BREATH TAKING – a book review

We take 7.5 million breaths a year and some 600 million in our lifetime. Breath Taking is an exhaustive review of why and how our lungs work, and what happens to our lives when they are attacked and injured by disease.

Usually when we call something “breathtaking”- a sunset, a painting, a song, a mountain- we mean it is awe-inspiring, wondrous, beautiful, or astonishing. But in his book Breath Taking, Dr. Michael Stephen describes conditions that literally cause us to lose our breath- the multiple and serious diseases that affect the human lung.

Prologue: Lungs =Life

Michael J. Stephen, M.D.

BREATH TAKING

by Michael J. Stephen, M.D.

The Power, Fragility, and Future of Our Extraordinary Lungs

I was approached by the publisher , FSB Associates, asking if I would review the book, and offered a complimentary copy. Otherwise, I was not compensated for my review. Some of the links in this post are affiliate links which may help support this blog financially.

image of God and Adam on the Sistine Chapel by Michelangelo
“The Lord God formed man, and breathed into his nostrils the BREATH of life, and he became a living being.” Genesis chapter 2, mentioned in the prologue.

the breath can be used to heal the body

from the prologue

Part i-THE PAST

the lungs shaped our beginnings, physically and spiritually

We take 7.5 million breaths a year and some 600 million in our lifetime. Yet humans have not always understood breathing, how the lungs work, or even what oxygen is. In Part 1 Dr. Stephens steps into the past to relate the story of how we came to understand this critical part of our physiology.

The human respiratory system diagram- the throat, trachea, bronchi, and lungs
The human Respiratory Tract from the nose all the way down to the lungs and alveoli . (photo complimentary from Pixabay)

For years physicians tried to understand why premature babies have breathing problems, known as neonatal respiratory distress syndrome. It took a determined young woman physician, Dr. Mary Ellen Avery, to discover the cause and rename it hyaline membrane disease, descriptive of the underlying disease.

a tiny baby lying in a bed with a breathing tube
phots by Alex Workman, from the LIGHTSTOCK.COM collection, an affiliate link

part ii: the present

our lungs-and us-against the world

In this section Dr. Stephen introduces us to the interactions between the immune system and the lungs. Ideally we expect our immune system to protect our lungs from threat of infections due to pathogens like viruses-influenza and coronaviruses- and bacteria that cause pneumonia. In all of human history, including today, tuberculosis has caused more disease and death than the others combined.

But the immune system can go awry, and cause disease rather than protect us from it. Such is the case with asthma in which inflammation out of control can lead to first shortness of breath and progress into respiratory failure.

Published early in 2021, the book does not cover the COVID-19 pandemic extensively. Dr. Stephen did say this,

“The coronavirus story is one illustration of how our air is communal, that the world is interconnected, and warnings about potential global health threats need to be taken seriously. ”
WHY WE NEED TO VACCINATE THE WORLD
graphic from the Johns Hopkins Bloomberg School of Public Health Facebook page

Next Dr. Stephen devotes a large section to the “seduction of nicotine”, explaining why we should not start smoking cigarettes and why we should stop if we do.

I was intrigued by the story of a man named Buck who came from a modest background but was quite an entrepreneur. In the early 20th century smoking was becoming more and more popular, enabling Buck to make a fortune by creating and marketing a machine that rolled cigarettes.

He became so rich that he donated $100 million to a small college. The college administration was so grateful they renamed the school after him, James Buchanan “Buck” Duke. The college, now Duke University, ranks among the top universities in the United States, including the medical school. The men’s basketball program is one of the country’s most successful.

I wonder if Mr. Duke knew how addictive his fortune making product was, thus assuring his company of success?

from the Facebook page of WHO, the World Health Organization

part iii-the future

the lungs provide a vision of what’s to come

Next to the infections-pneumonia, bronchitis, influenza, COVID-19, tuberculosis -the lung disease most people know and fear most is lung cancer.

A diagnosis of lung cancer strikes fear in the hearts of its victims and their families, and for good reason. “80% of patients come ..with stage III or IV disease, both very advanced.” Compare the average five year survival rates for

  • breast cancer-90%
  • colorectal cancer-65%
  • lung cancer-18%.

