By Elizabeth Bales Frank
I live two blocks from a hospital, so that the moans of passing ambulances never diminish but are choked off mid-cry. At the start of the pandemic, the ambulances wailed by my apartment building so consistently that it became a soundtrack, the woodwind section of a diabolical orchestra in a perpetual, unresolved tune-up.
The advantage to the hospital’s proximity is that I can walk to the emergency room. I have done this twice. The first time, I walked in on an ankle fractured in two places. News of my feat spread among the residents, some of whom swung by to ask for a demonstration after seeing the X-rays: “They’re saying that you walked here. Can you show me?”
The second time I walked to the ER, I couldn’t breathe. I’d been to Urgent Care that morning and was dismissed after an hour on a nebulizer with the diagnosis: “Sometimes you graduate from Urgent Care. You’re still wheezing.” I knew better than the doctor that I was still wheezing, but unsure of how I was meant to commemorate my “graduation.” I returned home and coughed in long hacking arias, propped up on pillows in my bed. Intermittently, I checked my work emails. Then that evening, after addressing a calamity in corporate communications, something inside of me clicked. Asthmatics know this click.
“I hope that helps,” I emailed my colleagues. “I need to go to the ER now.”
It was eight-thirty, approximately twelve hours since I had graduated from Urgent Care. I pulled on my coat and left my apartment so abruptly that I left behind both of my phones—my work iPhone and my personal cell. Midway on the journey to the ER, I realized that my lack of cell phones would be a problem when they asked at Admitting, “Person to contact in case of an emergency.” I considered “in case of an emergency” a semantic point, as the emergency was already occurring. I chose not to turn back. At a certain point in an attack, the lungs take charge, as they would if you were fighting to surface from a shipwreck and realized that your wallet is down on the ocean floor. You would not turn and dive down to retrieve your ID. You would dive up, towards the life-sustaining lungful of air.
The waiting room at the hospital was packed but calm. As I bent over the sign-in sheet, the admissions clerk asked, “Do you have asthma?”
For the previous two days, my breathing had whined like the fretful pipe of a damaged church organ, the congested whistling asthmatics try to fight with persistent but futile – “non-productive,” in medical parlance – coughing that results in no relief. The lungs, a collection of clogged, exhausted straws, ache. The ribcage aches. By the time I reached the admissions desk at the ER, my breathing had progressed to an ongoing crackle, like the static on a beat cop’s walkie-talkie.
Did I have asthma?
I nodded.
With gratifying speed, I was placed into a jaunty wheelchair, brightly colored, shaped like a folding chair on wheels, and propelled to an admitting station. My intake was eased by the medical record of that broken ankle (“Everything still the same?”) Then I was wheeled through another crowded corridor. I was parked at a crossroads of activity and stillness, a tumult of patients to my right, and before me a long corridor which held a few crash carts parked outside open doors, with a circular desk at the end of it, manned by a young woman with a high blonde ponytail.
On my right, the corridor was packed and in a waiting area, every chair was taken. Patients laid on gurneys in a long line waiting to be X-rayed. Patients sat in chairs clutching injured limbs. Agitated patients weaved through the supine and the seated, demanding food, water, sympathy, acknowledgement. They were attended to or ignored by scurrying staff propelled by such urgency that I thought they were responding to a recent catastrophe—a train crash, or a building explosion. I asked, but was told no. Just a Monday night in December 2017 in a hospital formerly known as Astoria General before it was upgraded and absorbed into the Mount Sinai system.
I breathed shallowly, but with a serenity new to the past thirty-six hours. When I had decided, the night before, to go to Urgent Care, I learned that Urgent Care cared urgently only twelve hours a day. It was three in the morning when I checked their website. I had to wait until eight to walk through their doors. Unlike the depictions of them on TV, asthma attacks are not flailing, thrashing affairs. You don’t have the breath to rock to and fro shouting “I can’t breathe!” as patients do on hospital dramas. You sit. You quell your panic. Panic drains breath. Your reservoir is perilously shallow. You sip delicately at each breath. You promise yourself that help is on the way.
At Mount Sinai, the ponytailed girl down the quiet hall called out my name and I raised my hand hopefully, like an airline passenger on standby.
