The conversation with the specialist at the cystic fibrosis clinic went something like this:

‘The indicators are telling us it’s time we think about transplant.’

‘I know.’

‘Your last few FEV1 readings were less than thirty per cent.’

‘My lungs have had it.’

‘How long has it been since you’ve been able to work? Have you been writing?’

‘I’ve been trying. It’s hard to concentrate.’

‘All the medication.’

‘Yes, ya. There’s that. It’s just. Nothing interests me.’

‘You’re spending more time on IVs than not.’

‘I haven’t got any ideas. For stories.’

‘Half your day is taken up with extra physiotherapy. I’m not surprised.’

‘So.’

‘If we stick to your current treatments, you haven’t got a lot of time left. Maybe a year.’

‘A year.’

‘And it’ll be a lousy year.’

‘You’re telling me.’

‘A successful transplant could give you six. It could give you more.’

‘Or less.’

‘We don’t know. But you can stop using supplemental oxygen. And you won’t be coughing. Imagine that, no coughing.’

‘I can’t imagine that.’

‘Post-op, you’ll still be on a lot of medication, but what matters is your quality of life will be better than it is now. And right now, it’s not very good.’

‘No.’

‘I think we should refer you to the transplant team. Get your name on the list. But it’s up to you.’

Up here, in the last days of September; up here, by this river banked on both sides by trees, a few houses and cottages; up here, the air is crisp and smells something like hope. Though everything is dying, death here is sweet and it smells like hope. Anouk and her mother have rented a cottage (the house just up the river from here, where Anouk was born, where her father lived until he died, now belongs to someone else) and it’s evening, and they’re sitting on the floating dock in two fan-backed, wooden chairs. They share a wool blanket, draped over their legs, and they share a cold beer, and there is the rustle of wind in the trees and the lap and suck of water against the gently rolling dock and the quiet, ubiquitous hiss of Anouk’s oxygen concentrator.

September is an ending and a beginning, both.

The trees are turning and the river reflects purple, yellow, orange burning. The loons haven’t yet flown south and they’re out there now, yodelling to each other.

‘Loons,’ says Anouk, more an exhale than a word. She leans back and sighs, content.

‘I always thought they sounded like a pack of crazies,’ says Nora. She squints across the mouth of the beer bottle, stares at the water. ‘Laughing at me. Loonatics.’

Anouk has learned that, of all the doctors and specialists out there, you’ll never meet a person more blunt than the transplant surgeon. The transplant surgeon deals in risks and percentages. The transplant surgeon deals in likelihoods. Her transplant surgeon, a tall woman in her fifties with shorn hair and smart stud earrings, loves percentages. In her comfortable office with cushioned chairs, she spoke about the percentage of patients who never make it out of the hospital. She spoke about the percentages of patients who make it through the first year, the second, the third. Not an especially high number. She listed, with one neat and tidy finger dabbing the palm of her opposite hand, the risks of post-operative infection, acute rejection, chronic rejection. Anouk’s new lungs, she explained, won’t be diseased like her old ones, but her immune system will slowly attack and injure them, and within a few years they too will become scarred and ineffectual.