Patch is guilt-ridden by Carin's death and begins to question the goodness in humanity. However, Larry murders Carin, then commits suicide. Encouraged, Carin wants to help a disturbed patient, Lawrence "Larry" Silver. When she tells him that she had been molested as a child, Patch comforts her and reassures her that she can overcome her pain by helping others. Patch's friendship with Carin soon turns into romance. When they get the clinic running, they treat patients without medical insurance and perform comedy sketches for them. Together with Carin, medical student Truman Schiff, and some old friends, he renovates an old cottage into a clinic. With the help of Arthur Mendelson, a wealthy man who was a patient whom Patch met while in the mental hospital, he purchases 105 acres (42 hectares) in West Virginia to construct the future Gesundheit! Institute. Patch begins a friendship with fellow student Carin Fisher and, during their third year as medical students develops his idea for a medical clinic built around his philosophy of treating patients using humor and compassion. Adams encourages medical students to work closely with nurses, learn interviewing skills early, and argues that death should be treated with dignity and sometimes even humor. Because of this and incidents such as setting up a giant model papier-mâché pair of legs in stirrups during an obstetric conference, he is expelled from the medical school, although he is later reinstated when it becomes apparent to the school that his unconventional methods often improve his patients' health. He questions the school's soulless approach to medical care, particularly why students don't work with patients until their third year, as well as the methods of the school's Dean Walcott, who takes an instant disliking to Patch and believes that doctors must treat patients his way and not befriend them.
Because of this, he wants to become a medical doctor, and two years later enrolls at the Medical College of Virginia (now known as VCU School of Medicine) as the oldest first-year student. Once there, he finds that using humor, rather than doctor-centered psychotherapy, better helps his fellow patients and provides him with a new purpose in life. In 1969, Hunter "Patch" Adams is suicidal and admits himself to a mental institution.