CHAPTER 17
You remember what people say when they are sick? What do they say? That after all, nothing is pleasanter than health. But then they never knew this to be the greatest of pleasures until they were ill.
Alright, Nat, it's time. Your blood gasses are back and they're pretty — A good. Your oxygen saturation is ninety-eight. I see no reason we can't pull that tube out. You ready?'
Natalie nodded vigorously to her doctor, Rachel French, the head of pulmonary medicine at White Memorial. For many hours she had been on a ventilator in the intensive care unit, drifting back and forth across the line separating awareness from the beyond, and often, when she awoke, French's kind, intelligent face was looking down at her.
It was probably whatever medication they had her on, but the endotracheal breathing tube wasn't nearly as bad as she had often feared it would be. She had no memory at all of the one that had kept her alive in Santa Teresa's, and doubted she would remember much of this ordeal, either. God bless the pharmacologists. After blacking out on the kitchen floor, her first indication that she wasn't dead was the siren of the ambulance that was speeding her up the Southeast Expressway to White Memorial. Apparently her oxygen levels were bad, because, according to Rachel, the tube was immediately inserted by somebody in the emergency ward. But of that turmoil, she had no recollection whatsoever.
According to the clock on the wall across from her bed, it had been about twelve hours since the sedation and painkillers had been cut back to where she could hold on to a thought for more than a few minutes. Altogether, nearly forty-eight hours had passed since the fire.
She had to be told several times before she had finally retained the news that both her mother and Jenny were alive and doing well in another hospital, and that she was being given full credit by the fire department and in the press for having saved their lives. Word was that only minutes after the firefighters pulled her and Jenny from the kitchen, the ceiling in Jenny's room collapsed, and the house went up completely — a total loss. The main unanswered question now in her mind was what, if any, damage had been done to her. It was one of those situations common to medical students and physicians, where she simply had too much knowledge of the possibilities.
French, the mother of twins as well as one of the youngest department heads in the hospital, was the sort of dedicated, widely regarded female physician that Natalie, herself, had hoped one day to become — assertive and effective without ever compromising her femininity and compassion. During Natalie's brief hospitalization following her return from Brazil, French had become her physician, and the two of them had spent hours sharing philosophy, life stories, and thoughts about the future.
'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, de- spite 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 mid-sentence 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 hyper heated 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.
