Living and Dying in Brick City (23 page)

Mark’s story moved and humbled me. I knew the frustration of feeling trapped by your circumstances. But I’d also seen firsthand that the seemingly impossible can become possible with determination and hard work. Talking to Mark that day helped me realize more than ever that my success was not just about me. I was living the dream of so many others who had found their own dreams smacked down by life: the black cooks, orderlies, and janitors who joked with me in the halls; the elderly men and women in the community who went out of their way to wish me well; and even the tough guys who locked me into their gaze as they lay dying.

Mark finished his cigarette, stamped out the butt, and then reached into his pocket. I was stunned by what he pulled out: an albuterol inhaler. Until that moment, I had no idea he had asthma. He quickly took two puffs from the small pump and returned it to his pocket.

“Now, you know better, Mark. Asthma and smoking—come on, man,” I said in my best cool doctor approach. I wanted him to know that I didn’t approve, but I also didn’t want to alienate him by being too preachy.

“I know, Doc, I know,” Mark said. “I shouldn’t be smoking.”

We made our way back into the hospital and headed our separate ways. Every time I saw him after that, we chatted about sports, music, the news of the day, or his eleven-year-old daughter, Trina. Soon after I met him, I was passing through the cafeteria and saw a cute little girl sitting behind the cash register, and Mark introduced me to her. Trina had the same rich brown complexion as her dad, a dimpled smile, and hair that flowed over her shoulders in small, neat braids with colorful rubber bands on the tips. I soon discovered that she came to the hospital nearly every day after school and sat at the register with an air of pride and confidence. No one could tell her that the small cafeteria wasn’t her daddy’s place. While waiting for him to get off work and take her home, she dutifully did her homework. She beamed in his presence and glanced at him for approval when she spoke.

A couple of times, I ran into Mark in the emergency department, where he’d come to get a breathing treatment when his asthma got out of control. About a quarter of all people who visit the emergency rooms throughout the country are there due to symptoms related to asthma. The number of those who suffer from it—an estimated 20 million Americans (one in fifteen people)—has been growing steadily across all racial and ethnic groups since the early 1980s. But the condition is slightly more prevalent and much more severe among African Americans, who are three times more likely to be hospitalized because of it. That seemed evident to me early in my tenure at Beth by the large number of black patients filling the recliners lined against a wall, there exclusively for those receiving nebulizer breathing treatments. The nebulizer converts liquid medication into a mist that can be easily inhaled through a mask and quickly absorbed by the lungs to open constricted airways.

“Doc, when you are having an asthma attack, it really is like breathing through a straw,” Mark once explained during a brief chat. “Can you imagine that? You are exhausted, using all your
muscles and energy just to get a small amount of air. Feels like you’re being buried alive.”

Mark had been diagnosed with asthma as a child and had been hospitalized for it several times through the years, but he’d learned to accept and manage his condition, he told me. He knew the triggers: some pets, carpets, heat, certain medicines, exercise, and, especially, smoke. But he just figured that with his inhaler, he was in control. Still, I reminded him every chance I got: “You know, cigarettes aren’t helping the matter.”

As usual, he would promise to quit: “Next year, Doc. I promise.”

The last time I asked if he’d quit smoking he told me he was down to eight cigarettes a day. “That’s better than the two packs a day I used to smoke,” he added.

Mark was flirting with death, though I’m sure he didn’t see it that way. But one in five deaths each year is attributed to cigarette smoking. More people die from smoking than from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicide, and murders combined.

For an asthmatic, smoking causes irritation of the airways, greatly enhancing the chances of an attack, and African American asthma patients are three times more likely than their white counterparts to die during an attack. Most of these deaths could be avoided, though, with proper treatment and preventative measures.

The same is true with many other medical conditions, yet every day I treat patients who keep smoking despite a diagnosis of asthma or emphysema, or keep eating high-fat or salt- and sugar-laden foods despite their diabetes, hypertension, or heart condition or the threat of developing them. And even after diagnosis, they are inconsistent with their medications, either neglecting to take them as prescribed or skipping them altogether. These destructive
patterns seem more acute in poor urban communities, where people frequently use cigarettes, drugs, and food to cope with stress and the miserable circumstances that often come with poverty. And the truth is perhaps easy to ignore for long periods of time because the human body is resilient and can withstand much abuse—until it can’t.

