Excerpt Reveal: ‘A Measure of Murder’ by Leslie Karst

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Measure CoverTitle: A Measure of Murder

Genre: Mystery

Author: Leslie Karst

Website: http://www.lesliekarstauthor.com/

Publisher: Crooked Lane

Find out more on Amazon

About the Book:

Sally Solari’s plate is beyond full between juggling work at her family’s Italian restaurant, Solari’s, and helping plan the autumn menu for Gauguin, the restaurant she’s just inherited. Complicating this already hectic schedule, Sally joins a chorus, which is performing a newly discovered version of her favorite composition, the Mozart Requiem. But at the first rehearsal, a tenor falls to his death on the church courtyard—and his soprano girlfriend is sure it wasn’t an accident. Now Sally’s back on another murder case seasoned with a dash of revenge, a pinch of peril, and a suspicious stack of sheet music. And while tensions in the chorus heat up, so does the kitchen at Gauguin—set aflame when Sally starts getting too close to…

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First Chapter Reveal: If Truth Be Told: A Monk’s Memoir by Om Swami

If Truth Be Told

Title: IF TRUTH BE TOLD: A MONK’S MEMOIR
Author: Om Swami
Publisher: Harper Element
Pages: 256
Genre: Memoir

BOOK BLURB:

If Truth be Told is an extraordinary memoir of the making of a spiritual life in today’s demanding and baffling times. The book unravels the true life story of Om Swami and his journey to becoming a monk. In the 1990s, an eighteen-year-old heads to Australia to realize his worldly dreams. With little money or support, he strives to make ends meet. Two years later, he’s earning an annual income of $250,000. By the age of twenty-six, Om Swami’s a multi-millionaire. But, the pull of the ochre robe is such that the boy whose hair Shiva had stroked in a dream and who at times could peer into the future of a complete stranger, gives up not just a multimillion dollar business, but every pleasure ever known to him. He renounces, in search of God.

Overnight, from a CEO Swami becomes an ordained monk in India. Reality hits him hard when he faces starvation and neglect at his guru’s ashram. A resolute Swami leaves for the Himalayas to burn his mind and body in the fire of intense meditation, to manifest God or die trying. A chance meeting with a mystical female tantric reinforces his faith in the existence of the divine. In the snowy and secluded reaches of the Himalayas, in terrifying silence and solitude, cut off from the world, Swami spends thirteen months in extraordinary, intense meditation. There in the woods, beyond the incessant chatter of the conscious mind, diving in the quietude of supernal bliss, the unimaginable happens: looking down at him are the effulgent eyes of the Empress. The Divine Mother.

If Truth Be Told: A Monk’s Memoir, is a true and inspiring story of success, renunciation and self-realization. It will light up your path wherever you are on your life’s journey.

ORDER YOUR COPY:

Amazon

ONE

The First Step

I checked out of my lodge and stepped out onto the crowded street. Spotting a cycle rickshaw, I waved it down. ‘Where to?’ said the rickshaw driver. ‘Ghat.’

‘Which ghat? There are so many here.’

I wasn’t prepared for this. How was I to know there were many ghats in Varanasi?

‘Just take me to any ghat.’

‘I can’t take you to just any ghat, sir. Then you will say this is not where you wanted to go.’

‘Alright, name a ghat.’ ‘Dashashvamedha Ghat.’ ‘Fine, take me there.’

I hadn’t been on a rickshaw since 1995. Back then, fifteen years ago, I was a teenager attracted to, and working towards, materialism. Now, at thirty, I was doing exactly the opposite. The vehicle hadn’t changed but the direction had; the person hadn’t changed but the priorities had.

I presumed I was headed to a quiet riverside but I couldn’t be more wrong. The ghat was crowded beyond description, like an agitated mind crowded with thoughts, like ants gathered on a dead insect.

India was hardly new to me; I had spent the first eighteen years of my life in this country. But, rather naively, I had expected a different India in Varanasi. An old image was locked in my head, an image I hadn’t seen but conjured up while reading medieval texts: Kashi by the Ganges, an ancient town full of scholars, saints, tantriks, yogis and other spiritually inclined people.

I roamed about for a while, not knowing where to go. A long time ago, I had heard about Telang Swami, a realized soul who had lived in Kashi more than a century ago. There was supposed to be a monastery at the site of his samadhi. I visualized a quiet monastery by the Ganges, where noble sadhaks sat under the shade of old banyan trees and focused on their sadhana under the guidance of a venerable guru. I enquired, but no one knew anything about the monastery.

I thought of visiting the only other place I’d heard of in this city— Manikarnika Ghat, a cremation ground by the river where dead bodies were burnt round the clock. I hoped to meet some tantrik, sitting there and performing esoteric rituals by the burning pyres. I marched back to the main road and stopped another cycle rickshaw. It was nearly noon and the heat was biting me. I tried to tell myself that it was only mid-March, but this intellectual balm failed to soothe my body.

‘Will you take me to Manikarnika Ghat?’

‘Yes sir, but I can’t go all the way there. I can drop you at the nearest point.’

‘How much?’

’Rs 20.’

I hopped into the rickshaw, which moved slowly but steadily on the busy road. Several times, the rickshaw driver had to actually get down to manoeuvre it through the crowd. I noticed he was barefoot even though the sun was spewing fire and the road was like a field of burning coal—it just exuded heat.

‘Why aren’t you wearing any slippers?’

‘They got stolen at the temple the day I bought them.’

‘I don’t know this area. Please stop by a footwear shop. I’d like to get slippers for you.’

‘I’ll manage, brother.’

‘What is your name?’

‘Mahesh Kumar.’

‘Don’t worry, Mahesh, I’ll still give you the money for the ride.’

A little later, I spotted a small shoe shop. Mahesh wasn’t keen on stopping, so I practically had to order him to halt. Getting off the rickshaw, I gestured to him to follow me into the shop. He came in after me sheepishly.

‘Hello, sir,’ the shopkeeper said, and asked me to sit down. I beckoned to Mahesh, who was hovering near the entrance, to join me on the sofa. He did so extremely reluctantly.

A young worker at the shop offered me water.

‘Please give it to Mahesh,’ I said, ‘he’s your customer today.’

‘Do you want sandals instead of slippers? That may be better,’ I said to Mahesh.

‘Whatever you think is best.’

The sales assistant went to the back of the shop and returned a few minutes later with a pair of sandals. Beige in colour, with dark-brown straps and shining steel buckles, they looked very comfortable. He handed Mahesh the pair.

‘Please put them on his feet like you would do for any other customer,’ I said.

Mahesh looked at me nervously. I looked into his eyes and nodded. Immediately, his face broke into a smile and he stuck out his feet so that the assistant could put on the sandals. I looked at Mahesh’s beautiful, dark face, his yellow teeth, slightly deformed and stained, his big eyes full of contentment, and felt very warm inside. His smile simply made my day.

Mahesh pedalled with renewed enthusiasm now, while his dusty, worn feet seemed to come alive in the new sandals. As I watched his feet pushing the pedals up and down, everything else faded for a moment—the shops, the noise, the heat. All I could see were those feet, which seemed to be performing a cosmic dance. Now a pedal went up and now a pedal came down; every movement seemed effortless, in perfect synchronization.

Mahesh dropped me off at the point closest to Manikarnika Ghat.

‘If you go to the temple again, don’t leave your shoes outside,’ I warned as I got off the rickshaw.

‘I won’t,’ he said.

I offered him a fifty-rupee note.

‘How can I take money from you, sir?’

‘Please keep this. It will give me great joy if you do.’

He came around from his rickshaw and reached down to touch my feet. I caught his wrists and pulled him up. ‘There are only three places you should bow your head,’ I said. ‘In front of God, in front of the elderly and in front of your guru.’

I thrust the money into his hands and walked away, thinking that Mahesh was not designed to be a rickshaw driver. He could have been a clerk, a watchman, an officer, an executive. For that matter, no one deserved to live a life that sought to break the body as well as the spirit. This man was living in a democratic country but did that make him a free man? The state did not provide for him and his fellow countrymen did not respect him. He did not have the freedom to own a roof over his head or break away from the harshness and drudgery of his daily routine. I don’t think Mahesh ever took a vacation or enjoyed any luxury in his life except perhaps the luxury of needs; he would never run out of needs. Come to think of it, there was no difference between him and me: we were both fettered by our needs. His were more tangible and essential for survival, while mine were more abstract and self-imposed.

I navigated my way to Manikarnika Ghat. I doubt if anywhere else in India there existed such tight streets as in Varanasi; at least, I’d never seen them. If you had a slightly bigger nose and turned your head, you were likely to hit something. Well, almost. I don’t know how I managed to reach Manikarnika Ghat, but I finally did.

