Free Oxygen by Carol Cassella

reality. I had to face it inside my own family’s private crisis.
    My mother had rheumatic fever as a young child, which damaged her heart valves. Over the five and a half decades of her life, her heart strained to push blood through a shrinking portal, building up its thick, muscular wall like the oil-slicked biceps of a weight lifter. Her heart strained and thickened while she ran with girlhood friends in her rural Texas school yard, fell in love with the older graduate student who lived in her mother’s boardinghouse, worked as a waitress to buy her husband’s books, tried for years to conceive a child and then bore my sister and me within fourteen months of one another. Her heart struggled and strained during all of this, quietly compensating for the misshapen valves so that all along she believed herself healthy, believed she would live to see her daughters marry, hold her grandchildren, help her husband into the infirmity of old age.
    Her heart granted her this grace period of apparent health until it turned some physiological corner of irreversible damage and she became aware of a breathlessness when she mopped her floors, a pain in her chest while weeding her rose garden. By the time Lori and I were in high school she’d marshaled a standard list of excuses for missing picnics or walks or trips to the lake. Even then her quiet pride, her maternal endurance, kept her symptoms a private matter, each year without medical intervention diminishing any chance to reverse her decline. She kept her symptoms hidden until I began to notice how she paused in the middle of our staircase every time she carried up the socks, books, sweaters or shoes that we, her family, ungraciously dropped in the middle of our kitchen.
    But it wasn’t until I was in medical school that I understood it well enough to insist—in a newly respected voice, propped up by my fresh white coat—that she see a cardiologist and take advantage of what modern medicine could offer her. By then her only choice was open-heart surgery.
    Her cardiologist explained that she would likely do well after the surgery. Yes, her risks were higher than they would have been in the early stages, but without the surgery her risks were higher still. My family turned to me to translate this foreign dialect of choice and consequence. And I could—even in that infancy of my medical life—explain ventricular hypertrophy, valvular areas and gradients, cardiac output, cardiopulmonary bypass. Those words I could look up in my Stedman’s Medical Dictionary, dissect down to their Latinate origins and offer their meanings up to my parents like gifts, proof that my education had worth. What I could not give them, and what they needed most, was the perspective of experience, the critical filter of judgment that might have made their choice clear: without heart surgery she would almost certainly die within two years.
    Somehow the choice seemed to paralyze them, having grown up in a world where illness rarely offered options. We talked in circles. I tried to persuade her, using simplified words and penned sketches of her circulatory system. She turned to my father, as always, for his opinion. He asked me to explain it all again, as if a more thorough description might guarantee her life would be saved. My mother sank into a depression that stalled her ability to see a future either way.
    Then one morning she rose from her favorite chair and collapsed to the floor with a crushing weight in her chest. The pain so ripped the breath from her that she couldn’t cry out. My father heard the shattering teacup and ran to the living room. She was still talking when we reached the hospital. But much of her heart was dying. The stiffening muscular wall that had granted her one last decade of life had grown so thick it squeezed shut its own blood vessels—retribution for its malfunctioning valves.
    She was rushed into intensive care, the very unit where I was assigned to learn the intricate