Authors: Courtney Moreno
Ruth takes it and thanks her. She gestures for me to follow and I do, into Room 1, Bed A, where our previous chest pain patient is sitting upright on the hospital bed. His clothes have been exchanged for a gown and the
oxygen mask replaced with nasal cannula. His hair is no longer dewy with sweat. Recent vitals on the overhead screen show that his blood pressure is down to a mellow 162/90. Other than the occasional beep from the monitor, the room is very quiet. My chances are much better in here than in the back of the ambulance, but I wonder what happens if I still can’t hear anything. Will Ruth fail me? Will A & O Ambulance fire me? I only have one more training shift after today.
Ruth hands me the stethoscope without a word. It’s much fancier than the one we use on the rig, probably costs close to two hundred dollars.
I clear my throat even though I don’t need to. “Hello, sir. I’m Piper. I met you earlier?”
“This is my third day.” Clutching the stethoscope with both hands, I hold it out to him, like it’s some kind of peace offering. “May I?”
“Go ahead, little lady.”
I listen to the tops of his lungs, just below his clavicle, and for the first time, I hear air moving. Moving the bell to the sides of his rib cage, I hear it again—air in, air out, what a relief—and then travel to the bases of his lungs, a few inches below his nipples. There’s a slight bubbling there, like air moving through water.
“Rales! I can hear it!”
Ruth nods. “And what are rales?”
I’m so glad she asked. They’re caused by trapped fluid, I tell her. It can happen from a near-drowning or because the heart isn’t working properly, and signifies that backup from the circulatory system has entered the lungs. Specifically, I say, the
ventricle must not be working properly, because when the
ventricle doesn’t work, blood gets backed up in the body, causing swollen feet and ankles, known as pedal edema. I smile at him, pleased with myself, but he looks bored. Ruth and I walk back to the hallway. It’s just as chaotic as before. The halls are packed with gurneys, a
patient is screaming at a nurse, and Betty chooses this particular moment to start singing opera.
She’s good. She’s really good. I have no idea what she’s singing, or in what language, but I am aware that the whole ER stops, momentarily, to listen.
If they were removed from your body, your lungs would look like two inconsequential pink-gray sacks, hinged together only by their mutual attachment to the bony rings of your windpipe. If all the tissue were removed, your lungs would reveal an extensive series of narrowing tunnels that descend and branch off from the main bronchi. Each lung has what looks like an inverted and hollow oak tree hidden underneath its pink flesh folds.
There are very few involuntary bodily functions you have control over. Eyesight is one. Breathing is another. You can’t tell your body to wait until 5 p.m. to digest the cereal you ate for breakfast, but you can hyperventilate until you pass out. You can hold your breath, cough, or deepen your respirations, forcing yourself to become dizzy, irritated, or calm. By shifting the focus of your breathing, you can make your back expand more than your chest, or your right side expand more than your left, or fill up your belly with so much air it pushes out the walls of your abdomen.
The structure works like a bellows, the ribs, intercostal muscles, and diaphragm expanding and contracting, the pulmonary tissue quick to inflate on the inhale and elastic in its recoil. The inner surface of your lungs is honeycombed with three hundred million air sacs that specialize in gas exchange. When trapped fluid, airway blockages, or damage to these air sacs occurs, your lungs start to sing. Depending on the source of injury, a listener will hear coarse crackling, high-pitched wheezing, bubbling, or coughing.
This effect isn’t singular. Anything that moves creates vibrations; where there is motion, there is sound, whether or not the human ear or technology can hear it. Musical instruments live inside you: wind, percussion, and stringed. Your tongue clicks against your palate every time you swallow; air pushes against your tightly strung vocal cords, giving pitch to your breath. Flooding happens in all of your various cavities, cascades of saliva, intestinal juices, bile, blood, and mucus. Gaseous by-products bubble and gurgle their way out of your organs in as many directions as they can. Eating is a cacophony from start to finish, carried out by an uncooperative orchestra.
