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Last Reviewed on June 19, 2019, by eNotes Editorial. Word Count: 445

This book is narrated by Tyler, a nurse at the Paradise Alms House, in the Caribbean town of Lantanacamara. He cares for Mala Ramchandin, an idiosyncratic old woman who does not speak and who may or may not have murdered her father. The other nurses are afraid of her, but in the absence of evidence or witnesses (her house was burned down with her father's corpse in it), a judge ordered that she be sent to the Alms House to be cared for in her old age. Tyler struggles with expressing his gender identity, and Mala seems to understand and support his desire to present as a woman. Meanwhile, their rapport grows, and Mala begins to reveal her history through mumbled and disjointed words. Tyler learns that Mala's father was in love with a woman, named Lavinia, who was not his wife, named Sarah. Lavinia and Sarah were in love, however, and ran away together, leaving the children, Mala and Asha, behind. After this, Chandin, the girls' father, began to rape them. Asha eventually ran away, but Mala always felt sorry for her father—in addition to fearing him—and would not leave him.

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One day, an older man and his son arrive to visit Mala at the Alms House. The older man, Ambrose, is revealed to have been a childhood friend and one-time lover of Mala's, and his son, Otoh, is actually a transgender man. Tyler gets confirmation of his interpretation of Mala's mumbled words from these two men. He learns that, when Ambrose and Mala were young, they were in a romantic relationship that was severed when Chandin found out, raping and torturing Mala and attempting to kill Ambrose, and Ambrose left. Mala, then, imprisoned her father in the basement (he may or may not have already been dead), and appears to have gone so wild that she did not recognize Ambrose when he tried to come to her again. In his guilt, all he could do was provide food rations for her so that she would not have to leave her home and would not starve there. When Ambrose became too weak to carry these provisions to her home, Otoh began to do so, but when Mala showed him her father's decaying body in the basement, he blacks out and runs from her home, revealing his fear and compelling the police to search her house and find the body. This is what precipitated Mala's being brought to the Alms House.

Ultimately, Ambrose and Mala reconnect. Tyler embraces the gender identity which he has tried to keep hidden, and he and Otoh develop a romantic relationship that affirms both of their gender identities.

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Themes