Chapter Ten

The city was wound tighter than a clock spring after Leo’s death. Several newspapers, despite claims to the contrary from police, ran stories linking the death of the high powered lawyer with several low level drug dealer deaths. From an internal takeover to police assassinations, possible causes ranged from probable to conspiracy theorist. While only I knew the truth, I had far more important things to keep me occupied. Namely, we had started what would be a residency back home.

Dr. Minton was rather insistent on overseeing mine, both to give me as much supervision as possible and to see how much he could learn about my diagnostic and treatment technique. I didn’t mind at all, since working at a teaching university hospital would give the widest variety of cases. So I spent a blissful week doing mundane doctor diagnoses. Broken bones from foolish stunts, overprotective moms freaking out about a rash, the normal ER issues. Of course there were serious cases too, but nothing incredibly difficult. After my impromptu dealing with Leo, I was ready for a week of mundane. Alas, there isn’t an ER in the country that could be described as mundane.

“Next up we have an older male with respiratory problems. Shortness of breath with a raspy cough, could be anything. Ready to narrow the field from almost anything down to a few possibilities?”

“Dr. Minton, do you get your kicks from the problem solving aspect of all this, or from foisting nigh unsolvable problems on the backs of people who can’t necessarily tell you no?”

Laughing, he replied, “Oh it is the problem solving part of it Larry. The sense of satisfaction from looking through a list of symptoms and a patient’s history and figuring out how to help them. The tougher the case, the better it is.”

Entering the room with a doctor’s trained knock and wait a half second before opening the door, we finally got to meet our patient. A pale white male sat on the exam table, hunched over with elbows on his knees. The first thing I really wanted to do was slather him with sunscreen and send him outside for a few days. His wife had some skin color, even though you could see the fear in her eyes for her husband. Clutching his hand with a fierce determination, I could see the steel in this lady’s backbone. Hopefully the situation wouldn’t be as grim as her husband seemed to think it would be.

“Hello, I’m Dr. Minton and this is my associate, Dr. Davidson. Are you Mr…”

“Landis. Harold Landis and this is my wife Francis.”

“A pleasure to meet you both. Now it says here you were having some respiratory problems, could you walk me through what happened?”

“Of course doctor. Earlier today *hree* I woke up and was having *hree* trouble breathing. Not much *hree* you can do with miner’s lung.” Unable to stop himself, Harold descended into a wet, hacking cough that lasted for half a minute.

“Miner’s lung, have you been diagnosed with this before?”

Patting her husband’s hand, Francis took over the narrative. “Sorry doctor, but since this is a long story I hope you don’t mind hearing it from me. Harold has been a coal miner for 37 years, just like his father and grandfather. I’m still shocked he even spent enough time above ground to marry me.” She softened this last with a sad smile directed at her husband, as though it were a joke they had enjoyed throughout their married life. “All that time underground, working in the mines has taken its toll on him. A few years ago he was diagnosed with miner’s lung. He kept working though, because I always had a dream to come and see Nashville. We finally managed to save enough money to pay for the trip, and just arrived in town yesterday. The travel seemed to have worn Harold down, so we stayed in and went to bed early. This morning his coughing was a lot raspier, and he was having trouble getting air so we came to the hospital.”

“I’m so sorry to hear that. As I’m sure you are aware, there really isn’t much we can do for miner’s lung. We will have a windbrand come and make your breathing easier for a while.” Finished delivering his bad news, Dr. Minton headed for the door and I quickly followed him.

As we exited the room, I pulled him to the side and whispered in his ear, “Dr. Minton, why is it that we can’t do anything with miner’s lung?”

“Well, nobody really knows what causes it other than it occurs in the majority of miners who spend years in the mines.”

“Would you be willing to take a chance with another of my theories? If so, we will need an earthbrand, preferably Leah if we can get her down here. Luckily for her it shouldn’t be too hard on her this time, there won’t be any conjuring of small metal wires.”

