The other day I said to someone in the office, “You remember when we would say, on Friday, that something happened on Monday and it seemed like six months ago? Now something happens at 9 a.m. and by 3 p.m. something else has happened and it’s like, ‘oh, that’s so 9 a.m.'”
It’s about 9:30 p.m. now, and there are multiple scoops breaking all over Newsville, which makes yesterday’s astonishing press conferences seem like they happened a year ago, but come on, this picture is one for the ages:
The President of Finland is like, “Hey, America, I think it’s time to put your toddler down for a nap.” pic.twitter.com/qmwh6oR1Oz
— Adam Best (@adamcbest) October 2, 2019
I used to work with Chip Somodevilla. Great photographer.
Yeesh, what a week. The last 48 hours have been bananas, necessitating a drive to Goddamn Lansing in which it rained, hard, both ways. Welcome to fall, bitch, every drop seemed to say. I don’t mind an overcast, drizzly day from time to time, but it’s never fun to pass an 18-wheeler in that sort of weather. You just drive into the mist and hope the road is still under your tires as you do so. And it’s worse at night.
But never you mind that. Because anything I write now will be outdated in 15 minutes, some bloggage to take you into the weekend, then.
I read this piece by Gene Weingarten, an excerpt from his upcoming book, the other day, marveling at how well it’s written. It’s likely something you’ve read before, a story about an organ donor and organ recipient on their separate journeys, but it’s just So. Good. You want to know how to write about complex medicine? Watch and learn, kids. Here’s the moment where the donor heart is extracted from the chest:
If you’ve read about open-heart surgery or seen videos, you may have a mental image of what followed: hours of precise, delicate work on gossamer tissue and threadlike vessels, performed by beetle-browed people wearing those eyeglasses with little telescopes in them.
Discard everything but the furrowed foreheads and telescope glasses. Compared with other open-heart procedures in which Lefrak was already expert — say, coronary artery bypass — heart transplantation seems like butchery. The heart as a whole is a large, unsubtle organ, and those vessels feeding it that aren’t the circumference of a D battery are still as fat as thumbs. Edward Lefrak removed Mark Willey’s heart with a single tool: a pair of scissors not all that structurally different from what second-graders use on colored paper. There were no nurses beside him handing him tools or mopping his brow.
First he separated the superior and inferior venae cavae, the two large vessels that return blood from the body into the right atrium, and severed them. Then he lifted the organ with his left hand and cut behind it with his right, one snip on each of the four pulmonary veins that run lung to heart. He lowered it back into the chest. Below the clamp, he cut through the aorta and finally the pulmonary artery, which runs heart to lung. The heart was now in the doctor’s hands, free of the body. It felt cold, even through a latex glove.
All that detail, using both simple and specialized language, in images you can see in your mind’s eye – D batteries, a child’s scissors. And here’s the moment after it’s been attached to the recipient, before it’s brought back to life:
What happened next defied everything most people presume about the human heart. Lefrak lowered Eva’s head, cupped her new heart with his left hand and tilted the bottom of it up so it became the highest point in her body. Then he accepted from Dellinger a long 18-gauge hypodermic needle and stabbed it into the heart’s apex, clean through the muscle to the cavity of the left ventricle. From the plastic collet of the needle came a bloody froth. When that stopped, Lefrak withdrew the needle, then pushed it in again, a few millimeters away. More bubbles.
If a heart is sliced by the thrust of a knife, that is usually fatal. If it is pierced by a bullet, it is nearly always fatal. But the heart is, in the end, a muscle, and as anyone knows who has ever gotten a vaccination in the arm — or anyone familiar with the overdose scene in “Pulp Fiction” — muscles can withstand and survive a needle. They close back up and heal instantly. Lefrak repeated this unnerving stab of the needle more than a dozen times. The goal was to empty the heart of all air bubbles before reconnecting it to its prime source of blood, via the venae cavae. Air bubbles cause embolisms, and embolisms cause brain damage.
Satisfied all the air was gone — no more froth — Lefrak allowed the heart to fill with blood.
The magic phrase there is “anyone knows who has ever gotten a vaccination,” because it makes you understand immediately. Of course you can stab a heart with needles; it’s a muscle.
Alan used to be a medical writer in Fort Wayne, doing disease-of-the-week stories. He was good at this sort of explanation. Not this good.
OK, I’m going to bed. I’m going to nibble a quarter square of an indica edible, swallow a melatonin and go off to dreamland. Let’s hope we survive the weekend.