In 1976 Parambil flourishes under Joppan’s management, even as the old house shows wear. Mariamma renovates with Anna Chedethi, introducing a refrigerator that wins Anna over. Across the canal, the nearly finished Mar Thoma Medical Mission Hospital (Triple Yem) draws hopeful crowds that watchman Raghavan must turn away. When Raghavan wakes Mariamma at night for a child in severe asthma, she saves the child with adrenaline, then pleads at the board meeting to open a casualty room, only to be ignored in favor of debating an inaugural plaque.

Frustrated, Mariamma accepts discreet help from Uplift Master, who refuses a public role but outlines a plan: order essential supplies and invoice the bishop, collect patient letters to pressure the Metropolitan, and expose the plaque’s extravagance versus lifesaving medicines. With Master’s covert pressure, the hospital’s ground floor comes alive: a casualty room, an outpatient department, an emergency ward, and a theater with mismatched donated instruments. Patients pour in, sometimes as family outings.

Forced into surgery before she feels ready, Mariamma performs a midnight emergency caesarean. The night nurse falters, so Joppan administers ether while Mariamma operates alone and delivers a healthy baby. Later, for a stabbing, Raghavan manages anesthesia and Joppan assists scrubbed; he quickly grasps sterile technique and anticipates her needs. Mariamma postpones elective operations until staffing improves, but momentum builds as the Metropolitan compels the bishop to bring Uplift Master back formally to unstick equipment in customs.

In the evenings, Mariamma expands the Water Tree, meeting family reluctance. A breakthrough comes when Cherian, the tea seller who quietly sends her refreshments, confides that his sister and other relatives drowned and that he’s heard of similar Christian families. Mariamma conceives a spoke-wheel genealogy: multiple afflicted families radiating to a common ancestor, and decides to find more “spokes.”

She summons Broker Aniyan, who delivers three lessons on marriage—set the date, most impediments are minor and adjustable, and judge character through the mother—before learning her real purpose. Aniyan rapidly corrects and extends earlier generations of her chart but avoids current ones. When he asks about utility, Mariamma describes safer future surgery and preventing risky unions through understanding inheritance. He agrees to help after retiring and warns that families are defined by the secrets they share, making her task delicate. Leaving, he repeats: set a date.

After an exhausting day, Mariamma walks home past familiar landmarks, thinking of Elsie’s drowning and the burden of legacy. Over a simple kitchen meal with Anna Chedethi, Joppan discusses a new rubber-processing shed. The three eat together as equals, a quiet sign of Parambil’s transformation into a home and a hub for Mariamma’s twin callings: hospital and heritage.