Caravaggio gives the English patient more morphine, which makes him talk in a different way, as if he were outside his body. He talks about Almásy out on a dance floor with Katharine, drunk and making a fool of himself. Neither of them would back down until finally they both collapsed, Geoffrey watching from his chair. Caravaggio wonders who the patient is speaking as now, and watches him and wonders about him. The man who sometimes speaks of himself in the first person, sometimes in the third, yet never refers to himself as Almásy. Caravaggio asks the patient who was talking in this story, and the patient replies, "Death means you are in the third person."

The English patient remembers how he took Katharine from the plane crash and placed her in the cave. He took the colored sand on the cave walls around them and placed it on her body, transforming her as if with makeup. He promised to return to her and walked out into the desert for three days with no food, using only the stars and his shadow to guide his way. When he finally got to El Taj, the English soldiers surrounded him and took him away, refusing to listen to his story about an injured woman who was just seventy miles away.

Caravaggio asks the patient why the English would not believe him. The patient tells them it was because he gave them the wrong name: he gave them his own name, which sounded foreign, instead of giving them Katharine's. At this point in the war, both sides were looking for spies in the desert. The English just locked him up and refused to listen to him.

Caravaggio is still uncertain. He realizes he must break out of this desert that morphine has put him in. He asks the English patient flat-out whether, in trying to kill Geoffrey, he killed Katharine as well. He tells the patient, whom he now calls Almásy, that Geoffrey Clifton was no ordinary friendly Englishman. He was working for British Intelligence as an aerial photographer sent to compile information on the desert as a contingency for whenever that area broker out as a theater of war. British Intelligence knew about Almásy's affair with Katharine the whole time. They thought Clifton's death in the plane crash was suspicious. The English had been waiting for Almásy in Cairo, but finally captured him in El Taj.

Caravaggio explains to Almásy his own role in the war. He was a thief whose skills were legitimized when the war broke out, as he began work for the British and had access to British Intelligence files. Caravaggio says that Almásy had been an enemy of British Intelligence ever since the affair with Katharine Clifton began. They charted his every movement in Cairo and through the desert, and knew that he had worked for Rommel and guided Eppler across the desert. They had figured out the code that was carried in the novel Rebecca a long time ago, and they were waiting for the right time to capture Eppler. Then, after the German had been captured, they were supposed to kill Almásy in the desert, but lost him in his travels. The English patient listens to this story in wonder, surprised that his movements were so talked about by others.

Almásy then fills in the rest of the story for Caravaggio. In detail, he tells him how he waited in the desert for Clifton to pick him up, and nearly missed being killed by Clifton's plane when it crashed. He tells how he carried Katharine from the plane into the cave. Finally, he philosophizes on the nature of love and the importance of dying in holy places.