Angel’s Breath

Angel’s hooves stay planted, but I feel the question in his back, the offer to spin and gallop. I hold firm in my seat, knees forward, signaling to my horse that we should not move. He trusts me and squares his stance.

Ahead of me, framed by Angel’s ears, I see a bear crossing the path a few dozen feet away. The bear is fast as it lumbers, chuffing, footfalls impossibly silent, its cinnamon bulk parting the fescue and buffalo grass. Here in Montana’s Bitterroot Mountains the scattered human population shares space with some formidable wild inhabitants.

When the dirt track is once more unobstructed, my horse and I exhale together. I lift my weight in the saddle, think, Forward, and we resume our ride through bottlebrush and sage.

Halfway up the Coyote Coulee’s last climb, I feel the power in Angel’s haunches start to wane, and his breath comes too audibly for a quarter horse. He drops his head and digs in, determined to carry us to the top. My heart aches at his effort, his desire to please even as he struggles. I can’t stand it. I tense my belly, whisper, “Whoa,” and hop off to walk beside him. The incline on this section of trail is gradual, but after a dozen steps I am puffing, too. My bronchi burn, and I force air out. I pat my pockets for the albuterol inhaler, then recall my morning rush: splash of a shower, coffee to go, bite of Angel’s apple for breakfast. No time to grab the inhaler or the allergy pill. As a doctor, I should have known better — but then, doctors make the worst patients.

My shoulder brushes Angel’s as we expand our chests to breathe. I reach under his blond mane and scratch. He huffs. I want him to rest, but he charges ahead, eager to reach the top and the last gentle meander to my truck and his trailer.

“It’s his wind,” I said to the California veterinarian three summers ago, when this problem began. “He gets short of breath on hills.”

He paused, rubbed his weathered jaw, then listened to Angel’s chest, the stethoscope bell held between two calloused fingers. Angel stood silent and still, as if he knew what to do.

“Old boy is twenty-one now, isn’t he?” the vet asked, pulling out the earpieces and scanning my horse mane to tail. He ran his hand along Angel’s spine. “He’s got good muscle tone. Looks good.”

I beamed. “He still works. We ride in the parks: Anna-del, Sugarloaf, Sonoma Mountain. He’s so eager to go. He just has trouble with hills.” I put my nose to Angel’s muzzle, and he nudged me back, smearing grass on my face.

“How long you had him? Nigh on fifteen years?” The vet stepped to his truck’s tailgate. “You two had a good run of it.”

The hair on my neck rose. I knew what he was going to say. He tapped a Marlboro out of its pack, flicked a lighter. “Ever considered easing him into retirement?”

“It doesn’t feel like his time yet,” I said as the vet packed up his truck. I wasn’t sure whether I felt this way because I knew Angel better than the vet did or because I couldn’t stand the thought of his mortality. He would never be that horse to me, solitary and swaybacked in the pasture, watching dull-eyed as others are led out to ride. I couldn’t even contemplate a time when we didn’t spend our days journeying in the mountains, reading each other’s thoughts, the only sounds Angel’s footfalls and the saddle’s creaking leather.

“He trots to me in the pasture,” I said, hoping my earnestness would convince the vet. “He bolts into the trailer.”

“Comes a time when we’re all a little short on wind,” the vet said around the cigarette in his mouth.

For me the asthma had started two decades earlier, in my twenties, with an abrupt tightness in my chest and shortness of breath during trail runs. I attributed the coughing spasms to my stockiness and poor athleticism, and I persisted in jogging, determined not to let unfortunate genetics stop me. Despite the tautness and heaves, I relished my jogs, expelling stress into the coastal fog, experiencing joy with each step past live oaks and blackberries. I continued running well into my medical residency, until, one brisk Sunday morning, I attempted the Sacramento Half Marathon only to end up hunched over in the first-aid tent, sucking nebulized albuterol while the event’s physician suggested I undergo pulmonary-function testing as soon as I had the time.

