The scalpel sliced through the uterine wall. The amniotic sac ruptured, and fluid flowed across the blue surgical drapery toward me. The obstetrician’s fingers curled around the baby’s head while my gloved hands pressed firmly against the mother’s abdomen. The baby was larger than we had expected. I shifted my full body weight against the mother’s belly, and, at last, the newborn’s head slipped through. Her shoulders quickly followed, and there she lay, eyes taking in the bright world for the first time.

Before she could cry, she took her first breath. Air rushed in, pushing aside fluid that had filled her lungs from six weeks of gestation. The oxygen diffused through the blood vessels of the alveoli, tiny air sacs within her lungs, relaxing the pulmonary arteries and allowing blood to course through her lungs for the first time. The short vessel connecting her lung arteries and heart began to close. Pressure built in her heart, causing the tiny hole between its chambers to snap shut.

She breathed more vigorously than anyone else in the operating room, her purple hue softening to a rich pink. Squinting against the glaring light above, she cried again. What a foreign world this is—where air becomes breath, and then breath returns to air.

Ruach is a Hebrew word meaning breath, wind, or spirit. (In the Septuagint, an ancient Greek translation of the Old Testament, it is rendered as pneuma or pneumon, the roots from which we get many English words pertaining to lungs.)

In Genesis, ruach is both the Spirit of God bringing light and order into an unordered world (1:1–4) and the breath of life that God breathes into Adam (2:7). Psalm 33:6 says, “By the word of the Lord the heavens were made, and by the breath (ruach) of his mouth all their host,” and Job affirms that “the spirit (ruach) of God is in my nostrils” (27:3, ESV throughout).

We also see God’s ruach animating and energizing all of creation, including us. Breathing in God’s ruach shapes us into his image, and just as the newborn’s internal anatomy was physiologically shaped by her first breath, so too does God’s ruach change us and give us new life. In the Old Testament, the Spirit of God promised the future salvation and renewal of all of God’s people, and at the Last Supper, Jesus promised the Spirit would come to his followers as “the Helper” to teach, guide, and “be with you forever” (John 14:16, 26).

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When “the goodness and loving kindness of God our Savior appeared, he saved us,” Paul wrote to Titus (3:4–6), “not because of works done by us in righteousness, but according to his own mercy, by the washing of regeneration and renewal by the Holy Spirit, whom he poured out on us richly through Jesus Christ our Savior.”

We are constantly reminded of that need for renewal. Just moments after returning from that C-section—still marveling at the miracle of first breaths—I crowded into a cramped ICU room, trying desperately to palpate a femoral pulse on a patient between chest compressions. No breath. No pulse. I watched her chest rise and fall with each compression and heard the rush of oxygen as the respiratory therapist artificially filled her lungs. But it was not a true breath. It was not her own ruach.

Time began to blur. Two minutes. Ten minutes. Twenty. “Please, don’t stop!” the patient’s daughter cried from behind me. But 45 minutes later, there still was no pulse. No matter how hard we tried, her ruach would not return.

Ecclesiastes says that “all are from the dust, and to the dust all return” (3:20), but that as “the dust returns to the earth as it was,” the “spirit (ruach) returns to God who gave it” (12:7). Without the context of Christ’s incarnation, death, and resurrection, the fact that God takes away his ruach can be a very somber thought. Yet the rich news is that because God himself experienced a first breath and a last, we are offered renewed life in the Spirit to restore and sustain us.

Christ too was forced from the familiar rest of his mother’s womb into a bitter, cold world, his body contorting as air reeking of manure and sour hay poured into his lungs. To think, God’s ruach poured into Christ’s own flesh.

It left his body too, as he took his last breath as our perfect and righteous Savior on the cross. “Jesus called out with a loud voice, ‘Father, into your hands I commit my spirit (ruach)!’ And having said this he breathed his last” (Luke 23:46).

Following his resurrection, Christ appeared to the disciples. His own ruach restored by God, in vindication of his sacrifice, he “breathed on them and said to them, ‘Receive the Holy Spirit (ruach)’” (John 20:19–22). Then, at Pentecost, there was “a sound like a mighty rushing wind (ruach) ... and they were all filled with the Holy Spirit (ruach)” (Acts 2:2, 4). As God breathed life into Adam at Creation, so too Christ breathes the Spirit into his disciples.

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This was the promised renewal. God promised that he would give us a new heart and put a new spirit within us. He promised to remove our hearts of stone and give us hearts of flesh—that he would put his Spirit within us and move us to follow his decrees and laws (Ezek. 36:26–27). At last, David’s plea in Psalm 51:10—“Create in me a clean heart, O God, and renew a right spirit within me”—was fulfilled, and the prophesy of the Old Testament rulers was made complete. Now, all people are offered the sustaining breath of the his Spirit through the death and resurrection of God’s own son.

How then shall we respond? Every breath, every gust of wind, every act of the Spirit—in all of these may the ruach of God remind us to do what the final psalm commands (150:6): Let everything that has breath praise the Lord!

Mariellen Van Nieuwenhuyzen (MD, UC Davis School of Medicine) is a family medicine resident physician who writes for several online Christian publications and literary magazines.

[ This article is also available in русский and Українська. ]