It’s not the inhalation; it’s the exhalation. You can pull oxygen in, but your lungs are already full with the wrong stuff, with all that C02 you haven’t expelled. So you sip air. That’s what the doctors call it, sipping. But that doesn’t come close. Sipping is modest and moderate, shy, wise, sometimes coy, but never desperate. When you can’t breathe, you’re desperate. Coaxing air in through a sick fluttering wheeze and forcing it out in a staccato series of coughs. Then trying again. Not sipping air. Sucking.
I’d come home from fighting a forest fire coughing hard. Nothing new about that; you always come home from fighting a forest fire coughing, everyone does. Once I fought a fire in November, in sub-freezing temperatures, where crews slept packed wall to wall on the floor of the local National Guard Armory—like displaced disaster victims, like contagious napping pre-schoolers—and came home with an annoying phelgmy cough that lasted until March. The TB fire, we called it, for tuberculosis. For years, whenever we ran into the grunts we met there on the line, we said: Remember the TB fire? And we laughed. Coughing, back then, was a laughing matter. Now I coughed from the core of me, an unworldly croak, like an elk cow in search of her calf, and it wasn’t funny.
“Go see a doctor,” Laurie, my partner, told me.
I didn’t answer. I didn’t intend to go. I’d already decided there was little to be done, that I’d make a long expensive trip to the doctor—we lived in a remote corner of the Pacific Northwest and I had lousy health insurance to boot—only to be told to sit tight and wait it out. Take two aspirin. See you in the morning. That’s what I expected. No solution I could imagine seemed workable. No solution seemed worth the cost. Wheezing, at any rate, did not seem the biggest problem the world was facing.
While I was off fighting that fire, airplanes had careened into buildings 3,000 miles away, and the world shifted like continental plates beneath us. At home, too, the rules seemed to have shifted. This was now more than an annoying cough; my body was not recovering, not kicking back into gear. On the fire line we’d been digging in a frenzy miles from the fire itself, on a dusty dry grass hillside, overturning sod. When I stepped off the line to pee, from twenty feet away, I couldn’t see the rest of the crew, but since it wasn’t smoke but dust that was the problem I didn’t tie my bandanna around my mouth and nose. No one else was doing it. Still, when visibility drops below twenty feet, you ought to take that as a warning. Right then, on the fire line and at home, as in the world, all the important signs were missed. What would come next no one knew.
The average respiration rate for humans is 44 breaths per minute. Multiply that times 1440 minutes per day, and you get 63,360 breaths per day. Or attempted breaths. From where I sat, that seemed like an awful lot of work, an unfathomable struggle. It was best to stay calm, I knew, to conserve energy, not force your muscles to work and drain the blood of oxygen rich cells and make it worse. Not even your heart. Don’t work your heart, I told myself. But how can you stop that? You can’t. By day, I went to work, hauling my pack and tools up the trails I maintained—firefighting was just a part-time money-making deal for trail workers like me—and stopping too often to catch my breath. By night, I sat pillow-propped in bed staring out at the dark, not sleeping, not reading, not dreaming or philosophizing or even complaining. Just sucking air.
“You could die,” Laurie cried, exasperated.
“No one dies of asthma,” I said.
A week later, a doctor stood before me, hands on his hips:
“You could’ve died,” he said.
I looked away.
“I had a twelve year-old patient die of asthma last week. What the hell were you thinking? Way up there in the boonies? With no medical help? In a heartbeat, you could’ve died.”
Asthma affects 300 million people world wide. Every day in the U.S. 40,000 people miss work, 5,000 go to the emergency room, 11 people die. Eleven die! Every day! That means that since 9/11 tens of thousands of Americans have died a horrible can’t-breathe death. If we’re going to bother with war, why not war on asthma? It’d be hard, I admit, in that wearyingly familiar way: Who’s the enemy exactly? Where can we point the bombs? Who the fuck is to blame?
Me, probably. That’s what I thought as I sat in the clinic: this is my fault. Weren’t kids with asthma milky-cheeked and soft palmed? Weren’t they the ones in grade school who had to sit out dodge ball? This I did not want to be. Never show weakness, my trail crew boss always said. By god, I did not intend to. If fire was no good for my lungs—a likely culprit in this whole rotty mess—it wasn’t the only one. From down the hall, I overheard the doctors having fun with my x-rays while I sat half-dressed on the examination table.
“Ever seen this?”
I leaned out to peek past the door at a small crowd of white-coated doctors gathered around the light screen in the central area for a little med school quiz.
