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I’m publishing this chapter a day early, given the U.S. holiday on Friday. It picks up just after the asthma attack that ends chapter 1 (published back in January). If you’re new to the story and looking for a summer read, start here at the T.O.C.
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PART 2
Late-October 2009
Grace sits at one end of a long table in a pool of light across from her mother. Dr. Margherita Hack sits to her left, at the end. Caught in the light, the plates, bowls, and platters before them glisten with food, piles of white, red, green, yellow, orange, purple. Steam rises in currents to conceal and reveal her mother’s animated face.
“I do not fear death,” Dr. Hack is saying. “When there is death, I won’t be here.” She reaches for a bowl of pasta. “Francesca, you’ve outdone yourself. And no animals, grazie.”
The table stretches away from them into darkness animated by shadowy figures.
“Nor do I fear death,” Francesca says with a smile. “But for the opposite reason.”
“Ah, the tunnel of love light,” Dr. Hack says with a teasing laugh. She spoons crimson gravy over the pasta on her plate. “Your . . . afterlife?”
Grace says, “It’s all exchange. The exhale of angels.”
The two women startle.
“My dear, how are you here?” her mother asks.
“I invited her. She was lost between worlds,” Dr. Hack says.
Francesca’s eyes widen. Her fork stops mid-air, fettucine dangling. “Is that true?”
“I’m not lost.” Grace waves a hand. “I’m right here. I’m fine.”
It’s then that she notices there is no floor beneath her chair, beneath the table. Everything is floating above . . . she can’t make out what’s below them, but she knows the weightlessness of flight. She hooks her foot around the table leg to anchor her chair.
“You two know each other?” she asks.
“Oh, we’re old friends from school days,” her mother says.
“Rivals, you mean,” Dr. Hack says with a wink. A wink?
Francesca laughs. “We traded mathematics prizes. I won the most.”
“So you say.” Dr. Hack pats her mouth with a snowy white damask napkin that Grace recognizes from her mother’s own table. When she’d said she hadn’t met Dr. Hack.
“What is this?” Grace asks. “Where are we?”
They exchange a look, then stare at her. “You tell us,” her mother says.
“Am I . . . Did I . . .” She can’t bring herself to ask it.
“Well,” Dr. Hack says. “Since there is no afterlife, we can deduce that, no, you are not dead. Yet.”
Francesca squeezes her friend’s hand. “If you do meet God, you’ll have to tell her you were wrong. Va bene?”
“Certo.” Dr. Hack sips glowing garnet wine. “Cara amica, we don’t need God to be moral. We already have the capacity to love and understand, to treat others as we would want to be treated.”
“It’s all exchange,” Grace says. “The exhale of angels.”
“So you keep saying,” her mother says. “What does it mean?”
“Air. It’s alive. In me. In . . . us.”
“Or it would be, if you weren’t so hostile a host,” Dr. Hack says, a bit harshly.
“So much technology, so many promises and treaties, there is no way to repair what is broken. Nor to invent a replacement.”
Her mother looks alarmed. “Grace, you’re so pale. What’s wrong? Don’t go—”
“Lasciala stare, Francesca. Everything changes, ages, dies. It’s her choice—”
“No! Not before me—"
Grace wakes in a white room, her nose and mouth imprisoned by domed plastic. Her throat is raw. Tubes snake over shoulders, across her torso and arms. The back of her left hand aches, its pointer finger in a vise. The crooks of both arms throb. Machines hum, whir, beep.
Fingers tickle her forearm. “Grace?”
She swivels her eyes to the source. A blurred form resolves into the dangling silver stethoscope of a dark-haired woman in blue scrubs. Grace lifts her right hand to pull off the mask, but the woman guides it down.
“Easy there. You’re doing well now. We’ll get that off soon.”
Grace closes her eyes, too tired to register fear.
“Grace, you had a severe asthma attack,” the woman says. “You’re in Barnes-Kasson County Hospital. I’m Doctor Cannedy. Is there someone we can call for you?”
How does she expect me to answer?
