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Authors: Carol Cassella

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BOOK: Oxygen
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I pull a leftover wild rice salad out of the refrigerator, pour a glass of wine and sit in my study watching the last light give up the day. Downtown city windows scatter just enough glow to cast everything in the room gray or black, familiar in shape instead of detail. My father stares at me from his picture frame, ghostly in the low light, nailed square in the center of a wall of books—a suitable setting for him. Maybe this is how the world looks to him right now as he loses his sight.

After twenty-two years of sharing only the most neutral and essential information with him, of studiously living without his advice, I suddenly wish I could repeat to him the perfect summary of Jolene’s anesthetic, memorized after days and days of telling it to lawyers. Maybe we are far enough away from each other by now that he could listen and reassure me, convince me that I missed nothing, overlooked nothing, did nothing that might have precipitated her death. There was a time in my early life when he would have done that for me. But the woman I am today is too remote from the favored child I once was, and if forgiveness is what I need, he taught me well not to look to him.

For the tenth time in a month I pull my pediatric anesthesia textbook off the shelf and read about anaphylaxis and cardiac resuscitation, convincing myself once more that nothing could have made a difference, hoping I find enough peace to sleep.

9

I’m sitting on a beach,
and a breeze combs the fronds of three coconut palms rising into the cloudless canopy of sky; they ruffle like frayed emerald sheets. I hear the rattling crescendo before my hair lifts in the cool wash of air. The ocean stretches taut against the world’s curve, bright and blue, striped light and dark above hidden hills and valleys. The clean sweep of the horizon is notched by a dark scratch, a bobbing boat filled with three or four children. They are singing. Words ripple to me on gusts of air:

The Owl and the Pussycat went to sea

In a beautiful pea-green boat.

I walk into the blue, and cold creeps up to my ankles, my knees, my thighs. My abdomen contracts and then relaxes as my skin shunts blood back to my core, warming my heart, my lungs, my gut, my womb. A wave lifts me, buoys me up to swim across the sea to the boat. The children’s voices beckon, their flushed faces shaded by sun hats; light and shadow cleave their bodies as the boat rocks and they stretch over the gunwales to splash the sea. I reach up to the polished wooden railing, the shadow of my hand splayed across it like a glimpse into the future, ready to grasp hold.

I push my torso up and over the edge, poised, when a sucking tug in my pelvis, a vortex of gravity, pulls me, drags me below the water, beneath the boat. Salt washes into my nose and stings my open eyes. I hear the swallowed sound of the children’s singing over the humming pressure of the ocean, see the barnacled bottom of the boat above me, swaying on the water in the sunlight, marking the sharp break between air and ocean.

The sea is so beautiful I don’t struggle at all, even as the water gets colder, heavier around my skull. Only at the last minute do I think of breathing, only just before the burning in my chest reminds me. Miles of ocean stretch over me and I am still swirling down, down until the evolutionary root of my brain, planted long before the higher fluff of my frontal lobes—site of all the judgments that make me unique among humans—forces my diaphragm down, gasps in whatever substance surrounds me, reflexively inhaling any possible source of oxygen.

 

The breath wakes me up. In the disoriented space of near dreams I’m only aware of my heart pounding, rocking inside my skull, racing with the panic of impending catastrophe. My heart—the central organ of immediate survival that links all organs together through the oxygen-rich bath of circulating blood. It is as sensitive as a precision-tuned Ferrari—contracting and accelerating, throttling blood and oxygen and life ahead at the first physiological inkling of disaster.

Jolene Jansen’s heart should have been racing when her body plunged out of the controlled and level plane of anesthesia into the strangling spiral of anaphylaxis. Her heart rate should have sped up before terminal oxygen deprivation checked it. Something was wrong with her heart. Something was wrong with Jolene’s heart even before I put her to sleep.

I rest the tips of my fingers against my carotid artery and count my pulse as it slows down from one hundred to ninety to seventy to sixty. Outside I hear the last of the revelers leaving Pioneer Square as the street transforms from night to day, from bars to businesses. Circling red lights on my ceiling reflect the city’s sweep to bustle drunks off to emergency rooms or jails before the Starbucks and French patisseries open. In another two hours, pale-skinned baristas clothed all in black, silver rings ladder-stepping up the curves of their ears, will begin picking their way through the broken glass and oil-sheened puddles to turn on their espresso machines. It has been thirty-two days since Jolene’s autopsy, and the report is still not back. I creep down the hallway in my nightgown, padding on tiptoe as if there were anyone else here to awaken. My alarm is set for five. I have an hour to begin reading about congenital heart defects.

 

Karen Leece, one of the gynecologists, pages me during my first case to say she has an extra ticket to the symphony at Benaroya Hall tonight. Her husband, Rick, travels a lot as a manager for Alaska Airlines, and she often adopts me as her spare date.

“There’ll be eight of us—Glenn and his wife from my old practice, and some of Rick’s colleagues. We’re coming back to my house after for a drink. Please come, Marie—it’s Ravel. We’d all love to see you getting out again.” There is a brief moment of awkwardness as she realizes where she has trod.

