All That is Left is the Air

ROSE HAD ALWAYS been a profoundly uncurious person. Which is not the same thing as being stupid. Conventional you would say. To be frank, she went into medicine for the money. Yet, the allure of convention also prompted her to become a doctor. Medicine is prescriptive, not only in terms of the prescriptions doled out to the patient, but also in the actions dictated by the medical canon for the physician. Protocol. There is a protocol for everything.

“How was your day, honey?” asks Vincent, as he gingerly shuts the door in a measured fashion on the cold gales that threaten to snap it out of his hand.

“My feet are killing me but other than that I’m fine. You?” Rose fibs. At the clinic, she runs between examination rooms, rarely sitting down. But the pressure on her diaphragm making it increasingly hard for her to breathe has nothing to do with that. She can’t bear the thought of putting on a bra each morning. No matter which one she tries, it digs into her rib cage creating a permanent cramp where she’s never felt one before. But she doesn’t want to worry Vincent.

“Before me, how is our little Bougie?” Vincent asks as he lays his hand gently on Rose’s protuberant stomach and their baby, so named because the first time he moved it felt like the heat from a candle – a bougie in French – warming and grazing Rose’s inside. It was the earliest concrete evidence of the actual baby (as differentiated from the impact of being pregnant) that Rose could share with Vincent. They thought it an apt, and clever, nickname because the verb, bouger, means to move. Rose informed Vincent that a bougie is a medical instrument used for dilating a passage in the body. They laughed because that worked too, little Bougie was dilating her uterus quite well, in fact.

“Oh, he’s fine. Quiet today. Saving up energy to bother me all night, I suspect,” Rose answers.

Vincent’s eyes light up and the budding wrinkles dazzle her as he smiles.

“Now for you. Were you able to concentrate on your case, or were you distracted again?” Rose asks, flicking her eyes between her husband and the apple she is peeling. She nudges her glasses up with the back of her pinky, the other fingers being sticky-sweet.

Vincent had become a lawyer for the same reasons that Rose became a doctor. This is what drew them to each other at university. They both practiced contentedly for years, judiciously setting money aside. They had a stately apartment in the old part of Limoilou, a gentrified neighborhood in Québec City, and a chalet in the Eastern Townships, close to where Rose grew up in Sherbrooke. They had planned to build a significant nest and then have two children, ideally a boy and a girl.

Vincent dealt with cases that had precedents set decades, if not centuries ago, and he carried them out brilliantly by not deviating from the playbook. Recently, though, he began to take interest in cases – not his own – on the margins of legal practice.

It all started with the case brought against the Canadian government by fifteen kids and teens in 2019 alleging that Canada’s greenhouse gas emissions are not compatible with a sustainable climate. At first, it was in jest because of the case’s title: La Rose et al. v Her Majesty the Queen. Vincent liked teasing Rose that next she would be getting into a fistfight with the Queen – a teetering old lady up against the CrossFit training, young physician.

Then one day in early 2020, Vincent came home with altogether more information about the case than Rose thought necessary. He was animated by the technicalities of it, excited by the twists and turns. Rose had never seen him that way. As they huddled in the intimacy of their four-poster bed that night Vincent shared, “I hadn’t anticipated that my trade was also an art.”

Throughout the pandemic, his exploration only grew, and he began to research obscure cases from across the country on those long quarantine nights with the wind howling outside against the stone façade of their apartment. While he remained devoted, Rose felt that they were drifting apart somehow. It was time to launch their common project of the perfect 21^st-century family. Rose got pregnant in the blink of an eye, and here they are in November 2021 with her going on seven months pregnant.

“Oh, yes,” Vincent replies to her query about his day, “but what a slog, I mean how many couples are going to get divorced this year? It’s all the same too, ‘he didn’t…’ ‘she wouldn’t…’ Most of it’s navel-gazing if you ask me.” This is nothing that Vincent would have said just two years ago. Rose clears her throat and fastidiously tidies up from her snack, wiping and rewiping the counter where a few drops of apple juice had fallen. Without the periodic office get-togethers that were common before the pandemic, she feels she doesn’t have the pulse of what’s going on at his work.

