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We will do what we can, Preeta said. She covered her mouth and nose with her hand, like she was trying to catch her own words.

As they exited, Preeta said, Did you notice? Most of the trash pickers are women. A refuse truck rumbled in. It dumped its contents with a pneumatic push, and in its wake, silence. But then, the cry of egrets circling ceaselessly overhead, and the steady crunch, crunch as people walked over the new offerings: half a toilet seat, discarded diapers, empty bags of chips. Cattle roamed the area. One boy found a carton of something and ate from it.

Over the next six months, Preeta returned to Ghazipur three more times for awareness sessions, emphasizing syringe safety. She told them to avoid medical waste. She taught them the biohazard symbol. She handed out pamphlets.

I’m sure those went directly into the recycling piles as soon as I left, she said. But I had to try.

On her final trip, before she left to take a job in New York, Preeta informed Dev that the man had died. His widow and son had disappeared.

Dev’s gown is smeared with the boy’s blood. He has no time to change into something more presentable, so he removes it, balls it up, throws it in the corner. They will preserve the boy’s body for the inevitable inquiry. The blood bank will serve as a makeshift morgue. One nurse closes the incisions with hasty and uneven stitches, while the other wipes the body clean of blood. There’s too much of it. Color has begun to drain from the boy’s face. He is handsome, this boy, and immediately Dev feels shame heat his cheeks. Desire always comes unbidden, quick and vicious, like a mosquito.

— Are you well? a nurse asks. The question sounds odd coming from another person’s mouth.

Dev nods. — I need to catch my breath, he says.

He sits on a child-size plastic stool, something Arusha would use. Decals are stuck to its surface, butterflies and bunches of flowers that have begun to peel away from the surface. The legs bow beneath his weight. He can’t recall the last time he laid with Padma. Not since Arusha’s birth. They sleep beside one another in their nightclothes. She makes no moves toward him, and they both breathe quietly, as if waiting for Arusha to make a sound. As a courtesy, he relieves himself outside of her presence, and never with another person. Not since Ted. Dev tries not to think of Ted at all. Ted is so distant that he comes from another era, when people like Dev were expected to kowtow to him. The world is no longer this way, and the sooner both he and Ted realize it, the better off they’ll be.

Years from now, Dev will encounter Preeta at a conference in Washington, DC; Padma and the children will have come along. Arusha will be fourteen and defiant; sensitive, quiet Amrita will be a gangly ten; Arjun will be five. For them, it will be a vacation.

Preeta and Dev will greet each other with hugs—Look at you! You haven’t aged a bit! Liar! She will live in New York City, still working in prevention and outreach. She will tell him, You went to school with Mark Rifkin, didn’t you? You know what happened to him?

She will whisper, He lost his license. But not only that: he will have been arrested at the airport with illegal methamphetamines and have had criminal charges filed against him for treating patients while intoxicated.

Dev will know that Rifkin is not alone. Other doctors specializing in HIV have also fallen into addiction, depression, suicide. The tide they tried desperately to hold back swept them out to sea.

Back in the hotel, his family will prepare for dinner. Padma will have Arusha in the bathroom, teaching her how to apply eyeliner. Amrita will have given up trying to join them. Arjun will sprawl on the bed, watching cartoons. Dev has made the right decision. His family is a beautiful, precious thing. This is all a man can ask.

But even so, he will feel a violent clamor inside him, like a falling bell.

Amrita will approach and ask, Are you well? She will wipe a tear off his cheek with her palm.

Yes, darling, he will say. He will pick her up, put her in his lap. Just remembering a dream.

Was it a bad dream?

No, he will say. It wasn’t a bad dream. But it wasn’t a happy one, either.

— Shall we? Dr. Ferrell asks.

Outside the tent, the men are a puddle of uniforms, the same uniform he and Dr. Farrell cut the boy from. The uniforms disturb Dev, the color of jaundice, hepatitis, cirrhosis. The color of excess bilirubin in the blood. Even before Dev fully emerges, they barrage him with questions: —How he is? Will he make it?

The tallest among them raises his arm to staunch the babbling, and they hold their breath.

— Your friend has suffered serious injuries, Dev says, and the rest of the sentence should come easily, but it does not. Dev is blinded by the reflective stripes on their uniforms, by their expectant faces, and as he moves his hand to shield his eyes, he realizes where he has seen these uniforms before: the boy wore one, of course. But Dev remembers the uniform from long before the boy was brought into the tent. He remembers it from when he came into his hotel room and saw Ted sleeping there with the boy, pressed against each other like clasped hands; he interrupted them, too exhausted to be angry, and as Ted sputtered apologies, the boy pulled up his uniform, the stripes on his shoulders catching the light from the lantern, shining fluorescent for one brief flash, an unmistakable brightness, and sneaked off. That boy now lies beneath a sheet, and the explanation dries in Dev’s throat. The words choke away. He tries to keep his face neutral, but surely the men can read the failure on his face. They study him for answers, and the answers do not come. The boy’s death should be no different from the hundreds and thousands that have come before; these men will grieve no differently than the residents of Bhuj, survivors one and all, bereaved one and all. Dev himself should treat this death no differently, but he circles back to seeing this boy, asleep, in Ted’s arms, and sadness overwhelms him, not because the boy is dead, but because he could have been in the boy’s place had his life gone another way, but that life is dead, and the boy is dead, and, for once, he cannot find the words to explain this.

— His wounds were too severe, Dr. Ferrell says. — He died during surgery. You have my deepest condolences.

And now comes the mourning. Dev braces himself.

Ted needs to know. Dev owes him that much. The more Dev prepares, the less likely he will be caught off guard and stumble over his words. The easier it will be to look Ted in the eye and tell him that his lover is dead.

Maybe not lover. Maybe friend. It is impossible to say with certainty how one relates to another. He and Ted, for instance. Ex-lovers, friends, earthquake acquaintances — all these and more. There is something pitiable about Ted, a kicked man who begs forgiveness for getting in the way of the foot. He tries to make things better by making things worse. Ted reminds him a bit of Padma. There’s an unwhetted softness to both, as if the world’s cruelty were constantly surprising. He’s been careless with them, and he will always regret that.

The boy’s pockets were empty when he was brought in. Death in the commission of a robbery. So much suffering, and for so little. There is no way to describe how someone has died in vain. Dev is unsure why he feels compelled to tell Ted. Why this duty falls upon him, he cannot say.

Up ahead, two men repair their house. One stirs a bucket of plaster, and the other, standing on a chair and using a length of plywood as a palette, slathers it into the cracks with his hands. They make no attempt to smooth their work. The house grows bulbous gray keloids. They are resourceful, these two, to have secured building materials. But the handkerchiefs around their mouths are insufficient to keep from inhaling airborne particulates. Their alveoli will clog, and their lungs will harden. In years to come, they will develop respiratory problems, a cough that rakes the inside of their chests like a trapped rodent.