And subtler music-makers are also at work. If only it were possible to listen closely enough, you would hear the sweeping sound of cilia rhythmically moving particles toward your throat. You’d hear the tap of your eyelids closing, the plunk of your cells separating as they reproduce, the lapping of cerebrospinal fluid bathing your brain, the rubbing of muscles sliding over each other as you move, and the creak of bones swiveling in their joints.
There are silences, too, tucked away in hushed pockets amid the tricklings and murmurs and thumps. Most distinct is the deafening pause right before the clamor, such as occurs before the
of blood ejecting from your heart. Or when the rib muscles and diaphragm contract—pulling the chest cavity outward in all directions, followed quickly by the lungs—and the smallest suction of soundlessness occurs before a great rush of air.
About once a month I have Sunday brunch with Ryan and Malcolm at the house they bought together in Culver City. Malcolm is an accomplished legal advocate (although he likes the word
better) and there’s something very meticulous about him, with his tweezed eyebrows and straight, square teeth. Ryan deals really well with any kind of upheaval—he’s
a bit of a fixer. He got practice at an early age, of course, holding the family together after Mom left, and even now, if your car breaks down or your house gets broken into or your girlfriend dumps you and you need a shot of whiskey stat, Ryan’s the person you want to call. But Malcolm—prim, cheerful, smart, pushy, needy Malcolm—always wants to psychoanalyze every last thing, and Ryan is not that kind of fixer. Even when they are on an upswing after their most recent bout of fighting, smiling lovingly at each other, it’s hard for me to understand how they’ve lasted six years.
On my way to their house, I stop in Hollywood to pick up a loaf of za’atar bread from our favorite Armenian bakery. Sometimes Ryan will devise omelets that complement the za’atar spices, the thyme, sumac, and sesame; other times he doesn’t and we eat it anyway. I drive down De Long-pre Avenue, east of the 101 freeway, past the apartment Jared and I lived in for two years, and then past the restaurant I used to love so much, an old-fashioned deli that serves a tower of large dill pickles on a small white plate as an appetizer. This isn’t the well-known part of Hollywood. There are no pink terrazzo stars embedded in sparkling sidewalks, no elaborately made-up celebrity look-alikes doing their routines for tourist tips. For a long time I avoided this area because I worried about running into him, then I started coming here whenever I was depressed, inexplicably half-hopeful about running into him.
The last time I heard from Jared was an email he sent about six months after we broke up. I remember sitting at my computer, staring at the screen, acutely aware of all that had taken place since I’d last seen him—how I rushed out of our apartment in a daze, refused to answer any phone calls, only dealt with the logistical aftermath of our breakup and resisted any emotional processing; how I showed up late many times to Mad Dog Bar & Grill, where I used to bartend, got drunk off snuck shots of whiskey on an empty stomach because I’d forgotten to eat again, and the owner was forced to fire me (and I cried like a baby when he did); how Ryan called me
not too long after and told me in an unfamiliar voice, a voice that sounded somehow shattered, that our mother was dead, and I stood in a gas station with a bag of Skittles and a water bottle in one hand, the phone pressed to my uncomprehending ear in the other, and didn’t cry at all—and after all this, I got an email from Jared saying he would like to be friends.
He told me that he and Elizabeth had stopped seeing each other, and apologized in what appeared to be a heartfelt and genuine way that was simply not enough. This tiny bit of bait almost prompted me to pick up the phone and arrange a meeting, to hash out all the painful things, to yell at him in person, as Ryan so often advised me to do, rather than punish him with a wall of silence. But Jared also included a postscript saying that he’d heard about my mom, and to let him know if I needed anything. The extent of my rage upon reading those last lines actually stopped me, my feelings too complicated to sort out. It wasn’t my desire to punish Jared that made me ignore him. I was scared of how ugly I would be if I saw him, how angry and vicious; I was scared of all the questions I would ask that I didn’t want answers to. After he sent that email I retreated so far into myself that Marla and Ryan—the only two people I saw with any regularity anymore—really started to worry. Jared’s betrayal was hard enough, and my mother’s death confusing enough, but the combination of the two laid me flat for longer than I like to admit.
