Orla Tinsley: Returning to Covid-19 Ireland after my lung transplant

The writer and cystic fibrosis campaigner spent six years in New York where she had an operation

The art of telling time feels more delicate as the year moves on. When New York City emptied out in March, birdsong became the discernible dictum of the morning, and my job teaching creative writing moved online. Nature announcing its presence was somehow soothing in the early days, when silence surrounded the city, before sirens sounded the arrival of death daily. In the streets, social justice protests marked the movement for change and fireworks, at nightfall, divided opinion. The spark of people power despite the pandemic was undeniable, even though many people I know left the city.

After six years of study, one graduation and minus one immune system, it is hard to leave. On my mind, as I board the plane, are Joan Didion’s words: “It’s easy to see the beginnings of things and harder to see the ends,” she writes. In my hands, I am carrying a collection of stories in which writers calculate their love of the city, Never Can Say Goodbye, because I’m in love with New York City.

I am thinking about the privilege of being able to return home, at all, and of what a doctor said when he entered my room, some weeks previously, with a mask and a visor on: "It can get in through your eye ducts," he said, "so you should wear a visor on the plane." Words float independently from the pages when I try to pin them down. They have been carefully crafted into sentences but I cannot see clearly. I am thinking about whether the visor shielding the KN95 mask I am wearing and the 2m distance I am keeping from other passengers will get me back to Ireland safely. In any case, I will return home in this dreamlike state, as though the blinds are half shut on a world that has been fully alive in my heart and mind for the past six years.

My donor, who saved my life, is travelling to Ireland with me. Without the donor there is no story. Without my donor there are no words or movement or air

Of course, to survive and to be alive at all is an immense privilege. Who gets to be that lucky? Not enough people. I ask myself this question often, when I lack motivation or I am concerned about what happens next, and I remember gratitude and the power of the stories we tell to elevate or evaporate us. The voice of the air hostess cuts through my sentimental thoughts like an old school friend telling a joke. The intimacy of Irishness, that familial ability to create connection through humour before names are even spoken, makes me laugh. Luckily, masks cannot hide a smize. (And the extra pretzels? Thank you so much.) The presence is a welcome comfort as I know I will spend the next 14 days in quarantine, alone, although this is not difficult after a lifetime of illness.


I finally open the book and a sentence from an essay jumps out: "It's a real live wire, hard to leave, like a living, breathing entity in your life". What Whoopi Goldberg wrote about New York City. It reminds me of the virus: this living breathing entity in our lives, everywhere. It is highly unlikely, almost three years out from my double lung transplant, that my lungs will spontaneously collapse mid-air as they had previously done with cystic fibrosis. After all, because of the generous and selfless act of my donor, I can breathe now. And my donor, who saved my life, is travelling to Ireland with me. I remember the energy, electricity and empathy that kept me tethered to Earth when my face turned blue and I could not breathe. Without the donor there is no story. Without my donor there are no words or movement or air. It is easy to see the beginnings of things, and harder to see the endings. Life fades, refocuses, and then flits away again. Organ donation creates a gap, an unexpected space in which you can live on and in which life becomes more acutely beautiful and, somehow, it feels like there is more to lose.

The book, once on my lap, had migrated to the empty tray table beside me. I had hoped to find a framework or some words that would balance out the discomfort of uncertainty and reveal to me what I could not yet articulate. Frozen by a collision of contradictory impulses, I felt for what was really wrong. I had forgotten, mid-air, that I could now breathe. I pull air in through my nose, down into my lungs and flow it back out again. Passengers pass by on the way to the toilet. The lungs move with ease and I look out the window as the ducts in my eyes begin to work. How many different shades of blue could there be out there? Looking at the sky I try to list them: aquamarine, sky blue, the blue of my black cat’s paws in the sunlight, International Klein Blue, Wildfang jumpsuit blue, the bruised blue on my legs where the life support machine entered and exited, the blue of the yoga mat I left in New York, the blue of the face under the eyes when oxygen levels are low. The blue of breathlessness. The blue of endlessness.

Mid-air I need to slow down and feel the anxiety running my thoughts and hold it apart from my body. I am still breathing. The beginning and the ending of my existence will feel forever split between the two countries that saved my life. I will forever be grateful. It will take another lifetime to adequately measure the intricacies of these experiences. In searching, as in writing, I had entered some kind of default mode, turning over what was not there in search of what was. It was one way in which I could try to figure things out.

WITH NO NOTEBOOK on the plane, I pulled out my iPhone, opened up the familiar yellow notepad square and began to type:

Note 1
At the beginning of March I handed in my graduate thesis and, that same day, an alert on my phone confirmed the first case of coronavirus in New York City. As masks became mainstream, some of my friends, who also had transplants, spoke of their discomfort as words such as "ventilator" and "life support" became part of our lexicon again. Unexpected additions included, "shortage" and "morgue" and "mass graves". In this moment, listening – the ability to hear – feels acutely important.

Note 2
In June, the New York Times reported about the first person to have a double lung transplant because of Covid-19. I worried about this young woman and what would happen next. What had the paper said? A patient in her 20s with no serious underlying conditions at Northwestern Memorial Hospital. This meant that she experienced 30 years of cystic fibrosis scarring and devastation at the speed of a brutal car crash. How could this be? I thought of my privilege: of being able to prepare, being given the chance to understand that lung failure would happen. The mental workout in the mind, a kind of premonition of what could happen to the physical body. In July, the New York Times wrote that, before the transplant, the young woman had an autoimmune disease. I thought of my friend in the UK who had an autoimmune disease and who, like me, stayed inside for five months and saw no one. I thought about how even though we can follow every protocol, the virus advances. I thought of the damage those who do not care cause.

