He questions the school's approach to medical care, and clashes with the school's Dean Walcott (Bob Gunton), who believes that doctors must distance themselves from patients. Because of this and other incidents, including a prank during a medical conference, he is
...expelled from the school, although he is later reinstated. Adams develops a relationship with a fellow student, Carin Fisher (Monica Potter), and develops his idea for a medical clinic built around his philosophy of treating patients through humor and compassion.
With the help of Arthur Mendelson (Harold Gould), a wealthy man who was a patient whom Patch met while in the mental hospital, he purchases 105 acres (425,000 m? ) in West Virginia to construct the future Gesundheit! Institute. Together with Carin, medical student Truman Schiff (Daniel London), and some old friends, he renovates an old cottage. When they get the clinic running, they treat walk-in patients without medical insurance, Patch performs comedy sketches for the patients, such as wearing thick glasses and pretending to be near-sighted.
Carin is fascinated by Patch's talent, and their friendship turns into romance
She reveals to him that she had been molested as a child and had always wanted to become a butterfly to escape her torment; Patch reassures her that she can overcome her pain to help others. More encouraged than ever by Patch and his spirit, Carin wants to help a disturbed patient, Lawrence "Larry" Silver (Douglas Roberts), by visiting him at home.
Larry turns out to be far more disturbed than anybody had expected, and he murders her, turning the shotgun on himself soon after. Patch is devastated and guilt-ridden by Carin's death, reconsiders his outlook, and questions the goodness of humanity. He contemplates suicide, but tells God that Heaven is "not worth it" and turns to see a butterfly. He then realizes how Carin mentioned to him that she always wanted to be a butterfly, and decides to continue his work in her honor.
Dismissed from the school for a second time ecause he ran a clinic and practiced medicine without a license, he files a grievance with the state medical board at the advice of his former med school roommate, Mitch Roman (Philip Seymour Hoffman), and must attend a hearing where it is decided whether he can graduate. Patch is able to convince the board in a final speech that he did his best to help the people that came to him, stating that treating a disease of the body is a win-or-lose situation, but treating a person's spirit guarantees a win regardless of the outcome.
He encourages medical students to cultivate relationships with nurses and learn their interviewing skills early, and argues that death should be treated with dignity and even humor. In the end
the jury accepts Patch's medical methods and decides to allow him to graduate. He receives a standing ovation from the packed hearing room. Even at graduation, Patch cannot help but be a non-conformist. After handing Adams a diploma, Walcott states, "Well, I see you've finally decided to conform". Patch responds, "More than you know, sir. " He then bows to the professors and the audience, revealing his nude bottom under his gown.
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