An impassioned and gifted neonatal physician, Dr. Maggie Claymore fights for the lives of her newborn patients with a fierceness that has gained her the devotion of worried parents and sometimes the ire of her colleagues. Maggie is just shy of forty, and her career is on the rise: she is on the verge of receiving a coveted promotion at a prestigious Boston research hospital. That is, until an anonymous hate campaign calls her credentials and her ethics into question, threatening to destroy her professional reputation. Suspicion and doubt begin to shade all of her relationships, from her professional connections to her own blissful marriage. Worst of all, the rumors surrounding her begin to shake her deepest sense of who she is.
Psychologically riveting, The Mystery of Breathing explores modern personal and ethical dilemmas in a story of one woman's struggle to mainatain her identity.

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Like the works of Jodi Picoult and Chris Bohjalian, The Mystery of Breathing explores highly contemporary ethical dilemmas in a page-turning drama. An intense medical thriller, psychologically riveting, The Mystery of Breathing takes readers inside the competitive world of emergency medicine. Maggie Claymore is a brilliant neonatal physician at the top of her game and the height of her career when she falls prey to an anonymous hate note campaign designed to destroy her reputation. Klass, herself a pediatrician, lends firsthand immediacy to the breakneck pace of high-tech medicine and its toll on a dedicated doctor. In her acute portrait of Maggie, Klass "specializes in that space between a rock and a hard place that contemporary women find themselves in" (Seattle Post-Intelligencer).

