As part of the celebration of the new century, Dr. Urbino and Fermina ride the first hot air balloon in their country and deliver the first piece of airmail. The flight goes well except that as they fly over banana plantations, they see many dead men lying below. Dr. Urbino and Fermina are told the men have died of cholera, but they all show deep injuries in their necks. Florentino witnesses their ascent and their return three days later, and it is in moments like this that he realizes how time is passing, for he sees the changes in Fermina.
As Florentino becomes more successful he sees Fermina in social settings more often, and he starts to believe that her indifference to him could actually be a shield for her timidity--or more, her deep love for him. This belief reinvigorates his feelings for her, and he starts to haunt her villa as secretly as he can. He waits to see them outside of their church, but for four Sundays in a row he sees Dr. Urbino and the children but not Fermina.
Her absence from all civic or social ceremonies continues for the rest of the year. Try as much as he can, Florentino cannot find out what happened to her. He becomes convinced that she has gone to a private hospital to die, and for the first time he considers what would happen if she died before either Dr. Urbino or himself. Florentino becomes so desperate that he goes so far as to try to find out from Lorenzo Daza what happened, but he learns that Lorenzo has died.
Fermina actually was at her Cousin Hildebranda Sanchez's ranch in a small village near San Juan de la Cienaga. She had sailed near midnight with her face covered to protect her privacy so that no one but her family and Hildebranda knew where she went. She left as a result of a crisis in her marriage, expecting never to return. Dr. Urbino did not stop her because he was too burdened by his guilt. Fermina felt a nostalgic longing to return to San Juan de la Cienaga, so she went to stay with Hildebranda.
Fermina is gone for almost two years before Dr. Urbino finally goes to take her home. Towards the end of that time the children come to visit her, and Marco Aurelio's letters home lead Dr. Urbino to believe that she is somehow content with her new life. The Bishop of Riohaca comes to see her and asks for her confession, but she says she has nothing to confess--an answer she knows will reach her husband's ears.
The problem: Fermina discovered that Dr. Urbino was having an affair. She found out by employing her habit of smelling his clothes to decide whether they needed to be laundered. Her sense of smell was impeccable, and one day when she smelled Dr. Urbino's clothes, she found a completely new scent on them. She began to smell his clothes carefully every day. She even went to Dr. Urbino's office to look through his notebooks to try to determine the source of the smell. She grew even more suspicious as she noticed changes in Dr. Urbino's behavior.
Fermina could not bear her suspicions any longer, so after four months she confronted Dr. Urbino. He met Barbara Lynch when she was a patient at Misericordia Hospital, and from the moment he saw her he became obsessed. As the story goes, he stops by her house on the way home, and the next day he returns for a supposed follow-up checkup that quickly becomes sexual. He starts to visit her as close to daily as he can--it is very risky because his carriage is so conspicuous, but he cannot help himself. His obsession and the pain of keeping it secret start to have physical effects on Dr. Urbino. Once Fermina has confronted him on some level, he assumes she knows it all, and he makes the decision not to return to Barbara.
Thus, Dr. Urbino decides to unburden himself to Fermina in an attempt to cure his physical and spiritual ailments, telling Fermina the whole story. As he does so, she visibly ages and becomes completely enraged, convinced that she is the gossip of the town. A few days later she leaves for Hildebranda's ranch with the idea that she will stay there as long as she needs before coming to a decision about how to continue. Fermina feels very disappointed as she travels to Hildebranda's, for the time of her youth spent in San Juan de la Cienaga included some of her happiest times, and she finds it changed to a depressing degree. She also finds it horrifying to see Hildebranda, who is much fatter and much older, because it makes her realize that she too has aged very much. Thus begins her two years away. When Dr. Urbino finally comes to get her after the two years, Fermina is happy to return home with him.
Two years later-two years after her return with Dr. Urbino-Florentino goes to the movies with Leona. He realizes that Fermina and Dr. Urbino are sitting right behind them. After the movie Florentino and Leona walk around the city until very late, and he invites himself into her house for brandy. He tries to seduce her for the second time, but once again she turns him down. Florentino realizes how old they are all getting, and he considers the terrifying possibility that he might die before Dr. Urbino.
