Chapter 6
The breathing changed at 4:17.
I'd been counting the bottle. I'd been listening to the clock. I didn't hear it at first over the hum of the window unit, but then the rhythm broke. A wet rattle caught, then stopped. The chest under the dark blanket rose too fast and not enough.
I was at the nightstand, notebook closed. The glass of water hadn't moved. The cat was gone. I stood and my chair scraped the parquet and the guard looked up from his spot by the wall.
"He's working harder," I said. I didn't wait for permission.
I reached for the stethoscope around my neck. The metal was cool from hanging against my uniform. I warmed the diaphragm for a second in my palm out of habit, the way I'd been taught. My hands weren't shaking anymore.
The guard took a step forward, then stopped. "You need something?"
"Space," I said. "And the head of the bed up."
He didn't move to help. He didn't move to stop me either. He clasped his hands again and stepped back half a foot, giving me the rail. That was the most room he'd given me in two days.
I pressed the button on the side of the hospital bed. The motor whirred, too loud in that bright room with the gold-frame painting watching. I brought the head up to about thirty degrees, slow. The patient's eyes were half open, unfocused, lips dry. The blanket had slipped and I could see his hospital gown, the collar damp with sweat.
"Hey there," I said quietly. "I'm going to listen to your chest, okay? Just breathe with me if you can."
No answer, just that shallow, fast breathing. I slipped the stethoscope earpieces in. The world narrowed to that sound.
I placed the diaphragm on his back first, reaching under his shoulder. I had to lean over the rail, my brown bag shifting against my hip. Upper right, then left. The breath sounds were tight, wheezy on the right, diminished at the base. Crackles low and fine, like cellophane. Not clear. Not good. I moved to the front, just above the uniform piping on my own collar, trying to keep my hair from falling forward. Left side, then right side. Same thing. Air was moving, but it was working too hard to get there.
I counted his rate against the second hand on my watch. Twenty-eight. Too fast. Pulse ox on the nightstand read 89 and dipped to 88 when he tried to cough and couldn't.
I pulled the earpieces out and let the stethoscope rest again around my neck. My neck felt lighter with it there, like I remembered who I was supposed to be.
"He's retaining," I said, more to myself than to the guard. I lifted the blanket just enough to see his ankles. Pitting edema, left worse than right. Two plus. His hands were cool. I pressed his nail bed and watched the color come back slow.
The guard was watching my hands. "Is that bad?"
"It's his lungs," I said. I kept my voice low and even. "Fluid. He's tiring out. I need him sitting up higher and I need to keep his airway clear."
I didn't ask. I cranked the bed another ten degrees. I rolled a spare pillow that had been left on the white chair and tucked it behind his back so he wasn't slumped to one side. I turned his head slightly, checked his mouth was clear. No vomit, just dry tongue. I reached for the clear glass of water on the nightstand, wet my gloved fingertip, and touched it to his lips. He reacted, just a flicker.
"Can you swallow?" I asked him. His eyes found mine for a second. Really found them. He gave a tiny nod.
"Small sips only," I told him. I tipped the glass barely, just enough to wet his mouth. He swallowed, coughed, then breathed. That next breath was a little deeper than the one before.
I put the glass back. I put my hand flat on his chest, not listening through anything, just feeling. The rise was still fast but it wasn't jerking anymore. I counted again. Twenty-four. Pulse ox climbed to 91, then held at 92.
"There you go," I whispered. "That's better. Stay with that."
For a full minute I just stood there with my hand on the rail, watching the monitor and watching him. The daylight from the large window on the right cut across the parquet and made a bright rectangle on his white sheet. The room was quiet except for the bed motor cooling and his breathing evening out.
The guard hadn't moved closer. He was still by the wall, hands clasped, sunglasses reflecting the window.
"You knew what that sound was," he said. It wasn't a question, but it wasn't an accusation either.
"I've heard it before," I said. I adjusted the stethoscope around my neck again, straightening it. "Left base crackles. Early failure signs. You catch it early, you buy time."
He nodded once. Short.
The patient’s hand moved under the blanket, just his fingers. I slid my hand to the edge of the bed rail, close enough he could reach if he wanted. He didn't, but his breathing stayed at that new, better rhythm. 92 on the monitor. 93.
I looked at the small amber bottle where I'd left it near the rail. I didn't touch it. I didn't need to. Right then the job wasn't the bottle or the notebook. It was the man in the bed and the air going in and out of him.
I felt steady for the first time since I'd walked into that suite. My grandmother's voice wasn't in my head. The money wasn't in my head. Just the count, the sound, the angle of the bed, the next breath coming easier than the last.
"He's stable for now," I said, finally. I made sure the guard heard the 'for now.'
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The guard's shoulders dropped a fraction. "Good work."
It was the first time he'd said anything that sounded like it was to me, not past me.
