In Chapter 4, Estrella and her family finally arrive at a remote, worn-down clinic. The only staff member, a nurse, seems distant from Alejo and unwilling to give him any but the most clinical of attentions. She suggests that the family take the boy to a hospital; however, she does not recognize how very little money the family has to pay the clinic's fee, to buy gasoline, or to pay a doctor's bill. Estrella repeatedly recommends Perfecto to the nurse as a repairman, so that the migrants can barter his work for medical services rather than pay money for them; the nurse repeatedly cannot read the vast gulf between even her small earning power and her patients’. At last, Estrella threatens the nurse with a crow bar, takes back the meager fee she had paid the clinic, and uses the money to buy gasoline to take Alejo to a hospital, where the family leaves him to the doctors’ care and to his fate.