Oxygen (9 page)

I’m on call.
A Sunday. A quiet day. The techs have a Mariners game on in the lounge and the ER staff invites me down to a potluck. I pull a chair into the corner, behind the lunch tables, and call my father.

“Hey, Dad. It’s me.”

“Lori?”

“Marie.”

A pause. “What’s all the noise?”

“A baseball game on TV. I’m at the hospital today—in the lounge. How are you?”

“All right. Same as always.”

My legs are tucked into a knot beneath me; my foot tingles and starts to cramp. I get up and walk around, trailing the phone cord. “You said you had a doctor’s appointment this week—any news?”

“Good news is no news. I try not to listen to him. How’s your job?”

In the background a line drive sends up a swell of rowdy yelps that sound more like I’m in a bar than a hospital. “Great, Dad,” I lie with an audible smile. “Challenging.” Closer to the truth, at least. “Your birthday’s coming up soon. What’s on your wish list?”

He pauses again, so long that I think I’ve lost the connection. “Get me a new pair of eyes. Maybe there’re some spare ones rolling around in those operating rooms.”

I order a HoneyBaked ham, a basket of flowers and season tickets to the Houston Symphony, and try not to wonder who he could share them with.

By midnight I have only two labor epidurals running. The corridors are silent except for the hum of cleaning crews and the occasional sleepless patient pushing a rattling IV pole on his way to the vending machines; I could actually sleep for a while.

Instead I find the isolated elevator to the subbasement. The elevator is scuffed and dented from the wheeled metal carts used to shuffle volumes of data from storage to clinics to hospital wards to operating rooms and back to storage, thicker each trip with coded diseases. The sheer weight of paper becomes a quantifier of suffering. The secretaries’ desks are deserted, dried coffee grounds ring Styrofoam cups, incomplete charts are piled in metal trays and stacked in leaning towers on shelves and folding chairs and sagging laminated tables.

Jolene Jansen’s medical chart is alphabetically filed among the thousands—tens of thousands of charts packing miles of metal racks in First Lutheran’s basement records department. It is a part of the hospital I’ve never visited before—a part usually reserved for transcriptionists and the tapering levels of administrators who convert illness and disability into thick paper files of diagnostic codes and insurance billing numbers. Ten letters down the alphabet, dozens of rows into the racked aisles, I almost miss it because it’s so thin, a half-inch pile of paper describing the medical facts of Jolene’s short life. The majority of pages deal with the day of her death.

I’ve turned on only one light; it barely penetrates this deep into the room. I walk to the end of the rack, under a single overhead spot, and crouch with the folder across my knees.

The elevator shudders inside the wall and startles me. I clatter against an empty metal shelf to catch my balance and hold my breath until the elevator stops somewhere above. If discovered here in the desertion of midnight, I could say I’m looking for my own uncompleted charts, lacking the signatures that might stall insurance reimbursements or incite punitive fines from hospital inspectors. I could say that I have to review a chart for an upcoming surgical patient, or the past anesthetic records of all craniotomies. But I came here to see if any doctor before me wondered why Jolene couldn’t run as well as other children, whether her impaired mind and small stature cloaked an impaired heart. And I came here to learn more about Jolene Jansen’s mother.

Bobbie and Jolene had been connected with First Lutheran’s medical social workers, as commonly happens with Medicaid patients or handicapped children. The overwhelming job of finagling governmental regulations and pharmacy coupons and mental health evaluations and home care plans would have swallowed the allotted time and patience of Jolene’s doctors. So she was passed to the idealistic and bureaucratically talented assistants capable of unscrambling the loopholes of subsidized medical care. Their notes are filed at the end of the chart under a tab labeled Miscellaneous. The room is silent as a vault now. I relax my crouch enough to sit cross-legged on the thin carpet and read.

