Mercy (4 page)

If smoking were not the single cause of Tommy’s health issues, it was certainly the star of the show. At one time Tommy could catch the eye of most any girl, including his beloved Gladys. He had been tall and fit, with a stomach flat as an ironing board, and blessed with a thick head of dark hair. A three-sport athlete in high school, Tommy could swim like a fish and still smoke like a chimney.

Over the years, Tommy’s dark hair turned gray and eventually fell out. His gut expanded as his lung capacity shrank, and a flabby chin overtook a jawline that once turned many heads. The two-pack-a-day habit that took away Tommy’s good looks had started back when Brownsville Station made smokin’ in the boys’ room sound like a cool thing to do. The habit continued until his college-bound son extracted a promise to quit that came too late.

He had gone almost a decade without a cigarette before the first signs of COPD appeared. The seeds of the disease, however, had been planted long ago, and could not have cared less when Tommy last had a puff.

These days, Tommy’s son was married, and there were grandchildren in the picture who lived a few hours away. They might as well have nested on top of Mount Everest. Tommy was too sick to travel even short distances. Being out of breath was a terrifying sensation, and one Tommy did everything in his power to avoid—well, everything but follow his doctors’ orders to the letter.

When he was not at the hospital, Tommy was either in rehab waiting for too few nurses to help him from his bed to his chair or the bathroom, or he was homebound and tied to a ratty recliner positioned strategically in front of the TV.

Tommy, who had hypertension to go along with COPD, had been watching TV (as usual) when he experienced the familiar sensation of shortness of breath. One second he was enjoying a Sox game and the next he felt like someone had dumped a pile of bricks on top of his chest. He fought to get sips of air into his battered lungs. He coughed and wheezed and managed to squeak out a single panicky sentence directed at Gladys: “I can’t breathe.”

Gladys, accustomed to the drill by now, encouraged Tommy. “Pursed-lip breaths now, in and out. Remember, blow out the candle. I’ll grab your hospital bag and get the car ready.”

Gladys drove Tommy to the ER, following a route seared into her memory. In the car he coughed up a thick, viscous ball of mucus. Trouble. His breathing grew shallower, and Tommy knew that carbon dioxide was building up in his blood, making it hard for him to stay awake.

Once in the ER, it was an all-too-familiar scene. A respiratory therapist and an ER nurse (Tommy knew them both by name) stood at his bedside, talking to themselves and to the doctor, dressed in a white lab coat (Tommy knew him by name as well).

“Mr. Grasso, I’m sorry you’re back so soon,” the respiratory therapist said. Her name was Lynn and her sympathy came across as genuine. “We’ll do what we can to make you feel better. Jill, can you listen to his breath sounds? Dr. Chan, Mr. Grasso is currently eighty-two percent on a four liters nasal cannula. I’d like to get him on the BiPAP.”

“I agree,” Dr. Chan said.

“How are those breath sounds?” Lynn asked.

The other nurse, Jill, was pretty and always sweet to Tommy, but he wished he did not have to see her again so soon, if ever. “Prolonged expiratory time and lots of wheezing,” Jill answered.

“Respiratory rate is forty. He’s barely moving air,” Lynn said.

“Start a continuous nebulized albuterol,” Dr. Chan said. “Go with fifteen milligrams, please.”

To Tommy, the exchanges between the doctor and nurses were lines of a play he could recite before they were even spoken.

She’s going to tell me about the mask,
he thought.

“Mr. Grasso, I’m going to put a mask on, it will let you breathe a little easier. It will feel tight at first, but it will help assist your breaths.”

Tommy wanted to laugh, but beneath the oxygen mask, he felt his own respirations diminish.

“Mr. Grasso, how are you feeling, sir?”

“Hard … to … breathe…”

And stay awake,
he wanted to add, but lacked strength in his mind and lungs. The only thing Tommy could focus on was his need for more air.

Tommy’s acute exacerbation of COPD could have been caused by an infection, some sort of bacteria, but most likely it was mismanagement of his medication again. He had so many pills and inhalers to keep track of, and a slew of complex instructions to follow.

“If these stats don’t come up, we’re going to have to tube him. Call the ICU and give them a heads-up.”

If Tommy had seen that his oxygen saturation was down to eighty-one percent, he would have known that ventilation was inevitable.

