Hospice and the Next Breath

One of our hospice patients was SOB. No, I didn’t say that patient was a son-of-a . . .!

Like scuba (Self-Contained Underwater Breathing Apparatus), Nabisco (National Biscuit Company) or a laser (Light Amplification by Stimulated Emission of Radiation), the hospice/medical use of SOB is an acronym.

Which is to say the patient was short of breath. When a patient’s medical history is recorded, acronyms play a key role in sharing and keeping information brief. Until I started working at hospice, I hadn’t seen MOM used for milk of magnesia . . . but there it was, betwixt lasix (a medication dealing with water retention in the body) and MSIR (morphine sulfate instant release).

Under any circumstances, being short of breath is scary.

Once, in a middle school football game, I had breath knocked out of me. Yes, I remember that far back, and that experience! For several precious seconds, I struggled to breathe. As kids, we may feel indestructible—but in that long, literally breathless moment, a hint of mortality created fear. In my late twenties, in prime physical health, I hiked to the top of Mt. Whitney. At 14,505 feet it’s the highest peak in California’s Sierra Nevada (and outside of Alaska, taller than any other mountain in the United States). Nearing 13,000 feet, I wondered why my breath felt labored and my stride had slowed. It was like trudging through molasses. Less oxygen!

A few years back I read Victoria Sweet’s 2012 memoir, God’s Hotel. A physician, Sweet became intrigued with medicine before the modern era, especially the work of Hildegard of Bingen. Now known as Saint Hildegard (1098-1189), she was a German-born mystic, nun and—among her many and varied talents—a medical practitioner. With none of today’s tools and technology, Hildegard knew the importance of breathing for a patient. Sweet writes . . .

But she was not getting a respiratory rate of so many breaths a minute the way I do; she was interested in something other than a number. Breath for her meant spiritus—the essence of life—and what she did was simply observe her patient breathing. Was his breath weak or strong? Fast or slow? Continuous? Or—most serious of all—discontinuous, with long spaces between each breath? Breath told her a lot about just how sick her patient was.

Many in hospice care need portable oxygen tanks to aid breathing. It is a lifeline.

When nearing death, breathing can become difficult . . . and then more difficult. Activity is limited, exertion costly. Some medications, like morphine, may help.

I recall sitting with my mother in her final days in 2013. Alone with her, without first being aware, my breathing mimicked hers: her breath slowed, so did mine; her breath paused, so did mine. At times, I wanted to breath for Mom. At other times, for I despised the depths of her suffering during the worst and final stages of her illness, how I wished her breathing would cease. I believed her faith meant that in life, and also after her death, she would forever be in God’s care. But as she continued living—and breathing—the suffering persisted.

As a way to avoid saying the word “death,” a friend or family member often will say they saw the “last breath.” In a sense, they are witnesses to the sudden, startling absence of spiritus.

Breath is life . . . spiritus.

I invite you now—right now—to take a next breath. Inhale. Exhale. Deep. Lung-filling. Life-giving.

But don’t take it for granted. With our breath, we can share words of hope and forgiveness with another. With steady breaths, we can stride toward an ill friend’s home or hospital room when they are sick, and maybe are SOB. We can bring a casserole or our reminiscences or our companionable silence or our honest prayers and we can, breath by breath, accompany their journey.

As long as we are breathing, we have the opportunity to experience—and share—the essence of spiritus.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

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