The Number on the Card That Explained Why I Had Been Slowly Losing My Strength Since Spring
Every October I give blood at the fire hall down on Fourth Street. I am seventy years old, and in thirty years of rolling up my sleeve on that folding table beneath the humming fluorescent lights, they have never once turned me away. My iron has always been steady, stubborn as a fence post, the kind of blood they like to take and put right into someone who needs it. This year the room smelled like the usual mix of floor wax and stale coffee from the urn by the scoreboard.
The young man working the intake station had acne scars on his jaw and a plastic nametag that crookedly spelled out Marcus. He pricked my ring finger, squeezed the small drop onto the glass slide, and slid it into the little grey machine that spits out the readout. He waited. Then he took the slide out, cleaned it, and ran it a second time while chewing the inside of his cheek. I sat there with my cardigan buttoned to the collar, watching the red numbers flicker on the screen, feeling perfectly ordinary except for the familiar dull ache in my lower back that I had blamed on gardening all summer. Marcus looked up from the machine, his eyes wide and uncertain behind wire-rimmed glasses, and shook his head very slowly. Ma’am, I can’t take yours today. I laughed, thinking it was just some minor glitch in the calibration, the sort of thing that happens with old government surplus gear.
I’m healthy as a horse, I told him, smoothing my skirt over my knees. He didn’t laugh back, not even a twitch of his mouth, which should have warned me right then. Instead, he grabbed a blank registration card from the stack, turned it over, and scribbled a string of digits in ballpoint pen before folding my fingers right around the stiff paper. Show this to your doctor this week, he whispered, leaning in so the other volunteers wouldn’t hear past the hum of the box fan. Please don’t wait. My fingers went still around that warm, folded card. I had been tired since spring, breathless every time I hauled the basket of wet laundry up the basement stairs, but I had blamed my age, the way everyone does when the years start piling up like leaves against a screen door.
I walked out of the fire hall into the crisp October air, the card heavy and sharp against my palm like a pebble in my shoe.
The sun was dipping behind the grain elevator at the edge of town, throwing long purple shadows across the gravel lot where my old Buick was parked. I didn’t start the engine right away. I sat behind the wheel with the window cracked an inch, smelling the sweet rot of fallen cottonwood leaves and the faint exhaust of a passing tractor. I unfolded the card under the weak glow of the dashboard clock. The number written there was 7.4. I did not need to be a nurse to know that a normal hemoglobin count is supposed to be up around twelve or thirteen, where mine had lived comfortably for decades. Seven point four meant I was running on fumes, though my body had somehow kept the engine turning over without me noticing the drop. I thought about the heavy cast-iron skillet I had lifted out of the oven just that morning to bake corn bread, and how my arms had felt like water by the time I set it on the trivet.
I had told myself then that the stove was just getting heavier, or that the damp weather was getting into my joints. It is a strange thing to realize that your own mind is your worst accomplice, covering up for the slow, leaking ruin of your body with convenient excuses about getting old. I turned the ignition key and drove home through the gathering dusk, the headlights catching the white fences along County Road Twelve, feeling a cold little knot tighten behind my ribs that had nothing to do with the evening chill.
The next two days at home dragged like a wet wool blanket. I didn’t tell my daughter Sarah when she called on Sunday evening to check in, because Sarah has three kids and a mortgage and enough on her plate without her old mother borrowing trouble over a slip of paper from a fire hall volunteer. I spent those forty-eight hours moving through my kitchen like a ghost, doing the dishes by hand, watching the clock hands creep around the face of the yellow wall clock, and telling myself that Marcus was probably just being cautious because liability laws make everyone terrified of their own shadow these days. But every time I reached for the hand towel hanging by the sink, my eyes drifted to the index card propped up against the sugar canister where I had left it. Seven point four. It sat there like a little grey anchor weighing down the whole kitchen.
By Tuesday morning I could not stand the waiting anymore, so I called Dr. Alan Vance’s office right at eight o’clock when the receptionist, Brenda, picked up with her usual clipped efficiency. Alan has been my family physician for over a decade, a man who smells faintly of spearmint gum and listens with his chin propped in his palm while tapping a yellow pencil against his knee. Brenda tried to give me an opening three weeks out for my regular annual checkup in November, but I cut her off right there in the middle of her sentence. Brenda, I need to see him today, I said, and my voice had a dry, sharp edge to it that must have surprised her because she stopped typing. I didn’t mention the fire hall or the card; I just told her I wasn’t feeling right, and she squeezed me into a ten-forty cancellation slot between a teenager with strep throat and an old man needing his blood pressure meds refilled.