The day an ambulance carried him to Beth Israel, Mark had hopped into Shawn’s car for a quick trip across town to visit another friend. Sometimes, when I think of Mark and what happened that day, I imagine him flashing that easy, ever-present smile, showing every one of his flawless teeth, low-riding on the passenger side of Shawn’s Mazda RX-7. I can see the two friends, bouncing to the rap beat thumping from the stereo as the car rolled through the streets of Newark. I can almost feel the hot, humid air rushing through the open window, causing Mark’s shoulder-length dreads to flap in the wind. I can smell the cigarette burning between his mahogany fingers.

If only Mark could have that moment back …

He was wheezing when he sat straight up in the car and began fishing furiously through his pants pockets. He pulled out his albuterol inhaler, wrapped his lips around the mouthpiece, and squeezed the pump with his fingers. A tiny bit of mist came out. He squeezed again, and again. The canister was empty.

Hearing his friend’s wheezing grow louder, Shawn panicked and sped through the light. I can only guess that he figured paramedics could get to them faster than he could drive to the hospital, and so he raced the one block to their friend John’s house, and within seconds was whipping the car into the driveway. As soon as the car stopped, Mark hopped out and began jumping up and down and slapping his chest, as if to force the air into his lungs. Shawn punched 911 into his cell phone, honked repeatedly, and jumped out of the car just as Mark collapsed onto the pavement. It
all happened so quickly. John and his parents rushed outside and became hysterical, then ran back inside to grab the telephone to call Mark’s family. Neighbors and passersby gathered and watched helplessly. Paramedics arrived within minutes and quickly loaded Mark into the ambulance.

At the hospital, Shawn seemed in shock, recounting every detail of the story, as if to convince himself he’d done all he could do to save his boy. But guilt was eating away at him. “I shouldn’t have given him that cigarette,” he said, blaming himself.

Mark had asked for the cigarette, and he’d promised Shawn—just as he’d promised me many times—that he was going to quit smoking. I was angry at myself for not pushing Mark harder to stop, and I was angry at him for gambling with his life every time he took a puff. This time, he’d lost it all. There would be no miracle. At just twenty-nine years old, Mark was dead. He had died before he made it to the hospital, and my medical team could not bring him back.

Shortly after I made the official pronouncement, Mark’s girlfriend and daughter joined other family members in a small private room at the hospital. They were all in shock, hugging and consoling one another. I introduced myself to them and expressed my condolences. Trina recognized me from the times I’d joked with her in the cafeteria. Her mother was weeping when she led the child over to me and asked me to tell her—she couldn’t do it. I’d broken bad news to families many times before, but never like this. I knew this little girl. I knew how much she adored her father and how hard he had worked to make life better for her. I started there.

“Your daddy loved you so much,” I said, handing Trina an apple juice. “You remember how he sometimes had asthma attacks and couldn’t catch his breath? Well, this time, he had a really bad one. We did everything we could to save him, but I’m sorry to say that we couldn’t.”

Trina certainly must have known something was seriously wrong from the grieving all around her, but she didn’t want to hear it. “Stop saying that, Dr. Davis,” she replied. “My daddy is downstairs.”

She knew better. She didn’t take her eyes off me, and the seriousness of my face confirmed what she didn’t want to believe. She suddenly began to sob.

A few days later, I attended Mark’s wake. Perry’s Funeral Home in Newark was packed with flowers and mourners, including many familiar faces from Beth Israel. I sat in the back, full of sadness, looking at a large portrait of Mark sitting on an easel next to his oak coffin. The image in that picture was the one I would carry in my memory: Mark in his oversized white T-shirt, long dreads, and that wide, perfect smile.

My caffeine runs at the hospital were never quite the same after that. I missed my friend, and every time I walked into his old spot, I couldn’t help thinking: another young brother, gone too soon.