The third-floor off-campus apartment where I’d failed to live had no buzzer, making it hard for my friend Laura to let her visitors in. That’s what I was, our junior year in college: a visitor. Not the roommate she’d asked me to be, not the one she called out to in the middle of the night when thick, sticky mucus caused by her cystic fibrosis–a genetic disorder she’d lived with her entire life–clogged her lungs and made it impossible for her to breathe.
When I came over, she would tie the key to a small metal airplane and throw it out the window. Coming back from coffee or a movie, the walk up often made her cough until her eyes dripped and she had to sit down. I would hover on the step below her. Red blotches stained her chalky skin like circus makeup. I was nervous for her, of course, but I was also afraid that if she stopped breathing, or coughed up blood, I wouldn’t know what to do.
Was it a small metal airplane? Maybe I have it wrong, and if I’d lived in the apartment, then I would remember. There wouldn’t be any question. The airplane would be a fact of my life, as would the steep stairs, and the knotted floorboards, the blood-soaked coughs, the building where Laura spent the year after her double lung transplant, the last full school year of her life.
Six months before the transplant, I sat with Laura at Rue de L’Espoir, a breakfast place named after its Hope Street address. In Providence, the street names choked with meaning. Friendship. Benevolent. Power.
We were halfway through sophomore year in college. Laura and I ate often at Rue, even though its farm-fresh menu, and brunch in general, were not in my budget. Although my background was more than comfortable, I spent the first half of college struggling to keep up with high-rolling peers: New York weekends, houses in the country, debutante obligations. With Laura, though, the spending felt urgent. Digestive obstructions often forced her to eat through an IV, but on that day, she could have whatever she wanted, and it offended her that I might not join in the pleasure. “Eat!” she commanded. “Don’t just get a muffin again.”
I dutifully ordered sweetbread French toast. Laura had that effect on people. She bossed, and we did what we were told. Bossiness had been a matter of survival for her. She grew up in hospitals, where if you weren’t careful, some unthinking resident might prescribe a regimen that would swell your face like Water Wings, just in time for junior prom.
We chatted about Laura’s recent decision to go active on the transplant waiting list.
“I’m pretty much guaranteed lungs,” she told me, leaning in over her coffee. “I’ve been on the inactive list my whole life, you know.”
The transplant had been haunting Laura for a long time. A lung transplant isn’t a cure; it’s a last resort treatment for already failing lungs. But if one waits too long, the body might become to weak to handle the new lungs. The risk of sudden rejection, when the body reads the new lungs as invasive and refuses to accept the air they might provide, is greatest during the first few months. More than 80 percent of lung recipients survive the first year, but only 51 percent make it past five. The life-long course of immunosuppressants that is necessary to prevent rejection leaves the patient at risk for lung infections, lymphoma, and cancer. So as we chatted casually about new lungs, as we might talk about a new pair of boots, on some level, we were also talking about what might be the beginning of the end.
“You name it, I’ll try it,” she said, dumping four packets of sugar into her coffee and scanning the menu. “Look at this deliciousness. Feta! Spinach!”
“Are you coming back to school in the fall?”
“Funny you should mention that.” Laura slapped her palms against her chest. She wore silver rings on all her fingers, which were clubbed from low levels of oxygen in her blood. Her fingertips looked like little ET heads. “Do you know that you can only get permission to live off campus before senior year if you are married?”
“Oh?” I said. “Who’s the lucky man?”
“Right.” She snorted across the rim of her mug, causing coffee to splash up and spackle the inside of her nose. Laura laughed louder as the waitress cruised by with narrowed eyes, seeing us as just two more hungover Brown students, breakfasting on our fathers’ dimes. Laura looked at the waitress and winked at me.
“Ma’am,” she said, between gasps. “Can I get a warm-up?” The waitress sulked away and Laura erupted. At that point I was laughing, too. Wheezes and coughs peppered Laura’s laughter with greater frequency.
“Okay,” she said, working to convince herself that the joke was over. “Okay.”
I slid my water across the table, but Laura was already gulping hers. When it came to the daily rituals of cystic fibrosis, she anticipated her own needs much faster than I could. I never wanted to ask Laura too many questions. Acronyms peppered her talk, and I would search them later on Yahoo. Chest PT meant physical therapy, or a trained professional beating her ribcage, to dislodge the mucus in her lungs and keep them open for air. So that’s where they came from, the bruises I sometimes saw on her skin. I couldn’t keep up with her premed friends, who talked PFTs and bronchoscopies and sodium levels as if it were their native language.