“Larry, you should be well aware I am willing to risk a lot where you are concerned. I’ll have a nurse track down Leah and we will see what we can do. I assume you will want to save the explanation until everyone is assembled?”

“First, let me try talking to the patient. If they don’t want to go through with what I assume will be a tremendously painful procedure, then we won’t be doing much other than confirming the cause of miner’s lung.” With that I turned and walked back into the room with the aging couple, desperately trying to convince myself that I was truly offering them hope rather than an excruciating death.

“Harold, I have something I would like to try with you if you are willing. I’m not going to mince words here; I believe you deserve the unvarnished truth. This is a highly experimental procedure, and could very well either kill you or leave you with permanently diminished lung capacity. It all depends on how bad your lungs truly are. Best case scenario, we remove the cause of the miner’s lung. I can’t even guess the odds of success, as far as I know this has never even been attempted before.”

With a grim look on his face, Harold pondered what I had just told him. “Well son, you said you could remove what’s causing my miner’s lung. That would be wonderful, but just a moment ago everyone agreed that the cause of miner’s lung is a great big unknown. First off, why don’t you explain how a whippersnapper like yourself knows more than everyone in this room.”

“A fair point, and I suppose you just wouldn’t trust a doctor off the street who looks as wet behind the ears as I do yet claims a miracle cure. In a little while, another associate of ours, a quite talented earthbrand, is going to join us to confirm the cause of your illness. If either of you is an earthbrand, you can double check my claims. When you worked in the mine all those years, you breathed in a lot of dust. Over the years, the miniscule particles of coal in the dust collected in your lungs. Eventually enough coal dust mixed with the mucus in your lungs and started to block your airways. The mixture forms little globs, and these globs in turn form a network that restricts airflow through your lungs.”

To say that everyone in the room was stunned by my explanation was an understatement. Even Dr. Minton, a bastion of professionality, had a mouth gaping like a fish out of water. Looking at his wife with tears in his eyes, Harold asked, “Can it really be true? All miners have heard the stories, all dismissed as crazy. Earthbrands that worked in the mines too long, and got this cursed disease. The really strong ones kept saying that the coal always came home with them, they couldn’t get away. It drove so many of them mad, poor bastards. I’m not strong enough of an earthbrand to sense coal that small, and my dear Francis is a waterbrand.”

“Well, if it isn’t my favorite theoretical doctor. That’s a rather interesting theory, I’m surprised that nobody has thought of it before. Hello folks, sorry to barge in like this but apparently my expertise is at this guy’s beck and call. Please, call me Leah, and I’m the earthbrand specialist junior here requested.” Finished throwing me under the bus, she held out her hand to greet the couple. “If you don’t mind Harold, I’m going to pick Dr. Davidson’s mind to see just what and where he wants me to try and sense, the narrower of a range he can point me to the better we can determine what needs to be done.”

“Always good to see you again Leah, but can you really blame me if I need the strongest earthbrand I know to come and lend me a hand?”

“Flattery will get you nowhere doctor.” She flippantly retorted, “OK, well maybe it will get you a little bit. However, had you sent the message that you needed me to solve a decades old medical mystery I would have been a lot more excited to be coming down here.”

“Sorry Leah, I’ll keep that in mind the next time. Anyway, back to what we need. Starting an inch below Harold’s collar bone, I want you to see if you can sense anything that resembles coal. Scan through his body front to back, moving down to the bottom of his rib cage.”

Stepping up to the patient, a reassuring smile on her face, Leah consoled Harold, “Don’t worry Harold, this won’t hurt at all. I’m just going to be sensing, I won’t be moving anything.”

Visibly relaxing, Harold took his wife’s hand while Leah inspected his chest. Even with all our reassurances, I could still see a slight tremor in his fingers. After a few minutes, Leah leaned back on her stool. “I don’t know how nobody thought to check for this before, but you were exactly right on the cause of miner’s lung. There are thousands of little balls of coal spread throughout his lungs, but now that we have a definitive cause I don’t see how we can get them out.”