Don Leo is ordered by his doctor to retire, and he slowly becomes more and more senile. At ninety-two he finally recognizes Florentino as his sole heir to the company and then retires. By this point Florentino has stopped acquiring new lovers, but he continues to see established ones. By the time of Dr. Urbino's death, he has only one lover left, America Vicuna, a relative of his from Puerto Padre who is in his city for boarding school. He is entrusted as her guardian. She is only fourteen, but they develop a close relationship and love each other. He has just made love to her when he hears the bells tolling on Pentecost Sunday for, unknown to him, Dr. Urbino's death.
Florentino takes America back to school so that he can go to Jeremiah de Saint-Amour's funeral, but on their way he hears from the coachman that it is Dr. Urbino who has died. He goes immediately to Dr. Urbino's house and sees Dr. Urbino's body lying in his bed. Florentino is so happy that life has interceded for his sake that he cannot prevent himself from making his declaration of love to Fermina, who kicks him out. He grows more and more desperate over the next two weeks, and he finally believes he is going to die unrequited. Then he finds a letter on his doorstep from Fermina Daza.
Sickness comes up repeatedly in the fifth section of Love in the Time of Cholera. Dr. Urbino meets Barbara Lynch because she comes to the hospital for treatment; Florentino goes to the doctor, believing he is ill, to hear that he is only suffering from old age; Fermina sees bodies covering the streets from what is called a cholera epidemic; Don Leo retires in senility; and Urbino convinces himself he is physically ill because his passion for Barbara is so great. It is not surprising that sickness appears more prominently as the characters get older. Earlier in the novel, class is a strong predictor of illness, but this section shows that age is even more susceptible to disease than poverty is.
Still, the experience of illness remains highly different between the rich and the poor, as this part emphasizes. When Fermina disappears for two years, Florentino assumes she has left the city to go to a private hospital where no one will know of her illness, as all the rich who fall seriously ill do. In contrast, the cholera victims in San Juan de la Cienaga are left lying on the streets without even the benefit of burial after their death.
Surprisingly, it is Dr. Urbino and not Florentino whose physical illness is a symptom of his love in this section. This fact seems to solidify the book's connection between love and illness; Dr. Urbino is significantly less romantic and obsessed with love than Florentino, yet his love is strongest (if we are to believe him after the end of his affair and the return of Fermina) as he ages. Florentino's illness is simply the illness of age. Even so, this condition is related to love in Florentino's case, because any sign that he is aging is a sign that he is running out of time to share love with Fermina.
Age is significant for Fermina in this section too, because it is the first time she really seems to change. After hearing about her husband's affair, she ages ten years in a night, and for the rest of the section almost all of the descriptions of her are focused on her aging. The possibility that Florentino's love for Fermina might wane with her aging is never raised; he is disturbed by the changes in her because it shows that time is running out, not because she is losing attractiveness. His fourteen year-old paramour cannot tempt him away from his true love, wrinkled though she may be.
In this vein, more shocking than any of the characters' physical symptoms of aging is Florentino's gradual loss of all his other lovers. That many of them have died highlights how long he really has been waiting for Fermina. Even more, the fact that Florentino stops pursuing new loves (except for America) shows the most profound change in his behavior since he first decided to wait for Fermina for as long as it took. This fact shows that Florentino, for the first time, realizes that whether he finally ends up with Fermina or not, the chase will end soon with his own death, for he no longer bothers trying to fill her spot in his life with the love of others.
When he finally has his chance, Florentino acts rashly. Dr. Urbino's death is too fresh for Fermina to turn immediately to Florentino. She kicks him out for good reason--with her dead husband in front of them. A little reflection would reveal that Florentino might still have a chance at another time. The portentous letter provides suspense, and readers who have been rooting for Florentino all this time have reason for new hope.