The one-page summary of Barbara Helen Jansen’s life tells me she moved to Fairbanks, Alaska, from Florida at the age of nineteen. She supported herself as a cook for the North Slope oil field workers. After four years of cooking and cleaning, Bobbie earned enough to move to Yakima, buy a house and begin taking occasional classes at the community college. Jolene’s father, a supervisor of migrant field workers for one of the large apple orchards in eastern Washington, walked into Bobbie’s life relatively late. Shortly after Jolene’s conception her father was reported missing. Bobbie was thirty-one years old at the time. His disappearance fell on the heels of a major labor dispute with the orchard’s owners, and the social worker writes that Bobbie Jansen believes her husband was a victim of the violence and corruption scorching the farm labor community at the time. The police recorded his disappearance as abandonment.

Jolene’s mental retardation was diagnosed when she was three, when she had still not begun to talk. Over the next several years Bobbie’s money was consumed by doctors, psychologists, speech and occupational therapists, and specialized teaching programs until she had no more to spend, no more to sell and trickled out of mainstream health care to join the voiceless swell of public health patients. Jolene’s infected cyst had reconnected her to the medical and social services available to her tier.

I rifle through scrawled Urgent Care Clinic notes and a few faxed pages from the public health clinic. There is no mention, in this abbreviated, summarized medical review, of any confirmed heart defect. But there is also no hint that any doctor ever listened carefully enough to consider the possibility.

I know Bobbie Jansen’s
neighborhood. Ten years ago, after my internship, I worked in her public health clinic for six months.

My original plan had been to go to Africa and work with AIDS patients for a few years between internship and the three-year residency required for anesthesia. My father was stone-faced when I told him—not that I’d expected him to like my decision, but as a history professor he would at least appreciate, I’d hoped, my desire to see the world from another culture’s point of view. If my mother had been alive, I know she would have been distraught and anxious and even skeptical, all the while helping me pack my bags with unconditional support.

But I had only my father and Lori. And below his impassive disapproval I sensed, or wanted to sense, a need to keep me at least somewhat closer to home. After four years of college, four years of medical school and the near poverty-level wages of internship, I was too far in debt to even buy the plane ticket. So I compromised. I answered a small ad in the back of a public health journal and moved to Seattle to work in an understaffed and poorly supplied clinic with some of the most irreverent, dedicated doctors and nurses I’ve ever met. I found the third world in the middle of urban America.

The clinic was part of a loose network offering medical care to the increasing numbers of uninsured people in the region. I had to postpone my anesthesia residency to work there, a decision my program director and certainly my father considered pointless. What use would primary-care medical experience be to an anesthesiologist? Pap smears and family planning were skills I would never need in my future. But the work quieted some loss I felt about specializing in anesthesia, a more anonymous field—most of my future patients would sleep away the time I spent with them. I would never get the Christmas cards and homemade brownies that
real
doctors might receive from the families they cared for.

Anesthesia was the antithesis of the complete, personally involved physician I had idealized to myself and my parents for all the years I studied chemistry and physics and biology alongside music and literature. It came as an unexpected, almost uncomfortable surprise to me when I discovered the immediate gratification of my specialty—injecting a local anesthetic at the precise nerve plexus to relieve the unrelenting pain of strained backs or injured limbs; calming a terrified obstetrical patient rushed into an emergency cesarean section, keeping her pain-free and hopeful, so her infant could make the miraculous transition from fetus to newborn uninjured; pulling the sleeping heart bypass patient back to consciousness and the inexpressible relief that they are still among the living. All of this, I discovered, was in contrast to general medicine, which could often do little more than shift the incessant, declining slope of mortality that begins the day we are born.

The patients I treated at the Rainier County Clinic, Bobbie’s neighbors, were a mixed group—some unemployed and uninsured, some who’d tumbled down the social ladder to a bewildered state of neediness they’d never anticipated or saved for and many who were employed in low-wage jobs that gave them no health insurance and no sufficient means to pay for their own care. A lot of them came to us long after their early symptoms had ballooned into unchecked diabetes or hypertension or heart failure or metastatic cancers, because the balance of debt versus illness had to tip before they could risk visiting a doctor.