Harold looked at me, and I could see the desperate hope in his eyes, hope that he could spend more time with his beloved. Not wanting to crush his dream, I still needed to be pragmatic. “Harold, I know this seems like a giant leap forward, but trust me when I say this is the easy part. I am going to try and describe what I want to do in rather graphic detail, because I don’t want you thinking this will be easy on anybody. I also want you to be fully aware of the possible risks before we go through with any of this. There is a very real chance you will die.”

Harold looked to his wife, then turned back toward me and nodded.

“Ok, what I want to do first is have Leah try and break the fibers connecting the coal nodules. This will make removing them easier. As a precaution, we are only going to be doing one lobe at a time, and there are five lobes we will have to do. While she is doing that, I want you to concentrate on taking as deep of breaths as you can Harold. When she is done, take a breath and hold it. The next part will be the hardest, both because we will need to coordinate it and because we will be expelling at the same time. I will draw water from your blood and flood the lobe of your lung we are trying to flush out, and I want you to cough and expel everything from your lungs. I will help as much as I can, but you will be coughing up the biggest slurry of black phlegm in your life. We will have a collection bowl for it, and it may cause you to vomit as well.”

“Son, I can handle a little discomfort. You said it was the dangerous part, can you tell us what the dangers are?”

“Of course. If you don’t expel all the water that can cause major problems. Forcing the water through the air sacks that exchange air with the blood can cause them to rupture, permanently lowering your ability to breath. The coal slurry could irritate the bronchial tubes on the way out, making each breath painful. In fact, I fully expect some irritation for a while.”

Looking at Francis, I saw tears in the corner of her eyes. She looked at her husband, and said with a shaky voice, “Harold dear, I can’t tell you how bleak my life would be without you in it. Miner’s lung will kill you eventually, and there’s a chance that you will die if you tried what he is asking of you. But there’s a chance we can beat this, and spend the time we would normally have together. I think we should do it.”

“I could never tell you no dear, and I wanted to try this anyway. Let’s do it.”

Turning to Dr. Minton, I asked him, “Any ideas on possible safety measures that I might have overlooked?”

Dr. Minton put a finger on his chin and stared of into space for about ten seconds, obviously lost in thought. “You seem to have most of your bases covered, I would only suggest a windbrand as an emergency measure in case of breathing issues. That would be a few too many people for this small of a room, I will go see if there is an opening in one of the lecture demonstration rooms. For something like this, we should really get several of the department heads to watch since it isn’t an emergency. Any objections Harold?”

That’s how we found ourselves an hour later with the heads of Medicine, Research, and Legal along with several of their underlings. Who would have thought that every spare doctor in the building would want to see an experimental procedure for a disease that had no known cause the day before? No pressure or anything. Legal was making Harold sign so many disclaimers that I’m pretty sure he was going to develop carpal tunnel and have his hand cramp into a permanent claw. While Harold was finally making some headway on the stack of paperwork, and hopefully not signing away his soul in the process, I decided to do an outline of the procedure for all the spectators.

“Okay everyone, while we finish up some preparations I will go over the theory of the procedure and what we hope to accomplish. First, our patient has been previously diagnosed with miner’s lung. In order to confirm causation, we had an earthbrand scan the patient’s lungs. They confirmed that there are small granules of coal in the bronchia of the lungs, held in place with a fibrous matrix. In order to minimize the risk to the patient, we will be treating one lobe of the lungs at a time, starting with the patient’s upper left lobe and moving counter clockwise. We will first attempt to use the earthbrand’s power to disrupt the fibrous matrix. While this is happening, our patient will be trying to maximize lung inflation in anticipation of expulsion. With the final inhale from the patient, I will then force water into the lungs from the bloodstream, through the alveoli, and use this water to flush out the granules of coal while the patient expels everything via coughing. Any questions before we begin?”

