Drawing a Breath

I

It starts and ends with a breath.

The shock of air on a newborn’s cheek, the cold kiss of it. This is what beckons a first breath. It isn’t born of need, not a hunger for air nor scarcity that compels us to fill our lungs for the first time. Rather, drawing a breath is our natural response to the abundance of air. Air stirs the fine hairs on infant bodies, sways lanugo like seaweed underwater. A galeforce rush of stimuli triggers neurons, which spark in the brain. Unfamiliar waves of sound and light roll in: vibrations resonate within the ear canal, and brightness flashes upon the retina in fuzzy shapes.

So it happens upon arrival, within the first ten seconds of extrauterine experience. It seems our first breath holds wonder. More an involuntary gasp of surprise than of survival. Upon encountering the world, the most fitting response is to open our mouths and take it in. We expand as it fills us. This initial inhalation is a moment that is unrepeatable: for the first time lungs trade fluid for air, an exchange of gases, and then, the umbilical cord with its oxygen-rich blood is cut.

My friend, who is a midwife, stands in her kitchen making pizza and talking about the first breaths she has witnessed. Her hands hold the fixed ends of a rolling pin as she leans over the counter, working the dough. She tells me about the small, slippery bodies she catches. She holds these curled newborns up to their mothers’ chests and waits for the shallow expansion and contraction of tentative lungs under her palms.

She pauses and smiles as her toddler interrupts our conversation. He chases a toy across the tiled kitchen floor while exclaiming ‘‘woah.’’ He says this many times, always with the same ecstatic appreciation. He is amazed that a toy man can sit in a toy car, amazed at the pizza pan in the oven, amazed at his own reflection as he presses his hands, lips, and nose against the chilled glass of the back door, leaving smudgy fingerprints in fog.

You can measure a lifetime in breaths. An eighty-year-old: 672,768,000 breaths. A fifty-five-year-old: 420,480,000 breaths. A twenty-five-yearold: 210,240,000 breaths. In and out, impossible to count each one, and yet not one of them is like the first breath.

‘‘I once took a nine-hour seminar on infant resuscitation,’’ my friend says. ‘‘Not just the mechanics of it, but to explore the meaning of it, the significance.’’

She tells me what happens when a baby is born but doesn’t breathe, tells me of the stillness in the room except for the effort to bring into being the one small body whose chest has yet to rise and fall.

She tries to tell me what it’s like to breathe in and out, offering air to airless lungs. This giving of breath, to breathe for one who has never known air, is unlike any other resuscitation, more a suscitation, a rousing to life.

II

In the old-growth forest, the nearness of aged beings silences me. It is the quietude of Douglas firs, hush of hundreds of years of respiration. I sense in the air the scent of reciprocity, stomatal openings receiving carbon dioxide and delivering oxygen in return.

My parents have traveled across the country to visit us and they walk with my husband and me under a canopy of firs as we hike toward Fragrance Lake. Mottled light covers the chipped path before us, carved into a carpet of vigorous sword ferns. All around us, moss makes its patient creep across bark and stone.

The first mile is a steep incline. My father pauses occasionally to unclip his cell phone from his belt and take a photo, to study the globed web of an orb-weaver spider or the exposed root system of a fallen tree. He lags behind us, taking his time, smiling up at us during switchbacks. When he stops again to retie the laces of his sneakers, I fall back to walk with him. I overhear his ragged breathing and listen for what each rasp might mean.

I don’t mention my father’s shortness of breath, but together we decide against finishing the hike. Instead, we follow the spur trail to a lookout point, which offers a view of Samish Bay and the San Juan Islands. We catch our breath, gather it up from the ocean, from the plants below the water’s surface which exhale half the world’s oxygen.

There at the lookout, with the islands rising and falling below us, my mother and I pose for a photo. I turn around to ask my father if he’s ready to return to the trailhead, and I’m surprised to find that he’s climbed the trunk of a tree growing out of the ground slantwise in order to get a better view of the bay. He is fifty-five, and I feel as if I am encountering him middle-aged for the first time, an amalgamation of the boy he once was and the aged man he is becoming.

Later, sitting in sunlight and drinking beer together, warmth and easy laughter makes us peers until a chill forces us to notice the passage of time. I detect my father’s breath made visible against the deep blue air of late summer.

III

I feel uncomfortable looking at it: this proof of how long we have understood the breath as inextricably linked to life. An ancient amulet of stone, carved into the shape of windpipe and lungs. It was once intended for the afterlife, to protect the organs it represents, but the amulet was excavated from a tomb, catalogued, and photographed.

The Brooklyn Museum obtained the amulet from the family of Charles Edwin Wilbour, a nineteenth-century American Egyptologist. His children donated it to the museum, along with the rest of his collection, as a memorial to their father. His death occasioned the changing of hands.

I look at its image on the screen, and imagine holding it in my hand like a marble chess piece from the set on which my father taught me to play, or as one of the many rocks I collected as a child and stored in shoeboxes stacked in my closet and under my bed. I feel the invisible weight of it, a reminder that this amulet is not mine to hold, meant instead for the dark places of decay.