Most medical personnel present to me as highly confident high school seniors. ERs in particular are staffed by recent graduates eager to combat their medical student loans with hefty schedules of overtime. The ponytailed young woman told me this after she trotted over and began firing questions. I responded with a few of my own, including why does the entire staff look like the student body of a high school. She herself looked like the captain of the varsity track team: fit, steely, restless with energy. She was my attending physician. I handed over the report from Urgent Care. She and the nurse at her side frowned as they read it.
“Left lung X-ray ‘abnormal,’ ” Dr. Track rolled her eyes. “How helpful.”
“This is the worst asthma attack I have ever had as an adult,” I told her in careful breaths. But history was irrelevant. I was no more than today’s readings. The doctor at Urgent Care had taught me this twelve hours earlier.
“This is the worst asthma attack I’ve ever had that didn’t involve a cat,” I had told Dr. Urgent Care. “I had very bad asthma as a child. My parents were both heavy smokers and we had four cats.”
Dr. Urgent Care had gazed at me as though I myself were a cat, pussyfooting around his exam table while he waited for me to settle down so he could measure my signs.
At Mount Sinai, Dr. Track asked, “How often have you been admitted overnight for asthma?”
“I’ve never been admitted overnight.” I added. When her raised eyebrow hinted that I was a lightweight, as asthmatics go, I supplied more unnecessary history: “The last time I was in the ER was the John Muir Medical Center in Walnut Creek. I was visiting my brother. He had a cat. It was a wonderful ER,” I went on talking about my California stay as Dr. Track tapped at her device. “They had heated blankets.” I was, also, their sole patient for two whole hours, until a boy came in with a sprained wrist, but it seemed rude to bring that up. “And an oxygen tent!”
“There’ll be oxygen in your nebulizer treatment,” Dr. Track told me with a touch of disdain, as if oxygen was just another drug junkies craved. “How long ago was this?”
“John Muir? Um, it was the year E.R. debuted.” Dr. Track exchanged an unreadable glance with her nurse. “The show, E.R.? George Clooney? I guess . . . you’re too young.”
“X-ray,” said Dr. Track to the nurse, and once again I was rushed away to wait.
After my mother died when I was eight, I developed severe asthma. I’d had allergies before then. I remember my mother’s impatience with me when I couldn’t easily swallow my first prescribed antihistamine pills. But a few years after her sudden death, I found myself unable to breathe to the point where I was hurried to the ER. I was then sent to an allergist to determine the cause.
I was subjected to a scratch test in which my back was pricked repeatedly with dots of potential allergens in long even rows (“hold still, hold still”), which raised hot itchy wheals as though an angry army had set up tents on my back. I was allergic to dozens and dozens of triggers. I was allergic to things I had never encountered, like cattle, things I had never heard of, like Brazil nuts, and things that filled my waking days and sleepless nights, such as cigarette smoke, cats, dust, and most of the grasses and the trees in the yard outside.
Treatment in those days, at least in my part of the world, at least for children, was random and arbitrary. A belief prevailed that asthma was “all in your head.” It was the ‘70s, the era in which Susan Sontag was diagnosed with breast cancer and explored the culture of victim-blaming in the literature of health. In Illness as Metaphor, she wrote, “A disease of the lungs is, metaphorically, a disease of the soul.” But she also wrote, “Theories that diseases are caused by mental states and can be cured by willpower are always an index of how much is not understood about the physical terrain of a disease.” At Children’s Hospital in downtown St. Louis, I was made to drink water, glass after glass after glass, until I vomited. And then I was made to do it again.
My future stepmother Claire, who had just started dating my father, sat with me, urging me on. “Honey, you know I’d drink that water for you if I could,” and “honey, the doctors know what they’re doing.” She said this after I pointed out that my stomach and my lungs were in no way connected. Why was I being made to drink water as though I had been poisoned? It wouldn’t clear my lungs. I was only eleven, but I knew that much.
I also knew that I was a burden, that if I’d had any decency, I would have made myself easier, not more difficult, to care for, after my mother died. My grief was a corset and invisible hands pulled its strings. I was learning to manage the panic of an attack, but I hadn’t yet mastered the shame of one. My father wouldn’t sit with me. During the long night of the water, he sat in the waiting room where he could smoke in peace while his girlfriend, a woman so alien that she didn’t know enough to refrain from calling me “honey” – that we were not a family of endearments – coaxed me through the ordeal.
