In the first story, it’s past midnight and we’re driving way too fast through the winding residential streets of Ravenna. Rain falling, the road glistening black, down the hill and then up ahead the bright lights of Seattle Children’s Hospital. I don’t remember Oliver, himself, his tiny eleven-day-old body. I remember the echocardiogram monitor’s pulsing, surreal images of his heart. I remember pulmonologists and cardiologists and neurologists, but I don’t remember anything anyone said, except that everyone was concerned but no one could explain why Oliver was breathing so fast. I don’t remember holding Christine’s hand or the fear that must have swamped her sleep-deprived face. I don’t remember the slow drive home. I don’t remember feeling that everything would be fine—which is my default mode, my temperament, and not a reliable barometer of the truth of things as they are. I remember that after a few days, Oliver’s breathing returned, somehow, to normal, and we never knew why. The problem resolved itself, as some problems do. I remember what they called it—Idiopathic Infant Tachypnea, which has a simple, straightforward lay-person translation: We have no fucking idea why / baby / is breathing so fast.
This breathing problem and its uncertainty would likely have given other infants pause. But not Oliver. I remember. He flailed his arms and kicked his supremely chubby legs. He rotated inches, amoeba-like, in all directions. He rolled triumphantly onto his stomach. He sat up, raising his arms in the universal gesture. But he was not done. He crawled over and under and through a series of incrementally more challenging obstacle courses. Then lap after lap of interval-based cruising around the coffee table, along the couch, one long step to the armchair, then a cool down along the windowsill, and one unsurprising day, Oliver crushed his target goal and walked at eight-and-a-half-months! Yes. My son, the walker. Christine worked full-time as a labor and delivery nurse, I was a stay-at-home-Dad who drank strong coffee all day the way one ought to drink water, and Oliver was a prodigy, far better than all the other non-walking, unprecocious babies his age. For almost three years, I forgot about that day when so many specialists thought something might be terribly wrong.
In the second story, it’s past midnight and we’re in the Emergency Room of the University of New Mexico Hospital, and the doctor is asking Christine if she does cocaine. The rings under her eyes are unconvincing, but Christine answers in a clear voice, “I don’t even eat non-organic fruit.”
“Sorry,” the doctor says. “It’s one of the questions.” He puts the clipboard down and looks at four-week-old Evan, sleeping soundly in Christine’s lap. “He seems to be doing OK now.”
“That’s the problem,” Christine says.
We know this doctor. Sam. He’s our neighbor, and his front yard comforts us. It’s the only yard in the neighborhood more weed infested and neglected than ours. If he ever landscapes and installs a drip-system, we’ll have to take out a loan.
Sam listens to our story. Evan has been breathing too fast for more than a week, 90, 100, 110 respirations a minute. Christine took him four times to the urgent care pediatric clinic, but each time, on the way in the car, Evan fell asleep, and his breathing slowed down. It never quite got to normal, but it dropped down into the seventies, still too fast, fast enough for concern, but not fast enough to freak out. Tonight, at ten o’clock, Evan was breathing 150 times a minute, and the triage nurse on the phone said to Christine, “Hang up and call 911.”
We live less than a mile from the hospital. Christine grabbed Evan, ran to the car, strapped him in his seat, drove too fast to the ER roundabout, abandoned the car, and ran inside with Evan who had fallen asleep, his respirations dropping below 100. Back home, Oliver was asleep as well. He was almost three, and our friend, Emilie, herself a pediatrician, came over and slept on our couch so I could join Christine, Evan and the homeless reeking drunks sleeping it off in the waiting room, their respirations audible, in the low twenties. We waited forever. We were eventually seen by a bored, dismissive resident, used to nocturnal drug-seekers with nebulous pain. Sam was at least bemused by us, a change in the scenery. But he had no idea what might be going on with Evan. We drove slowly home.
