The Air We Breathe

Men are like plants; the goodness and flavour of the fruit proceeds from the peculiar soil and exposition in which they grow. We are nothing but what we derive from the air we breathe, the climate we inhabit, the government we obey, the system of religion we profess, and the nature of our employment. Here you will find but few crimes; these have acquired as yet no root among us.

—J. Hector St. John de Crèvecœur,
Letters from an American Farmer, Letter III, “What Is an American?” (1782)

In the first place, tuberculosis is largely a disease of the poor—of those on or below the poverty line. We must further realize that there are two sorts of poor people—not only those financially handicapped and so unable to control their environment, but those who are mentally and morally poor, and lack intelligence, will power, and self-control. The poor, from whatever cause, form a class whose environment is difficult to alter. And we must further realize that these patients are surrounded in their homes by people of their own kind—their families and friends—who are also poor. It is this fact which makes the task so difficult, and makes the prevention and cure of a preventable and curable disease a matter of utmost complexity.

—Ellen N. LaMotte,
The Tuberculosis Nurse: Her Functions and Qualifications (1915)

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 10

Chapter 11

Chapter 12

Chapter 13

Chapter 14

Chapter 15

Chapter 16

Chapter 17

Chapter 18

Chapter 19

Chapter 20

Chapter 21

Chapter 22

Chapter 23

Chapter 24

AUTHOR'S NOTE

I
MAGINE A HILL
shaped like a dog's head, its nose pointed south and resting on crossed front paws. The main buildings of Tamarack State Sanatorium for the Treatment of Tuberculosis, including the two long brick wings where we used to cure, are set where the eyes would be. There's a siding at the base of the hill—four posts, a metal roof, space for a cart and the portable steps—where the train makes a special stop and where, on arrival day, we'd each looked up to see the sanatorium windows staring back at us. We all remember looking down for the first time, after getting settled in one of those wings, to see the new arrivals sagging down the steps or being passed on stretchers through the windows of the train.

Back then we lay on our porches in orderly rows, the two chairs assigned to each room still separated by shoulder-high panels and sheltered by canvas awnings. Fields surrounded us—they still do—and also a river, three ponds, and the road curving down toward the village. After the cities from which we'd come, this looked to us like wilderness. Rivers, mountains, wild geese honking. The air meant to cure us pouring antiseptically through the woods. The Adirondacks were new to us, and we were shocked to learn that Canada was so near. The snow shocked us too, along with the dark winter days and the heavy mist that sometimes blanketed the fields. A fox, hunting, would brush his tail through the surface, leaving a track we followed with our eyes. Ducks escaping the fox would burst into the air as if they'd been shot. The sight made us think that our own lives, hidden similarly, might still be launched on their proper paths.

We weren't a big group even then—sixty women and sixty men, if every spot was taken—and a single arrival shifted scores of relationships, as did a single discharge, or a death. On the porches we gossiped as eagerly as we drew breath. Twice each week, if the mist didn't block our view, the train pulled up to our unmarked siding and we inspected who might join us next.

IN LATE JULY OF 1916,
the train from New York City brought us Leo Marburg. Tall, thin, with black hair worn too long and big hands with spatulate fingertips, he paused on the boarding steps until a porter passed him like a sack of wheat to the driver of our cart. The driver, without asking, draped Leo over the pallet in the back. Leo forced himself back up.

“I'm not that sick,” he said. Up on the hill, our windows blinked at him. “Let me sit beside you.”

He eased himself down and around until, with the driver's grudging help, he was on the bench and looking out over the horses. The cart climbed from the siding and up the track, the buildings dotting the lower slope wavering slightly in the suffocating haze. Staff cottages, laundry, incinerator, power plant; he recognized only the stables, the others he'd learn later. The mountains were cool, he'd been told in the city, the air crisp and restorative. So what was this steamy batting wrapped around him?

Inside the door of our central building, Leo found it hotter still. The linoleum floor felt sticky; the hands of the nurse to whom the driver delivered him were hot and moist, and she treated him, Leo thought, like a bag of raw sugar being taken off a ship. Plop into a wheelchair, plop went his carpetbag into his lap; plop on top of the carpetbag went a pamphlet bound in olive paper:
Rule Book,
this said helpfully.

“Read it,” said the nurse.

