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In a photograph I've kept on or near my desk for 12 years, my brother Ryan is a small, 8-year-old boy standing outside with a mitt dangling from his left arm. A baseball hangs, blurred, in the air in front of him, suspended over his outstretched palm. Everything in the frame around him seems gigantic -- the too-big glove, the rows of pines and palm trees behind him -- but Ryan's confident grin is the center of all this wilderness and movement. A baseball player almost since he was old enough to stand, Ryan also spent his childhood as a severe asthmatic, enduring a seasonal tightening of the chest that made a precious currency of his breath, exhausted him after nights of bleary-eyed coughing and required him to consume an endless stream of pills and inhaled medicines. Yet all this somehow gave Ryan the most unlikely, serene composure. As in the picture, he always stood tall above the turbulence. He may have been at the fragile heart of a malignant universe, but when you saw that smile, you knew he was going to catch the spinning baseball.

But one night five years ago, Ryan's resilience all but vanished. In its place was a frightened 15-year-old. That afternoon had been routine -- high school baseball practice -- but he spent the night in the intensive care unit of the local children's hospital, a place he hadn't seen since spending Easter there at age 2. A sudden virus had come over him and caused a lung to collapse, but no one foresaw how his asthma would complicate this problem. Ryan would nearly die in this ICU. All told, he'd be in intensive care for almost two weeks, half of it unconscious.

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There are 17 million asthma patients in the United States, about a third of them children. The real shock, however, is that asthma-related deaths have risen 40 percent in less than 20 years. The death rate for children under 19 increased by 78 percent between 1980 and 1993, according to the Centers for Disease Control and Prevention. But the greater prevalence of asthma remains a mystery to doctors and health officials.

People who don't have the chronic disease often associate it with breathlessness, as if it were a generic condition that could be induced by a brisk run for the bus. But a full-blown asthma attack involves uncontrollable, hunched-over, red-faced coughing. Each breath gets a little shorter, the wheezes in between more pronounced. When it's over, you feel exhausted just from observing it.

Ryan once described it to me this way: It was as if he were at the bottom of a pool of water, his lungs empty, trying to swim to the surface without knowing exactly where it was. "You're kicking for breath. You're swimming as fast as you can for a breath," he said. "And you're just hoping that the surface is getting closer so you can get out."

When I arrived at the hospital five years ago, Ryan had moved briefly into a private room. I could see very little of him. Two intravenous drips fed his left arm, a heart monitor protruded from a fingertip and his flushed face was hidden behind an oxygen mask. Something had clogged the entrance to his right lung, causing it to collapse from within. He was sleeping on and off. Every time he took off his oxygen mask to talk to me, a monitor over his bed would begin beeping. Attached to the glowing red light at his fingertip, it measured the oxygen saturation in Ryan's blood. The oxygen level dipped precipitously, tripping the alarm, whenever he took the mask off. We quit talking after a little while.

Every two hours, a respiratory therapist woke him and drummed on his back, trying to dislodge the blockage in his lung. The 20-minute therapy continued into the night, which I spent in a chair. The therapist tapped the space behind Ryan's clogged lung from every angle. He took the treatment stoically. But with each new round, he had to be roused from a deeper sleep.

Shortly into an after-midnight session, Ryan began gasping into his one working lung. The therapist looked bewildered. It was an attack. Doctors and nurses began hustling in and out, taking X-rays, increasing his oxygen. Lying in his bed, he was wheeled out of the room and down the hall. I followed close behind. Our eyes met in the mirrored ceiling as we waited for the elevator that would take him back to the ICU. His eyes suggested despair, laced with disgust.

In an asthma attack, the bronchial tubes go into a spasm in reaction to a virus or an allergen; they become inflamed to a point doctors refer to (in cases such as my brother's) as "shutdown" -- virtually no air coming in. In compensation, every breath becomes harder and faster. The panic that sets in only makes it worse, increasing the heart rate, making the body require even more oxygen.

Ryan sat up in bed for four hours trying to catch his breath. At dawn, the doctors performed an emergency bronchoscopy -- tunneling into the collapsed lung with suction. A few hours later doctors told us they'd successfully removed 98 percent of the blockage, and we thought it was over. But Ryan's body was war-torn. The other 2 percent would have to be excavated, but not for a few days. In the meantime, he would remain unconscious, a drug paralyzing him from the neck down so that a respirator could do his breathing for him.

Next page | He felt like he was riding in an ambulance that was being hijacked by terrorists dressed up as doctors