Chapter Fourteen

BREATH

Inspiration and Expiration

WHAT TREE RIVALS THE BANYAN in extravagance? It extends roots not only from its trunk but also from its branches, dozens and eventually hundreds of sinewy stalks wending toward the ground to sprout root systems of their own. Uninterrupted, a banyan tree will grow forever, renewing itself in the radial extremities even as the inner core dies of old age. A single tree may cover acres of land, becoming a self-perpetuating forest spacious enough to shelter a full-scale bazaar (its name comes from the Hindi word banian: a caste of merchants).

A majestic specimen thrives in Calcutta (Kolkata) today, preserved in the city’s botanical gardens. The Great Banyan Tree looks like a giant, bushy tent supported by colonnades of wooden poles. Somewhere in the midst of that thicket of roots and branches, the central trunk began growing two centuries ago. After sustaining damage from a fungus and a cyclone, the inner core was removed in 1925, yet the outer tree grows on.

For a child who likes climbing and swinging from vines, the banyan tree provides endless amusement. As a six-year-old, I explored one for several days when my parents camped under a banyan during a missionary venture. As they went about their medical and spiritual work, my sister and I played Swiss Family Robinson inside the huge tree. The stalks that fell like stalactites from upper branches made for ideal climbing. Even better, some helpful visitors had looped and knotted various vines to form high swings and trapezes.

I was swinging on one such loop through a corridor within the tree, calling for my sister to push me higher and higher. As the height of my arc increased, I felt another loop of tendril brush against the back of my neck on my back-swing. I ducked to avoid it but failed to duck again as the swing lurched forward. The high loop caught under my chin, causing the swing to abruptly stop. The vine had clamped shut my windpipe, and I could not speak or scream or even breathe. I hung suspended in air, like a puppet tangled in its wires. My sister, on the ground, made a few frantic efforts to pull me loose and then must have run for help.

I woke up sometime later with my mother stooping over my camp cot, pleading with me to speak to her. When I said “Mother,” she burst into tears. She had feared brain damage, and my first word came as a welcome relief.

Other than a sore neck and a slight skin abrasion resembling a rope burn, I bore no lasting damage from the experience, though for many years I harbored a primitive terror of breathlessness. Anything that covered my mouth and nose, even immersion in water, brought back that terror, and I would fight as if for my life. I learned that lack of breath does not feel like anesthesia or sleep; it feels like death.

Fuel of Life

Since my experience in the banyan tree, I have seen many medical situations that corroborate the terror I felt that day. Emergencies of all types produce panic—heart attack victims clutch their chests; people with brain damage may thrash violently; soldiers in war stare, unbelieving, at a severed limb—but I know of no human experience that produces an uncontrolled panic to rival breathlessness.

The marathon runner staggers across the finish line with mouth agape, her ribs heaving, her head bobbing like a rooster’s, her whole body jerking in a bellows motion until gradually the oxygen floods in and the emergency subsides. The runner herself, however, feels no panic, for she has planned to end the race in a critical oxygen debt. Her gestures underplay those of a person who must have oxygen: eyes bulge, hands grasp frantically at empty air, and the heart races. Oxygen shortage sets in motion a vicious cycle, for the accelerated heartbeat, trying to distribute faster what little oxygen is present, requires even more oxygen.

We live, all of us, five or six minutes from death. Existence depends on our access to oxygen, the fuel that keeps our vital fires burning. When deprived of air, a person actually turns blue, first around the fingernails, tongue, and lips—a projection of the internal drama onto the visible screen of skin. High school biology students learn what causes the color shift: blue blood lacks the supply of oxygen from the lungs that normally turns it a rich scarlet.

The earth supplies an atmosphere we humans can relate to, and if our physical bodies leave the earth, for example on a space mission, we must somehow reproduce the oxygen in that atmosphere. Indeed, the entire animal kingdom subsists on this one life-sustaining element. Some animals’ means of collecting oxygen show remarkable beauty: the jewel-like fronds of marine worms, the fluted gills of tropical fish, the brilliant orange skirt of a flame scallop. Our own lungs opt for function, not form, yet they work well enough to make an engineer sigh in envy.

I remember being a medical student first cutting into a corpse’s torso. I had studied the various internal organs: heart, kidneys, liver, pancreas. But the lungs! Supremely important, they crowd all the rest, spilling into every crevice and cranny. Pump in air to simulate breathing and they expand as if to burst out of the chest cavity. Such vital organs need the space.

