The climax of this rather surreal short story comes rather abruptly at the very end of this tale, when it becomes clear that Kenny is not heading towards any hospital and that Tub and Frank hold their flourishing friendship to be more important than the life of Kenny, their former friend. Note how this is described in the final paragraph:
Kenny lay with his arms folded over his stomach, moving his lips at the stars. Right overhead was the Big Dipper, and behind, hanging between Kenny's toes in the direction of the hospital, was the North Star, Pole Star, Help to Sailors. As the truck twisted through the gentle hills the star went back and forth between Kenny's boots, staying always in his sight. "I'm going to the hospital," Kenny said. But he was wrong. They had taken a different turn a long way back.
A deliberate parallel is drawn between the stars and Kenny's companions: both are out of touch with Kenny's suffering and danger, and there is significant irony in the way that the narrator points out the North Star, which was seen as a symbol of "Help to Sailors" as it was what sailors used to guide them safely to their destination. There is no such hope for Kenny, unfortunately, as teh final line makes clear. Although he is clearly weakening, and, the reader infers, in danger of dying, his uncaring "friends" place more value in their burgeoning friendship than in Kenny's health. The reader now realises that there is very little hope of Kenny actually getting to the hospital and that he will probably die long before he receives any medical attention.