Evan steadfastly insisted on breathing too fast. Emilie came over to check on him at least once a day, usually twice, on her way to and from the hospital; she was in her third year of residency. She didn’t call first; she just came over. We’d met Emilie, Jerry, and their son Jeremy the day we arrived in Albuquerque, after driving straight from the airport to the park closest to our new house. There they were, in the sand with enviable sand toys. Oliver was thirteen-months, Jeremy nineteen-months. Soon I was opening their refrigerator without asking—that kind of friendship. Emilie knew that Oliver had tachypnea when he was an infant, and that it had gone away after a few days. But she kept coming over, counting Evan’s respirations—120, 130—and saying things like, “That’s not OK,” and, “Normal is thirty to sixty. This isn’t normal,” and “You get to be worried. I’m worried,” which helped more than Christine can now say—she will always be grateful— because she was so sleep-deprived from staying up all night watching Evan, so afraid to be anything less than vigilant, because she was so full of anxiety, and even in her best moments she felt like just another post-partum mom going crazy over nothing, another helicopter mom who can’t fucking relax, who won’t come down off the playground equipment. But in her worst moments she felt like one of those moms accused of Munchausen-by-proxy, who make up their child’s illnesses, because she’d taken Evan into the urgent care clinic five times now, and each time Evan had fallen asleep on the way in the car, and each time she imagined the nurses and doctors there doubting her more, and because late one night the pediatrician-on-call said to her on the phone in a tone of undeniable exasperation, “You do know how to count respirations, don’t you? Are you doubling his breaths? You don’t count the in and out.” Or because she felt alone, undermined, ignored, because her husband, your narrator, woke up every morning at five and shut himself in the guest bedroom and worked on a novel and then, a few hours later, went to work all day, abandoning her and rambunctious Oliver and tachypnic Evan, because her husband’s mild, not-quite concern wasn’t remotely reassuring, because she did not want to be reassured that everything would be fine because everything was very much not fine. Because she felt that if she did not find a way to fix this, to stop this, then the worst could happen, and she would never forgive herself.
One fine ironic morning, six-week-old Evan found himself at his well-baby checkup, scheduled long before this suspect breathing problem. He lay on the exam table in his diaper, his blue eyes open wide, his chest rising and falling like a hummingbird’s, and the nurse turned to Christine and said in a panic-stricken voice, “I can’t count his respirations. They’re too fast.”
Christine said, “I got 130. Try again.”
The nurse tried again. “You’re right,” she said. “130.”
“I know,” Christine said.
The nurse glanced quickly at the emergency alarm on the wall. Christine thought, “She’s going to call a code.” Then the nurse looked at the oxygen saturation monitor. She had velcroed the tiny oximiter to Evan’s finger before she started counting respirations. In red, digital numbers, the monitor displayed 97%. “OK,” the nurse said, more to herself than to Christine. “His sats are normal.” Then she said, “You can’t stay here. He can not be here. We need to get him over to urgent care right now.”
Christine grabbed Evan and they rushed down the hall to the urgent care clinic. Christine saw the name of our pediatrician, Ben Hoffman, on the dry erase board. Ben had not been in the clinic any of the previous times she’d brought Evan in. The nurse put Christine and Evan in a room. Christine waited. She could not let Evan fall asleep. She bounced him on her knee. She paced the room, “Don’t fall asleep. You are doing so well. Don’t fall asleep.” She did not know why it was taking so long. Hadn’t they just run down the hall? She heard Ben’s voice at the doctor’s station speaking to someone about a patient. She fought with herself, with her adult-child-of-a-violent-unpredictable-alcoholic ingrained deference. “We’re gonna do it,” she said to Evan. “We’re interrupting.” She carried Evan in her arms out to the station and said, “Ben. Please. Come right now.”
Ben followed her back to the room, a young resident behind him. Ben is average height, has brown curly hair, a small hoop earring in one ear; he’s gregarious, quick to laugh and high-five. We have known him, now, for ten years, and it is a true, easy thing to say that we cherish him. His youngest son is Oliver’s age. They play each other in soccer. Ben refs. I coach. I have once or twice silently doubted his penalty calls. But Christine did not know him so well then. The resident, Alwin Koil, was a shorter man, of Indian descent, and walked with a pronounced limp due to childhood polio. They immediately began examining Evan on the table, standing over him silently.
Koil said, “I got 130.”
“Me, too,” Ben said. He stood up and let out a breath. “OK,” he said. “I’ll be right back.” He left Koil there with Christine and Evan. A minute or two later, the attending pediatric pulmonologist came into the room, a man in his late fifties with graying hair and eyeglasses.
