Coming Up for Air

Listen, are you breathing just a little, and calling it a life?

Mary Oliver, "Ever Tried to Enter the Long Black Branches"

During my years of expatriation, I have celebrated some singular Christmas holidays, from a hotel in Morro Bay in California to a friend's row house in north London and onwards to a Christian ashram in Tamil Nadu, India (twice). Some notable experiences, however, must await my posthumous memoirs to be fully told.  This year the stores in Bangkok marked the end of severe flooding by restocking their depleted shelves and putting up Christmas decorations everywhere.  While the religious touch is missing, Santa and his elves frolic under mammoth artificial trees outside shopping centers here, not so much to lure the tourists, I think, as because Thais love festivity (Valentine's Day and now Halloween are becoming very popular).

What I didn't expect was to be lying in a hospital bed several days before Christmas struggling to breathe.

Not long after Thanksgiving, Nan and I put up the tiny fake tree we bought two years ago and festooned it gaily with ornaments.  But we wouldn't spend the holiday together since she'd been invited to go on a student exchange trip to Brunei for 10 days with other students from her university.  The night before she left I came down with a fever but kept quiet about it.  My chest had been congested for weeks.  In the afternoon I felt progressively worse and took at taxi to Chao Phaya Hospital not far away (for me, a decision of last resort).  The doctor gave me some pills and sent me home.  But I didn't improve and four days later went back.  This time the x-ray showed pneumonia and my oxygen saturation percentage was dangerously low.  I was admitted immediately, given a private room, put on a bronchodilator device, an oxygen tube stuck in my nose, and pumped full of antibiotics and steroids.

Dr. Tanasit recognized the wreck of my lungs from their causes, an asthmatic childhood, several cases of youthful pneumonia, and probably thirty years as a heavy smoker.  Both my father and his brother suffered from emphysema.  A long time ago in California my breathing was tested and I was diagnosed with "impaired lung function."  Since it didn't appear to be progressive, I put off any worries.  The current medication of choice for maintaining airways and preventing acute asthma attacks are glucocorticoids combined with a bronchodilator, and I was prescribed the Advair discus, two puffs a day.  But when I moved to Thailand in 2004, I foolishly stopped taking it because of expense (though much cheaper here, of course) and possible side effects.  I also stopped taking my cholesterol-lowering statins, but that's another story.

My first memory of asthma was being rushed to the hospital in Greensboro when I was six because I couldn't breathe.  Treatment then was an oxygen tent and a nebulizer.  Worse attacks followed and I recall the distinct relief from suffering that a shot of adrenaline (probably epinephrine) would bring.  When it was difficult to breathe, I remember sitting hunched over in a chair struggling to draw air, mom hovering by my side.  It felt shameful to be an asthmatic because it limited my sports activities and I couldn't be like the other kids.  One summer I went to camp and had an attack in the middle of the night.  I still recall clearly dragging myself up the hill to the camp counselor's office, pausing to breathe by every tree.  My father drove up to the camp and brought me home.  Despite this disability, I took up the clarinet when I was 10 and managed to pump enough air through my woodwind instruments to dream of becoming a professional musician.  Once sprays were invented, for many years I took Medihaler-Iso, a bronchodilator that contains isoproterenol sulfate, a drug like epinephrine which overstimulates the heart and simulates an amphetamine high.  One druggy friend of mine was always trying to bum a puff.  For much of my life, though, I could neglect the act of breathing and smoke, snort and swallow dangerous substances with no thought for the future.

Until, that is, I became aware of the centrality of the breath and breathing in many religious practices like meditation, yoga and, in the Christian tradition, contemplation to which I had become attracted.  The goal of some meditative techniques is to silently observe exhalation and inhalation through the nose or from the rising and falling of the stomach without interference.  I could never do that.  No matter how I tried to let go, I always found myself attempting to force each and every breath.  Breathing is one of the few bodily functions that, within limits, can be controlled both consciously and unconsciously.  Meditation remained for me a struggle between conscious intention and blissful release.  I found it easier to count the breaths or recite a mantra but, as mentioned in a recent post, transcendence of any kind from the body proved impossible.