Rose quickly changes topic. “What’s for supper?” she inquires as her blonde bob falls coquettishly from behind her ear, tickling her cheek.

“There’s a lasagna in the freezer. Your favorite,” Vincent says, raising the wine glass she had handed him in salute to her.

Just as Rose had thought, her night is piecemeal. As she uses the side of the wall to heave herself out of bed and then the ledge of the sink to lower herself onto the bowl to pee for the umpteenth time, her hamster kicks in. This hamster had implanted in Rose’s brain right about the same time that Bougie implanted in her uterus as a zygote. Rose had never been a very anxious person. Privileged, smart, sure of herself and her ambitions, and pretty, she had breezed through life with no setbacks. She certainly didn’t look for obstacles. But since getting pregnant, she’s started to worry. Would they have time to finish the baby’s room before he came? Would Vincent fall deeper into the rabbit hole of eccentricity? Would her mom be OK in the CHSLD they put her in?  When would this pandemic end and would she and Vincent survive it, or would they fall prey to the syndemic, all those parallel pandemics that Covid was provoking, like divorce? 

ROSE AWAKES TO the aroma of coffee, the only thing to tell her it’s morning, it still being pitch black outside.

“Votre lait au café, Madame.” Vincent mimes a demure bow as he hands her warm milk with a hint of coffee.

Rose pats the edge of the bed and asks, slightly apprehensively, “What are you working on today?” He had stopped telling her much about his actual work.

“Well, between my disputes, I think I’ll have time to look further into your case,” the moniker he’d given La Rose et al. v Her Majesty the Queen. Rose bristles inwardly, feeling uncharacteristically hapless but gives Vincent a wane smile. Ton cas, as if she could ever be the undoing of him, which is exactly what she thinks this nonsense might become.

As they slowly prepare for their days, Rose admires her husband from across the kitchen island. “You look so smart in that dark suit.” Rose smiles. “It sets off your skin and highlights your hair.”

As they part, Vincent kisses her gently on the lips, one hand on her chin and the other on her stomach. Then, the father-to-be squats down earnestly to kiss Bougie and whisper something to him in French that isn’t quite audible to Rose.

As a family doctor, her appointments are routine and rushed by necessity – the government requires her to see fifty patients per day. She keeps her questioning strictly on the condition being consulted for, even though parents are always trying to sneak in other concerns. She deliberately avoids looking for associations outside those offered by her textbooks and only feels a pang of guilt when the parents themselves bring up possible outwardly spiraling webs of connections. But with the next patient conspicuously coughing outside her consultation room, it’s easy to push down that feeling of culpability. Someone else’s discomfort could perhaps be immediately relieved.

Fifty family units in varying degrees of distress later, she’s on her commute home. Her turn to cook supper, but with what energy? The excess of get-up-and-go from the second trimester is a faint memory and she feels like a dead weight. Especially in the waning light of November. Pasta with sauce from a jar. Vincent wouldn’t complain. Or, not about the supper anyway. His legal interests are slowly turning into indignation, working him up into a frenzy that often surprises, and increasingly disturbs, her.

Sure enough, Vincent is incensed like never before. “This time, the fight is right at our doorstep, Rose! There’s inside talk that the provincial government will be putting in a resolution to raise the allowable levels of nickel in air from 14 nanograms per cubic meter to 70! Limoilou is already a hotspot, and because they want more nickel through the port for batteries, it’s just going to get worse.” Vincent shakes his head, his dark hair falling forward and framing his pale skin perfectly. Rose is eying him with both desire and apprehension, biting the inside of her lip in a newly acquired habit that she’s already tried – and failed – to quit multiple times.

“Can you believe it? They’ve gotten the Direction de santé publique de la Capitale-Nationale to come out in favour of this, balancing our health and the environment with economic considerations, of course. Which equation did they concoct that weighs economic factors so much more heavily than our health? N’importe quoi,” he vents.

This time Rose stops in her supper preparations. The city’s public health authorities came out in favour of raising nickel levels? A known carcinogen?  That doesn’t make sense. Rose raises her eyes to him instinctively, but just as quickly lowers them to her saucepan watching the steam rise on the very air they are discussing, afraid that the slightest show of interest will encourage him.

