Strangling Angel

It starts as a cough and a runny nose, just one more cold. My husband and I think nothing of it. I wipe my son’s nose, spread ointment on his chapped cheeks and put him to bed. Then Andy and I leave for one of our biweekly “dates”—this time at an Italian restaurant near our house, the kind of place that aims for kitsch, serving breadsticks in a brown paper bag and plates big enough for two. We dine on garlic-laden food and drink peppery Chianti and then, because our two hours aren’t quite up yet, decide to drive the long way home.

Haven is babysitting again. She lives next door with her four younger brothers and sisters, and we suspect that she finds our house a welcome retreat from all the commotion. She always arrives after we’ve put Eli to bed—which is sneaky but convenient. Haven and Eli have not met in the formal sense. Whenever she walks by our house with Rider, her little Corgi, she always smiles and says hello, and for reasons I don’t fully understand, Eli scowls at her every time. Maybe he doesn’t like having my attention diverted, even for a minute. One day soon, they will meet and get to know each other, but for the time being we’ll continue this arrangement: Eli goes to bed, Haven arrives and then we quietly slip away. He always sleeps soundly—never waking, blissfully unaware of our absence—while we enjoy ourselves for a couple of hours and Haven watches Animal Planet in the living room.

What our three-year-old doesn’t know can’t hurt him.

 

Andy enters the house first, and I follow him a minute later, after dragging the trash can to the curb. The first thing I notice is the empty living room. No Haven. No Andy. Then I hear the sound on the monitor: Scraping metal. Whistling.

I run upstairs two steps at a time. Eli’s nightlight casts a purplish glow in the far corner, but otherwise his bedroom is dark.  Haven stands silent beside Andy, who has lifted Eli out of bed and now cradles him in his moose pajamas. And now, that sound again: scraping metal and whistling.

“It started a couple minutes ago,” Haven says in a low whisper. She’s trying hard to look nonchalant, but her shaking voice gives her away. “I came right up, but I think he was surprised to see me, and his coughing seemed to get worse.”

My feet are bolted to the floor. What does this remind me of? Eli cries and struggles to breathe. His face is pale, his mouth oozes sticky saliva. The more upset he becomes, the more he struggles to breathe. I pick him up and rock him.

We send Haven home, assuring her that she did the right thing. Eli’s mouth is dusky blue. His coughs are ragged, whistling on the inhales. A barking seal, that’s what it sounds like. I read about it recently, but I can’t recall where.

“It’s okay, Eli. It’s okay,” I croon, rocking him, but I am shaking. I don’t remember ever feeling this scared.

 

Only later will I remember the two photographs I unearthed a few months earlier—sepia prints mounted on cardboard— in my grandmother’s overfull suitcase, a faux snakeskin relic that sat untouched in my uncle’s St. Louis basement for more than a decade. It would have remained so if I’d not just then become obsessed with my family’s forgotten history, my interest piqued by a grad school writing assignment that sent me sleuthing online. Even before I peered into that suitcase, I’d already uncovered some skeletons. It was quickly becoming clear that silence had sunk its teeth into the warp and weft of my family. And soon I would learn more: Silence rippled back generations. It had twinned with my ancestors’ existential struggle to survive. Up and down my family tree, you could see the effects: broken branches, fissures, wounds. Disfigurement came from all directions, a battery of assaults: alcohol and divorce; abandonment and grief, so much grief.

In Nana’s suitcase, I found letters, albums, cards, photographs and clippings, all smelling vaguely of must and camphor. But the childhood photos of Nana’s old sister, my great aunt Sylvia, were the discoveries that most haunted and fascinated me.

There are two of them. In the first, Sylvia is a toddler in a gown of white lace, her hair parted straight down the middle. In the second, she sits with her extended family on a sun-dappled hillside in St. Louis—my best guess is Forest Park. Long ago, somebody wrote “1920” in the upper right corner, meaning my grandmother would have been four and Sylvia ten.