But I never really had the time. Residency was too busy, with the long shifts and night call — or, at least, that’s what I told myself as I scuttled between hospital and clinic. I put aside the pulmonary-function tests, along with oil changes, dental cleanings, and Pap smears: all non-urgent tasks that could be relegated to a less-stressful future time. Meanwhile exhaustion shortened my increasingly infrequent runs, until I was just doing laps around a well-lit block. When I thought about the lung studies, I bristled. Medical residents don’t have control over much — not their schedules or their workload — but at least I had control over my health. I could handle a random wheeze the way I’d always handled problems, starting when I was a kid, and afterschool activities meant laundry and dishes and cobbling together meals for my younger brother, because our mother was sprawled nightly on the couch in a Scotch-induced stupor. I pedaled to the corner store for cold medicine when he had sniffles, or allergy pills when I huffed and coughed. Like many eldest children raised in an addict’s household, I took on the caregiving, never receiving care myself.

After my residency, my husband’s nephrology fellowship took us to Silicon Valley during the dot-com boom, and I worked three jobs to keep us afloat. Over the next two years I color-coded my schedule, blocking out sections in green whenever I thought I could squeeze in a trail run. I kept a bag with running clothes in my car and darted out between shifts, changing awkwardly in the driver’s seat at traffic lights or in the parking lots of nature preserves. At first I blamed the huffing and puffing on my lack of conditioning, as evidenced by my belly roll and chafing thighs. But one lunch hour, as I trudged up the Powerline Trail at Rancho San Antonio, my coughs halted me. I leaned over, hands on thighs. When it took too long for the corset around my chest to release, I slapped my palm against a live-oak trunk and remembered the half-marathon doctor’s advice.

The truth struck me hard, dropping me beside the trail, where I coached myself — breathe in, breathe out — and waited for my chest to find an easier rhythm. I willed the western bluebirds to distract me as they flitted among the trees. Chipmunks hopped in the grass, the sun warmed my damp back, and my traitorous lungs finally accepted air. Only then did I concede that, even on my best runs, my chest tightened, and my exhalations caught in my lungs. High pollen counts triggered coughing fits. Cold air stopped me dead. I leaned back onto my elbows and stared at the cloudless sky. My denial and hypocrisy embarrassed me. How many of my patients had annoyed me by dismissing the facts staring them in the face? But how can I have high blood pressure? I feel fine!

I decided to experiment. Against my principles, I slunk into a pharmaceutical-company-sponsored lunch and, avoiding eye contact with my colleagues, scooped pasta salad onto a paper plate and aimed intently for a seat at the rear. On my way out I pilfered samples of the new drug formoterol, touted as treatment for exercise-induced asthma. On the days I remembered to use it, my quadriceps churned me up the hills with new endurance, and I accelerated with reserve into the last half mile toward the car. Yet I remained unwilling to schedule a doctor’s appointment and undergo testing to receive a prescription.

“Have you considered more age-appropriate exercise?” my new doctor asked as she stared at her computer, tapping keys.

By then my husband and I had left the bustle of Silicon Valley for an agricultural community north of San Francisco, and I had made this appointment to catch up on my health. When she’d asked about exercise, I’d chattered about my happy trail runs, but I’d dropped my voice and swallowed a few syllables when I’d mentioned my trouble breathing. She’d zeroed in on it.

“Trail running seems like a millennial thing,” she said. “Maybe Zumba?”

“But I love running.” I scowled as I buttoned my shirt. “Why stop? No knee or hip pain. Improves my mood.” I made a show of hopping off the exam table.

“When it’s not aggravating you,” she said. “Any chest tightness or coughing at other times?”

“Not really.” I averted my gaze and silently admitted to myself that the symptoms had begun to reach like fingers into other parts of my life: I wheezed on chilly mornings, hurrying from car to clinic. Sometimes I woke coughing. After the last restless night, I’d filched an albuterol inhaler from the clinic’s sample closet. Two puffs had helped me return to sleep.