The thought of making small talk with strangers feels ludicrous. But she’s right, I’ve cloistered myself since Jolene’s death. So I accept.

Benaroya Hall’s arcing glass wall fractures into glistening panels that rise three stories above the symphony patrons. Karen meets me at the front entrance with my ticket just before the auditorium lights go down so I won’t have to socialize until after the concert.

“Do I look OK?” I ask her. I threw on a gauzy summer dress just before the taxi came, and couldn’t find the right shoes.

Karen kisses my cheek and guides me past the usher with an arm around my waist. “Gorgeous. Are you eating anymore? Your belt is slipping off. How come I only gain when I’m stressed?”

There is a swell of applause, and the pianist bows and sweeps the tails of his coat over the piano bench. Notes gather and swirl into imagined shapes; Ravel’s minor chords and runs stir a communion of unresolved pathos that cuts to my core. We are two thousand strangers revering music composed almost a century ago, discovering emotion evoked through vibrations of air. I close my eyes and let the piano crescendos wash over me, penetrate me, sweep me into a universe where these last weeks of my life could dissolve into inconsequential bits of fallen stars.

After the concert we share cars to Karen and Rick’s house in Madison Park, a boxy glass and stucco structure plunked between two pastel Victorian-style mansions, its front porch overhung with evergreen clematis, the fading white blossoms fluttering like small ghosts against the dark leaves. Karen pops some fancy hors d’oeuvres out of the Sub-Zero refrigerator and pours champagne into gold-rimmed flutes. Glenn builds a fire of pressed-wax logs, unnaturally colored flames incinerate the paper on the fake wood, and we pull armchairs and kitchen stools around a pink marble coffee table. I’m hungrier than I’ve felt in days, and the champagne feels like it’s untangling something inside me.

Louis, one of Rick’s trainees, and his wife, Jeanne, are over from France for a year. Their fourteen-year-old daughter is enrolled in the public high school.

“She wants me to drive her everywhere,” Jeanne says. “At home she walked to school. If she wanted to see friends, she took the bus or the subway. Now she says she would be too embarrassed—her friends would laugh at her. Be glad you have boys, Karen. It is too difficult raising a teenaged girl.”

“Well, don’t trade her away too quickly.” Karen shakes her head. “You should have been here to clean out the washing machine last summer when they forgot to take all the tadpoles they’d caught out of their pockets.”

The conversation circles around the myriad trials of parenting until Glenn includes me with a remark about the financial freedom I’ll have without a college savings account to worry about. And then, as always in a gathering of physicians, we debate the U.S. health-care system. Glenn’s wife, Sharon, a public health physician, talks about funds redirected from a community clinic so her hospital can create a bioterrorism office. “They want me to prepare for smallpox while my older patients are dying of the flu.”

“I’m always reading that America has the best health care in the world, yet you give new hips and knees to eighty-five-year-olds, and nothing to millions of children,” says Jeanne, crossing tanned legs so one high-heeled sandal dangles from a scarlet-nailed toe.

Glenn deflects the medical criticism back onto the legal system, pointing out the outrageous malpractice premiums driving obstetricians out of the state.

“I’ve heard about this. And Marie,” Jeanne says turning to me, “it sounds like hell what you are going through with the lawyers. Do they really videotape your testimony?”

I rise and pick up plates and crystal from the table. “Hell would be a close approximation. Next year you must find me a job in France, Jeanne.” A hot flush floods my face and I tip my head so my hair falls forward in a veil.

In the kitchen I run steaming water into the sink and pour in an iridescent blue soap. Laughter and competing voices rise and fall through the half-closed doors. I jump when a hand rubs my back. Karen has put on an apron covered with dancing black and white cows. She stands a head taller than me, with wide gray eyes pregnant women must find soothing. Her front teeth overlap. I suspect her parents couldn’t invest in nonessential dentistry, that Karen must have worked hard for scholarships and living wages so her children could grow up in a well-padded lifestyle, a lifestyle that would safely assure them long and happy lives. She grabs a dish towel and plucks wet stemware from the stainless rack beside the sink.

“I’m sorry about that. We shouldn’t have talked to them about the suit. I can’t excuse myself for it.” She twists the end of the dish towel deep into the funnel of the fragile crystal to polish the inside back to clarity.

“Well, I might as well get used to explaining this—it’ll be on my permanent record.” I keep my voice light, but she stays self-consciously silent for a minute. We both know that from now on, every year when I renew my medical license or my hospital privileges, I will have to write a detailed description of the malpractice claim.

“Marie,” she says, pointlessly buffing the gleaming steel faucets. “What
do
you think really happened? What caused it?”

She can’t help asking. She is searching for the consoling nugget that will guarantee her own child is not vulnerable, that her own child can proceed to the tonsillectomy, the appendectomy, the ear tube placement, and come back home alive.

