After leaving Mr. Walters’ room, Marion sits on a park bench and thinks how unfair it is that the kind man had to receive his darkest news on such a glorious day. The colors of fall are new to Marion; this never happened in Africa. Nearby, laughter and squeals come from the dormitory; sometimes Marion feels as if he is living in Sodom. When it gets chilly, Marion goes inside, where he smells spices and tobacco and marijuana smoke. (Nestor has a garden in the back that grows tomatoes, sage, and cannabis.) Behind Our Lady is a fence topped with razor wire that separates the medical complex from a housing project named Friendship, though everyone now calls it Battleship. The sounds of handguns can be heard emanating from the neighborhood at night.

On Mondays the nurses generally invite the interns to their quarters for a communal dinner; tonight it is the nurses’ turn to visit the interns. Marion and a few other interns, plus Deepak, engage in a discussion about the ironies of clean living versus living as a hedonist who abuses his body. The theory is that the “four dirtballer” (the man who beats his wife, abuses alcohol, falls off buildings, has heart attacks, gets stabbed, suffers strokes) will always live through a major operation because he has already demonstrated his capacity to survive. The “zero-to-one dirtballer,” on the other hand, does not fare as well because he has lived a good, clean life (stays married to the same woman, goes to church regularly, monitors his blood pressure, does not eat ice cream, raises his kids). In short, they conclude that Mr. Walters, as a zero dirtballer, is fortunate to have survived his surgery.

They pass a joint, but it does nothing for Marion’s deep fatigue. The noises around him continue, and Marion expresses something about which he has thought much: it is strange that foreign doctors are taking care of American patients. Nestor is more blunt and asks if he wonders where the White doctors and White patients are. Marion asks if all hospitals are like theirs, and Nestor bursts out laughing at Marion’s naiveté. Marion’s colleagues try to explain the way things work.

The pepper shaker, they say, is their kind of hospital; this hospital can always be found in poor neighborhoods and is not connected to a university or medical school. The salt shaker is the other kind of hospital and is almost always connected to a major university or medical school. Every American intern wants to avoid the former and be accepted at the latter. “Their worst nightmare” is coming to a pepper-shaker hospital; no matter how much these hospitals are willing to pay, no one wants to go there. Because there are more internships available than there are graduating American medical students, the worst hospitals must fill their internships with foreign students. The government staffs its worst hospitals with cheap labor, and when the internships are over, these doctors go anywhere they can—small towns and places American doctors will not live or practice medicine. Marion asks why American doctors will not go to such places. The sardonic reply is that there is no culture there, no symphony or professional ball team.

One intern, Ghandi, intends to practice where the needs are greatest; he plans to work on Park Avenue and attend to the crisis in health care there. Those citizens, he says, are suffering because their breasts are too small, their noses are too big, or they have an extra roll of fat around their stomachs.