Coming Up For Air

Your dark eyes are wide and serious above the mini oxygen mask. Still wearing your pink polka dot pajamas, you clutch a new stuffed bear to your chest, a gift from the paramedic who wheeled you into the ambulance. Perched to your right, I grip your other hand for the 25-minute ride to the ER. To keep you feeling safe, I try to relax my brow, despite my own fear and confusion. What is wrong with my three-year-old?

They cut the sirens when we arrive at the hospital, and I quickly snap a picture as they wheel you out, ashamed of my urge to document this vulnerable moment; it comes out blurred. Since we brought your baby sister home from this hospital 10 weeks ago, you’ve suddenly looked so remarkably big, so grown. But on the stretcher, in your footie pajamas, your loosened nighttime braid forming a wispy halo, you’re once again tiny.

Inside, things happen fast. You’re hooked up to monitors and a new flow of oxygen. I tell the story yet again, recounting how quickly you progressed from just a runny nose to hyperventilating at 4 a.m., first fearful and then, once your breath slowed, deeply lethargic. How you fell back asleep, and we thought maybe you just needed rest, but each inhalation remained shallow, raspy. I tell them how, hours later at the pediatrician’s office, despite two nebulizer treatments back-to-back, your lungs stayed tight, your breath labored. How the doctor compressed your tiny chest for a standing X-ray while I held your hand. And how, as the number on the oxygen monitor refused to budge over 92 percent, she calmly but firmly told me she needed to call an ambulance; driving you to the ER myself would be too risky, since you needed oxygen on the way. I don’t tell them about the guilt that washed over me in that moment—but maybe that part goes without saying.

Here at the hospital, they listen attentively, take notes, speak reassuringly. The steroid, they tell me, should kick in fast. When it does, your heart rate might spike as high as 200 beats per minute. I should not be alarmed. The focus is on getting you stable; the underlying cause of your symptoms is more an afterthought.

Once it’s just me and you, I glare at the oxygen saturation monitor, willing the fluorescent red number to climb. Somehow, hours pass. I borrow a breast pump to relieve my engorgement, storing the milk in urine sample cups one of the nurses provides. My own breath eases as the number on your monitor climbs to 94, 95, 96. At one point it dips to 89, but I don’t tell anyone.

It’s long past bedtime by the time we get home. The baby is still awake. Your dad’s eyes are weary. We have a loose diagnosis—asthma—and I’m stunned that such a common condition hadn’t even crossed my mind. Eventually, we all rest.

***

The ER trip breaks the spell of my postpartum bliss. I’d been feeling so uncharacteristically relaxed, self-assured. When your sister was just 10 days old, I took you both to story time. We went raspberry picking at two weeks. I cooked dinner every night with the baby in the carrier, high on my own capability. Becoming a mother of two somehow buoyed my confidence while softening my edges. But upon our return from the hospital, I sharpen.

Now, obsessing about your breath, I remember the weeks after you were born, when I’d scrutinize each rise and fall of your tiny belly as you dozed in the swing, convinced you’d turn and suffocate if I glanced away. After barely leaving the house during the day, in the middle of the night I’d hover my finger under your nose while you lay in the bassinet, ever bracing myself to feel nothing. I ran an air purifier incessantly, picturing the plumes of smog from La Brea Boulevard and the falling ash from the wildfires up north seeping into our apartment, sullying your pure baby nostrils, your perfect baby lungs. Sleep when the baby sleeps, every well-meaning older relative told me. I watched you breathe instead.

***

I knew next to nothing about asthma before that long day at the ER. Now, faced with that timeless maternal lament—why is this happening to my child?—I seek out data.

Asthma diagnoses are more than twice as common in Black children, compared to white, I learn, and many occur among children living in poverty. There’s also a genetic component, with a diagnosis more likely among children born to parents with the condition. It can be triggered by allergies, infections, environmental conditions, even anxiety. I scan the medical literature when I should be working, mapping your own risk factors as if that will bring some sort of peace.

Your dad dealt with asthma growing up. You’re biracial—Black and white—but middle-income, buffered against some of the worst economic manifestations of structural racism. Though we live in rural Vermont now, you were born in the heart of a city known for its lung-searing smog. There have been smokers on both sides of your family, but no direct exposure to cigarette smoke. Then I consider the emotional climate of our home; since we became parents, the tension has been acute—were we foolish to assume it wouldn’t affect your little body just like the air itself?

Current medications ease symptoms more effectively than ever before. But here too, underlying inequalities matter. We pay $189 per month for two puffs of the generic version of Flovent twice a day, right before we brush your teeth. Even as a solidly middle-class family, the cost is enough to make me consider rationing doses during lower-risk seasons. Online, parents talk about just relying on the ER instead.

