“Mom, it’s Mordy. Levi collapsed in the beis medrash and they don’t know what’s wrong. We’re in an ambulance together on the way to the emergency room.”

Do I drop everything and head to the airport? Mordy convinced me to stay put until we knew what was happening, and he did a great job relaying over the phone all the details, but it still felt awful to wait and listen. This test was negative, that check was negative… what could it be? They were about to send him home and tell him it was some kind of gastrointestinal attack when a doctor caught it.

“See here on the chest X-ray,” I could hear her saying over the phone. “Right there we can see a minor pneumothorax, which is a collection of gas in the pleural space between the lungs and the chest wall. It’s also called a collapsed lung.”

We got in touch with an amazing medical askan in Lakewood to help us with what came next. A specialist came to see Levi, who told him the pneumothorax was a minor case and they were going to watch it for a few hours in the hospital to make sure it wasn’t getting worse. They told him that this was common with tall, skinny boys; that often when boys grow long and lean during later adolescence, it can predispose them to this condition. He was in a lot of pain, but they gave him some medication and assured him he would start to feel better.

And then, the doctor looked at him and said, “By the way, do you vape?” Levi nodded. The doctor gestured at Levi’s attire and said, “Because you’re the tenth boy this year dressed like you are to show up in this hospital with this issue. You should know that vaping thins the lining of the lungs, and truthfully, we don’t even have enough studies yet to say exactly how it is related to pneumothorax. But a lot of young male vapers have shown up suddenly in the ER with this exact condition.”

Levi was discharged six hours later, with an appointment to follow up with the specialist in a week. His restrictions were no flying on a plane, no exertion to the point of heavy breathing, and under no circumstances should he vape.

After Mordy escorted Levi back to yeshivah and returned to his own beis medrash, his rosh yeshivah called him over to find out what happened and then asked, “Is your brother tall and skinny, and does he vape?”

“Yes,” Mordy answered. “How did Rebbi know that?”

The rosh yeshivah shook his head and said, “There have been a lot of cases of this with tall, skinny vapers in Lakewood this year.”

When we heard what Mordy’s rosh yeshivah had said, my husband and I were devastated. If this is such a pervasive problem, why aren’t we doing more to stop it? How did we get to a place where our son, who had been “harmlessly” vaping for the past four years, would end up in the ER with a collapsed lung? But even worse were other questions: Would Levi get it? How addicted was he? While everyone around him vapes constantly, how will he be able to handle that pressure and stay away?

My husband and I asked doctors for help finding studies and information about vaping to share with others. We called the yeshivos in our hometown and other yeshivos around the country that we have connections with, and told them what had happened. We begged them to tell this story to their bochurim to warn them. If our story could get even one bochur to stop — or even better, not start — we felt that Levi’s ordeal was not for nothing.

We got a lot of support from yeshivah administrations, but we also got the following response from many well-meaning rebbeim: “But do we really know that vaping is dangerous?”

Well, this is what we do know:

While research is still in the initial stages about exactly how using e-cigarettes, or vaping, affects the lungs, pulmonary experts have seen a huge uptick in patients who vape. Both smoking and vaping involve inhaling fumes — with traditional cigarettes, it’s smoke from burning tobacco. With vaping, vape juice or e-liquid is heated up until it turns into a vapor that’s inhaled — and then coats the lungs with potentially harmful chemicals. E-liquid concoctions usually include some mix of flavorings, aromatic additives, and nicotine or THC (the chemical in marijuana that causes psychological effects), dissolved in an oily liquid base that serves as a delivery agent.

Some of the culprits include vitamin E oil, which can become a lung irritant when inhaled; diacetyl, a food additive used to enhance e-cigarette flavors that can damage small passageways in the lungs; formaldehyde, a toxic chemical that can cause lung disease and contribute to heart disease; and acrolein, a common weed killer that can also damage lungs.

The most common vaping-linked conditions include: “popcorn lung,” called that because this generally rare lung condition was discovered when popcorn factory workers started getting sick after inhaling quantities of diacetyl, which is used to give butter flavor to microwave popcorn; lipoid pneumonia, which develops when fatty acids enter the lungs, and can be sparked by inhaling the oily substances found in e-liquid; and pneumothorax (collapsed lung), which happens when there’s a hole in the lung through which oxygen escapes. Pneumothorax can result from an injury, or occur when air blisters on the top of the lungs rupture and create tiny tears — blisters that typically occur in tall, thin people who’ve had a period of rapid growth during adolescence. While these blisters are harmless and don’t usually rupture on their own, vaping is associated with an increased risk of bursting these blisters, leading to lung collapse.

I wish I could tell you that Levi’s story ended with that first visit to the ER.

A month later, Levi called and told me he felt like it was happening again. It wasn’t as acute as the previous time, but it felt the same. We got him in to see the lung surgeon he had met in the hospital that same day. She took X-rays and told him he was fine, that maybe he was just anxious because they had mentioned that once it happens, the chance of it happening again rises.

The next night Levi called again and said, “Mom, I know it’s happening again, what should I do?”

Hundreds of miles away, I was at a loss. I told him to go to urgent care the next day, Friday — maybe it was just a nasty bronchial infection.

Friday morning, he went to Chemed Health Center. The doctor he saw that morning told me later that she almost didn’t repeat the chest X-ray, because she knew he had seen a specialist the day before. But she followed her gut and took another one. She gasped when she saw how bad the pneumothorax was this time, with the lung even more collapsed. She ordered him to go straight to the emergency room — and quite possibly saved his life.

Mordy again went with Levi to the emergency room, but this time, his condition was much worse. And, we realized, there was no way we could make it before Shabbos.

