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When the Nurse tries to convince the patients that McMurphy does not care about them, only their money, Harding reminds them that McMurphy has never hidden the fact that his main purpose in coming to the hospital was to make money. Then McMurphy fights the orderlies to prevent George from having to have an enema, and the Chief comes to his aid. Suddenly the patients are back on McMurphy's side; but he and the Chief are in for some serious punishment. They are both sent to the Disturbed ward and given shock treatments.
McMurphy's treatment is filled with religious imagery. The table where the shock is administered is in the form of a cross to which the patient is strapped. McMurphy jokes about the graphite salve by saying, "Anointest my head with conductant. Do I get a crown of thorns?". He sees himself as a martyr, willing to sacrifice himself for the good of the others. McMurphy is also given a hose to bite on during the treatment, just as Christ was given a piece of cloth dipped in vinegar to suck on. There is even a man on the ward who says, "I wash my hands of the whole deal," referring to Pontius Pilate's washing his hands of Christ's trial.
Suffering from his shock treatment, the Chief remembers a rhyme his grandmother used to sing to him. "Ting. Tingle, tingle, tremble toes, she's a good fisherman, catches hens, puts 'em inna pens. . . three geese inna flock... one flew east, one flew west, one flew over the cuckoo's nest. . .O-U-T spells out. . .goose swoops down and plucks you out." The rhyme is obviously the source of the novel's title. The fisherman is the Big Nurse, who catches "hens" and puts them in pens, referring to the patients in the hospital that she encourages to "peck" at one another. The one who flies over the cuckoo's nest, "the bullgoose", is McMurphy, with the nest being the hospital. The one he plucks out is the Chief.
When McMurphy comes back to the ward after his shock treatments, he sees that Harding has taken his place as the leader. Harding tells McMurphy that the patients are not "rabbits" any more, only "sick" people who will get well some day. Ironically, McMurphy has lost his sanity, while helping the others to become sane. When he tears open the Big Nurse's uniform, he proves how far he has slipped away from sane behavior. There is no way that she will let him get by with such an insult. Fortunately, the other patients are much better, due to his efforts, and do not need him anymore. Even the Chief has been restored to his full height and acts with logic and sanity, thanks to McMurphy.
The price McMurphy has to pay for violating Nurse Ratched is a lobotomy. After the operation, he is returned to the ward as a vegetable to serve as an example to other potential troublemakers. The Chief cannot let this happen to McMurphy and mercifully kills his friend. Having logically performed his duty, the Chief is now sane enough to face the outside world; he escapes (flew the cuckoo's nest) by breaking the window with the control panel, which he can now lift as a result of McMurphy's coaching.
The novel ends on a question. The whole story has been narrated from within the hospital shortly after McMurphy's death. Has the Chief been captured and brought back to the cuckoo's nest? It is important to notice that he rejected McMurphy's hat, saying it is too small, and indicating that he will not accept McMurphy's role as a martyr. Is it also important to note that he has escaped in the direction that he had seen the dog take towards the highway; but the dog was on a collision course with the car, foreshadowing that the Chief was also on a collision course when he ran away. It is also important to note that Nurse Ratched is a representative of the Combine, which is omnipresent and omnipotent. It is doubtful whether the Chief could really destroy her. Instead, it is more likely that the Combine will destroy him, just as it did his father.
The ending of the novel is ambiguous; but it must be remembered that the narrator is a paranoid schizophrenic. The Chief even says about the story, "It's the truth even if it didn't happen".