A pyre was burning; another had been mostly reduced to ash, occasionally lit up by smouldering embers. Pieces of broken clay pots lay scattered around. Breaking a pot full of water at the time of cremation is a Hindu custom

signifying that the soul of the deceased has severed all ties with the human world. The pot symbolizes the human body, and its breaking indicates the liberation of the soul that has trapped within.

There were no saints to be found here, no practitioners of the occult sciences, no evolved tantriks or yogis who beckoned to me to join them in a journey to self-realization. Instead, around the pyres, dealers sat selling wood; beside them sat paanwallahs and chaiwallahs. Milling around were countless people, cows, dogs and cats.

The ghat had turned out to be a disappointment, so I began asking about Telang Swami’s monastery again. Of the many souls I asked, one seemed to know. He pointed in a certain direction. I walked down narrow streets with decrepit buildings ready to crumble and shops selling all manner of things. Dodging the maddening traffic, I found myself in winding alleyways, going past houses standing cheek-by-jowl and children playing beside parked two-wheelers, doing my best to avoid stepping into puddles of animal urine and dung.

After forty-five minutes, feeling tired and hopeless, I stopped. I couldn’t see the monastery and I couldn’t find anyone who had ever seen it. I sat down on the kerb and wiped the sweat off my forehead, wondering how to proceed. After a few minutes, I raised my head and there it was, on my right, a sign written in Hindi: ‘Telang Swami Math’. It was a temple.

I went inside. A middle-aged man was sitting on the pujari’s seat. Everything about him was round—head, face, torso, belly, hands, feet. A barber came in behind me, took his kit out of his bag and began shaving the priest. I watched quietly, enjoying the coolness of the temple after the searing heat outside. After a few minutes, the barber picked up his things and left; no money exchanged hands. Perhaps they had some kind of monthly arrangement.

I asked the priest about Telang Swami and his lineage, and about the monastery. He said there was no disciplic succession or ashram. This temple was all there was and there was no arrangement for anyone to stay even if they could pay.

I felt betrayed, although I was not sure by whom.

‘Telang Swami is buried there.’ He pointed to a corner of the temple compound. Walking across to Telang Swami’s tombstone, I prayed, ‘Please guide this lost soul, O Swami, so I may attain what I’ve set out to do.’

On my way out, the priest stopped me to ask exactly what I was looking for. I told him I was in search of a guru and wanted to take sanyasa diksha, initiation into the life of a renunciant. He said there was no need to renounce the world or look for a guru, and that I should get married and lead a normal life.

Normal life? There’s nothing called a normal life. What is normal from one’s viewpoint may be most abnormal from another’s. A yogi thinks that the world is abnormal and people live like animals, mostly focused on feeding and fornicating. The world thinks the yogi is a fool who wastes his life sitting around doing nothing, enjoying none of the many pleasures life has to offer.

Naturally I didn’t say any of this to the priest. I had no interest in pursuing a conversation with someone who could understand neither my desperation nor my intention.

I went towards the ghats again. It was nearly 3 p.m. and the sun was even hotter now. I hadn’t eaten anything all day. In the morning, I hadn’t been able to find any place to eat where the food wasn’t deep-fried. In the afternoon, I was busy with my self-realization business. My water bottle had been empty for hours and the reality of hunger was tugging hard at my stomach.

Lacking a sense of direction, I didn’t know if I was heading towards the ghats or away from them. When I saw the number of people on the streets reduce significantly, I knew I was heading in the wrong direction. Coincidentally, I saw some lodges there and asked a few if they had any vacancy. I just wanted to lie down in a cool, quiet place. Oddly enough, at each place, they asked me where I was from, how many people needed the room and for how many days. Then they would tell me there was no room available. I was intrigued. Why would they put me through a whole heap of questions if they had no room available?

I walked on and eventually found myself by the river. The Hindu texts talked a great deal about the sacred significance of ‘Ganga Maiya’. Well, her ‘children’ had polluted her beyond imagination. Seeing the filthy state of the river flowing past me, I shook my head in as much disgust as disbelief. I had seen the Ganga till Haridwar, where it was clean, but what had happened here in this holiest of holy cities, the Kashi of my imagination? I decided I would not bathe in the river here. Inwardly though, I paid obeisance to the sacred Ganga. A ma remains a ma, no matter how she’s dressed.

‘Massage?’ I looked up to see a man standing near me.

‘No massage. I need a guide.’

‘Sure, sir. I’ll be your guide.’

‘You do know this area well?’

‘Yes, sir.’

‘What will you charge? I need you with me for the rest of the day. And maybe tomorrow as well.’

‘You can pay whatever you like.’

‘Rs 250 per day?’

‘Okay, sir.’

‘Let’s go.’

‘I’ll take your bag,’ he offered kindly.

It took me a few minutes to realize I was free of the load. That’s the thing with baggage—you get used to carrying it around. You know it’s heavy but the weight has a way of becoming a part of your life. Only when you take it off your back and feel the lightness does the awareness of the load hit you.

Manish took me to a couple of guest houses and I got the same questions there too. Finally, my guide solved the mystery for me by explaining that when the employees at these lodges weren’t busy with work or occupied watching a cricket match on TV, they longed to chat with people as a way of passing their time. They didn’t have any rooms available but a conversation with a stranger was welcome.

Not getting very far in my search for a place to stay, I asked Manish to take me to a bigger hotel, but he said there wasn’t one. I realized that he didn’t really know the area; he had lied to me. Anyway, I was starving now. We managed to spot a vegetarian Jain dhaba that served meals without onion or garlic. I avoided eating onion and garlic, so the menu was fine with me but the food wasn’t; it was tasteless. I was too tired to fuss and my head hurt. I swallowed whatever I was served, though my guide seemed to savour the meal. After we left the dhaba, I bought two chilled bottles of water from a small provision store. Opening the first one, I washed my face and poured the rest on my head. The second I guzzled right away.

It was nearly 6 p.m. by the time we resumed our hunt for accommodation, and we finally got lucky at Pooja Guest House, where they gave me a room. I let Manish go and asked him to come again the next morning.

Even though I had a room now, I couldn’t sleep because of the fatigue and dehydration, which was evident from the colour of my urine. I hadn’t known I was so fragile. There was a time not long ago when I had played badminton daily, spent hours at a stretch on the golf course, pumped iron and run 12 miles regularly, and all this had felt effortless. But today, just one day spent in the ‘real’ world, and I found myself stretched beyond what I could take. My belief that I was fit and strong seemed merely a conceited notion.

I realized that my body was far from ready for the hardships of monkhood. If I couldn’t even tolerate the heat of a day, what chance did I have to endure the rigours of meditation and the harsh life of an ascetic? I had no idea how to prepare my body for intense penance. Yet, I knew that life would teach me. I had only to be open and willing.

I lay there thinking about my worldly journey thus far.

About the Author

 

Om Swami is a monk who lives in a remote place in the Himalayan foothills. He has a bachelor degree in business and an MBA from Sydney, Australia. Swami served in executive roles in large corporations around the world. He founded and led a profitable software company with offices in San Francisco, New York, Toronto, London, Sydney and India.

Om Swami completely renounced his business interests to pursue a more spiritual life. He is the bestselling author of Kundalini: An Untold Story, A Fistful of Love and If Truth Be Told: A Monk’s Memoir.

His blog omswami.com is read by millions all over the world.

You can visit his website at Omswami.com.

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Talking Craft with John Herrick, Author of ‘Beautiful Mess’

jh_image001_thumbA self-described “broken Christian,” John Herrick battled depression since childhood. In that context, however, he developed intuition for themes of spiritual journey and the human heart.

Herrick graduated from the University of Missouri—Columbia. Rejected for every writing position he sought, he turned to information technology and fund development, where he cultivated analytical and project management skills that helped shape his writing process. He seized unpaid opportunities writing radio commercial copy and ghostwriting for two nationally syndicated radio preachers.

The Akron Beacon Journal hailed Herrick’s From the Dead as “a solid debut novel.” Published in 2010, it became an Amazon bestseller. The Landing, a semifinalist in the inaugural Amazon Breakthrough Novel Award contest, followed. Publishers Weekly predicted “Herrick will make waves” with his next novel, Between These Walls.

Herrick’s nonfiction book 8 Reasons Your Life Matters introduced him to new readers worldwide. The free e-book surpassed 150,000 downloads and hit #1 on Amazon’s Motivational Self-Help and Christian Inspiration bestseller lists. Reader response prompted a trade paperback.

His latest novel, Beautiful Mess, folds the legend of Marilyn Monroe into an ensemble romantic-comedy.