“Furthermore, they all said that they were going to work together to lower levels to improve air quality. Why raise the limit if you’re working to lower current levels? And why do any of this if you know that air quality needs to be improved?” He’s now gesticulating in his characteristically Québécois way, hands fanning from his sides to in front of his torso in rhythm with his speech.

Rose hadn’t taken the health research path – that would have involved asking too many questions – but the hospital where she practices houses a research centre, so many of her colleagues do conduct research. She knows what most of the people drawn toward research are like: skeptical, inquisitive and, above all else, analytical. How did they buy the economic argument? Rose doesn’t have to ask the question out loud.

“They’ve registered twenty-three Glencore lobbyists with the government! Do you know how much money those people have? Glencore, that’s the company providing all the nickel for the batteries for the electric car boom. And they want to expand their operations,” her husband elaborates. Vincent has, of course, said thank you for the meal and that it’s delicious, but Rose doubts if he tastes anything but bitterness.

Rose thinks of her colleagues, perpetually on the cusp of burnout. She thinks of her patients, primarily working-class families who can barely put together the semblance of an organized family life, despite their best intentions, let alone follow through on the treatments she prescribes them. There certainly aren’t twenty-three of them throwing thousands of dollars at persuasion, urging the government to reweight the equation in favour of health – human or environmental. This schism seems insurmountable, folly to even try.

Rose is too exhausted to voice these thoughts. She slumps down into her seat and shovels the pasta into her voraciously metabolizing body. A good night’s sleep is what she needs, but now she had one more thing to worry about – how are the increased nickel levels going to affect the health of her patients, already suffering from unprecedented rates of childhood asthma and respiratory cancers? And all the ramifications of this? School performance, inability to exercise…it goes on and on. Rose can feel her hamster scratching at the edges of her comfortable reality, roughing them up. And she doesn’t like it one bit. Instead of being vexed at the Government and Glencore, Rose is annoyed at Vincent for disrupting her sleep with preoccupations that are beyond her control.

The next day at work, the nagging new information taints every coughing spell she witnesses, and there are a lot of them.

After their full workdays, they’ve planned to make the trip out to the cottage. Heading south on a Friday out of Québec City is notoriously slow going. Usually, they put on some music and amiably talk about what they’ll do over the weekend, but this time there is a loaded silence, just the hum of motors reverberating off concrete. Rose can feel her stress level rising rather than tapering off as it usually does on this ritualistic route. It’s as if the stepwise nature of her workday had allowed her to stave off some sort of lurking anxiety, which is unleashed now that there are no barriers posed by busyness.

The classic advice for stress is to breathe. Rose closes her eyes and begins some deep breathing exercises. She knows, of course, from her elementary respiratory health class that deep breathing means that you’re bringing in a greater volume of air through your lungs. This is usually presented as a good thing. But by breathing more deeply, isn’t she also inhaling more pollution from the neighbouring cars? Neither her textbooks, nor the baby books she diligently reads, address this topic. She takes walks because it’s good for the baby. Eats impeccably because she’s supposed to. Sleeps eight hours, talks to Bougie, plays music for him. And she’s supposed to reduce her stress, so she goes to the cottage, but by doing so, steeps in smog for two hours to get there. Contrary to feeling calmer, Rose is getting more and more agitated by the minute. She decides to break the silence.

“Vincent, do you think that the higher nickel levels could harm Bougie’s health?” Rose releases her fear into the space between them.

Vincent’s gaze leaves the stationary bumper in front of him as he looks at her from the corner of his squinting, brown eyes. He makes an expression that Rose has never seen before, somewhere between worry and pride, if those can coexist. His hand automatically goes to Bougie.

“I don’t know, you’re the doctor. But I do know that they are not considering Bougie’s health in these calculations. Or if they are, they are diluting it with a whole lot of mumbo-jumbo about economic benefits, as if those same children who get asthma will be so much better off financially because a company got richer. What is the point of having regulations if you can just up them for a profit?” Vincent has apparently also been holding in thoughts on the topic.