“Did we get an ABG measurement yet?”

The arterial blood gas test measured acidity and levels of oxygen and carbon dioxide in the blood. Tommy guessed his number was 7.2, maybe as low as 7.16. Either way, he was most likely experiencing respiratory acidosis, a condition resulting from lungs that were incapable of removing all the carbon dioxide the body produced.

“Seven point one two,” Jill said.

Her voice sounded far away … so far from here. Tommy’s eyes began to shut. He was tired, tired of everything. What he would not give for a good set of lungs, for a decent breath of air again.

Dr. Chan said, “Draw up the succs.”

Succinylcholine, Tommy knew the drug well. It was used for intubation.

*   *   *

WHEN TOMMY’S
eyes fluttered open, he had a tube shoved down his throat and a machine to do all the breathing for him. It took a moment to get oriented to the fact that he was back in the ICU. Tommy had no idea if it were day or night. His cubicle had no windows; no other patients either.

There was, however, a visitor in his room. The room lights were off, and Tommy could not make out a face, and he couldn’t ask for a name because of the tube shoved down his throat. His vision was badly blurred both from sleep and the sedatives he’d been given. His mouth felt like he had swallowed sand, it was so dry and gritty, and he had no way to alleviate that sensation.

“Hi there, Tommy.”

The voice sounded soft and gentle, but somewhat distorted, with a bit of a delay, as though it had bubbled up from a deep well. It was like the voice in a dream. Tommy wondered if the sedatives also distorted his hearing. Or maybe it was just hard to hear over those awful mechanized breathing sounds.

“You’re up again, I see.”

I’ve been up before? When?
Tommy could think those thoughts, but could not voice them.

He liked having company, any company, but what Tommy really wanted was Gladys. He figured it was at least the afternoon, because Gladys always spent her mornings with him in the ICU.

“You keep coming back here, Tommy. It must be awful. You really
should
learn how to manage your meds. Maybe try to eat a little better, or, God forbid, take a walk. It certainly would help keep you out of the hospital.”

Tommy picked up something unsettling, as if he were being taunted, or maybe scolded. Either way, he wished he could speak, have a conversation. Then he would know for sure.

A phone rang. The visitor answered. “Hello. Yes, I did call … it’s Mr. Tommy Grasso. He’s back … yes, again, in the ICU of all places … what do you think? COPD, of course … yes, he has tested positive.… I think we did it the last time he was here … Oh, I absolutely think we should give him the treatment … I can do it so that there’ll be a little delay before it takes effect. Just enough so I’ll be long gone … well, if anybody deserves the treatment, it’s Tommy … it’s best for him and that’s my role here, that’s what I care most about … Good, I’m glad we’re in agreement.”

The visitor put the phone away and came to Tommy’s bedside.

“I’ve got great news.” The visitor sounded calm, the way his doctors spoke, but somehow Tommy felt uneasy for reasons he could not comprehend. “You’re going to get the treatment. Do you know what that means?”

I don’t think I want to know,
Tommy wished he could say.

“It’s the ultimate cure, Tommy,” the visitor continued. “Once you get it, you’ll never have to come back here again. Think about it. No more hospital visits. Not ever. You’ll be cured for good.”

Tommy’s skin prickled. He did not know what this treatment was, but it was something he did not want to have. Helpless on his back, eyes wide with terror, unable to speak, Tommy could barely make out a bag of clear fluid in the visitor’s hand.

“The treatment won’t take long, but I can’t promise it won’t hurt. If you could talk, you’d thank me. Nobody wants to live in a hospital, Tommy. It just isn’t right. Someone needs to show you a little mercy.”

The visitor undid one of Tommy’s IVs and hooked the catheter line into the bag of fluid, then titrated the flow.

The last words Tommy heard were, “I am merciful.”

CHAPTER 6

Sam Talbot lived on the kind of wide, tree-lined street where Julie had once imagined she would raise her family. The houses here were spacious, but not too grand. Her ex-husband, Paul, had railed against the trappings of suburban life, so they’d ended up buying a condo in Cambridge. And Julie, to her surprise, fell in love with urban living. The conveniences were hard to beat. Once the excitement of her engagement to Sam had worn off, Julie made clear her concerns regarding living arrangements. She was a full-fledged city mouse, and Sam was of the country variety.