This same mix of crises meant social and psychological care became as fundamental to their cure as medication or surgery. I loved that part of it—opening a window into the back rooms of other lives, lives I walked past every day at bus stops and McDonald’s and Wal-Marts; the hidden rooms of the people who served me restaurant meals, kept the floors of my local grocery store swept clean, restocked the clothes littering my fitting rooms—even the people tucked into doorways at dawn wrapped in donated blankets, sleeping through the shuffle of early commuters. I was still young enough to see myself in their lives.

At night, when I come home from work and should collapse into bed, I sit in my living room and stare out across the swallowing blackness of Puget Sound. And I envision Bobbie’s house. Maybe a white clapboard bungalow with chipped green trim around the windows and front porch columns. Maybe a chair on the porch, the old kind of outdoor metal chair with curving arms and a curved metal tube for the base, so she can rock while she watches a swing set rust in her front yard. Maybe she sits there at dusk listening to the new emptiness in her life and looks out to the lights of downtown Seattle, the lights of Pioneer Square, my home, dangling like pearls out of reach.

It has been five weeks now, and I still dissect the choices I made in the hours between singing Jolene to sleep and telling her mother that she was dead. I imagine myself on a witness stand, before a jury or before Bobbie Jansen, explaining the sequence of my thoughts on that day, trying to convince my listeners that each decision was issued from a calm and confident physician, detached and objective, clinically critical, never stalled by emotion for the pivotal moment that might have made all the difference. Had I waited too long to turn her over and start chest compressions? Had I given too little epinephrine, too much anesthetic gas, too much narcotic? And if Jolene had a congenital heart defect, one of the dozens of malformations described in any anesthesia textbook, what would I have done differently? If her autopsy proves I missed that diagnosis in the pre-op interview, does it prove I caused her death? Even if any physician might uncouple her heart from her death, I doubt any lawyer would.

I fill a mug with sweetened tea and carry it into the bedroom. There are only five more hours left in the night before I will turn off my alarm clock and go back into the hospital for another day of colon resections, cataracts, hysterectomies and hernias. All those patients are now tossing sleeplessly somewhere, suppressing the natural trepidation that accompanies surgery, the reluctance to give oneself up to the control of others and trust them to do their best, to be well rested, well trained and alert.

I lie on my back and watch the streetlight glint off the slowly rotating ceiling fan, and I try to lull myself into sleep by counting my breaths, letting the growing number crowd out background voices. I let my rib cage lift up and expand, my diaphragm suck down into my abdomen, my nostrils flare and pull in the largest volume of air I can hold. Then I close off my vocal cords and listen in the night to the rocking flush of blood in my carotid arteries. I watch the seconds pass in glowing blue on my bedside clock. I can’t even make a minute. I can’t force my body to fight its own reflexive terror of oxygen starvation for one full swing of a second hand.

It is an impossible thing to commit suicide by voluntarily holding one’s breath. In psychiatric hospitals and jails we remove the occupants’ belts and scarves and sheets—all possible bridges to death—but no one dies of self-suffocation. Because as soon as the mind goes black, reflex kicks in and volition is superseded by the natural dominance of survival.

Lori calls
more frequently than usual these days. We talk about whether her recent bouts of nausea could be her gallbladder, the cough Gordon brought back from the Far East, an Alaskan baleen basket I found in a nearby gallery, the latest news on my father. The noisy chaos of her household in the background is comfortably distracting, my borrowed family. She laces her conversation with oblique allusions to the lawsuit followed by pregnant pauses that I leave empty. One night I finally ask her what he would think if she found out it had been my fault.

“But we know it wasn’t,” she immediately answers.

“But what if the autopsy proved it was?”

“How could the autopsy prove that? You said this was an allergic reaction or something.”