He examined Evan and listened for a long time with his stethoscope. He turned to Christine. “Did you have a vacuum delivery?”
“No. I pushed once and he came out.”
“Any problems with pregnancy?”
“No. Vaginal delivery, no medications, clear fluid, no fever.”
The pulmonologist asked Ben and Koil to step out into the hallway. Evan fell asleep. Christine was awash with conflicting feelings. She was so proud of Evan for staying awake. She was so scared, oh God, she was scared, but she was also so relieved that she wasn’t alone, so relieved to finally be believed.
Evan received a chest X-ray and a brain ultrasound through his fontanel. A twelve lead EKG, its sticky circle electrodes attached to Evan’s tiny chest, measured the electrical activity of his heart. Ben and Koil came in and out of the room. Evan’s lungs looked normal. The ultrasound looked normal; there was no bleed in his brain. His heart looked normal. The day passed into early evening. Koil came in to draw arterial blood gases, poking at Evan’s tiny wrist with a long needle. He dug around with the needle a long time.
Christine knew well how hard it was to find a vein with infants; it was a lot harder to find an artery. She knew also that if you screwed up you could cause nerve damage.
Ben was there, watching. Christine saw him shake his head. He had a worried look she didn’t like. “Is something the matter?” she said.
Ben paused for a moment, then said, “He must be really worn out if he can sleep while getting that needle.”
Koil set the needle down on the tray and said, “I’m sorry. I can’t get it.”
Ben tried and got the needle in. The sample was sent off to the lab. The results came back normal. Then Ben told Christine that if she wanted, Evan could be admitted inpatient and monitored with machines, but right now, he didn’t recommend it. In seven visits, Evan’s oxygen saturations had always been normal. His blood gases were fine. He’d never been blue. If they admitted him, all they would do was monitor him. Ben thought it would be better to have Evan at home, to keep watching him closely, to call or come in whenever she felt the need.
Christine said, “I’m worried that he’ll just get tired. Can you just tell me he won’t get tired and stop breathing? Tell me that I’m not going to wake up and he won’t be breathing.”
Ben sighed. “That’s the problem,” he said. “I can’t. That’s what we’re all worried about.”
Christine strapped Evan into his carrier and then stood up and gave Ben a hug. She stunk, she hadn’t slept in so long and she reeked of body odor, and for a brief moment she was embarrassed, but then she didn’t care—her smell was the visceral confirmation of weeks of justified worry. She wasn’t embarrassed anymore about her worry itself. She stunk and she didn’t care and she hugged Ben for a long time.
Christine counted. 120. OK, she could live with 120. 130. Fuck. 110, that was better. She decided not to check for half an hour. God, now it was 140. Should she call? Should she bring him in? Last time, when it was 150, it was call 911. Her nerves were shot, her maternal instincts paralyzed by doubt. Should she act? Should she watch?
Christine spoke on the phone with a pediatrician in Minnesota. This doctor’s two children had been in Christine’s mother’s kindergarten class. Christine’s mom had been a kindergarten teacher for twenty years and was deeply connected in St. Paul; the Doña of the Highland Park syndicate, except that when she called in favors, they were done out of gratitude, not fear.
“He needs an echo,” this pediatrician said. “You’ve got to rule out cardio. There’s no reason not to get one. I don’t care if New Mexico is a poor state. You’ve just got to demand one. And it’s safe. It doesn’t require sedation.”
“What if Evan falls asleep in the waiting room?” Christine said. “What if all this cardiologist sees is a beautiful, sleeping baby?”
“Demand an echo anyway,” the pediatrician said.
It took forever for the cardiologist to come into the room. But Evan was like an athlete in a human interest story. All his life, it seemed, he’d been preparing himself, training for this moment. Christine set him and his little bare chest down on the bed. He was wide awake. Ready. He performed. 150. He could not have been breathing faster, and Christine could not have been more proud. She was like Michael Phelps’s mom before that photo of Phelps taking a hit at a frat party.
The cardiologist studied Evan. He didn’t touch him or move to examine him. He had white hair and wore a jacket and tie. He turned to Christine: “How long has this been going on?”
