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Last Reviewed on June 19, 2019, by eNotes Editorial. Word Count: 233

A nurse named Tyler, who works at the Paradise Alms House, narrates the story. He is gay, and he struggles with his gender identity, feeling much more himself when he is dressed in a female nurse's uniform. He cares for an old woman named Mala Ramchandin because all the other nurses are afraid of her. She may or may not have killed her father, but she definitely kept his decaying body in her basement. Mala is the story's protagonist.

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Mala's father was Chandin Ramchandin, and when he was a boy he was adopted by a minister and his wife. He fell in love with his adopted sister, Lavinia Thoroughly, but she did not return his feelings. He married her friend, Sarah, but Sarah and Lavinia fell in love and ran off together. They were forced to leave Sarah's daughters, Mala and Asha, behind, and Chandin begins to rape them.

Asha eventually runs away, but Mala stays. She is eventually courted by a childhood friend, Ambrose Mohanty, known by the childhood nickname Boyie, but when Chandin finds out about their relationship, a violent altercation among the three ends it. Ambrose marries another woman, named Elsie, and has a daughter named Ambrosia. However, Ambrosia becomes a transgender man, named Otoh. Ambrose and Otoh come to visit Mala in the Alms House frequently, and Ambrose and Mala reconnect while Tyler and Otoh develop a romantic relationship.

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