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A Profile in Courage

In His Fight To Stay Alive, Darrin Bernstein Returned To The Hospital For A Critical Operation. His Enemy Was A Terminal Disease Called Cystic Fibrosis.
By Skip Hollandsworth |

“The horrible part is that it nerer stops. Well wait a minute. I guess what would be more horrible is if it ever did stop.” -Darrin Bernstein

A FEW DAYS BEFORE THE SURCERY OF seventeen-year-old Darrn Bernstein, an operation that he feared would end his life, his parents began to talk about the death of their first daughter.

It was oddly out of character for them. They almost never discussed Denise. Born in 1964, she died when she was four years old, and for the next sixteen years, Monica Bernstein, the mother, would not mention her name out loud. Her husband. Bill, said she was just being silly, that life goes on, but no one needed to remind him that on the day of her death it was he who staggered into Denise’s room, grabbed all her clothes from the closet, and threw them into the garage. During those four years, Bill had been the one who kept assuring Monica, as they sat together outside Denise’s mist tent watching her struggle to breathe, that their child would live.

Denise lived an absurd life. She barely gained any weight and her lungs couldn’t pull in enough air By 1968, her stays at the hospital were growing longer. Her cough was like the dying of a car engine. That June, as Denise lay in bed on the hospital’s ninth floor, Monica checked into the maternity ward on the fifth floor to give birth to their second child-a boy. They named him Damn, because Denise loved the character Darrin Stephens from the old “Bewitched” television show. The next day, Monica was back at Denise’s side. The doctors would not let her return to maternity to hold Darrin because they were afraid she would spread germs, Monica felt trapped between two floors, between a baby just brought into the world and one ready to leave it. Still, she knew all along that she would go to Denise: the little girl’s hair was starting to fall out and her eyes were the color of ash.

Five months after the birth of Damn, Denise was dead. By then. Monica and Bill Bernstein had been told what they suspected from the moment of Damn’s birth, that he too was afflicted with the same disease that had killed Denise. The disease, cystic fibrosis, kills children by producing a sticky, phlegm-like substance that clogs the lungs and blood passageways, eventually strangling the child. Getting it out of the body, a doctor once said, is equivalent to sweeping spilled molasses off the floor with a broom.

When Denise and Darrin were diagnosed with CF, the doctors could only tell the Bernsteins that a child inherited the disease from parents who both had a certain defective gene-but doctors did not know how to detect the gene, and they did not know why some children were born with cystic fibrosis and why other children from the same parents were not. Today, researchers are still baffled by the disease that is the number one inherited killer of children and young adults in the United States. Though a rare malady-30,000 Americans have CF, and one out of every 2,000 births results in CF-the disease kills more children than diabetes, multiple sclerosis, and muscular dystrophy combined. Every five hours a child is born with CF. Every eight hours someone dies from it. CF patients can try to cough up as much of the mucus as they can, but it is only a matter of time before they die. When Darrin was born in 1968, the life expectancy for a CF victim was about eight years.

Whenever a couple with the CF gene conceives a child, there is a 25 percent chance that the child will have the disease. But Monica and Bill Bernstein could not imagine the odds would strike them a second time. When Darrin was diagnosed with the disease, Monica, in shock, turned to her husband and said, “My God, Darrin shouldn’t have been born.”

And yet they tried again. Surely, they thought, God would not curse them a third lime. Two years after the birth of Darrin, Monica became pregnant with their third and last child. Their friends were horrified. “What if this one, too, is a cystic?” they asked. “What guilt will you feel then?” The Bernsteins tried to ignore them. When the third child was born, a girl named Beth Ann, the doctors tested her and then announced she had CF. Monica fell herself collapsing. Her face went numb and her husband thought she was having a nervous breakdown. A few days later, the doctors said they had made a mistake.

NEARLY EIGHTEEN YEARS AFTER THEIR FIRST CHILD’S death, in the early spring of 1986, the images of those early days pierced their memories like razor blades. Monica and Bill Bernstein were silting in their Piano living room, Beth was curled upon the couch, staring lovingly at her fingernails the way fifteen-year-old girls do.

“The scar we will live with the rest of our lives,” said Monica Bernstein, her fist opening and closing upon nothing, “was that we were not there with Denise when she died. She had lapsed into a coma and the doctors told us to go home, that they’d call us when she came awake. Denise came awake for a few minutes that morning, asked the nurse for a glass of milk, and then fell back into a coma and died.”

