The fifth vial

CHAPTER 14

Unbelievable!"

The physical therapist and pulmonary therapist stood back from the treadmill and watched in absolute amazement as Natalie passed thirty minutes of brisk uphill walking — 4.5 miles per hour with an elevation of four.

Gradually, Natalie had felt her breathing becoming more strained, and a burning beneath her sternum, but she was determined to hang on for another few minutes. It was little more than two weeks since her medevac return from Brazil, and little more than three since her right lung had been removed at Santa Teresa Hospital in Rio. She had spent the first three days out of the hospital at her mother's, and might have stayed longer were it not for the pervasive odor of cigarettes — present even though, out of respect for her daughter, Hermina was limiting her smoking to the porch and bathroom.

Jenny delighted in having her aunt around, and especially in having the chance to be the caregiver for a change. The two of them spent hours talking about life and standing tall against adversity, as well as about books (Jenny had reluctantly tried the first Harry Potter, and was now devouring the series), movie stars, opportunities in medicine, and even boys.

"Aren't you a little young to be interested in boys?"

"Don't worry, Auntie Nat, the boys are young, too."

Natalie's progress and her attitude had astounded her physicians and rehab specialists. The scimitar scar on her right side was still sensitive, but there were no other outward signs of the massive operation she had undergone. And with each passing day — each passing hour — her left lung was accepting more and more of the responsibilities for gas exchange that once two lungs had shared.

"Hey, Millwood," she said, "I think tomorrow we should hit the track."

The surgeon, trotting briskly on the adjacent treadmill, looked over at her incredulously.

"Just don't hurt yourself," he said. "You know, time is nature's way of keeping everything from happening at once. You don't have to totally rehabilitate in a single session."

"Before this is all over, I'm going to run a triathlon. That's going to be my new sport."

"I think you should stop now, Nat," the physical therapist said. "I promise we'll add something tomorrow."

As Natalie started a cool-down, Millwood turned off his treadmill and hopped off.

"Thank you, ladies, for allowing me to take up your machine like this, but I had to see for myself if the rumors about superwoman, here, were true."

"Are you a believer?" Natalie asked.

"Believer, hell, I'm a disciple."

"In that case you can disciple me over to Friendly's for a hot fudge sundae. If you can stand my grubbiness, I'll wait and shower after I get home. I have to do a little grocery shopping for my mom anyhow, and Friendly's is sort of on the way. We can meet there."

Natalie finished the short cool-down and performed a set of pulmonary function studies under the guidance of her pulmonary therapist.

"The numbers are okay," the woman said, "but your actual performance is much, much better. I honestly have never heard of anyone making this sort of progress after a total pneumonectomy."

"You just watch. If it can be done, I'm going to do it."

Natalie toweled off and changed into a floppy sweatshirt. Macabre and disastrous as losing an entire lung sounded, the recovery, at least to this point, had been nothing like the agonizing ordeal of rehabilitating her surgically repaired Achilles. She had bounced back from that ordeal, and she was determined to make it through this one.

Her phenomenal recovery so far had been marred only by recurrent flashbacks to her attack, which were disrupting her sleep and sometimes even occurring during the day. They were almost identical to the ones she experienced at Santa Teresa's — distorted, indistinct, and emotionally detached in some ways, utterly detailed and viscerally terrifying in others. One minute she was a frightened participant in the horrific cab ride from the airport, the next she was little more than an observer to her assault and subsequent shooting. She had discussed the phenomenon with her therapist, Dr. Fierstein, who spoke to her of the many faces of post-traumatic stress disorder.

"Your mind chooses to remember what it can handle," she had said. "Much of the rest is dummied down, if you will — put in a form that your emotions can deal with. It's a matter of preservation and sanity, and when those defenses begin to break down, the true emotions connected with the precipitating event can be quite overwhelming. We would both do well to watch out for that."

For the time being, it was decided not to treat Natalie's PTSD with any medications unless and until the symptoms began to interfere with her life. But except for some lost sleep, to this moment, at least, that was hardly the case. Fierstein's belief was that Natalie was meeting the challenge of her rehabilitation so successfully because she functioned best when she had something to push against.

Millwood met her in the parking lot of Friendly's, a seventy-year-old chain throughout the Northeast that had survived inconsistent food and service largely because of their matchless ice cream.

"I can't totally explain what's happened to me since I woke up from the operation," she said to Millwood after they had settled into a booth and begun quickly replacing the calories they had burned off on the treadmill with hot fudge sundaes, "but something inside me has changed." She grinned, pointed to her thoracotomy scar, and added, "I mean something besides the obvious."

"I've seen the changes in you," Millwood said. "So has Doug. We expected to bring home a morose, self-pitying, bitter woman. And to tell you the truth, that wouldn't have surprised us in the least. I suspect that if I were in your situation, that's the way I would have responded."

"I did feel that way for a while, but then something started happening to me. It began after I moved back to my own place from my mom's. I found myself thinking about how this whole business would never have happened if I hadn't gotten suspended from school, and I would never have gotten suspended if I hadn't decided that I needed to show Cliff Renfro what being a good, compassionate doctor was all about."

