Health
No. 5
Catching your breath
When the breath goes short, the first thing that arrives is fright, and fright asks for more air than the moment can give. Here is the slow way out that the lung people teach, where to put yourself while you do it, and where the line sits between a bad few minutes and a phone call.
Kept by Sophia Williams, North Carolina
The first house I ever worked in belonged to a man named Ray, and Ray had a chair by the window that he called his catching chair. I thought it was a joke for about a month. It was not a joke. That was the chair he went to when the breath got away from him, and he had worked out on his own, with nobody teaching him, most of what the lung people put in their pamphlets.
I am not going to pretend I understood any of it at the time. I was there to make breakfast and help him get his socks on. But I watched him do the same three things in the same order, dozens of mornings, and years later a respiratory therapist stood in another kitchen and described the very same three things to a family as if she had invented them.
So this entry is about the minutes themselves. Not about what is underneath the breathing, which is your doctor's business and nobody else's, but about what people do while they wait for the minute to pass.
Everything below is general information, the kind you would find on a hospital handout. It does not treat anything, it does not fix anything underneath, and it is not a substitute for a plan made by the person who knows your history. If breathing is a regular problem in your house, the appointment is the thing that matters. This is only what to do between now and then.
5.1
The moment itself
Why the fright makes it worse
Here is the part that surprised me most when it was finally explained properly. When a person feels short of breath, the instinct is to pull harder. Bigger breath in, faster, chest lifting, shoulders climbing toward the ears.
The trouble is that the problem, most of the time, is not on the way in. It is on the way out. Air that did not finish leaving is still sitting there taking up the room, and pulling harder on top of it is like trying to pour more into a glass that nobody emptied.
So the fright and the body work against each other. The faster you breathe, the less of each breath actually turns over, and the less turns over the more frightened you get. Anybody who has watched somebody they love go through it has seen that loop from the outside, and it is a terrible thing to stand next to.
Which is why every version of this I have ever seen taught, in a pamphlet or by a therapist or by a man in a chair by a window, starts in the same place. Slow the way out first.
5.2
The one to learn first
In through the nose, out through pursed lips
The American Lung Association calls it pursed lip breathing, and it is the one I would learn before any other, because it costs nothing, it needs no equipment, and you can do it in a parking lot without a soul noticing.
In plain words, the way it was taught to me:
- Let your neck and shoulders drop. This is most of it, honestly. Shoulders up around the ears is the body bracing, and bracing takes work.
- Breathe in through your nose, mouth closed, for a slow count of two. Two. Not a heroic breath, an ordinary one.
- Purse your lips as if you were about to whistle, or cool a spoon of soup.
- Breathe out gently through those pursed lips for a slow count of four. Twice as long going out as coming in. Do not force it, and do not push the last of it out.
That is the whole thing. The long, narrow way out is the point of it: it keeps a little back pressure in the airway so it stays open while the air leaves, and it slows the whole rhythm down, which is what takes the panic out of it.
I would rather you saw it done than read me describing it, so here is the American Lung Association's own demonstration. It runs just over two minutes.
Watch, 2 min
The advice I would add, and it is the only piece I feel qualified to add, is this. Practice it on an ordinary afternoon when nothing is wrong. Four or five times a day, a few breaths at a time, sitting in a chair with the television on. Nobody learns a new way of breathing for the first time in the middle of a bad night. The whole value of it is that your body already knows it by then.
5.3
Position
Sitting down is not giving up
Ray's second thing was the chair, and I have since learned that the chair is not incidental.
Lying flat is usually the hardest position, because everything inside presses up against the sheet of muscle that does the breathing. Standing straight with your arms hanging is not much better. What tends to help is sitting, leaning forward a little, with your forearms resting on your thighs or on a table, so your arms and the table are carrying the weight of your upper body instead of your chest doing it.
You will see the same shape at the side of a football field and at the top of a flight of stairs, and there is nothing undignified about it. It is what the body reaches for when it wants its arms braced. In a kitchen it is a chair pulled up to the table with your elbows on the table. On a walk it is a low wall, or a shopping cart, or a hand against a lamppost.
The third thing Ray did was open the window, winter or not, and I have never found a physiologist who would defend that one. But I have also never met a single person short of breath who did not want moving air on their face, and a fan pointed at the cheek is in more than one hospital handout. I have stopped arguing with it.
And if you are the one standing next to somebody in that chair: the most useful thing you can do is breathe out slowly and audibly yourself, where they can hear you, and count for them. Not talk to them. Not ask them questions they have to spend air answering. Count. They will follow you without being asked.
5.4
Where the line is
A bad few minutes, or a reason to call
This is the part I most want to get right, because everything above is for the ordinary bad minute, and there are minutes that are not ordinary.
Call 911 in the United States, straight away, and do not spend time on counts or chairs, if a person is struggling to breathe and any of this is true:
- They cannot get a whole sentence out, or cannot speak at all.
- Their lips, face or fingertips look blue or grey.
- There is chest pain, or pain going into the arm or jaw.
- They are confused, drowsy, or hard to rouse.
- It came on suddenly and hard, out of nowhere.
- They have a rescue inhaler or a plan from their doctor, they have used it as prescribed, and it has not helped.
Nobody has ever been embarrassed for long about calling. I have sat with families who waited because they did not want to make a fuss at two in the morning, and not one of them, not one, was glad afterward that they waited.
Short of an emergency, the other line is quieter and easier to miss. It is worth an appointment, not an ambulance, when something has changed and stayed changed. Winded on a walk that used to be nothing. A cough that has settled in and made itself at home. Waking up in the night to breathe. Doing less than last year without ever having decided to. That is the sort of thing to write down and take in, and there is a page in this handbook about how quietly that happens.
I'm no doctor, honey, and nothing here is a diagnosis or a treatment for anything at all. It is a way of sitting and a way of breathing out, taught by people who do know, and passed along by a woman who watched it work in a lot of ordinary kitchens. It does not replace your own doctor and it was never meant to. What it can do is give you something to hold onto in the four or five minutes before the thing passes, and give whoever is standing next to you something to do with their hands.