In 1962, soon after One Flew Over the Cuckoo's Nest was published, Ken Kesey and Viking Press were sued by an employee of the hospital where Kesey worked while he wrote his novel. The plaintiff claimed that a minor character in the book, a Red Cross nurse who appears in two scenes, was too obviously based on her, and that the characterization was defamatory in nature. Rather than argue the merits of the case after the book was already in print, Kesey and Viking agreed to change the passages in question. As a result, though Cuckoo's Nest is one of the most popular novels of our time (reprinted more than 100 times in the US alone), few have had a chance to read the text as the author and publisher intended it.
     The Red Cross nurse appears in two passages, each about a page long, but before that she is named on page 11. The only revisions made to this paragraph come near the end, where two references to the Red Cross woman are changed to "Public Relation." In this scene McMurphy, the novel's protagonist, has just entered the mental ward where most of the novel's action takes place.

     He talks a little the way Papa used to, voice loud and full of hell, but he doesn't look like Papa; Papa was a full-blood Columbia Indian — a chief — and hard and shiny as a gunstock. This guy is redheaded with long red sideburns and a tangle of curls out from under his cap, been needing cut a long time, and he's broad as Papa was tall, broad across the jaw and shoulders and chest, a broad white devilish grin, and he's hard in a different kind of way from Papa, kind of the way a baseball is hard under the scuffed leather. A seam runs across his nose and one cheekbone where somebody laid him a good one in a fight, and the stitches are still in the seam. He stands there waiting, and when nobody makes a move to say anything to him he commences to laugh. Nobody can tell exactly why he laughs; there's nothing funny going on. But it's not the way the Red Cross woman laughs, it's free and loud and it comes out of his wide grinning mouth and spreads in rings bigger and bigger till it's lapping against the walls all over the ward. Not like that fat, wet Red Cross laugh. This sounds real. I realize all of a sudden it's the first laugh I've heard in years.

     He talks a little the way Papa used to, voice loud and full of hell, but he doesn't look like Papa; Papa was a full-blood Columbia Indian — a chief — and hard and shiny as a gunstock. This guy is redheaded with long red sideburns and a tangle of curls out from under his cap, been needing cut a long time, and he's broad as Papa was tall, broad across the jaw and shoulders and chest, a broad white devilish grin, and he's hard in a different kind of way from Papa, kind of the way a baseball is hard under the scuffed leather. A seam runs across his nose and one cheekbone where somebody laid him a good one in a fight, and the stitches are still in the seam. He stands there waiting, and when nobody makes a move to say anything to him he commences to laugh. Nobody can tell exactly why he laughs; there's nothing funny going on. But it's not the way that Public Relation laughs, it's free and loud and it comes out of his wide grinning mouth and spreads in rings bigger and bigger till it's lapping against the walls all over the ward. Not like that fat Public Relation laugh. This sounds real. I realize all of a sudden it's the first laugh I've heard in years.

The first scene involving the Red Cross nurse occurs when she guides a group of visitors through the ward, on pages 35-36. In the revised text, the character is changed to a man, and he is identified with Public Relations. The scene, like all in the novel, is narrated by Chief Bromden, who is schizophrenic.

     Ten-thirty the Red Cross lady comes in with the ladies' club, clapping her fat hands at the day-room door. "Oh, let a smile be your umbrella… Isn't it nice, girls? Clean and cheery? This is Miss Ratched. I chose this ward because it's her ward. She's, girls, just like a mother. Not that I mean age, but you girls understand…"
     She laughs louder and faster than if it was real, like the sharp, nervous laugh some women make at the table wround guests they're uncomfortable with. The Red Cross Lady's underclothes are so tight it bloats her face up when she laughs, makes it round and red as the sun that some first-grader painted and put a big smiling face on it. She's a Jew girl and tell lots of Jew jokes to show us it's okay we're not Jews too. She's got funny blond hair and a brown mustache and no eyebrows at all to speak of, so she's drawn curved lines over her eyes to make do. She conducts these tours — serious women in blazer jackets, nodding as she points out how much things have improved over the years. She points out the TV, the big leather chairs, the sanitary drinking fountains; then they all go have coffee in the Nurses' Station. Sometimes she's by herself and she'll just stand in the middle of the day room and clap her hands (you can hear they're wet), clap them two or three times till they stick, then hold them prayerlike together under one of her chins and start spinning. Spin round and around there in the middle of the floor, looking at the TV, the new pictures on the walls, the sanitary drinking fountain: "Oh, everything is so spanking brand new. How nice. How fun-ny!"
     What she sees that's so funny she don't ever let us in on, and the only thing I can see funny is her spinning round and around out there like a toy — if you push her over she's weighted on the bottom and straightaway rocks back upright. Like a spinning top. She never looks at the men's faces…

