The hospital begins to float and the survivors try to retain a semblance of normal life, combating the illness of their patients and setting up an internal government.

Jemma is particularly troubled by the loss of her brother, Calvin, who filled her early years with the supernatural and eventually took his own life.

On a particularly stormy night Jemma aides in the birth of a disfigured child, a daughter of a “King of the East” who had come to New Jersey and married.

When they emerge, the storm has submerged the entire world beneath a vast ocean, with only the hospital and its inhabitants left floating above.

No one finds time to mourn the loss of the world as the condition of the hospital's patients suddenly turns for the worse, and every adult is busy attending to them.

A man named John Grampus reveals that he is the architect of the hospital, and was contacted by the angel long ago to create the building which would serve as an ark when the Apocalypse came.

The hospital hierarchy remains intact as medical personnel and parents focus on their sole mission- to make the children well.

Jemma's best friend, Vivian dates constantly, while secretly obsessing with a long list of reasons leading to the end of the world.

A council is elected (of which Jemma is named the highest title of Universal Friend) and the adults are put in charge of leading classes for the children.

They return with one person, a teenage boy who carries with him a diary detailing his sexual exploits with male and female passengers of the cruise ship, now long gone.

Soon the only people left in the hospital are the sleeping children, heavily pregnant Jemma, Rob, and Ishmael who is delving into insanity.