Themes
Key
LitCharts assigns a color and icon to each theme in This Is How It Always Is, which you can use to track the themes throughout the work.
Gender and Binaries
Secrets and Misunderstanding
Violence and Discrimination
Storytelling
Family
Summary
Analysis
Rosie and Claude ride bikes from their guesthouse to the clinic, where a mechanic named K meets them to show them around. Rosie is surprised that K is a woman and what passes for the welcoming committee. K introduces them to Ralph, the clinic’s truck and ambulance. It is how Rosie will get back and forth to the clinic and move supplies—if Ralph starts, that is. As K shows Rosie around, she can’t believe her eyes. The buildings are ramshackle and falling down, and there are patients waiting everywhere. There is little medical equipment, and the floors and walls are covered in dirt, but the floor is surprisingly clean.
Rosie is surprised that K is a mechanic and a woman because mechanics are stereotypically men. Sexist assumptions are that cars are too complicated for women and should be left for men. Thailand is obviously a poor country, and there is likely even less money for Burmese refugees. People in Thailand have very, very little, which puts Rosie’s own problems and worries into perspective.
Themes
In what is considered the emergency room, there are no beds or gurneys. The patients are on wooden pallets and on the floor, and K leads Rosie to a pregnant woman. This is Rosie’s first patient, K says, who also turns out to be the midwife. K says the woman has a C-section scheduled for next month, but she won’t make it. She had scarlet fever as a child, and she is going into labor now, at 32 weeks. Rosie searches her brain for what she knows about heart failure caused by rheumatic fever, and it is clear that the woman’s pregnancy has been too much for her weakened heart.
K obviously fills many roles at the clinic, which mirrors the hybridity that is present for most of the book. If left untreated, scarlet fever in childhood can turn into rheumatic fever, a strep infection that can settle into the heart valves and cause heart failure. Pregnancy has clearly been hard on Rosie’s patient’s heart, and she is going into premature labor because of it.
Themes
Rosie delivers the baby, but the woman’s heart rate is dangerously high. Rosie asks K for some cardiac drugs or even some morphine, but they don’t have any. Rosie asks what she is supposed to do then, and K says they just move on. They “witness” and next time, they try to do better. “The next patient?” Rosie asks. No, K says, the “next life.”
Buddhists believe in rebirth and cyclical living. K knows that there is nothing to be done in this lifetime to fix the Burmese refugee crisis, but she is thinking about the next life and the one after that. Improvement is a process, just as it is for Poppy. All of society won’t magically accept people who different in this lifetime, but with enough people collectively trying to do better, there is hope for acceptance.
Themes