Herrick admits his journey felt disconnected. “It was a challenge but also a growth process,” he acknowledges. “But in retrospect, I can see God’s fingerprints all over it.”

Q: Congratulations on the release of your latest book, Beautiful Mess. To begin with, can you gives us a brief summary of what the story is about and what compelled you to write it?

Beautiful-Mess-Low-Resolution-Color-Book-CoverA: Thanks very much! Here’s the gist: Del Corwyn hasn’t had a hit film since his Academy Award nomination 40 years ago. He’s desperate to return to the spotlight but teeters on bankruptcy. Del is a forgotten legend—until, while combing through personal memorabilia, he discovers an original screenplay written by his once-close friend, Marilyn Monroe, who named Del as its legal guardian. The news goes viral. Suddenly, Del skyrockets to the A-list and has a chance to revive his career—if he’s willing to sacrifice his friend’s memory and reputation along the way. 

As for what compelled the idea, years ago, I read a biography on Marilyn Monroe and learned the actress was forced into a mental institution against her will. That ordeal frightened her because she was trapped, all alone, and couldn’t do anything to stop it. 

I thought to myself, “Even though they released her, the experience must have left scars. Nobody could escape that predicament unchanged.” I sensed a story and couldn’t shake the idea. I sought a way to delve into that experience while respecting her memory and presenting her as a human being who had vulnerabilities like you and I.

Q: What do you think makes good contemporary fiction? Could you narrow it down to the three most important elements? Is it even possible to narrow it down?

A: The key elements, for me, seem to be point of view, balance and heart. POV is important not only because it’s part of the craft, but readers recognize when it goes astray. Writing from your heart breathes life into the story and gives your readers a way to identify with the characters. And balance makes sure all the bases get covered, but recognizes one size doesn’t fit all.

Q: How did you go about plotting your story? Or did you discover it as you worked on the book?

A: Beautiful Mess features an ensemble cast. So I started by developing a story arc for each character, then overlaid them to see where their stories bled into each other. In a way, I treated each character’s story like a subplot for development purposes. My IT background had me assigning alphanumeric codes to each event, then drafting the story by piecing those blocks together much like a flow chart or storyboard. (A total geekfest on paper!) I didn’t intend to plan the book that way—my personal motto is “Whatever works!”, and that method got me moving forward.

Q: Tell us something interesting about your protagonist and how you developed him or her. Did you do any character interviews or sketches prior to the actual writing?

A: Del is 78 years old, but he feels like a perpetual 29-year-old. So in terms of his perspective and behavior, I started with that younger mentality, then aged him. I added his biographical sketch, which gave him decades of life experience. Finally, regardless of how Del sees himself, he can’t deny reality—in fact, reality of his age annoys him most—so I sprinkled in physical characteristics of someone his age. For example, I gave him recurring lower-back pain to bring him down to earth.

Yes, I create biographical sketches for all my main characters. Usually, I also conduct character interviews to get a feel for their voices. But Del and the other characters were so clearly defined in my mind, this book didn’t require as much prep work. Once I got past the initial mental barriers, the project unfolded fast. 

Q: In the same light, how did you create your antagonist or villain? What steps did you take to make him or her realistic?

A: In Beautiful Mess, my antagonist isn’t a person; it’s the realization that Del is aging. But he can’t admit that to himself, so he creates his own antagonists, and those people/facts aren’t out to get him like he believes. In his own mind, it’s Del against the film industry, Del against the world, Del against his competitors. Not to be crude, but he’s always on the lookout for the latest excuse to tell someone, “Go f*** yourself!” He thrives on that—on being the lead actor in his life’s movie. But the truth is, by living that way, Del has become his own worst enemy. That becomes part of his self-discovery process. On the surface, Beautiful Mess looks like a man-vs.-man story, but when you get to know Del, you discover it’s a man-vs.-self story.

Q: How did you keep your narrative exciting throughout the novel? Could you offer some practical, specific tips?

A: Subplots are so valuable. They add depth to your novel; offer opportunities to highlight aspects of your plot or protagonist through parallels or symbols; and buoy up your novel during lulls in your plot, which helps maintain a sense of motion for your reader. That’s one reason richly drawn characters are so critical: they help you develop those subplots. Their stories and backgrounds provide so many places to dig for ideas. And in Beautiful Mess, Tristan’s subplot provided comic relief—it allowed me to dabble in caricature without sacrificing the gravity of Nora’s plight.

Q: Setting is also quite important and in many cases it becomes like a character itself. What tools of the trade did you use in your writing to bring the setting to life?

A: Instead of simply decorating the scene, I try to allow my characters to experience the setting and incorporate all five of their senses. I also try to use setting to give clues about a character’s emotion or inner predicament. 

The world is much smaller than we tend to think. Beautiful Mess examines how, in a pool of humanity, individual lives can cross paths and produce startling consequences. It describes every person’s need to rise above that pool and be known and appreciated for their distinct natures. Los Angeles provided the perfect setting—America’s second-largest city, a mecca where millions flock to pursue the same dream, where it can be easy to feel lost. The cityscape on the cover conveys that sense. The city and its foremost industry are not just the setting for the story, but also symbols for what the story is about.

Q: Did you know the theme(s) of your novel from the start or is this something you discovered after completing the first draft? Is this theme(s) recurrent in your other work?

A: Del, my protagonist, came to me early, along with his insecurities. So his internal predicament drove the story’s theme and structure. To date, my books have focused on the human heart, those hidden corners we all possess but try to hide. As a result, my books are character-driven. Each book has an external plot, but the true plot—the more important action—occurs internally. I create an external parallel to amplify and shed light on the protagonist’s inner struggle.

Q: Where does craft end and art begin? Do you think editing can destroy the initial creative thrust of an author?

A: I’m a fan of balance. Because of how my planning process works, I conduct a lot of “pre-editing” before I write a word, which has prevented me from having to rewrite any chapters from scratch. And I’ve gotten to the point where I tend to edit a bit as I write, but if it starts to interfere with my creative flow, I force myself to postpone edits to the revision phase. But when it comes to craft vs. art, if you want people to read your books, it’s important to remember that the book isn’t about you—it’s about your audience. What will serve your readers best? Has your manuscript answered the questions your readers will have? Will your readers relate to a character or care about a storyline, or at least be able to get on board it? As a writer, it’s your responsibility to locate win-win scenarios. You need to sacrifice some things you want in order to give the reader what they want. You can also look at art vs. craft as hobby vs. profession—you can keep a 100% focus on art if your goal is 100% hobby.

Q: What three things, in your opinion, make a successful novelist?

A: 1.) Cherish your audience—respect them, appreciate them, serve them, be aware of their expectations by reading what they read. 2) Understand people. 3) Pursue excellence in your work—do whatever it takes to achieve it.

Q: A famous writer once wrote that being an author is like having to do homework for the rest of your life. What do you think about that?

A: Another famous writer, Mark Twain, said that if you love what you do, you’ll never work a day in your life. That’s a more accurate description for me. Yes, it’s hard work, but that work should bring you joy.

Q: Are there any resources, books, workshops or sites about craft that you’ve found helpful during your writing career?

A: Read, read, read. Anything and everything, especially your counterparts in the marketplace. You’ll stay aware of current standards, and you’ll learn what to do (or NOT to do) as your technique evolves. Oftentimes, when I read another author’s work, it gives me technique ideas. 

Learn, learn, learn. Pay attention to the news. Read or scan nonfiction books, magazine articles, books on business or computer programming or wines. Anything. When you meet people, ask them about their careers. Ask your Starbucks baristas which products customers like best (and why), or how a promotion is working. The more you learn, the more background you have on the world around you. It will trigger novel ideas, give you direction for how to plan a novel (“I remember reading about X, where it said…”), and will expand the network of people you can talk to for research purposes. Reading nonfiction helps you ask better questions when your path crosses with someone in that field. Also, watch people; listen to what they say and how they say it, which will help you sharpen your dialogue skills.

Q:  Is there anything else you’d like to share with my readers about the craft of writing?

A: Never give up! Books are a subjective field, so rejection doesn’t necessarily mean you won’t succeed or your work is poor; often, it just means your work isn’t the right fit for the needs of that particular moment—but needs change. Feel free to say hi at http://www.johnherrick.net, Facebook, Twitter or Goodreads!

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A Chat with Phil Kimble, Author of ‘The Art of Making Good Decisions’

philBorn in Atlanta, Phil Kimble went to school in Utah, lived for 2 years in LA, then moved back to Atlanta.  He and his wife Julie live in Conyers. Mr. Kimble is an avid motorcyclist and competitive distance runner.

Q: What’s inside the mind of a Motivational/Self-Help author?

