As the line dwindled, a small boy came to me limping. His big toe was red, infected, and there was a hole in it about the size of a pencil lead. I asked him to sit and poked around a bit. He tried to act tough, but I could tell it hurt him. Leena encouraged him to let me look at it. He stiffened and gritted his teeth. I felt like there was something stuck up in his toe, but I couldn’t get at it without hurting him. Seeing the muscles of his jaw flex, I squeezed his toe like I was popping a zit. At first, nothing. I stopped to get a better grip, and he took a deep breath and held it. I knew it was hurting him, so something had to be stuck in there. Finally, I pressed with both thumbs, and he let out a small cry. When I did, pus oozed and the tip of something stuck through his skin. His eyes were teary, but I showed it to him and asked Leena to ask him if I could keep going. He nodded and pointed at his toe, then poked me in the arm and nodded some more. I took that as a good sign and squeezed one more time. This time, white-and-green stuff shot out followed by a thorn. I took Leena’s tweezers and slowly pulled it from his toe. His eyes grew wide as I held the thorn—nearly three-quarters of an inch long—in front of him. He smiled wide. We bathed his foot, massaged as much antibiotic ointment into the hole as we could, and then wrapped it in a bandage with strict instructions from Leena not to walk barefoot for at least a week. He nodded and carried the thorn in the palm of his hand to show his mom. When he walked off, his chest had puffed out a bit. He looked up at me. “Gracias, Doctor.”

The words swam around in my head. When they came to rest, so did the meaning. I turned to Leena. “What’d he just call me?”

Leena whispered, “I think you’ve made a friend.” A sly smile. “And more than one.”

“What do you mean?”

“Anna is quite taken with you.”

“That’s some…lady.”

“Let me tell you something about that lady. When her husband was sick last year, the medicine he needed was very expensive. Most people in his condition die. But Anna would work all day in the coffee plantation, then walk down the mountain at dusk to the peanut fields and work all night, by moonlight, digging up peanuts with her bare hands. She slept in the field for an hour or two before dawn; then she’d hide her peanut bag and walk back up the mountain to check on her husband and then make it to work on time. It’d take her three to four days to fill a hundred-pound bag with peanuts, and for that bag, they’d pay her ten dollars.”

“And her husband?”

“Healthy as a horse—thanks to her.”

When we’d finished, we packed up and moved toward the dwellings. The dwellings were about the size of a closet. Bunks on one side. They were made years ago from raw hardwood. Over the years, use had smoothed the wood, and oil in hands and bodies had turned it dark. People in the States would have paid thousands for the beauty of this wood. Those living in it would have paid thousands to be rid of it. The plantation filled a small shoulder off the southern end of Las Casitas. The owner’s house was a large plantation house equal in size to Colin’s house on the coast. Paulina walked me toward the middle of the building where a channel or walkway cut through the middle proving that just as many people lived in the middle as on the outside. The air was still and the heat oppressive. She waved her hand at the dirt, grime, shoeless kids, and snotty noses. “Don’t let your eyes fool you, these are proud people. They have nothing, but what they do have is kept. The dirt is swept in neat lines, they’ve sought out and placed smooth river stones at their front doors to wipe their feet and welcome guests, fresh bananas are hung above their beds, their clothes may be dirty but they’re folded neatly. The men wear belts, they remove their hats when they meet you, and the women wear scarves to cover their heads.”

I understood what she was telling me. I just couldn’t understand why. “Why’re you telling me this?”

“I am pointing out the difference between poverty and squalor.”

“How so?”

“You can be poor without living in filth.”

We walked into the row houses, which were more like a giant barn with dozens of stalls barely wide enough for a single horse. She explained, “These are for the younger workers with less seniority. Or”—she pushed on a door—“older ones who sell their homes on the outside when they are too old to work.”

