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This is one in a series of reports from hospitals responding to the Covid-19 pandemic.

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The hospital’s aboriginal agent to die of Covid-19 was a kitchen artisan alleged Marie Deus. She was 65, and a longtime germophobe. Years afore the pandemic, years afore the new coronavirus was accepted to exist, she consistently kept a backing of masks and Purell in her bag. She was never afterwards cardboard towels, to absorber her easily from whatever concealed dangers lurked on doorknobs, on handholds in the bus. She’d appear home from the grocery abundance with Lysol, Pine-Sol, ammonia, Clorox. She didn’t aloof like accommodation tidy; she basic them spotless and disinfected.

“She wasn’t that way aback she was in Haiti,” said her sister, Yolanda Desir. It was alone afterwards she confused to Boston in her 20s that her abhorrence arose. Growing up, she’d dreamed of acceptable a nurse; in a new country, with its amaranthine blitz of bills, she bare a job fast, and acceptable a nursing home abettor seemed like the abutting best thing. She admired the work, but she knew how attainable it would be for her to bolt something, spending canicule with patients, aptitude abutting abundant to spoon-feed them.

She abhorred affecting things, fabricated a ritual of abrasion her hands. She kept accomplishing it aback she got the job at Brigham and Women’s Faulkner Hospital 15 years ago, analytical surfaces, alert of annihilation that ability not be clean. “Terrified she’d get sick,” said her aide Antonette Brade. Extreme as it might’ve been, the fixation fabricated Deus a archetypal kitchen worker, a agitator of hygiene, a hand-sanitizer-in-chief. “Everybody was admiring with what she do,” Brade said. Aback the communicable arrived, she alone seemed added prescient.

Her ancestors had acclaim ribbed her about her obsession; it about seemed like a affectionate of superstition, and they teased her about that too, bedlam at the books she acclimated to adapt dreams. Occasionally, she’d stop in at the bend abundance afterwards assignment to aces out action tickets, and the numbers she chose consistently came from those books. She admired sitting in the kitchen with her niece, watching Nigerian movies, and she’d construe the artifice twists into advantageous numbers to play. If she had a dream about a car, she’d comedy the digits of the authorization plate. If she dreamed about you, she’d ask how old you were and comedy your age. Sometimes she won — $500, $700, $1,000 — annihilation huge, no quit-your-job jackpots, but abundant to argue her that she was assimilate something.

“Because she knew, if you can’t appear to work, eventually or afterwards you may be blow your job. … That’s the alone way we can accumulate up in America, you know?”

Daniel Joseph, advance baker at Faulkner hospital

The morning she burst began like any other, accepting up afore sunrise, communicable the bus in the acquisition light. She admired actuality early. She admired accession an hour afore she was expected, whether activity to assignment or demography her niece to ballet. On weekdays, she’d leave the abode by 5 or 5:15. She’d change into her compatible — dejected shirt, atramentous pants — accept coffee, eat a allotment of toast. If the aperture administrator were a minute backward unlocking the kitchen, she’d be there by the time clock, waiting, attainable to bite in. “Bonjour, Marie, bonjour,” he’d generally say, his American emphasis aggravating to fit central the French words.

She’d been ailing in the canicule before, annoyed and sneezing. Allergies, she insisted. Her sister kept allurement if she had fevers, chills, annihilation that could be a assurance of coronavirus? No, no, no, Deus replied, annihilation like that — and it fabricated sense. “She was the aftermost actuality you would accept would accept corona,” her sister said. She took a few accidental canicule off to rest, and by April 1, she was her accepted crammer self, abashed to be back.

“Don’t forget, we’re foreigners,” said her acquaintance Daniel Joseph, a advance baker at Faulkner, who’s additionally from Haiti. Alike afterwards decades in Boston, the activity could be adamantine to shake: the connected wariness, the ability that at any moment, alike the best accurate activity could appear apart. Deus generally told him that if the hospital cut staff, she’d be first. She was older, she said, her English imperfect.

To him, that was why she was consistently early, consistently hand-washing, consistently abashed of accepting sick. “Because she knew, if you can’t appear to work, eventually or afterwards you may be blow your job. … That’s the alone way we can accumulate up in America, you know?”

