THE BREATH
In a pulmonary ward, something becomes visible that most people otherwise go through their entire lives without paying much attention to—something that is constantly there, present from the very first moment we come into the world until the day we leave it, but which is at the same time so self-evident that we almost never reflect on it. The breath.
Usually, it moves silently in the background of our lives. We wake up in the morning, go to work, exercise, worry, plan for the future, get caught up in thoughts of what has been or what has not yet happened, and all the while, the body continues its work without asking for our attention—inhaling, exhaling, over and over again. We rarely think about the air around us, and even more rarely about the remarkable fact that our entire existence ultimately depends on something as simple as the next breath coming. It’s only when that changes that we realize how closely intertwined it is with the very experience of being alive.
I myself come from a background in endurance sports, where breathing has always been a natural part of everyday life. During long training sessions, interval workouts, and competitions, I’ve often felt my lungs working at the limit of their capacity, my heart rate rising, and my body screaming for more oxygen. But that kind of shortness of breath has always had a context. It has been temporary—part of development, recovery, and improvement—and once the session was over, my body got to rest and my breathing returned to its normal calm. In the pulmonary ward, I encounter something entirely different, where labored breathing isn’t about performance but about limitation—not about running faster or getting stronger, but about making it through the next move, the next meal, the next night.
Many of the patients live with diseases that have gradually limited the body’s ability to absorb oxygen. COPD, lung cancer, heart failure, recurrent infections, and other chronic conditions mean that something which, for most of us, happens automatically suddenly requires an enormous effort, and the longer I’ve spent on the ward, the more I’ve come to understand that shortness of breath isn’t just a physiological condition. It’s also deeply existential.
Because when a person can no longer breathe as usual, something happens to the whole person. Of course, it’s about oxygenation, lung function, and the body’s biology, but it’s also about fear—a very primal fear. The body reacts immediately to the lack of air as a threat to survival itself, and many patients describe a feeling of panic that is difficult to put into words—as if the entire system goes into alarm mode all at once. Their gaze changes. Their body tenses. Their thoughts revolve around a single thing: getting air.
It is only when you stand next to a person struggling for their next breath that you fully understand how much we otherwise take for granted. Air is all around us; we literally live in the midst of an ocean of oxygen, and yet we almost never think about it. It’s only when the body can no longer take in what’s all around it that its value becomes apparent, and only then do you realize that something as obvious as a simple breath is, in fact, a small miracle that continues uninterrupted throughout one’s entire life. The more people I’ve met who’ve struggled to breathe, the harder it’s become to view breathing as merely a mechanical exchange of oxygen and carbon dioxide. For even though it is, of course, exactly that from a medical perspective, it also seems to carry something that touches people on a much deeper level.
On the ward, I often see something resembling sheer fear of death in people’s eyes—not necessarily because they know they’re dying, but because their bodies react as if they are. When there isn’t enough air left, much of what otherwise occupies a person’s thoughts—plans for the future, everyday worries, and things that might have seemed important the day before—suddenly fade away. All that remains is the most fundamental driving force of all: the will to take the next breath. It is as if the whole person is reduced to something very primal: the body seeks air, the mind seeks security, and somewhere in between arises the fear that so many patients try to describe but that cannot really be fully captured in words.
At the same time, I have also witnessed the opposite. I have seen people whose breathing has gradually become slower and more still as life has neared its end—people who have long struggled against illness, pain, and limitations, but in whom something finally seems to soften. It’s hard to describe exactly what it is—perhaps it’s about acceptance, perhaps exhaustion, perhaps something else that can’t be measured or explained—but sometimes a special stillness fills the room as someone nears their final breaths, as if the struggle is gradually ceasing and the body is no longer trying to hold on to the same strength as before.
I have often thought that there is something strangely beautiful in that contrast. Earlier in the course of care, every breath may be accompanied by effort, anxiety, and struggle, while the final breaths sometimes seem to possess a completely different quality—not always, but sometimes—as if the body is slowly letting go of what it can no longer control.
Throughout history, the breath has taken on such strong symbolic significance in so many cultures and traditions, and it is difficult to imagine anything more fundamental to life than breathing itself. In many languages, the words for spirit, life force, wind, and breath are closely intertwined. In the Hebrew tradition, the word ruach is used for spirit, wind, and breath—almost as if the language itself suggests that humans have always intuitively perceived a connection between the air we breathe and what we experience as life. In Genesis, a human being comes to life only when God breathes the breath of life into her nostrils. Life begins with a breath, and in a strange way, it also ends with one.
The first thing we wait for when a child is born is the cry and the breath—that first inhalation that fills the lungs and marks the beginning of a new life. The last thing to leave a person is also a breath. Between these two moments lies everything we call a life—all relationships, all experiences, all joy and all sorrow, all successes, failures, dreams, and fears. The entire story is contained between the first and the last breath.
The more I think about it, the more fascinated I am by how rarely we actually pay attention to this. We live in an age where people seek advanced methods for well-being, performance, and recovery, even though one of the most powerful tools already lies within us. In recent years, research has also shown how strongly breathing affects the nervous system—how slow, mindful breaths can activate the parasympathetic nervous system, lower stress levels, and help the body return to a state of calm. But humans seem to have understood this long before we could measure it scientifically.
In meditation, yoga, and mindfulness, the breath constantly reappears as the path back to the present moment. Thich Nhat Hanh often wrote about the simplicity of simply following one’s inhalation and exhalation—not to achieve anything in particular, but to return to what is already here. Eckhart Tolle describes how paying attention to the breath can serve as a door back to the present when thoughts drift toward the future or the past. The breath resonates deeply with me after my time in the pulmonary ward—not only because I’ve seen people struggle for it, but because it has become a reminder of how close life truly always is. We often seek meaning in big projects, plans for the future, and achievements, while life is happening right now—in the body, in the present moment, and in the next breath.
In the pulmonary ward, that realization is hard to ignore. There, human vulnerability becomes visible in a way it rarely is in everyday life. Modern healthcare can do amazing things: oxygen, inhalers, CPAP, high-flow therapy, and advanced medical technology can support the body when the lungs can no longer manage on their own; machines can help people breathe when their own bodies are no longer sufficient. And yet, the contrast is sometimes almost painfully clear between all this advanced technology and something as simple as the longing to take a normal, unhindered breath.
It is only when breathing is threatened that a person fully realizes what a miracle it actually is—to wake up every day and effortlessly fill one’s lungs with air, to be able to go for a walk without thinking
on oxygenation—being able to lie down at night without fear of not being able to breathe.
After my time in the pulmonary ward, I find it hard to take breathing for granted. Every time I pause and take a deep breath, I think of the people I met there—the fear in some of their eyes, the relief in others, the struggle, but also the stillness—and perhaps above all, how something so ordinary can embody so much of what makes us human. For breathing is perhaps not just something that keeps us alive. It is also what, moment by moment, reminds us that we are, in fact, alive