“A few crackles at the base,” French said after a prolonged examination with her stethoscope, “but that’s not a surprise. Dr. Hadawi is here from Anesthesia. Just do what he says, and that tube should be out in a few seconds. You understand that if things aren’t perfect, we’re not going to wait too long before we put it back, yes?”
Natalie nodded. Her deep trachea was suctioned out, a totally unpleasant sensation for her. Then, as instructed by the anesthesiologist, she coughed, and just like that, the tube was out. For several minutes, all she could do was lie still, a mask in place, taking in humidified oxygen in slow, deep, grateful gulps. A pervasive, quiet tension held as she adjusted to the change, waiting fearfully for signs that her breathing was deteriorating and a new tube needed to be inserted. French examined her several times, and then finally thanked the anesthesiologist and sent him away. Natalie continued almost motionless, gauging her degree of discomfort, anxiety, and air hunger.
Something wasn’t right.
Even after two days, the odor of smoke was still present, probably coming from within her nose and sinuses. Although her vision was unclouded, her eyes still felt gritty and uncomfortable, despite an ointment that was being layered under her lower lid every few hours. But the real trouble, she sensed, was in her lung. Thanks to her intense workouts during therapy, her breathing had come to feel essentially normal. Now, despite being able to inhale deeply, it felt as if not quite enough air was getting in with each breath—not enough to be called air hunger, or even to cause panic, but she knew her body as only an athlete could, and something wasn’t right. A look at Rachel’s expression and Natalie could tell the pulmonologist knew as well.
“You okay?” French asked.
“I don’t know, am I?”
“You’re doing fine.”
Natalie could see the concern shadowing her doctor’s face.
“You’re doing fine. Isn’t that what they told Marie Antoinette…right before they dropped the blade?”
The midsentence pause she took to breathe wasn’t natural.
“Believe me, your outlook is significantly rosier than hers was,” French replied, smiling at the image, “but even though I thought you were well enough to have the tube removed, your oxygen saturation is still a little low, and you still have some edema fluid in parts of your lung. I think that’s what you’re feeling right now.”
“You expect that to go away?”
“Much of it has already.”
“But were the alveoli in my lung burned?…Is that why I have the edema and the low oxygen?”
“Nat, you did inhale a lot of smoke and hyperheated air.”
Natalie felt a knot of fear materialize in her chest.
“And?”
French raised the head of the bed past forty-five degrees, then sat on the edge.
“The lining of your trachea, bronchial tubes, and alveoli were damaged. There can be no question of that.”
“I see. Damaged. That edema fluid is not just a reaction to…my lung having been irritated by the smoke?”
“Some, I’m sure, but a lot of what’s happened is from the heat. You know how someone in a fire might have first-, second-, and third-degree burns on his skin? Well, that’s what your injuries are—first-, second-, and third-degree burns to the tissue in your lung.”
“First and second degree tend to heal completely,” Natalie said.
“Exactly. But third-degree burns are full-thickness—through the epidermis, the dermis, and the subcutaneous tissue. Rather than heal as it was, tissue burned to the third degree generally heals by scarring. Scar tissue offers some physical protection, but little in the way of natural function—in your case, gas exchange.”
“So the question here is how much…of my lung has third-degree burn.”
“And at the moment, we don’t know. That was an amazingly heroic thing you did, Nat. I’ve been praying since they brought you in that the damage isn’t too extensive.”
“But you don’t know,” Natalie murmured, as much to herself as to French.
“I don’t know. Nat, with what happened to you in Brazil, and now this, you’ve had a real raw deal. I don’t want it to get any worse.”
“But it might.”
French seemed to be searching for an answer that would skirt the statement.
“We don’t know how much damage has been done, or how much of what may be second-degree burn turns out functionally to be third.”
“Jesus. Is there anything I can do?”
“Wait a week or so and then we’ll get some pulmonary function studies and also get you back into the therapy room.”
“I…I don’t know if I can.”
“The woman who crawled back into that burning house to save a ten-year-old girl can do it.”
“I don’t know,” Natalie said again, trying a deep breath that seemed only marginally to fill her lung. “What if it’s bad? What if there’s too much damage for me ever to breathe normally?”
French looked at her evenly.
“Nat, you mustn’t project like this. You’ll end up getting so wrapped up in what might happen that you’ll paralyze yourself.”
“Wouldn’t you want to know?…Wouldn’t you want to know if you were ever going to be able to run again?…Or even walk without having to gasp for air?…Isn’t there anything I can do?”
“Easy does it, Nat, please.”
“There must be something.”
“Okay, there is,” French said reluctantly. “I’ve taken the liberty of having your blood sent off for tissue-typing.”
“A transplant?”
“I’m not saying you’re going to need one, but as you probably know, the process can be a complicated and drawn-out one.”
“Get on the list.”
“There is a regional list, yes, but for the past year or so it’s not like the kidney list, which is sort of a first-come, first-served deal. The lung waiting list involves a pretty complicated mathematical evaluation called the lung allocation score. But listen, this is probably not the time to talk about all this. I only started the process because it’s so time-consuming. You are a long way from needing a transplant.”