Vincent’s job involves talking – a lot – and more specifically, using arguments. Rose feels decidedly uneasy in this position. She resumes her silence but does not return to her deep breathing.

After unloading the groceries and suitcases from the car, they briefly open the mullioned windows to flush out the week-old air. Rose keeps Vincent company while he prepares steak et frites. They play their favorite soft jazz while eating a candlelit supper. After the meal, they move to the living room and have their first fire of the season. The soon-to-be parents lay together on the beige throw rug, Vincent holding a glass of Cabernet Sauvignon, while Rose’s hand lilts slightly to the jazz notes wafting in from the other room. If you had asked Rose ten years ago to describe where she would like to be in her thirties, she would have described exactly this. Yet. Yet something is off, and it isn’t Vincent.

Rose turns to Vincent and asks him, for the first time, a pointed question about his new passion, “What avenues does the law provide for protecting human health from pollution? What have you been learning from those lawsuits you follow?”

Vincent rises on one elbow, his bicep visible through the T-shirt he has stripped down to in front of the fire, beaming down at Rose. “Well, unfortunately, not enough, but there are some promising cases. Do you really want to hear about them?”

In the hour that ensues, Vincent shares a wealth of knowledge that Rose had only seen the tip of in their superficial conversations at the bookends of a day. He tells her about countries that have given personhood to rivers or enshrined the right to a healthy environment in their constitutions. With gusto, he regales Rose with stories of people trying to make ecocide an international crime. He tells her that Québec is one of the few places to have anti-SLAPP legislation, SLAPP being Strategic Lawsuits Against Public Participation. Intimidation really. But he also shares his worries. He doesn’t know how, for example, to begin to fight against the influence that the industry has on all levels of decision making. Rose has been hoping for hope, and Vincent’s monologue does provide some of that, but unfortunately, it brings with it more questions than answers.

THE FOLLOWING DAY is one of those November days, grey. Nonetheless, after breakfast, and Rose’s disappointing, but better than nothing, decaffeinated café au lait, they take their customary walk around the lake. The leftover pumpkins from Halloween have been smashed, but haven’t frozen and thawed yet, so those that haven’t been kicked to oblivion, hold their vessel-like form. They make Rose think of a placenta. For the whole month of October, they keep safe a candle, une bougie, a child’s wish for a well-loved costume and a bountiful candy haul. It’s really all that a parent wishes for the little candle harboured in the womb – that they are well-loved and well-provisioned.

MONDAY IT’S ONE piece of bad news delivered after another. Diagnosis of childhood asthma, malignant tumours, even bloods showing signs of leukemia.

At this time of the year, the sun sets around 4:15 and by 5 o’clock when she leaves the hospital it’s already pitch black. The wind has picked up and the rain bears down. All Rose wants when she gets home is a glass of wine, but that, of course, she will not indulge in.

When Vincent tramps in, he is drenched from head to toe, water glistening on his goose feather-filled, black jacket. Rose surprises both of them when she leaps up to greet Vincent at the door with a very intentional hug before he has even removed his sopping coat. After a bit of coaxing, his worry imprinted in the creases of his forehead, Vincent finally gets Rose to share some of what she’s feeling.

“Vincent, I just feel this pressure, this pressure on my lungs, it’s like one of those trees we saw on our vacation to Cuba, like the guide said about the vines that strangle the tree that initially supported them. It makes breathing difficult,” pants Rose in evidence.

“What do you think it is?’ asks Vincent, concern tinging his usually confident voice.

“It’s partly the bulk of Bougie and the womb, but it’s not only that. I’m…worried. And I know that’s not good for Bougie.”

“What are you worried about? You’re doing everything right, my love.”

“Somewhere, I know that. But now…and now I’m worried about something that is completely out of my control.”

Vincent just holds her, listens and nods. He doesn’t tell her to look at it another way or to lighten up. He simply says, “Nous sommes ensemble.” We are in this together.