We sat in a room filled with steam humidifiers, which would indicate a token acknowledgement that the crisis was in my lungs. But they made me drink on and on, glass after glass of water, all through the night. I have no memory of how this night ended, or when the morning came. Years later, one of Claire’s sons asked one of his professors why the doctor would put me through that torment. He replied, “To take her mind off things.”
After that, the prescription was to sit in the bathroom near my bedroom with the shower turned fully to hot until steam filled the room, and the doorknobs dripped fat drops of condensation. I was to breathe in steam until my lungs became “relaxed.” I did this on numerous long nights, in the spring, when pollen was at its worst, and in the fall, when mold was at its worst, until dawn—however a poet would describe it—gentled the sky with a smear of light.
Only if that failed – and it nearly always did – only then was I permitted to wake up Claire. She was my stepmother by then, and tasked wholly with my care. So she packed up her cigarettes and drove me to the emergency room.
Friends and therapists have asked where my father was. He was in one of three places: asleep in bed, at the office, or standing in the kitchen corner with his cigar, his sports talk radio and his gin and tonic. “You’ll outgrow it,” was his only contribution, accompanied by a baleful stare reproaching me for not having got on with the outgrowing, the metamorphosis into healthier lungs.
My stepmother smoked and muttered in the car but delivered me into a suburban ER where the water torture was replaced by actual medicine: a hypodermic needle of adrenaline. I grew to associate the chemically-induced timpani of an adrenalized heartbeat with a profound sense of well-being. Once back home, I fell into a deep sleep, even while my heart raced.
At Mount Sinai, they gave me vials of albuterol administered through a nebulizer which wafted out medicinal steam. I breathed through a mask through three courses of the medication. Although a stimulant, albuterol is no adrenaline. It relaxed my bronchial tubes but it did nothing for the mucus clogging them, which could only be dislodged through violent coughing, and then only temporarily. When I tried to lie down, mucus gurgled through my lungs with the groan and drama of pipes of an old apartment building. I had to sit up and cough it out in wracking jags that lasted two to three minutes, sometimes crouching on my hands and knees.
When I had inhaled every drop in the vials, a nurse appeared and replaced them with fresh ones. When those, too, were absorbed into my lungs, he appeared again, plucked out the empty vials, and replaced them with full.
“Last round,” he said, patting my hand, before he disappeared for good.
I suppose the pat was a reward for good behavior, for not having dementia, like the woman on my left who continuously shrieked, “What’s taking so long? I’m gonna miss the ambulette!,” for not having loud combative relatives, like the woman on my right, for not complaining, like the ones cluttering the hallway. I spent my hour-long albuterol sessions quietly breathing in the medication, removing my mask only to cough. An ideal patient.
Although my father believed that my asthma was a rare malady I had plucked out of thin air to complicate his life, asthma is almost certainly as old as breathing. It is first mentioned in The Iliad, when Hector, mighty Hector of the glancing plume, lies out of breath (the word Homer uses is asthmatì) after battle on the plains of Troy. Asthma then meanders through the ancient world, through Aristophanes and Plato, generally employed to mean “breathless” before it is taken up for serious study by the father of medicine himself, Hippocrates, who describes it in some detail in his treatise On Airs, Waters and Places. Asthma then catapults to ancient fame with the asthmatic Seneca, who wrote to a friend: “anything else may be called illness; but this is a sort of continued ‘last gasp.’ Hence physicians call it ‘practicing how to die.’ ”
When I graduated from the Mount Sinai ER, I was released into the crisp, still air of a December near-dawn. I had been in the ER for roughly seven hours, the last fifteen minutes of which were spent with the hospital bursar, who was unable to convince the hospital software to process my hundred-dollar co-payment. She waved me away cheerfully. “We’ll bill you,” she chuckled. I laughed with her, as though hospital expenses were merry. Part of me laughed just because I had the air to do it.
