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She seems to be ashamed of her own sexuality, consistently buttoned up in her white nurse's outfit, but she cannot hide her large breasts, her one incongruous physical trait. McMurphy likes to remind Nurse Ratched that she is indeed a woman. As the tension builds with McMurphy, Nurse Ratched overcompensates to show her masculinity. As a metaphor, then, it is only appropriate that her final comeuppance involves McMurphy (symbolizing freedom) tearing open her uniform and unleashing her breasts and body.