The amulet belonged to somebody once before. Others handled it first: the hands of a craftsman carved the figure from stone using hammer and chisel and file, scattering chipped flakes. The hands of an embalmer made an incision, extracted organs and placed them in canopic jars, returned the heart to its perfumed cavity, tucked the amulet between cloth bandages, which encircled the chest of the corpse. Thousands of years later, a disturbed tomb. This palm-sized stone, which held the hope of breath resurrected, emerged cold and dusty.

Now, museum curators lean over the amulet on display, their focused breath falling upon the glass case.

IV

When it’s autumn, my sister calls me on a Monday before work. She assures me that everything is fine, but she also tells me that our father is at the emergency room. He thinks he’s having a heart attack. The symptoms are consistent; she lists the pain in his arm, high blood pressure, and shortness of breath. But he is stable, so my mother and sister persuade me that I do not need to fly home.

An angiogram reveals that my father’s arteries do not require stents, though his heart shows signs of strain. Most alarming, is that the pressure in his lungs measures four times higher than normal. So, the diagnosis is severe pulmonary hypertension. After several days of scans and medical imaging, his doctors finally sight the cause. His legs and lungs contain many clots. A revised diagnosis: chronic thromboembolism pulmonary hypertension, a disease that often goes unseen for years, until the patient’s clotted breathing becomes too difficult to ignore.

My aunt sends me a text message with a photo of my dad sitting up, smiling, and eating a meal from his tray. I notice that he hasn’t shaved for several days, and the shadow of gray stubble makes me uneasy. The plastic tubing of his pronged nasal cannula delivers a controlled flow of oxygen, supplementing what his body cannot easily accept from the air.

I picture my father sitting on a hospital bed fidgeting with the thin fabric of his gown. He feels the cold tap of a stethoscope against his back and a hand on his shoulder.

Sit up straight please. Now breathe deeply.

I imagine the many people with disinfected hands who have eavesdropped on my father’s breathing, sounded the cavity of his chest, read the dark radiographs and scans of his lungs illuminated on a wall, drawn his blood, administered oxygen. I think, too, of the people who have come to care for the parts of him that cannot be touched or imaged, the family and friends who sit by the hospital window watching baseball on the television, who bring flowers and coffee, who pray for him, who text me to say that God has a plan.

V

It was dust gathered in hands and a divine breath, according to scripture, that made a living soul. The soul: I cannot say exactly what it is, what the word means inside of a body, the low vibration the word makes when spoken. But when I parse its origins, I find the confluence of soul and breath, the ethereal and the palpable: nepes, the Hebrew word for soul, means a breathing being; pneuma, Greek for spirit, also means breath.

The impetus of dissection was soul-searching. Supplied by grave robbers, Leonardo da Vinci opened up decaying bodies, even those of pregnant women and stillborn children, to search for the coordinates of the soul, a quest for the fixed position of the unseen. The same hands that painted The Last Supper, applying careful brushstrokes of tempura to a convent’s wall, also applied his knife to cadavers.

He was drawn to perspective, to realistic representations of parts and their functions. Once he exhausted his study of machines and the mechanizations of pulleys, levers, and tools, he turned his eye on the human body, to make the incision and peer within. He drew the mechanism of the breath as if it were made of metal and wires. ‘‘From the heart, impurities or ‘sooty vapors’ are carried back to the lung by way of the pulmonary artery,’’ he wrote, ‘‘to be exhaled to the outer air.’’

His sketch of lungs reveals a steady hand. He mapped the snaking path of arteries, the framework of bones, the folds of intestines, the webbed lobes of lungs. He could not place the soul, to draw its interstices and attachments, to make it visible.

VI

If I were to take up pencil and sketch my father’s airways, to trace the microscopic surfaces of my father’s tracheobronchial tree, the task would require fifteen hundred miles of graphite lines. And still, that would be shorter than the distance of flying home if his condition worsened.

My dad calls to tell me he will need to travel to San Diego for a highly specialized surgery, called a pulmonary thromboendarterectomy, to remove the pervasive scar-like obstructions from his arteries. My father is elated by the alternative to a lung transplant and the possibility of making a full recovery.

Surgery is an option I investigated weeks prior. A delicate operation, I watched a video of it on the surgical center’s website, studying their hands as surgeons extract clots, fleshy tissues that they arrange on a blue surgical towel, lined up like ginger roots plucked from the garden. While they work, controlled hypothermia protects the body’s tissues and organs from damage; the patient is frozen to time, a cessation of brain activity and circulation, a life suspended.

Twice during surgery, they turn off the heart-lung machine, for up to twenty minutes, rendering the surgical field bloodless and the patient clinically dead. But the surgeon’s hands have the power to flip the switch, restore the patient’s circulation, warm his body, and bring him back. I don’t know what to make of these pauses.

