Move Out

Written by  Nicole Walker

Salt Lake City in a bottle:

The valley. The mountains. The snow. The Great Salt Lake. Salt Lake City is its own microclimate. I have lived in that climate for most of my life.

Stand on the bathtub ring where Lake Bonneville once crashed its waves against these foothills.

From here, on a clear day, you can see the LDS Temple, the Wells Fargo Building, the Oquirrh mountains and the Great Salt Lake, the watery remnants of the same lake upon whose ancient edges you're standing. You can see the oil refinery and the coal plant, the smokestack at Brickyard plaza, Kennecott Copper Mine. You can see I-15 running straight through the middle of the valley and 2-15, the belt-loop, circling. However, a clear winter day doesn't last long. A high pressure has settled in. The city too starts to disappear. First the Oquirrhs. Then the refinery. Then the Temple. I-15 goes next. Then 2-15. Your own feet look hazy. You're not sure which way to walk. You're stuck now in the foothills of a mountain. Below has turned to murky soup. The big lake has returned.

The emissions from the cars, from the oil refineries, from the coal burning plant have billowed up from the tops of buildings and settled in a layer of atmosphere that will continue to collect particulates until a storm comes in and flushes the haze out.

Stand at Primary Children's hospital. The view is the same.

I was sitting with Zoë, dressing her up in her snowsuit with lamb ears. We were planning to meet Erik for lunch. At eight months old, she'd survived the worst of cold season. We'd survived the trip to New York. She just had a cold. But her cough did hack as if through walls. You could see her ribs as she tried to inhale enough air. I thought that maybe we could stop by the pharmacy after lunch and pick up some decongestant. I didn't know what kind to get for an eight month old.

I called Dr. Feldstein's office to ask if he could prescribe something.

"Is that sound I hear her breathing?"

"Yes. That's why I called. I wanted to get something for her cough."

"You need to take her to the hospital. Right now."

At the ER, Zoë stopped coughing entirely. She was smiling in her car seat, batting at the animals that hung from the handle. Her cheeks were pink. She was honking in her normal goose noise. And yet, they admitted us immediately. The number of breaths per minute, the amount of oxygen in her lungs, the way I must have looked unsure about how serious a situation to take this must have made the intake nurse rush.

You don't think babies die. Not from head colds. Not at all. But the nurses whispered under their breath as they put a pulse-ox monitor and a heart-rate monitor on Zoë.

Their E.R. They sent a woman home. Kid had RSV. Died in his car seat.

Their E.R. was not this E.R. In this E.R., they would never let you go.

There is a difference between sour cream and bad milk. When you dip a celery stick into sour cream, you expect some degree of acidity. Perhaps the delight is in the creaminess stops the acid at the just-too-far-gone point. And when you push back the triangle of cardboard and put the milk to your lips, you expect smooth, tongue-coating mostly-bland-a-little-hint-of-vanilla flavor. When you get any hint of acid, a chunk of proteins, a texture where there should be none, you don't reach for a stick of celery. You run to the sink to spit. There should be no globules in your refrigerated, pasteurized milk. When milk begins to separate, it does not make you think of creamy cream. It makes you think of things expectorated—mucus, vomit, slurry.

In that layer of air, particulates hang. They're called PM2.5 particulates because they're 2.5 micrometers in diameter or less. A micrometer is tinier than a sperm. Smaller than an egg. An order of magnitude smaller than a human hair.

The humans, and other lung-equipped creatures, are good at inhaling tiny things.

Inside the lungs, PM2.5 particulates get stuck. Easy to breathe in. Hard to breathe out.

Here is where they undo my daughter. She's lying on the hospital bed, happily staring at the monitors. She looks at me like aren't you glad we're having one more adventure. And then the respiratory therapist approaches her with a tube. She loves tubes or all string-like instruments. She opens her eyes as wide as she can as if to welcome him to her world of upside-down fun.

She startles when the RT takes hold of her shoulder. She looks over at me, when he asks me to hold her other shoulder down, with hope. But when the tube goes up her nose and the RT turns on the pump, her look changes. She doesn't open her mouth to protest. Her eyes roll away from me. My hand on her shoulder will never be anything but a bad sign again.

As the machine pulls gunk from her sinuses, her face muscles clench up to scream but she can't get enough air what with the tubes and the layers of gunk. They pull the tube out and Zoë and I both relax a little until the RT shakes his head in my direction. This time, my hand on her shoulder makes her scream. He digs in again, winding the tube as far into her sinus cavity as it will allow. He thinks maybe using a larger size will pull more mucus. He pulls out the tube. He goes in again. Her nostrils strain against the plastic. She must feel like she's under water. I feel like I'm under water. I think, it's so unfair that I know how to swim.