***

You’re sick every month for the rest of the school year, and at least one of us usually goes down with you. We stock up on Pedialyte and Children’s Tylenol. Throw in some elderberry extract to cover our bases. Give you honey by the spoonful for your throat. The nebulizer sits at the ready on the dining room table, and your Hello Kitty humidifier runs nonstop.

You were six months old when the pandemic started, and the isolation kept you from getting sick until you were two. Meanwhile, we left Los Angeles for a place where the skies were clear, and we could afford a backyard, and you’d grow up with cousins. But now you’re in preschool, and during the darkest days of winter, we are worn down by the constant illness as your new little immune system ramps up. Each time I hear you cough, my whole body tenses, and my heartbeat accelerates. At night it’s even worse. The smallest ehh ehh rouses me in a panic from my deepest sleep.

***

Of course, there is no “Vermont air” or “California air.” There is only air. The summer after we move, smoke and soot from the west coast drift all the way across the country, stinging our eyes and prompting weather advisories. On the news are images of landscapes ablaze from Canada, to Siberia, to India. And it’s not just the wildfires, I know. The burning of fossil fuels creates fine particles that trigger respiratory illnesses, while climate change is leading to longer growing seasons, and an increase in pollen and mold. It still comes as a shock to learn that asthma is responsible for over a thousand deaths per day worldwide, mostly due to the lack of preventive care in lower-income countries.

Since you were born I’ve taken comfort in knowing that my singular experience as a mother is part of something much larger, communal, eternal. When I was up with you all night, trying to soothe you back to sleep while my eyes felt heavy, and my bones heavier, I’d envision the thousands of other women doing the exact same thing at the exact same time, each alone but sharing in a timeless ritual. Now, caring for you when you’re sick, your body having revealed new vulnerabilities, I cling to this same sense of sisterhood. At the same time, the injustice of it all—whose children will face the greatest risks, whose children will get the medications they need, whose children will survive—cuts through my romanticism.

At work, as the pandemic ebbs and flows, I pen op-eds advocating universal access to paid leave, so all parents can care for themselves and their kids when they’re sick. It often feels like writing into the ether—but at least it feels like something.

***

Ten months after your first asthma attack, smoke from Quebec is snaking down the east coast, turning our skies sepia. You’ve been coughing on and off, but it’s early July, we’re in summer survival mode, and I let you go outside anyway.

Days later, just before bath, you say you have something stuck in your throat. We check, confirm there’s nothing, offer your rescue inhaler when the coughing persists. You feel better, you tell us, and we put you to bed. At midnight you rush into our room, wheezing, scared, your voice raspy.  After a 15-minute nebulizer treatment, your coughing subsides, and you fall asleep.

By the next day you are no better, coughing so hard you repeatedly vomit, even after another treatment at the pediatrician. Your breathing is still a bit quick, I tell the nurse who calls to check on you later. “How quick?” she asks. “We get concerned when it’s around 35 breaths a minute.” I tell her I’ll call back.

In the guestroom, I lay my hand on your belly like I did when you were a newborn, counting each inhale as I time a minute on my phone. 36 breaths. I do it again. 33. Again. 38. I measure your oxygen, using the pulse oximeter I bought when the pandemic began, fitting it around your tiny finger, and waiting for the reading. It reads only 89 percent. I gasp.

We buckle you into your carseat and drive through torrential rain to the hospital. Another nebulizer, another steroid, another chest X-ray. The doctor tells us that the unusually wet summer—we are days before Vermont’s unprecedented and devastating floods—has resulted in excessive mold in the air. Alongside the wildfire smoke, it’s triggering people’s allergies and asthma. We’re not alone, in other words.

***

What does it mean to raise children at the end of the world? Maybe every generation asks this. Maybe it’s not the profound existential question millennial parents believe we uniquely lay claim to, but simply the nature of cultivating human life in a world that humans ultimately do not control.

And maybe the question itself is flawed. Maybe these aren’t the death throes, the planet’s painful last gasps, but instead the brutal transition before a new birth. They say a woman will know it’s almost time to push when she truly cannot withstand the pain of labor a minute longer, when she can no longer cope. Maybe this is where we are, or what we’re approaching. The overwhelming intensity, the unbearable exertion, the collective pain that cannot be sustained, but that brings new life on the other side.

My mother-in-law tells me that I need to believe in God to get through this. This being motherhood. This being raising two Black girls in America. This being coming to terms with my own mortality and that of everyone I love. Increasingly, I wonder if she’s right. The conventional internet wisdom—take it moment by moment, practice mindfulness, just breathe—helps me endure each day but falls short of scaffolding my long-term survival. I need to surrender; I also need to step up.

The planet is burning; the waters rise. The consequences will be unequally borne, as they have been already. Yet this collective still exists beneath it all, as does my agency within it. I cannot clear the smoke, but I can write to bring some clarity in the haze. I cannot breathe for you, but I can create space for you to breathe slowly, deeply on your own. I cannot cleanse all the air around you, but I can help ease its passage.