TUESDAY THE RAIN stops but it’s still grey. Rose decides to walk to the hospital instead of taking a stroll later on. It isn’t that far, really. It’s 7:30 when she leaves the house, and the sun is having a real time of getting above the horizon. Post-Halloween pumpkins litter this neighbourhood as well. One specimen has been carved into the likes of a murderer on the scene of a crime hovering over the mutilated victim – its own innards, which have been eviscerated into a pulp and are lying next to the shell. The pumpkin flesh reminds her of some of her patient’s lungs, all roughed up with lesions. And the pumpkin itself, the battery company. She feels like coming back with a poster saying, ‘these are your lungs on air pollution.’

About midday, a mother comes in, fretful, and the child, doleful. “She just doesn’t have any energy anymore,” the mother begins, her hands flitting nervously in front of her while her daughter sits lethargically by her side, eyelids half-shut as if to emphasize her mother’s point.

“Hmmmm, well, can you tell me what she was like before?” Rose gently prods, tucking a strand of her pale hair behind her ear, where it’s just barely long enough to stay.

“She was such a happy, energetic kid. Almost too much so,” the mother explains wistfully.

“What happened?”

“She got this darn cough and now she’s, like, sleepwalking. She’s also got rashes and no appetite. I don’t understand.” The mother laments, while raising the child’s sleeve to show a raw, red patch on her daughter’s arm near the elbow. Eczema.

Rose is facing respiratory, dermal and digestive complications all in one. Where to begin?

Rose leaves the girl’s file on the counter where she had been standing and sits heavily in the unused desk chair. She zooms out, “OK, can you remember back to that cough? What was happening right around that time? Where did you go? What season was it?”

“Well, it was weird because it was summer, not cold season,” begins the mother. “There was a heat wave and a smog warning and we had brought Ally to a splash pad to cool down. That’s when it started. I thought maybe the water wasn’t clean, a fungus or something because of the rash, but then the cough…it didn’t make sense. Her tummy started hurting not long after. And, well, she’s had all that ever since, five months now.”

Rose still has her pencil with her. She taps the eraser end ever so lightly on the desk, meeting the mother’s worried eyes. It is curious. Rose had been taught the body systems separately. They were compartmentalized. Very little emphasis put on integration, but they’re all working together in the end. Other structures also know how to collude – like the government and the industry…

On her walk home, her first pedestrian, post-work commute, Rose catches herself repeating her upcoming evening conversation with Vincent over and over again, saying the same things about her day, fretting. Until she can’t handle it anymore. She chides herself, Stop reciting! To keep the obsessive rehearsal at bay, Rose observes the wildlife, what little of it there is. In November, after the abundance of the harvest season, Rose muses, one can turn around and around, use a magnifying glass and binoculars, all the tools of science and all one will find in cities and towns are the crows, chickadees, the occasional cardinal and the squirrels with their nervous, wind-like energy. What sustains them?

At home, Rose chooses to share her zoological observations with Vincent, rather than her worry. “When it comes right down to it, we really think of birds as land animals – they fly through the sky from one point to another, but the in between is given less thought than the two end points: their nest and food source. Even the ocean, as vast, foreign and incomprehensible as it is, gets more attention than the atmosphere, air being invisible.” Rose pauses for a breath of it. “Come to think of it, even we are much more in the air than on land with only the soles of our feet touching soil and the rest of our body rising up. We bathe in air for our entire postpartum lives. Bathe, see, even that is a word that references water, not air.”

Trying to make it sound spontaneous, although the words had been carefully curated, Rose offers her growing qualms about pollution, “Take Covid. Covid’s made us, for the first time, collectively notice the air. People turn their heads when passing on the sidewalk instead of looking toward each other in greeting. But, in order to rid the air of SARS-CoV-2, we fill it with cleaning supplies and off-gassing plexiglass.”

“Exactly. We’re so short sighted.”

“Pollution is invisible and its link with illness is too. There’s no lingering antibody I can test for to demonstrate that a patient was exposed to nickel in childhood.” Rose tells Vincent about her frustration in the face of the young girl’s mystery ailment (or ailments). “Shouldn’t the law be there to protect us from potential harm?”

Vincent takes up Rose’s clammy hand in his. He continues to use it to emphasize points about the legal conundrums of the precautionary principle and the tragedy of the commons, their hands floating through the space between them together. As he guides her through these concepts governing collective usage rights, she feels like an uninitiated tennis player being gently instructed in swing technique on a first date.