When we were told that they needed to put in a chest tube, I felt tears running down my cheeks. I knew from a different family member that this is an incredibly painful medical intervention. They have to keep the lung inflated so he can breathe and stay alive, but in order to do that, they insert a plastic tube from the side of the ribs, through the bones and into the lung itself. They kicked Mordy out before they did it.

Levi told me later he begged to be put out from the pain. They told him he needed to be fully conscious for the procedure, but the local anesthesia wasn’t enough. He passed out and had to be revived.

The ER doctor then told us that they were admitting him, and that he needed surgery early the next week to repair the lung, which would entail a long hospital stay.

That next week was winter break for my younger children, and we’d long been planning a vacation for our four youngest beginning that Sunday. Instead, we sent the older two with my husband’s parents, booked a ticket for me to fly out right after Shabbos to New Jersey, and prepared my husband to drive the long, long route to Lakewood, because we knew that when Levi was released, he would not be able to fly home.

The chesed of our community never ceases to amaze me. I was anxious knowing that my 20- and 19-year-old sons would have to be in the hospital by themselves for Shabbos without another adult. But Bikur Cholim checked in with them, called to tell me, “Mom, your boys look great,” and provided them with Shabbos food. The askan checked in and called the doctors to make sure Levi was well taken care of medically. A family offered us their home for the duration of our week in Lakewood. Our people handle crisis well.

I arrived at Levi’s hospital room at 1:15 a.m. Saturday night, after a kind family on my flight drove me from Newark to Lakewood. Levi was in so much pain from the tube that he could barely eat or sleep. They had tried morphine, Toradol, IV Tylenol, and oral oxycodone by this point, but nothing seemed to ease the many pieces to the discomfort of the chest tube. I couldn’t believe it was this bad. No parent wants to see her child in so much pain and so incapacitated. I put a few chairs together and lay down next to him, but I don’t think either of us slept that night. He was in so much pain and I was frozen in sadness by it.

My husband arrived with our two youngest the next day by car. For the next week we took turns, one parent doing activities with the little ones and one parent sitting in this hospital. Monday was surgery day. Levi tried to act nonchalant as they wheeled him into the OR, but I could see the fear in his eyes. I gave him a brachah and kissed the top of his head as they wheeled him away.

I sat for the next few hours in the operating room’s family waiting area (except for my trip to the incredibly stocked Bikur Cholim room for food and water). I davened, I cried, I talked to Hashem. I knew this was something totally out of my control, but I felt embraced and completely in His Hands at the same time.

I’ll skip through the rest of the week and just share the highlights. The surgery was successful in repairing the piece of the lung that had become “leaky.” They kept the chest tube in for three more days after the surgery and Levi was in agony over it, both physically and mentally. I was able to help the understaffed nurses stay on top of his pain, but it didn’t seem to help much.

Every morning, I would arrive at the hospital at 5:45 a.m. to make sure I didn’t miss the doctor’s rounds, and every day Levi would ask if this could be the day for his chest tube to be removed. The residents instructed Levi to try to move around more; his body seemed to become resigned to the agony as he painstakingly put on tefillin and attempted to learn every day. Toward the end of the week, we still didn’t know if we would be discharged with enough time to drive back to the Midwest for Shabbos, and so we simultaneously started making plans both in Lakewood and back home.

Thursday morning at 6 a.m., the doctors came around and asked Levi if he wanted his chest tube out. They removed it and the surgeon called me over to show me how much of the tube had been inside of his lungs.

The surgical resident asked me to take a picture of the tube, and she put her thumb on the place to show how far into his thin body it had been inserted.

Then she looked Levi in the eye and said, “Look at this tube. This is why you are never going to vape again, right?”

I think he was angry at her for saying it, but I wanted to hug her. Maybe too strong of a statement, maybe not strong enough. Should I frame the picture for his wall?

They kept an eye on him for a few more hours, and then he was finally discharged. We quickly packed up and loaded up the car for the long drive home, piling in lots of extra pillows and blankets. We arrived home at 2 a.m. Friday morning, to be met by our incredible community, who provided Shabbos for us. A special nurse friend of mine came over and changed the bandages for the first time, showing me how it’s done (the hospital was so busy that they released us without giving further wound care instructions). The chest tube wound was huge and gaping. Its scar would surely be a reminder of everything Levi had been through.

Slowly Levi started coming back to life. But his body needed time — it had gone through a huge trauma. He missed a lot of yeshivah, which devastated him, but I could only feel gratitude that he was alive and well. A pneumothorax that goes on for too long can be dangerous, even fatal.

I deliberated quite a bit before writing this piece. When I asked Levi what he thought, he surprised me by telling me he wanted me to write it. (I’m still not sure if he said that because he knew it would be therapeutic for me, or because he wanted to promote awareness.) He promises that he’ll never vape again, and I daven that he should be successful fighting the strong current of what is happening around him constantly.

So that’s my story. I hope this is the end of it. I want you to know it and I want you to share it. Sometimes it takes the medical field decades to catch up with studies and evidence — people were smoking nicotine cigarettes and dying for years before warning labels were slapped onto cigarette packs, and women were taking approved medications that were later shown to cause birth defects.

I know many people are going to say that Levi was tall and skinny and had a growth spurt and that’s why this happened; I know many people are going to say that vaping is not a big deal and I’m blowing it out of proportion. And I, too, will be honest and say, I am not G-d, I can’t ever know for sure. True, correlation doesn’t equal causation.

But the ER doctor knew it. The rosh yeshivah knew it. The surgeon who removed the chest tube knew it. Vaping is slowly but surely breaking down people’s lungs. There are many doctors who know that by the time we have the hard data, many of our young men will have been vaping for too long to reverse its damage.

And what I know with certainty is that I don’t want any other parent to go through what we went through, or chas v’shalom, worse.

(Originally featured in Mishpacha, Issue 1003)