Vanity, Oxygen, and the Things That Keep Us Alive

Vanity is one of those qualities everyone claims they don’t have, right up until life asks them to prove it.

Somewhere deep inside even the humblest among us lives a tiny, insecure creature clutching a mirror and whispering, Please don’t let this be how people see me. I never thought of myself as a vain man. I still don’t, most days. But vanity isn’t always about admiring yourself. Sometimes it’s about fearing the moment when your body announces its limitations to strangers before you get a word in.

Back in 2011, I wrote this while I was still learning how to exist in public with oxygen. I was younger then. Or at least, closer to the illusion of younger. Back when I could still tell myself that this was temporary, transitional, a phase before things “settled.” Sarcoidosis has a way of humbling those kinds of assumptions. Heart failure, too. They are excellent teachers if you survive them long enough to take notes.

You’ve seen them. We all have. The elderly person in the supermarket or mall, pushing a little cart with a green tank perched on it, clear plastic tubing looping up into their nose. They move carefully, like every step requires negotiation with gravity and lungs that refuse to cooperate. Most of us don’t give them a second look. We say we don’t notice. We say it doesn’t bother us. But watch their eyes for just a second. That flicker. That almost-imperceptible glance away. Self-consciousness doesn’t disappear with age. It just learns new disguises.

When my doctors first told me I needed to start using portable oxygen outside the gym—just walking, just living—I understood it intellectually. My oxygen saturation dropped fast. Two minutes of regular walking and my heart started paying the price. The logic was airtight. The feelings were not.

At that point, oxygen was something I used, not something I was seen using. There’s a difference. A big one.

I was still clinging to the comfort of passing. Passing as healthy. Passing as able. Passing as the guy who “doesn’t look sick.” I was told all the time that I looked younger than my age. People said it like it was a gift. And maybe it was, until it became another thing I felt I was about to lose.

I remember thinking: I don’t want to look like that. Like who? Like the future? Like survival? Like someone still here?

I was using the Helios system back then, liquid oxygen. Smaller, lighter than the standard tanks, tucked into a backpack or side bag. In fall weather I could snake the nasal cannula under my jacket so the tubing was the only visible clue. If you didn’t look too closely, you might miss it. That mattered to me more than I wanted to admit.

One morning I went to the hospital for routine bloodwork. Nothing dramatic. Just the usual monthly reminder that my body required monitoring like a temperamental stove. In the elevator were two women: an elderly woman with her oxygen tank in a stroller, and a younger woman I assumed was her daughter.

The elevator was quiet in that way hospitals specialize in. The older woman kept glancing at me—not rudely, just curious. She was trying to solve a puzzle. My setup didn’t match the one she knew. When we got off on the same floor, they followed me into the lab area. After I checked in and sat down, they did the same.

The older woman made a beeline straight for me.

She sat beside me and started asking questions. What kind of system was it? How heavy was it? How long did it last? How did it work? I became an unpaid Helios spokesperson, explaining liquid oxygen, portability, convenience. The younger woman sat a couple of seats away, listening without much expression.

When I finished, the older woman thanked me warmly and turned to her daughter. She said she wanted one of those. I scribbled down the information for her.

That’s when the daughter leaned over and asked, “Why does a young man like you need oxygen?”

I told her, simply, that I had a combination of conditions that made it necessary.

She frowned and said, “Poor you.”

I corrected her. Gently, but clearly. I wasn’t poor. I didn’t need sympathy. I considered myself extremely lucky. Blessed, even. Still here counts for a lot.

She studied me for a moment, then said, “No, I don’t mean what’s wrong with you. I mean… you’re handsome. And young. Having to wear that thing on your face. You must feel so self-conscious.”

I did feel self-conscious. She wasn’t wrong. But I also didn’t feel ashamed. There’s a difference there, too. I smiled and said, “Thanks for saying I’m handsome.” The older woman laughed.

Then the daughter doubled down.

“Don’t you feel embarrassed?” she asked. “I already told my mother that if I ever have to wear oxygen at her age, I’d rather just die.”

Without missing a beat, I said I was happy to wear it if it meant I got to reach her mother’s age.

The older woman laughed harder this time. Then she delivered the line that ended the conversation and probably lives rent-free in her daughter’s head to this day.

“Yep,” she said. “She’ll make a pretty corpse for her vanity. Problem is, she ain’t pretty.”

And just like that, my name was called for bloodwork.

At the time, the lesson felt almost neat. A tidy little parable about vanity versus survival. I told myself I’d do better. I told myself I’d bring my oxygen everywhere, use it consistently, listen to my doctors. And I mostly did. Mostly.

Looking back from 2026, I can say this: I was optimistic about how quickly acceptance would arrive.

I still use oxygen. More than I did then. Sarcoidosis didn’t retreat. Heart failure didn’t negotiate. They teamed up and made it clear that oxygen isn’t optional for me. These days I use an Inogen Rove 6 portable concentrator. No liquid oxygen, no tanks. Just batteries, tubing, and the low hum of a machine that means my organs get what they need.

It’s better technology. Smarter. Lighter. More efficient. And somehow, that hasn’t made the emotional adjustment any simpler.

Because here’s the truth no one tells you: you don’t have one reckoning with visibility. You have dozens. Every new setting. Every errand. Every “quick run into the store.” Every time you debate whether it’s worth hauling the gear for five minutes or gambling on your oxygen levels like you’re negotiating with a rigged casino.

I still sometimes think, I won’t be long. I still sometimes catch myself scanning a room, clocking stares that may or may not exist. I still feel that flicker of vanity, that wish to be unseen, uncomplicated, unremarkable.

But I also know what happens when I don’t use the oxygen. I know how my chest tightens. How my heart complains. How exhaustion stacks up interest I can’t pay later. The math is clearer now, even if the feelings lag behind.

Back then, my doctor told me the most important prescription I had wasn’t a pill. It was oxygen. Everything else was secondary.

That’s still true.

What’s changed is my relationship to that fact. I don’t romanticize acceptance. I don’t pretend I’ve transcended vanity. I just live with the understanding that survival sometimes requires accessories. That staying alive often looks less dignified than we imagined. And that dignity, it turns out, is overrated if it comes at the cost of breath.

I don’t think about that younger woman often. But I think about her mother. About her laughter. About how easily she chose life over appearances. I hope she got her portable system. I hope she used it everywhere. I hope she lived long enough to keep laughing at the absurdity of it all.

These days, when I sling my Inogen Rove 6 over my shoulder, I don’t give myself a pep talk. I don’t frame it as bravery or resilience or inspiration. I just do it. Like putting on shoes. Like grabbing keys. Like doing the quiet, unglamorous things that make tomorrow more likely than not.

I’m still learning to live with it. And that, as it turns out, is exactly the point.

If this resonated with you—if you’ve ever wrestled with visibility, medical gear, or the strange math of staying alive—I’d love to hear from you. Share your thoughts, experiences, or reflections in the comments, or subscribe to the blog so you don’t miss future posts.