A: For me, I’m trying to first help myself.  Most of the concepts I write about are ones I with which I at one time struggled.  I assume I am no different from the average person, so the things I figure out I believe will help others as well.

Q: Tell us why readers should buy The Art of Making Good Decisions.

A: It will help individuals in their decision-making process, from understanding the “Why did I do that?” basis for a less-than-optimal decision, to the “What do I do now?” basis for upcoming decisions of any complexity.

Cover

Q: What makes a good Motivational/Self-Help Book?

A: It has to get within the readers’ circle, answer the “what’s in it for me?” question. It has to give the reader an assignment—something tactile to do.

Q: What has writing taught you?

A: I think it has taught me the importance of empathy, being able to transmit your sentences into something someone else can understand.  It’s not a “talking down” sort of thing, but because everyone has different experiences, how I may explain a concept may be a miss with someone else.  So understanding where that person is coming from is important.

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The Story Behind ‘The Five Manners of Death’ by Darden North

The Story Behind the Book

The5MannersOfDeath_coverfinalEver thought about the manners of death – the ways to die? Routine stuff for a medical examiner, maybe, but excellent fodder for a thriller writer. Take your pick: death by accident, suicide, natural causes, homicide, or undetermined—then include all five and torture the mind of the novel’s protagonist. In “The Five Manners of Death” Surgeon Diana Bratton struggles to keep her southern family together and her Aunt Phoebe off death row while bodies stack up around her. If only Phoebe and Diana’s ex-husband would behave.

A writing conference and newsletter article by fellow physician and author D.P. Lyle exploring the five manners of death drew me to the novel’s core and this premise: In “The Five Manners of Death” there are five ways to die. Surgeon Diana Bratton believes that homicide is the only one left. Then the police prove her wrong. Diana learns that murder is…

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First Chapter Reveal: Chasing Hindy by Darin Gibby @DarinGibby

Chasing Hindy

Title: Chasing Hindy
Author: Darin Gabby
Publisher: Koehler Books
Pages: 284
Genre: Thriller

ADDY’S DREAM AS a patent attorney is to help bring a ground breaking energy technology to the world. Addy’s hopes soar when she is wooed by Quinn, an entrepreneur, to join his company that has purportedly invented a car that can run on water using an innovative catalyst. After resigning her partnership to join Quinn, Addy discovers things aren’t as they seem. The patent office suppresses the company’s patent applications and her life is threatened by unknown assailants if she doesn’t resign.

When she is arrested for stealing US technology from the patent office she realizes Quinn has used her. Now, Addy must find a way to clear her name while salvaging her dream of propelling this technology to the world, all while powerful forces attempt to stop her.

FOR MORE INFORMATION:

Amazon | Barnes & Noble

 

First Chapter:

ADDY FELT LIKE jumping out of her car and doing a quick happy dance in the middle of stalled traffic. Her excitement at becoming the newest—and youngest—partner at the intellectual property law firm of Wyckoff & Schechter was nearly overwhelming.She grinned at the shadow on the hood of Hindy, her treasured retrofitted cherry red Shelby Mustang. The shadow was created by a barrel-sized, hydrogen-filled balloon that floated above the Mustang’s roof. Gawkers pointed and laughed as the Shelby eased down El Camino pulling the tethered balloon as if in a Macy’s Thanksgiving Day parade. The balloon—which on one side sported her law firm’s logo, and on the other Hindy in giant cursive script—was just an advertising gimmick to show her passion for alternative energies. It was only strapped to the roof on calm, sunny days when she was travelling at slow speeds using routes that avoided overpasses. The retrofitted Mustang was really powered by four electric motors using electricity produced by solar panels and a conventional fuel cell.

At first, the Wyckoff partners questioned Addy’s prudence in strapping a floating balloon to the roof of any vehicle, but they’d

come to admire the effectiveness of her marketing innovations. They even lifted their champagne glasses at the end of her mentor’s welcome speech acknowledging that her Shelby was responsible for bringing in increasing numbers of the “green” companies sprouting like weeds all over the Silicon Valley— inventive, entrepreneurial companies in need of legal advice and support for their patents.

While the traffic inched forward, Addy chuckled with excitement. “Hindy, ol’ pal,” she said, patting the dashboard, “you and I are going places now! Next time some overzealous cops accuse you of being a traffic hazard, I’ll stare them down and inform them they’re messing with the partner of a highly prestigious law firm.”

Traffic momentarily loosened and Addy eased Hindy forward, careful not to snap the lines tethering the egg-shaped balloon. Addy sang along with Zissy Spaeth, pop rock’s newest and most flashy star, as Zissy belted out her latest hit, Light in Your Eyes, over the radio. In the corner of her eye she noticed a blaze of neon orange.

Her heart stopped. In the car next to her someone was pointing a bazooka-sized gizmo at her balloon. She blinked, trying to clear her vision.

A flare shot out, aimed straight at her floating ball of

hydrogen.

Even in the late afternoon sunlight, it was impossible to miss the explosion. The dirigible burst into a giant fireball, then slowly deflated and floated down toward the Shelby’s crimson hood.

Addy stomped on her brakes, hoping the balloon’s momentum would shoot the flaming mass forward. The fireball, safely secured by its fluorescent yellow nylon tethers, crashed down onto the windshield, blocking Addy’s view. She screeched to a halt, slammed her shoulder into the door, flung it open, and darted out, catching the heel of her pump on the doorjamb, which sent her sprawling headlong onto the pavement.

She heard tires squeal and at least a half dozen blaring horns. Stinging pain shot up from her elbow and knees. Thank goodness traffic had been just inching along.

Ignoring the pain, she bolted forward, arms raised, ready

to yank the still-burning fabric off the windshield. Before she got close enough to grab it, the sweltering heat from the flames scorched her cheeks, and she shielded her eyes with her forearm. Just when she reached the hood, a breeze lifted the infernal blob and propelled it directly at her, the nylon cords now seared through.

She braced herself for the fireball when she felt arms wrap around her chest and yank her back, barely in time to avoid the searing molten mass of goo about to descend on her head, threatening to fry her face and melt her hair.

“Are you crazy? What are you thinking?” a deep voice

bellowed in her ear, still holding her tight.

Together they watched what was left of the blimp float like a falling leaf onto the grassy shoulder, just like the Hindenburg did almost eighty years ago.

“Someone clearly doesn’t like you, short stuff,” her rescuer said, now standing next to her stroking his goatee, his face hidden behind dark sunglasses and a low-riding Dodgers cap. “More like out to get you. That was some kind of flare the driver shot at your blimp. I tried to spot his license plate, but it was covered up. Snapped a picture with my phone, though,” the man said fishing it from his pocket. “You can kind of see a tattoo on his forearm. The police will love this.”

Before she could thank him, someone cried out, “Call a fire

truck! The grass!”

Brush fires in California were no joking matter. Addy could smell the smoldering grasses. A strong breeze fanned the flames, pushing the fire toward a row of redwood trees.

Then she heard a whiny voice coming from the milling crowd of stranded passengers who’d gathered to find out what was holding up their homeward commute. “I’ve seen that blimp before. I knew it was trouble,” the whiner complained.

“Yeah, but at least she’s part of the solution,” said someone else. “Her car doesn’t use gasoline. Look at what you’re driving,” he said, sneering at the whiny woman’s crossover SUV.

Addy’s knees buckled, her head spinning. She plopped down onto the pavement and hugged her bare legs. This couldn’t be happening.

Why would someone try to destroy her car? Hindy, her

 

beloved Mustang, was just a marketing ploy, no worse than a billboard. Hindy’s fuel cell and solar panels were just two modern technologies that Addy hoped someday would become mainstream to the automotive industry. And her purpose was noble. Her “green” car told the world of inventors that she was one of them, that she would secure their patents and protect their investments. Now her expensive marketing project was in jeopardy.

Soon, swarms of firefighters were scrambling around dousing the flames, while police officers attempted to reroute traffic. A well-built bald man flipped out a paper pad and scribbled a few notes. After removing his sunglasses, he swapped the pad for a pocket camera and snapped random shots of the avid crowd.

All four local networks had sent news crews, and Addy knew two of the reporters. They had already run stories about Hindy, praising Addy’s creative marketing, which one reporter said was a refreshing change from the barrage of personal injury commercials littering daytime television.

As Addy told the reporter during her interview, Silicon Valley was going to be known, not just for starting the computer revolution and launching the social networking scene, but now for making the world green. And Addy was their lawyer.

Reality burst her daydream bubble when she was whisked aside by a team of Sunnyvale police officers. She told them what had transpired, hoping it would help them find the sniper. And she pointed out her rescuer, who was showing another pair of police officers the photo on his phone.

