Teddy lurks around Sacred Heart, mooning after Alice, feigning ailments to see her. When he finally gets up the nerve to confess his feelings, he decides to bring his gun along. It might send the wrong message, but he always feels better with his Mauser in his hand. He ambushes Alice as she’s leaving a patient’s room, holding a steaming bedpan. Wild-eyed and brandishing his gun, our Romeo chooses to open with: “I go through your garbage bin. I know everything about you.” To prove the purity of his affection, he waves the Mauser at her chest and shrieks, “When I think about you, do I think about these milk jugs?” He reassures her, “I think of your eyes only.”

The comic ante is raised by another unlikely duo in the ward. In the corner, a double amputee, poring over X-rays as if they were old family photos, is suddenly set upon by a large bird of prey. As Teddy harangues Alice, the amputee does heroic battle with the bird, defending himself with the X-rays of his missing legs. It’s a masterly little moment, antic and affecting, the kind Hanif nails scene after scene. (And reader, she marries him. Alice marries the bodybuilder, and together, they form one of modern fiction’s most unlikely and — for a time — truly contented pairs.)

At its best, “Our Lady of Alice Bhatti” isn’t amusing or entertaining or anything so mealy-mouthed. It’s belly-laugh-inducing. Sam Lipsyte funny. “Fawlty Towers” funny. The silliness is anarchic and profound. Hanif will heckle himself given half the chance. Here he is on love: “It’s futile to predict what love will make of you, but sometimes it brings you things you never knew you wanted. One moment all you want is a warm shower, and the next you are offering your lover your chest to urinate on.” But of course, there’s something deadly serious at work too. Hanif’s Karachi is the veritable definition of anarchy. Humorists are just trying to keep up.

In an essay on the comic novel, Howard Jacobson wrote, “The greatest comic novels give the impression of starting on a whim and heading for they don’t know where.” So it is with “Our Lady of Alice Bhatti.” It gambols along like one of its goons, from humiliation to blood bath and back again. It lacks the fastidious plotting and narrative neatness of “A Case of Exploding Mangoes” — and it’s better for it. It’s a loose, loping creature, less anxious about being a Novel, more interested in telling a ripping story.

And will this story — and grisly Sacred Heart — be taken as a parable for Pakistan? One hopes not. Mohammed Hanif’s criticisms are pointed and specific. He is unflinching on the abuse of women and religious minorities. But the world of “Alice Bhatti” is too rangy, too much its own perfectly realized universe to be stunted into stale allegory. It’s a rowdy piece of art; its concerns are local and universal. We’re all implicated. Sacred Heart, c’est nous. And we’re all terminal cases.