There are two different kinds of patients in the ward, the Acutes, who have a chance of being cured, and the Chronics, for whom there is no hope. McMurphy introduces himself to all the Acutes first, including Billy Bibbit, a young man with a restrictive stutter, and Harding, an older gentleman with effeminate hands. Harding introduces himself as the "bull-goose loony" (McMurphy's term), and he and McMurphy have a mock contest to determine who is nuttier. McMurphy wins. He then introduces himself to the Chronics, shaking hands with all of them who are willing, until he finally comes around to Bromden. He stares at the Chief for a moment, and Harding and Bibbit explain Bromden's state. McMurphy offers him a hand to shake, and Bromden takes it.
The Big Nurse is obsessed with having everything in the ward exactly as she likes it, running smoothly. She's been there longer than anyone else, even Bromden. Over the years Bromden has watched as she's manipulated things into getting the right doctor for the ward and three black aides who are perfect for her needs. The ward itself is operated on a strict, specific schedule of medication, meals, and sleep. Some time in the past, a patient named Taber had the temerity to ask what sort of medication he was getting. The Big Nurse treated him like a child, and later he was lobotomized in order to keep calm on the ward.
"Yes. This is what I know. The ward is a factory for the Combine. It's for fixing up mistakes made in the neighborhoods and in the schools and in the churches, the hospital is. When a completed product goes back out into society, all fixed up good as new, better than new sometimes, it brings joy to the Big Nurse's heart...." Chapter 4, pg. 40