Before he had time to glimpse more than a few of what seemed like hundreds of rules, she pointed out his Patient Number, inscribed in white ink on the booklet's cover, and then a page where he was meant to sign his name. Above it was a statement saying he'd read the rules and agreed to abide by them.
I understand that I am occupying a bed badly needed for someone else, that I am fortunate to be here, and that only by obeying the rules conscientiously can I show my value to the community.

“Sign,” she said. We'd all been through this, and all, like Leo, had felt uniquely prosecuted.

She pushed a pen at him, prodded his hand, said “Good” when his hand obeyed her request, and then rolled him briskly down the corridor and into the lift that rose to the infirmary. What had he signed? As if to make up for his slowness, she recited rules as they whisked along. No talking, during his initial period of total bedrest. No smoking, no laughing, no singing, no reading, no writing. Do not get out of bed for
any
reason, bathroom privileges come later. Do not think gloomy thoughts. Eat what's put in front of you. Rest. Think only of resting.

How was this better than Brooklyn? When the lift opened he saw metal beds, in which lay long lumps not talking, not moving, not singing. Then he was inside a bathroom with a dark red floor. Toilets to one side, washbasins on the other. An adjoining room held a huge white tub, in which the nurse proceeded to boil him. That he'd had a bath before getting on the train meant nothing to her:
All
new patients must be bathed on admission, she said firmly. This was a rule. So too was the astonishing temperature of the water, the disinfectant she poured in a copious stream, the harsh green soap with which she washed his hair. He tried not to wince as she scrubbed at his arms and back. Not to choke as she rested the heel of her hand on his head and gently, but quite firmly, pushed his head under the water.

“Take a breath,” she said, and then he was under, panic rising in him so swiftly that he could see, before it happened, his body bursting from the water, leaping upright, shaking off droplets like a dog. He stood there, naked and breathing heavily.

“That's not going to do us much good,” she said calmly. “I still have to rinse you off. But I can use a pitcher if you'd prefer.”

He squatted back down, squeezing shut his eyes while she poured water over his head. Count, he thought, as the acrid water streamed.
Onetwothreefourfivesixseven
…He had always hated being underwater, but how could she have known that? When she was done she draped him in towels and inspected his bag, first pulling on white cotton gloves. Piece by piece she pincered out and laid on a metal table two pairs of flannel pajamas, a shabby woolen robe, a sweater, pants, a few shirts, underwear, books.

“Why didn't you bring warmer clothes?”

“I packed exactly what the tuberculosis nurse in Brooklyn told me to,” Leo said.

She shook her head and made a note on her clipboard. “We keep telling them—these are
completely
insufficient. Put on those pajamas for now.” While he dressed she bundled up his belongings. “No books, you won't be reading for quite a while. We'll issue you appropriate clothes from the storeroom. The other things we'll fumigate and put away. I need the address of your next of kin, so we know who to contact if that becomes necessary.” She stood with her pencil poised.

“I
have
no family in this country,” he finally said. “Why else would I be here?”

“If you don't appreciate how lucky you are to be given this chance to cure,” she said, “and to be supported by the state while your health improves, there are plenty who'd be glad to change places with you.” How many times have we heard that? “You have
no
family?”

“None,” he said.

She shook her head. “Another one. Where do you all come from?”

If he'd had a place to go, he might have walked away. “I'm grateful to be here,” he said instead. He was twenty-six years old, and the nurse had just touched everything he owned. On a machinist's hand he could count the friends—Vincenzo, from the sugar refinery; Meyer, from the boat—who knew or cared where he was.

She stowed him in an empty ward, the top sheets of the beds around him pulled so taut that the edges hovered above the blankets. All of us, he later learned, started out here, wedged between those cotton sheets in one of the white enameled beds, each separated from its neighbor by a small white cupboard. He learned to eat, propped up very slightly, from a white tray on a wheeled stand that swung over his chest. He learned to use a bedpan, to brush his teeth and wash his face in bed, to cough always into a paper handkerchief and expectorate into a waxed-paper sputum cup, casting cups and handkerchiefs into a paper bag pinned to his stand. He learned that his meals, which came on trays, would almost always be cold but would be garnished by a bit of folded colored paper, a Daily Thought:
Resting is done with the mind as well as the body. Getting well depends on YOU.