“If I can’t be normal or close to normal,” Natalie said, “I don’t think I want to live.”
French sighed.
“Nat, I really should have waited to bring all this up. I’m sorry.”
“I’m blood type O, you know. That’s the most difficult blood type to match for a transplant.”
“Nat, please.”
“No way I’m going to take immunosuppressant drugs…every day for the rest of my life…. They cause a list of side effects as long as my arm…. Infection, osteoporosis, diabetes, renal failure.”
“Honey, please, take a deep breath and get ahold of yourself. You’re running way ahead with this thing. I don’t even know if you’re ever even going to—”
“I’m never going to be right, am I?…No matter what, I’m never going to run again…. And a surgical residency takes stamina—so does standing in the OR for hours at a time…. There’s no chance I’m going to make it as a surgeon…when I can’t even walk to the damn corner grocery without getting winded. How much can a person take?”
Instead of recoiling from Natalie’s projections and verbal onslaught, Rachel French did what came naturally to her as a physician, moving forward and putting her arms around her patient.
“Easy,” she whispered. “Easy does it, Nat.”
Natalie momentarily felt herself about to break down. Instead, she stiffened and stared stonily at the opposite wall, her tears unshed.
The next twenty-four hours did not pass pleasantly, even though Natalie sensed some small improvement in her breathing. She certainly felt grateful at having been able to save her mother and niece, but still the depression that accompanied news of her lung damage continued to deepen. Her psychotherapist stopped by several times, and finally succeeded in getting her to try a mild antidepressant. Rather than give the med
ication a chance, Natalie convinced a friend to bring in her laptop, and spent much of her time awake and online, reading about lung transplantation, tissue-typing, histocompatibility, and the newly adopted formula for deciding who would receive one of the very limited supply of lungs—the lung allocation score.
Heavily weighted in determining the score was the survival probability for the upcoming year. Very little emphasis in the complex mathematical equations was given to the extent of disability—only to the likelihood of death. Natalie’s already deflated mood became even more somber as she realized that the rather remote possibility she would die in the near future actually mitigated against her even being considered for a transplant. She could drag herself around indefinitely, working for every breath, but that didn’t count. Quality of life mattered little when measured against quantity.
But what difference did it make? She didn’t want a transplant anyway. She didn’t want the preparation and the waiting, and she didn’t want the surgery, and she didn’t want the damn antirejection drugs and their hideous side effects, and she didn’t want to spend her life under the Damocles’ sword of organ rejection and emergency rehospitalization. Live with all the energy of a vegetable, or live on toxic medications designed to make someone else’s lung keep her alive. Great choice.
To make matters even worse, the vivid recurrent visions of her horrible experience in Rio continued without warning, seizing her thoughts, usually at night, but sometimes in the day as well. The scenes were not memories—they never had been. They were powerful and terrifying at the most primal, visceral level. Having them continue with this intensity a month after the actual incident was something that Dr. Fierstein could not explain other than to invoke the old PTSD catchall.
Natalie was hanging from the fence in the squalid alley when movement and shuffling pulled her from the ghastly, terrifying situation. She opened her eyes slowly, half expecting to see another reporter, even though she had expressly requested that security and the nurses keep them away. What she saw instead was her mother, holding open the huge two-page article in the Herald about the daring rescue. Behind her were Doug Berenger and, holding some sort of a small plastic bin, Terry Millwood, both of them frequent visitors to her room.
“Hey, Mom, you’re out,” Natalie said flatly. “Jenny, too?”
“They discharged us both last night. We’re staying at your place until we figure out what to do. My friend Suki is with Jen until I get back.”
“That’s fine. I think I’m getting sprung tomorrow…. There’s room for the three of us, at least for awhile.”
“I’ve been so worried. You’re doing good?”
“Fine, Mom. I’m doing fine. You remember Dr. Berenger…and Terry?”
“Of course, we were all just talking in the hall.”
Natalie tried to keep her anger at Hermina in check, but the news about her lungs and the possibility of a transplant was just too raw.
“Well, they’re both chest surgeons, Mom,” she said, “and I hope they read you the riot act…. The house is gone, everything you owned is up in flames…. And you and Jenny nearly died. For what? So you can suck in just one more Winston…. I know what the courts have determined about the cigarette companies, and I know how horrible it was to lose Elena the way we did, but I also know how little effort you have put into trying to stop…. Here you do everything you can to make Jenny’s life as good as it can be, then you nearly kill the poor kid.”
Natalie was breathless from the effort of her verbal onslaught.
Hermina recoiled from the force of the attack.
“I…I’m sorry, Nat. Really I am.”
Natalie refused to let up.
“Sorry’s not enough, Mom.”
Hermina held her right hand out and rotated it back to front.
“For what it’s worth,” she said sheepishly, “I’ve been clean for three days now. No nicotine stains, see?”
Berenger and Millwood muttered words of approval, but Natalie was stony.
