This chapter kicks off Shutter Island’s climax, and the puzzle pieces of the plot start to make more sense. Teddy immediately notices the room has sheets taped to the wall, and Cawley has Teddy’s suit coat, his notebook, and Laeddis’ intake form on the desk in front of him. Cawley tells Teddy his rifle is not loaded, and when Teddy verifies that information, he invites the marshal to take a seat. Cawley tells Teddy that Dr. Sheehan is on his way, and when Teddy asks where he has been, Cawley explains that Sheehan has been on the island the whole time.

Cawley laments the loss of his car, and Teddy offers a half-hearted apology before asking for a glass of water. Cawley gives him one and then lists his symptoms, which Teddy already knows because “‘a woman doctor’” told him as much (323). Cawley corrects him, telling him he is actually experiencing withdrawals from chlorpromazine, an anti-psychotic medication that Cawley says Teddy has been taking “‘for the last two years’” while he has been a patient at Ashecliffe (324). Teddy does not believe Cawley, so Cawley removes the sheets from the wall to reveal four names connected by lines: