Living and Dying in Brick City

by Sampson Davis

  But just like that, Lil’ Moe’s tomorrow—and his friends’ chances to step in—had vanished.

  The Warning Signs for Suicide*

  The following signs may mean someone is at risk for suicide. The risk is greater if a behavior is new or has increased and if it seems related to a painful event, loss, or change. Seek help as soon as possible by contacting a mental health professional or by calling the Lifeline at 1-800-273-TALK (8255) if you or someone you know is:

  • Talking about wanting to die or to kill oneself

  • Looking for a way to kill oneself, such as searching online or buying a gun

  • Talking about feeling hopeless or having no reason to live

  • Talking about feeling trapped or in unbearable pain

  • Talking about being a burden to others

  • Increasing the use of alcohol or drugs

  • Acting anxious or agitated; behaving recklessly

  • Sleeping too little or too much

  • Withdrawing or feeling isolated

  • Showing rage or talking about seeking revenge

  • Displaying extreme mood swings

  HOW TO BE HELPFUL TO SOMEONE WHO IS THREATENING SUICIDE*

  • Be direct. Talk openly and matter-of-factly about suicide.

  • Be willing to listen. Allow expressions of feelings. Accept the feelings.

  • Be non-judgmental. Don’t debate whether suicide is right or wrong, or whether feelings are good or bad. Don’t lecture on the value of life.

  • Get involved. Become available. Show interest and support.

  • Don’t dare him or her to do it.

  • Don’t act shocked. This will put distance between you.

  • Don’t be sworn to secrecy. Seek support.

  • Offer hope that alternatives are available but do not offer glib reassurance.

  • Take action. Remove means, such as guns or stockpiled pills.

  • Get help from persons or agencies specializing in crisis intervention and suicide prevention.

  *Reprinted from the National Suicide Prevention Lifeline

  11

  NO AIR

  The patient’s face was a blur as the stretcher whizzed past me in the halls of Beth Israel one summer afternoon in 2002. But I recognized his dreads. Those thick, shoulder-length locks told me what my pager alert moments earlier could not: that I knew this patient.

  I ran to catch up. My eyes followed his oversized white T-shirt to his face, confirming his identity. It was my friend Mark, the cook and cashier in the hospital’s ancillary cafeteria. He’d suffered a severe asthma attack.

  “I’m here, man,” I said, trotting beside the stretcher as emergency workers rolled it to the resuscitation room.

  I had warned Mark about the cigarettes. Smoking and asthma are a deadly combination, and Mark knew it. But, like Mr. Tate and the millions of people in the country addicted to smoking, Mark wouldn’t—or couldn’t—quit. He probably thought he had forever to change. He surely couldn’t have guessed that forever would come so suddenly, on this beautiful summer day as he sat on the passenger side of his best friend’s car, idling at a traffic light, just moments from his destination. When the EMS team arrived, Mark was barely breathing. His six-foot frame lay stretched out on the pavement, as still as the air. His best friend, Shawn, kneeled beside him and held him. Emergency workers quickly inserted a breathing tube, administered intravenous drugs, and rushed him to Beth, where my team worked frantically to save his life. But the cardiac monitor showed no pulse, no heartbeat. I looked down at my friend’s lifeless body and knew it would take more than my medical skill and strong will to bring him back. It would take a miracle.

  Mark was one of the friendliest, most upbeat dudes I’d ever met. Most days, I’d rush into the cafeteria just before my shift or during a break, and he’d be there behind the counter, with his condiment-stained apron shielding his stylish clothes. Just a few months older than me, he was the cook, cashier, delivery guy, everyman, doing whatever it took to keep the small operation running smoothly. The main cafeteria on the second floor was closed part of the day, so the smaller one was always bustling with hospital workers who watched the clock while trying to grab a quick bite or a cup of caffeine, and family members needing food or respite from sick loved ones. But no matter how busy he was, Mark never failed to acknowledge me. It really touched me how much my presence at Beth Israel seemed to mean to many of the hospital’s hourly workers, many of whom had grown up in Newark. Beth hired heavily from the surrounding neighborhoods, and when I joined the staff, word circulated quickly that the new young black doctor had grown up in the hood, not far from the hospital.

  “Proud of you, man,” I heard again and again from the orderlies, janitors, cooks, and clerks, who became my first friends. Thanks to people like Mark, I loved coming to work. Mark went out of his way to be kind. He’d spot me in line and flash his brilliant smile, thirty-two perfectly aligned teeth set against flawless mahogany skin. “Hey, Doc, I got your drink ready to go,” he’d say, reaching over the counter to hand me my regular, a large hazelnut coffee with cream and two sugars.

  We became friends one day when I was picking up my regular. Traffic was relatively light in the cafeteria that day, and Mark joined me on my side of the counter. He carried a pack of cigarettes, and I assumed he was headed outside for a break.

  “Doc, you leaving?” he asked.

  “Yeah, I got to make it upstairs,” I said. “I heard things are already pretty busy today.”

  We headed toward the exit, and I held the door open for Mark and followed him into the hallway, just short of the escalator. It was a Friday, and only a few hours stood between Mark and his days off. But his spirits seemed unusually heavy. And I could tell he wanted to talk.

  “I wanted to be a doctor once,” he began matter-of-factly. “But I messed up in school. Following the wrong crowd, you know, and then dropped out.” He paused and shook his head, reflecting on the past. “I had a bunch of toos. Too fast, too grown, and too dumb for my own good. Look at me now. I’m working in this dead-end job, no future in sight.”

  It surprised me to see Mark in such a mood. He continued without any prompting, “Man, the only good thing that ever happened to me was my baby girl. You’ve probably seen her around here. I was eighteen when she was born. I was so happy, though if I had to do it all over again, I’d wait. I got a job as soon as I found out my girl was pregnant. I figured I would work double shifts, sixteen hours a day, whatever it took to give her and my baby a better life. You know, I didn’t want her coming up like me, without her daddy. I promised her and her mother when she was born, right there in the delivery room, that I would always be there for them. The years went by and, you know, I never made it back to high school, let alone college. Before you know it, you’re working hard just to stay in place.”

  By then Mark was fidgeting with his cigarettes. The nicotine was calling, and I knew he had only a few minutes for break. The emergency department wouldn’t shut down if I got there a few minutes late, I figured. I motioned for him to follow me outside. As soon as we stepped onto the concrete, he reached for his lighter, pulled out a cigarette, and touched it to the flame.

  “I know what you mean,” I said. “It’s so hard to get ahead. But it’s never too late to go after your dreams.”

  He took a long drag on the cigarette. “I’ve been here at Beth ten years. I do it all, man, but I’ll never own this café. I’m just a worker to the owner, nothing else. I’m reminded every day that I have to take shit from people. They walk all over you when they know they can. But what can I do? Just walk away?” He chuckled. “That’s why I’m so proud of you, Doc. You did it, man.”

  Mark’s story moved and humbled me. I knew the frustration of feeling trapped by your circumstances. But I’d also seen firsthand that the seemingly impossible can become possible with determination and hard work. Talking to Mark that day helped me realize more than ever that my success was not just a
bout me. I was living the dream of so many others who had found their own dreams smacked down by life: the black cooks, orderlies, and janitors who joked with me in the halls; the elderly men and women in the community who went out of their way to wish me well; and even the tough guys who locked me into their gaze as they lay dying.

  Mark finished his cigarette, stamped out the butt, and then reached into his pocket. I was stunned by what he pulled out: an albuterol inhaler. Until that moment, I had no idea he had asthma. He quickly took two puffs from the small pump and returned it to his pocket.

  “Now, you know better, Mark. Asthma and smoking—come on, man,” I said in my best cool doctor approach. I wanted him to know that I didn’t approve, but I also didn’t want to alienate him by being too preachy.

  “I know, Doc, I know,” Mark said. “I shouldn’t be smoking.”

  We made our way back into the hospital and headed our separate ways. Every time I saw him after that, we chatted about sports, music, the news of the day, or his eleven-year-old daughter, Trina. Soon after I met him, I was passing through the cafeteria and saw a cute little girl sitting behind the cash register, and Mark introduced me to her. Trina had the same rich brown complexion as her dad, a dimpled smile, and hair that flowed over her shoulders in small, neat braids with colorful rubber bands on the tips. I soon discovered that she came to the hospital nearly every day after school and sat at the register with an air of pride and confidence. No one could tell her that the small cafeteria wasn’t her daddy’s place. While waiting for him to get off work and take her home, she dutifully did her homework. She beamed in his presence and glanced at him for approval when she spoke.

  A couple of times, I ran into Mark in the emergency department, where he’d come to get a breathing treatment when his asthma got out of control. About a quarter of all people who visit the emergency rooms throughout the country are there due to symptoms related to asthma. The number of those who suffer from it—an estimated 20 million Americans (one in fifteen people)—has been growing steadily across all racial and ethnic groups since the early 1980s. But the condition is slightly more prevalent and much more severe among African Americans, who are three times more likely to be hospitalized because of it. That seemed evident to me early in my tenure at Beth by the large number of black patients filling the recliners lined against a wall, there exclusively for those receiving nebulizer breathing treatments. The nebulizer converts liquid medication into a mist that can be easily inhaled through a mask and quickly absorbed by the lungs to open constricted airways.

  “Doc, when you are having an asthma attack, it really is like breathing through a straw,” Mark once explained during a brief chat. “Can you imagine that? You are exhausted, using all your muscles and energy just to get a small amount of air. Feels like you’re being buried alive.”

  Mark had been diagnosed with asthma as a child and had been hospitalized for it several times through the years, but he’d learned to accept and manage his condition, he told me. He knew the triggers: some pets, carpets, heat, certain medicines, exercise, and, especially, smoke. But he just figured that with his inhaler, he was in control. Still, I reminded him every chance I got: “You know, cigarettes aren’t helping the matter.”

  As usual, he would promise to quit: “Next year, Doc. I promise.”

  The last time I asked if he’d quit smoking he told me he was down to eight cigarettes a day. “That’s better than the two packs a day I used to smoke,” he added.

  Mark was flirting with death, though I’m sure he didn’t see it that way. But one in five deaths each year is attributed to cigarette smoking. More people die from smoking than from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicide, and murders combined.

  For an asthmatic, smoking causes irritation of the airways, greatly enhancing the chances of an attack, and African American asthma patients are three times more likely than their white counterparts to die during an attack. Most of these deaths could be avoided, though, with proper treatment and preventative measures.

  The same is true with many other medical conditions, yet every day I treat patients who keep smoking despite a diagnosis of asthma or emphysema, or keep eating high-fat or salt- and sugar-laden foods despite their diabetes, hypertension, or heart condition or the threat of developing them. And even after diagnosis, they are inconsistent with their medications, either neglecting to take them as prescribed or skipping them altogether. These destructive patterns seem more acute in poor urban communities, where people frequently use cigarettes, drugs, and food to cope with stress and the miserable circumstances that often come with poverty. And the truth is perhaps easy to ignore for long periods of time because the human body is resilient and can withstand much abuse—until it can’t.

  The day an ambulance carried him to Beth Israel, Mark had hopped into Shawn’s car for a quick trip across town to visit another friend. Sometimes, when I think of Mark and what happened that day, I imagine him flashing that easy, ever-present smile, showing every one of his flawless teeth, low-riding on the passenger side of Shawn’s Mazda RX-7. I can see the two friends, bouncing to the rap beat thumping from the stereo as the car rolled through the streets of Newark. I can almost feel the hot, humid air rushing through the open window, causing Mark’s shoulder-length dreads to flap in the wind. I can smell the cigarette burning between his mahogany fingers.