Christine was particularly adept at giving this report. Evan was born on April 20th. The first time she noticed the problem was May 12th . . . Then the cardiologist listened with his stethoscope for a long time—at least five minutes. Maybe more. He looked at the EKG reports. He listened to Evan again. He looked up at Christine. “It’s not his heart. I can promise you that.”
Christine was relieved, but still, she said, “Don’t we need an echo? To rule things out.”
The cardiologist repeated himself. “It’s not his heart.”
If he explained more, about how he’d reached such a confident conclusion using only Amish technology, only the simplest of diagnostic instruments, Christine doesn’t remember. The cardiologist had this presence, this aura of authority. He was kind, yet he demanded to be believed.
Christine said, “All right.”
The cardiologist said, “I have no idea why he’s breathing like this. But I do have one piece of advice. Don’t let them do anything invasive in neurology. Nothing experimental. Nothing in his brain.”
Christine nodded and said, “Can I bring him to Minnesota? My grandmother’s dying. Can I take him on an airplane?”
The cardiologist considered this sudden, undeveloped plot point. The room went quiet. Evan fell asleep. The cardiologist ran his hand slowly through his hair. He was a man unafraid of silence. A man of iron, of stone. Time passed in this lyric, torpid silence as in a French existentialist novel. As in a James Salter novel, set in France. The cardiologist said, “I’m thinking through the possibilities.” There followed more quiet. Finally, he said, “Flying in a pressurized cabin is like being at seven or eight thousand feet. We’re at five thousand feet. If he has one of these episodes, how would he do if the air were that much thinner? That’s the question.”
“Why don’t I drive him up the crest road and hike around on the trails?” Christine said. The crest road wound up the east side of the Sandia Mountains, on the outskirts of Albuquerque.
The cardiologist smiled. “Yes,” he said. “Altitude training. That’s a good idea.”
The test was done that weekend, and I have been told that I was there, and Oliver, too—a family outing—and that all went well, if well can mean that a nice summer afternoon was spent hiking in the mountains with an infant who was breathing terribly fast, as per normal. That same week, Christine, Evan, and Oliver flew to be with Christine’s nanny, who had been on death’s door, teetering on its very threshold, for several years, who did not die that year or the next, who appears, in several photos taken from this emergency visit, to be swimming with Oliver in White Bear Lake.
There was a growing consensus of opinion, and it was clear: if you set aside Evan’s “call 911 breathing,” in every other way, he was a normal, healthy baby. Sometimes he interrupted his breastfeeding to throw up everything he’d just eaten because he’d taken in too much air. But he was gaining enough weight. He didn’t have gastric reflux. The barium swallow test came back normal. In two follow-up appointments with Ben, one question remained. Was this being caused by something in Evan’s brain, something undetected by the ultrasound? Like a tumor. The question was: should Evan be sedated and administered a brain MRI?
Christine spoke on the phone with a pediatric neurologist in Minnesota, a colleague of the pediatrician parent of the alumni from Christine’s mom’s kindergarten class. This neurologist did not think the problem was neurological. She’d never seen this kind of tachypnea in isolation; lots of other things were usually wrong as well, like seizures, like eyes not tracking.
But Evan was still breathing at 120, 130, 140. He wasn’t getting worse; he wasn’t getting better. Christine said to Ben, “I don’t want to do an MRI just out of curiosity. I don’t want to do it just to relieve my anxiety. Just so that I can sleep better.”
Ben said, “Maybe sleeping better is OK.”
“Is it worth risk? Could we find something that we would even treat?”
“I don’t know what we’ll find,” Ben said.
Emilie accompanied Christine to the hospital on the day of the MRI. A few days before, my mother had been diagnosed with stage 3-C ovarian cancer and had undergone surgery to remove her uterus, a third of her bladder, and much of her colon. I flew to Spokane, Washington, to be with her. I don’t remember my role in the decision to pursue the MRI; I don’t remember weighing the alternatives with Christine, the risk of sedating Evan against the possibility of having some kind of conclusive understanding leading to a course of treatment. I know, now, that the sedative used during Evan’s brain MRI has since been banned, contraindicated, because of the deaths of infants resulting from its use. I know also that if Evan had been one of those infants who died, then my failure to be there—physically, emotionally—not just on the day of his MRI, but for that entire time, would have had terrible consequences for my marriage, for my future life together with Christine, if that future would have still been possible, and that no explanation, no apology I might have offered would have been worth anything. But that’s not what happened. So there is in this second story only a ghostly algorithm of grief and remorse, a chalk-covered blackboard of hypothetical tragedy and hurt and reckoning.