I wanted to be her friend, not her doctor. But because of this, I kept the actual facts of Laura’s illness at a distance. When she talked about CF, I nodded in agreement, pursed my lips in concern, although I didn’t always follow. I was scared of failing her, so when I had questions, I never asked.
My act, it turned out, was working.
“In all seriousness,” she said, “although I will not be getting married this year–” Here she started to giggle again, but then swallowed it, her signature choice between mirth and coughing. “Next year I get to live in a real apartment.”
“Oh thank God,” I said. “If they made you live in the dorms again that would just be ridiculous.”
Laura’s time in the dorms had not been typical. At Rue she was healthy enough to order the Greek omelette, but the previous year she’d needed a feeding tube in her room. Instead of using intravenous needles, she had a Port-o-Cath implanted in her chest, just under the skin. I might chomp down a Luna bar on the way to class, or slurp at the stash of single-serving yogurts I kept in my mini fridge. But when Laura needed a snack before discussion section, she just jabbed a needle through her skin and into the port. Don’t flinch, she seemed to be saying, as she pinched the plastic wings of a Butterfly needle and inserted it into the raised surface on her chest, I dare you. If you wanted the grace of her company, you had to keep up. Scars seared into her skin from previous ports, which had been badly installed and then infected. Our aimless classmates would sometimes wander in by mistake, stoned, or otherwise unprepared for the sight of Laura, blouse unbuttoned, with a tube in her chest.
“I can’t believe you have to be married to get off campus,” I said. The waitress returned and topped off Laura’s coffee.
“I know,” Laura said. “It’s so old school. Like, we might be having sex or something. Because no one has sex in the dorms.”
“Oh no,” I said. “No one.”
Actually, neither Laura nor I had been having much sex since arriving at college. Laura was a rigorous flirt, but nineteen-year-old aspiring poets and presidents can’t always commit to a girl with a terminal illness. As for me, I had yet to develop any semblance of seductive graces. I sometimes talked with Laura about my loneliness along these lines, but felt silly complaining too much. She needed to find the world’s bravest college boy, while I was just an awkward, neurotic girl who thought sexy party attire to be corduroy pants and skateboard sneakers.
“Let’s get down to business,” she said, although I wasn’t aware of any broader purpose to the breakfast. “I need a roommate next year, for after the transplant. And you know what I think?” She grinned and raised her eyebrows. The cold weather gave her translucent skin a rich pink blush. “I think you’re going to live with me.”
I wanted to go back to an earlier part of the morning. Any part: me lamenting my loneliness, me sitting awkwardly through her coughs. Because the truth was, I already knew the answer. I don’t think I’d ever given this answer to Laura before.
“I can’t,” I said, with what must have been a shocking lack of hesitation. And then, because I didn’t know how to explain myself, I reached for the first legitimate reason I could think of. “I want to study abroad.”
“Of course, of course.” Laura didn’t flinch. “Where?”
“Havana,” I said, although I hadn’t given the subject much thought before that moment.
Our food came then, and we didn’t talk much. I may not have fully understood what I was doing or my reasons, but I made a choice that morning. I removed myself from our intimacy, afraid that I would not be able to keep my head above the coming flood.
When Laura was born, people with cystic fibrosis lived to be 18 on average. At 20, when she asked me to live with her, she had already survived the bulk of her CF friends. Although the median age of death had increased to 27 by then, it was unclear how much her life would be affected by the disease’s improving prognosis. We’d met at a writer’s conference in high school. The first night she read poems about coughing up blood, and according to her, I was one of the only young writers who didn’t ignore her after that.
“I have real teen angst,” she said, as we sat cross-legged on the grass. “They’re jealous.”
We talked about our favorite poets, Adrienne Rich (mine) and Theodore Roethke (hers). Laura found Rich’s politics whiny, but she did admit that her books had great titles.
“A wild patience has taken me this far,” she said, pinching the cap from a bottle of sparkling purple nail polish. “Word up.”
When I first met Laura, I thought of CF with a mixture of denial and drama. At 15, my life seemed a series of well-defined landmarks that would unfold exactly as I expected. Laura’s death eased into that list, another simple fact of what would happen in the future. How old would we be when she died, I wondered, with a simplicity that only the most naive can use to imagine the future. Would I have a driver’s license? Would I still be a virgin? Would she?