“How about pulmonary-function tests?” my doctor asked, pulling a sheet of paper from an accordion file. She checked boxes, signed, handed it to me. “Have you considered asthma?”

I knew what I was supposed to do, the medications I was supposed to take. I’d counseled countless patients with this condition (my condition): a daily maintenance inhaler and an antihistamine pill like Zyrtec — and always carry an emergency “rescue” inhaler. I knew the consequences of untreated asthma: wheezing, fatigue, scarred airways, heart failure. I continued to dismiss it all.

Occasionally I filled the prescriptions, but the inhalers slid around in my vanity drawer, next to the unused allergy pills, travel-sized shampoos, Q-tips, and mascara. Treating my asthma made me feel like a fusser, an overreactor. When I thought of my patients, the ones who ended up intubated and dependent on a ventilator to breathe, I felt like a whiner. So I coughed sometimes and ran a little slower. I wasn’t sick.

And so many of those patients were smokers, like my mother, with her daily hack and frequent respiratory illnesses. She regularly had prescriptions for the antibiotic erythromycin. I would bring her four daily doses, dissolving the pills in instant coffee. Then I would negotiate with my brother about taking his amoxicillin for his ear infections. After he let me squeeze a dropperful into his mouth, I’d rummage in the freezer for our microwave dinners. I managed illness; I didn’t succumb to it.

Any nagging thoughts about controlling my asthma vanished entirely when I realized a longtime dream: I bought a horse. I’d been taking riding lessons for a few months when, taking a break at my desk one Tuesday, I opened dreamhorse.com — just to browse, see what was out there. In the lead ad I saw Angel for the first time: “Big, beautiful trail horse.” He filled the screen with his palomino-and-white coat, his flaxen mane and tail, looking like sunshine against the grass. Seated among charts, medical texts, and anatomy models, I became as giddy as a young girl. His soft brown eyes reached for mine from the screen. I called the number.

“You’re calling about Angel?” the seller asked. “Already?” She’d only just posted the ad.

From the time Angel arrived, we became a herd of two — “joined,” as horse people say, ambling side by side to the pasture, eating lunch in the tall grass, moseying along the mountain trails. He had an uncanny ability to intuit what I needed on any given day, from friendship to protection. When I felt energetic — when open, flat ground stretched in front of us — I could feel the question in his back: Go? Go? And we would, the gentle wind brushing our faces. One afternoon, ignoring my pushing him forward, he sidestepped off the trail just before a mountain bike careened around a blind corner and passed us. Another time he refused to back out of the trailer, craning his head around to indicate a baby barn swallow that had fallen from a nest in the trailer’s corner and landed in the dimple on Angel’s substantial behind. And, ten years later, when the Tubbs wildfire destroyed our community, displacing us to an isolated ranch in Montana’s Bitterroot Valley, Angel became my closest, steadiest companion. We went exploring together among the ancient, vanilla-scented Ponderosas, underneath the big sky.

“Have you considered asthma?” asks the Montana veterinarian I’ve called to examine Angel. Her blond ponytail swings as she grabs a tablet from her truck’s tailgate. “Does he cough?”

“Yes.” I frown. “Mornings. And sometimes when we start out.” Angel noses my hand. I show him it’s empty, focus on the vet. “Can’t believe I would have missed that,” I say, thinking of all the times when Angel has breathed hard underneath me. I wrap my arms around him and inhale his grassy smell.

“With some horses it’s subtle,” the vet says. “They don’t always wheeze.” She opens drawers in her truck bed. “It’s also treatable. Let’s try these meds, see if he improves.”

After the vet’s visit, I speed into town and buy all the antihistamine on the drugstore shelf.

Now the sun is sinking behind the Bitterroots, and I am in my barn, squinting at Angel’s tiny white Zyrtec pills, counting out twenty, soaking them, and mixing them with oats. I offer him the oat mix, sit back against Angel’s stall wall, and watch him bury his head in the bucket.