“What do you call a lung mass like that?” my doctor asked, tapping the screen.
The doctors leaned forward and struggled with grade school eagerness: Oh I know that one. I know. It’s on the tip of my tongue.
I tensed. Cancer? Please Jesus don’t say cancer.
The doctor returned to me.
“Where did you grow up?” he asked.
In Southern California. In the 1970s. When we were kids, the air quality gauge would drop below unhealthy and we’d get smog days the way Northerners got snow days.
Except that Valley Fever isn’t caused by smog, but by a fungus spore in the earth that, once soil is disturbed, rides the Southwest wind. More prevalent in inland places like Phoenix or Fresno, the spore can make it as far west as Riverside, apparently, but no further. Not Los Angeles. Not even Pasadena. The sea air, the doctor explained, dilutes the dust, disarms it. And it didn’t matter any way. The valley fever damage was done years ago, only the scarring remained, he said. Now the problem was asthma. Plain and simple.
But what had caused it? Was it dust or smoke or smog? Was it the cigarettes my parents smoked when I was a kid? Or the fires I fought as an adult? Was it our cat, Daisy, who I loved inordinately but to whom I was deathly allergic? Was it congenital weakness or plain dumb luck?
The doctor shrugged and prescribed inhaled steroids. Two puffs a day: morning and night. Two bucks a day. The wheezing, he said, should subside. The coughing should stop cold.
I wrote a check and came home, crumbled newspaper in the woodstove, laid in straight split slices of cedar, crisscrossed, and lit the match. The familiar orange glow reflected off the pine floors of my cabin and the pine board ceiling and the log walls, the flame and the tinder ridiculously close as always. I picked up Daisy and held her in my lap. I went back to work on the dusty trails. And despite it all, within a few days, my lungs were clear. I might as well have started smoking cigarettes.
By the time we’d gone to war with Iraq I’d inhaled steroids every day for two years. So what if it was a habit started with dubious motives, a problem with an uncertain cause, the solution, at least, seemed to be working. That statue of Saddam toppled; my lungs fell into step. I could run even. Run! If it took two dollars a day, that was cheaper than a beer or pot or coffee habit. It was also less than what I personally was paying for the wars in the Middle East.
So I sucked on my inhaler. My huffer, I called it. I used it morning and night. Sure, I tried quitting a few times, but the sick squeeze in my chest, the watery wheeze, the inevitable croaking cough always sent me scurrying back. I knew I should try acupuncture or yoga. I should quit coffee and sugar and alcohol. Instead, I took a fistful of vitamins and exercised fanatically. I avoided stress, living in a gorgeous woodsy place, free of traffic and crime, with no boss, no children. Such low stress I should’ve just keeled over from boredom. Still, I couldn’t breathe without that huffer. With it, I could go running day after day along the dusty dirt road near our home.
When I was a teenager I ran cross country. The air hung brown as the sweat ring on a collar, omnipresent, the same dirty brown as the drought-scarred foothills. But they told us: it’s not what you can see but what you can’t see that causes the trouble. Not the particulates, but the gases. Particulates, particulars, it didn’t matter to us a whit. We ran up Mary Street on the sidewalk, under the freeway, into the orange groves, then back, heading downhill toward school, toward snow-dusted Mt. Baldy on the horizon—big beautiful Baldy—omnipresent, too. Even when you couldn’t see it.
Now there are summer days when you can’t see the high jagged peaks that surround my cabin-home for the smoke. Wildfires burn more often and more acres than ever, and the experts say it’s a good thing they do. From my window, I can see an army of straight-trunked firs. Firs, firs, everywhere—not a single native Ponderosa pine since pines require wildfire to regenerate—grey-trunked firs with dead limbs outstretched inelegantly as if in supplication. Many of them are dying, bug-eaten or disease-infested. Mistletoe hangs in whorls large as haystacks. Witches brooms, they’re called, and even in imagination these would be awfully big witches. The forest is unhealthy. For lack of fire. We suppressed fire for too long, so now we have to let it back in. Fire is good! Fire is good! cry the forest managers. Problem is, for me, for my lungs, fire is bad.
It’s all or nothing. That’s the hell of it, isn’t it? Win the war or bring the troops home. Put the fire out or let it burn. Use the huffer or wheeze yourself to death. Not because of politics or preference, but because that’s reality. We want to live as we always have. We’ll do our damnedest, yes, to parse the problems and do what’s right. To a point. In the end we just want to breathe.
