Chapter 4
Mom didn't turn on the radio when we drove to the ER. She kept one hand on the wheel and one on my knee, and the inhaler sat in the cup holder between us where I could see it. I didn't touch it. I just watched it while I breathed. The rescue puff Officer Daniels made me take on the couch had helped, but my chest still felt tight, like a rubber band around my ribs that hadn't snapped back yet.
"You're doing good," she said at every red light. "Just keep breathing like that. Slow. We're almost there."
I remembered she'd said the same thing on the living room floor, her hand flat over my hands on my chest. I nodded but I didn't answer because talking still made the wheeze come back. Outside the window, the light had gone flat, that kind of late afternoon where everything looks gray even though it was warm in the house.
The ER smelled like cold air and cleaner. The automatic doors hissed open and Mom pushed me in a wheelchair even though I told her I could walk. The nurse at the desk looked up and saw my face and stood up right away.
"How old are you, sweetheart?" she asked me, not Mom.
"Eight," I said. My voice sounded small.
She wheeled me straight back past the waiting room chairs to a hallway with curtains instead of walls. She had a little clip she put on my finger. It glowed red.
"Ninety-three percent," she said to Mom, frowning. "After the rescue inhaler, that should be higher. How long was she without it?"
Mom swallowed. "I don't know exactly. My mother-in-law put it upstairs. My daughter asked and she said to wait."
The nurse didn't say anything right away. She just wrote it down. She lifted my shirt a little and listened to my back with her stethoscope and told me to breathe big. I tried. It whistled.
"Cyanosis around the lips," she said quietly to the chart, then to me, "Your lips were blue at home, honey?"
I nodded. "Mom said they turned purple."
She tucked the blanket around my legs and said the doctor would be right in. Mom stood beside the bed and held my hand. Her thumb kept rubbing the same spot on my knuckles. I could hear the monitor beeping, not fast, but steady, marking every breath I took.
The doctor came in with a rolling stool and sat down so his eyes were level with mine. He was young, with glasses, and he had my inhaler in his hand. The clear box was with it.
"I'm Dr. Patel," he said. "This yours, Maya?"
"Yes," I said.
He turned it over, checked the date, checked how many puffs were left. "This is albuterol. Rescue medicine. This isn't the kind you take every day. This is the kind you take when you can't breathe. You know how that works?"
I nodded. "Two puffs. Shake it. Wait."
"Good. That's right." He looked at Mom. "Do you have an asthma action plan at home? Paper from her pediatrician, green yellow red zones?"
Mom's face got pink. "No. We had verbal instructions. We never got a written plan."
Dr. Patel nodded and wrote that down too. He listened to my chest again, front and back, and pressed gently on my ribs.
"She's still wheezing heavily in both fields," he said to the nurse. "Prolonged expiratory phase. Retractions are better than before but still present." Then he looked at me. "Maya, can you tell me what happened today? In your own words."
I took a little breath first. "I asked for my pump. Grandma Diane said I was disrespectful earlier. She said she put it away and I could have it after I learned respect. I couldn't breathe and Mom asked where it was and she said that."
Mom made a small sound. I didn't look at her. I just watched Dr. Patel's pen moving.
He didn't look shocked. He just kept writing and then he asked Mom, very calm, "Where was the inhaler kept normally?"
"In her backpack for school. And on the kitchen counter at home," Mom said. "My mother-in-law moved it to her bedroom closet upstairs. In the box."
"And Maya was downstairs on the floor when she couldn't breathe," he said. It wasn't a question. He wrote it exactly like that. Withheld rescue inhaler in upstairs closet during severe attack. Delayed care. Cyanosis observed by mother.
Mom nodded. "The police are still at the house with my mother-in-law. They told us to come here."
Dr. Patel capped his pen. "I'm glad you did. Asthma kills kids when the rescue isn't within reach. You did the right thing bringing her in immediately after she got the puff. But that delay matters. We have to document it."
The nurse brought in a printout and a plastic spacer, and Dr. Patel showed Mom how to use it properly, how to count breaths, how to watch my lips and ribs. He gave her a sheet with colors on it, green at the top, yellow in the middle, red at the bottom. He circled things.
"This is her action plan now," he said, and he put it on the bed where I could see it. "Green means go, yellow means caution, two puffs with spacer. Red means emergency, call 911, keep giving puffs. And listen, this part is important for both of you. This inhaler stays with her. Not in a closet. Not on a high shelf. With her. In her backpack, on her nightstand, where she can reach it without asking permission. Do you understand why I'm writing that as a medical instruction?"
Mom nodded fast. "Yes. It will stay with her."
"It has to," he said. "I'm also going to note in her record that access was denied as discipline. That language triggers a report. I am a mandatory reporter, Lauren. That means I'm required to send this chart to her pediatrician and to child protective services. It's not to punish you. It's to make sure she has what she needs to breathe at home."
Mom's hand tightened around mine. "I understand."
He signed the papers and handed Mom the copies. Discharge instructions. Asthma action plan. Prescription for a second rescue inhaler for school. And under instructions, in capital letters, he had written: RESCUE INHALER MUST REMAIN WITH CHILD AT ALL TIMES - DO NOT WITHHOLD.
I read it twice. The letters were thick and black.
When he left, the nurse brought me apple juice. My oxygen clip now said ninety-six. I breathed and it didn't whistle as loud. Mom folded the action plan carefully and put it in her purse next to my inhaler, not under it, not hidden. She zipped it where I could see the zipper.
May you like
"You good to sit up?" she asked.
I sat up. My chest still ached, but the band had loosened. Mom helped me into the wheelchair and kept her hand on my shoulder the whole way down the hallway, past the beeping rooms, toward the doors that hissed open again.