In the background, you can see picnic benches and chairs, the white back and stiff pants of an unidentified boy—a cousin, perhaps?—eating hunched over, and behind them, the trunk of a single tree. The men wear ties and white shirts with rolled-up sleeves. Their hats rest in their hands. Nana—little Ruth—is perched on her father’s knee, wearing a clownish smile. Nearby are her mother and older brother, Eugene, who would be six. Sylvia sits at a remove from the rest of the group. Her legs are crossed. She is lanky and tomboyish, with the same deep-set eyes as Nana and a page-boy haircut cropped at her chin. Her hands are obscured by an uncle sitting in front of her. They might be folded, or fingering the head of a dandelion.

Nana died at age 83, when I was in my early thirties. But Sylvia died young. I knew only that little bit about her until my September trip to St. Louis—to visit Uncle Rick, my mother’s brother, and assorted other family members. I was determined then to crack open the vast family silences that had calcified with time. And while neither my mother nor my uncle could tell me what had happened to Sylvia, I soon learned that their uncle—my Great Uncle Lee—knew a few things.

“Sylvia died of diphtheria; she was only 10,” Lee told me as we sat around the dining room table in Uncle Rick’s ranch house. Lee is Nana’s half-brother, a product of their father’s second marriage and nearly a generation younger than she. He looks nowhere close to his age. At 86, he rides his horse twice weekly and proudly tells us about the one thousand pushups he performs nightly, resting a few minutes between each set of one hundred. He is the last living member of his generation on my mother’s side of the family.

After Lee informed me when Sylvia had died—September 1920—I pulled out the photo of the long-ago picnic and studied it again. I examined each picnicker, struck by how dreamy and content they all seemed. Maybe their stomachs were full of fried chicken and potato salad—or instead, they’d eaten liverwurst and knish. I studied the shadows, the clean demarcations of sun and shade, the dark trunk of that single tree, slick as wrought iron. My skin prickled.  In that speck of time, there was no discernible hint of future sorrow.  There was no way to know that within months—by the time the leaves were off that tree—Sylvia would be dead and buried.

Diphtheria. Besides the DtaP shot Eli received as a toddler, it was a disease I knew nothing about, but soon after my trip to St. Louis, I looked up the symptoms: Sore throat and hoarseness. General malaise. Difficulty swallowing. As time goes on, breathing grows more labored.  Scraping metal cough, whistling breaths—those are the sounds associated with diphtheria, which harkens to the Greek word diphthera, meaning prepared hide, leather, so named because of the tough, leathery membrane that forms in the throat. In Sylvia’s day, I learned, diphtheria was known as the “strangling angel” of children.

∞

My own throat is dry; my heart thuds in my ears. “We need to take him in,” I tell Andy, and he simply nods. We rocket downstairs, out the door and into the car. I settle into the back seat and rock Eli in my lap as Andy pulls out of the driveway. It is 10 p.m., and cold enough for frost. He gets the heater going while I sing to Eli.

“Hush little baby, don’t say a word

Mama’s going to find you a hummingbird.”

 

His brassy cough won’t let up. My teeth chatter. We turn left onto Summit Avenue, where the minivan in front of us inches along in spite of my bodily exhortations to Move! Move! At the intersection with Dale Street, the van scoots last-minute through a yellow light. Andy accelerates but then thinks better of it, slamming to a stop.

I ball my hands into fists. “Just go through it,” I hiss at him, but to my dismay, as the seconds tick by and Eli continues to drool and gasp, Andy dutifully waits out the red light. I cup Eli’s chin in my hands, rub my fingers through his soft brown hair. For a second or two, he relaxes in my arms and his breathing eases. But once the car starts back up, Eli jerks awake again. The sudden movement has stirred something up in him. As we hurtle down the steep hill of Grand Avenue, toward the hospital lights below, his eyes go wide with terror. His inhales are harsh, crowing. I can’t tell if he’s getting any air at all.