On the other hand, I didn’t really understand the disease. CF is a genetic disorder that causes abnormally thick, sticky mucus to build in your lungs until you can’t breathe. I didn’t get Laura’s situation in practical terms. Once, I saw her wearing a tee shirt from her high school’s soccer team. I played the sport, and asked if she did too, overeager to have something in common with this outspoken girl who wore frameless glasses long before they grew trendy. “Please,” she said, lifting up the shirt to show her pale belly, which was scarred and distended from a bowel obstruction. “Soccer? You do know that I can’t always breathe.” But that was exactly how I saw it, youthful in both my melodrama and my obliviousness. Laura was dying! I reveled in the dark glamour of the fact, the seriousness it gave my otherwise normal life. I knew that she was going to die, but it took me much longer to figure out that she couldn’t breathe well enough to play soccer. For the next few years we wrote frequent letters, and had coffee when I visited my grandmother in New York. Senior year, when we both were accepted at Brown, she sent me a card with a black and white picture of a small girl blowing bubbles. Congratulations, Abby, she wrote, in her familiar exuberant script. Our friendship is FATE.
During our first year in college, Laura often confided in me about how frustrated she was by our classmates. She took a popular lecture course on city politics, and other students started a vicious thread about the “PS 22 Coughing Girl” on an anonymous Internet forum called the Daily Jolt, where they complained about the disruptive coughing noises and what on earth could be wrong with her. Steamed at the meanness and how they refused to sign their names, Laura responded with an editorial in the student newspaper. “I am completely open about my illness,” she wrote. “I want people to know about it, yet I have found that not everyone deserves to know or can understand once they are told.”
I relished my place in Laura’s inner circle. At college, I had few friends of my own. I was trying on different versions of myself, and none of them fit. Abby the radical! I joined the library workers in their strike against the University, but couldn’t ever reconcile my street stance with the fact that I wanted to check out more books. Abby the translator! I studied theories of literary translation, but wasn’t fluent in any language but my own. I was shouting these postures to drown out my insecurity, and it didn’t exactly win me friends. But Laura called me often, especially when new acquaintances cancelled their plans with her. “Don’t they get it?” she’d say, shaking her head and readjusting a brightly colored scarf over her thin hair. “This coffee date might be the last chance they get.” She showed me poems composed in recent stays at Hasbro Children’s Hospital, poems still too raw and close to put up in class. I always told her what I didn’t like. That’s why she trusted me; she’d said as much herself on several occasions. I treated Laura just like anyone else, not some fragile princess who couldn’t bear to hear it when a metaphor misfired.
But what happens when you get too good at pretending that a sick person is well?
In so much of the time I spent with her, I felt the presence of another Abby sitting in the room. I had to be two people at once. I knew that new lungs or old, Laura would still suffer from CF, and the damage it did to her digestion and nutrition would still weaken her against infections her post-transplant suppressed immune system would no longer be able to fight. In the past, my ability to shelve this kind of information had kept me from obsessing about her death, and letting the sadness of it swamp our friendship. When I decided not to live with her, I may have known, if only in my gut, that now she needed something more honest, something I wasn’t sure I could provide.
I finalized my plans for spring semester in Havana. I bought sleeveless dresses that fit tight across my hips. I attended a Lung Retirement Party for Laura, a sendoff before she withdrew from school to get ready for the transplant. The country was experiencing a lung drought. “Nothing I can do,” Laura would say, fondling the beeper clipped to her belt, “except maybe go hit someone with my car.” She planned to keep her old lungs in a specimen jar. Then, the summer before our junior year, Laura got her call, and woke from her the operation, breathing through a new pair of lungs.
In August, I visited Laura in the hospital on what turned out to be one of her best post-op days. Thanks to the work of a tall, jovial German whom she called the “stent cowboy,” her pulmonary function tests were all the way up to 95 percent.
She tore through the corridor towards me, throwing her hands up in extravagant greetings to nurses and medical assistants. Her father pleaded for caution. “Please,” he said, more to himself than to either of us. “Slow down.” Her face was swollen from the necessary steroids, but she masked her puffy cheeks with a brand new pair of Jackie Onassis shades. She talked about playing intramural soccer when she came back to Providence. She believed it would happen. But in some other version of that happy moment, she must have also known that it would not.