Note 3
"The way we are doing medicine is changing", said a nurse, when I first presented with nausea and vomiting. I heard her voice shake and when she did not phone back about the medication, I felt her absence. I worried about her. I worried about me. Photographs of large white refrigerators brought in to store the bodies of the dead are broadcast worldwide. The cathedral beside my apartment converts into a field hospital. Op-eds in newspapers argue the merits of not saving one patient in order to save another and, at the same time, neighbours write to offer support: "We remember how sick you were and we want to keep you safe" they say. We just happened to live in the same building. This was the greatness of New York City at work.

I LIFT MY BRAIN out of cruise control by setting the concrete task of packing my things before the plane lands. There is so much to look forward to: the crisp clarity of Irish air, the toasted crunch of McCambridge's brown bread, my mother's Irish stew. As the plane turned towards home, I could feel the curve and swoop of metal in the air, but I could not see the difference it was making to the sky outside. Inside, my breath held steady and deep as though my body already lay sleeping by a sittingroom fire on a cold Irish night. There was more to unpack but something else the transplant taught me was to try to get comfortable with things falling apart. A simple runny nose can mean rejection and lifesaving surgery. It can also mean a simple runny nose. It has been helpful to try to see things as a curiosity, as an endless question mark, rather than as unsolvable.

In quarantine, when my online groceries arrived, it was hard to understand why the delivery driver did not wear a mask and yet, in Manhattan, since April, delivery drivers wore masks. In September, when the schools opened, I wondered why masks were not compulsory inside all classrooms. Children on scooters, of primary school age, wore masks alongside parents in parks across New York City. I wondered why masks were not mandatory outside in Ireland or when meeting someone from a different household, outside. Why could children sit in school with no masks, when the role of asymptomatic transfer was known? A friend suggested I had a kind of neurosis after being in isolation in New York for five months.

As a person with zero per cent immunity and 100 per cent vulnerability, I wear a mask to protect others that I know are counting on me to do this one thing

One day in Ireland, after quarantine, I bought more than I intended while grocery shopping, and stood cradling the purchases in my arms. At the same time that my father pulled up to the kerb in his car, a woman finishing her shopping walked towards me, with her arms outstretched, not wearing a mask. Terror shot through me. The woman, who could see my overzealous love of jelly babies on display, was offering kindness in her hands: she was handing me one of her reusable shopping bags. In her eyes, and according to the health protocol, she was doing nothing wrong. I could see why the word “neurosis” was applied to my very real and valid fears.

That same month, scientists at Princeton published a paper on how far the flow of breath travels when speaking. It found that certain sounds create a “jet-like” airflow that could quickly carry tiny particles beyond two metres when speaking at a loud volume for 30 seconds. Reading studies is like watching the news these days, the information is best administered in small doses.

Inside the Mater hospital in Dublin in October, I was faced with protocols that surprised me. Unlike at New York-Presbyterian Hospital, which I attended during the pandemic, nobody checked my temperature on entry – a move that can protect patients and frontline workers. A woman working behind plexiglass had a mask on her chin. When she beckoned me forward, I questioned our safety. The woman assured me that the plexiglass protected us and that she did not need to put her mask on – but there is yet to be any scientific evidence of plexiglass being as effective as mask-wearing.

I breathe air in through my nostrils, feel it flow downwards and fill up my lungs, and flow out again. This helps me remember that we are all connected. We must commit to connection above all else

When my lung function was at 30 per cent, when I dragged a tank that was 50 per cent my body size around Manhattan, I wore a mask. Afterwards, when my chest wall had been held open by a large clamp and my lungs removed – disintegrating in the surgeon’s hands as they arrived out – I wore a mask to stay safe. Any time I was in a crowd for six months after my transplant – I wore a mask. My oxygen did not drop, my breath did not become shallow and I stayed alive. My family and friends wore masks to protect me and the gratitude I feel for this care is overwhelming. Kindness is still the most important thing.

I am here because, like for many people, immunosuppressants create a kind of alchemy between my organs and my body. This is half science and half luck, if they stay in sync then I survive. As a person with zero per cent immunity and 100 per cent vulnerability, I wear a mask to protect others that I know are counting on me to do this one thing. If love is the answer, like John Lennon said, then wearing a mask and physical distancing is love in action.

In a time when watching the news cycle feels like picking at an old scar, it is helpful to stand still amid the rush of information. I search for my toes and flatten my feet firmly on the ground.

I breathe air in through my nostrils, feel it flow downwards and fill up my lungs, and flow out again. This helps me remember that we are all connected. We must commit to connection above all else. However, this is not easy. This doesn’t take away from the real pain and hurt we are experiencing as life shifts rapidly. This doesn’t fix unemployment and deeply painful loss. It doesn’t explain public policy decisions around the virus.

I was grateful when, one evening, a brown paper bag appeared alongside red, yellow and purple roses on my kitchen windowsill in Ireland.  My neighbour, exercising the power of kindness and physical distancing, left flowers and four freshly laid eggs. I dwelled inside the generosity of the gesture. Even though we cannot physically hug our friends and families we can hold each other in our actions, our thoughts and our mutual gratitude and by believing in presence in these invisible-making times. Acts of kindness passed on can create a chain of hope.