At the end of the interview, one of the officers handed her a ticket. “You were carrying a flammable substance without a permit. You’ll need to make a court appearance.”

Addy gasped. “But they shot at me.”

“And we’re not taking it lightly. There’s been a serious crime committed here, but that doesn’t mean you can break the law. If you hadn’t been toting that blimp, none of this would have happened.”

Addy’s eyes narrowed. “Am I’m free to go?” she said,

snatching the paperwork and turning toward Hindy.

“Yes,” the officer said, “but we’re going to need to impound

your vehicle.”

Addy halted. “Hindy? You can’t.”

The other officer beckoned with both hands, big gestures, as if directing an airplane to the gate. A tow truck wedged its way through the onlookers and began backing up in front of Hindy. “But Hindy works perfectly fine,” Addy protested. “The balloon, that was all for show. The hydrogen for the fuel cell is

where the gas tank used to be.”

The officer shook her head. “We need your car for evidence. As I said, a serious crime has just been committed, and we need to take the vehicle to the station for a thorough evaluation.”

“But I need to get home, and get to work tomorrow.”

“There’s always Uber,” said the officer with a shrug.

 

About the Author

Darin Gibby

In addition to a thriving career as a novelist, author Darin Gibby is also one of the country’s premiere patent attorneys and a partner at the prestigious firm of Kilpatrick Townsend (www.kilpatricktownsend.com). With over twenty years of experience in obtaining patents on hundreds of inventions from the latest drug delivery systems to life-saving cardiac equipment, he has built IP portfolios for numerous Fortune 500 companies. In addition to securing patents, Gibby helps clients enforce and license their patents around the world, and he has monetized patents on a range of products.

Darin’s first book, Why Has America Stopped Inventing?, explored the critical issue of America’s broken patent system. His second book, The Vintage Club, tells the story of a group of the world’s wealthiest men who are chasing a legend about a wine that can make you live forever. His third book, Gil, is about a high school coach who discovers that he can pitch with deadly speed and is given an offer to play with the Rockies during a player’s strike. Gil soon discovers, however, that his unexpected gift is the result of a rare disease, and continuing to pitch may hasten his own death.

With a Bachelor of Science degree in mechanical engineering and a Master of Business Administration degree, he is highly regarded in Denver’s legal and business community as a patent strategist, business manager, and community leader. He is also a sought-after speaker on IP issues at businesses, colleges and technology forums, where he demonstrates the value of patents using simple lessons from working on products such as Crocs shoes, Izzo golf straps and Trek bicycles.

An avid traveler and accomplished triathlete, Darin also enjoys back country fly-fishing trips and skiing in the Rocky Mountains. He lives in Denver with his wife, Robin, and their four children.

His latest book is the thriller, Chasing Hindy.

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FIRST CHAPTER REVEAL: Surgeon’s Story by Mark Oristano

Surgeon's Story

Title: SURGEON’S STORY
Author: Mark Oristano
Publisher: Authority Publishing
Pages: 190
Genre: Nonfiction Medical

What is it like to hold the beating heart of a two-day old child in your hand? What is it like to counsel distraught parents as they make some of the most difficult decisions of their lives?

Noted pediatric heart surgeon Dr. Kristine Guleserian has opened up her OR, and her career, to author Mark Oristano to create Surgeon’s Story – Inside OR-6 With a top Pediatric Heart Surgeon.

Dr. Guleserian’s life, training and work are discussed in detail, framed around the incredibly dramatic story of a heart transplant operation for a two-year old girl whose own heart was rapidly dying. Author Mark Oristano takes readers inside the operating room to get a first-hand look at pediatric heart surgeries most doctors in America would never attempt.

That’s because Dr. Guleserian is recognized as one of the top pediatric heart surgeons in America, one of a very few who have performed a transplant on a one-week old baby. Dr. Guleserian (Goo-liss-AIR-ee-yan) provided her expertise, and Oristano furnished his writing skills, to produce A Surgeon’s Story.

As preparation to write this stirring book, Oristano spent hours inside the operating room at Children’s Medical Center in Dallas watching Guleserian perform actual surgeries that each day were life or death experiences. Readers will be with Dr. Guleserian on her rounds, meeting with parents, or in the Operating Room for a heart transplant.

Oristano is successful sportscaster and photographer and has made several appearances on stage as an actor. He wrote his first book A Sportscaster’s Guide to Watching Football: Decoding America’s Favorite Game, and continues to volunteer at Children’s Medical Center.

“We hear a lot about malpractice and failures in medical care,” says Oristanto, “but I want my readers to know that parts of the American health care system work brilliantly. And our health care system will work even better if more young women would enter science and medicine and experience the type of success Dr. Guleserian has attained.”

Readers will find all the drama, intensity, humor and compassion that they enjoy in their favorite fictionalized medical TV drama, but the actual accounts in Surgeon’s Story are even more compelling. One of the key characters in the book is 2-year-old Rylynn who was born with an often fatal disorder called Hypoplastic Left Heart Syndrome and was successfully treated by Dr. Guleserian.

Watch the Book Trailer at YouTube.

FOR MORE INFORMATION:

Amazon | Barnes & Noble

CHAPTER ONE

A Day in the Life

“We eat stress like M&Ms in here.”

 

OR-5

Children’s Medical Center, Dallas

November 5, 2009

I’m staring at eleven month-old Claudia, lying sedated on the operating table in OR-5, as still as a doll with no moving parts. She looks smaller than her charted weight of nine kilos (20 pounds). Nurses cover her with sterile blue surgical drapes so all that’s visible is a 4-inch square patch of skin on her chest. Bright white lights bathe the center of the table. Doctors and nurses in gowns, caps, and masks crowd around. They look almost identical. Except for the earrings. The earrings are the “tell.” That’s how you know it’s her.

Kristine Guleserian, pediatric cardiothoracic surgeon, is scrubbed in. Known throughout the hospital as Dr. G, she is one of only nine women in the U.S. certified to do what she’s about to do — take a scalpel sharper than a dozen razors, cut through Claudia’s skin, saw open her breastbone, and spread her ribcage apart in order to repair two congenital defects threatening a malformed heart the size of a walnut. It’s just after 9:00 AM. Claudia will be in OR-5 until 2:00 PM, along with a team of talented surgeons, nurses, techs, anesthesiologists, and others. Dr. G is in charge.

 

October 27, 2009

Children’s Medical Center – Heart Center

Two weeks before Claudia’s surgery, I had a 1:30 PM meeting with Dr. G at her office. At 1:25, I sat in the waiting room. At 1:30, Dr. G came through at her favorite speed — full. She headed for the door while putting on her white, starched lab coat over surgical scrubs and said, “Come on.” We trotted down the hospital hallway.

“This is my world. You wanted to see it. Welcome to my life.”

“Where are we going?” I was struggling to keep up with her even though I’m a foot taller.

“We have to do a consult.”

“We?”

“I have to. You’ll watch.”

We whisked past the main desk of the echocardiography lab. Dr. G motioned to the charge nurse.

“He’s with me.”

We squeeze into the dark and cramped echo lab, where there’s barely enough space for the two women sitting at the monitors. Dr. G introduced me to cardiologists Dr. Catherine Ikemba and Dr. Reenu Eapen, then turned her focus to the echo monitors. An echocardiogram is a moving image produced by sound waves directed at the heart and reflected back again as the waves pass from one type of tissue to another. To me it looked like a blurry, moving x-ray. To the eyes of these three women it was an intimate cardiac road map. A nine-year old boy had a malformed aorta, and the cardiologists wanted Dr. G’s opinion. She was Socratic, asking questions she likely already knew the answers to, saying, “Well, I might do…” so-and-so, and then asking her colleagues for their opinions.

Two weeks later, I came back for the first of many long days as her shadow. I wasn’t quite Alice in Wonderland, but the feeling of falling down a hole did occur to me.