That morning she hardly fabricated it accomplished the door. She was by the checkpoint breadth anybody was buried for coronavirus affection aback she collapsed. A aggregation rushed out of the emergency allowance with a stretcher, and agitated her in. The doctor on duty, Luis Lobon, accustomed her appropriate away. She was addition he saw all the time, wheeling a trolley of meal trays to patients, addition he said hi to, but didn’t apperceive well. Now, it abashed him. I ability be the aftermost actuality she anytime talks to, he thought.

She wasn’t gone yet. She wasn’t apathetic or comatose or afloat in and out. Instead, she was electric, wide-eyed, application every bit of her activity to accumulate herself alive. She stared at Lobon with terror, with the ability that she was trapped about airless and abominable and bare advice accepting out. “That archetypal attending of the absolutely bad asthmatic,” Lobon said. “This very, actual biting look, about like they’re conduct through your brain.”

She didn’t appetite to be intubated, didn’t appetite to be taken to the ICU. She basic to allocution to her sister. Admitting there wasn’t abundant time, addition handed her a phone, and Desir adequate her, said it was OK, a chase ability advice her breathe — but afresh Deus’ basic signs started coast and Lobon disconnected to say sorry, he bare to put her to sleep, she would be OK, she should say goodbye to her sister until they could allege again.

The IVs and sedatives were already in place. As he threaded in the animation tube, Lobon noticed that the anatomy of her airway, which should accept been red with oxygen-rich blood, were now grayish. Anybody in the allowance was tense. If a hospital kitchen artisan were adulterated — addition who didn’t absorb abundant time with patients — what did that beggarly for them?

Lobon was abashed for Deus, abashed for his staff, abashed for himself. Aback he bent the eye of a aide from abaft his goggles, what he saw through her face absorber wasn’t so altered from the abashed beam he’d gotten from Deus. “She looked at me like, ‘Oh my goodness, this is one of us. … Who’s activity to be next?’”

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Her affliction was allotment of a pattern, but not the one her clinicians were abashed about. Deus was amid their aboriginal Covid-19 patients, aloof as the Faulkner’s ambit of cases was about to get steep, and they accepted that they — doctors, nurses, respiratory therapists — would be at the greatest blow of infection. They were on the front-most of the advanced lines, acute electrodes assimilate skin, alert to the fluid-filled burst of lungs, suctioning out secretions.

But they weren’t the advisers accepting ailing at the accomplished rates. Amid the 25,000 or so bodies who agents the hospitals and clinics of Brigham Health, assertive units that didn’t accept abundant accommodating acquaintance were testing absolute added than their bedside colleagues. By mid-April, 4.1% of ecology casework workers were adulterated — admitting they wore accurate accessory aback charwoman accommodating accommodation — while 1.2% of nurses were. The allotment was 2.7 for those like Deus, who able and delivered food, which was agnate to that of respiratory therapists, who fiddled with Covid-19 patients’ animation tubes.

Overall, about 1% of advisers were adulterated — and that admeasurement backward the aforementioned aback you disconnected those who provided absolute affliction from those who didn’t. The manual didn’t assume to be basic with patients. In fact, anytime aback backward March, aback they’d started acute anybody onsite to be masked and to acknowledge any attainable affection at the door, epidemiologists hadn’t apparent a artisan infection they could trace aback to a accommodating as its best acceptable source, said Chuck Morris, one of the hospital’s communicable adventure commanders, on April 15.

That larboard the catechism of breadth these alien cases were advancing from. Morris wondered if they ability be affiliated to the city’s coronavirus hot spots, or to some concealed able in the hospital’s infection control, or both. Either way, Deus’ adventure fabricated the numbers harrowingly real: They independent not alone the blow of added spread, but additionally the achievability of added bodies like her, ailing abundant to become inpatients at their own workplaces.

The abstracts weren’t perfect. Some capacity had 20 or so employees; others had hundreds, and a few had thousands. There were abundant cases to appearance there was a problem, but not abundant to define why it arose. Plus, hospital leaders knew they were apparently missing some. While coronavirus testing was attainable to all advisers — if you had symptoms, you could get anointed — ecology casework and aliment workers weren’t accepting them as abundant as nurses and doctors. “As abundant as I feel like we try to abrade hierarchies,” arch medical administrator Sunil Eappen said, “there is a bureaucracy here.”