I park on Keystone Avenue. Ryan and Malcolm live in a light green, shapely one-level house that has a backyard and a mailbox. It’s the smallest structure on the block; they’re surrounded by multilevel apartment buildings, awkward and boxy, fitted on four sides with balconies too small to be useful. Still, when we were kids I never pictured this kind of domesticity for my brother.
Malcolm answers the door, looking pristine even in pajamas. “Piper!” He says it with surprise, like he hasn’t been expecting me. “Come on in.” Stiff blue cotton frames his long body like a nice suit; black hair hugs his
scalp in even rows. It’s as if he spent hours in front of the mirror this morning, ironing the pajama set, wetting and combing the shiny strands just so.
Ryan is hard at work, a dishtowel slung over one shoulder, a crackling bed of country-style potatoes in front of him. He sprinkles paprika over the mixture. Sitting on a cooling rack on the counter is a muffin tray, its pockets filled with red pepper goat cheese frittatas. The whole kitchen smells like browned butter.
“You amaze me,” I tell him. He smiles.
We sit in the living room, the boys on the couch, me on the floor, and talk loudly over each other as we eat. Once my belly is bursting, I push my plate away and lean my elbows on the coffee table.
“Have you rescued any cats from trees?” Malcolm asks, chasing what’s left on his plate with a pinch of bread.
“Not in my job description.”
“Is it true you should always wear good underwear in case you get in an accident?”
“Yes, it’s the first thing I check.”
“Tell me you have a crush on this Ruth person,” Malcolm presses.
“Actually, I went on a date with someone much cuter the other day.”
“What? I haven’t heard about this! Guy or girl?”
“Pipes, we got a new kind.” Ryan leans his cheek on the kitchen doorway. “You want regular or Lime-zest Jima?”
I make a face. “I’d rather drink cowboy coffee than that citrus crap.”
Ryan holds his hands up and backs slowly out of view.
“What’s cowboy coffee?” Malcolm asks.
“You pour hot water directly on the grounds, no filter.”
“That’s disgusting. So who are you dating?”
In my halting, awkward way, I tell Malcolm about Ayla, wishing I could capture how it felt to talk to her, trying to render her wry sense of humor and shy smile. In return I get a monologue about why certain coffees taste
nutty versus fruity, how the ones with citrus overtones have been grown in mountainous regions and wet-processed, because once Malcolm has smelled out an argument of any kind he can’t ever let it go. We’re busy bickering when Ryan comes back with a French press and some half-and-half.
“I don’t care how gourmet it is, coffee should not taste sour. That stuff always makes me think the milk has curdled.”
,” Malcolm says. “The beans are actually coffee cherries.”
“I never know which one of you is more stubborn,” says Ryan. He sits down, kisses Malcolm’s shoulder, and places his palm over the plunger. “Or why I always surround myself with stubborn people.”
“What about you,” I say to Malcolm, “any exciting cases?”
“I’ve got a new workman’s comp case, really interesting. Poor guy ended up with a doozy of a TBI. Stands for—”
“Traumatic brain injury.”
“Exactly. Apparently my client is a completely different person now than before. Crazy mood swings, and I mean crazy. Never seen anything like it. And he has memory problems, but that’s really common.”
“Who doesn’t have mood swings?” Ryan says. “And I’m the king of losing things.” He turns to me, his voice purposefully light. “We had to change the locks to the house last week. I think it’s the fourth time.”
. This guy never started a fight in his life and now he’s gone completely—here, wait, I’ll show you the reports.”
“Malky—” Ryan warns.
“What? She’s a medical professional now, this kind of information might come in handy.” He disappears into the bedroom.
Ryan fills my mug, the one I always choose, that has the words
NONE SHALL PASS
on the side in thick calligraphy, and he mixes in the cream until it’s the exact shade of tan that I take my coffee. He passes it to me, but won’t let go until I look up at him. “You finally met someone who might have half a chance,” he says. “Don’t you start spinning now.”