When he's finally done, he says I can pick her up. I do. Not that that necessarily helps. She's crying so hard she can't catch her breath. I wonder how good can this practice of nose-suctioning be if it makes her cry so hard she makes new mucus. How useful can it be for her lungs if, after the gunk-suctioning, she can't catch her breath? I walk her around the room, naming the faucet and the rocking chair, the phone and the window. I pretend this is normal. She has these same things at home, I explain. Sink. Faucet. Chair. I do not point out the pulse-ox monitor.

I look at the pulse-ox monitor. 93%. Holding steady. I look at my baby, laid waste, purple eyes, blue skin, shadow baby. She is heaving on her side, trying to sleep. She won't be able to. The cough will keep her up. I look at the pulse-ox. 93%. Holding steady. I look at my baby the color of the sky outside, as gray and as entrenched as the winter smog.

She is stuck in here.

I have to get out.

I leave her, in her bed, trying to sleep, struggling to breathe.

But outside is no better. The valley is socked in. When a flake lands on my hand, I think, thank god, the snow is coming. That will move this junk out of here. But when I look up, it isn't storm cloud, it is smog. The air has turned solid and now little particulates are falling on my head, making me feel heavy, making even my healthy lungs ache.

Gravity separation

Fat globules in milk are lighter than the plasma phase, and hence rise to form a cream layer. The rate of rise (V) of the individual fat globule can be estimated using Stokes' Law which defines the rate of settling of spherical particles in a liquid:

V = (r2 (d1 � d2)g)/9η
where r = radius of fat globules
d 1 = density of the liquid phase
d2 = density of the sphere
g = acceleration due to gravity, and
η = specific viscosity of the liquid phase

In cow's milk (but not all milk), the cream rises to the top because fat globules are far less dense than water. In cow's milk globules cluster. Upon clustering they rise faster than the cream of any other milk, faster than goat's, buffalo's, or sheep's. Their quick rising makes it easy to take the cream and turn it into solid. Milk will always stay milk. Cream becomes butter, yogurt, sour cream. Cream, once the fat globules are stuck, has hard time turning back into milk.

Eventually a storm will come in to dislodge the smog. "The greatest snow on earth" comes from the unique climate event of cold air traveling over the warmer Great Salt Lake, gathering up water. Lake Effect sends the dirty air up into the mountains where snow pummels down on the ski resorts. Eventually, the snow melts, and the water is returned to the Great Salt Lake.

The air seems clean after a storm. But those particulates haven't gone far. They're tucked into the snow. The snow will melt. The melt will flow into the Great Salt Lake. The air will fill with soot. The clouds will take up last year's particulates from the lake, combine them with today's smog and snow them down onto the ski resorts again.

In the Great Salt Lake, as well as in all of the other bodies of water in Utah, the nitrate, sulfate and mercury levels are extremely high. High enough fishermen are cautioned against eating the fish.

I was rocking Zoë in the chair next to her hospital crib when the chair of the English Department called. My mom was sitting with me, offering me sips of smuggled-in wine, watching me rock. She handed me my cell phone. The area code was Michigan's—616.

While we had been waiting to get out of the hospital, I had also been waiting for this call. Waiting to find out if I wouldn't be calling Salt Lake home anymore.

"The faculty voted yesterday and unanimously voted to offer you the job."

"That is great news."

It was great news. Jobs are good. But Grand Rapids, Michigan. My mom's face fell when I said Michigan.

I called Erik.

"We have to sell our house."

"They have houses in Michigan," he said. "How's Z?"

"The same. They're coming to suction her again in an hour. Come after that."

I let Erik off the hook from watching the nurses thread the tube down Zoë's nose since he would be the one sleeping over, listening to her cough through the night.

I had to feed her before the suctioners came. I untangled Zoë from the tubes, stretched them as far as the oxygen tank and the monitors would let me. The cannula in her nose, plus the mucus, plus the exhaustion in her cheeks made it hard for her to drink. But we tried this, every three hours except at night when we would pretend she slept through and didn't need any milk.

The point of making sour cream: Sour cream is not better than milk. Sour cream won't soak your cereal or thicken your soup. It won't fill your baby bottle—or, it will, but it won't come out the hole in the nipple. Sour cream is heavy, full of fat.

