5:57 A.M.
SCARVES OF SMOKE AND the occasional spark were still drifting past them. They couldn’t afford to stop—but it was clear Marco couldn’t go on.
His eyes were panicked, his hands pressed against his chest. As he strained to breathe, he made horrible whistling, wheezing sounds. Every time he attempted to inhale, his shoulders rose and a hollow triangle appeared on each side of his neck. The muscles in his upper body were trying—and failing—to help inflate his lungs.
Two years ago, a girl in Natalia’s PE class had had an asthma attack while they were running laps. Natalia had experienced a visceral reaction to the idea of not being able to breathe. She knew the consuming panic of your body screaming for oxygen. Afterward, she had looked up how asthma worked.
Right now, Marco’s inflamed breathing tubes were starting to squeeze shut and fill with mucus. Not only was fresh air not getting in, but old air was trapped in his lungs.
She stood in front of him. “Marco. Look at me. I need you to stay calm.” She put her hands on his hunched shoulders. His shirt was soaked with sweat and he was breathing at least twice as fast as she was. “Try to relax your upper body. You need to slow your breathing down. The faster you breathe, the worse it’s going to get.”
Beatriz stepped closer. She had her fingers hooked in Blue’s collar. Both of them were watching Natalia as if she actually knew how to fix things.
“He just got diagnosed with asthma last year,” Beatriz said. “It started when he exercised—his chest would feel tight. Now other things sometimes set it off. But he doesn’t really believe he has actual serious asthma.”
Marco rolled his eyes at Beatriz, but she just shrugged.
“What? You don’t!”
Exercise could be a trigger. Marco had been hiking all night. Another trigger was allergies or irritants. Like smoke from a forest fire. Her own nose and throat felt chafed.
Untreated, asthma could kill. Marco needed to rest quietly in a room with clean air. He probably needed supplemental oxygen. But at the very minimum, he needed an inhaler, which would open up his airway to help him breathe more easily.
Natalia looked at the ring of faces surrounding them. “Does anyone else have an inhaler?”
But she already knew the answer. Marco’s had been the only inhaler when they pooled all their stuff on Wyatt’s blanket.
Marco cleared his throat and swallowed. “It hurts.” He put one hand on his chest. “Like something pulling inside.” His words were separated by gasps.
“Shh! Don’t talk.” Natalia put her finger to her lips. “Save your breath.”
But that was actually part of the problem. He was saving his breath. Or his body was. In order to pull fresh air into his lungs, he needed to be able to push the old air out.
Natalia combined logic with what she had learned in the hospital recovering from smoke inhalation. “Try to breathe in through your nose. It will moisten the air and filter out some of the smoke. And then breathe out through your mouth. Purse your lips like you’re going to whistle. Try to exhale twice as long as you inhale. That will help empty out your lungs.”
As Marco followed her instructions, he started to look a little less agitated.
But as she was watching his mouth, his lips begin to slowly lose color until they were pale violet. He still wasn’t getting enough oxygen.
In her head, Natalia ran through the contents of her first aid kit. Aspirin, Tylenol, Advil. Could the Benadryl help? Maybe a little, but it would also make him sleepy.
Then she thought of Zion’s EpiPen, meant to reverse anaphylactic shock. In anaphylactic shock, two things happened. Blood pressure dropped as small blood vessels started to leak blood into the tissues. That wasn’t Marco’s problem. But anaphylactic shock also caused airways to narrow, which was exactly what was happening to Marco. Epinephrine—another word for adrenaline, the medicine in an EpiPen—narrowed blood vessels and opened airways, preparing the body for fight or flight.
Should she take Darryl aside, ask him privately? But there wasn’t time. Plus, it would be harder for him to say no in front of everyone.
“Darryl, I need to use one of Zion’s EpiPens. That’s the only thing we have that could help Marco.”
“What? No.” Darryl took a half step back. “We need to keep them for Zion.”
Blue, sensing the tension, let out a sharp bark.
“Come on, man,” AJ urged. “Just look at him.”
Every time Marco inhaled, the notch above his collarbone sucked in a half inch.
“And you have a two-pack,” Natalia pointed out. “Let me just use one. Please.”
“There’s two in there because the doctor said sometimes it takes two.” Darryl protectively put his hand over his pocket.
“Look.” Wyatt kept his voice low. “Marco could die if we don’t do something right now. It won’t be that long until we get back to civilization where you can get a new EpiPen. But Marco might not make it, not unless we do something now.”
Darryl sighed, reached into his pocket, pulled out the box, and handed it to Natalia.
Inside were two tubes. She pulled one out and flipped back the cap, remembering the instructions they had learned in first aid class, working with a dummy injector. “Blue to the sky, orange to the thigh.” The fake injector had lacked a needle, but the instructor had said the real one was strong enough to pierce even denim. Just to be sure, she raised the injector high and swung it down hard, popping it against Marco’s outer thigh.
He didn’t make a sound, but his eyes widened.
“One one-thousand, two one-thousand,” she counted out loud. When she reached ten, she pulled the injector away. The needle automatically retracted. Starting a new count, she began to rub the spot, encouraging the medication to spread. Again, she stopped when she reached ten.
Was Marco breathing any easier? He had managed to calm himself, so his breathing was slower, but it still seemed to be requiring all his effort. Wasn’t the medication supposed to work nearly instantaneously?
As she was sliding the used EpiPen back in the box next to its twin, she noticed the words on the packaging. “EpiPen Junior.” What did that mean? For the thousandth time since they lost cell service, Natalia wished she could google something. Even without Google, it didn’t seem good. The junior version of the EpiPen must be a smaller dose calibrated for a smaller person.
But Marco was a grown man, easily twice as heavy as Zion. Natalia muttered a swear word.
“What’s the matter?” Lisa asked.
“I don’t think it’s enough. This says EpiPen Junior. That means it’s for someone Zion’s size. For an adult dose, I think I need to use both.”
As if to underline her point, Marco made his loudest wheeze yet as he struggled to breathe.
Darryl shook his head. “If you use both, then we won’t have anything at all.”
“Come on, Grandpa!” Zion pushed his way in between them. “Marco is going to die if she doesn’t!”
Looking at Marco struggling so hard to breathe, Natalia was afraid Zion was right.
“No, he isn’t.” Anger as well as uncertainty colored Darryl’s voice. “And we have to save one for you. Just in case.”
But Zion took the decision out of Darryl’s hands. Grabbing the remaining injector from the open box, he pulled off the cap and in one swift motion plunged the needle into Marco’s thigh.