Monica stared at her husband. For them, grief and loss have accumulated like possessions. “’We weren’t there for that one drink of milk,” she said, “for that one moment when she woke up. She was four years old and weighed twenty-four pounds. She was alone in a hospital. We weren’t even sure how close she was to dying. God, we were young and stupid. You don’t know what it would have meant to us to have at least said goodbye.”

In the living room near Monica is a clock that stopped a day or two after Denise was born. It stayed that way for twenty-one years, frozen at exactly 3:20. until last October, when the Bernsteins heard the news that doctors were close to pinpointing the genetic origin of cystic fi-brosis. Finally, there was the ghost of a hope that a cure could be found. Without any fanfare, Bill fixed the clock. Of course, Monica, a proud, outspoken woman-called “the blonde bitch” by a couple of the nurses at the hospital- did what everyone in the family figured she would do. She got on the phone and in her flamboyant way declared that time was moving again, that CF was no longer going to stop the life in her family.

From a back bedroom, like a knocking at the door, came the sound of their son”s coughing. It began like a question, muffled and listless-but after another moment, the first cough was replaced by a louder one, and after that an even louder one, Darrin Bernslein, nearly eighteen, about to become a man, was putting on his clothes so he could come out of his room and spend one more day fighting a child’s disease.

Monica made a shadowy gesture, an imperceptible sign of, perhaps, courage, toward Damn’s room. “After all we went through before with Denise.’” she said softly, “we made the decision that this time we would do more, that we were going to put all we had into this kid, and that this time, he would stay with us.”



THE BERNSTEINS’ battle against an unconquerable sickness, their struggle against the slow corrosion of frustration, their almost terrified hope that a cure is on the way. is the story not only of the enormous agony caused by the largely underpubli-cized disease of cystic fibrosis. It is also the story of a single family, haunted by the slow repetition of days and the graceless pattern of their lives, finding a vital source of strength in their attempts to keep their dying son alive.

Darrin Bernstein is an ordinary’ teenager in many ways. Though he has watched most of his friends die and has seen his own life deteriorate until he can barely walk down a hallway without gasping for breath, he still has a silly sense of humor and an average adolescent’s ability to get on everybody’s nerves. He also retains an astonishing gallantry about the disease that makes the mucus inexorably pile up in his lungs, obstructing breathing, blocking digestion, inviting infections. Although new treatments and therapies now give CF patients a fifty-fifty chance to live past the age of twenty-one, the sight of a CF patient in his twenties is still rare enough to give Darrin a moment’s pause. “You can sense his feeling of panic.” says Hill Bernstein, a large, compassionate man whose eyebrows fly up and down when he speaks. “I mean, here he is, preparing to leave teenage life, and he realizes he has no dreams about a career. He’s too weak to go to college. He can’t turn to any of his other CF friends because they’re all dead. For everyone else his age, this is a time of change. And Darrin? He lies in his bed and wonders whether anything will be different.”

This past spring. Darrin made another trip to the hospital, this time for surgery to implant a permanent IV in his chest. He good-naturedly called it “the final blow, the thing that will knock me off for good.” His family began to shift into the all-too-familiar pattern that would help them wait out another crisis. They had done it so often that it had become as natural as breathing. They figured out who would be at the hospital with Darrin, who would call the relatives if Darrin died.

If Darrin died.. .Though Darrin almost died five and a half years ago after surgery to remove part of his lung, the Bernstein family rarely talked seriously about Darrin’s death. They had developed a shield against the pain with the only weapon they had- laughter. Before Bill Bernstein, owner of a construction subcontracting company, was forced to sell their Piano house with the swimming pool so he could pay the rising medical bills, the family would make up stories about how Damn’s funeral would be held in the back yard, where mourners would go swimming and hang their towels off Damn’s casket resting by the shallow end.

Their black humor offended people who did not understand that this was a way a stricken family endured. Once, when the Bemsteins were sitting in a restaurant, Darrin, his thin body sagging like a punctured sack, his face gray with weariness, and with oxygen tubes stuck in his nose, started complaining that the food wasn’t good. “I don’t feel good.” Darrin whined. “I’d rather kill myself than eat this,” Other diners had noticed Darrin the moment he walked in and could not help but overhear the family’s boisterous conversation. They nearly dropped their forks in shock as Monica leaned over the table and said. “Please, dear, don’t do it here. I wouldn’t want the nice carpet to get stained.”

