Lucas’ first tattoo was a work of deception: an attempt to mask the ribbon of ugly, pink scar tissue that curled around his torso beneath his right armpit. The scar provoked in him a sense of impotence, so he repurposed it. He imagined instead a compass, a guide towards a destiny of his own choosing, and the strip of tough tissue was converted into two dark arrows pointing east and west.
Years passed, and he felt compelled to cover more of himself. Next was a skull against his sternum, then two outstretched angel wings splayed symmetrically across his chest. The right wingtip’s graceful curl hid the scar from his old chest port, which he had abandoned years ago for the freedom of self-injecting his medication at home. When his abdomen became irritated from those weekly pokes, he devised a storyboard of angels, fairies, and dragons that twirled around his torso, diluting the visual reminders that his life was reliant on an external substance for survival.
Lucas felt compelled to fill every space, to make the entire canvas of his body a work of art under his creative direction. A colorful sleeve of elaborate mandalas and dazzling geometric configurations engulfed his right arm. On his neck, a single lotus blossomed into a garden of freshly burst purple peonies, trumpeting pink amaryllises, hypnotizing orange dahlias, and a soft spiral of plumeria petals. Lucas’ flowers accompanied him in times of celebration (gratitude, for having made it this far) and grief (mourning for the life he could’ve had, without his cursed condition).
The first time Lupita asked him about his tattoos, he felt an unexpected rush of vulnerability. He was used to having an outward form that enforced interpersonal distance: his abundant ink, his muscular frame, his avoidance of eye contact. But Lupita disarmed him completely that day, almost a year ago now. They had just finished caring for a hospitalized patient together, a dying grandfather whose emaciated ribcage rose and fell with each labored breath, each unsettling gurgle. The old man’s vital sign monitor was disconnected, and the door–-normally kept open to the shouts of hallway activity—was closed to honor his pending departure. In that artificially constructed silence, the room was filled only with the sharp inhalations, wet sniffles, and mournful groans of the man’s family.
Lucas, in his role as respiratory therapist, suctioned mucus and saliva from the man’s toothless, gaping mouth. He watched in awe as Lupita, the hospital’s chaplain, coached a cluster of scared adult children through this end-of-life moment, explaining what passing away would likely look like. No, he wasn’t in pain on the medications his nurse slipped under his tongue. Yes, even if he couldn’t communicate, he felt their presence, it brought him peace. Her stoic, unruffled role in an otherwise dramatic scene impressed Lucas. Amidst a chorus of whimpers and weeping, she didn’t shed a single tear. Her voice was steady, unperturbed, and reassuring.
“That’s a nice garden there,” she joked with Lucas, pointing towards his neck, after they closed the patient’s door behind them and escaped into the hallway.
“Thanks?” Lucas tensed, uncomfortable in the small talk, and kept a brisk pace forward.
“Do they mean anything? The flowers? Or just … flowers?”
“Well…they’re…” He stammered, searching for the right words to compel the conversation forward, to keep Lupita in his orbit. “Just flowers, I guess?” Lupita chuckled. Lucas relaxed.
Now, months later, Lupita had seen all of his tattoos. As their intimacy intensified, she came to know more about him, but not everything. She knew his diagnosis, but neither its severity nor how the fear of a premature death nipped at his heels. She watched him administer his weekly abdominal injections, which he made look effortless, but she didn’t know that he really felt exhaustion in needing to keep an impeccable schedule, and imprisonment in being trapped inside a broken body. Lucas left out any details that hinted towards how close he had been to death before, like when part of his lung was removed in third grade, or when he abruptly stopped treatments as a teenager in a desperate act of self-destruction. He shared enough to nurture a sense of intimacy, but kept enough secret so as to appear like a person in control of his body, not at the mercy of it.
It was finally just last night, lying on Lupita’s smooth linen sheets, legs intertwined, his hands gently framing her face, when her hand began to palpate the arrows of his compass, exploring the scar tissue beneath the ink that she’d not before been aware of. Lucas panicked. As her fingers pressed into his skin with a tender curiosity, he suddenly felt claustrophobic.
