'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 a hold 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 medication 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 anti-rejection 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 a while.'
'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.'
