"Her face is smooth, calculated, and precision-made, like an expensive baby doll, skin like flesh-colored enamel, blend of white and cream and baby-blue eyes, small nose, pink little nostrils—everything working together except the color on her lips and fingernails and the size of her bosom. A mistake was made somehow in manufacturing, putting those big, womanly breasts on what would of otherwise been a perfect work, and you can see how bitter she is about it.”

Bromden presents Ratched as an essentially sexless agent of the Combine. His comments foreground the body as a site of manipulation and resistance. Ratched’s body, mechanized in service of social norms, plays a role in controlling the bodies of others, including Bromden. McMurphy’s uninhibited physicality and sexuality run counter to Ratched’s efforts.

“But it’s the truth even if it didn’t happen.”

Bromden’s comment may suggest he is aware that his account, filtered through his hallucination-prone perspective, deviates from a literal recounting of events. It can also be seen as a metafictional commentary on the novel itself, or even the role of fiction generally. Though the specific characters and events are not real, they are analogous to things that could or do happen, making the novel truthful, if not literally true.

“I remember the fingers were thick and strong closing over mine, and my hand commenced to feel peculiar and went to swelling up out there on my stick of an arm, like he was transmitting his own blood into it. It rang with blood and power. It blowed up near as big as his, I remember.”

McMurphy manages to rouse Bromden and the other patients from their complacency. Bromden senses this charisma from the moment he first shakes McMurphy’s hand. The physicality of the handshake and Bromden’s sense of a blood transfer signifies the primal, instinctive level through which McMurphy acts and communicates, as opposed to the dry clinical environment of the ward.