Christine and Emilie stood right beside the machine—not behind the protective glass with the tech—as Evan’s sedated tiny body was shunted inside the hollow, cylindrical chamber, and it began to whir and click and thump. Now, Christine needed Evan to please stay asleep. She and Emilie watched the oxygen saturation machine, and after ten, fifteen, twenty minutes, they began to relax. It was going well. Evan would be fine. When the scan was almost done Evan stirred ever so briefly. Emilie walked down to radiology, and watched as the radiologist read the scan. Everything looked normal. One area didn’t come through because of Evan’s brief movement. But the part of the brain the radiologist was concerned about was normal. Emilie asked the radiologist, “If this were your son, would you re-do the test?” The radiologist said no.
A week passed. Then another. Christine made herself limit the times she could count Evan’s breathing in a morning or afternoon. She rationed her counting. She counted his breathing at regular intervals so that she wouldn’t count obsessively. Once an hour, no more. She remembers one time—and there are tears in her eyes as she’s telling me this more than six years later—when Christine thought to herself, “Oh my God! He’s breathing sixty and he’s wide awake!”
In the first story, Oliver is twelve days old and we are in the office of our general pediatrician. It has been a long day, and we have not slept in more than twenty-four hours. We’ve driven here straight from Seattle Children’s Hospital, on the recommendation of the doctors who had seen Oliver there. Our pediatrician came to us highly recommended from friends. She was not warm and fuzzy; we had acknowledged this to ourselves. She was tough, we said. Just because she was a woman didn’t mean she had to be all lovey and maternal.
It was past five in the afternoon, and our no-nonsense pediatrician was examining Oliver, his breathing slower now, in the nineties. She turned her head, her hand still resting on Oliver’s tiny chest. She looked Christine in the eyes. “You want to know why he’s breathing fast?” She paused, frowning. “I’ll tell you why. Because his mom’s a nurse.”
Our pediatrician said this on the very same day that Oliver received an echocardiogram, after urgent consults with every relevant specialist, after the full work-up at a world class Children’s Hospital. We did not demand this treatment. We just showed up. It was that same day. Our pediatrician concluded by saying, “You want him to stop breathing so fast? Stop counting.”
And so, unfortunately, I need to wrap up this epilogue to the first story with some uncharitable words, in the form of a direct address, to that She-Who-Should-Not-Be-Named pediatrician: Fuck all the way off. There. I feel better.
Near the end of the second story, Christine is in a room at the pediatric clinic with ten-week-old Evan, and Ben says, “Sixty is kind of high, but not too high. What’s the highest count in the last week?”
“Eighty,” Christine says. “And only that high once or twice.”
“So it’s pretty much normal, otherwise?”
“We’re moving in that direction, anyway,” Ben says. “Right?”
“I think so,” Christine says. “Yes.”
Christine’s greatest fear was that she would not have this baby very long. That she would never get to know him. She was never carefree. She was gone for those five or six weeks of worry. She only saw the problem. She didn’t enjoy Evan, not nearly enough. She remembers.
Now, rarely, she cannot help herself and a future crosses her mind like a shadow. Evan dies in his sleep as a young man and it’s said that, well, there was that breathing problem when he was a baby. She shudders. She shakes the thought loose from her imagination. But pretty much, she doesn’t think about it. Evan is six. He loves grapes. An award certificate from his first grade teacher for Being kind to others! is taped to the wall beside his bed. When he’s upset, he hugs his ugly doll. He takes a deep breath and counts to ten slowly.
Evan would get panicky and slap and scratch at Christine’s breasts, his open mouth groping, frantic, banging around. He couldn’t stay latched on and get enough air at the same time. He was really, really mad. He never once had a fever. You could never even say he was sick.