Tackling the curve, he knew, would beggarly arrest that, too. “’If I’m appropriate and I footfall out of assignment and I analysis positive, do I accept job security?’ You do, but are we abiding that you apperceive it?” Eappen went on. “‘And if I get sick, am I covered?’ There was absolutely advance that went out about both of those issues … and alike admitting that, you ability still be scared.”

When Desir got the alarm from the emergency room, and heard her sister asthmatic for air afterwards every word, she anon anticipation about her nephew. He was in his 30s, alive as a babysitter in a burghal high-rise, and he’d been coughing, too. They all lived together, with Desir’s 11-year-old daughter, four bodies in a three-bedroom. “I thought, ‘Oh my God, what am I activity to do?’”

She was sitting at her desk, at addition hospital, breadth she helps bulk out how abundant of a action will be covered by insurance, how abundant a accommodating will accept to pay. Audition snatches of what was activity on, her bang-up let her go home. By the time she brought her nephew to Boston Medical Centermost afterwards that day, he was so anemic he sank into a wheelchair. That night, he was aback in his own bed, self-isolating, cat-and-mouse for coronavirus analysis results.

They were positive. Desir kept her babe as far from him as the amplitude would allow, but addition had to booty affliction of him. Cautiously, a few times a day, she brought him baptize and food, so he wouldn’t accept to leave his room. She’d accomplish him tea from excellent and mugwort and bay leaf, accept him irrigate baptize with auto and baking soda and salt.

She abashed he would end up in the aforementioned accompaniment as his mother, hospitalized, organs damaged, clumsy to talk. By now, she’d been transferred from the Faulkner to the Brigham. The abode acquainted aberrant afterwards her. Marie the workaholic, abrogation for the hospital continued afore she had to; Marie airy on her day off, dredging angle fillets in abrade with her niece, rolling meatballs she wouldn’t eat herself. Marie, who was 10 years older, allotment of the acumen that Desir had appear to Boston from Haiti in the aboriginal place.

They’d absent their parents early, to a car accident, and they were aloft in Port-au-Prince by their uncle. He additionally hosted their cousins from the countryside, who’d appear bottomward to the basic for school, and the abode was beginning with kids, anybody like a affinity to anybody else, swapping clothes and shoes. They grew up account from the Palais National, Haiti’s domed-and-columned acknowledgment to the White House, with a band of august approach copse out front, like sentinels. It was a adorable neighborhood, advantaged by intellectuals — “pretty abundant in the centermost of everything,” Desir said.

Yet it was additionally at the agitated centermost of aggregate beneath the Duvalier regime, abominable for the abstruse badge force accepted as the Tontons Macoutes. Alleged afterwards a fabulous bogeyman, a child-snatcher who stuffs his casualty into a big gunnysack, they were agents of disappearance, accession with machetes and accoutrements and demography bodies away. Their targets were absolutely the sorts of journalists and academics who lived on Desir’s street. As a jailbait in the backward ’70s, she would see them abreast her house, their attendance a antecedent of terror. “They alike appear to my school,” she said. “They appear in and they coursing some of the teachers.”

The adjacency they knew began to abandoned out. Her uncle had already larboard some 15 years before, beat the repression of the Duvalier family’s aboriginal dictator. About that time, Haitian advisers say, their country acquired an extra, actionable province, its breadth addition from the Bahamas to Miami, Brooklyn to Montreal, Dominican sugarcane fields to Parisian arrondissements. As Desir put it, “That generation, they confused all over the world. Canada has a lot of agents acknowledgment to Duvalier.”

In 1980, Deus abutting their broadcast ranks, afterwards her uncle to Boston. Desir wasn’t far behind. The burghal captivated the third bigger ascendancy of Haitians in the United States, and its epicenter was a adjacency alleged Mattapan — an breadth of triple-deckers with its own history of comings and goings.

In the agitation that bankrupt out afterwards the annihilation of Martin Luther King Jr. in 1968, a accumulation of bankers basic to attending like they were accomplishing something, anything, to abode ancestral inequality. What they did was to draw a dejected band about assertive tracts of Boston, pinpointing sections of the burghal breadth they would action Atramentous families loans. It was a affectionate of adumbration redlining: Rather than befitting bodies of blush from accepting mortgages and affairs homes, as governments and banks and realtors had done aback the ’30s, now these suits-and-ties were accouterment ambit of acclaim — but alone aural those bounded confines.

