Dr. Richter allows Joana a moment to “freshen up.” She barely recognizes herself, and is happy to clean herself but can’t stop thinking about “The remorse [she] would never be able to wash down a sink.” She’s glad she can “help and heal” as a distraction. Still, Joana misses her family and her cousin. She misses Lithuania and her language. She thinks, “Survival had its price: guilt.”
Joana remains guilty over her past. Here, her dirty skin is a kind of metaphor for her perceived dirty deeds, however, unlike dirt, her remorse cannot be washed away. Although she has survived to help others, Joana feels it is unfair that she has been allowed to continue to live.