Conclude? Suppose? Alright.

Well, it isn't unusual for them to split a single confessional sequence into two parts, nor is it unusual for them to splice material into a confessional. They sometimes get very tricky taking things out of sequence, this time not so much.

On screen in confessional he didn't appear much different from when Tarzan examined him, he worsened afterwards, those two confessionals were actually from the same confessional sequence filmed around that time.

The VO section with the "die die die" stuff could have been culled from another later confessional, from comments he made to Dr. Ramona or Jeff while he was being examined, while he was on the way to the hospital after leaving the island, in the hospital, there's no way for us to know. I would suppose that he was administered some medication to help control the pain even before he reached the hospital, but that wouldn't calm his immediate distress.

If recorded much later then it was basically scripted and he did a reasonable acting job of recapturing his distress. Meh, I think that would be giving him too much credit, but believe what you like.

The final words material came from the episode 1 time frame when he was in a snit about the tribes being determined by gender, which upset his predetermined plan for playing the game.