THE MENTAL LOAD associated with being the perfect vessel for Bougie preoccupies Rose on her Wednesday commute. It seems incongruous to her that so much effort and thought is put into chastising women to keep the environment in the placenta healthy and then, on the other hand, how little care is taken to safeguard the environment that the baby is ejected into one portentous day.

On Rose’s lunch break she steps outside. It had been a rough morning. She’s hoping for a pick-me-up. The weather is still decidedly grey, but the sun is trying. Clouds hang in the sky like a high ceiling. The pale, southerly sun softly penetrating the stratus clouds and leaving their underbelly a creamy butter colour.

At supper it’s Rose’s turn to be indignant. “We cringe over other cultures having sacrificed members of the community to the gods, the Incans and the Aztecs, thinking ourselves so much better, so much more “civilized.” But are we really? We know for a FACT that 6.7 million people die from air pollution per year¹. Millions, Vincent, millions of people die per year directly because of air pollution. Is that not a sacrifice to the gods of the economy? Does it make it any better that we didn’t single out the people who died? Perhaps we didn’t name them off individually, but we do select who gets the brunt of the pollution. It’s the poor, and, most often, visible minorities. We have no moral high ground to stand on.” Vincent can’t agree more and this evening he does most of the listening.

THE WEEKEND COMES around again, and they make a sprint for the country, as much as you can while stuck in traffic. Instead of going around the lake, Rose and Vincent decide to take a walk along the railway tracks. Railroads the province over have the same look – scraggily strips of vegetation where wildlife concentrates. The vines like to grow up the fences every which way leaving a chaotic look when the leaves have fallen, almost like a four-year-old’s hair upon waking, thinks Rose. The sound of the crunch is not the same as just a few days prior, when it was the desiccated leaves that broke with the weight of each step, many light, airy noises in sequence. Today it is the ice crystals that had formed overnight all around the detritus layer that are giving way under Rose’s body mass as she assumes her stride. The ice has formed throughout the leaves but also into the first tier of soil, so that the sound is one uniform opening, a ceding of the new matrix, unifying the already decomposed leaves from years prior and this season’s new contribution. A welcoming into the fold. They walk in silence, or rather, in the murmur of the ephemeral ice medium yielding. A discarded Remembrance Day, red, felt poppy pin poking out from under the leaves brings Rose back to the subject that has been gnawing at her for the past week and a half. It’s a commemoration of the lives lost in WWI, and so the link with harm and death is obvious, but to be honest, recently almost everything makes her think of the risks associated with where they live, the activities going on there and the interests of a select few.

“Without operative matrices – the air, the water and the soil – everything else breaks down,” Rose begins. “Functions, like those that the respiratory system is responsible for, deteriorate in stride with the breakdown of their matrices. Only when there is a spike in the rate of decline do we notice it. Like smog, or Covid. Especially since some matrices habitually shut down. The soil will be inert for the next six months, off duty. The water, well, it will be virtually out of commission, a frozen hiatus.” Vincent smiles.

Rose continues unfurling, “Boxes, Vincent – as humans we put things in boxes to more easily understand the world – circulatory, respiratory, digestive system: air, soil, water. But we obscure the overlaps, the interconnections and the blending of them.”

“You’re becoming a right philosopher, Rose,” Vincent teases affectionately.

Pleased, Rose chuckles, spluttering a bit, and brings her mitten to her nose. “Take, for example, roots – they are buried in the soil, but they also require air and water. If you look for the connections, the barriers melt away.”

The day chimes in in favour of this point: it was again a suffusion of grey – no barriers between one shade and the next.

What Rose needs less than the tedium of the bleakness, though, is drama. That night, after softly blowing out the vanilla candles that have proliferated in their surroundings in the past few months – Rose’s procurement pattern approaching mania – they lie in bed listening to the wind steadily build, relentlessly beating the house from the west. Rose has always loved the electric exhilaration of a storm building. Vincent is rubbing her lower back where it has started to ache whether she’s on her feet at work or reclining at the country house. She’s curled half on her side, one knee up to create space for Bougie, the opposite shoulder tucked toward Vincent. This position gives her a view out the window, and although it’s dark, she can see the shadows of the branches swaying ever more wildly.