I take a deep breath and hold it for a second, then plunge ahead. “It could have been her heart. I think Jolene might have had a heart defect.”

I can hear Lori thinking, almost picture her biting her lower lip. “Where did this come from? You’ve never even mentioned this.”

“I had a dream about it. And I woke up just
knowing
it.”

“Knowing it? You’re deciding this because of a dream?”

“Yeah. Well, not really just the dream. I was thinking about how her heart slowed down right before her oxygen level started to drop. It would make sense if it had gone down
after
she ran out of oxygen. But not before. That’s always bothered me. I just never really separated it out from the whole scene.”

“I don’t get it.”

“Kids’ hearts are strong. When things go wrong in pediatrics it’s almost always a respiratory problem first, and then the heart gets starved of oxygen and fails. Before that a child’s heart should be beating faster.”

“Have you told your lawyer this?”

“No. Not yet.”

“Good. Don’t. I can’t even understand all you’re saying and it doesn’t sound reasonable. Don’t tell him. You want my honest opinion?”

I don’t answer her. I know she’ll tell me anyway.

“Your subconscious came up with this to justify how bad you feel. This was a dream, Marie. A nightmare.”

I gradually cleave my day into two parts—work and the solitude of my home. Of these two, work evolves into a restful escape. It’s odd, I think, because at the hospital I have to see all the people who were part of that day: Stevenson, Mindy, Alicia. I have to watch the faces of my patients as they sink beneath the spell of drugs and know they believe I will keep them safe, that I will wake them at the end of their surgery to rejoin the people they love. At work I have no choice but to wrap my guilt and anxiety in a tightly bound shroud and place them far away from mental reach. If they tumble from their high shelf for a moment, I might become too much the frightened defendant, too little the collected and confident physician. And then, it might happen again.

At home, the shroud tends to snag and unfurl, and my mind races into black corners of recrimination. I clean my house, dusting the tops of ceiling fans and closet shelves, scrubbing out refrigerator drawers and bathroom drains, organizing food pantries and file cabinets, arranging the books in my library by subject, then again by height or binding color. I polish the sterling my father finally gave me when I finished my residency—tired of saving it for a wedding gift. I alphabetize my CDs and walk from room to room wearing headphones, deafened by Prokofiev and Bizet and Bono. I watch old movies, bundled up in my bathrobe, until I fall asleep on the sofa buried beneath a down comforter. Even if I don’t like the movie, the steady prattle of stilted dialogue blocks out the noise of my memory. And every evening I decide I will ask Donnelly if he has the autopsy report back yet. And every morning I decide to wait one more day.

It occurs to me late one night that Bobbie and I are more alike than it would seem. We are both without a partner or child.

Joe calls to try to coax me out of social exile. He leaves unanswered messages three nights in a row and then starts talking to me through my answering machine, cajoling me to pick up the phone.

“Marie, I know you’re in there. Come on, talk to me. Be my friend tonight, I need one. What are you watching? You’re gonna run out of movies soon.”

I knew it. He’s spying on me. I wrap the comforter around me and shuffle over to the rain-streaked windows. He is there, hunched into his glossy yellow parka with the hood pulled up to cover his cell phone, squinting against the streetlight as he waves at my TV-silhouetted shadow. I place one palm against the cold glass and he holds his up in return, spreading the fingers into a victory V.

“Gotcha,” he says when I pick up the phone.

“Joe—respect for privacy, please. Can’t I escape from the world for a night?”

“You’ve been escaping for weeks. I want to go out. I want to go out with you. Hell, I want to drink. Things aren’t always so perfect in my life, either, you know. Come on, friend.” He pauses, listening to my hesitation. “I miss you.”

There is a familiar note of loneliness in his voice that always makes me want to take care of him. He surrounds himself with male friends for the sports betting and bashing, the single malt scotch ratings, the prideful litany of conquered women—but when any real pain starts he seeks me out. What is it that compels women to guard men’s secret frailties?

