Joan announces to Esther that she's decided to become a psychiatrist. And that she gets to live outside the asylum now – with a nurse in Cambridge.
The narrative shifts abruptly to Esther telling Irwin that "it hurts" (19.18).
Esther had met Irwin on the Widener Library steps at Harvard. After some drinks and dinner, Esther had decided that she would lose her virginity to Irwin.
But after they have sex, Esther starts to hemorrhage. Irwin drives Esther over to Joan's place.
Not really wanting to share with Joan what happened, Esther just says she's having a problem with her period. Esther, still bleeding profusely, gets Joan to help her to the emergency room, where she gets medical attention.
Back at the asylum, Esther is fast asleep when she's woken up by Dr. Quinn, Joan's psychiatrist. Dr. Quinn asks Esther whether she knows where Joan is. Since the episode in Cambridge, Joan checked back into the institution, although still able to leave the institution for visits into town.
Esther tells Dr. Quinn that she doesn't know, and goes back to sleep.
Esther is woken up again by Dr. Quinn, who tells her that Joan has been found. Joan had committed suicide by hanging herself in the nearby woods.