AUTHOR Michael J. Stephen, MD, is an associate professor at Thomas Jefferson University in Philadelphia, and director of the Adult Cystic Fibrosis Center. A graduate of Brown University and Boston University Medical School, he lives in New Jersey. Breath Taking: The Power, Fragility, and Future of our Extraordinary Lungs (Atlantic Monthly Press; January 19, 2021; @groveatlantic)
Everyone is thinking and talking about breathing, oxygenation and respiratory particles these days. Breath Taking, an enlightening new book by Dr. Michael J. Stephen, who has been on the front line caring for COVID-19 patients—and also recovered from the virus himself—arrives just in time for a curious public who wants to educate themselves about the lungs in order to understand the effects of the SARS-Cov 2 virus pandemic.
Over the past two decades Dr. Stephen has studied advanced end-stage lung diseases and worked with patients at diverse locales, including a Massachusetts prison hospital and a pediatric HIV clinic in Cape Town, South Africa. He is an associate professor at Thomas Jefferson University in Philadelphia, and director of the Adult Cystic Fibrosis Center.
The inability to breathe in those afflicted by the COVID-19 virus is physical, but the metaphor of not being able to breathe also is extremely relevant in our American society reeling from racial and cultural upheaval. Many of us may have started focusing on our breathing and meditation to deal with the stress of the pandemic. Last spring’s New York Times bestseller Breath: The New Science of a Lost Art by James Nestor revealed how breathing methods used through the ages had restorative powers.
There are even more reasons in Dr. Stephen’s new book to believe the truth behind these revelations: Breath Taking holds as its thesis that the lungs are equivalent to life; that all else flows from the lungs. With Breath Taking, Dr Stephen has written a far-reaching love letter to the respiratory system in which he links prominent developments in the history of pulmonary medicine, patient anecdotes and current events.
Dr. Stephen attempts to cover extensive ground. He begins with the evolutionary beginnings of land-based and lung-dependent life, through the history of medicine including the development of antibiotics to lung transplantation, and further into the future to speculate on the role of artificial respiratory systems that will take man to habitat on Mars. This is a lofty—and well-researched—assignment for sure, but he has been careful to hit highlights likely to keep the reader’s interest by incorporating vignettes—some poignant, others tragic, all well-told and engaging—that report back to his modern clinical work as a lung specialist.
His writing is casually conversational, but still rooted in the jargon of a physician speaking to trainees. While the book will appeal to the general public, as a physician myself I recognized the familiar trope of the senior physician on hospital rounds imparting his wisdom and aphorisms to trainees. The writing style evoked fond recollections of my time as a medical student when the senior faculty would delight the uninitiated with pearls from the history of medicine or share illustrative cases in much the same manner. Breath Taking shares the motivating passion for medicine that may not always be evident to patients in a routine clinical encounter.
Still. there are moments when the esteemed physician warmly invites others to share his passion for the lungs; nestled within the facts and statistics are moments when he asks the reader to pause and reflect:
Sometime after midnight, one deep January night, I remember walking into my bedroom and staring down at my first child in her crib, born on New Year’s Eve and now barely two weeks old. The silver moonlight poured in through the window, illuminating her outline. Her eyes were closed tight, her arms thrown over her head as if in an eternal stretch, her head tilted slightly to the right. Her intoxicating newborn smell brought rapture and calm.
Like millions of parents before, I considered the serenity of a newborn’s sleep, its restorative depth, but I also instinctively checked on function, to make sure life still blazed within despite the outward calm. This meant checking her belly, to make sure she was breathing. Of course she was: her chest and abdomen moved up and down under her blanket in the rhythmic flow we all know as life.
When we observe our loved ones sleeping, old or young, human or pet, we are instinctively drawn to their breath. There is something essential in it we are all attuned to, something we both automatically and unconsciously equate with life. Each time we check on each other, we are validating the words of the Roman philosopher Cicero, dum spiro spero, “As I breathe, I hope.”
Breath Taking brings a wide-reaching approach to the discussion of the lungs; one that welcomes in consideration the role the lungs and breath play in religion, history, society and medicine. A broader usage of medical illustrations and a glossary would have been helpful, however, to build health literacy and increase readability for those not fluent in the medical jargon used freely by physicians in the hospital. I found the discussions of public health and societal issues, such as the impacts of air pollution, climate change, embracing clean energy sources, engaging yet these topics that merge with complex policy considerations well beyond clinical medicine might have been covered in a more nuanced manner by collaborating with co-writers who could provide additional expertise. Still, in broaching them, Dr. Stephen opens a broad range of possible discussions that readers may well want to continue long after putting the book down.
Another strength: There is much in Breath Taking to encourage anyone suffering from lung disease. Breath Taking provides clear insight into how tremendously far medicine has come in the treatment of respiratory illness. The chapters touching on the triumph of lung transplantation, for example, demonstrate the difficulties of developing new treatments, while underscoring that improvements are in the works and evolving constantly. This well-structured book supports and encourages patients, caregivers and healthcare providers dealing with all manner of difficulties with breath, giving them reasons to exhale. —Lara Ronan
Lara Ronan, MD
Lara Ronan, MD is an Associate Professor of Neurology and Medicine at Geisel School of Medicine, Dartmouth College and Vice-Chair for Education in the Department of Neurology at Dartmouth Hitchcock in Lebanon, NH. She has research interests in the intersection between the Arts and Humanities and Medicine. Dr. Ronan has started the Columbia Narrative Medicine Certificate Program and writes and cartoons about the effects of individual narratives on the telling of the legacy of a single story.