“I haven’t even showered,” I say, hearing myself give in to him.

“What do I care how you smell? Isn’t that the beauty of being friends with your ex-lover? At least when I tell you I love you for your mind, I really mean it.”

“Joe, please? I’m not very good company these days, anyway.”

“Marie, please? Would I turn you down in your hour of need? Besides, I’m getting blasted by the rain and my phone’s about to die.”

“Big surprise.” Joe is notorious for being unreachable outside the hospital. He’s lost three cell phones in the last year. “Meet me at Larry’s in fifteen minutes. But I’m not staying out late tonight. I’m on call on Wednesday, since Sandy had to trade. Order a lemon drop for me.”

Despite my reticence I smile. The fact that we were lovers once has made our friendship strong enough to bear fallibility, intimate enough to tolerate imperfection. When Joe started at First Lutheran he was thirty-seven, I was thirty-three, we were both single, both apparently straight, and it seemed the entire department assumed we would become a couple—the very fact of which we turned into a private joke, falling into a flirtatious friendship that was secure because we were both utterly committed to separating work and love. It made it easy to counsel one another in matters of romance, easy to fill empty Saturdays with a ready-made, obligation-free date. There was no tension about income or personal habits, no whining about schedules or domestic tidiness.

There was a man I’d liked—seriously liked—when I first moved to Seattle, an avid kayaker and runner who owned a bookstore deep in the bowels of the Pike Place Market. Then I got my job at First Lutheran and started canceling dates when emergency surgeries kept me late, or when my low seniority put me on call three weekends in a row. Soon he quit calling, upset that I didn’t seem to have room for him in my life. I think it was the first time I wondered if my generation had tried to leap a little too far, plunging into the wilderness of equality without our trail of bread crumbs, turning around on the brink of infertility to discover that, enticing as the woods were, we were unaccountably lost. What I needed was some Microsoft executive who could accept my hours and retire early to raise our children. But not Joe. Never Joe. Joe was too close a friend to risk loving. In the meantime he could fill my weekends with bike rides and movies and the occasional symphony he would reluctantly allow me to drag him to—if I let him leave at intermission to smoke a cigarette.

Then we went camping. Friends of his were coming in from Boise, two men and a woman, and we were all going backpacking up at Harts Pass. We would meet in Winthrop, the closest town, and head up the precipitous twenty-two-mile forest road chiseled into the nearly vertical mountainside below Slate Peak. Joe and I packed on a hot, late-August day; camping gear littered his living room floor under huge south-facing windows. Butane stove, water filter, kerosene lanterns, cooking pans, a portable espresso maker, Therm-a-Rest sleeping mats, and enough warm clothing to summit Rainier. Joe had a list that ran two pages. I sat in the blazing afternoon glare squashing thick polyfill sleeping bags into bright-colored nylon stuff sacks with sweat trickling down my arms and face. Joe crammed bulky packages of pasta, tubes of pesto, imported Parmesan cheese and bottles of Chianti into the crannies of our backpacks, sculpting an ergonomically balanced gourmet restaurant to be hauled upon our backs. He would carry the heavier men’s tent and I would carry the women’s.

Joe got up to find more gear, a compass and waterproof matches and Capilene underwear (he should be an honorary Eagle Scout, I teased). I hefted my pack, and took out the fleece pants and jacket and tossed them behind his couch, pulled a wine bottle out from the bottom compartment and stuffed it under the sofa cushions. He found the wine bottle and put it into his own pack, but he missed the fleece. We both missed the fact that my tent stakes were wrapped up inside the jacket and pants.

We rocketed across the Cascades in Joe’s dented white Jeep to Pearl Jam and the Talking Heads and Van Morrison and, my own contribution,
Puccini’s Greatest Hits.
I’d never been this deep or this high into the mountains before. Highway 20 is surely among the most beautiful in America, only open in summer, swooping through the brash young mountains in manmade defiance of winter avalanches and rock slides. We passed Diablo Lake, a glacial sapphire blue, like a fragment of tropical sea exiled to a prison of cement dams and mountain walls. We got to Winthrop an hour late and went into the Duck Brand restaurant to meet his friends for lunch. The waitress took our name and said, “We’ve been waiting for you.”