Dr. Vance looked different in the harsh fluorescent light of Exam Room Three, his hair a little greyer around the temples than it had been when I saw him last autumn, but his eyes were still as sharp as daggers behind his wire frames. He listened while I told him about the breathlessness on the stairs and the way my coffee mug had felt too heavy to lift on Monday, nodding slowly while he tapped that same yellow pencil against the knee of his pressed khaki trousers. Then I reached into the pocket of my cardigan, pulled out the folded index card, and laid it flat on the shiny white paper covering the examination table. He picked it up between his thumb and forefinger, adjusted his glasses down his nose, and stared at the blue numbers for a long, quiet minute. He didn’t ask who wrote it or why I had gone to the fire hall instead of coming straight to him.
Instead, he dropped the card onto my open medical chart, reached for the mouse of his desk computer, and began pulling up my historical lab results from the past five years. Clara, your iron stores have been leaking out of a bucket with a hole in the bottom for at least eighteen months, he said, his voice dropping into that quiet, matter-of-fact register he uses when he is trying not to alarm an old woman who is already half-alarmed. We masked it with your annual donations because your bone marrow was working overtime to keep up until it finally hit the wall last week. He spun the monitor around so I could see the little graph he was looking at, a jagged red line that sloped downward like the roof of a barn, sliding lower and lower with every passing season. He didn’t waste time with comforting platitudes or patting my hand, which I appreciated more than he probably knew.
We need to find out where you are losing this blood, Clara, because at seventy, a drop like this doesn’t just happen because you are getting older. He reached for his prescription pad and began writing out an order in his jagged, hurried script. I’m ordering an advanced diagnostic enteroscopy and a contrast scan at the outpatient center downtown, and I want it done by Friday.
The cost hit me before the clinical reality did, like a cold splash of well water on a freezing morning. When Brenda handed me the printout of the referral at the front desk and whispered the estimated out-of-pocket facility fee after insurance adjustments, my breath caught in my throat. One thousand nine hundred dollars. That was nearly three months of my grocery and utility budget sitting there on a glossy sheet of white paper, a steep toll just to find out why my internal pipes were rusted out. I stood there in the narrow hallway of the clinic with Brenda looking at me with kind, pitying eyes that I despised, feeling the old, familiar panic of a woman who has lived on a fixed pension since her husband passed away twelve years ago. I thought about the cedar chest in my bedroom where I kept the emergency envelope with the burial money, untouched through three broken refrigerators and a new roof.
I could use that money, of course, but taking a chunk out of it felt like admitting defeat, like stepping across a line I had spent my whole life trying not to cross. I drove home with my jaw clenched so tight my molars ached, telling myself I could wait, that maybe if I ate a pound of beef liver and took some cheap iron pills from the pharmacy aisle, the numbers would climb back up on their own. But then I remembered the way Marcus had looked at me over that little grey machine, his eyes wide and serious behind his glasses, and I knew that waiting was just another way of hiding from the truth. By Wednesday afternoon I had written the check for the diagnostic center, my hand shaking just a little as I signed my name at the bottom, folding the pink receipt and sliding it right next to the card on the kitchen table where the whole mess had started.
The outpatient diagnostic center on Elm Street smelled of bleach and floor wax and cold leather, a clean, sterile smell that made you feel like you were stepping into a bank where they traded in organs instead of dollars. A nurse named Dolores with grey hair braided into a tight crown led me back through a maze of swinging doors into a room dominated by a large, pale green machine that looked like something out of a science fiction movie. She was brisk and professional, telling me to change into a thin paper gown that tied at the back and to leave my dentures in the little plastic cup on the sink. I sat on the edge of the narrow padded table with my bare legs dangling, shivering slightly in the air-conditioned chill while the digital clock on the wall blinked silently toward twelve-fifteen. There is a peculiar kind of loneliness that settles over you when you are stripped of your clothes and your shoes and your everyday armor, left sitting alone in a room where strangers are going to look inside your machinery.
I thought about Arthur, my late husband, and how he used to tell me I worried too much about my health whenever I got a summer cold or a touch of rheumatism. If he could see me now, sitting in a paper dress in downtown Amarillo with a thousand-dollar camera waiting to crawl through my insides, he probably would have grumbled about the expense and told me to drink some prune juice. The thought made me smile, a dry, twitchy sort of smile that didn’t reach my eyes, because for the first time in my life, Arthur wasn’t around to tell me whether I was making a mountain out of a molehill. The door clicked open, and the gastroenterologist, a young woman with sharp, intelligent dark eyes and a stethoscope draped around her neck like a scarf, walked in with my chart tucked under her arm. Ready for the grand tour, Clara? she asked, her voice light and steady, and I simply nodded because my throat was too dry to answer her.