“I have your phone here. You don’t have an I-C-E. Could you open it and choose someone?”
The home screen says it’s Wednesday, but that’s impossible, she teaches on Tuesday. She pictures a classroom full of impatient, entitled kids waiting, talking, texting. Emailing more complaints to the dean. Assholes.
“Anyone?” the doctor asks, tapping the phone.
Grace shakes her head no, unleashing piercing pain and nausea worse than the worst hangover. What if she throws up in the mask?
She relents, chooses Barbara, regrets it immediately. But who else? Her mother has enough on her plate. Ned is out of the question.
The doctor tells Grace she arrived by ambulance, unconscious. She was out for twenty-seven hours. “You were close to complete respiratory failure. Lucky you responded to BiPAP and ketamine.”
Lucky.
“I never want to intubate my asthma patients. Last thing you need is a piece of plastic jammed down your already inflamed airway. We’ll run some tests today, check on your lungs, assess the damage.”
Damage. Grace sips plastic-tasting water from a green plastic cup through a plastic straw. Her whole torso aches like it was stomped by shitkickers in a dark alley. At least she can breathe. She thinks of the stood-up students, the piling-up data analysis, the wreck of her tenure-track ambitions, the too-short job-hunt timeline. Other loose ends she can’t name tease at her fraying edges.
Over the worry plays Damage. Damage. Damage. “Tests?” she asks in the voice of a 70-year-old, three-pack-a-day smoker.
“We’ll start with peak flow, spirometry, and x-ray, see what we find. We also need to go over your medications, action plan, start you on therapy, the works. Do you have a history of hospitalizations?”
“No. Never.” But a vague memory has been stirring ever since she opened her eyes. A similar scene but long, long ago—
“That’s good. Has your asthma been under control until this episode? Any idea what triggered it?” She poises a pen over her clipboard.
And here it comes, a long-buried memory. She’s seven, no eight, it’s after her birthday because her father is there. He’s by her bedside, angry, no, afraid. Blinking and blinking. Helpless.
“I . . . have the inhaler. That always works.” That long-ago time, she didn’t even have an inhaler. At her father’s house, after he tore her from her grandparents, tore her from Holland Island and the herons and marshes and sunrise breezes.
She sips more water. Swallowing hurts and soothes.
“Has anything changed recently in your environment, either at home or at work?”
Grace shakes her head. But everything has. Everything. At her father’s house, she couldn’t stop crying. For days, she cried and he was helpless, then angry, then afraid. When she had cried her breath away, everything went black and she woke up in a white room just like this one.
“If it’s an occupational trigger, you might have a claim. We need to document—”
She shakes her head hard. “I don’t want to claim anything. I just want to get out of here.”
The doctor blinks. Glances at her watch. She focuses her kind, non-nonsense eyes on Grace. “Understandable. I’ll send the nurse in to start your testing. We’ll talk again later.” The doctor pats Grace’s arm. “Be sure to try the cherry Jell-O. It’s our specialty.”
“How long will all this take? I need to get back.”
Dr. Cannedy frowns, tilts her head as if listening to faraway music. “Grace. You nearly died. I came this close to intubating you.” She gives Grace’s arm a light squeeze. “Sixteen percent of patients exactly like you do not come back from that.” She pushes a button on the beeping monitor. “You’ll be here another day or two, ‘til you’re stabilized and we have a full picture of what happened. And, most importantly, how to prevent another attack.”
Grace dozes, then wakes, thinking of her mother’s culurgiones al pecorino. The doctor has left the phone on the bed near her hand. She opens it, sees a string of texts from Barbara.
She skims the rest. More of the same, escalating. Some all-caps.
With shaky hands she takes a selfie and sends it without comment.
A string of responses buzzes. She doesn’t read them. Her eyes water. She closes them. They keep leaking.
Complete respiratory failure echoes in her head. Grace doesn’t fail. She’s not afraid of failure, she’s never allowed herself the luxury of declaring defeat. She can always outwit failure, but now, twice in two days, it’s bested her. Now, she’s drowning in shame.
