Learning to Breathe While the Truth Burns

INK + OXYGEN: Chapter FOUR

INK+OXYGEN is my (mostly) weekly note from the intersection of medicine and making. Each entry starts with something I read recently (a book, an essay, a paper)
and ends with how it actually shows up in real life: in the ICU, at home, or
in my own head. No summaries, no book reports. Just one idea, one honest
application, and the next line I’m trying to draw. Published on BokaMD.substack.com.

Bursting with hot chilli peppers, aniseed and black peppercorns— enough to burn any mouth. —Normanton

There’s a West African bedtime story my kids love, partly because it’s absurd, there’s a rhyming singing part, and partly because it feels unfair in the way the best stories do.

It’s called Anansi and the Hot Pepper Soup. It goes like this…

The king announces a contest. In the center of the kingdom sits a large bowl of hot pepper soup. Not symbolic soup. Real soup.

Steaming, dangerous, alive, and HOT.

The rules are simple:

• You must eat all of the soup.
• You cannot blow on it.
• You cannot spit it out.
• Whoever finishes, wins.

First comes the crocodile.

All armor and confidence. Built for dominance.

He takes a mouthful and tries to endure it. His eyes bulge. His jaw tightens. And then instinct wins. He spits it out.

Disqualified.

Next comes the silverback gorilla.

Massive. Powerful.

Certain of his win for this is a test of strength.

He shovels the soup in and holds it longer than the crocodile. Long enough to impress the crowd. But heat doesn’t care about brawn.

His face changes. His breath shortens.

And finally, his mouth burning bright red, he spits it out too.

Disqualified.

Then Anansi the clever spider steps forward.

Small and smiling. Never the obvious favorite.

He takes a spoonful.

Slowly. Calmly.

And as he eats, he sings.

Not loudly. Not theatrically. Just enough.

Each note pulls a thin stream of cool air into his mouth. Not blowing. Not spitting. Just breathing.

The soup is still hot. The pain is still there. But the heat becomes tolerable.

Spoon by spoon. Breath by breath. Anansi finishes.

He wins.

The trick isn’t strength. It isn’t bravado. It isn’t pretending the soup isn’t hot.

It’s regulation. It’s knowing that survival isn’t about overpowering the heat, but about how you breathe while it’s there.

I think about that story a lot in the ICU. Because the ICU is full of hot pepper soup moments. Family meetings where the air feels thick. Conversations about prolonged mechanical ventilation that sound hopeful until they don’t. Codes that end without the ending anyone wanted. Rooms where fear is so loud it presses against your chest.

We are trained to tolerate heat.

• Protocols.
• Algorithms.
• Checklists.
• Difficult conversations.

We learn to swallow hard truths efficiently.

But communication doesn’t work like an endurance contest.

When conversations get too hot, people stop hearing. Cognitive load spikes. Fight or flight takes over. Hearts pound, emotions flood, and meaning evaporates.

Families don’t remember your precision or your care. They remember whether they could breathe while you were speaking.

The mistake we make is thinking the answer is more information. (I know I do.) Or less.

But, you know what? It’s neither.

It’s air.

Good ICU communication isn’t about dumbing down the truth or overwhelming people with it. It’s pacing. Pausing. Naming uncertainty instead of rushing past it. Letting silence do some of the work. Checking understanding instead of assuming it.

It’s singing while eating the soup.

Not distracting. Not minimizing. Just enough regulation to keep the nervous system online so the truth can land without burning.

The crocodile loses because brute force doesn’t help. The gorilla loses because strength alone can’t regulate pain. Anansi wins because he understands something quieter:

Heat doesn’t go away. And life doesn’t either. The question is not whether the soup will burn. Because it always does.

The question is whether you know how to pull breath while you’re in it…

Ink to remember the story. Oxygen to pull the breath.