Their excitement turns to worry when a branch from an aged and towering Manitoba Maple begins to knock at the window. The tree is too far away from the house for the branches to touch the gables in normal circumstances. Vincent has alternately sung it praises and scorned the tree since they bought the house. He often chuckles when he sees it, imagining faces in the knobbly knots that stud the sloping bouquet of trunks. Last summer he even attached some riffraff strategically to the trunk to highlight the appearance of a wizened grandfather that he couldn’t help but see. But Manitoba Maples are notorious for their instability. Multiple times he’s had ‘obtain a permit from the city’ to have it taken down on his list of things to do, but he’s never had the heart to carry through.

Knocking grows to pounding, Rose’s heart rate keeping pace. “Vincent, I’m scared.”

“Merde,” swears Vincent and continues under his breath, “I knew I should have done something about that tree. Rose, we need to move. Vite, tout de suite !” In her condition and that position moving quickly is out of the question. Vincent is already up and standing at the side of the bed, offering his hand, which she can’t take. She struggles to shift her body fully to the side, freeing the stranded arm. She uses it to push herself up and feels a jolt of pain in her lower back and down her sciatic nerve, which she ignores. The floorboards are cold on her bare feet, but Vincent’s hand is warm as they make their way across the room just as the tree comes crashing through the roof in a spray of glass onto their bed.

Huddling on the floor of their room by the door, Rose panics. Her breathing picks up and she recognizes the signs of hyperventilating. She can feel her face flush, the skin prickling under a stretching, a deformation. The sweat somehow emerges through the tectonic plate forming on her forehead. But she can’t seem to lift her trembling hand to wipe it away. She is slumped to the left, propped up against the wall, and she can feel her heart pounding against gyprock. She imagines her heart as the wrecking ball that will bring their house down, surely their only option.

Her mind is very consciously telling herself to calm down, to slow the breath, and she registers that Vincent is doing the same somewhere far off in that outside-of-herself place. But she can’t get control, she just can’t. The more disenfranchised she is from her own bodily performance, the more rattled she becomes.

Rose’s attention is almost exclusively on her breath. The inhalation simultaneously everything – her concentration on that alone – and nothing – never enough to convince her that she can let go. She feels her lungs expand, brushing up against Bougie’s mass, but she can’t push the breath throughout her body, can’t get enough oxygen into her and Bougie’s blood stream. She acknowledges at some point that Vincent is on the phone and the next thing she knows their property is engulfed in sirens – both the fire department and an ambulance. The only other thing she notes is the rain coming in through the roof. She’s not directly under it, but she can feel the plumes of mist emanating off her bed where she had been not minutes ago.

Vincent never leaves her side; he turns his back entirely on their roof and follows the paramedics into the living room with her, leaving the structural aspects to more competent hands. In a moment when her thoughts are not consumed by respiration, it occurs to her that he would have made an excellent nurse. But even that doesn’t help her come up for air. She also registers the protocol that the paramedics are adhering to in snippets, like an old film that jumps awkwardly and abruptly from one scene to the next. Here they are checking Rose’s vitals, there they are administering oxygen, a splash of cool water. Throughout the entire procedure, one paramedic monitors Bougie’s heart rate.

In the end, it is the familiarity of these conventions that calm her. Her mind eventually latches onto the paramedics, their fluid movements, their reassuring tone, the fluency of their medical speak. Rose begins to clench and relax her fingers, then her hands and feet. She does the same with her arms and legs, slowly massaging them back into submission. It’s about an hour before she feels she is the proprietor of her own lungs again, at which point the structural soundness of the house had been regained through a series of temporary props. The wind has died down in the meantime. Vincent helps her into the guest room, one hand firmly supporting Bougie’s weight from the crease of the hip flexor and the other clamped around hers. Rose drops into the bed beside her husband and has one of the most restful sleeps of her pregnancy.