The procedure itself was a blur of heavy sedation, the ceiling lights sliding past like smeared yellow stars while a low, rhythmic beep ticked away somewhere behind my left shoulder. When I woke up in the recovery bay, the room was dim and quiet, and Dr. Vance was standing at the foot of my rolling cot with his hands tucked deep into his coat pockets. He didn’t look grim, which I took as a small mercy, but he didn’t look like he was bringing party favors either. He pulled a folding chair up beside the metal bed rail and sat down, resting his forearms on his knees. We found the culprit, Clara, he said, and the way he said it sounded almost like he was talking about a stubborn latch on a screen door. It wasn’t the big scary thing you were lying awake thinking about in the dark. No malignancy, no polyps the size of marbles.
It was a little cluster of dilated blood vessels right there in the cecum, a pocket at the beginning of your large intestine that doctors call angiodysplasia. He explained it to me in plain English without any fancy medical jargon: just a tiny, fragile nest of blood vessels that had grown a bit weak with age, weeping microscopic drops of blood day after day since the spring without ever giving me a sharp pain to warn me. It was like a pinhole leak in an underground pipe, too small to notice until the pressure dropped low enough to stall the whole engine. They had cauterized the little cluster right there during the scope using a tiny heated probe, sealing the leak shut like a welder mending a split seam on a water tank. You’ll need a couple of iron infusions over the next month to top off the tank, he added, standing up and patting the metal rail of my bed with his palm.
But you’re going to feel like a new woman by Thanksgiving. I lay there in the quiet recovery room staring up at the acoustic tile ceiling, feeling a strange, hollow sort of relief wash over me, mixed with a sudden, sharp anger at my own body for keeping such a quiet, stubborn secret.
The recovery weeks at home were slower than I wanted them to be, measured out in weekly trips to the clinic for iron infusions that left my arm bruised a deep, mottled purple from the elbow down. Brenda would sit me in the corner chair with the warm blanket across my knees while the cold saline and iron dripped slowly into my vein through a tiny plastic tube, drop by drop, like rain off a tin roof. At first I felt washed out and irritable, spending my afternoons sitting in the faded floral armchair by the front window, watching the neighborhood kids ride their bicycles past the yard with a heavy, leaden fatigue that seemed to settle right into my bones. But by the third week, something subtle and undeniable shifted behind my ribs. The grey fog that had lived in the back of my mind since April began to lift, replaced by a clear, steady alertness I hadn’t realized I was missing until it came back.
I could walk up the basement stairs with the laundry basket without having to stop halfway to catch my breath against the whitewashed wall. I could lift the cast-iron skillet out of the oven with one hand while holding the potholder with the other, feeling the old strength return to my wrists like water filling a dry cistern. I didn’t mention the cost of the scan to Sarah or anyone else, treating it as the price of admission for staying in the game a little longer. Dr. Vance was right; by the time November turned into the cold, grey prelude of December, I felt sharper and lighter than I had in three years, moving through my house with a quiet, efficient rhythm that felt less like enduring old age and more like managing it.
On a cold Tuesday morning in early December, I walked out to the backyard shed to put away my gardening tools for the winter, stepping carefully over the frozen crust of the lawn where the frost had turned the dead crabgrass silver. The air smelled of woodsmoke from a neighbor’s chimney and damp cedar mulch, clean and sharp enough to make my eyes water. I reached up onto the high shelf above the workbench for my grandmother’s copper gardening trowel, the one with the hickory handle that she had brought with her from Missouri when Eisenhower was still in the White House. My fingers closed around the smooth, worn wood without a single twinge of stiffness in my knuckles, and as I pulled it down into the dim light of the shed, I noticed how steady my hand was. There was no tremor, no sudden dizzy spell when I bent down to check the winter mulch around the peony roots, just the steady, unlabored rhythm of my own breath moving in and out of my chest.
I stood there for a long moment with the trowel in my hand, looking out over the quiet yard toward the fire hall four blocks away, where the red brick chimney poked up above the bare maples. I thought about Marcus and his little grey machine and that scrap of index card sitting in my kitchen drawer like a stray receipt. He had saved me from myself simply by refusing to let me ignore what my body was whispering in the dark. Next October, when the leaves start turning brown and the air gets that crisp, metallic edge to it, I will walk right back down those steps to the fire hall, roll up my sleeve without a second thought, and let them take whatever they need.