The head of medicine raised her hand, and at my nod asked, “This sounds like it might take quite a bit of water out of the body. What steps have you taken to minimize the threat of dehydration?”

“The patient has drunk nearly a quart of water in the past hour, and Dr. Minton will be monitoring the patient’s hydration. In case it drops into dangerous levels, we will stop the procedure and depending on the progress made, resume in 24 hours.”

Taking a minute to make sure there were no more questions, I headed over to check on Francis and Harold one more time. “How are you two doing? I know this is coming at you rather quickly, and there are probably a lot more people here to watch this than you first thought.”

Harold tried to lighten the mood, “After all that water I drank you should probably be thankful I don’t get stage fright son. I might pee my pants.” With a quiet chuckle he continued, “Seriously though, aside from a little nervousness from the unknown, I’m ok.”

“Glad to hear it. I think we are about ready, is there anything you need before we start? Also remember, we can stop at any time. If you only want to do one lobe today, we only have to do one. You are in charge.”

“Thanks, but I’ve always been one to get as much done as possible. Before we get started, I have one request.” Turning to his wife, he kissed the top of her hand and said, “Dearest, I know you have stood by me through trying times, and there have been a lot of them. But I don’t want you to see this. I will be uncomfortable and in pain, but I can handle that. I’ve done it all my life. Please, wait outside so you don’t have to see this.”

With tears in her eyes, Francis asked, “Don’t you want me with you?”

“Always my love, but there are some things I would do anything to save you from and this is one. Besides, you have a very sympathetic gag reflex, and I wouldn’t want you to be embarrassed in front of all these strangers.”

“You always knew just how to convince me of anything dear. I will wait outside if you promise to stop if it gets too much. I still need you in my life.” She said with a sad smile, wiping the last of the tears from her eyes. Standing up, she kissed him on his forehead and started to walk away. As she got to the door, Leah handed her a box of tissues and whispered something in her ear.

Walking down to the floor, she picked up what appeared to be a small trash can on her way. “Well Harold, are you ready for this? Instead of a bowl, you get these lovely plastic garbage cans, and we have six of them just in case.”

Taking the trash can from Leah, Harold slid onto the waist high table that was prepared for our attempt. Sliding back from the edge, he positioned the can between his legs for better control. At this angle, he could bend forward slightly and have his chin about six inches above the edge of the can, and he wisely oriented it so that the shorter side of the can was against his chest in case he got some unexpected range as he expelled the coal from his lungs.

Dr. Minton and Leah both took up positions behind Harold, and I stood in front and to his left side. “Ok Harold, whenever you are ready let Leah know and start taking as deep of breaths as you can. She will try and loosen the matrix holding the granules in place, and that might start making your breath rattle a little more than normal. On your tenth breath, I want you to breath in as deep as you can and hold it. I will flood the lobe we are working on with water, and try and help you expel it. At that point, you probably won’t be able to do much but cough. Don’t fight it, just try and cough as hard as you can. If you vomit in the process that’s ok, I will make sure no liquid will come back into your lung. We can start when you give the word.”

Nodding his head, Harold gave a one word reply, “Go.”

*hree*

*hree*

*hree*

*hreee*

*hreeee*

*hrrreee*

*hrrrree*

*hrrrrrr*

*hrrrrr*

*hrrrrr*

As his rattling breath reached the count of ten, I flooded his lungs, attempting to modulate my power so I didn’t tear the delicate tissue. Harold went from back slightly arched with his shoulders back to doubled over the trash can in an instant, face beet red as he tried to force out the gunk that had built up in his lungs over the years. I was frantically sending it out through his bronchial tubes before he suffocated. Even with his mouth wide open there wasn’t enough room to exit, his expulsion was so forceful. The poor guy had a soupy black liquid pouring out of his mouth and nose.

*GAACHHHAAAUUUK*

Spluttering after the initial outpouring, the poor man sank into himself as tremors wracked his body. As the dry heaves finally started to subside, Harold wiped the tears from his face. Leah, bless her heart, was right there with a box of tissues to help him clean up with.