On an average day our lungs expand and contract around seventeen thousand times, ventilating enough air to fill a medium-size room or blow up several thousand party balloons. Any slight change in effort, such as climbing stairs or running for a bus, can double the demand for oxygen, and an involuntary switch orders a speeded-up rate of breathing. Receptors scattered around the body constantly monitor oxygen and carbon dioxide to determine the ideal rate.

Breathing proceeds without conscious control during sleep, or we would die. And the utilitarian body borrows the same air-flow system for such acts as speaking, singing, laughing, sighing, and whistling. My own love affair with breath, which began after my young body hung from the banyan tree, only intensified after I studied the mechanisms involved.

I have watched many patients live out the drama of breathing. Shortly after arriving in India as a physician, I received two telephone calls on the same day, one from Calcutta and one from London. Both concerned the medical predicament of a young polo player. The only son of a wealthy British lord, he had come to Calcutta to learn international finance on behalf of his father’s global network of banks. The doctors in Calcutta and his relatives in England urged me to take the very next flight to Calcutta to examine the young man who, the day after a strenuous polo match, had become suddenly paralyzed with polio.

Over a staticky phone line I shouted instructions for the hospital to prepare an iron lung and also to perform a tracheostomy if he developed breathing difficulties. Then I dashed to the Madras (Chennai) airport to catch the night flight. When I arrived in Calcutta, a car sped me to his hospital bedside.

I have a lasting impression of the figure I found inside that hospital room. A life of good nutrition and much leisure time on the rugby and polo fields had given the patient a superb physique. His arm and leg muscles, though paralyzed, bulged even in repose. He had built up an enormous lung capacity, now virtually useless apart from the assistance of an iron lung. The machine worked on a bellows principle, mechanically pushing his chest in and out to replace what his lungs could no longer do on their own.

The cruel irony of the scene struck me: that marvelous body shoved inside an ugly metal cylinder that noisily forced air in and out of his lungs. I thought briefly of Michelangelo’s sculptures, The Captives, in which magnificent bodies seem trapped in marble despite their efforts to free themselves. Before me, this man’s athletic body lay enclosed in steel. Nurses told me he had felt flu-like symptoms on Friday but had gone ahead with a polo match on Saturday so as not to disappoint his teammates. At the onset of polio, exertion may prove deadly.

To my dismay I learned that the hospital had not performed the tracheostomy, so I immediately sent for an anesthetist. I worried about the fluid that collects when muscles used for coughing or clearing the throat no longer function. I explained to the young athlete what we planned to do. An aide who stood beside him assured me that money was no object and we should take any measures that might help.

The young man himself responded, in two sentences. He could only say one word per breath, and that with great effort. Every sound came in a clicking, wheezing, almost choking expulsion of air. “Give . . . me . . . breath,” he said and paused. I leaned closer to hear him over the rhythmic pumping of the iron lung. And then, “What . . . is . . . the . . . use . . . of . . . money . . . if . . . you . . . can’t . . . breathe?” I looked at his face with great sadness.

After reassuring him we would do all we could, I stationed a nurse with a throat suction by him and went downstairs for a cup of coffee and bite of breakfast. The anesthetist had not yet arrived and I, having missed a full night of sleep, sought a little nourishment to improve my concentration. I had not finished my coffee when a nurse came with the news that the patient had died. Evidently he had regurgitated some fluid, which obstructed the flow of oxygen, and the suction device could not keep up. His breathing stopped, and with it his life.

Wind, Breath, Spirit

The English language describes breathing as a succession of two acts: inspiration and expiration. “I have expired” means I have breathed out; “I have inspired” means I have breathed in. If changed slightly to “I am inspired,” it could mean I am filled with an enlivening breath from the artistic muses or, in a religious context, filled with the Holy Spirit. The writers of the Bible claim to have been inspired or in-breathed.

Our vocabulary, superb and precise when describing the material world, falters before the inner processes of spirit. The very word spirit in many languages means nothing more than breath or wind. Thus Greek and Hebrew use exactly the same word for the Spirit of God, biological breathing, and even the wind gusts from a storm.

The words spirit and wind or breath have a clear affinity, as Jesus’ conversation with Nicodemus shows: “The wind blows wherever it pleases. You hear its sound, but you cannot tell where it comes from or where it is going. So it is with everyone born of the Spirit” (John 3:8). An invisible force from far away, whether wind or Spirit, has visible manifestations. And as a dying person breathes his or her very last breath and expires, life departs. Breath becomes air. Although the body remains intact, breath and spirit leave hand in hand.