On Thursday, his weekly bath day, he squinted with fear when an orderly came, heaved him from his bed onto a stretcher, and rolled the stretcher into the bathroom, but the tub was now off-limits to him; instead he was sponged gingerly and then patted dry, covered with blankets, and inserted back into bed. Food came endlessly, more than he'd seen since childhood. The nurse followed the food cart, taking his temperature and his pulse, and the minute she left—“Coughing can be
controlled,
” she scolded—he hacked and heaved and rattled in ways that he couldn't, before, have imagined. In the early evening a resident doctor made rounds, peering briefly at him and then making notes on his chart. If all went well, the doctor said, and he rested thoroughly and ate everything, he might be allowed in a few weeks to walk once a day to the bathroom, to sit in a chair for fifteen minutes, to read or write for another fifteen.

DURING HIS CONFINEMENT
to the infirmary, weeks spent staring out the window while time clotted like blood in a bowl, Leo thought often about the Lithuanian forest of his earliest summers, dark and leafy and crowded with men who cut down trees and lashed them into rafts they sent hurtling down the river. Because he'd been a Russian citizen, people he met in this country usually thought he was Russian. But in fact his father's people were Baltic Germans and his mother's were Polish, and divided; her parents were converts. When he was small, and his mother was still alive, he'd lived near her parents, in Grodno. Every summer, though, he'd spent six weeks in a forest called Bial
^ł
owiez? a, near the rest of his mother's family, who were Jews. In Grodno he learned to speak as his mother did: Polish to her parents and her parents' friends; Russian to his father, who worked for the government, and his father's friends. His mother's other language, which she spoke in the forest, he lost when she died.

The forest, which he lost as well, remained in his dreams. When his father sold the house and started moving them from village to town to marshy plain, always south until they finally settled in the outskirts of Odessa, Leo retreated in his sleep to the woods where his cousins had taught him to use an ax. His father married a plump Ukrainian with bright yellow hair and narrow eyes, and then he had brothers and sisters who looked like buttercups. He shot up, gangly and dark, amazed at the black hairs sprouting from his knuckles. The year he was thirteen, soldiers murdered Jews in nearby Kishinev and his father stormed around the house until the new wife seized Leo by the shoulders, thrust him in front of his father, and said, “This one makes you feel like that. The son of that Yid.”

“She was Catholic,” his father said. “My wife.”

“Pfff,” the new wife said. “Once a Jew…”

So he was Jewish, then? Yes to his stepmother, no to his father, yes in Odessa, no in New York. His father hadn't defended him, and everything that happened in the years just after Kishinev, after he'd run away from home, was jumbled. In Odessa, a stray boy knowing several languages hadn't been unusual; the city was filled with strangers born in Italy and Germany and Turkey and Sweden, all busily trading and making money. He'd found work in a cooperage run by a Greek; later with a French wine merchant who offered him room and board. He was clever, the merchant said approvingly. And had clever hands. With the merchant's help, he studied chemistry at the polytechnic institute, learning along the way about fermentation and the making of wine. For a while he worked at a winery, but later, as the strikes and the riots continued and his friends fled one by one, the balance had tipped for him as well. At twenty he felt like a middle-aged man; what was there to keep him at home? His mother was dead and his father was dead to him. He left for America convinced that here, he might be anyone.

Instead, somewhere between his first days on the Lower East Side and his move to Williamsburg and the sugar refinery, between the job in the char house, which he'd hated, and the one he'd made for himself, as the head chemist's assistant, his lungs had rotted and all his prospects had disappeared. Working one day at the refinery, he'd walked from the room upstairs, where he'd been testing effluent from the melter, down four flights and past the hall that led to the char house, across the floor where the graders were working, and into the corner laboratory next to the dock, where the head chemist was analyzing a sample from the ship. He'd given Karl his results, said good night, and stepped outside. Near the door was a bin of raw sugar, the last load left to be tested. He'd leaned over to look at the color and rubbed a pinch between his fingers. Then he'd coughed—the same cough he'd had all spring, no more—and watched, astonished, as blood sprayed over the pale crystals.

Everything after that had also caught him by surprise, and that itself had been surprising. Despite his six years in New York, despite all his jobs and the people he'd met and the evening classes leading up to his citizenship hearing, he still hadn't expected the way that, once the government was involved, one step led to the next and the next, until he was cornered and forced up here. A nurse came to the flat where he'd boarded in Brooklyn. Someone who had seen what happened at the refinery had told someone else, who'd told someone who worked at the clinic. What a fool he'd been, not to spit over the side of the dock, not to hide his cough! A mouthful of blood on a mountain of sugar, and then this.