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The adventure was generally told to explain the re-segregation of Boston, and specifically, how Mattapan went from majority white to majority Black. Yet the about-face had already started beforehand in the 1960s. Atramentous families, some displaced by demolitions, began clearing in areas that white suburbanites-to-be were abrogation — and speculators affable in, alarming association into selling, flipping houses at a profit, accouterment neither aliment nor the inspections that would accept appear the charge for them. As demographics shifted, racist admiral downgraded acreage values. “Once African Americans alpha clearing in Mattapan, all the white institutions of our association alpha adage this isn’t a adorable neighborhood,” said Gerald Gamm, a abettor at the University of Rochester, whose book, “Urban Exodus,” is about that change.

That meant amplitude was affordable for the antecedents of the Haitian diaspora, who founded churches and opened shops, and it was into this mural that Deus and Desir arrived, blockage at their uncle’s until they could acquisition assignment and accommodation of their own. Their accepted accommodation is a 15-minute bus ride arctic of there. They anniversary had stints in added places, but for the accomplished decade or so, Mattapan has been home. Anniversary beachcomber of new arrivals could allocution about the armament in Haiti that brought them here: one Duvalier absolutist and afresh his son, convulsion and hurricane, aliment curtailment and political turmoil.

Back in the day, they accepted themselves to be Haitian, aboriginal and foremost, no bulk how bodies in the US saw them, explained Carline Desire, controlling administrator of the Association of Haitian Women in Boston. Yet slowly, identities shifted, still Haitian, but acceptable American as well.

In abounding ways, Deus’ career was accustomed in her circle, the years of assignment in a nursing home, the alteration to a added abiding job in a hospital. The way Desir was caring for her nephew wasn’t so altered from what Deus had been accomplishing for a active all along, agriculture patients, generally amidst by added Haitian-Americans, some her clients, some her colleagues. Aback nursing home association asked, she’d accomplish them joumou, winter annihilate soup. Aback she got to the Faulkner, and was accumulating accommodating commons on the tray line, she’d sometimes sing her admired Haitian accompanist classic, and the others who knew it would accompany in:

“Marie, tu es très charmante,Tu es une rose san pareil.”

Marie, you are so charming,A rose like no other.

Desir absurd her sister had bent the virus in her assignment at the hospital, but she couldn’t be sure. She didn’t accusation anyone for her sister’s illness. No bulk how accurate you were, she said, there were still risks that came with alive in bloom care, with activity to assignment in general. “That’s the activity about corona, you don’t apperceive breadth you can get it,” she said. “It’s everywhere and nowhere.”

The hospitals’ infection trackers sometimes acquainted article similar. Assertive cases were straightforward, with no breaches in claimed accurate accessories but a bright acknowledgment to a ancestors affiliate whose affection acutely predated the employee’s — or, in the pandemic’s aboriginal days, abutting acquaintance with a anaplasty accommodating who’d alone been appear to accept coronavirus afterwards a while in the hospital. But added cases were fuzzier. Could anyone bethink if a specific accommodating was cutting a mask? What if the agent lived with a ancestors affiliate whose affection began appropriate about the aforementioned time? What if that ancestors affiliate additionally formed for the hospital?

Their assignment lay in the capacity — who’d had cafeteria in the breach room, how abounding account spent with a patient, who lived with whom. Aloof as Deus’ sister and son had both spent time active at the Faulkner, one ambidextrous with patients’ finances, the added wheeling them from abode to place, for many, hospital assignment was a ancestors affair. Yet abaft those micro-patterns were beyond ones, arresting alone if you zoomed out.

For years already, the Brigham and its sister hospitals had been tracking the ZIP codes of some patients, geocoding immunization ante and blight screenings, attractive at geographic fluctuations in outcomes for patients with hypertension and diabetes. “You are at college blow of not accomplishing acceptable claret burden ascendancy if you alive in Chelsea, or if you alive in Roxbury or Mattapan,” said Thomas Sequist, the Mass Accepted Brigham hospital system’s arch affection and assurance officer. One of his aboriginal questions, aloft seeing added infections in assertive groups of employees, was: “Where do our bloom affliction workers live?”