CONTRARY TO WHAT one might expect, the next morning Rose feels more solid than she had the impression of being in her third trimester to date. She senses Vincent eyeing her, watching for any signs of a relapse or permanent damage, without wanting to demean her. What Rose mostly feels is empathy and solidarity with the countless asthmatic patients in her care. And a tinge of remorse that she hadn’t been able to offer that as yet. In every crisis, there is an opportunity.

The day starts out the usual grey, but as they walk, the humidity evaporates leaving a piercing blue sky. It’s as if someone has plucked a load off the back of Rose’s neck, an affliction of worry and mental agitation that Rose harboured and that made her stoop, as if the low hanging clouds had been physically pressing down on her, making her withdraw. The cold is welcome, the bright blue December-like day a relief from the dozen or so previous days of gloom.

The sun, now unfettered by clouds, picks up the subtle colours of the landscape and reflects them back to Rose, who, for the same reason, is better able to receive them. She notices the green mosses on the tree trunks that must have been there the day before. She wonders at their resilience. The fallen leaves are not quite a sodden brown mass yet. There are still hints of the reds, oranges, yellows and greens of October peeking timidly through. The frost lay more thickly on the surfaces of things than it had the day before, adding a flash of white. The switches of underbrush glow with a rose colour tint that spans the extent of the wooded band, the red just barely suffusing the frost. Where the shafts of sun penetrate the veil created by the bare branches, the ice is beginning to melt already. There’s a pale yellow, the colour of her hair, still clinging to the frost-bitten grasses. As the breeze makes a lock of her hair flutter in front of her face, it could be a stalk of that meadow, so much they sway the same, prompting Rose to remark to Vincent on the movements and sounds of a not quite frozen habitat, one that would soon enough be in hibernation.

They’re on a stretch of railway that continues past Rose’s childhood home. She used to play in the scrapy woods on the edges, never quite daring to go too close to the tracks. “You know, I really feel like I belong here. I feel of this place, of a piece with the surroundings,” Rose confides.

“I feel really good here, too. I’m glad you seem to be thriving today,” Vincent adds.

“You know, that’s it, Vincent. In medicine, we focus so much on surviving, we forget about thriving. I hadn’t realized either that my trade ought to be an art.” Rose comes full circle.

Back at the chalet they tarry over a hot chocolate, Rose both reluctant to leave and anxious to get into the hospital. They leave with just enough daylight to see the setting sun glinting off the galvanic wind turbines that have popped up on the landscape in recent years. They certainly have their raison d’être in November.

ROSE TAKES THE long way to work. In a park she spots the “arm” of a tree growing horizontally close to the ground and is monetarily tempted to walk it, but her stance on risk gives her pause. On a whim, though, she decides to do it anyway. It’s only about a foot off the ground, but taking that risk allows her to see that her love of conventions and being conventional has been about reducing risk. But in the context of others not being so judicious and basically risking the health and wellbeing of her child, she can no longer comfortably sit back and write out prescriptions for asthma medication. She must take a stand. That is health care.

During a break at work, she ventures into the comparatively calm research ward of the hospital. She knows that some doctors and affiliated researchers have labs there and that they are slowly filtering back into their offices after the long months of Covid lockdown. One of the research streams is in ecosystem approaches to health. Rose is curious. What did they have to say about the rumours of raising permitted nickel levels? What impacts would that have? And what, as doctors, could they do?

Her lengthy conversation with a charismatic and energetic researcher based at the Université Laval gives her the hope she has been yearning for these past weeks. There’s a group of doctors coalescing around the issue through the Canadian Association of Physicians for the Environment.

On her way home, with contact number in hand, Rose observes how thin, yet piercingly present, the air is. Walking vigorously – as one does in the late fall in the North – whips up tendrils of excited draughts that spiral off one’s being into the ether. Rose feels vivacious and inspired. In that moment, she catches sight of the season’s first snowflake, a stray. She scrutinizes the air to find another, and another. The wandering snow floats as much up as it falls down. Rose thinks, in November, after the last tenacious leaf has fallen, seemingly, all that is left is the air.

¹ Fuller et al. (2022) Pollution and Health: a progress update. The Lancet Planetary Health. 6:6; E535-E547