 

November 5, 2009

7:30 AM – Heart Center Research Meeting

There’s more to being a surgeon than surgery. This particular day begins in a windowless media room, the kind of video-meeting-training center you’d find in any school or business. Rows of desks and chairs give it a classroom feel. A/V equipment hangs from the ceiling and a large video screen dominates the front of the room. The dress code is strictly medical, no business attire here. Doctors and nurses in scrubs and lab coats shuffle into the room, many with the ubiquitous cup of Starbucks in hand. Today will feature a presentation of two ongoing cardiac studies being conducted at the Children’s Medical Center’s Heart Center. The room is very cold, and Dr. G wears a black turtleneck sweater under her white lab coat. She pulls the sweater neck up over her nose and mouth as the meeting goes on, seeking warmth. A presenter advances to the lectern, and the unmistakable look of the PowerPoint presentation flashes on the screen behind her. The title slide reads:

CHROMOSOMAL COPY NUMBERS IN

HYPOPLASTIC LEFT HEART SYNDROME

Before I ventured into Dr. G’s world, I had begun my own rudimentary study of congenital heart disease (heart defects present at birth), trying for a foothold in the maze of childhood cardiac problems. I had read that hypoplastic left heart syndrome (HLHS) is a life-threatening cardiac deformity where the left ventricle, which pumps blood to the aorta and then around the body, is so weak that without surgical intervention any infant suffering from it will likely die. The pediatric heart specialists in the meeting room critique what they’ve just heard. A senior cardiologist might question the validity of this or that portion of the research methodology. These are works in progress, not ready for publication. Ongoing study is a part of the surgeon’s job description.

In the meeting room, the media screen glows again.

ECHOCARDIOGRAPHIC PREDICTION OF SPONTANEOUS

CLOSURE OF DUCTUS ARTERIOSUS IN PREMATURE INFANTS

After only two weeks shadowing Dr. G, I was able to make some sense of this title. The Heart Center team is using echocardiography to predict whether the ductus arteriosus in the hearts of premature infants will close properly after birth, sparing the need for open-heart surgery. That was about all I knew. I had to dig deeper into the textbooks to learn more about what was beating beneath my own breastbone.

The human heart is a four-chambered pump, designed to send deoxygenated blood to the lungs to get a new supply of oxygen, and then sending that oxygen rich blood on its journey around the body to nourish organs and tissues. The left and right sides of the heart each have two chambers — an atrium on top, and a slightly larger ventricle on the bottom. Each side is like Dali’s version of an hourglass. The atria and the ventricles are each separated by a thin wall called a septum. The ventricular septum is slightly more muscular than the septum for the smaller atria.

In a normal heart deoxygenated (blue) blood enters the right atrium from large blood vessels called the vena cavae, which bring blood back from the rest of the body after distributing oxygen. The right atrium contracts, opening the tricuspid valve, and blood flows down into the larger right ventricle. The contraction of the right ventricle sends blood through the pulmonary valve to the pulmonary arteries, and into the lungs for oxygenation. The newly oxygenated blood enters the left atrium through the pulmonary veins. When the left atrium contracts, blood is sent through the mitral valve into the left ventricle. The left ventricle contracts, blood moves through the aortic valve into the aorta, and off to oxygenate the rest of the body — the brain, the coronary arteries of the heart itself, deep into the internal organs, and superficially to the skin. Over and over again, on average 100,000 times per day. That’s in an anatomically correct heart. (Anatomic trivia: The pulmonary arteries are the only arteries that handle deoxygenated blood, while the pulmonary veins are the only veins that handle oxygenated blood. Otherwise, oxygenated blood always flows through arteries, and deoxygenated blood through veins.)

The number of things that can go wrong with the human heart is staggering. Heart disease in adults is usually acquired. When we develop a heart condition in later life, it’s most often our own doing. Smoking, obesity, hypertension, poor diet, lack of exercise, diabetes, genetics and more, contribute to the clogged coronary arteries, heart attacks, strokes and other events that make heart disease the leading cause of death in most developed countries. Congenital heart disease is present in approximately 35,000 newborns in the U.S. each year, although many of these show no symptoms and don’t learn of any problems until years later, if ever. Since infants haven’t had a chance to do much damage to themselves, it’s fair to wonder how a newborn heart can have so many problems. Congenital heart defects occur because of interruptions in normal fetal heart development.

The developing fetal heart contains a series of shunts, like miniature bypasses, to keep blood away from the pulmonary arteries and lungs so that blood flow is kept low, and the tiny lungs won’t be overtaxed. Fetal lungs are non-functional, because the fetus gets oxygen from the mother through the umbilical cord. The shunts in the fetal heart are:

1) foramen ovale, which lets blood flow from the right to the left atrium,

2) ductus venosus, which draws umbilical blood away from the fetal lungs and into the vena cava, and;

3) ductus arteriosus, which connects the pulmonary artery to the descending aorta, thus allowing most blood from the right ventricle to bypass the non-functional fetal lungs.

All three of the shunts alter themselves after birth to create the normal heart design. When something interferes with the natural switch over from fetal to breathing infant heart, physicians call it “persistent fetal circulation.” It can manifest in hundreds of way. In certain situations, it’s never even noticed.

Anatomy of the Heart 101 is over. Bookmark these diagrams and return PRN (medical for “as needed”).

 

8:15 AM

3rd floor Cardiovascular Intensive Care Unit

The Cardiovascular Intensive Care Unit (CVICU) has twenty rooms arcing around a large central desk. The furnishings are modern, corporate-like, and austere. The pulse of the CVICU is the rhythm of the beeping sound common to every TV medical drama. Each patient is attached to a monitor measuring blood-oxygen saturation (sats), heart rate (HR), blood pressure (BP), respiratory rate, temperature, and more. Each monitor is a computer, producing different sounds for different reasons. The one constant is that audible beep, one for each heartbeat. An infant’s tiny heart beats significantly faster than an adult’s, so the pace of the beeping is rapid, and each baby here suffers from a potentially fatal malfunction of that rapidly beating heart.

Nurses move everywhere, monitoring every child. Intravenous (IV) fluid bags hang at each bed — six, eight, sometimes more. One patient has ten IV drips, each one delivering a different life-supporting medication — sedation, painkillers, antibiotics, anticoagulants, blood products, nutrition and others. The drips hang from poles, and flow directly into the tiny patient’s arm or leg, or more often, into a catheter inserted into the chest for easy access. The drips feed into a large control panel with the concentration and rate of flow of each drip handled by computer. All these babies are critically ill, critically tiny, many premature. Most of them are smaller than the stuffed animals that sit, unnoticed, next to them.

I’ve been volunteering at Children’s for 13 years, but this is my first time in the CVICU. I’m here for cardiac surgery rounds, following Dr. G as she checks on the progress of patients. Another familiar sight from medical TV shows is on display here — the long, white coat — the peacock feathers of physicians and surgeons. Children’s Medical Center is a teaching hospital, part of the University of Texas Southwestern Medical School in Dallas. Doctors and surgeons, long past their residencies now and specialists in their fields, wear the long, white lab coat. Medical students, residents and interns are in shorter coats. Dr. G is the shortest of the long coat-clad. Sure, she’s only five feet tall, but as they say in the sports world, she plays six-two. She’s not the only woman in the group, but she’s the only one wearing a long white coat. The young doctors listen to her.

Heart surgeons, ICU doctors, cardiologists, nurses, nurse practitioners, physician assistants, fellows, residents and students start at one end of the unit to move room by room around the floor. A cardiology fellow pushes the computer on wheels (COW), and presents each case. This young doctor has made several of the basic choices his career path requires. He’s just finished his residency where he worked in various specialties. He’s chosen medicine over surgery, pediatrics over adult, and cardiology over other disciplines, making pediatric cardiology his career choice. He’s taking his first steps down the six-year road it will take to earn “attending” status, when he’ll be in charge of cases. He’ll then be a pediatric cardiologist, a doctor who treats young people with heart disease. He’ll refer cases needing surgery to people like Dr. G, a pediatric cardiothoracic surgeon. Her career path was twice as long, requiring twelve years to attending status. Cardiologists diagnose — surgeons repair.

Even though he’s out of residency, this doctor is still learning. He stops in front of the door to the first patient room and runs down the important events from overnight — vital signs, patient status, complications, and planned treatment. The male attendings ask questions that are pointed and occasionally harsh. Dr. G draws the younger doctors out with her questions, gently nudging them back on the right track. “I didn’t hear anything about left atrial pressure there,” she tells the presenter, who immediately refers to the COW screen and spews a series of numbers out in a specific order. The young doctor’s voice is tense, rising a bit, as he makes up for his omission. It’s unlikely he’ll make this mistake again. Terms like “open-chest” and “life-threatening event” are heard on cardiac rounds, said calmly and with nonchalance. Hospital personnel in critical care settings are outwardly detached. It’s a key to staying focused.

The CVICU nurses rounding make notes while answering questions concerning how patients fared overnight. There is a pecking order among hospital personnel, and some doctors treat nurses as underlings; nevertheless, a tremendous level of trust exists between the doctors and nurses at Children’s. If the doctors are the officers of this army, the nurses are the sergeants, the ones who make sure everything gets done.