Truth is, in high school, I was a lousy runner. I performed more respectably on the swim team. I joined as a ninth grader who had spent hours splashing, diving, flailing, body surfing, even, in the California summers, but who had never actually learned the technique required to swim competitively. The first time I tried to swim fifty yards, I came up panting, gripping the concrete lip of the pool at the YMCA, incredulous. How could people do this? How on earth did they breathe? By pacing themselves, of course, by pulling the air in and holding it for a long steady stroke, two, three, then expelling it slowly underwater before coming up again. The kids who’d been on swim teams their whole lives did this with ease. I was agog. They did not even seem out of breath at the end of 500 yards let alone 50. Not for the first time in my life, I was wowed by what patience and practice, time and training, could engender. I was humbled. After a year on JV, I moved up to varsity, swimming butterfly of all things, a stroke I’d admired since 1972, since watching Mark Spitz rise orca-like from the green chlorine depths on TV, then submerge, undulating. By the end of my sophomore year I could swim 100 yards butterfly. Not only that. I could swim it faster than I could swim 100 yards crawl.
If you’re patient, you hold your breath and you can survive anything. You can thrive. Maybe it’s not all or nothing. Maybe it’s pacing and practice, trial and error, plenty of error. The air is cleaner now, thirty years later, in Riverside. You can run the wide sidewalk down Mary Street for a mile with a calendar view of Mt. Baldy snow-dusted and brilliant. Even the evil unseen gases, researchers say, have dissipated. They fixed it with laws and science, research and regulation, a shift of behavior. Up here in the woods, there are prescribed fires, set in the shoulder seasons, in spring or fall when the conditions are right, that can mimic the work of wildfires, clearing underbrush, setting pine seeds free, making the forest healthier and less likely to get blackened in a catastrophic burn. In the wider world, there are diplomatic negotiations, tedious and trying, requiring humility and compromise, heartburn and exhaustion on a grand scale, that have brought tenuous peace in Ireland, in the Balkans, maybe someday in the Middle East. I try to be hopeful, I do.
The label on my steroid prescription warns me that it might cause the following: headaches, dry throat, infection, depression. Some of my friends believe that’s not the worst of it, just the tip of the iceberg, what the drug companies are willing to admit.
I called a doctor friend to ask outright: “Is the inhaler going to kill me?”
“Wheezing will kill you faster,” he said.
Maybe, I think. Maybe not. I have no way to know. I only know that I remember those nights awake sucking air—the terror, the desperation—and those memories haunt me.
Another memory. I stand waiting for the gun. One hundred yards butterfly. At take your marks, I’ll bend forward and clutch the slanted platform at my feet. At the gunshot, I’ll arch up then dive shallow and surface in motion. But for now, in the interminable seconds atop the starting block, I’m terrified. Nothing short of that. I’m convinced that I won’t make the full one hundred yards. The sheer physical feat seems impossible—implausible!—even though I’ve done it a thousand times, and I’m certain, absolutely sure, that I’ll flail gasping, and have to call for help in shame. I can conjure that whole scene more easily, much more easily, than I can imagine what will really happen, which is this: I’ll dive then take two strokes head down, one head up. The head-up stroke will take more energy, since I’ll have to pull my torso out of the water. For the first fifty yards it’s not hard, not at all, but as the race goes on, and my lungs burn, I’ll try to breathe too soon, jerking my head up a millisecond before my abs have lifted my shoulders, and I’ll take water into my windpipe. I’ll choke. I choke—actually, literally—every single time I race butterfly in high school. And once I begin to choke, I swim much faster. In the end, that’s the only reason I am worth a damn at all on the team: because I am swimming for my life. Swimming freestyle I am trying hard, but I am sated; it’s too easy, nothing at stake but a plastic trophy and my pride. Swimming butterfly I crave air, and I’ll do anything to get it. Turns out, if you want to win races, that’s a good thing.
Just recently I made some progress. I cut my steroid dose in half. I tried quitting whole hog again with predictably bad results, so I scaled back to mornings only – one buck instead of two – and wheezed some at first, then less over time, until any more there’s only a hint of struggle when I linger too long in bad air: shoveling ashes from the woodstove, say, or jogging behind a school bus on a gravel road or idling in traffic. Laurie is, so far, wary. The doctor advises against it. Me, I want to stick with the experiment not so much because I believe things will get back to how they were—breathing free—but because it feels right. For so long I’ve been trying to tell myself that everything is fine, just fine, that we are, all of us, doing the very best we can, but there is, in me, beneath the salve of the huffer, a hint of uncertainty. There is always, with every inhalation, 63,360 times a day, an edge of panic. I’m thinking that’s a good thing.