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A question about the ending

So, at the end of fight club, the narrator ends up in an hospital which he thinks is heaven, but i had two questions about it: first, it seems as if he somewhat knows he is not actually in heaven, since he says things like "calling marla from heaven" and says that marla writes to him from earth, i know that the narrator is crazy and fucked up but it seems that even in the ending he should have enough sanity to reason that those things are impossible (or else someone in history would have done that). And second, ¿does he have the possibility of abandoning the hospital?, it says that there are space monkeys in there, and that they are expecting him to "return" as Tyler, but it's somewhat shown in the novel that women and older men are not members of Fight Club and Project Mayhem (The Shrink, which the narrator calls "god", for example) and the hospital would not actually be run by space monkeys, or even if that were the case, he could just pretend to be Tyler, and then escape.

Sorry if my question is too stupid.