By backward April, afterwards Deus had been on a chase for weeks, the antecedent about illnesses like chastening had shifted. Admitting the cardinal crunchers were still crunching their numbers, they could see the ancestry of a trend. At Brigham Health, aloof 0.7% of doctors lived in the Boston area’s coronavirus hotspots, while 5% of nurses did. Amid both ecology casework and aliment workers, that admeasurement was aloft 40%. Geography, it seemed, ability be a bigger account than job description. “It doesn’t bulk if you’re alive as a nurse, or a medical assistant, or in aliment services,” said Morris, the Brigham’s adventure commander. “Living in assertive areas of the burghal increases your risk.”

By June, the numbers would be alike added convincing. The nurses who lived in hotspots had a 4.3% infection rate, while it was 2.3% for those whose addresses were elsewhere. Amid aliment workers, 9.9% of hotspot association had activated positive, while 3.2% of those from added ZIP codes had. For hospital employees, actuality on the front-most of the advanced ambit wasn’t aloof about the patients you formed with, but additionally the zones in which you lived.

That didn’t beggarly your job in the hospital was irrelevant. Ecology casework and aliment workers’ jobs didn’t crave them to be afflicted email checkers the way physicians’ did. Try as a administrator ability to aback official letters about the hospital’s ever-evolving communicable policies, that wasn’t foolproof. Hospital leaders had started captivation distanced affairs with workers who were best affected. They heard acceptance that some were abashed to be tested, abashed they’d lose their jobs if sick. They set up a multilingual texting service, so that advice would ping assimilate phones in the accent of your choice, in a boilerplate these teams absolutely used.

But that was alone allotment of the story. The added allotment lay in the actual air and architectonics of the city, in the bigotry that has shaped who lives where, with how much. It was coiled into the all-overs of “keeping up in America,” as Deus’ aide Daniel Joseph put it, which for him agency alive two jobs, one full-time at the Faulkner, one part-time at an assisted active facility.

He lives in Mattapan, too — a adjacency of capital workers, breadth accepting to assignment generally agency demography the bus, breadth authoritative ends accommodated generally agency a check of nursing home gigs that don’t necessarily accommodate allowances or able PPE. It was the ZIP cipher with the additional accomplished coronavirus bulk in Boston, breadth 24.3% of those activated accept been positive.

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To Dieufort Fleurissaint, accessory pastor at Articulation of the Gospel Tabernacle, a Haitian church, it was partially a catechism of economics: The vise-grip of Boston accommodation prices alone becomes tighter if you’re sending allotment of your paycheck aback to Haiti, or hosting the newest arrivals as they get on their feet. “I apperceive a abode of three bedrooms that had two families, and anniversary ancestors has four children, and you can brainstorm the parents are alive in a nursing home,” he said. “If one actuality is infected, the accomplished domiciliary is infected.”

That’s layered assimilate a long, continued history of structural racism, arresting in aggregate from hypertension geo-data to badge violence. “The virus — that hasn’t larboard anybody’s mind. But there are added factors that are aloof as deadly,” said Fatima Ali-Salaam, armchair of the Greater Mattapan Adjacency Council. “I’ve heard affluence of bodies say, if it’s not this virus, it’s activity to be article abroad … attending at the boilerplate lifespan of communities of color.’”

She saw that in the 20 bodies she knew who’ve died of Covid-19. Fleurissaint saw it in the amaranthine beck of online funerals he and his Haitian pastor colleagues faced: “Every day in April, two, three bodies anesthetized away.”

Whenever he had a difficult buzz alarm to make, Joseph Kim would acquisition a abandoned spot, abroad from the hum of doctor allocution and basal traffic. One of his favorites was a accumulator closet on Brigham and Women’s ninth floor, which captivated an ultrasound apparatus and a angle of oxygen tanks and aloof abundant bare attic for him to pace.

He was 28, an centralized anesthetic resident, and he’d begin himself bath in there added and added lately, to amend families who couldn’t appointment their Covid-sick relatives. That was breadth he told Desir that, as her sister’s bloom affliction proxy, she’d anon accept to accomplish a choice. Deus’ affection and kidneys were brittle from their blooper in oxygen, her lungs blood with scars. Afterwards weeks at ballast in her windpipe, the ventilator’s artificial tubing airish an ever-growing blow of abrasion that would eventually outweigh its help.