Darrin arrived at the third floor of Dallas’ Presbyterian Hospital with a little suitcase and a paper bag filled with his socks and underwear. He knew he didn’t need anything else. His life at the hospital always consisted of a bland routine where he remained in bed and received vast amounts of antibiotics through intravenous injections. Four to six times a day he was given a treatment. each one lasting an hour, that almost seemed trivial compared to the scope of the disease. He first breathed into an oxygen machine that sprayed a mist into his lungs to break up the mucus. Then, while he breathed into another mucus-fighting machine, a respiratory therapist slapped him on the back so the mucus could be coughed up into the stained sputum cup by his bed. After a particularly rough treatment. Damn would throw up, or lie back on his bed. ex-hausted. looking worse than before. His parents administered the same treatment to him at home; his room was jammed with oxygen tanks and machines.

As a cystic patient grows older, the treatments have less effect on the disease. Still. Damn’s parents claim that he is alive because they have stuck diligently to the treatments.

When Darrin entered the hospital, he weighed eighty-two pounds. His bones stood out so starkly in his arms that it seemed they would puncture his nearly translucent skin. His large, round eyes were devoid of any child-like qualities whatsoever. One of the doctors who had been treating Darrin since he was a child came into the room. “Darrin,” he said, “You look like shit.”

“Thank you,” said Darrin, his face deadpan. “I just wanted to please you.”

A young nurse walked in, a portrait of health. “It’s the suave and debonair Darrin,” she said, and immediately went to work to stick an IV in his arm. “He’s back again.”

In a way, the hospital was like a vacation for Darrin. After spending weeks at home, with little company except his family and his dog, Chelsea, who woulld sit on his lap when he’d take treatments. it was oddly encouraging to be among the sick. For Darrin, who spent at least one hundred days a year in the hospital, the staff and patients were his social life. Darrin was an infamous patient: he and some other CF kids once threw rubber snakes into the psychiatric ward, creating a near-panic. Another time, during an emergency on the floor as (he entire staff tried to save a patient undergoing cardiac arrest, Darrin got on the intercom and said loudly, “I guess this would be a bad time to otrder a Coke, huh?” When he was stronger, he would sail kites off the seventh-floor balcony, participate in wheelchair races in the basement, or send a remote-control car roaring into other people’s rooms to scare them.

But during this last visit to the hospital, Darrin didn’t feel like doing much at all. He was there to get antibiotics and build back the strength he had lost since his last visit, and to have the IV implanted. Darrin’s arms had become so weak that a nurse would have to stick him a dozen times with a needle to find a vein for the IV. Often the vein would collapse, and the nurse would have to try again, Implanting a permanent IV isn’t a dangerous operation-except when it involves a feeble victim of CF. Whenever a CF patient is put under anesthesia and kept alivej by an artificial respirator, there is a possibility that the patient will not regain consciousness; the scarred lungs may not kick back in and operate after the respirator is removed. A couple of his friends had died that way; Darrin worried that he would, too.

In Darrin’s wing of the hospital were a couple of other teenagers and young adults being treated for CF (the young children stay at Children’s Medical Center), and there were the very old people dying of chronic lung disease. The coughing ran down the hospital corridors, bouncing from one wall to another, each cough as distinctive as a voice to the families and friends waiting outside. In his bed, under the flickering images of the television set with the sound turned off, Damn would stare through the doorway at the people passing slowly down the hall.



THE BERNSTEINS SPENT THE EARLY PART OF DARRIN’S LIFE in New Jersey, where Bill began his subcontracting business. And for the first six years of his life, Darrin was a normal child. In the early photographs that Monica has kept of him, he has a rounded face. He is running after things. “He used to eat dishwashing powder and feed the dog rocks,” Monica said, holding up a photograph of a smiling, blond-haired child on a camping trip, a boy barely recognizable now as Darrin.

During a recess in the first grade, Darrin won a foot race. It was an extraordinary moment for him, one that he recalled more often as he got older. But by the time he joined the little league baseball team, he had already made one trip to the hospital. He was falling behind. He was having trouble making the throw from second base to first. Bill, a former football player in college, would come back from the baseball games and look at Monica and shake his head. They couldn’t believe it. They honestly believed the disease would not affect him so soon. “All right,” said Monica. “So he’s terrible at baseball. He doesn’t have to play.”