During junior year, Laura sent mass e-mails chronicling her post-transplant battles: rejection, obstruction, anxiety attacks, lymphoma, cancer scares. These updates were addressed to so many people that the archaic computers at the University of Havana couldn’t show the names. “In terms of the PTLPD,” she wrote, “I’ll probably be having CT scans once a month for awhile to keep an eye out for recurrence. Unfortunately the CT scan also showed some new infiltrate in the right upper lobe and one in the lower left, I think. So I’m taking an oral antibiotic for my sinus infection and Vancomycin by IV for the pneumonia.” In these e-mails, I had a hard time sorting the good news from the bad. I didn’t know which drugs helped and which ones made it worse, which part of her body she was even talking about anymore.
Instead of learning about post-transplant lymphoproliferative disease, I was perfecting my Spanish. I could learn it at night, drinking peso rum by the seawall. I enjoyed my growing proficiency. Now I could understand the men who complimented me as I walked down the street. I learned to tease back.
Laura’s roommate back in Providence was also named Abby. When Laura moved into a one bedroom on the first floor of the building to avoid the stairs, she installed an intercom between her room and Abby’s. Abigail wasn’t such a common name in the early ’80s, and the odd coincidence kept reminding me of what I hadn’t chosen. Of how that might have been me, answering Laura on the other end of that line.
It’s not as if I never saw Laura again. Her actual death was more graceful and deliberate than my teenaged self had imagined. But when I came back from Cuba, something had changed. During senior year, Laura withdrew from school. She planned her memorial service and drafted a memoir. She got a tattoo and a dog, because she’d always wanted those things. She had an older boyfriend and they rented an apartment near Union Square in New York.
It became hard to reach Laura on her cell phone. Now everybody wanted to visit. This was it, the final act. This was what you didn’t want to miss. But I knew that I had already missed it.
In order to see her, you had to make an appointment with her mother. I heard grumbling about this policy at school. “Don’t we have a right to just go there?” people complained. “After all that we’ve done?” They wanted to be in on the action.
We passed through in our scheduled slots. The last time I came Laura was on so much oxygen and medication that she could barely speak. Although I didn’t quite understand what she was saying, she asked me to confirm several rumors about who had slept with whom, and told me not to stop writing, no matter what got said in workshop.
Laura died a few weeks later, in her apartment, in the company of her boyfriend, her parents and her former roommate. Abby told me later that the last thing Laura did was to take off her respirator and breathe on her own. I came back to New York for her memorial service, which happened according to Laura’s instructions: poetry, slideshows to Otis Redding, electric guitars, purple programs. The service was on the Lower East Side, in a sanctuary where bright spring sun leaked in through upper windows. Afterwards, I wandered up to Tomkins Square Park, wanting to stay in that light. It was warm enough that the park smelled like urine. Living statues in gold paint and junkies greeted each other. I listened to them chat about the gorgeous weather. As a child from a small town in New England, I’d been terrified by early trips to the city–visions of falling onto a subway track would keep me up at night. But that day New York gave me the feeling that time was already moving more quickly than I could imagine, and that the face of it was going to be electric, maybe harsh, maybe disgusting, but always stunning and alive.
Laura wrote from a relentless need to document her own experience. She’d already written memoirs of her eighteenth, nineteenth and twentieth years and self-published them at the off-campus copy shop. When Breathing for a Living came out after her death, published this time by an actual press in New York, I read it slowly, not wanting to get to the end.
“It’s been three months,” she wrote in the hospital, away from the Providence apartment. “And I hear myself say that and it’s supposed to be a long time. But in the grand scheme of a life, it isn’t. Yet in three months so much has happened to my body I’m not sure I even know it. There was one body before the transplant and one after. And I don’t think you can go through something like that without it affecting your mind. Who am I now? Yet this milestone is not what it was expected to be. I’m still at the hospital every week, getting bronchs, about to be readmitted for rejection therapy. I walk up the stairs and I can’t breathe. When I cried today I started coughing just like before—hacking, even though I don’t have the same nerves to feel my lungs.”
People who had read the book would approach me in awe, mistaking me for the other Abby. “That must have been so intense,” they said, in reference to midnight hospital admits, ambulance rides, or surgeries. “How brave you are. Thank goodness you could be there for her like that.” For years, I thought that Laura had suffered from the same confusion. When she asked me to live with her after the transplant, to be intimate not just with saucy survival but with the possibility of dying, she saw in me some more capable self. You’ve got the wrong girl, I have told them, shrugging. I’m the other one. I’m the girl that wasn’t ready. But when staring down loss and all the other terrifying moments that wreck but also shape our lives, readiness carries us the smallest part of the way. Laura wasn’t looking for the magical twenty-year-old who knew how to deal with death. She was looking for someone to say yes.