The Mystery of Breathing

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By Klass, Perri, MD

Mariner Books

Copyright © 2005 Klass, Perri, MD
All right reserved.
ISBN: 9780618562077

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Excerpt

1
Who Do You Think You Are?

A tiny new body slick with blood, limbs unfolding for the first time into air. The
very first time she saw a baby born, Maggie knew: This was her moment.
Like a farmer who follows an unexpected breeze blowing out of a hillside and
finds himself in an endless, fabulous underground cavern: This is the glory
that was there all along, just waiting for me. Maggie finds herself in all kinds
of unlikely places thinking of birth — in the shower, on line at the bank
machine, or now, driving to work. For the first time, for the first time — the air
of the world inflates a brand-new set of lungs, air sacs like tiny bubble wrap.
And a heart no bigger than a golf ball beats and beats again. Maggie will
never get over it.
She is on her way to work, and this is her job, taking care of
those babies in the first moments and hours and days, making it go right
when it starts to go wrong, helping the hearts and lungs that cannot do it on
their own. Maggie will never doubt her choice: This is her moment, this is her
window, this is where her game is played. You get only certain moments,
certain sequences, certain golden hours, even in medicine, times when every
decision makes a real and true difference for a whole life"s stake. She was
raised with religion, Maggie was, and she has reimagined and reinvented
herself as a woman of science and a woman of medicine, but she knows holy
when she sees it. She knows a miracle. And this participation in the miracle,
this knowing what to do, is her job, her place in the universe. If she prayed,
which she was raised to do but which she doesn"t do — if she prayed, she
would probably pray, Thank you for letting me be here, thank you for letting
me help, thank you for a brain that understands what to do, and hands that
can do it. But she doesn"t pray; she works. She does her job.
She drives to work, a little too fast because this is Boston and
that"s how everyone drives but also because she wants to be there. She
doesn"t eat in the car, though at red lights she notes the coffee drinkers and
bagel and muffin eaters in the other cars with a certain fellow feeling,
admiring their commuter privacy as she savors her own. She likes her car,
she likes even this little piece of being in control — well, what doctor
doesn"t? Alone in her comfortable car, Maggie sings. She puts a gospel tape
into the tape deck and sings along, loud enough sometimes to leave her
throat slightly raw, bouncing her voice off the luxury tan leather interior, taking
her curves with the swing of the melody. It is Maggie"s most unbuttoned
moment of the day, though in fact she is buttoned tight into respectable
woman-doctor clothing.
Maggie parks her car in the doctors" lot, picks up her briefcase,
and off she goes. Into Blessed Innocence Hospital for Infants and Children
not through the main lobby doors but through the sliding- glass emergency
entrance, which is that much closer to the parking lot. Through the green
entrance hall and right into the bright white corridors of the emergency room,
quiet and calm at this early hour, charging in as if she"s coming off an
ambulance. I belong here: a good way to come to work. Here I am, where I
belong.
Upstairs in Newborn Intensive Care are the new babies brought in
overnight, hooked up to their heart monitors, lungs bathed in oxygen — to
Maggie, they are the most important patients in the hospital, and she thinks
of them, always, as she comes in — but today they belong to someone else.
Today she is on her way to her mailbox, then up to her office, on her way to
spend the day writing up a research project, yakking on the phone with
colleagues, sorting through papers. But though all she is heading for is her
mail- box, her desk, her computer, though she doesn"t ever work in the
emergency room, she still walks into the hospital with a deep breath of
ownership; she still claims these corridors as home turf.
And this morning the emergency room claims her in return;
someone pops out of a trauma room and grabs her arm. Mark Kristensen, a
senior resident she has supervised in the past, up in that newborn intensive
care unit. A wiry, deft boy, conscientious and intense, rumored to be
destined for a brilliant career in endocrinology.
"Dr. Claymore!" he says, and she notes that he looks genuinely
rattled. He clings to her arm. What does it take to rattle a senior resident at
the end of a long night in the ER? Mark Kristensen is very smart, but maybe
not the person you want calling the shots in a crisis; more of a thinker than a
doer. A little cerebral — a research guy.
"Maggie — Dr. Claymore — what a piece of luck!" Then he
swallows, takes a deep breath, and says to her more calmly and more
formally, "We need your help here, please."
"What"s going on?" She walks through Emergency every damn
morning, and even when it"s insanely busy no one tries to rope in a passing
neonatologist.
But he does not let go of her arm; he is pulling her into the trauma
room, which turns out to contain all the purposeful medical chaos absent
from the quiet hallway.
"I got a fourteen-year-old here been in an MVA."
So what? Maggie could answer. What do I know about fourteen-
year- olds? What do I know about motor vehicle accidents? But she has
already guessed the punchline, and though some small part of her is
grumping about not getting upstairs to her desk and why can"t the residents
do their job for crying out loud, most of her is suddenly eager and buzzing
and on: Let me at her!
The girl on the table is chunky and childish in appearance. She
wears a loose sweatshirt and ratty jeans, which are being efficiently cut off
her body by two nurses with shears. She is writhing, moaning on the metal
exam table, screaming when the intern jabs in the second IV line. But her
movement is limited; she is strapped to the table, and her neck and
shoulders are immobilized with large red foam blocks. Until an x-ray shows
no injury to the spinal cord, they don"t want her to move her head or neck,
and they cut her clothing off rather than roll her or jar her, rather than pull
anything over her head. The shears clip rapidly up the front of the sweatshirt,
splitting the lettering in half. Parkdale Country Day. Underneath, just above
the girl"s left breast, is a tattoo of a snake encircling a rose. Maggie herself
reaches for a box of surgical gloves and sorts rapidly through the sealed
packets. Eights, eights, nines, what the fuck do they think, that all doctors
are big men with big hands? Ah, a seven.
Mark Kristensen has been over at the bed, checking the girl"s vital
signs. Now he comes up to Maggie, nervously thanks her one more time.
"How far along is she?" Maggie asks.
"We"ve called over to St. A. They"re sending an OB —"
"How far along is she?"
"Best guess is maybe twenty-two, twenty-three weeks. Doesn"t
really show." He gestures to the abdomen of the girl on the table. An
abdomen Maggie has already noted: looks plump but not particularly
pregnant. An abdomen that suddenly arches up off the table as the girl
screams out a long, quavering howl of pain and terror.
"Baby"s crowning," says one of the ER nurses, employing the
patented I"ve-certainly-seen-all-this-before tone of ER nurses everywhere.
"Looks like OB isn"t going to make it," Maggie says cheerfully to
Mark. Pats him on the shoulder. "You do the delivery, I"ll take care of the
baby." As Mark seats himself on a metal stool at the bottom of the table, as
the nurses gently bend the girl"s legs and fit her feet into the stirrups, Maggie
sets up for the baby. Selects the smallest endotracheal tube out of the crash
cart drawer, turns on the wall oxygen, turns on the warming lights that a
nurse has just wheeled in for her, a metal tree on wheels with a cluster of
lights at the top like pointy coconuts. She rips open the pack of gloves and
snaps them on to her hands, tight and taut as the skin.
"Where are the rest of the doctors?" she whispers to the nurse.
"The intern"s out sick —"
"What if I hadn"t been passing by? Is Mark supposed to handle
the mother and the baby all by himself?"
"Here it comes!" says one of the people over at the big table,
around the mother.
Maggie is ready. The lights burn down on the back of her neck, a
familiar and oddly comforting warmth, warming up a table ready for that wet,
cold little passenger. Was the girl in labor before the car accident happened?
Was she being driven to a hospital, perhaps, or did the trauma send her into
premature labor? Who was driving, one of her parents, her boyfriend? Is the
driver alive or dead? All vague questions, all of very little interest right here
and now. The oxygen is hissing and Maggie wants that baby, wants that
baby in her hands, wants that baby to be a little further along than Mark
Kristensen thought, wants that baby to have a chance.
A very premature baby, whatever other problems it may
encounter, doesn"t usually have a hard time passing out of the birth canal.
It"s easier to push out a one-pounder than a seven- or eight-pound full-term
baby, even if your head and neck are immobilized and you"re screaming and
you"re only fourteen years old and not very big. The baby comes out in a slow
corkscrew, blue and glistening into Mark"s hands, which catch it and ease
the final half-turn of buttocks, legs, feet. Mark holds the baby, which fits
easily into his hands, and looks from side to side. The nurses hand him cord
clamps, scalpel, nudge him along. Mark probably hasn"t caught a baby since
medical school, but at least his hands don"t shake; he isn"t afraid of the baby
itself. Babies are his business, but they"re Maggie"s business too, and this
one is hers. Let Mark deal with the fourteen-year-old pediatric patient on the
table. He swivels on his stool and Maggie takes the tiny thing from his hands
and lays it gently down on her table, in the warm spot under the waiting lights.
The baby is limp and gray, not a good sign. It"s not really a baby
yet, to tell the truth, but what the residents call fetusoid. A disproportionately
large head, bruised and tinged with blue, like a thin-skinned fruit fallen victim
to an early frost. Arms and legs like chicken bones, and no tone in the
muscles at all.
Maggie is not thinking any of the things you might expect her to
think. Not thinking, Oh, how sad, how perfect. Not noticing the perfect
fingers, so whisper thin and slightly curled (though she would probably notice
if there were not five on each tiny hand). She has no awe to spare right now
for life and its formation, no grief. She has bonded with this baby, become
this baby: This baby is hers and she is his. His — she has registered the
bean-sized penis, and the smooth sac of testes.
"Looks a little older than twenty-two weeks," she says to no one
in particular. Her fingers have checked the pulse, squeezing the thick coiled
umbilical cord where it meets the baby"s stomach; the cord twists between
her fingers, its slippery vigor the most alive thing about the baby. But way
down deep where this baby is rooted at the cord, there is a pulse beating.
Not as fast as it should be, but beating. Maggie"s other hand is applying
oxygen, and she is annoyed; this could be done by a nurse, and would be, in
a real delivery room, with a real delivery room nurse. The nurse she had
expected to help her has gone over to check on the mother, who is having
some bleeding. I am in charge. You are helping me. Maggie tries to put this
thought into her gesture as she beckons the nurse to join her at the table. I
have done this hundreds of times, and you are all damn lucky that I
happened to be passing by.
"Heart rate"s about fifty and dropping," she says firmly. "Let"s put
the tube down, give him some breaths, and see how he does." Looking down
at the limp body, which in its thirty seconds of independent life has not yet
tried to take a breath, she adds, "I think he"s gonna be a real fighter."