Still, Monica kept the group picture from that baseball team. Darrin is kneeling on the front row, his glove nearly dwarfing him, surrounded by other boys, all much larger and looking much more confident. But what catches a viewer’s eye is not that Darrin looks out of place. It is the fierce way he stares back at the camera, determined to play a game that everyone knew he was becoming too weak to play.

By the time Darrin was nine, the family had moved to Piano, where Biil Bernstein thought the business opportunities were better. It also didn’t hurt to leave an area where the memories of Denise were still strong enough to make Monica stop her work in the kitchen and stand there with dishes in her hands until, minutes later, Bill would ask her what was the matter.

But there was little time for relief. Two weeks after they moved, Darrin had to be put into the hospital. He had never met another CF patient before he came to Texas, and he wasn’t sure what CF would do to him. One night in the hospital, Darrin saw the parents rush crying out of the room of a fourteen-year-old girl with CF to whom he had spoken once or twice. Nurses and doctors rushed up and down a hallway. They shut the door to the girl’s room when she finally died. Darrin, still very much a little boy, stood in his doorway and watched. Very soon, his boyhood would be stripped from him entirely, as it became a struggle just to go to school, or ride a bike.

“I guess,” said Darrin, “that I was in the sixth grade when I knew I would never be able to keep up again. My favorite game I liked to play with other neighborhood boys was to ring other people’s doorbells and then run. I loved it. It was exciting for a kid, you know. One day we were doing it, and we started running from the house, and I began to lose my breath. I heard the door open behind me. I knew I was going to get caught. Everyone else was way up in front of me. I wanted to shout for them to wait up, but I couldn’t breathe. I couldn’t get my lungs to breathe in! I don’t know how I got away, but, you know, I knew that was it, that I couldn’t play that game anymore. I had to go tell my parents. I got-well-I suppose I was a little lonely after that.”

As the disease progressed, knocking nutrients from his body, Darrin could not gain weight. Among his mother’s photographs is one of Darrin, thin and bony in a bathing suit, about to dive into the backyard pool. Soon, as the pressure of the water against his chest became unbearable, he had to give up swimming as well. Kids at school would ask him to arm wrestle, then run down the hall laughing. He began to ride the elevator to the second and third floors of his school because he was too weak to take the stairs. The hospital stays grew even longer, so by the time he returned to school, he had to start all over redeveloping his friendships. As he moved into junior high, he sometimes would be too exhausted to awake before

11 a.m. At his bar mitzvah, he told the congregation, “I don’t knowwhat the future will hold, or what I’ll be doing when I get older.But I hope I will keep on making the best of things.”

By 1981. he could no longer attend school. A tutor began coming out to the house to sit by the bed and teach Darrin a limited number ot courses. It was a crushing blow for the Bemsteins. The fate of the CF child is that the longer he lives, the more isolated he becomes. Monica would notice a neighbor’s teenage boy walking out of the house in a rented tux to go to his high school prom, and she would feel the fury rising in her throat. “I would see other CF kids frolicking around, feeling so alive, and I would say, ’God, why didn’t you give Darrin that kind of quality of life? Why?’ And then, I would hear, two months later, that the other child I had seen so happy was dead, and I would shout, “Oh, thank you God. Thank you for letting my son live a little longer.’”

In the photographs Monica has kept of Darrin during his teenage years, he is surrounded by his friends, all of them CF kids. “Look, look there,” Monica would say as she leafed through the pictures. “All the kids in this shot except Darrin are dead. What does a mother say to her son when they look at a picture like that? I remember that Darrin used to keep count of his friends who have died. I think he lost track a couple of years ago.”

As each of his friends was dying. Darrin would quietly ask his parents to drive him to the hospital so he could stay with them. There was Yancey Young, who died at age twelve in Damn’s arms, and David Fambrough. dead at twenty-two, who persuaded a bunny from the Playboy Club in Dallas to come see Darrin when he was twelve (“What is she supposed to be?” asked an unimpressed Darrin). There was the minister’s daughter, Patti Wynn, who, just before she died at the age of twelve, sent Darrin a couple of dollar bills so he could have money to spend in her memory; and there was Ben King, Damn’s best friend, the one with whom he shared the experience of adolescence, like drinking beer for the first time and driving around in a car looking at girls. Ben died when he was eighteen.