“That’s nothing,” he dismissed, quickly, pulling his body away from hers.
“Well, it’s something,” she gently teased back.
Lucas sat up and shifted towards the edge of the bed, and Lupita looked towards him, understanding that a boundary had been set. “It’s OK. It’s your business.”
Lucas rose and stepped into the bathroom, where he splashed water on his face. Should he just tell her how fragile he really was? Their intimacy was the first he felt willing to gravitate toward, and not flee from, but fear still held him in its grip. What if his revelation caused her to walk away?
“Do you have a minute for something else then, Lucas?” she called across the room. He had a feeling he knew what she wanted, and it made him uneasy. The hospital had just announced a series of job cuts last month, and Lupita’s entire department was on the chopping block. Lucas imagined she’d want to talk about moving in together, given they spent all their time together anyway.
“I’m really tired, Lu. Can we talk tomorrow instead?” He turned in the doorway and glanced towards her disappointed gaze. But she held her hand out and welcomed him back to bed. “Sure thing. Tomorrow’s fine.”
***
The next morning, Lucas found himself staring into a child’s bloodshot, tear-rimmed eyes, imploring the boy to take slower, deeper breaths as he secured the elastic band of an oxygen mask around his small head. The boy inhaled with a high-pitched wheeze, then let out a petrified cry. “You will be ok,” Lucas shouted emphatically through his N95 mask, and signaled to a nurse to take the boy’s nervous mother into the hallway as he initiated the nebulized medications to calm his asthmatic airways.
Lucas had been close enough to death himself to understand that emotions were unhelpful in the intensive care unit. Some people had good luck, some had bad luck. Emotions were a distraction away from calculated actions; focus always got you farther than feelings. As a respiratory therapist Lucas had mastered managing ventilators, expertly translating each waveform on the screen to determine if the patient’s breaths were synchronized with the machine, twisting knobs and pressing buttons to protect the patient’s lungs from machine damage. He could manipulate settings to minimize wasted breaths, or “dead space”, to protect the essential exchange of oxygen and carbon dioxide so that every breath mattered. Intensive Care had once been his worst nightmare as a patient, but as a respiratory therapist, he was blissfully in control.
The nurse re-entered the room and Lucas asked her to release a bolus of steroids into the boy’s intravenous line. Watching the boy’s eyes squeeze shut, he remembered his own distress, gasping for air and getting none, terrified his current breath would be his last, teetering on a cliff’s edge at the mercy of whoever showed up at his bedside to help. The boy’s rapidly beeping bedside monitor slowly began to tick at a steadier pace as his airways opened up. Lucas offered him a high five, and a skinny arm raised up to meet his.
Stepping into the hallway, Lucas spotted the boy’s mother leaning against a far wall whispering to herself with closed eyes, dressed in stretch pants and an oversized sweatshirt, hair pulled into a messy bun, having rushed in overnight.
“Ma’am,” he said, approaching her slowly, “Your son’s doing OK.”
Her tired eyes fluttered open, glistening. “Thank you,” she replied, and paused, breaking her stoicism to shake her head and sigh. “This place is really something. The rushing, the beeping. That circus of an Emergency Room downstairs. It’s like a few doctors for a few hundred people. Wild.”
Lucas nodded. She was right; on paper he was only meant to manage five patients, max. But two RTs left last month for a higher-paying private hospital uptown, after the layoff announcement spooked them, and now Lucas had all the ventilators, plus the consults, and the intubations, when anesthesia didn’t show up to a code fast enough. Downstairs was a mess. People were sick enough to need admission, but without enough open beds they had to stick it out in a crowded corner of the busy ED, doctors and nurses flurrying past, only worthy of professional attention if they were decompensating towards death.
“We’re doing the best we can, ma’am. I’m glad your boy is improving.”