I’m on the verge of telling her what I suspect. I’m on the verge of asking her opinion about which heart defect Jolene must have had, what twisted unfurling of the chambers and vessels must have occurred when one flawed scrap of DNA misfired and finally, fatally, declared itself on my operating room bed. We could discuss it as equally educated physicians, as uncompetitive friends, talk through the physiology to find an answer. She would never tell. Surely she’ll never be deposed against me—she wasn’t even in the hospital that day. But what look will cross her face when she realizes I might have missed a diagnosis that could have saved a life? What will be her own verdict?

I carefully refold the damp dish towel and place it on the counter before I turn to face her. “I don’t know, Karen. I may never know for sure.”

Karen ducks out to collect dishes and I slip into a spare bedroom to call a taxi. Sitting on the bed by the phone, damp coats piled beside me, I wait on hold and study the room, paintings of hunting dogs above the bed, Ralph Lauren plaid comforter and drapes. Family photographs are arranged on the bedside table and dresser: Karen and Ricky and their twin sons in front of a fireplace draped with Christmas stockings; Matt at his first T-ball game, his baseball cap so big on him his ears are folded in half and stick out like tiny pink wings; Karen in the delivery room just at the moment of birth. I’ve always sworn I would never display pictures of my own babies’ births throughout the house like some public anatomy lesson.

Once the taxi honks, no one can protest enough to drive me home. The usual misting rain has progressed to a steady fall of tear-shaped drops and the taxi’s headlights glint off puddles in the intersections.

The driver lets me off at the corner of First Avenue, just beyond the arching Gothic-carved stone doorway of the converted red brick factory where my top-floor loft collects Seattle’s northern and western horizons and cityscapes through windows as tall as trees. It went to a bidding war, this loft, when it first went on the market. I paid 30 percent more than the asking price—already at the peak of Seattle’s housing boom. I fell in love with its wood-burning fireplace, its exposed brick library walls and honey-colored cherry cabinets. It felt like a complete home to me, even if I didn’t share it with anyone yet. Eight years later I’m still the only one with a key.

I let myself in and put hot water on for tea, watch the blue flame wrap the bottom of the kettle in a fiery flower. Then I pull the Seattle white pages off the shelf beside the kitchen phone and look for Barbara Jansen’s address.

10

Bobbie Jansen
lives in Rainier Valley. Her address is not far from mine when measured in blocks or neighborhoods or even miles. But it falls across an invisible line that separates lives with leeway for art collections and exercise clubs and dinners out from lives of juggled utility bills and generic food staples and unsympathetic landlords.

She lives so close, in fact, that from my balcony I can stretch around the scarred redbrick corners of my building and look down the canyon of high-rises to the point where the rooflines drop to one or two stories, just beyond the dim globe of downtown lights. It makes me feel like I live in one of those glass spheres, and the hand of God might shake up a sparkly snowstorm while Bobbie’s house sits darkly fixed.

My head throbs. I walk into my bathroom and twist my hair up, run hot, hot water over a washcloth until it stings my hands, drape it across my face and exhale a steamy plume. Water. Touch. Temperature. Contact with something soft and warm and moist, like skin, like breath.

I strip off my dress and it puddles to the floor, a sylph’s scarf. It was a foolish choice for the evening, too early in the year. I was shivering half the night. My bathrobe hangs on the door hook, next to my jeans. I reach quite specifically for the robe, not surprised at all when I put on the blue jeans and an old sweater. There are some things you know you are going to do despite the voice screaming at you to stop.

I drop my car keys into my pocket without even bothering to pick up my purse. Does some part of me think I’m more anonymous without my wallet? The only pen on the kitchen counter skitters dry in the middle of her street number, so I rip the “Jan” page out of the phone book and fold it twice, three times over. I’m in my car and leaving the garage before I start talking out loud to myself. Who will even notice me—one car circling the block, one woman out for a midnight drive on a Friday night? What are the odds that Bobbie will be awake and outside on her porch (if, indeed, she has a porch), or watching from her upstairs bedroom (if her house has stairs), or sitting by the living room windows (if they face the street)? What harm could I cause by trying to attach some concrete image to the ones I can’t quit imagining? Halfway there I cut closer to the bone. What
is
my goal here? To see if her house has a For Rent sign? To see if she has wiped out any clue that a child ever lived there? To see if, maybe, there is some chance, some small chance, that she isn’t in that house alone night after night?

I’m at a stoplight three blocks away when a siren screams through the intersection, and my heart races until it hurts. I feel illicit, thieving, deceitful, desperate. And still I don’t stop. I make it all the way to the corner of her block. I am turning, I can almost see her house.

And then…What? God! What am I about to let myself do? Walk up to her door? Ring her bell? Wake her up? Ask her to forgive me? I press one foot on the brake and one on the accelerator, squeeze the steering wheel until my knuckles are white and the two halves of my mind slam together, fuse in shame, and I force myself to turn my car around.

BOOK: Oxygen
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