Lung cancer causes more deaths per year than colon, breast, and prostate combined.

chapter 11

Lung cancer is treated with a combination of surgery, radiation, and/or chemotherapy. However, a small percentage of cancers are due to a genetic mutation that can function as a “kill switch” if found. For those who qualify, about 4%, such treatment can extend life much longer than the conventional treatment.

Another option is harnessing the immune system to attack cancer cells, and a new drug, pembrolizumab has recently been approved by the FDA.

Most important now is prevention, by decreasing cigarette smoking, reducing other inhaled carcinogens such as radon, and toxins from air pollution .

2 preserved human lungs, one normal, one damaged
Two preserved human lungs, one normal,-left, one damaged from disease-right. Photo by Dr. Aletha at the Denver Science Museum

part iv

life, love, and the lungs

Dr. Stephen introduces this section by reiterating the three main themes of his book-

  • the central importance of the lungs
  • the courage of patients afflicted by a devastating illness
  • the importance of hard work, intelligent observation, and collaboration in the advancement of medical science

He illustrates these themes by telling the story of the discovery , and advances in treatment of cystic fibrosis (CF), “the Most Heartbreaking Lung Disease”.

Again, it was a woman physician, Dr. Dorothy Anderson, who did the groundbreaking work which described the pathologic changes caused by CF, established the genetic origin of CF (a defective autosomal recessive gene), and developed the first test for CF.

My final thoughts

Breath Taking is an exhaustive review of why and how our lungs work, and what happens to our lives when they are attacked and injured, sometimes fatally .

Dr.Stephen achieves this by weaving stories of real people afflicted with lung diseases together with the scientists who studied those diseases, and the physicians who treat them.

He believes it is imperative for us to protect and improve the enivironment, especially the air we breath and challenges us to choose lifestyles that can save not only our own lungs but of everyone else on this planet. He discussed this in a piece written for Each Breath, a blog by the American Lung Association.

2020:The Year We Lost Our Breath

tops of skyscrapers obscured by smog
photo by Brandon at Lightstock.com

“The Clean Air Act (1970) was designed to protect public health and welfare from different types of air pollution caused by a diverse array of sources, and passage of this landmark legislation has saved countless lives. While we enjoy healthier air thanks to the Clean Air Act, climate change poses new risks to our air quality. We know air pollution harms health and can be deadly, and new research suggests that exposure to particle pollution can even increase the death toll from COVID-19.” (continue reading at the link)

Conclusion

  • Acknowledgments
  • Notes- more of an exhaustive bibliography
  • Image Credits
  • Index
  • Author bio on the inside back cover

The author- Michael J. Stephen, M.D.

Michael J. Stephen, MD, is an associate professor at Thomas Jefferson University in Philadelphia, and director of the Adult Cystic Fibrosis Center.

He has led numerous clinical trials and has cared for COVID-19 patients. Over the past two decades he 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.

A graduate of Brown University and Boston University Medical School, he lives in New Jersey with his wife and two children.

About this post

I chose all of the photos and graphics in this post, they are not from or affiliated with the book.

The two graphics were shared on Facebook by the organizations identified and I thank them.

I took the photo of the lungs which were part of the Expedition Health exhibit at the Denver Museum of Nature and Science.

The photo illustrating Genesis 2 is of course the ceiling of the Sistine Chapel at the Vatican, painted by Michaelangelo from 1508 to 1512. The photo,available on Lightstock.com (affiliate link), was shot by Rob Birkbeck.

exploring the HEART of breathing

I appreciate all of you who are following Watercress Words, and if you aren’t I invite you to join the wonderful people who are. You can meet some of them in the sidebar, where you can click on their image and visit their blogs. Use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me.

Dr. Aletha

This graphic is from SundaySocial.tv
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Dying with Ease- a book review

Dr. Spiess doesn’t suggest that confronted with terminal illness we refuse treatment and give up. He advocates thinking about and planning for the dying process long before we develop an illness that might be fatal.

This is at least the fouth book about death I have reviewed. I didn’t plan to, but it just happened. Maybe because of what Dr. Atul Gawande wrote in his book Being Mortal, another book I reviewed.

Death may be the enemy, but it is also the natural order of things.

Atul Gawande, M.D.