Inside, a hammock stretched from wall to wall. In it sat what was once a man. Skin draped across bones. Barefoot. His shirt lay unbuttoned, pants were pulled up to his thighs, but his groin and bottom were exposed. His hands were large and had been muscled at one time. On the floor next to him sat a half-full bottle of water.

The door swung and light slowly entered the room. When the old man saw Paulina, he smiled and his eyelids closed and opened slowly. His lips were chalky white, and his tongue seemed swollen and stuck to the roof of his mouth. He made an attempt with his hands to pull his shirttail over his groin but was unsuccessful. Judging by the soaked hammock and the smell permeating the room, he’d been too tired to rise so he’d urinated on himself. She pulled off her pack, held his hand—letting her index finger rest on his pulse—and knelt on the ground next to him, whispering quietly and never letting her eyes leave his. Every few seconds, he would nod and his lips would move, but I couldn’t hear him. Isabella stood behind me outside the door, listening but not looking.

Keeping her eyes on the man, Leena pulled some baby wipes from her pack and began to gently bathe the man’s torso, arms, groin, and legs. Then, with delicate tenderness, she bathed the man’s bottom and penis.

When she finished, the old man patted Paulina’s hand and then placed his hand on her forehead as though he were giving her a blessing. She rose, kissed his forehead, his cheek, and then his hand.

When she walked out, a tear trickled down her face. She stopped at a basin to wash her hands, but collecting herself, she said nothing and offered no explanation. In the ten minutes she was with him, Leena’s smile never left her face, yet in that room I saw nothing to smile about. Finding him naked, she’d dressed him in honor and dignity. And in dressing him, she’d undressed me.

I’ve seen a lot of things in my life, many I’m not proud of, but until that day, I’d never seen the face of an angel. Maybe for the first time, I saw one in that room. Sadly, if the angel of mercy had visited him today, I had a feeling that the angel of death wasn’t far behind. I think he knew that, too.

And the tear trailing down her cheek told me that Leena knew that most of all. She caught the disconcerted look on my face. “You want to say something?”

“No, well yes. It’s just that no one seems overly affected that that man is lying there dying right in front of their eyes. As if they’re not surprised.”

“People here don’t feel entitled to perfect health.”

“Yeah, but shouldn’t they? I mean, isn’t it a worthwhile goal?”

“Sure. But at what cost?”

“Well, at any cost.”

“That’s where you and them differ.” She held up a finger. “I’m going to let you in on a little secret. When I first traveled to the States to study, I was struck by how everyone I encountered spent their days working feverishly to make enough money to buy a better tomorrow. Here, people are content—they buy what they need today and leave tomorrow to God. These people don’t have a death grip on their life here. They hold it loosely because they’re not in control of it in the first place, and—” She paused, weighing her words. “In their experience, it can be ripped from their hands no matter how tightly they squeeze it.”

Somewhere in there, I clued in to the fact that for people like me, there is an undoing that occurs here. A breaking. Like dropping a glass rod. It is the sound of the shattering of our assumptions when we learn that our pretending, our masquerading, is all vanity. As if we have any control over any of this. I, like most everyone I’ve known, spent most of my life furiously attempting to protect myself from the truth, from the undignified bottle beneath the hammock. Truth is, we can’t protect us. These people don’t suffer from the illusions that I have built up to insulate myself—namely that death won’t come for me on a hammock in Nicaragua when I don’t have the strength to stand so I pee in my pants. That somehow I deserve different. As if my money or social status could buy me, could guarantee me, a dignified death. These people know that they are born, they might grow up, might be given in marriage, might live long, might laugh, and might know love, but they all know that they will die. That what they see here is fleeting. I, on the other hand, don’t think much about it. I looked around me, at all the eyes staring down on that skeleton of a man, knowing they don’t have that luxury. Nor do they pretend to. The contradiction was striking. I have lived my life fighting against a tidal wave of forces that I am powerless to defend, like a man standing at the ocean’s edge, swatting at the waves. I can no more turn back the tide than I can light up the sun.