Sandra slid the heavy window open. Smog and car exhaust wafted into her high-rise apartment. The sounds of the city on this Sunday afternoon were jarring and loud — the rumble of a subway train, a car honking, bus brakes squealing. In her bare feet, the 28-year-old woman climbed up and eased herself onto the window ledge, her legs dangling. The experience was vivid: the cityscape all around her, the wind blowing her hair into her eyes, the building’s rough concrete scratching at her calves. Her heart beat faster as she watched the traffic far below, and she gathered up the strength to push off.
Thankfully, she didn’t jump. Instead, she was in my hospital’s emergency department an hour later. Sandra was sitting up on a stretcher, her legs crossed. She looked drawn and haggard, her hair an uncombed mess. I could tell she’d been crying and hadn’t slept much. After a few questions, she began to tell me her story. Several months earlier, Sandra landed her dream job in advertising and moved to the city from a small town. She was excited; things had been going well at work. Shortly after moving, she developed asthma, which is common among transplants to an urban environment with its poor air quality. Her physician tried treating her asthma with inhalers, but they weren’t effective. She was switched to an oral steroid, which made breathing much easier.