My dad calls and we don’t discuss these details. He tells me a story that made him laugh earlier that day: ‘‘When I was a kid, we’d drive down to visit family in southern Illinois. ‘Down home,’ my mother called it. She’d bring six, maybe seven, packs of cigarettes. I’d swipe one from the car and me and my cousins would hide out in the henhouse at Uncle Ed’s place.’’

They smoked through the pack together, emerging from the dense, hot shack, smelling of chicken shit and smoke.

I keep quiet about the standstill, the implications of suspended animation. I want to avoid puncturing his optimism, imagine it as if he’s blowing a bubble, air expanding within a slick orb, fraught with all the usual perils of surface tension. Picture it growing larger and wobblier. Picture it floating away.

VII

I watch as a performance artist brings a self-portrait to his face, so that black scribbled lines look out at his audience. He purses his lips and inhales deeply, while releasing his grasp on the drawing paper. The force of his drawn breath holds the portrait to his face, freezes it there until his next exhalation. The camera zooms in. He sets it down and inhales another portrait to his face.

He inhales one hundred self-portraits. He releases his breath, and one hundred times a sketched representation of his face falls, revealing the face of skin and muscle and bone underneath. He is middle-aged and graying, and his face changes throughout the strenuous performance. With each breath, a loss of water, perhaps more than two fluid ounces under the strain. I worry he will hyperventilate.

Sheet after sheet of paper falls to the floor.

VIII

I have a premature sense of loss, can already feel the absence in the hospital room as attendants wheel my father’s hospital bed away, the strange anticipation, knowing that he will die twice before I see him again. I remember when his mother stopped breathing in a hospice bed. We prayed after she left us; he committed her spirit into the hands of God.

I know that I don’t want for him to be bereft of his last breath, cold, split open, and alone, a machine breathing for him.

I understand that after the resurrection, Thomas wanted proof, needed to see the pierced side, feel the flesh and blood with his own hand in order to believe, a kind of closure. And I’m surprised by my want for proof of suspended animation, to see the blood suctioned from my father’s body, the heart-lung machine turned off, the circulation’s flat line. The need to be in the operating room when he gives up his breath, when his breath returns.

Before, I did not know this desire of mine: to be with the ones I love when they stop breathing, not to leave them lonely.

IX

Most adults can hold their breath for up to a minute before excess carbon dioxide accrues in the bloodstream, turning blood acidic. But a free diver presses on from the diaphragm, drawing a deeper breath, holding it longer through uncomfortable contractions, following the rope line down a cave’s open mouth.

The sunlight filters through seawater and strands of bull kelp as a wetsuit-clad figure walks underwater toward the cave’s edge. Above, other dark figures float nearby, descending and ascending an oceanic ladder. Below, the diver’s bare feet send a cloudy spill of sand over the edge. A moment of preparation, and then the dive into the sink hole, arms spread, chest first.

He draws his arms back toward his body, streamlined, goggles and black cap leading his descent. As the dark of his wetsuit disappears into the chasm, only the bright spots of his bare hands and feet remain visible, until these too fade from sight.

Everyone watches for his return. The record-holding free dive is twenty-two minutes. He swims down more than three hundred feet before making a turn for the surface. At these underwater depths, human hearts beat slower, just fourteen times per minute, one-third the heart rate of a coma patient. Half the divers who attempt to reach this depth return to the surface unconscious. Yet expert free divers retain control in deep water by training their mammalian dive reflex. Still they must practice rising. In order to avoid a loss of motor control or the danger of shallow-water blackouts they practice releasing pressure, expelling air during their ascension, the art of returning to the surface.

X

My parents pick us up at the airport for Christmas. At their home, I notice on the bureau by the door an arrangement of flowers from the hospital, a spray of baby’s breath and four small purple flowers. The tiny white blooms branch out on spindly stems. They are browning, becoming brittle and delicate.

Winter in the Midwest and all deciduous trees look bronchial to me, but we pretend our way through the holidays. My father’s illness is an undercurrent, and we are all treading, waiting for the phone call with the surgery date. When he prays to bless the holiday meal, he leaves the dining table. My mother follows him to the bedroom. My husband, sister, and I begin to eat.

XI

The lung float test: Lungs are the only organs, when extracted from a body, which float. Forensic examiners once looked to the lungs during an autopsy to determine when an infant died. According to this theory, the lungs of stillborn babies, whose alveoli have yet to bloom with air, never having experienced its abundance, sink. The lungs of those who have partaken of air, drawing it in and absorbing the wonder of it, float.

Lungs are named for their lightness, known in Old English as lunge, the light organ.

XII

While waiting for a surgery date, the pressures in my father’s lungs subside after months of rest and a regimen of anticoagulants despite the remaining clots, leaving us all to grapple with what his doctors cannot explain, to accept what many call a miracle.

‘‘Enjoy your life,’’ his specialist said. ‘‘See you in a couple months.’’

When I find out my father will not need surgery, I exhale. It’s a slow rise to the surface, but I release the pressure that’s been building inside me, undetected.

Who can say what prompts a final breath? Lifted by the buoyancy of lungs, to ascend when it is finished, to release what we’ve taken in of the world, exhaling fully and finally, and away.