In this instance, I was approached by the publisher , FSB Associates, asking if I would review the book, and offered a complimentary copy. Otherwise, I was not compensated for my review. The book links in this post are affiliate links which may help support this blog financially.

Dying with Ease by Jeff Spiess, M.D.

A Compassionate Guide for Making Wiser End-of-Life Decisions
Dying with East-a book

In the introduction, author Dr. Jeff Spiess explains his purpose for writing this book.

my primary hope is for you, dear reader, to become more informed and at peace regarding your own dying.

Jeff Spiess, M.D.

Dr. Spiess doesn’t suggest that confronted with terminal illness we refuse treatment and give up. He advocates thinking about and planning for the dying process long before we develop an illness that might be fatal.

His book reviews the challenges of the dying process, and guides us in making choices that make it smoother and with ease.

Let’s review the titles of each chapter with a brief description of what each contains.

1. Dying in America

Here he proposes a definition for what is a “good death”; it’s one that matches the wishes of the dying person and their family.

2. I’m Going to Die? What Can I Do?

In this chapter he explains Advance Care Planning

  • Advanced Directives
  • Durable power of attorney for healthcare
  • Do Not Resuscitate-DNR
  • Physician Orders for Life Sustaining Treatment
  • Artificial Nutrition and Hydration

3. Hospice

In this chapter he reviews the history of hospice care care and explains the basics of palliative (rather than curative) care

4. Suffering

Most dying persons want to minimize suffering so Dr. Spiess lists ways to do so, some of which are controversial and even illegal in some states.

  • Palliative sedation
  • Voluntary stopping eating / drinking
  • medical aid in dying
  • voluntary euthanasia

5. It’s My Life, Isn’t It?

Here he discussed autonomy , bioethics, and the legal system using past high profile cases as illustrations, those being

  • Karen Ann Quinlan
  • Brittnany Maynard
  • Theresa Schiavo
"To every thing there is a season" Bible verse with fall color leaves
from Ecclesiastes 3

the time of peril, what St. John of the Cross called the “dark night of the soul,” … both tests the validity of one’s faith and initiates that essential process of incarnation

page 109

6. What’s God Got to Do With It?

Here he talks about “Religion, Spirituality, and the End of Life. He finds many people turn to religion when faced with death and sometimes that is not an altogether positive experience. However, he denies being anti-religion saying,

many find religious traditions to be sources of profound comfort and meaning. …it has been so for many friends, relatives, and patients, and also because it is true for me.

page 109

He finds it essential to differentiate religion as primarily a matter of intellectual assent to doctrines and beliefs, or whether the essense of a person’s faith has become understood and embodied in their being.

photo by DJ Thomas, Lightstock.com

7. What Does It Feel Like to Die?

In this chapter he invites the reader to do a guided exercise to encounter the inner experience of dying. Putting pen to paper you will answer a series of questions about your life. Then you review it as you finish reading the chapter. I did the exercise and found it enlightening and sobering.

8. Envisioning Your Own Death

Here he expands on the idea of Advanced Care Planning introduced in chapter 2. He adds such steps as

  • Know the rules (insurance coverage)
  • Disposition of your body
  • Disposition of “stuff”, making a will
woman sitting in a cemetery
photo from the Lightstock.com collection, an affiliate link

9. What’s It All About, Anyway?

Dr. Spiess concludes with a true story about a wife’s journey to finding meaning after her young husband’s unexpected death.

living well increases the likelihood of dying well

page 161

Conclusion

After the obligatory Acknowledgments this book has

  • Discussion Questions which seem most appropriate for personal reflection . There is one question based on each chapter.
  • Notes, which are chapter specific
  • An extensive Bibliography
  • An Index
  • Brief Author bio

Jeff Spiess, M.D.

Dr. Jeff Spiess

Dr. Spiess started in medicine as an oncologist, cancer specialist, then transitioned into palliative and end-of-life care as director of a hospice. His website, https://drjeffspiess.com/, offers a complete bio, audio interviews, his blog posts, social media links, and form to join his email list.

exploring the HEART of life and death

I appreciate all of you who are following Watercress Words, and if you aren’t I invite you to join the wonderful people who are. You can meet some of them in the sidebar, where you can click on their image and visit their blogs. Use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me.

Dr. Aletha

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