When it revealed itself, the battle proved age-old but not animal: motion versus stasis, senescence versus youthful tenacity, the maw in question neither beast nor human but mineral: an ancient, heretofore pickup truck. It had a mechanic swearing under its open hood and two small children giggling in its cab, one on the floor using two hands to depress and release (usually all at once) the clutch, one shifting and turning the key (with more tenacity than would have been ideal) as directed.

“Truck” was a generous term. It was more rust than engine, more dirt than vehicle, and not the kind of dirt you could just wash off with a good scrub either because Rosie had a feeling this dirt was load bearing. The body had once been green and probably lovely. It was one of those pickups from the 1950s with the bubbled hoods and rounded wheel wells that someone at home would have dressed up with whitewall tires, a chrome grill, a thousand hours with a Q-tip and a cloth diaper, and then paraded for the Fourth of July. This one didn’t look like that. Apparently, it didn’t run like that either.

The filthy truck spit out a filthier mechanic. “You new doctor?”

“I am. Rosie Walsh. This is my dau … um, son,” she stammered. “Claude.” She glanced at him to see if she could apologize with her eyes, but he was staring at the ground and wouldn’t meet them.

“You drive?”

“No, we biked.” She turned back to the mechanic, distracted. “The guesthouse where we’re staying lent us bicycles.”

“Sorry, my English.” The mechanic tried again. “You can drive? Manual shift car?”

“Oh. Yes!” Rosie’s own English comprehension was apparently jet-lagged.

The mechanic shooed the two children out of the cab, performed final ministrations under the hood, and gave Rosie the international sign for “Pray to your gods and hit it again.” The motor turned over like a well-trained seal. There was much rejoicing. Rosie’s first procedure at the clinic was a success. The patient—improbably, it seemed to her—lived.

The mechanic was slick with grease from the elbows down, but fortunately, greetings in Thailand involved not shaking hands but pressing your own together in front of your chest and bowing toward one another. “Very glad to meet you. I am K. Do not ask what K stand for. It stand for so much. We happy you here. I show you around. First, meet Sorry Ralph.”

“The truck is named Ralph?”

“Sorry Ralph,” K corrected.

“Why?”

“He very sorry.”

“I can see that.”

“Sorry Ralph is ambulance. Also fetch medicine and supply if there is medicine and supply. Also hearse. Usually sorry though so hope you do not need.”

Rosie nodded. She was surprised to see that the mechanic was both female and the apparent welcoming committee. K turned and headed off at what appeared to be a saunter, but Rosie and Claude found themselves practically running to keep up. At each turn, their entourage grew, everyone eager to welcome them with pressed hands and a bow and to trot alongside, everyone happy to let the mechanic lead. Claude was whisked away, and Rosie reached for him as if the wreckage they clung to had suddenly split in stormy seas, but he was already too far off, waves of people between them. Rosie felt at once swept along and struggling to keep up. A chorus of voices in a variety of languages informed her what was where and offered helpful hints that were probably important. A shoe tree of fingers pointed in all directions at once.

There was a building that was clearly obstetrics. At least you could tell obstetrics by looking. There was a workshop from which disembodied limbs hung—legs and feet mostly in various states of doneness, some still being assembled, a band saw, a drill press. There were patients sitting in chairs or wheelchairs whose legs ended before their pants did, so she could see where they belonged too. There was an open-air portico—really just a swept dirt floor under a roof of flattened cardboard boxes tied to the underside of a tarp—littered with plastic lawn chairs, sleeping bags, and blankets in piles where whole families seemed contentedly camped out. Whether they were awaiting treatment or news about someone else receiving treatment or something else altogether, Rosie could see only that they were not bleeding or moaning in pain or about to give birth. There were half-formed, halfhearted lines everywhere. There was an eye chart taped to a cement wall at the end of a rock-strewn dirt path. There were stray dogs wandering lazily in and out of all the buildings, including the one labeled Surgical Department, a building with holes for doors and windows but with no doors or windows filling them. There was a large patch of dirt with lounge-style lawn chairs and then the regular sitting-up kind behind them, and though patients were reclining, openmouthed, on the former, and though there was a medic, lab-coated and rubber-gloved, on the latter, Rosie could not quite believe this was a dentist’s office, but she was wrong.

The buildings were cinder block with barred windows or patched plaster with grated cutouts like lace. Corrugated metal roofs covered in debris gapped several inches over the tops of the walls. Curling linoleum floors, their patterns worn nearly away, spilled onto dirt or cement spaces out front. Empty, open drains lined all the walkways, auguring a rainy season that must turn all the dirt floors to sopping, sticky, insect-harboring mud. All of it un-air-conditioned, unsterile, unsealed, and undifferentiable. But the entrances, the doorways, the open spaces where doorways should have been, were all heaped with flip-flops and plastic clogs and sandals, a broom made of straw always propped nearby, and so, though the walls and ceilings were grimy with decades of dirt, the floors were miraculously, significantly, clean.