Philosophers and theologians have written books exploring these and other links, but I will limit my comments to an aspect of breathing I deal with daily. I must stay close to what impressed me first as a six-year-old dangling limply from a tree, and then again as a doctor watching my patients’ last few expirations. Breath sustains life. Any interruption in the fuel it supplies causes immediate death (the fastest poisons, such as curare and cyanide, work by interrupting the transport and absorption of oxygen).

Analogously, our entire faith begins here. We are told in so many words that eternal life cannot consist of mere oxygen and other nutrients. For eternal life we must establish a connection to a different kind of environment. Jesus makes it clear: “Very truly I tell you, no one can enter the kingdom of God unless they are born of water and the Spirit. Flesh gives birth to flesh, but the Spirit gives birth to spirit” (John 3:5-6, emphasis added). I think of an astronaut on the moon, or someday Mars, who must rely on an oxygen source to survive. Spiritual life will likewise fail unless we have contact with a spirit like the wind, the Holy Spirit.

“Blessed are those who hunger and thirst for righteousness,” said Jesus—a picture comes to my mind of a runner gasping for breath or an athlete in an iron lung—“for they will be filled” (Matthew 5:6). The psalmist called up the image of a deer panting for streams of water; “so my soul pants for you, my God,” he cried (Psalm 42:1). God’s Spirit offers the only adequate solution to the spiritual “oxygen debt” hinted at in these phrases.

I confess a hesitance to write on spirit. Has any aspect of faith become more muddled? The word spirit itself, taken from a metaphor as common as the air outside, remains nebulous and imprecise. As one trained in scientific disciplines, I find it much easier to write of the material world that I can touch and see and analyze. And yet there is no Christian faith without spirit. Because God is spirit, only spirit can convey the image of God in us, Christ’s Body on earth.

Present in the original act of creation, the Spirit of God hovered over the waters as matter came into existence. The Spirit inspired the prophets through the spiritual droughts and famines of Old Testament history. The Spirit anointed Jesus at the beginning of his ministry and was passed on to the disciples when Jesus breathed on them (John 20:22). We need the Spirit, said Jesus, for the quickening—a new birth, as Jesus once termed it—necessary to enter the kingdom of God.

At Pentecost the Holy Spirit (with “a sound like the blowing of a violent wind”) entered and dramatically transformed a tiny band that was to become the church. This event more than anything caused church leaders to include the Spirit as a separate person within the Godhead. They could not exclude the Spirit: evidence seemed as real and convincing as evidence for another Person whom they had seen and touched.

The Holy Spirit, then, allows the reality of God’s own self to establish a presence inside each one of us. God is timeless, but the Spirit becomes for us the present-tense application of God’s nature—the Go-Between God, in Bishop John Taylor’s lovely phrase. Correspondence with the Spirit keeps us spiritually alive.

I Can Breathe!

Alas, the life of the spirit is neither as instinctive nor as urgent as the mode of breathing in the physical body. We can get out of breath spiritually and yet not sense it. Breath may choke off slowly, unnoticed at first until a constant state of energy shortage sets in. I saw the physical parallel to this spiritual process in a woman I treated in London.

She came to me as a patient during my medical residency—a middle-aged widow and a hard worker—complaining about her recent tendency to drop things. “My hands tremble,” she said, “and just this week two of my best china cups broke when they slipped out of my fingers. I get so tired, and now I can’t seem to control my hands or my nervous disposition.”

“I must be getting old,” she concluded with a deep sigh and a shaky voice. I told her that fifty was certainly not old and that I would try to locate the physical cause for her condition. As she described a variety of symptoms, I began to suspect thyrotoxicosis, a disease of the thyroid gland that can cause tremors and shakiness.

First I felt for a thyroid swelling but found none. When a chest x-ray showed a shadow behind the upper end of her breast bone, I examined her neck again, this time probing with my fingers down into the base of her neck while she swallowed. Indeed there was an obstruction—I felt a rounded lump rise up out of her chest and touch my fingers. Her windpipe also seemed bent over to one side.

Another x-ray of her upper chest revealed that the rounded shadow had compressed her windpipe. I asked, “Do you have trouble breathing?”

“No, not at all,” she replied, to my surprise. “I just get tired.”