Darrin soon quit asking his father what would happen after he died. “There are still times,” said Darrin, “when I’ve imagined what it would be like. It’s hard for me to understand. The only picture that comes to mind is that my parents are in a room watching TV, waiting for me to come out to join them, and I never do.”



WHEN DARRIN ENTERED THE HOSPI-tal again this spring, the image of death seemed even closer. Another one of his CF friends, Tres Musselman, had lost fifty pounds in three months and could not seem to find an antibiotic that would work. He was thirty-one, and had spent years lifting weights as his way of beating back the disease. Now, much of the muscle was gone-eaten away by CF. At the other end of the hall was sixteen-year-old Brian Whatley. who didn’t receive much company when he came to the hospital- Darrin walked down there one night to watch Brian perform a card trick-they were both fascinated by tricks that seemed impossible-and, without warning, Brian laid down his cards and began to talk about his fears that no one would show up for his funeral.

“Brian, don’t be silly,” said Darrin, but without saying so. he understood the fundamental solitude that every CF patient feels.

About a week after Darrin entered the hospital, Dr. Claude Prestidge, one of three doctors in Dallas specializing in cystic fibro-sis, came in to tell him that it was time to put the IV in his chest. Prestidge is an unusual man who has chosen a specialty that dooms him. every time, to fail. All his patients die. But he has never apologized for his attempts to make dying kids feel good about their lives, and though there is nothing he can do to cure a CF kid, he can postpone the inevitable. So, standing beside his bed. Prestidge told Darrin, who was trying to back out of the operation, that the surgery had to be done now, while he was still healthy. Darrin, of course, knew what the doctor was getting at. The next time he entered the hospital, he might be too ill to have the surgery, and if they couldn’t get an IV in his veins to pump in antibiotics, he would die.

“This sounds stupid.1’ Darrin told his father later that evening, “but in my mind, this is like a milestone. I know it’s just another sign that I’m getting weaker.’”

“And you’re afraid of running out of milestones?” asked Bill Bernstein.

Darrin didn*t reply.

“Well, I’ll say this,” his father continued. “We’d be kidding ourselves if we didn’t admit this was a progressive disease, that it’s beating you little by little-and it’s a race against time. This is simply giving us a little more time.”

“But Dad, I’m afraid of the anesthesia.”

“Darrin, you don’t have any more veins that will work in your arms.”

“But Dad, what if my lungs don’t work after the anesthesia?”

Bill Bernstein rubbed the stubble of beard on his chin. It had been a horrible year for him. He didn’t let many people know, but a slumping construction industry had forced him to close his business last summer. For more than six months. Bernstein had been unemployed. The hospital bills, easily more than $200,000 a year, were mounting. He was afraid that the bill collectors were going to start pushing him for hundreds of thousands of dollars. Bernstein didn’t know how much his own insurance policy was going to pick up, or what he would receive from the state’s program for crippled children.

Even worse, by the end of last summer, Darrin seemed to be slowing down even more. The treatments weren’t making him feel any better. By early fall, his coughing became more violent, and at one point he threw up into his oxygen tubing. He was red with fever. One day he told his parents that he had given up his childhood dream of making a million dollars and having a lot of cars. He knew he would spend the rest of his life in a bed.

The Bernsteins had grown used to Damn’s at least coping with the disease. But after this attack destroyed all their delicate work to keep him healthy, Monica turned to Bill and said-and she was serious-that she was so tired of watching Darrin suffer that she wanted to go into his room and blow his brains out.

For the Bernsteins, the only satisfying moment in 1985 came one day in October, white Bill was watching the news. Suddenly, he leaped to his feet and screamed for Monica. When she rushed in, eyes wide with fright, she saw him staring at the television screen. The announcer was saying that researchers had ruled out 99 percent of the genes that might have been responsible for CF. There was no guarantee the doctors could find the gene in Damn’s lifetime, and then there was no certainty they would know how to correct it once they found it; some doctors speculated that the breakthrough would only result in a test to determine adult carriers of the CF gene. But right then, for the Bern-steins it didn’t matter There was still a sliver of hope. They began to weep and hug one another in the middle of the living room.

