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For Bulosan, America is a paradox because it displays great kindness alongside horrible cruelty. Throughout the novel, Carlos struggles to make sense of this paradox by attempting to discern whether the “real” America is naturally kind or naturally cruel. This paradox is yet another reflection of the book’s theme of beauty in despair. As is the case after the incident with the railroad detectives, Carlos often witnesses beauty (via the kindness of the hospital workers, in this case) after moments of seemingly relentless despair.