She opens her eyes. There’s a sharp aching hole in her chest and her face feels packed with cotton. She has no energy to reach for a tissue.
Her phone vibrates with more of Barbara’s texts. She skims, then replies.
More responses. Grace ignores them and texts her mother’s number to Barbara. She closes her eyes. They keep watering. She drifts off.
Grace’s respiratory therapist is a grandmother from central casting, complete with the sweet, powdery smell. Purple-tinged salon-set short gray curls, lavender cardigan with dainty silver chain clipped below the first button, fireplug body, stockinged legs in sensible brown shoes. The silver chain holds tiny pink and blue glass hearts, one for each grandchild. Four girls, three boys. It’s nonsense, but Grace is glad the girls outnumber the boys.
“Mild exercise will help your breathing, but don’t overdo it. Walking, yoga stretches, nothing strenuous.”
“So, no CrossFit for a while?” Grace wouldn’t do CrossFit if someone paid her.
The therapist’s expression is blank. “As long as it’s not strenuous. This is serious, Ms. Evans.”
“Doctor Evans.”
“Oh.” She consults her clipboard, makes a note. “My apologies. Someone missed that on your chart.”
“Are we done here?”
She guides Grace to a stationary bike. “Are you in a hurry, dear?”
Grace admires the subtle power move. She has nowhere to go and Nurse Nanna knows it. She slumps on the bike.
The therapist presses on Grace’s back. “Posture, dear. Your lungs will thank you.”
Grace exaggerates throwing her shoulders back and chest out.
“Much better.” She places a hand on Grace’s top ribs and presses gently. “Tuck in here. That’s it. Relax your shoulders and lengthen your spine.”
The position is awkward. Grace feels older than this woman.
“Sometimes it’s easier if you close your eyes. Breathe in slowly. Picture a balloon in your chest and inflate it as fully as you can. Side to side and front to back. Keep those ribs tucked. That’s it. Exhale slowly, one, two, three—”
Grace coughs a dry hack.
“That’s good. Try it again. Relax, tuck, expand, count.”
This continues for two hours that are really ten minutes on the clock.
The therapist gives Grace homework. “Every day for ten minutes, morning, midday, and before bed.” She holds out a paper with drawings and instructions. “You can also try it lying down, but give it a week or so of diligent practice before you try that.”
Grace feels mild humiliation for having to take breathing lessons from a woman twice her age. Everyone else breathes without thought.
“One more thing,” the therapist says. “Do you sing?”
“In the shower sometimes. The car.”
“Bless your heart. I mean, a choir. Regular singing is marvelous for breathing.”
“If only I had that kind of time.” Grace shuffles toward the door.
“Not to mention the added bonus of community. And the sheer pleasure of creating something beautiful.”
“Got it.”
The therapist holds out the homework sheet. “Your at-home exercises are critical to help use your remaining lung capacity to its fullest. I hope you reconsider the choir. Everybody needs community.”
I have what I need, Nanna, Grace thinks, feeling judged. A career woman show a little solidarity.
Remaining lung capacity echoes in her head. She’s too young to be giving up body parts.
Grace wakes to the smell of cedar and wet soil. The woman from the farm. Caroline?
“How? Why?” She can’t form a coherent thought.
“Barbara texted me.”
What the hell? How is Grace’s health any business of hers?
“She wanted me to know what happened, when you missed our meeting.”
Grace closes her eyes in embarrassment. She was meant to take water samples at Dragonfly Farm after her site visit to Warbird. “Sorry.”
She hadn’t told Barbara anything about the disastrous meeting with the dean. But on the chance of being more marketable in her job search, Grace had relented to Barbara’s pressure to expand their research to include water.
“Oh, don’t even,” Caroline says. “We’re all so relieved you’re okay.”
Grace has no energy to ask who this we-all is.
“So scary. I’m relieved you’re doing better. Brought you some mushroom powder. We’re developing a line of immune-support blends. This one includes chaga, reishi, and turkey tail. Cleared up my chronic bronchitis in, like, three weeks—”
Grace waves a hand. “Thanks. I’m fine.”