∞

By September, 1920, Sylvia would be quarantined in a hospital south of St. Louis, one created expressly for the kinds of diseases that screamed in those days like currents through telephone wires. Sylvia was sick, and even then she was slowly disappearing from Nana’s memory. Her parents wanted to shield Nana, to minimize the collateral damage. Why call it angel? Why not call it what it was—a hideous, breath-sucking beast? Sylvia was sick and four-year-old Ruth—Nana, my grandmother—couldn’t visit her, because khas veshalom—she could get snatched, too.

Diphtheria. It was a bacterial disease that Ruth couldn’t have pronounced, even if she’d known of it. Strangling monster. Harsh luck. Segregate the sick from the healthy, burn to ash all clothes plus any discharge from the throat, nose or mouth. Inter the feces. Entomb the deceased in a coffin with disinfectant and close it tight. Hide, isolate, bury. No possibility of a public funeral, of releasing grief to the air.

The sounds of diphtheria portended a gradual decline. And besides the fortunate few who had somehow built sufficient immunity, the trajectory was virtually inescapable. Upon infection, the throat slowly succumbed to a leathery, gray membrane that choked off air. Lips and nose turned blue, coinciding with a barking cough and whispery voice—dull, quiet, drowsy. Extremities became chilled, breathing more ragged. Air tubes closed.

Relentlessly, the noose tightened.

∞

Andy pulls up to the emergency room at Children’s Hospital. The building abuts the same garage where I have parked dozens of times over the past many months for Eli’s speech therapy, the place I’ve taken to calling “Talking School” since I learned of Eli’s speech disorder. Apraxia of speech—deriving from Latin, meaning loss of knowledge of the uses of things. Eli knows what he wants to say. But his mouth won’t do his bidding.

Tonight the building is bathed in red. It feels foreign to me. The automatic door opens and I run inside, carrying Eli, who continues to bark and cry. His face is doughy, his eyes wide and darting. His hair is plastered to his head.

The emergency room is sleek and modern, with green stars on the floor and giant white stars on the wall behind the receptionist.

“My son can’t breathe!”

As soon as I say it, I realize I’m barely breathing myself. The receptionist takes one look at Eli and summons a nurse, who quickly beckons us down a long white hallway to a private trauma room, bypassing the waiting room. The nurse darts out and returns pushing a nebulizing machine with a clear plastic mask attached.

“He’s got croup, there’s no doubt,” she says, and hands me the mask to put over Eli’s mouth. “It’s a severe case. That barking cough was all we needed to hear.”

For a few moments, Eli fights me over the mask, but he is too weak to struggle for long. He inhales, then exhales, and slowly the barking quiets. The nurse explains that the nebulizer contains epinephrine, a steroid that opens up air passages. We did the right thing by bringing him in, she assures us; in fact, we would have been perfectly justified calling 911.

Croup most often arises from the influenza virus.  Although the infection that causes croup sometimes occurs in adults, it is exponentially more serious in young children. Sometimes, it croup comes without warning. Because vocal cords are the narrowest part of a child’s airway, breathing can become labored or cut off. Eli was in respiratory distress; his inflamed vocal cords didn’t allow him to breathe or speak. If he could have spoken, if he didn’t have apraxia of speech, I wonder if he could have found the words to tell us what was wrong.

“If a child with croup gets upset, his symptoms get worse,” the nurse tells us. “It becomes even harder for him to breathe. That’s why panicking is the worst thing you can do. It’s important to stay calm when you see it happening.”

The ingredients, then, were in place for a worst-case scenario. I imagine our son waking up in the dark. He sees the fish mobile swaying above him. He opens his mouth to cough, then struggles for breath. His throat is a straw, and the straw is pinched shut. He hears footsteps on the stairs, figures it’s Mommy or Daddy. Whoever comes in will pick him up, make him feel better. Then the door opens, and the person staring at him is no one he recognizes. Her long, blonde hair and blue eyes look vaguely familiar. She bends down, reaches for him.  Who are you? Where are Mommy and Daddy? Why can’t I breathe?  This is what he wants to say but can’t.  Eli’s apraxia, his inability to form words, would have added to his panic, making things even worse.