The surgery was scheduled for a Monday morning. Two nights before the operation, Darrin had his mother bring his good suit to the hospital so he could wear it to the local CF foundation’s annual banquet. There, in a lavish hotel ballroom, the national cystic fi-brosis president declared that the world was about to see “a new era in cystic fibrosis.” Darrin didn’t seem to be listening. He was reading in the program the names of the twenty-three local CF patients who had died the past year.



ON THE MORNING OF HIS SURGERY, when Darrin was rolled out of the elevator on his stretcher onto Presbyterian’s operation floor, his lips quivered like jelly. Monica and Bill were beside him. Monica holding his hand and peering anxiously into his face.

“Listen, Mom and Dad,” said Darrin in his dramatic way. “If you get me out of this operation now, then I’ll forgive you for all the terrible things you’ve done to me.”

“Oh, for God’s sake,” said Bill Bernstein.

Dr. Darrell Hermann, a well-respected pediatric surgeon who was to perform the operation, also seemed a little impatient. Hermann had performed dozens of these chest IV operations, none with complications, and he had been baffled by this family’s sense of humor. Visiting Darrin once before the surgery, he was trying to explain how the operation would be a snap, only to be interrupted by Darrin, who wanted to talk about all the things that could go wrong.

“It will be a nightmare, I’m telling you,” Darrin informed the doctor.

“Please, Darrin,” said his mother, who was there at the time. “Pretend you’re dead so we can hear what the doctor has to say.”

In the operating room, Darrin lay straight and motionless under the harsh light shed on the operating table. The sheen gave his forehead a liquid gloss. The only noise in the room came from the steady beep of the monitor connected to Darrin’s heart as an anesthesiologist prepared to put him to sleep. This was a scary moment for a cystic fibrosis patient. The stories were endlessly circulated along the CF floor about those who weren’t able to pull themselves out of anesthesia. As Hermann, standing a couple of feet from the operating table, looked on, the anesthesiologist carefully put the mask over Damn’s mouth. He took it off for a moment. Darrin didn’t move. It looked, in fact, as if he were asleep.

Then, with the timing of an old professional comedian, Darrin opened his eyes and said, “Well, this is it. So long, everybody.” One of the nurses rolled her eyes. As Darrin went under, the anesthesiologist placed the respirator that would breathe for him during surgery into the teenager’s mouth, and the surgery began. Hermann quickly began to slice into Damn’s chest.

Outside in the waiting room, Monica and Bill stood among their friends. Bill seemed oblivious to the drama-the only sign of the pressure inside was in the lines around his eyes, which were growing tighter. Monica walked down the hall with the mother of the CF boy, now dead, who had been Damn’s best friend. “You won’t believe this, Monica.” the mother said, “but as much as I thought I’d be ready for my son to stop suffering, I’ve come to miss all this. I miss fighting for my child.1” There was a kind of power in the faces of those two women-a handsomeness shaped by passion and grief.

An hour later. Hermann walked outside and called for Monica and Bill. Darrin was awake and off the respirator. He was breathing normally.

After all that Bill and Monica Bernstein had been through, in all the years of pain. this one event should not have been that significant. But suddenly, with the doctor’s words, a surge of noiseless tears began to drip down Monica’s face. No one had seen her cry in public since Denise died. Bill, his arched eyebrows rising, turned and hung his arms around his wife until it seemed he would be locked to her. As Darrin was wheeled out of the recovery room, his hair pressed down on his head like a bad rug and his face gray. Monica wept some more into her hands. Feeble as he appeared. Darrin still was able to lift his thin arm toward his parents in a gesture of victory.

By that afternoon, the crisis was over. Except for the thin IV tube sticking out of his chest, Darrin was back to his usual personality, complaining about the hospital food, ogling the young nurses, trying to get his mother to do things for him.

The doctor came in and said the operation was a success. And so it was-another milestone passed. But as the day waned and the sky outside the hospital window broke into long streaks of red. Darrin went into one of his spasms of coughing. His mother stared at him, knowing she could only wait until it ended. It was a sound similar to the noise of one rock scraping another, deep and dry. The skin around Damn’s throat caved in with each cough. The cough threaded through all other hospital sounds like a dark theme in a symphony.

Monica walked out to the nurses’ station to get hi m a cup of ice. Even there she could hear it, clear and distinct, as if caught on a draft of wind: the bewildered, coughing protest of a boy struggling to survive.

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