“Well, thanks for looking out for us up here. Hope you got someone looking out for you too,” the woman offered lovingly as she crossed the hall to rejoin her son. Her words echoed in Lucas’ ears, and he instinctively pulled his phone from his pocket to see if Lupita had messaged him yet.
Lunch today? She had texted, just minutes earlier. Lucas shifted his weight from one foot to the other, thinking. He should say yes; why should it be so hard to just sit down and talk about housing, or whatever it was she wanted to talk about? He paced, phone in hand. No. Not yet.
ICU is wild. Got my appointment today. Drinks after work?
Three dots appeared; Lupita was typing a reply. Then they stopped. He stared at the screen. The dots emerged again, then disappeared. There again, gone.
Suddenly a static burst blared from the overhead speakers and a stern voice yelled out a room number, announcing a resuscitation effort underway at the far end of the unit. Lucas sprinted towards a sea of uniformed bodies. He shoved his phone back in his scrub pants pocket, and disappeared into his job.
***
It was 1PM by the time Lucas finished seeing all of his patients in intensive care. He hadn’t heard from Lupita, a silence that felt disconcerting as his doubts began to fill in the empty space. He tried calling her, but it went to voicemail. His stomach gurgled.
Lucas raced into the darkened stairwell that connected the ICU to the Oncology Unit one floor below; his friend Dewi, the head nurse, surely would have seen Lupita already that morning. She’d be able to give him some intel. Dewi had been Lucas’ friend first, all those years ago she’d known Lucas as a patient, when he got his monthly infusions alongside her chemo patients. Now she’d become a fairy godmother to him and Lupita, always finding reasons to call him to the Oncology floor when Lupita was making her rounds, always hungry to hear their latest relationship developments, a confidante to both, a cheerleader for the partnership.
“Lucas, love, how are you?” Dewi greeted him. She pulled her glasses off her head as she examined a long strip of EKG squiggles in one hand, beckoning him to approach with the other.
“Hey Dewi. Listen, has Lu been around yet this morning?” he looked to Dewi with pleading eyes, and she raised her eyebrows at him, beckoning him to say more, knowing his stubborn tendency to offer as little as possible, and matching it with hers. She wasn’t going to budge without more information from him. “I’m trying to reach her and she isn’t responding.”
Dewi shook her head at Lucas and picked up a clipboard, onto which she scribbled a set of notes. “You really don’t know what’s going on, Lucas?”
The way she said it, he felt even more worried. Was this an accusation? Was there a “something” going on–something heavier than his expectations–that she knew and he didn’t, that he should know?
“I…well…I mean, I’d like to know if there’s–,” he stuttered.
“Lucas, love,” Dewi grabbed his hand and gave it a squeeze.
“I just had a busy morning is all. And I have my appointment…,” he looked down at his watch, realizing he was already late. “Now, now.”
“I know you’ve got a lot going on, love. But listen to me. You gotta talk to her. Today. It’s for the best.” Dewi smiled at him and shooed him away from the nurse's station. “Now go, get to your appointment.”
A dread bubbled up inside Lucas. He sprinted to the elevator and rode it down to the ambulatory care offices, thinking about their conversations of recent days, searching for clues that he might have missed. Was this a break-up? Had she found out more about his situation? He cursed the monotony of disease maintenance, these constant check-ins, the inescapable reality that an invisible pathogen could end his life any one of these days. When he stepped into the clinic lobby, Doctor Owusu had just entered the waiting room and was calling his name.
“Lucas, come on back,” Dr. Owusu’s warm, gravelly voice rang out.
They settled into their exam room seats. Doctor Owusu pulled up Lucas’ medical record on the screen, and squinted while examining a recent chest CT from after he had contracted RSV from a pediatric patient the past winter. Dr. Owusu shook his head. “You really need to be more careful, Lucas. I know you know that. But this area here is worse than the last scan.” He tapped on the screen at an area of fuzzy white lines scribbled across his black lungs. “Scarring. Dead space. You’re looking at losing more of your lung if things don’t change.”