Breathing, the inspiration of air by creatures, the metabolism of oxygen, is one of the central metaphors for life in all cultures and languages.  As I lay in my hospital bed on Christmas Eve, watching James Bond movies on TV while medication designed to keep me alive dripped through the IV line, this was no trivial fact.  Nurses wearing face masks trooped through my room, periodically taking blood pressure (out of sight from the steroids), and measuring temperature under the armpit.  While washing me with a warm cloth, a nurse's aide shyly asked , "You love the King?"  Who was I to quibble?  My blood pressure was unusually high, and a dry cough failed to clear gunk from the plugged bronchial tubes.  At night I sweated buckets and saw LSD colors behind my eyes.  I had no idea if the infection could be stopped, or if I would ever regain full control of my lungs (no thought of abdication now).  Would I be able to teach again?  Was it time to go out to pasture?   Nan was far away and the internet was not cooperative.

Contemplating the possibilities took my breath away, or better, gave me some breathing room.  Air passed into, through, and out of my body (breaking wind, since the medication made it hard to poop).  Oxygen-starved blood can bring death quickly.  The Hebrews pictured God breathing the breath of life, ruach, into clay to make life; the breath returns when the mortal dies.  Sophocles wrote, "A human being is only breath and shadow." No one possesses for long this breath, called pneuma by the Greeks, spiritus by the Romans, and prana in India.  Is this metaphysical quality, beyond its gaseous substance, passive or active?  The Chinese call it qi, the Japanese ki, and French philosopher Henri Bergson named it "elan vital."  Yogis and various Eastern teachers believe we can use and direct this power to achieve remarkable deeds.  Some think that the universality of breathing affirms soul or psyche, while others believe its communal nature erases our personal attributes.  These questions made little sense at the time as I lay in bed on Christmas Eve, remembering Christmases past when I joined with fellow Catholic Christians in Santa Cruz and also in India to celebrate the incarnation of the spirit of God and the promise of goodwill to all on earth.

The doctor discharged me on Christmas morning and I felt reborn.  No one was home when I got back to my apartment but I opened the windows and let the light and air inside.  Foolish as it seems, I felt I had cheated death.  This time I got to keep my breath.  I could sing along with country singer George Strait: "Life's not the breaths you take, but the moments that take your breath away."  Bangkok outside my window seemed paradise.  There were more pills to take and baby steps to walk in recovering my strength, to the 7-11 next door and two days later up to Starbucks.  I've learned that asthma and emphysema now fall under the general heading of Chronic Obstructive Pulmonary Disease (COPD) and that many of my older friends have it (my college roommate died of it earlier this year).  Nan returned to home our great double joy and the phlegm in my chest is gradually loosening, the breaths deepening.  A checkup today showed all chest infection gone.

I once again pay attention to the question above and to the challenge from poet Mary Oliver: "Tell me, what is it you plan to do with your one wild and precious life."  And I could not speak of the importance and meaning of air better than she in her wonderful poem "Oxygen":

Everything needs it: bone, muscles, and even,
while it calls the earth its home, the soul.
So the merciful, noisy machine

stands in our house working away in its
lung-like voice.  I hear it as I kneel
before the fire, stirring with a

stick of iron, letting the logs
lie more loosely.  You, in the upstairs room,
are in your usual position, leaning on your

right shoulder which aches
all day.  You are breathing
patiently; it is a

beautiful sound.  It is
your life, which is so close
to my own that I would not know

where to drop the knife of
separation.  And what does this have to do
with love, except

everything?  Now the fire rises
and offers a dozen, singing, deep-red
roses of flame.  Then it settles

to quietude, or maybe gratitude, as it feeds
as we all do, as we must, upon the invisible gift:
our purest, sweet necessity: the air.