Roy moves into his third rotation, this time back with the Fat Man as his resident supervisor. The Fat Man warns the interns that the ward they’re working in is “the worst” but is optimistic that the group will do well. He also tells the interns that he’s applying for a gastrointestinal fellowship and needs a letter of recommendation from the Fish, so they should all try to stay on the Fish’s good side. The Fat Man introduces the interns to some of the patients, all of whom seem to be gomers with gastrointestinal issues. Roy and the other interns are disgusted on their first day and run out of a room with patients in it because of the smell. The Fat Man decides to try out a bowel-binding remedy on the patients, to help him find a remedy for an antibiotic he prescribed at another hospital (he received a kick-back for doing so) that has a side effect of terrible diarrhea. 

Roy notices a change in the Fat Man’s demeanor, as the other man begins to make more of an effort for the patients, sitting up with the woman with terminal cancer from Chapter 13. One of Roy’s former patients, Saul, who had cancer and then went into remission, is admitted again with a resurgence of the cancer.