“All your life?” asked Joe.

“Your friends called. They left a phone number.”

Joe’s friends weren’t coming. Their car had broken down eighty miles east of Spokane. He looked at me and shrugged, hanging up the pay phone on the nearly deserted street that ran through the middle of the three-block town. “Lotta food for two people. Hope you’re hungry.” And we headed up to the top of the pass.

We trudged four miles in to our campsite, hiking along the spine of the Pacific Crest trail with wildflower meadows and broken rock scree and blue-green pine forest falling away on either side like a grand embroidered skirt. Joe set up the tents under a single enormous evergreen. Then we discovered my tent stakes were still safely hidden behind Joe’s sofa, inside the fleece that I would also dearly miss. I was too exhausted to cut new wooden pegs, so I lodged stones about the corners of the tent fly and fell asleep before the sun set, before the wind herded massive clouds down from the Canadian plains, before the temperature dropped thirty degrees. In the night I was startled awake by a profound, absorbing silence, and a moment later my tent humbly collapsed under the weight of the first autumn snow.

Joe’s geodesic shelter was as unfazed by this anachronistic winter as any Russian onion dome. I hobbled to it in my sleeping bag. There had been wine for dinner, there had been schnapps and hot chocolate for dessert, and I suspect for Joe there had been a neat whiskey or two to replace the cigarette I had forbidden.

We began apart, crept closer for warmth, zipped bag to bag as the night grew colder, and finally pressed skin next to skin, not for warmth but because it was what we both wanted and could excuse as an emergency. We lay together in mutual, unspoken acceptance that we would not discuss whether this was wise or rational or intended for eternity. And for the next eight months we continued as the best of friends and the best of lovers.

In retrospect I recognize the nearly invisible barrier we both defended, careful never to discuss whether we were actually headed to the same place, acting as if time would stand still while we dallied with companionship and soulful conversation and purgative sex. We were so careful, during our eight-month entanglement, to be lovers without being in love—each of us poised in a waiting game for something more real to follow.

At twenty it would have been expanding. At twenty-eight it would have been explorative. But at thirty-four it begged to be nurtured or abandoned. Did I consider him a vibrant lover but unlikely father? Did he shudder at the glimmer of lost freedom? All I know is that we reached the precipice of those conversations and backed away, both of us, me when I noticed he still noticed other women, he when I told him I wanted more time to myself.

There was a sting, for a while, when he dated other women, when I wanted someone to wake up with. It is amazing, though, what pains your subconscious will undergo to achieve sustainable peace. It is amazing how quickly I was able to convince myself that the possessiveness of love would have inevitably suffocated our friendship.

I pull on a wool sweater and blue jeans, rake a brush through my hair and lick my fingers to wipe the mascara smudges from beneath my eyes. But under the white lights in my bathroom I see an aging face that doesn’t bounce back from a seventy-hour workweek. I put my hands flat up against my ears and pull back to remember what I looked like ten years ago. If I squint a little, even the uneven skin tones blur. I push the right hand up and the left hand down, then put my thumbs in the corners of my mouth and pull them back. There. Now I can see what I’ll look like in seventy years at age one hundred and seven, assuming I’m not cremated. I spritz perfume over my hair and neck—you do what you can in this world.

I jaywalk diagonally across First Avenue and up three blocks to Larry’s. Posters of hip-hop and reggae bands flank the century-old brick and stone doorway. Odors of smoke and beer and the soft clink of heavy glass tumblers make the long, dark room feel oddly intimate—a dozen or so customers clustered over tables or half hidden behind high booths, the bartender easy with the pace of drinks, sloshing glasses through soapy water with up-rolled sleeves.