"You had a near-death experience," Millwood said. "Different people react to that sort of trauma in different ways. Some enter a life of fear and hesitation. Others are absolutely liberated."

"Dr. Fierstein thinks I might just be in denial, but I don't. It's like what happened in Rio has begun opening my eyes about myself- my own intensity and the effect it has on people around me. You know, sometimes it's possible to care too much about some things. Over the years, I've sort of been caring too much about everything. Passion is wonderful when it's focused, but applied without any filter, it can be crazy-making for all concerned."

Millwood reached across the table and put his hand on hers.

"I can't believe I'm hearing this," he said.

Natalie made no attempt to wipe aside the tear that had broken free on a course down her cheek.

"I've always taken such pride in being as tough as I was smart — especially in my belief that whomever I might be dealing with was lacking because they didn't care with as much energy and commitment as I did. It's always been, like, this is who I am. Take me or leave me, but don't expect that I'm going to change. Now, at thirty-five, with one lung and every reason to pack it in, I don't care anymore if I'm tough or not."

"Believe me, Nat, even at your most difficult, you still bring more to the table than almost anyone I know. Your friends love and respect your passion for things, although I'll admit that sometimes we're a little scared of you going off like a Roman candle."

"Well, I'm going to try like hell to be a little gentler on people. And if you catch me going off on anybody, you can rub the bridge of your nose or something to tell me to back off. Got that?"

Got it.

Millwood practiced the maneuver.

"Perfect, thanks. Until I really get it down, you can be my Jiminy Cricket."

"Count on it."

"Speaking of consciences, Terry, you'll never guess what I did the other day. I wrote letters of apology to Dean Goldenberg and also to Cliff Renfro. There was nothing in it for me, but I really wanted to do it — to go on the record that I finally know what I did wrong and why it was wrong. I also wanted to thank the dean for not kicking my butt out of school for good."

Millwood's expression was enigmatic, but there was a spark in his eyes.

"You said there was nothing in it for you to write those letters, but you did it anyway?"

"That's what I said, yes…Why?"

He leaned back in the booth, arms folded, his gaze fixed on her.

"Because you're wrong," he said simply. "There was everything in it for you — especially since you didn't think there was. I read the letters, Nat, both of them. Dean Goldenberg asked for my opinion about them — Doug's, too. They were powerfully written and undeniably from your heart. You can say all day and all night that you're changing, but those letters say it better." He paused a moment for emphasis. "Nat, the dean's going to recommend that the committee on discipline allow him to terminate your suspension."

Natalie stared at him, wide-eyed.

"You're not messing with me?"

"I'm cruel," Millwood said, "but I'm not that cruel. He's also going to have a talk with Dr. Schmidt about the possibility of reconsidering your residency. No guarantees, but he sounded somewhat optimistic. I really wanted to be the bearer of the news, so Sam gave me permission to tell you. Welcome back, pal."

"Oh, man, this is just — I…I don't know what to say."

"You don't have to say anything that you didn't already say in those letters. On the track that day you raced the St. Clement's kids, we talked about how who you are should always be more important than what you are. But there is a balance we all need to find, and it appears you're in the process of finding it. So" — he reached across and shook her hand — "congratulations."

"Hey, thanks, Terry. Thanks for hanging in there with me."

"Anything else?"

"Yeah, just one. Are you going to finish the rest of that sundae?"

Nearly airborne with excitement, Natalie managed to make it through the Whole Foods Market. When it happened, she had chosen not to tell her mother that she had been suspended from school. Sooner or later, though, especially as graduation time approached, she knew she was going to have to say something. Now, thanks to the dean, and Doug, and Terry, and whoever else had stepped in to speak on her behalf, that wouldn't be the case.

Best of all was that what she had told Terry was the absolute truth. She had written the letters taking complete ownership of her actions without any consideration that things would change for her externally. During their second-year course on addiction medicine, her class had been required to attend at least two AA meetings and to read in detail about the famous twelve steps — the tools for changing the person in various programs who found it necessary to drink, or drug, or overeat, or gamble, or sleep around. The eighth of those steps had to do with making a list of those the addict had harmed by word or deed. The ninth required making amends to those people without any adherent agenda or expectation of forgiveness. Perhaps, she was thinking now, it might be time for her to expand her list — beginning with her mother.

A detour and subsequent four-block tie-up made the drive to Dorchester twice as long as usual. Natalie noted proudly that her profanities, traditionally X-rated in all traffic situations, would barely have made PG.

Who is this woman, and what have you done with the real Natalie Reyes?

Humming softly, she pulled up in front of Hermina's house and looped two plastic bags of groceries around each wrist, then set them down and retrieved the key from beneath the planter on the front porch. She turned to the front door, and at that moment smelled smoke and noticed that gray-black wisps were floating out from beneath the door.

"Oh, Jesus," she muttered, plunging the key into the lock and grasping the ornate doorknob, which was hot to the touch.

"Fire!" she screamed to everyone and no one in particular. "Fire! Call 911!"

She slipped her hand under her sweatshirt to hold the knob, and turned the key. Then she lowered her shoulder and slammed it against the heavy door with all her might.