Breathing, and what changes with the years

Getting winded is not the same thing as getting old. Here is what I learned to notice, in twenty years of letting myself into other people's houses in the morning.

Kept by Sophia Williams, North Carolina

For about twenty years I let myself into other people's houses at seven in the morning. Coffee on, curtains open, help somebody sit up on the edge of the bed. And the first thing I listened for, before I said good morning, was how the person in that bed was breathing.

Not because I knew anything clinical. I'm no doctor, honey, and I never was one. But you sit in enough kitchens and you learn what an ordinary morning sounds like, and what it sounds like when something has changed.

Breathing is the thing people worry about in private and describe badly out loud, so I want to lay it out plainly. What happens when you take a breath. What honestly changes as the years go, and why that is ordinary. And where the line sits between the winded everybody gets and the winded that is worth an appointment.

1.1

What changes anyway

One breath, in ordinary words

Underneath your lungs there is a flat sheet of muscle called the diaphragm, and it does most of the work. When it pulls down, your ribs swing out and the space inside your chest gets bigger. Air moves in to fill it, the way it moves into a room when you crack a window on a windy day.

It travels down the windpipe into branches that split and split again, like a tree turned upside down. At the ends are millions of little air sacs, each as thin as the skin of a soap bubble. Oxygen crosses into the blood there, what the body is done with crosses back, and then the muscle relaxes and the air goes out on its own.

That is the whole business. In, across, out, thousands of times a day, and you decide on almost none of them.

Now, what changes with the years. Three things, and not one of them is a catastrophe.

The chest wall gets a little stiffer. The ribs and the joints between them do not spring back as easily as they did at thirty, so the bellows take more effort to open.

The muscles that do the pulling lose some strength, the same way every other muscle in the body does.

And the lungs do not empty as completely as they once did, so a little more air stays behind after each breath out, leaving less room for the next one.

Put those together and most people in their sixties and seventies carry less in reserve than they used to. On an ordinary day you would never know. Carry a laundry basket up two flights and you find out. That is ordinary. It belongs in the same drawer as knees and eyesight.

What this entry is about is telling ordinary apart from something else.

1.2

What people hide

There is a difference between being out of breath and being out of breath

If you hustle up the porch steps because the phone is ringing and stand at the top puffing, that is the body doing what it should. You asked for more air than you had ready and it arrived a few seconds late. A man of seventy does it and a boy of twenty does it, and the boy just gets his wind back quicker.

The one worth paying attention to is a different animal. It is being out of breath doing something that used to be nothing at all. The same stairs. The same walk to the mailbox and back. The same aisle in the grocery store. The job did not get harder, so something else did, and that is worth knowing about.

Here is the trouble, and it is why I sat down to write this one. Almost nobody notices it happening to themselves, because almost nobody keeps doing the thing.

My own daddy smoked most of his life. He tried to quit more times than I can count and never could, God bless him. Year after year I watched the stairs in our house get longer for him. He would stop halfway up and make a show of hunting for something in his pocket, then go on like nothing happened. He was not fooling me. What worries me now is that he was doing a fair job of fooling himself.

In the houses I worked in I saw the same quiet arithmetic over and over. Park closer to the door. Carry one bag of groceries and make the second trip. Use the downstairs bathroom. Take the chair nearer the door. Let the church service come over the radio this Sunday because it looks like rain. Nobody announces any of it. It just happens, one small surrender at a time, over a couple of years.

Then at the appointment the doctor asks how his breathing is, and he says fine, and he is not even lying. He genuinely is not short of breath any more. He rearranged his life so he would not have to be.

1.3

When it is worth a call

The short list I would not sit on

I am not going to pretend I can tell you what any of this means. That is not mine to say and it is not yours either. But there is a short list worth an appointment rather than a wait and see, and every item on it is something you can notice at home without a single piece of equipment.

Breathlessness that is new, or that has clearly gotten worse over a few weeks or a few months.
A cough that will not settle. Weeks rather than days, and especially one that has changed its character or its sound.
Waking in the night short of breath, or needing more pillows than you used to just to lie flat and sleep.
Ankles or feet that swell, particularly by the end of the day.
Any blood at all, coughed up, even once, even a little.

Not one of those is a diagnosis, and not one is on the list because it means something terrible. They are there because a doctor would rather hear about them in October than in February, and because each one is easy to explain away at home. The cough is the weather. The pillows are the mattress. The ankles are the salt. Maybe so. Let the person with the training decide that.

And there is a shorter list that does not wait for an appointment at all. If somebody is fighting for air right now, has chest pain, or seems confused or blue around the lips, that is a call to 911 in the United States this minute. Not the office in the morning.

1.4

Making the appointment count

How to say it so it is actually useful

An appointment is short, and a piece of it goes on paperwork and hello, so the words you carry in do a lot of work. And "I get winded" tells a doctor almost nothing. Everybody gets winded. It is the least useful true sentence in the English language.

What helps is a measure nobody can fudge. A count, a distance, a task, compared to the same person a year ago and not to anybody else.

"I stop twice on the stairs I used to climb without stopping."

"I used to walk to the mailbox and back. Now I go one way and rest at the fence post."

"He sleeps on three pillows now. It was one, and it changed sometime after Easter."

Each of those has a thing, a number and a date. That is a doctor's kind of sentence, and you need no training to build one. Write two or three on the back of an envelope before you go, because the room makes people forget and pride makes them cheerful.

If you are going along with somebody, settle it in the car and not in the room. Ask him what he wants said out loud, tell him what you intend to say, so it is a plan and not an ambush. Then say it. I never saw a family regret being honest at an appointment. I saw plenty regret waiting.

And if you are the one being asked about, tell the truth even where it embarrasses you. There is no prize for the man who never mentioned it.

I'm no doctor, and nothing here is a diagnosis or a treatment for anything. It is what one woman noticed in a lot of ordinary kitchens over a lot of years. The only person who can tell you what your breathing means is the one who knows your history, and the way to use that person is to go and sit in front of them. If you have been putting it off since spring, call in the morning and get on the book.