Caroline exhales through her teeth and makes a show of looking around the too-bright, antiseptic-reeking room. “Just thought you could use a nice boost from mother nature.” She pulls another jar from her cloth bag. “Also brought some of our honey. This stuff, don’t ask me how, is an amazing rescue for asthma.”
“Damn. If I’d had it earlier, I could’ve avoided all this.”
“Really. I’m not kidding. It’s an old farmwife remedy.”
“But I’m not an old farmwife.”
Caroline smiles, shakes her head.
Grace closes her eyes, hoping Caroline will leave.
“We can catch up later. . . There’s so much . . .but that’s—It’ll keep. Rest up. Feel better.” She pats Grace’s forearm.
“Umm hmmm.”
“There’s instructions for the mushroom powder in the bag. It has a nice nutty taste. I could ask the nurse to bring you some hot water, get you started now.”
“That’s okay, I’m good,” she says without opening her eyes.
“Of course, yeah, sure.” She squeezes Grace’s hand gently. “Feel better.”
Grace wakes to darkness outside. Enough light spills through her open door to see shapes. A machine whirs and beeps. Time is meaningless. Last she was awake, the window promised an outside world. Now it mirrors her small room, the machines, the strip light over the bed, the rectangle of light from the door. She closes her eyes.
When she opens them again, Ned is standing there looking anxious.
“What the hell?” she whispers.
“Oh, geez, Grace, how are you? You look . . .”
“Asleep?” She closes her eyes, convinced she’s dreaming. But she can smell his sweat and the pizza he must have eaten in the car.
He touches her wrist. “I was gonna say, like death eating a cheeseburger.”
“Don’t make me laugh. It hurts.”
He pulls up a chair and sits. Squeezes her hand. Worry bleaches the green from his hazel eyes. “You gave us all quite a scare.”
She blinks, letting her eyes settle on his face. “What are you doing here? How did you . . . Why?”
“Barbara texted me. Next thing I know, I’m on 95 crossing the Susquehanna.” He pulls the chair closer to brush hair off her forehead. “Oh, Grace.”
“Barbara is a regular Paul Revere,” she says. What an annoying busybody she’s turned out to be. “What time is it? What day is it?”
He checks his watch. “It’s Thursday. 4:22 a.m.”
Grace groans. Another day of classes she’ll miss. “Don’t you have a kid? A job? A life?”
“Shhhhh.” He touches her tip lightly.
“You should go.”
“Fuck that. I’m not leaving ‘til I find out what’s up.”
“I bet you’re here to do a series on struggling rural hospitals.”
He looks around the room. “This one seems to have done all right by you.”
“The respiratory therapist told me to join a choir.”
He smiles. “I can hook you up.”
She smirks. “Why does that not surprise me? Anyway, I can’t sing.”
“If you can talk, you can sing. You’ll love it.” He checks his watch again. “Are they springing you today? I can drive you back.”
“I’m not an invalid. I have a car. No idea where it is, though.”
“We can caravan.”
“Just try to keep up with me.”
The first bill arrives three days later. Grace tosses it unopened into the shoebox with BGE, Verizon, Geico, and VISA. Two more bills arrive. Into the shoebox. A fourth bill screams TIME SENSITIVE in red, so she opens it. Listed charges run to three pages, each with a revenue code and description.
One day in private room, $8000. Grace was too unconscious to request semi-private.
Intensive care, $125,000.
Pharmacy, $14,000. They sent her home with Tylenol and asthma meds. For that price, they could at least throw in some ketamine.
Medical / surgical supplies, $2000.
Sterile supply, $20. Seriously? Why not bury that in one of the other costs?
Labwork, general, $17,000. So vague. She’d never get away with that on a grant proposal.
Labwork, immunology, $4500.
Labwork, hematology, $1000.
Labwork, microbiology, $2200. Grace wishes she could charge these prices for her own labwork.
Chest X-Ray, $200. A bargain.
Another item, also called Chest X-Ray, $850.
