Sister Mary Joseph Praise nurses the severely seasick Dr. Thomas Stone on a ship bound for Africa.

Sister arrives at Missing Hospital travel-worn and bloodstained after something terrible befalls her in Aden.

Thomas discovers Sister near death in her room and carries her to the operating theater.

Hema rushes into the operating room, takes over from Thomas, and delivers the conjoined twins by C-section.

Sister dies after childbirth; Thomas refuses to look at the newborn twins and disappears from Missing.

Hema names the twin boys Marion and Shiva and vows to raise them as her own.

Ghosh proposes to Hema, and she agrees to marry him for one year to start.

Brigadier General Mebratu stages a coup to depose Emperor Haile Selassie, which ultimately fails.

Soldiers arrest Ghosh from Missing Hospital because of his close friendship with the failed coup leader.

Shiva has sex with Genet; Rosina arranges female genital mutilation on Genet, nearly killing her.

Genet's airplane hijacking implicates Marion as a coconspirator, forcing him to flee Ethiopia immediately.

Thomas Stone appears in Marion's operating room at the Bronx hospital without knowing who Marion is.

Genet appears at Marion's New York door, ill and apologetic; they have sex, and she vanishes.

Marion's liver fails from hepatitis; Shiva donates part of his liver in a groundbreaking transplant operation.

Shiva dies from a brain bleed after the transplant surgery; Marion and Hema return to Ethiopia.

Marion and Shiva are born in Ethiopia after their mother, Sister Mary Joseph Praise, dies in childbirth and their father, Thomas Stone, abandons them. The twins are raised at Missing Hospital by adoptive parents Hema and Ghosh, growing up amid Ethiopian political upheaval. Shiva's betrayal with Genet fractures their bond, and Genet's involvement in an airplane hijacking forces Marion to flee to America. In New York, Marion builds a career as a trauma surgeon and cautiously reconnects with Thomas Stone, working toward an uneasy peace with the father who left him. When Genet reappears and infects Marion with hepatitis, his liver fails, and Shiva makes the ultimate sacrifice to save his life. Shiva dies after the transplant, but Marion carries a piece of him inside and returns to Ethiopia as ShivaMarion at last.

The central story of Marion's birth, exile, and reunion with Shiva.

Thomas asks Sister Mary Joseph Praise to join him at Missing Hospital; she declines and sails to Aden.

Thomas realizes he has been in love with Sister for seven years only as he carries her dying body.

Hema's plane engine apparently fails mid-flight; during the crisis, she resolves she wants to marry Ghosh.

Thomas, believing the twins are dead, prepares to crush a skull with forceps in order to save Sister.

Ghosh cancels his plans to emigrate to America and stays to help care for the premature twins.

Ghosh successfully performs emergency bowel obstruction surgery on the secretly revolutionary Colonel Mebratu.

Matron buries Sister on the hospital grounds; Gebrew, an Ethiopian Orthodox priest, leads the ceremony.

An old woman throws a shoe at Emperor Selassie's car; police beat her and the surrounding crowd savagely.

Mebratu is sentenced to hang and is executed; Ghosh is released from prison after 48 days.

Rosina dies by suicide; Genet moves permanently into Hema and Ghosh's household with the twins.

Ghosh reveals his preleukemia diagnosis to Marion alone and asks him to keep it secret from the family.

Marion arrives at Our Lady of Perpetual Succor and discovers the hospital is staffed entirely by immigrant doctors.

Marion attends a liver transplant conference in Boston where Thomas recognizes Marion's strong resemblance to himself.

Thomas takes Marion to an Ethiopian restaurant in New York and returns Sister's bookmark to him.

Marion finds Sister Mary Joseph Praise's unsent letter to Thomas hidden behind the framed St. Teresa picture.

From Thomas's first invitation to Sister on the ship to Hema's mid-flight resolve to marry Ghosh, the foundations of Missing Hospital's makeshift family are built through quieter but consequential events. Ghosh's decision to abandon his American plans and stay in Ethiopia sets him on the path to becoming Marion's surgeon, mentor, and surrogate father. The political world intrudes sharply when police beat a crowd near the Emperor's passing car, and Mebratu's eventual execution closes that chapter of Ethiopian history. Rosina's suicide and Ghosh's secret diagnosis of preleukemia mark the losses that push Marion toward adulthood and medicine. After Marion flees to America, a charged dinner with Thomas and the return of Sister's bookmark begin the slow thaw between father and son. The discovery of Sister's hidden letter to Thomas finally explains the love at the heart of the novel's entire story.

The supporting moments and relationships that shape Missing Hospital's world.

Sister Anjali dies of typhoid on the ship, leaving Sister Mary Joseph Praise alone and grief-stricken.

Matron examines the laboring Sister and announces she is pregnant, stunning everyone at Missing Hospital.

One twin stops breathing after birth; Hema revives him and rigs a bell alarm using her jewelry as an anklet.

Shiva stops speaking for two years while Marion unknowingly speaks for both of them as a single voice.

Puppies are killed at Missing; Shiva breaks two years of silence to condemn the adults and removes his anklet.

Genet blindfolds and kisses Marion in the pantry during blind man's bluff; he resolves to marry her someday.

Marion accidentally shoots and kills the man who came to claim Zemui's motorcycle; the body is quietly hidden.

While Ghosh is imprisoned, Marion begins diagnosing patients at Missing using his extraordinary sense of smell.

Shiva's betrayal with Genet drives Marion to move into separate quarters, sleeping apart from his twin for the first time.

Ghosh dies of leukemia; his final wishes ask Marion to travel to America, contact Thomas, and forgive Shiva.

Marion breaks into Thomas's sparse apartment and leaves Sister's bookmark with her handwritten message on the desk.

Thomas visits Marion's hospital room and reveals the full story of his past, including the night with Sister.

Shiva volunteers to donate part of his liver to save Marion, saying it is what Marion himself would do.

Marion lies beside Shiva as the ventilator is turned off and understands they are and always were ShivaMarion.

Marion and Hema stop in Rome to kneel before Bernini's sculpture of St. Teresa before returning home.

From the moment one twin stops breathing after birth to the discovery of Sister's hidden letter, Pool 3 traces the pivotal shifts that define Marion's inner journey. Childhood turning points — Shiva's two years of silence, a stolen kiss from Genet, a deadly accident with a motorcycle — quietly shape Marion's moral and emotional world. The shattering moment arrives when Shiva's betrayal forces Marion to sleep alone for the first time, breaking the ShivaMarion bond that had defined his entire identity. In America, Marion's break-in at Thomas's apartment and Thomas's revelation about the night with Sister give Marion the information he needs to begin forgiving his father. Shiva's selfless decision to donate his liver transforms their fractured relationship, and his death in a hospital bed beside Marion finally reunites the twins as one. The prayer before Bernini's sculpture in Rome closes the circle of faith that Sister began.

The decisions and discoveries that transform Marion's identity and relationships.