  If only Mark could have that moment back …

  He was wheezing when he sat straight up in the car and began fishing furiously through his pants pockets. He pulled out his albuterol inhaler, wrapped his lips around the mouthpiece, and squeezed the pump with his fingers. A tiny bit of mist came out. He squeezed again, and again. The canister was empty.

  Hearing his friend’s wheezing grow louder, Shawn panicked and sped through the light. I can only guess that he figured paramedics could get to them faster than he could drive to the hospital, and so he raced the one block to their friend John’s house, and within seconds was whipping the car into the driveway. As soon as the car stopped, Mark hopped out and began jumping up and down and slapping his chest, as if to force the air into his lungs. Shawn punched 911 into his cell phone, honked repeatedly, and jumped out of the car just as Mark collapsed onto the pavement. It all happened so quickly. John and his parents rushed outside and became hysterical, then ran back inside to grab the telephone to call Mark’s family. Neighbors and passersby gathered and watched helplessly. Paramedics arrived within minutes and quickly loaded Mark into the ambulance.

  At the hospital, Shawn seemed in shock, recounting every detail of the story, as if to convince himself he’d done all he could do to save his boy. But guilt was eating away at him. “I shouldn’t have given him that cigarette,” he said, blaming himself.

  Mark had asked for the cigarette, and he’d promised Shawn—just as he’d promised me many times—that he was going to quit smoking. I was angry at myself for not pushing Mark harder to stop, and I was angry at him for gambling with his life every time he took a puff. This time, he’d lost it all. There would be no miracle. At just twenty-nine years old, Mark was dead. He had died before he made it to the hospital, and my medical team could not bring him back.

  Shortly after I made the official pronouncement, Mark’s girlfriend and daughter joined other family members in a small private room at the hospital. They were all in shock, hugging and consoling one another. I introduced myself to them and expressed my condolences. Trina recognized me from the times I’d joked with her in the cafeteria. Her mother was weeping when she led the child over to me and asked me to tell her—she couldn’t do it. I’d broken bad news to families many times before, but never like this. I knew this little girl. I knew how much she adored her father and how hard he had worked to make life better for her. I started there.

  “Your daddy loved you so much,” I said, handing Trina an apple juice. “You remember how he sometimes had asthma attacks and couldn’t catch his breath? Well, this time, he had a really bad one. We did ev
erything we could to save him, but I’m sorry to say that we couldn’t.”

  Trina certainly must have known something was seriously wrong from the grieving all around her, but she didn’t want to hear it. “Stop saying that, Dr. Davis,” she replied. “My daddy is downstairs.”

  She knew better. She didn’t take her eyes off me, and the seriousness of my face confirmed what she didn’t want to believe. She suddenly began to sob.

  A few days later, I attended Mark’s wake. Perry’s Funeral Home in Newark was packed with flowers and mourners, including many familiar faces from Beth Israel. I sat in the back, full of sadness, looking at a large portrait of Mark sitting on an easel next to his oak coffin. The image in that picture was the one I would carry in my memory: Mark in his oversized white T-shirt, long dreads, and that wide, perfect smile.

  My caffeine runs at the hospital were never quite the same after that. I missed my friend, and every time I walked into his old spot, I couldn’t help thinking: another young brother, gone too soon.

  Things People With Asthma Can Do to Manage It:

  • Have an individual management plan (a written action plan developed with your doctor) containing:

  Your medications (controller and quick relief)

  Your asthma triggers (the environmental or other factors that cause your attack)

  What to do when you have an attack

  • Educate yourself and others about how to reduce your risk of an attack:

  Reducing your exposure to house dust mites

  Use bedding encasement

  Wash bed linens weekly

  Avoid down fillings

  Limit stuffed animals to those that can be washed

  Reducing humidity level (between 30 percent and 50 percent EPR-3)