While the rest of the group moves along the hallway, Dr. G stops to look inside the room of the patient just presented. If she sees a family member inside, and they’re awake at this early hour, she goes in to say hello and ask how things are going. She feels a responsibility toward every family, even if the case isn’t hers. It’s not done for effect or because her medical training requires it. This is the way she treats everybody. It doesn’t matter if your child has a serious heart condition. It doesn’t even matter if you have a child. When Dr. G sees you, in the hallway, in the cafeteria, in the OR, she says hello.

Rounds end, leaving just enough time to dash up to the eighth floor cardiac unit and check on patients who are out of ICU, waiting to be discharged. One young heart transplant patient has turned up her oxygen level without the nurses knowing about it. Dr. G tells the 13-year old girl, in a firm, motherly way, that medical decisions are made by the pros and here’s how we’ll manage the oxygen for the remainder of your stay. The girl hangs her head and nods.

The moments after rounds, before the next issue presents itself, offer a chance to head down to the first floor food court for a snack. As Dr. G stands in the register line, her pager beeps. She checks the number and heads up to the third floor office suite she shares with her partners and staff. She phones the person who paged her and, in a flash, it’s out the door and back to the echo lab, a half-eaten banana left behind on her desk.

Two weeks after my first visit to the echo lab I stood to the side again, this time better able to make sense of some of what Dr. G and the cardiologists discussed as they looked at the screen. Eleven-month old Claudia’s diagnosis was Tetralogy of Fallot (TOF), a syndrome with four separate cardiac abnormalities:

1) Ventricular septal defect (VSD) — a hole in the wall between the two ventricles;

2) Overriding aorta — the aorta is not positioned properly on the heart;

3) Right ventricular outflow tract obstruction — for any of several possible reasons, the blood flow to the lungs is restricted, leading to:

4) Right ventricular hypertrophy, (which surgeons pronounce “hy-PER-tro-phy”) — a dangerous buildup of the right ventricle’s musculature.

Claudia has alarming episodes of cyanosis where her lips, fingers and toes turn blue because her oxygen saturation rate becomes dangerously low. She also has what are called “Tet spells,” when her oxygen level drops so low that she loses consciousness. The preoperative indications of most concern to Dr. G are an extremely small pulmonary valve, which leads from the right ventricle to the pulmonary arteries; the significantly thickened muscle bundle below the valve; and the somewhat larger than average VSD.

Thirty minutes later we were walking down a second floor hallway toward the operating rooms. Dr. G walked quickly, straight ahead, focused. She was getting her game-face on.

 

10:30 AM

OR 5

Claudia lay motionless on the table in the center of the OR, her head sticking through a hole in the draping around her neck. It’s visible to the anesthesiologists seated at the head of the table where they are concerned with the numerous gauges, medicines, inhalation gases and monitors at their fingertips. They’re also in charge of tilting the table at the surgeon’s request, to put the patient at a more favorable angle, because the motorized table can be raised, lowered and tilted to various angles at the touch of a button.

(Example of pediatric cardiothoracic humor —A flight attendant goes on the p.a. and asks if there’s a pediatric cardiac anesthesiologist on the plane. There is one, in the rear of coach. He signals the attendant and asks what the trouble is.

“There’s a pediatric heart surgeon in first class. He wants his tray table lowered.”)

The scrub tech stands at the opposite end of the table, facing a series of trays that hold an array of odd looking tools; forceps for picking up or grasping things; scalpels that slice through human flesh as if it were air; sutures (thread) finer than human hair, attached to small needles curved like fish hooks. The scrub tech is the right hand person to the surgeon, responsible for pulling instruments and supplies for the operation, knowing what the order of the operation is, and arranging everything in the most efficient format for this particular surgery and this particular surgeon. Dr. G knows that when she calls for an instrument, the proper one will be there in a flash. Often, it will be offered to her before she has to make the call.

A six-foot-by-six-foot metal frame sits to one side of the operating table, containing gauges, canisters, and clear plastic hoses. This is the cardiopulmonary bypass machine —“the Pump.” This technology will serve as Claudia’s circulatory system while her heart is stopped for repairs. Developed in the 1950’s, modern bypass machines still use hoses much like the beer keg tubing in the first experimental models. The two specialists in charge of operating the pump, the perfusionists, sit at the machine.

The small patch of Claudia’s chest that’s visible is covered with a material called Ioban, plastic coated with iodine in a further effort to reduce any risk of infection during surgery. Dr. G will make a tiny incision to get at this heart that was compromised in utero by Tetralogy of Fallot. To give you an idea of the progress of medical knowledge, TOF was first medically described, though primitively, in 1672. Two hundred years later Etienne Louis Fallot, a French physician, described the clinical pathology of the condition, but the first surgical treatment for TOF wasn’t available until the late 1940’s. Dr. G, ever the teacher, drew a diagram of the surgery for me before she scrubbed in.

After scrubbing, Dr. G re-enters the OR with hands and forearms still wet. She dries with sterile towels provided by a scrub tech who then helps her into a surgical gown and gloves. She wears loupes over her cap. They look like small telescopes growing from each eye, and they give her a magnified view of the tiny area in which she’s working. A fiber-optic cable runs up her back, over the top of her cap and onto a small, bright lighting instrument/video camera at her forehead, to light and televise what she sees to monitors hung around the OR. Dr. G is at the center of the sterile area, where only those who scrub in can go. The rest of us, wearing surgical masks and caps in addition to our scrubs, have to stay away from the table. She climbs up on a small step stool to get her five-foot frame high enough above the table to work easily, without making her taller assistants bend over.

She takes a scalpel and makes a four cm incision in Claudia’s chest. Next, she cuts the breastbone open with a small saw and puts retractors in place to hold the ribs apart. The first object Dr. G encounters inside Claudia’s chest is the thymus gland, a small, flesh-colored organ. It has some minor involvement with the lymphatic system, but it gets in the way of open-heart surgery, and you can live without it. So the gland is removed and discarded.

Dr. G takes an electronic scalpel called a “Bovie,” which cauterizes as it moves through tissue, keeping bleeding to a minimum. She cuts the pericardium, the sac-like membrane containing fluid that lubricates the heart. The pericardium has extra meaning for Claudia. Dr. G precisely excises a small portion of the sac and places it in a dish containing 0.6% glutaraldehyde, a preservative fluid. She’ll use this patch later to close the VSD, the hole between Claudia’s ventricles that failed to seal itself properly at birth. She works around the small space filled with tiny body parts, freeing up the aorta and the pulmonary arteries from the underlying tissue. Claudia has been given heparin, an anticoagulant, so that her blood is less likely to clot when it goes through the pump. Dr. G inserts cannulae, small tubes, into the aorta and the vena cavae. The other ends of these tubes are attached to the pump, connecting to Claudia’s circulatory system. Because Claudia has very small blood vessels, the work is delicate and precise, and the tubes they need for this bypass, like the vessels in Claudia’s chest, are extremely narrow. Her cannulae are smaller than the width of a ballpoint pen.

The mood in the OR shifts at various moments. Dr. G has been casually introducing me to the OR team while routine work is going on — as routine as heart surgery can be. But when the cutting starts, the room goes quiet. Dr. G hovers over the small body on the table, staring down into the chest she has cut open. The view from the camera attached to her loupes doesn’t shake on the OR monitors. She’s a human tripod.

The perfusionists are cooling Claudia’s body down to 28 degrees Celsius, 82.4 Fahrenheit, to slow her metabolism and protect her heart. Hypothermia lowers the amount of oxygen the brain requires, giving the surgeons time to perform the needed repairs. They aid this chilling process by turning the temperature in the OR down to 64 degrees, so cold that several people drape their shoulders with blankets from a nearby warmer.

Dr. G clamps the aorta, and blood stops flowing to Claudia’s heart. Dr. G tells the perfusionists to run the cardioplegia, a solution of chemicals inducing cardiac arrest. In order to operate on the heart they must intentionally cause something that usually kills when it happens on its own. The cardioplegia solution includes potassium chloride, one of the chemicals used in lethal injection executions. Claudia’s heart stops beating and the blood exits her vena cavae into the bypass machine for oxygen, returning to her body through the cannula inserted just above the clamp on the aorta. Her heart and lungs have been turned off. There’s no more beeping or EKG activity on her monitor. She has flat-lined. When the patient goes on pump the heart is like a water balloon with the water let out. It changes in shape from full and throbbing to flat and motionless. The only way to repair Claudia’s heart is to stop it and empty it.