Lucas understood. Every time he looked at an image of his lungs, a whole piece missing, he could practically hear his mother’s anxiety when the diagnosis was first put on his mysterious illness.
“A gamma what?” her voice had yelped.
“A-gamma-globulin-emia,” the first doctor emphasized each syllable. “It’s genetic. Lucas’ immune system doesn’t produce certain cells, which leaves him vulnerable to infections. But he can take an infusion every month, to treat it.”
“For how long?”
“Well…for his whole life.” Lucas and his mother had no idea back then what it would all entail. Month after month they would drive into the city for infusions, park their car in a dark basement lot, wait to check in, wait for blood draws, wait for the infusion. When he would sit, angry at his fate of endless needle sticks and obligatory hypervigilance, the immune cells rushing to the rescue inside his vasculature, his mother would sneak him packets of salted crackers and tiny plastic tubs of sugary juice from the nurse’s station and offer empty reassurances that things would be OK. By adolescence, when his mom’s job threatened to fire her for taking too many days off, she began to drop him at the hospital instead. During those teenage years he sometimes wouldn’t go in, once running for a streak of 3 months before he was caught—nearly dead in the emergency room with a raging pneumonia.
It had been his mother’s pleas that forced Lucas to start taking his meds and showing up at appointments again. But it was his own desire that he answered when he went back to school to be a respiratory therapist. The hospital had become a place of healing for him not because of infused medications or doctor’s visits, but because at work he finally possessed an identity outside of his illness. He was happy to finally be known as, “the respiratory therapist here to help you today”, not as, “a 35-year-old man with severe immunodeficiency presenting with worsening productive cough and fever.”
“You ever think about a new career, son?” Dr. Owusu startled him back to the present, chastising his choice of constant germ exposures. Lucas didn’t know how to explain that mastering lung anatomy and physiology was the only thing that allowed him to feel less powerless. How, even behind his N95, being well-equipped to challenge death around every corner somehow made his disease feel less potent.
“Or at least let your manager know about your condition? You know you can request work accommodations to protect you more. Get you off intubation duty at least. Just say the word, I’ll write the note!” His eyes pleaded with Lucas, but Lucas looked away.
“Lucas, you know, the few patients I’ve had with this condition come into my office with family or friends or someone who helps them. I know your mom moved away last year. Who can we get in here to support you? Have you even told your girlfriend yet, how serious this is?”
“I’m good Doc. Won’t happen again. I promise.” Lucas’ phone felt heavy in his pocket, wishing Lupita would reply to him, nervous that she hadn’t. He had always thought of his cover-ups as offensive fronts. But it occurred to him at that moment that maybe conceding victory to his shitty immune system was the only way to stop it from having such power over him.
***
Lucas looked at his watch, nervously. It was 6:55PM. Lupita had finally texted back and suggested a 7PM meal in the hospital’s lobby diner instead of drinks at the bar. Hiding behind a wide column in the busy lobby, he peered into the diner’s floor-length glass windows and saw Lupita sitting, twisting the various rings on her fingers, eyeing a glass of water on the table in front of her, stirring her straw around and around. A small envelope, stuffed thick with what looked like photographs, lay on the table beside her.
Staring at her through the window, Lucas couldn’t deny that Lupita had breathed fresh air into days that had become uninspiring to him. She pulsed life into parts of him that had fallen asleep. Lupita’s love perfused his emptiness, allowing moments of insecurity and doubt to be filled with meaning and joy. But how long would that last? When would his unpredictably broken body inevitably disappoint her? How could he make commitments under his life sentence of chronic illness? She’d have every right to reject him once she realized he couldn’t be counted on for the long-run.
He had brought her a handful of cheerful daisies, dyed neon blue, from the bodega across the street. Standing in the column’s shadow, unsure what an uncovered truth would mean for their trajectory, Lucas summoned his courage to finally share it. He passed the flowers from one hand to the other, debating whether they would accompany celebration or mourning, wondering in which direction his compass would see the two of them move.