     Ten-thirty Public Relation comes in with a ladies' club following him. He claps his fat hands at the day-room door. "Oh, hello, guys; stiff lip, stiff lip… Look around, girls; isn't it so clean, so bright? This is Miss Ratched. I chose this ward because it's her ward. She's, girls, just like a mother. Not that I mean age, but you girls understand…"
     Public Relation's shirt collar is so tight it bloats his face up when he laughs, and he's laughing most of the time I don't ever know what at, laughing high and fast like he wishes he could stop but can't do it. And his face bloated up red and round as a balloon with a face painted on it. He got no hair on his face and none on his head to speak of; it looks like he glued some on once but it kept slipping off and getting in his cuffs and his shirt pocket and down his collar. Maybe that's why he keeps his collar so tight, to keep the little pieces of hair out.
     Maybe that's why he laughs so much, because he isn't able to keep all the pieces out.
     He conducts these tours — serious women in blazer jackets, nodding to him as he points out how much things have improved over the years. He points out the TV, the big leather chairs, the sanitary drinking fountains; then they all go have coffee in the Nurses' Station. Sometimes he'll be by himself and just stand in the middle of the day room and clap his hands (you can hear they are wet), clap them two or three times till they stick, then hold them prayerlike together under one of his chins and start spinning. Spin round and around there in the middle of the floor, looking wild and frantic at the TV, the new pictures on the walls, the drinking fountain. And laughing. What he sees that's so funny he don't ever let us in on, and the only thing I can see funny is him spinning round and around out there like a rubber toy — if you push him over he's weighted on the bottom and straightaway rocks back upright, goes to spinning again. He never, never looks at the men's faces…

The Red Cross nurse appears for the last time on pages 85-86, when Chief Bromden is in a hallucinatory spell. In the revised text, the Public Relation man reappears instead.

     I hear a silly prattle reminds me of someone familiar, and I roll enough to get a look down the other way. It's the plump Red Cross woman Gwen-doe-lin, with the blond hair the patients are always arguing about is it real blond or not. "I say it's brunette," they'll argue."And I say it's true blond; you ever hear of a good Jewish girl bleaching her hair?"   "Yeh, but you ever hear of any blonde what had a dark brown moustache?" The first patient shrugs and nods,"Interesting point."
     Now she's buck naked except for a little white apron with a red cross on the pocket and red rick-rack on the edges. And I see once and for all (the string cuts into her belly clean out of sight and pulls the spron up short) that she's a definite brunette.
     Dangling from that apron string she's got half a dozen withered objects, tied by the hair like scalps.
     She's carrying a little pad and a mechanical pencil inlaid with jewels, taking notes on the pain and hell around her, plans to write a funny novel about it all later. There's a clutch of schoolteachers and college girls and the like hurrying after her. They wear blue aprons and their hair in pin curlers. They are listening to the Jew woman give a brief lecture on the tour.
     She thinks of something funny for her book and stops her lecture long enough to note it down, giggling as she writes. During the pause one of her pupils stargazes around and sees the gutted Chronic dangling by his heel. She gasps and jumps back. The Red Cross woman turns and catches sight of the corpse herself and rushes to take one of those limp hands and give it a spin. The student shrinks forward for a cautious look, face in a trance.
     "You see? You see?" The woman squeals and rolls her brown eyes, slaps the girl on her bare thigh,"Didn't I tell you? It's funny, honey, funnneee!"
     She starts back along the row of machines and goes into her lecture again. She stops suddenly and slaps her forehead —"Oh, scatterbrained me!" — and comes flapflipping back to the hanging Chronic to rip off another trophy and tie it to her apron alongside the others.

     I hear a silly prattle reminds me of someone familiar, and I roll enough to get a look down the other way. It's the hairless Public Relation with the bloated face, that the patients are always arguing about why it's bloated. "I'll say he does," they'll argue. "Me, I'll say he doesn't; you ever hear of a guy really who wore one?"   "Yeh, but you ever hear of a guy like him before?" The first patient shrugs and nods. "Interesting point."
     Now he's stripped except for a long undershirt with fancy monograms sewed red on front and back. And I see once and for all (the undershirt rides up his back some as he comes walking past, giving me a peek) that he definitely does wear one, laced so tight it might blow up any second.
     And dangling from the stays he's got half a dozen withered objects, tied by the hair like scalps.
     He's carrying a little flask of something that he sips from to keep his throat open for talking, and a camphor hanky he puts in front of his nose from time to time to stop out the stink. There's a clutch of schoolteachers and college girls and the like hurrying after him. They wear blue aprons and their hair in pin curls. They are listening to him give a brief lecture on the tour
     He thinks of something funny and has to stop his lecture long enough for a swig from the flask to stop the giggling. During the pause one of his pupils stargazes around and sees the gutted Chronic dangling by his heel. She gasps and jumps back. The Public Relation turns and catches sight of the corpse and rushes to take one of those limp hands and give it a spin. The student shrinks forward for a cautious look, face in a trance.
     "You see? You see?" He squeals and rolls his eyes and spews stuff from his flask he's laughing so hard. He's laughing till I think he'll explode.
     When he finally drowns the laughing he starts back along the row of machines and goes into his lecture again. He stops suddenly and slaps his forehead — "Oh, scatterbrained me!" — and comes running back to the hanging Chronic to rip off another trophy and tie it to his girdle.

There's a little more to this story. The woman who sued Kesey — who thought she saw herself in the the Red Cross woman — became a writer herself. In the 1970s she wrote a popular novel about the so-called human potential movement, set in a California spa which may or may not have been a thinly disguised version of Esalen. A well-known nude therapist thought he saw an unsavory portrayal of himself in her book, and took her to court over the matter. Whether or not she would have revised her text to satisfy the therapist, as Kesey and his publisher did for her, soon became moot when her book lapsed out of print, apparently for good.

Excerpts from One Flew Over the Cuckoo's Nest © 1962, 1990 Ken Kesey. The illustration at the top of the page is from the uncredited cover art for Signet's 1963 paperback version of the novel. The illustration at bottom is by R. Crumb, from the cover of The Last Supplement to the Whole Earth Catalog (1971). Thanks especially to Ken Lopez, Bookseller, of Hadley, Mass., for the info.