Respiratory services, $45,000. She pictures Nurse Nanna with a second home on a lake somewhere in central PA.
Physical therapy, $275.
Another physical therapy, this one called eval, $550.
Emergency department, $12,000.
EKG, $300.
Grace laughs at the total. She can’t imagine budgeting that much for a house. Ever. She’s had grants in that range, but only on multi-year contracts. She was in that hospital for less than four days.
One of the other bills is for Dr. Cannedy’s services: $12,000. She probably spent a total of twenty minutes in the room. Grace is in the wrong line of work.
The ambulance also rates its own envelope and itemized pages: $1500 for Advanced Life Support-2. Grace paid half that for her first car ten years ago.
She calls her insurance company and waits on hold for twenty minutes, to the extremely low-fi soundtrack of instrumental ‘90s grunge alternating with the message Your business is important to us. She puts it on speaker and tries some deep squats, then a few careful jumping jacks. Her chest still aches, so she stands still to stretch. She manages eight pushups before her arms give out. Her heart is pounding, so she stops to catch her breath. She should move on to burpees, but she hates burpees more than she hates insurance companies.
The recording shifts to, “Your call may be monitored or recorded for quality assurance purposes.” A chirpy woman comes on with, “Thank you for calling. My name is Angela. How may I assist you today?”
Grace grabs the phone and begins pacing. “I’ve been . . . getting all these . . . bills but they don’t say what’s covered.”
“I can help you with that.”
Grace reads her insurance numbers off her card. Angela’s keyboard clacks over the background din of many voices.
“For your inpatient care on October 13, 14, 15, and—”
“I checked out on the 16th.”
“So, that was an out-of-network provider.”
“It was an emergency. I stopped breathing.” She resists admitting that to herself, but she’ll say anything to buy sympathy from this woman.
“I’m very sorry to hear that. But Barnes-Kasson County Hospital isn’t in your network.”
“No shit. It’s not even in my state. Tell you what. Next time I’m unconscious, I’ll insist the ambulance drive me two hundred miles back to Baltimore.”
Angela responds with more keyboard clicks. “Please hold a moment.” A thin electronic stream of “Smells Like Teen Spirit” trickles out.
The soundtrack has begun “Touch Me I’m Sick” by the time Angela returns. Grace wonders who has the balls to choose such ironic songs. “Thanks for your patience. I’ve escalated your inquiry to a billing advisor. You should receive a call back within two to four business days.”
“Aren’t you a billing advisor? I need to talk to someone today.”
“Yes, but . . . Your case is . . . more complicated. Expect that call back in—”
“That’s not acceptable. I don’t have $233,000. I will never see that much money in my entire life.”
“I understand your concern—”
That fucking word, concern. “Do you?” Anger flares hot, then ashes into shame when she remembers working at Wendy’s in high school. What a shitty job that was. “I’m sorry. I’m being an asshole.”
“It’s okay.”
“It’s not okay.” Grace suppresses an urge to say Have a nice day. She hates that mindless platitude worse than concern. “Hey, I hope you get to cut loose tonight. Go dancing. Or get drunk and fuck your boyfriend.”
The low background voices hum. Angela’s keyboard clacks. “Thank you, Ms. Evans. Is there anything else I can help you with today?”
She tamps down the reflexive, It’s Doctor Evans. “Not unless you want to send me a few hundred grand. Or fix this miserable health care system.”
“I wouldn’t know where to start.”
“Nobody does.”
“Have a nice day.”
Grace stands there after the click, picturing Angela on her next call with a morose forty-two-year-old man awaiting a kidney transplant. And after him, a thirty-something appendectomy patient calls her a whore. She loads Pearl Jam’s 2006 CD into her boombox and dances alone to “Life Wasted.”
Next chapter ➡️
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That Grace is a pistol, as my Texan relatives would say. I’m eager to see what she does next.
Julie, it feels like much is hidden in Grace's fear in this chapter and I wonder, not for the first time, quite how she will manage to divert attention from her own trauma?
I felt like the proverbial fly-on-the-wall, your dialogue and description are transformative!