“We’ll work it out,” Sam had assured her.

That was almost a year ago. They had yet to reach any decision. Now the wedding was fast approaching—six months and counting down—and some sort of resolution was in order.

“He’ll be fine here,” Sam said, speaking of Trevor.

“Well, I know he’ll adjust,” Julie replied. “But how long will it take? How well can he manage?”

They were working side by side in Sam’s two-car garage. Julie had an underground parking space, but no storage, and a real garage was one of many amenities suburban living had to offer. Julie attended to her motorcycle and Sam to his in preparation for the day’s long ride.

“He’ll make new friends,” Sam said. “How many middle school chums are you still close with?”

“Plenty,” Julie answered. Julie did not make eye contact with Sam. She was too busy going through her pre-ride checklist, which she approached with the same fastidiousness she brought to a bedside exam.

Sam was less diligent, in part because he was far more experienced. He rode a BMW K1600, which had an engine roughly seven times the cubic capacity of Julie’s bike. Julie’s ride was plenty powerful and she had confidence in her ability to control her bike, thanks to fifteen hours of instruction from Training Wheels, a premier motorcycle riding school. It was the other motorists she worried about.

“Who are you still close with from middle school?” Sam asked.

Her focus still on her bike, Julie answered, “Sandy, Claire, and Eileen.” She rattled those names off the top of her head, but she could have mentioned others as well.

“You talk to them only on Facebook,” Sam said with a grin.

“They’re still my friends, and isn’t Facebook how
we
reconnected?” Julie strode over to Sam, giving her hips an extra playful swagger. She wrapped her arms around his neck. He was taller than Julie by five inches, but she did not mind stretching to meet his lips. His close-cropped beard, sandy-colored like his thick, wavy hair, tickled her face and she enjoyed the sensation. She threw herself into the kiss, making it clear that wherever she and Trevor lived, Sam would be in her life forever.

“Maybe I’ll keep my condo for a while, you keep your house, and we’ll see each other when Trevor is with Paul.”

Sam frowned. “We sound like we’re already divorced.”

“I just don’t know if I can move him now, sweetheart. He’s acting out at school and at home. The whole notion is daunting.”

Sam fell silent, not brooding, but thinking. “What if I sold my house and we bought a new place together in Cambridge?”

Julie was stunned. “You would do that for us?”

“That way Trevor could go to the same school, and we could be together as a family.”

“Why not just move into my place, then? There’s more than enough room for the three of us.”

“That’s your place with Paul,” Sam said. “I want something that’s just about us. A place where we can make memories from scratch.”

“And you can make new cabinets,” Julie said, smiling.

Mostly self-taught, Sam had painstakingly stripped his house down to the studs and rebuilt it using secondhand tools and limitless ingenuity. It was a true labor of love. From decorative moldings with intricate carvings to the kitchen cabinetry and furniture, Sam was an artist with wood.

“But you hate the city,” Julie said. “And now you’ll have a commute.”

“I’d hate living apart from you even more. Trevor’s not the only one who can adjust.”

Julie purred and pressed her body against him, running her hands along his backside in a playful, teasing way. Sam’s hazel eyes flickered with excitement.

“How about after this ride I help lube your throttle cable?” Julie whispered in his ear.

Sam laughed and kissed Julie with passion. “I love it when you talk motorcycle to me.”

Julie pulled away and her expression became more serious. “We’ll figure it out, okay? I love you and I’m excited to spend the rest of my life showing you how much.”

Their lips met again.

“Thank goodness for Facebook,” Sam breathed in Julie’s ear.

Back in high school, Sam Talbot had hovered near Julie’s close circle of friends, but they remained acquaintances and nothing more. Occasionally they would bump into each other at a party or some school happening, but Sam was a band and drama club kid. Julie was more of a jock, and for the most part, those groups didn’t interact.

But then came life, and later Facebook, and suddenly Julie’s friend list was replete with people from her past whose names she could barely recall, including Sam Talbot’s.

When Sam posted about his divorce, a year after Julie’s had been finalized, she worked up the nerve to send him a message. It was the tone of his post that had her so intrigued. She could still recall some of that text verbatim.