“Ugh, well *cough* that was about the most unpleasant experience *cough* I have ever experienced.”

“I’m so sorry you had to go through that Harold, but you did wonderful. If you don’t mind, please don’t throw your tissues away in the trash can you vomited into. I’m sure several of these doctors watching would love to see what you just coughed up for *ahem* research purposes.”

Chuckling, Harold nonetheless handed me the slightly less than quarter full trash can and used a wire basket Dr. Minton had stealthily placed on the table beside him for the tissues. “Y’all have some rather odd hobbies, don’tcha?”

“Harold, you don’t know the half of it.” Leah replied before I could stop her. “There’s doctors that will study any liquid, so long as it came out of a living body. They must have iron stomachs, the sight and smell would drive me insane inside a week.”

Interjecting before they could go further off topic, I tried to maintain a slightly professional decorum. “Putting that aside, Harold, how are you feeling? I want you to take a deep breath and tell me anything you notice.”

*Hhhhaaaa*

Tearing up a bit, I was worried at first until I heard Harold speak. “Doc, that is the clearest breath I have taken in a decade. It does hurt a little bit, but I can actually feel part of my lung filling up with air. Completely full.”

Smiling at his fortune, I placed my hand just below his collar bone. “I’m so glad to hear that. I’m going to check for any ruptured air sacs and possible bleeding.” Closing my eyes to concentrate, I did an extremely thorough scan of Harold’s lungs. I noted some areas of scar tissue, probably from trying to expel the coal matrix for years with no success. A lot of his tissue was highly irritated and inflamed, but thankfully there was no bleeding or burst alveoli. “Dr. Minton, I’m seeing some inflammation of the tissue, but no bleeding or ruptured alveoli. Do you agree?”

“Aside from some scar tissue you neglected to mention I concur. Before we move on to another lobe though, I would like at least a half hour break to let Harold drink some water and let the irritation subside a little bit.”

“That sounds right wonderful Dr. Minton,” Harold said. “I could use a break, but I would really like to get this finished today. While we wait, can someone send in my wife so she can see I’m ok and stop fretting? I know she’s worried sick out there. She always jumps to the worst possible conclusion unless shown otherwise.”

“OH HAROLD, YOU’RE STILL HERE!” Apparently while we were checking on the patient, Leah had seen that this would take a while and let Francis back in the room. Taking the container of expectorant from Harold’s hands, I stepped back so that it didn’t get knocked over in his wife’s rush to embrace him.

Smiling smugly, Leah sauntered over to where I was. “I’m sure you wouldn’t have let that poor old lady fret outside any longer than she had to for no reason, so I decided to let her in.”

“Well done. Let’s let them reassure each other, no need to intrude on a moment like that.”

Two and a half grueling hours later, we had Harold’s lungs entirely cleared of coal gunk. Although he was rather pale and shaky by the last bit, he was ecstatic to be breathing free and clear for the first time in decades. The head of medicine was busily organizing notes on the procedure for publication, while several research doctors had each claimed a container of what they lovingly labeled “black liquid death” and were animatedly discussing experiments to be performed.

Pulling Dr. Minton away from the group, I asked, “Dr. Minton, this has been rather draining. Is there any chance I could get next week off? I know it’s short notice but”

Cutting me off, Dr. Minton answered, “My boy, you just discovered the unknown root of a major health issue and came up with a treatment to cure it in the span of a day. Things like this just don’t happen, and there are serious ramifications. I don’t think we can do next week judging by the looks the head of medicine is giving you, but we can try for the week after. I’m sure next week you will be working closely to write up a paper for the journals detailing your treatment. You know what they say, ‘Publish or Perish’ and all that.”

As I turned to see the looks that I was receiving, I just knew Dr. Minton was right. Oh well, a week delay wouldn’t kill me while helping publish a new treatment to save lives. I wouldn’t even mind if I was relegated to second or third author.