it was probably the presence of his wife who can have that effect on people. McMurphy says it couldn’t be her, he just met her—she can’t be responsible for the nightmares he’s been having the past week.
Harding and his wife have a very odd and almost combative relationship. McMurphy's blow-up shows how much he is feeling the pressure of Cheswick’s death hanging over him, and now the pressure of all the men on the ward looking to him as a kind of symbol of hope and freedom. It is worth noting also that McMurphy's feelings about women are almost entirely sexual—his only comment about Harding's wife pertains to her breasts. It might be possible to argue that McMurphy looks at women in much the same way that Ratched looks at men.
On a Friday, three weeks after the vote about the World Series, everyone who can walk is taken for X-rays for TB in Building One. Across the hall from the X-ray office are those for electroshock therapy. McMurphy asks Harding what goes on in there, and Harding explains the Shock Shop (EST). Harding says it isn’t always used for punishment, like Nurse Ratched uses it, and can sometimes actually help people. Harding says McMurphy shouldn’t worry about it because EST is “almost out of vogue” and used only in extreme cases, similar to a lobotomy (which Harding calls a “frontal-lobe castration.” He says that Ratched is the one in charge of sending the patients for EST or a lobotomy.
Harding emphasizes that there are actually some people who benefit from EST. Nurse Ratched, though, doesn’t use these tools as treatment, but punishment. Harding’s claims that EST and lobotomies are “almost out of vogue,” foreshadow McMurphy eventually receiving both. Harding calls lobotomies “frontal-lobe castrations” because he believes this is the closest Ratched can actually get to castrating the men.
McMurphy tells the men that he finally understands why none of them ever said anything to quell his rebellious actions, because he was unaware of the stakes and the danger it put him in with Nurse Ratched: shock treatment, lobotomy, not being able to leave. Harding shocks McMurphy by responding that Scanlon is the only other Acute on the ward who is involuntarily committed—everyone else can leave whenever they want to. McMurphy asks Billy Bibbit in disbelief that he surely must be committed, why would he be here when he could be off with girls driving around in a convertible, and Billy begins to cry, claiming his mother is a good friend of Nurse Ratched and he doesn’t have the guts to leave, like McMurphy does.
McMurphy is shocked that he and Scanlon are the only two involuntarily committed Acutes on the ward. It shows how much these patients are so terrified of the outside world and its social pressures, that they would subject themselves to Ratched every day rather than face it. They don’t believe they are worth enough to live a full life beyond the walls of the ward because they have been convinced by society and the hospital that they are incapable of ever being happy or being viewed as “normal” or “sane.”
Heading back to the ward across the grounds, McMurphy lags behind the others, smoking a cigarette. Bromden drops back to walk with him, wanting to tell him not to worry. McMurphy asks one of the aides if they can stop and buy cigarettes, and buys three cartons. Bromden feels a ringing in his ears that persists until that afternoon when they have a group session. After the meeting finishes, Nurse Ratched says that she has decided with Dr. Spivey that because of the lack of remorse the men have shown for their behavior surrounding the World Series protest, the tub room that has been used for card games now has to be taken away as a privilege. She doesn’t look at McMurphy but everyone else does, including the Chronis. McMurphy just smiles at everyone and tips his hat at Nurse Ratched
Bromden can sense, with the ringing in his ears, that something is about to happen with McMurphy. McMurphy’s anxiety has been building up. Ratched believes she has McMurphy beat when she doles out the punishment for the game room and McMurphy does not respond beyond tipping his hat, as if giving in after a game well played.
Nurse Ratched ends the discussion. McMurphy shrugs and stretches as he stands up. Bromden says he can see it’s too late to stop McMurphy from whatever he’s going to do. McMurphy walks over to the nurse’s station where Nurse Ratched is sitting, and her eyes get big because she figured this was her “final victory over him” but suddenly sees that it isn’t. She starts looking for her aides to protect her, but McMurphy just stops at the glass window and says he wants some of the cigarettes he bought. Then he punches his hand through the glass, and apologizes saying the glass was so clean he forgot it was there. He turns around as Nurse Ratched sits still, her face “jerking,” and he finds a chair and starts to smoke. The ringing in Bromden’s ears stops.
The ringing in Bromden’s ears stops because McMurphy has made his decision—even if it means he will never get out of the ward, he will keep on rebelling, continue to be a leader and a source of fun and hope for the other patients. In this moment, he has sacrificed himself for them. And in doing so he has fought back against the Combine, not just angering Ratched but actually scaring her. By instilling this fear in her, stemming from his physical prowess, he believes he can undo her.