I walked out of the hospital, toward my bed, in which I would be able to lie flat and sleep for the first time in three nights. I went out as I had come in, on my own two feet, walking the 80 paces down Crescent Street to home, past the echoey pre-war brick apartment buildings with their grand colonial names – the Mayflower, the Queen Anne, the Jefferson — and the Church of the Redeemer, built in the 19th century with local granite. I have always loved this church, with its Gothic design, its humble height, and its rambling garden made more bucolic by the intermittent nature of its tending. I remained sick, weak, coughing and bedbound for another week. My primary care physician prescribed steroids. Eventually, this fierce, mysterious illness left my body.
When the coughing finally abated and I came off the steroids, in early, pre-pollen spring, I looked up “deaths by asthma” on the website of the Centers for Disease Control and Prevention. In 2017, 3,564 people in the U.S. died from asthma. It struck me at the time as a very large number of people to die from respiratory failure.
Although I had, during several of my adolescent asthma attacks, felt an encroaching blackness, there was only one time that I felt truly imperiled. It was bad enough that my stepsister fetched both my parents, bad enough that my father actually climbed the stairs to look at me. I was sitting cross-legged on my stepsister’s bed, hunched over, clutching my kneecaps.
“I’m gonna die,” I gasped.
“No, you’re not,” my father answered. His scorn was shriveling, as though I were indulging in mere teenage drama, claiming that I would just die if I didn’t get a certain prom dress.
I didn’t know, at the time, that people did die from asthma. I didn’t know until I moved to New York for college and the chancellor of the New York City Schools died. According to his obituary in The New York Times, he said to his wife, “Babe, I’m not gonna make it this time,” before he collapsed. He heard the click and this time, it was fatal. He never regained consciousness. Reading this in my dorm room, I thought of all the clicks I had experienced. I thought of my father’s disdain. I thought, now that I had control, or what I could muster of it, of my health, I would take this seriously.
In April 2020, Elmhurst Hospital was the epicenter of the epicenter of the COVID pandemic, and the Astoria branch of Mount Sinai served as its overflow hospital. Ambulances rushed three times an hour past the Jefferson, the Mayflower, the Queen Anne. Crescent Street teemed with flashing lights and triage tents. The Church of the Redeemer set up cots for the staff of the hospital so they could snatch a nap between shifts, without having to risk carrying the infection home. I pictured Dr. Track, before she could so much as loosen her hair, collapsing on a cot into the gentle arms, as Shakespeare would have it, of “Nature’s soft nurse.”
In Romeo and Juliet, Juliet petulantly demands of her Nurse: “How are thou out of breath when thou hast breath/to say to me that thou art out of breath?” The Nurse has returned from her visit to Romeo. Juliet is far more interested in what the Nurse has to say about Romeo than the fact that the Nurse lacks the breath to say it.
The pandemic brought us many Nurses out of breath, and a not inconsiderable number of Juliets who resented the Nurse’s breathlessness as an inconvenience to their own affairs. In my small corner of the world, some of us even functioned as a kind of Chorus, marking the shifts of the health care workers wearily trudging home from the hospital with what became known as the “the clap,” the applause that started up when the shift change struck at seven o’clock, leaning out of their windows to cheer weary hospital staff trudging toward the subway. Some, not content with their hands and voices, banged cookware for greater effect and sound.
“Pots and pans,” I pictured Dr. Track muttering, “How helpful.”
But I tried not to picture the patients inside the ambulances keening past my window, the patients attended by EMTs in HAZMAT suits, wheeled into ICU’s as they fought for breath until, all too soon, they lost the fight, without so much as a part on the hand or the promise of a last round. In the early days of the pandemic, I was terrified, as everyone was. I was simultaneously more terrified, as someone with an existing respiratory disability and so more vulnerable, and less terrified, as someone who had, so many lonely, aching nights, been practicing how to die. It is a feat I have yet to master, just as I have yet to return to that hospital, on foot or any other way, as I live and breathe.
Elizabeth Bales Frank is an essayist and legal researcher who lives in Astoria, Queens, New York City. Her work has appeared in several publications including The Arkansas Review, Cosmopolitan, and The New York Times. She holds a BFA from the Tisch School of the Arts at New York University and an MLIS from the Pratt Institute.