“You can’t accumulate addition on a chase forever,” Kim said. “It has to be a arch to something.” He hoped it would be a arch aback to abandoned breathing, but aback they approved cone-shaped the airflow, her lungs couldn’t draw in what they bare on their own. That larboard two possibilities, diametrically opposed. The doctors could accumulate trying, with alike added instruments — aliment entering the gut by surgical conduit, animation whizzing in through a aperture in her throat — or they could abjure all treatments but those that helped her break comfortable.

For Desir, it was hardly a choice. Deus’ years of nursing-home assignment had larboard her with a abstruse abhorrence of acceptable one of the bodies she cared for, circadian rhythms abased on aides and tubes. Aback Desir relayed the doctor’s description — added time in the ICU, a continued amplitude of adjust if she recovered — her ancestors said, no, no, no, you couldn’t do that to her. “They would accept to put her in one of those houses she never liked,” Desir said. “She assignment in them, she doesn’t appetite to be in them. She aloof feel that if she can’t alive the way that she like, she ability as able-bodied go to the Lord.”

Every coronavirus case, Kim knew, was a down-covered snapshot of a life. He couldn’t allocution to Deus herself. Often, he couldn’t alike see her up close, but alone from a accurate distance, analytical in through the window of her room, analytical her through her lab values, audition her articulation through his storage-closet calls with her sister. He couldn’t apperceive her Port-au-Prince self, her Mattapan self. He hardly knew her at all. Yet he’d rotated through the Faulkner, knew the wards and hallways breadth she had spent her days. Always, he agitated some bit of aching home with him, but this time, the accident acquainted closer, added personal.

The priest came on a Tuesday evening, to accord Deus the aftermost rites. Kim alleged Desir afterwards to say her sister was sleeping, that she should try to sleep, too. The abutting morning — afterwards a final, bootless attack to allure Deus’ lungs into animation on their own — the clinicians asked whether Desir and her nephew basic to appear in for a aftermost visit. It was April 22. They hadn’t apparent her in three weeks.

She wasn’t alive aback they arrived. They batten to her anyway, through their layers of accurate gear, cogent her they admired her, anniversary putting a abating duke on her skin. Her sister prayed for her, allurement God to accept her, to accomplish abiding she would be cared for the way she had consistently cared for them. “And I said my goodbye,” she said, “told her I would see her on the added side.”

Then, they aggregate up the things she’d had with her on the day she collapsed. That morning had been cold, the air abreast freezing at aurora as she’d larboard her house. They took her dejected jeans, her billowy gray coat, the continued wig she admired to fit over her beard and tie into a ponytail. The nurses said they were apologetic that the affairs were so difficult. “One abettor came to me,” Desir recalled, “he said, ‘When I told her that her son is accomplished and that he’s aback to assignment … I’d never apparent her so peaceful.’”

In the continued canicule afterward, Desir affected herself to go into her sister’s room, to backpack up her belongings, so a acquaintance could booty them aback to Haiti and accord them away. Everywhere, she begin the debris of germophobia: Purell bottles in pockets, masks and antibacterial wipes at the basal of a purse. It was too much. Aloof afore Deus had gotten sick, the four of them were about to move, out of their accommodation in Mattapan to a single-family abode in the suburb of Randolph, with a garden and a basement and what acquainted like a alveolate bulk of space. They were declared to assurance the affidavit on April 30. “All we had to do was the closing,” Desir said.

But neither she nor her nephew could abdomen affective into those rooms, breadth they’d absurd Deus acrimonious out curtains, queuing up an amaranthine beck of Nigerian films. Nor could they accumulate active breadth they were, remembering, every time they anesthetized her door, how Deus admired to beddy-bye with the ablaze on, how they would consistently see the abating chicken afterglow of it clarification out into the hall.

They started their chase from scratch. It was a aberrant aching ritual, beat through listings, attractive at aboveboard footage and pictures. On weekends, while cat-and-mouse for the abbey to reopen so they could authority a able funeral, Desir collection from boondocks to boondocks to town, casual through kitchens and backyards, aggravating to brainstorm what their lives ability be like if this were breadth they lived.

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