Unlike yogurt, sour cream has never saved anyone's health. Yogurt has all those probiotics, acidophilous, ensuring good microorganisms in your gut. Sour cream. You put it on potatoes. On spicy soups. No one eats sour cream by the spoonful. And yet there's something fundamentally alluring about sour cream. Stay here, it seems to call. You don't need to go anywhere. Everything you need is right here. Why leave such thick tanginess?

Zoë's RSV must have thought the same things about her lungs.

The mercury levels in the Great Salt Lake are higher than in any other body of water in the United States. Mercury is a heavy metal. It sinks deeply. And yet, it's not above being whirled into clouds, dissipated into snow, dripped into rivers. Small birds eat heavy brine shrimp. Big birds eat heavy, small birds. The birds, it is surprising, still fly.

This doctor was not making my kid any better. She walked in wearing scrubs and surgical gown. She put on a mask before she looked at Z. I could tell it was to protect herself, not Zoë.

"She's getting worse," I said. You could see Zoë's ribs when she tried to breathe. She couldn't get enough muscle to cough. Her mouth bobbed back and forth as if she was trying to bite the air.

"She has atelectasis. It's like pneumonia." Later, I looked it up: Atelectasis is deflated alveoli complicated by pulmonary consolidation, or edema, fluid-filled cavities. The layman's term was collapsed lung but collapse suggests an ending, buildings pancaking after earthquakes. Nothing gets through a collapse, not light, or hands, or air. The water from the fallen levies surges in. What had been in the service of air had turned into the service of solid.

The doctor said, "Touch her fontanel. See how it depresses. The striking thing about collapsed lungs is that yes, the air sacs are heavy with proteins and those proteins are taking on water. But it takes more fluids to separate them. You can tell by the way her fontanel is concave that Zoë's dehydrated."

I'd been breastfeeding her regularly. We'd been weighing her diapers to ensure she was excreting a reasonable amount of urine. The numbers might have been off. Or, it just might take a lot more fluid than we knew to make the tiny air sacs to shake off the hanging-on proteins. Either way, I brought in the milk from the freezer. I gave her a bottle of pumped milk. She drank it like we'd been starving her. Thank god I'd kept all that milk I'd pumped when she was in the NICU after she was born so early. I gave her another. She drank that one down too. I swear I saw the top of her head fill like a lake.

After another two bottles of pumped milk, she was coughing like a regular baby, meaning productively. Meaning getting the gunk out of there on her own. By the next day, we waited for our regular doctor, Dr. Feldstein, to measure how much she retracted when she breathed. He could only see one rib when she inhaled. He counted only fifty-five breaths per minute. He forecasted with these numbers we'd be discharged the next day. Instead, she drank so much milk and coughed so cleanly, the doctors let us go home that afternoon.

The nice, new thing was I could give Zoë a bottle. She drank on it happily while we drove home. The radio told us a big wind was coming, hopefully strong enough to blow the smog out of the valley.

"At least Michigan won't have the inversion," Erik said.

"At least Michigan will be full of water. Think of how easy it will be to grow lettuce. Spinach. I bet the ground is as fertile as Oregon's."

"The economy isn't so good there."

"But at least we won't die of thirst. I hear they have big lakes there. Great big, unsalty ones.

Perhaps Michigan's water currents would be strong enough to drag me there.

Say that one day, you have to leave the place you had lived for your forever. Say that to leave that place felt like you were leaving everything you knew. The streets would turn differently in Michigan. The trees would smell differently, deciduously. At least in Salt Lake City, even in the smog, you could feel your way to the grocery store. You could have, if you'd had to, find pinyon pines to pull pinenuts from. You knew how to grow tomatoes, in Salt Lake City. How much Miracle Gro to use. How much sun they could tolerate. Where to curl the hose. You knew where your grandmother stashed the peaches and where your mother kept boxes of granola bars from Costco. You know where the hospitals are.

But there are other foods out there. You can make them from scratch. Notice the breast milk. You saw from the way you handed your daughter a bottle, you can transform milk into milk—that the vessel might be the important thing. Get yourself into a vessel and drive. It's easy to make sour cream, just like it's easy to stay put. Open up some windows and let the lactic acid in. But here, you've got to do something harder. You've got to take that sour cream, turn it back to milk, ride the car east, the other direction from the one your ancestors trekked, the way against open spaces and wild animals. You've got to turn against your own nature, your own desire to stay, your own love of the stuck. 


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