Later, I will wonder: What if Andy and I had decided to linger at dinner that night? What if we had ordered dessert, or gone for a walk afterward? Haven might have called her mother, losing precious time. I think about the noose growing tight.

∞

Sylvia died on September 23, 1920—two days after Yom Kippur, the Day of Atonement. Back then, before the availability of antibiotics and immunizations, tens of thousands of children died from diphtheria each year. Parents lived in dread of any disease that spread quickly—through contaminated water or milk, through the air or human contact. Families could suffer multiple losses in a matter of days. The loss was unimaginable, the pain incalculable.

Nana never spoke of Sylvia to my sister or me. And if it hadn’t been for Uncle Lee, I never would have learned what had happened to her—yet even he didn’t know much. Sylvia had been gone for nearly a decade by the time Lee was born. But this much he knew: His father held Sylvia in the end, in the hospital where she’d been quarantined.

“She passed away in his arms,” Lee said quietly. “That’s what my mother told me. But he never talked about Sylvia. Never. Never. Never.”

I tried then to see the loss through Nana’s eyes: To have a sister, and then not. The gaping hole in the fabric that was once her life—and the silence, always silence. Her father, wobbly with grief, had tried to scrub away reminders. He flicked the memory of his daughter out of reach, out of sight, like a dead fly on the windowsill.

Because of this, Sylvia must have faded from Nana’s memory—because, of course, memories must be fed, given air, to survive. For my grandmother, the choking off of memory and the silence that ensued became Sylvia’s second death. She became little more than a couple of pictures in a trunk, an acorn cap of brown hair. And then she was a phantom, a ghost, the barest outline, and then not even that. Nana was young, and so she forgot. But the pall of grief, the heavy burden of loss, still surrounded her. How could that loss not shape everything she would still become?

I thought of Nana’s mother: losing the child she had borne when she was only a child herself, becoming at age twenty-six a lumpish matron who looked more than a decade older. I imagined the unspeakable fright, the sure, slow-moving devastation. To see her daughter struggling for breath and being helpless to stop it. Her first-born, a part of her body, sent away to die.

I think of my own terror in the back seat: holding my son’s soft, warm body, wrapping my fingers around the small, jutting blades of his shoulders. Hearing him nearly convulse with breathlessness, seeing my panic reflected back in his eyes. We were only five minutes from help. And now he is safe, thank goodness he is safe, but only because we are fortunate enough to live in the era of emergency rooms and epinephrine.

 

Back in Sylvia’s day, antibiotics had not been invented and vaccines did not yet exist. Croup was a thing to be dreaded.  Well into the 20th century, croup was the term used for any form of obstructed breathing in a child and was commonly associated with the diphtheria bacteria. Many children died from it. In both cases, the cough sounded the same—scraping metal, whistling. Today, croup is common and the vast majority of children who contract it recover without consequence. It becomes dangerous, however, when the trachea closes, and that is what Eli experienced. Doctors suspect he had spasmodic croup—not a virus—which comes on suddenly, typically at night, and quickly can become life-threatening.

Tonight, the epinephrine kicks in and Eli begins to breathe normally again on his own. Even so, we stay in the ER for two more hours just to be safe. He and I rest on the hospital bed together. Eli, woozy with sleep but still not sleeping, stares at cartoons floating across the television screen bolted to the wall. And when we finally bring him home, Andy heads to bed while I prop pillows on the guest-room bed; we’ve been told to keep him upright tonight. I try to sing him to sleep as he rests his head in the crook of my arm. But for once my singing fails; Eli fidgets and squirms beside me, and I finally give up. I deposit him back in his crib, lie beside him on the floor and try, unsuccessfully, to sleep. In the loamy dark, the fish mobile sways above my head like the shadow of something secret and ungraspable, something already lost.

Header photograph © Marybeth Cohowicz DeYoung.