The English patient flashes back to another of his memories, describing the time in Cairo when he was in love with Katharine. One day he asks his friend Madox what the spot in the front, right at the base of a woman's neck, is called. Madox tells him to pull himself together.
Caravaggio tells Hana that he thinks the English patient is not really English. He thinks he is a Hungarian man named Almásy who worked for the Germans during the war. Almásy had been a desert explorer throughout the 1930s. He knew all about the desert and its dialects, and when the war broke out, became a guide for spies, taking them across the desert into Cairo. Caravaggio thinks the patient is Almásy because one night the patient suggested some very peculiar names for the dog—names only Almásy would know. Hana sticks to her opinion that the patient is an Englishman.
Caravaggio continues, telling Hana the whole story of the Hungarian man. Almásy had helped the German spy Eppler get across the desert. Eppler was an extremely important man, as he delivered coded messages directly to General Rommel through a code hidden in a copy of the novel Rebecca. Almásy was known for both being able to fly planes and being able to sound English. He was educated in England and in Cairo he was even known as "the English spy." Caravaggio is almost certain that the English patient is Almásy.
Since being wounded, Caravaggio has become a morphine addict. Hana noticed that he found and raided her supply of medicinal morphine as soon as he got there. Now Caravaggio wants to give her English patient a Brompton cocktail—morphine and alcohol—to get him talking. Hana is concerned and thinks Caravaggio is too obsessed with her patient's past. She figures that it does not matter what side he was on now that the war is over. Hana tells her patient that Caravaggio thinks he is not English. She also tells him that Caravaggio was a thief, albeit an unsuccessful one, in Canada.
After the Brompton cocktail, the English patient talks freely about the events that led up to his plane crash. He tells Caravaggio exactly where he was in the desert, having just left the Gilf Kebir. Driving through the desert, his truck exploded. He assumed it had been sabotaged by one of the Bedouins, as there were spies from both sides among them. Escaping the explosion, he set out in the direction of a plane he knew was buried at one location in the desert. After four nights of walking, he arrived at Ain Dua, where the plane was buried. There, he cooled himself in the waters of the well and entered the cave where Katharine remained. He had promised to return to her. He found her in a corner wrapped in parachute material, dead. He approached her, as a lover does, and made love to her dead body. He then carried her out into the sun, dressed, and brought her to the plane.
Katharine had been in the cave for three years. In 1939, she was injured when her husband Geoffrey attempted a murder-suicide with his plane. Geoffrey had somehow found out about their affair and intended to kill all three of them in one moment. He was supposed to pick up the English patient in the desert at an appointed time. He arrived, but was flying erratically. He landed not fifty yards away from the English patient, intending to crash into him and kill all three at once. But the English patient was unhurt and Katharine was only injured by the crash. Still, she was too weak to walk across the desert, so he carried her to the cave to wait for him. He left his copy of Herodotus with her. He promised to come back for her and take her to safety. Three years later, he did.
The English patient flashes back to the events leading up to the fateful plane crash that injured Katharine. It was during their months of separation, when Katharine insisted that they not see each other anymore, that the English patient became bitter. He could not bear that she would not see him, and he became determined that she had taken another lover. Her last endearments to him seemed false, and he trusted nothing. In his copy of Herodotus he wrote down all her arguments against him, wanting to record them so he might remember and believe them. It was the patient's meanness to Katharine that made Geoffrey suspect that he was her lover.
While he was carrying Katharine's injured body from the plane to the cave, they had a few moments to talk. She told him that he killed everything in her during their separation. She said that she left him not only because her husband was mad, but because she knew she could never change him. He would not reveal one more inch of his character to her, and she felt isolated.
Three years after he had this conversation with her, he came back to find her dead body. He dug up the buried plane, for which he had brought fuel, and placed her inside it. They took off in the plane and flew a small distance when the plane begins to fall apart. Oil poured over his knees as the bottom of the plane brushed the trees. There was a spark and the whole plane caught fire. He parachuted down to the ground, and only then did he realize that his entire body was on fire.
Back in the present, the English patient talks to Kip. They share a can of condensed milk, which the English patient greatly enjoys. He tells Kip that they get along so well because they are both "international bastards," born in one place and choosing to live elsewhere. Kip thinks of all the teachers he lost, his English mentors. He is emotionally withdrawn.
In The English Patient, there is no single narrator, as each of the main characters has a voice at one time or another. The point of view shifts from one character to another, sometimes within the same chapter, offering descriptions of a single event from multiple perspectives. The critic Lorraine York points to the evening of Hana's birthday to illustrate this "complicated dance of gazes." On this evening, Caravaggio watches Hana's legs as she walks: "her legs and thighs moved through the skirt of her frock as if it were thin water." Then, from Kip's point of view: "Hana moved alongside them, her hands in her pockets, the way Kip loved to see her walk." This change of perspectives adds depth to the narrative, emphasizing the presence of multiple realities and various points of view within a scene. There is no one character who is the only watcher, or other characters who are the only ones watched. Each character watches in his or her own right, taking in sensory experiences and mixing them with memories. Ondaatje's use of this technique makes the narrative a complete tale, rejecting the idea that there is only one story to be told.