There is no one second when she turns it around, no one instant when the
baby makes the choice to live. You could argue, in fact, that the baby does
not get the chance to make that choice; Maggie"s history is his destiny. She
spends her entire working life concerned with the saving of sick and
premature infants. She knows her business. She is more than a hundred
times his weight, she has been alive twenty million times as long as his
couple of minutes, and she does not question her right.
She gives the baby breath. A tube narrower than a drinking straw,
though made of a much firmer plastic, is down in his airway. The nurse"s
hand is ready on the oxygen bag, but Maggie pulls the bag away. A
newborn"s lungs are stiff, particularly a premature newborn"s, and she wants
those first few breaths to go in with sufficient pressure. She squeezes down,
watching the hand swing on the face of the pressure gauge.
At one minute of life, the baby got his first score; Maggie awarded
it automatically as she requested a dose of adrenaline and shot it down the
breathing tube. The one-minute Apgar score was one out of a possible ten;
the baby got one point for having a heart rate. Nothing for breathing, nothing
for color, nothing for muscle tone, nothing for a grimace when the breathing
tube went down. Maggie was already focused on the five-minute score as she
got ready to slice off that stump of umbilicus and insert an emergency
intravenous line into the big vein leading up inside the baby"s belly. The drugs
slide in through the line threaded through the umbilical stump: adrenaline to
kick the heart, some normal saline fluid to get the blood pressure up.
Oh, the joy of it! No one who has not personally and individually
saved a life and started a heart will understand it, and perhaps only those
who have been fortunate enough to save a life right at the beginning. The
heart rate comes pumping up, and the nurse, listening through her
stethoscope, calls it out with pride. "Heart rate"s sixty. Heart rate"s eighty.



Continues...

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Excerpted from The Mystery of Breathing by Klass, Perri, MD Copyright © 2005 by Klass, Perri, MD. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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PERRI KLASS is the award-winning author of both fiction and nonfiction works. Most recently, she wrote Treatment Kind and Fair: Letters to a Young Doctor. She is a practicing pediatrician and the medical director of the national literacy program Reach Out and Read, dedicated to promoting literacy as part of pediatric primary care.