“I am so sorry,” I whisper, worried that I have failed him. He looks up, then dives in again, happy for the twice-daily oats.

In the morning I count out the pills again, this time with my reading glasses and headlamp to aid my aging eyes. Then, thirty minutes before we ride, I measure out exactly five milliliters of horse albuterol. “I hope this helps,” I say, slipping Angel a peppermint to mask the taste.

Later we are climbing out of Calf Creek’s northern ravine, where the trail switches back and traverses a high meadow before it descends by a circuitous route. Angel stops, eyeing the steepest section of trail, a serpentine path through jumbled boulders and lodgepole pines. He starts up again. I feel for his heaving sides, listen for his breath.

Angel slows where we usually rest, and I whisper, “It’s OK,” stroking his neck. “Let’s take a break.”

But Angel only pauses, takes a giant inhale that widens my legs, and charges like a young horse again. Joy fills my chest, and I feel the bunching in his back that indicates a gleeful buck coming. I allow it, since he is a geriatric gelding and I am (mostly) confident I will stay in the saddle.

On the return trip, climbing out of a stream bed, I hop off and walk beside Angel. He has done well, but I am afraid to push him too hard. We are best friends, bumping shoulders, sharing the secret of our special day. A breeze moves up the hillside, rippling the grasses, and I sneeze. Then it comes: the tightness, the cough. I stride on, unwilling to succumb. Near the top I bend forward, and before I know it, I am sitting in the dirt, looking up at filmy clouds moving past, sage poking my thigh.

Inhaling is hard work, and my exhales feel stretched thin like rubber bands. Angel stomps a fly, stirring dust, and when I look up, he is watching me struggle to breathe in, breathe out. Can he see that I am ashamed? My tears collect, not for me and my burning chest but for Angel, who felt this same pain, this same struggle, and I didn’t help.

Then I am shaking as I remember a time as a child when I reached for help and found no one there: We are in a tent, my brother and I, and I am coughing, my shoulders heaving as I try to suck in air. My mother and her friends are silhouetted around a campfire outside. I sit up, but I am swallowed by my sleeping bag and too tangled in it to rise. A zipper whines, and my brother’s slight shape scurries out of the tent. His feet clatter over beer cans, and I hear his voice but can’t make out his words over the roaring flames and popping wood and laughter. Snippets of the adults’ replies reach me over my wheezes: “Go back to bed. . . . She’s fine. . . . Just wants attention.” I look up, searching the ceiling of the too-large tent, my cot creaking beneath me with each attempt to draw air, and I know that I am alone.

Then my aunt Nancy is there. She wraps her arms around me, rocks me, holds steaming water under my face, tells me to slow down my breaths: “In . . . good. Out . . . good.” I feel my chest expand and contract against her breasts.

“You’re going to outgrow this,” I hear in the dark.

On the trail, the Montana sun cuts through the juniper, and my breath settles. It stuns me, the fractured emergence of my childhood world, the one that would not accommodate my vulnerability, my needs. An ache for that girl seeps into me like blood into a bandage. Then Angel bumps my shoulder, nuzzles my hair, blows his warm breath on my cheek. And I step out of the ache and into the sharp scent of sage, into bunchgrass and sand reed, into my middle-aged self, who is still the worst patient but who can no longer hide behind an old cliché; who has allowed a childhood with an alcoholic parent to hold her captive even as a middle-aged physician.

I drag air into my lungs, force it out. I start to hoist myself, then change my mind and fall back. Instead I reach up with two hands, and Angel responds by dipping his head toward me. I grab his generous mane, and together we raise me onto my boots. I glance at the saddlebags and wonder if there’s a small pocket in them where I can stash my rescue inhaler, and if it’s OK for me to pop a horse Zyrtec. Angel nickers, steps forward, eager for apples at the trailer. He looks back to make sure I follow.