“No more, Mom. Not one more butt!” she snapped.
“I promise. I’ll try my best.”
“No more,” Natalie said again, visualizing the damaged alveoli in her one remaining lung. Finally, she sighed and added, “Well, you and Jen are alive and unharmed, and that’s what matters.”
Doug Berenger, looking totally professorial in his knee-length clinic coat, stepped forward, kissed Natalie on the forehead, and handed her a box of Godiva chocolates. Then he turned to her mother.
“Mrs. Reyes—Hermina—I wonder if Terry and I could speak alone with Natalie for just a few minutes.”
Hermina, bewildered, and trying not to pout, muttered, “Of course,” and left.
“You are certainly the buzz around this place,” Berenger said. “I heard the mayor and Sam Goldenberg have already been talking about some sort of award ceremony.”
“Do what you can to get me out of that one,” Natalie said.
“I never did get the chance to congratulate you on getting reinstated at school.”
“Thanks. I always celebrate good news by getting myself put on a ventilator. It’s a tradition.”
Millwood set the plastic bin down beside her.
“Get well cards,” he said. “Everyone loves a good old-fashioned heroine, including us. These are from all over, not just Boston.”
Although their eyes met only momentarily, Natalie had no doubt her friend sensed her deep melancholy.
“Just set them in the corner,” she said. “I’ll open them all when I get home.”
“Natalie,” Berenger said, “I have an idea I’d like to discuss with you. Some friends and I have a small business rehabilitating apartment buildings and turning them into condominiums, which we then sell at an obscene profit. Well, it just so happens that at the moment we have a new building in East Boston that we’ve just finished, and all the units are sold except for the demo, which is a nicely furnished two-bedroom. I’d be honored to have your mother and your niece live there until they can settle up with their insurance company and work out something more permanent. It’s on the first floor and totally wheelchair accessible.”
Natalie suppressed the knee-jerk impulse to say they would be fine in her place.
“That’s very kind of you,” she said instead. “It’s a wonderful gesture. Just one thing if you do it. If my mother smokes…she’s out. No second chances. She can go and rent a room or an apartment, and I’ll take Jenny. I should have put my foot down more firmly years ago.”
“If she smokes, she’s out,” Berenger said. “Hopefully this will be the event that does it for her, and if you say that’s the rule, that’s the rule. But nicotine addiction is a powerful monkey. Just think about Carl Culver, that patient of mine whose head your pal Tonya Levitskaya almost bit off. Getting a new heart put into his chest wasn’t enough to keep him from smoking again. You’d be amazed at how many liver transplant recipients drink alcohol—some quite heavily, even though it’s been proven that as little as a couple of ounces causes fatty changes in the liver.”
Natalie wouldn’t be moved.
“We’ve got to keep the pressure on,” she said.
Berenger tented his fingertips and bowed.
“So it is written, so it shall be done,” he said. “I shall see if your mother wishes to make the deal.”
“That’s terrific. I’ve always suspected that my mother has mystical powers…. Don’t let her persuade you to back down about the cigarettes.”
“I will do my best,” Berenger said, backing from the room.
“I’m not kidding, Doug. I love her very much, but the highway in her rearview mirror is littered with people who thought they could get the better of her.”
“Mostly men, I’ll bet,” Millwood said after Berenger had left.
“You got it.”
“Pardon me for saying it, but for a heroine you don’t seem too bubbly.”
“I’m not. Rachel French says my lung’s been damaged. At this point there
’s no way to tell how badly. She said that just in case, she’s turned my name in and started me on the road to a transplant.”
“I know,” Millwood said. “I just spoke with her. Nat, the transplant thing is just a precaution because the whole evaluation and lung allocation formula is so cumbersome and time-consuming.”
“I can’t do it, Terry.”
“I know it’s hard, but you’ve got to try and stay in the moment. No projecting until you know what you’re up against.”
“Easy for you to say. You’re not the one whose lung is rotting away.”
“I’m just saying don’t get down about what you don’t know about. You’ve come too far to give in to this.”
“I’ll see what I can do,” she said acidly.
Millwood stood.
“Nat, I’m sorry. I really am. If you need anything, anything at all, I’m your man. Our friendship means everything to me.”
“Good enough,” Natalie said with little enthusiasm.
Millwood seemed for a moment as if he were going to say something else. Then he merely shook his head in frustration and sadness, and left. Once in the hallway, he turned to the right, away from the elevators, and went to the nurses’ station. Rachel French, working on some notes, was waiting for him.
“Well?” she asked.
Millwood sighed.
“She’s as close to beaten as I’ve ever known her to be. Just a few days ago she was high as a cloud over the news that she had been reinstated at school. Now this.”
“I’m afraid I haven’t handled things too well. I should have waited until after she was discharged before even bringing up the word ‘transplant.’ The whole business has her believing that her lung is done for, even though I keep telling her that we have no way of knowing at this point.”
“She’s very smart and very intuitive.”
“Good thing she doesn’t have all the facts yet.”
“What facts?”
The Fifth Vial Page 17
