During the first days of his treatment, Van Gogh repeatedly and unsuccessfully asked for Gauguin, who asked a policeman attending the case to "be kind enough, Monsieur, to awaken this man with great care, and if he asks for me tell him I have left for Paris; the sight of me might prove fatal for him." Gauguin fled Arles, never to see Van Gogh again. They continued to correspond and in 1890 Gauguin proposed they form a studio in Antwerp. Meanwhile, other visitors to the hospital included Marie Ginoux and Roulin.
Albert Aurier praised his work in the Mercure de France in January 1890 and described him as "a genius". In February, Van Gogh painted five versions of L'Arlésienne (Madame Ginoux), based on a charcoal sketch Gauguin had produced when she sat for both artists in November 1888. Also in February, Van Gogh was invited by Les XX, a society of avant-garde painters in Brussels, to participate in their annual exhibition. At the opening dinner a Les XX member, Henry de Groux, insulted Van Gogh's work. Toulouse-Lautrec demanded satisfaction, and Signac declared he would continue to fight for Van Gogh's honour if Lautrec surrendered. De Groux apologised for the slight and left the group. Later, while Van Gogh's exhibit was on display with the Artistes Indépendants in Paris, Claude Monet said that his work was the best in the show. After the birth of his nephew, Van Gogh wrote, "I started right away to make a picture for him, to hang in their bedroom, branches of white almond blossom against a blue sky."
In May 1890, Van Gogh left the clinic in Saint-Rémy to move nearer to both Dr Paul Gachet in the Paris suburb of Auvers-sur-Oise and to Theo. Gachet was an amateur painter and had treated several other artists – Camille Pissarro had recommended him. Van Gogh's first impression was that Gachet was "iller than I am, it seemed to me, or let's say just as much."
During his last weeks at Saint-Rémy, his thoughts returned to "memories of the North", and several of the approximately 70 oils, painted during as many days in Auvers-sur-Oise, are reminiscent of northern scenes. In June 1890, he painted several portraits of his doctor, including Portrait of Dr Gachet, and his only etching. In each the emphasis is on Gachet's melancholic disposition. There are other paintings which are probably unfinished, including Thatched Cottages by a Hill.
On 27 July 1890, aged 37, Van Gogh shot himself in the chest with a 7mm Lefaucheux à broche revolver. There were no witnesses and he died 30 hours after the incident. The shooting may have taken place in the wheat field in which he had been painting, or a local barn. The bullet was deflected by a rib and passed through his chest without doing apparent damage to internal organs – probably stopped by his spine. He was able to walk back to the Auberge Ravoux, where he was attended to by two doctors, but without a surgeon present the bullet could not be removed. The doctors tended to him as best they could, then left him alone in his room, smoking his pipe. The following morning Theo rushed to his brother's side, finding him in good spirits. But within hours Vincent began to fail, suffering from an untreated infection resulting from the wound. He died in the early hours of 29 July. According to Theo, Vincent's last words were: "The sadness will last forever".
Many of the late paintings are sombre but essentially optimistic and, right up to the time of Van Gogh's death, reflect his desire to return to lucid mental health. Yet some of his final works reflect his deepening concerns. Writing in July 1890, from Auvers, Van Gogh said that he had become absorbed "in the immense plain against the hills, boundless as the sea, delicate yellow".