I explained that I believed her problem stemmed from a lump of cells that had grown in an unusual place in her thyroid gland, causing thyrotoxicosis. The lump had further extended into her chest, and because of the possibility of cancer, we needed to remove it. Otherwise, she might soon find it difficult to take a breath.

I assisted at the surgery conducted by my chief. We started at the neck, fully prepared to saw through bone to open up her upper chest if necessary. After some gentle pulling, the lump popped into view. It was fibrous and well-nourished, the size of an orange. It had indeed bent the windpipe, constricting it from both sides. We removed the tumor and closed the wound.

I next saw the woman a few weeks later when she returned for a checkup. She rushed up to me, and even before I had a chance to greet her, she almost shouted, “I can breathe!”

I was puzzled. “Were you afraid the operation would stop your breathing?” I asked.

“No, no, you don’t understand,” she said with great excitement. “Now I can breathe for the first time in years and years. I can run up stairs! I feel like a teenager again. I can breathe!”

Her condition became clear. That lump must have been growing slowly for fifteen years or more, gradually compressing her trachea, like a boa constrictor tightening its grip. The woman had adapted, at first by stopping frequently to catch her breath. It bothered her, but since she knew elderly people who became breathless and unable to climb stairs, she assumed she too had an aging heart. Over time she learned to walk very slowly and mount steps one at a time. In her eyes she had become prematurely old, and the hand tremors corroborated this doddery image of herself.

Now, however, she could take great gulps of air and dash upstairs. Over fifteen years she had forgotten how good it felt to breathe deeply and freely. I was struck by the near-miraculous change in the posture, facial expression, and total attitude toward life of this woman with the retrosternal thyroid lump. Absolute ecstasy spread across her face as she swelled her chest and announced loudly, “I can breathe!”

Spiritual Fuel

Occasionally I try to savor the pleasure of God’s good gifts, like breathing, by imagining for a moment that I have lost them. I hold my breath and pretend my trachea is blocked. I sense the rising panic spreading throughout my body. I envision my red corpuscles turning blue. I hear a drumming in my head. Then suddenly I open my mouth and suck in a gulp of air. I blow out carbon dioxide and vapor and then distend my chest and let the air rush in. I feel a short burst of the relief and ecstasy experienced by the woman with thyrotoxicosis.

The cells of my body need the fuel of oxygen to survive. Herbert Spencer expressed the scientific principle: whatever amount of power an organism expends in any form equals the power that was taken into it from without. The same principle holds true in the spiritual world. Christ’s Body needs breath, the inspiration of his Spirit. One epistle warns, “Do not quench the Spirit”—or “put out the Spirit’s fire,” as some versions have it (1 Thessalonians 5:19). We need the stream of life that comes from God, and only the Spirit can provide that.

The Old Testament gives one striking example of spiritual renewal as performed by a Jewish official in the worldly government of Babylon. For Daniel, praying toward Jerusalem meant a public display of civil disobedience punishable by imprisonment or death. Disregarding the king’s edict, three times a day Daniel flung open his window and turned toward Jerusalem for his prayers. Surely when he did so, the reality of Babylon—the aroma of spices and produce from the bazaar, the strange language, the jumble of urban noise—blew in. Yet as Daniel prayed in the midst of that foreign culture, he also breathed in a kind of spiritual oxygen that reminded him of a different reality.

Daniel’s practice of facing Jerusalem stemmed from a prayer articulated by Solomon at the dedication of the temple when he asked God to hear any call for help prayed toward the temple in Jerusalem. Jesus later discounted the notion that location mattered in worship (see his dialogue with a Samaritan woman in John 4), and most of us do not pray toward a geographical place. Still, the scene captures for me the concept of planting my feet firmly on earth while sighting along a line of spiritual direction. I need a time of day to orient myself, to bring heaven and earth together. In the midst of the clamor and tumult of this material world, I must find a place of quietness to listen to the still, small voice for guidance of my life.

I too live in an alien culture that bombards me with false values of lust, pride, violence, selfishness, and materialism. To survive, I must pause to breathe in the power of the living God and consciously direct my mind to how God wants me to live. Spiritually, I cannot survive the foreign atmosphere of earth without live contact through the Spirit. Daniel looked out over the streets of Babylon, but his mind and soul were in Jerusalem. The astronauts walked in the cold, forbidding atmosphere of the moon only by carrying with them resources from another world to keep them alive. I need just that kind of daily reliance on the Spirit of God.