The first task is to examine the heart to see if the preoperative diagnosis is correct. Dr. G uses delicate instruments to retract portions of the tricuspid valve and examine the extent of the defect of the ventricular septum, the wall between the two ventricles. She determines the exact size and shape of the VSD and trims the segment of pericardium she saved earlier in preservative. She cuts miniscule pieces of the pericardial tissue and sutures them along the walls of the VSD, creating anchor points for the actual covering. Each suturing is an intricate dance of fingers and forceps, needle and thread. Dr. G works with a small, hooked needle, grasping it with forceps, inserting the needle through the tissue, releasing and re-gripping with the forceps, pulling the hair-thin suture through, using a forceps in her other hand to re-grip the needle again and repeat. The pericardial tissue being sewn over the VSD has to be secure, and it has to stand up to the pressure of blood pumping through Claudia’s heart at the end of the operation. This isn’t like repairing knee ligaments, which can rest without use and heal slowly. Claudia’s heart is going to restart at the end of this operation, and whatever has been sewn into it has to hold, and work, the first time. The VSD repair involves cautious work around the tricuspid valve, and their proximity is a concern because the valve opens and closes along the ventricular septum with each beat. Dr. G and her team find that it’s preferable to actually divide the cords of the tricuspid valve to better expose the VSD. After the patch is fully secured, the tricuspid valve is repaired.

Things don’t go as smoothly during the attempt to repair the pulmonary valve. When Dr. G looks inside Claudia’s heart she discovers that the pulmonary valve is not nearly large enough, and it’s malformed. It only has two flaps where there should be three. She repairs it by what she later says is “just putting in a little transannular patch.”

Here’s what it’s like to “just” put a transannular patch on the pulmonary artery of a child as small as Claudia:

First, take a piece of well-cooked elbow macaroni. Tuck it away in a bowl of pasta that has a bit of residual marinara sauce still floating around in it. Take several different sized knitting needles. Slowly, without damaging the macaroni, insert one of the knitting needles into it to see if you can gauge the width of the macaroni on which you’re operating. Then using a delicate, incredibly sharp blade, cut a small hole in the piece of elbow macaroni, maybe a little larger than the height of one of the letters on the page in front of you. Now use pliers to pick up a small needle with thread as fine as human hair in it. Use another pliers to pick up a tiny piece of skin that looks like it was cut from an olive, so thin that light shines through it. Take the needle and sew the olive skin on to the hole you’ve cut in the piece of macaroni. When you’re finished sewing, hook up the piece of macaroni to a comparable size tube coming from the faucet on the kitchen sink, and see if you can run some water through the macaroni without the patch leaking.

That’s the food analogy. Those are the dimensions Dr. G worked with as she patched Claudia’s pulmonary artery. She made it a little wider to give it a chance to work more efficiently, to transport more blood with less blockage, requiring less work for the right ventricle so that the built-up heart muscle could return to a more normal size. It wasn’t the repair she’d planned to make, but it was the most suitable under the circumstances, and it gave Claudia her best chance.

Before restoring Claudia’s natural circulation, the team makes certain that no air is in the heart or the tubes from the pump, because it could be pumped up to the brain. Air in the brain is not a safe thing. When all the repairs are completed, Claudia is rewarmed and weaned from the bypass machine. She was on pump for 114 minutes and her aorta was clamped for 77 minutes, not an extraordinary length of time in either case.

Claudia’s heart starts up on its own, with a strong rhythm. With her heart beating again the beeps, and the peaks and valleys on her monitor return. All is well. An echo technician wheels a portable machine into the OR and puts a sensor down Claudia’s throat where it lodges behind her heart to perform a transesophageal echo —a more detailed view than the normal, external echo. Everything looks good. Chest drains are put in to handle post-operative drainage, and wires are placed for external pacemakers, should anything go wrong with Claudia’s heart rhythm during her recovery from surgery. Dr. G draws Claudia’s ribcage back together with stainless steel wires, perfectly fastened and tightly tucked down.

Claudia and the surgical team return to the CVICU, and Dr. G monitors her reentry to the unit, making sure the nurses understand Claudia’s condition and the proper procedures to be followed for the next 24 hours. From there, Dr. G enters a small room tucked away from the noise of the unit to meet with the family. Claudia’s mother, father, and aunt are waiting. Dr. G sees Mom wiping tears away.

“Are you crying? Oh, no, no need to be crying, everything is fine.” Her wide smile reassured Mom, who put away her tissues.

She tells the family what she did, and why she did it, using a serviceable mixture of medical and lay terms.

“I got in and saw the valve and it was really abnormal,” Dr. G tells the family, “really, really small. It only had two leaflets, and that’s not good, it’s supposed to have three. So I did a little transannular patch through a mini-sternotomy, which is really good for her — much smaller scar. Her echocardiogram was beautiful. There’s no hole where we closed her VSD. We know there’s another small, little hole in the muscle, but we all agreed that because it’s in the muscle it’s going to close on its own, so we won’t worry about it. My plan is, once she wakes up later today, to get the breathing tube out.”

There is a noticeable sense of relief evident on the family faces, even though one or two of the terms may have been unfamiliar. Then, comes the caveat.

“The arteries that go to each lung are a little bit small. She’ll need to have a pulmonary valve at some point. Some people need one not so long from now. Some people go a good portion of their lifetime without needing one. My brother had this same surgery when he was little, and he still hasn’t had a new valve put in yet. But he will some day.”

The simple fact that her brother had similar surgery seems to put the family a little more at ease. They know Dr. G has been on both sides of the equation, and she can relate to their anxiety.

 

From there it was off to a brainstorming session with the architects designing new cardiac surgery suites. They wanted staff input on what should go where, how far the doors should be from the operating tables, etc. In the OR, a matter of a few feet can mean the difference between life and death.

Lunch came at 3:30, which can actually be early in Dr. G’s world. She debriefed herself from the surgery as we ate, describing to me what had taken place. She would later dictate all this for the official surgery report in medical terms such as, “The right-sided pericardium was fenestrated to approximately 1 cm anterior to the right phrenic nerve.” It may be true that “the heart has reasons which reason knows not of.” It also has a language that’s pretty hard to understand as well.

I told Dr. G this was my first time in the OR and I couldn’t believe I’d just seen a kid’s heart beating inside her chest.

“You’ve never seen that before?” she asked me.

I reminded her that I’d spent the last 30 years as a sportscaster.

“It’s not exactly the kind of thing you see in the Dallas Cowboys locker room.”

She was genuinely surprised at my sense of wonder.

The rest of her day consisted of phone calls, emails, consults with other surgeons, afternoon rounds through the CVICU (which move more quickly than morning rounds, as these are just for checking up on each patient one more time), and the never-ending battle with paperwork.

On rounds at 7:30 tomorrow morning, Dr. G will check up on Claudia to see how she’s doing. That’s assuming she makes it through the night easily. If problems develop, it’s likely Dr. G could spend the night here with her.

“We eat stress like M&Ms in here,” said Dave Bartoo, her surgical tech this day.

This is where Dr. Kristine Guleserian repairs the tiny hearts of tiny children.

Come on in.

 

 

About the Author

Mark Oristano

Mark Oristano has been a professional writer/journalist since the age of 16.

After growing up in suburban New York, Oristano moved to Texas in 1970 to attend Texas Christian University. A major in Mass Communications, Mark was hired by WFAA-TV in 1973 as a sports reporter, the start of a 30-year career covering the NFL and professional sports.

Mark has worked with notable broadcasters including Verne Lundquist, Oprah Winfrey and as a sportscaster for the Dallas Cowboys Radio Network and Houston Oilers Radio Network. He has covered Super Bowls and other major sports events throughout his career. He was part of Ron Chapman’s legendary morning show on KVIL-FM in Dallas for nearly 20 years.

In 2002 Oristano left broadcasting to pursue his creative interests, starting a portrait photography business and becoming involved in theater including summer productions with Shakespeare Dallas. He follows his daughter Stacey’s film career who has appeared in such shows as Friday Night Lights and Bunheads.

A veteran stage actor in Dallas, Mark Oristano was writer and performer for the acclaimed one-man show “And Crown Thy Good: A True Story of 9/11.”

Oristano authored his first book, A Sportscaster’s Guide to Watching Football: Decoding America’s Favorite Game. A Sportcaster’s Guide offers inside tips about how to watch football, including stories from Oristano’s 30-year NFL career, a look at offense, defense and special teams, and cool things to say during the game to sound like a real fan.

In 2016 Oristano finished his second book, Surgeon’s Story, a true story about a surgeon that takes readers inside the operating room during open heart surgery. His second book is described as a story of dedication, talent, training, caring, resilience, guts and love.

In 1997, Mark began volunteering at Children’s Medical Center in Dallas, working in the day surgery recovery room. It was at Children’s that Mark got to know Kristine Guleserian, MD, first to discuss baseball, and later, to learn about the physiology, biology, and mystery of the human heart. That friendship led to a joint book project, Surgeon’s Story, about Kristine’s life and career.

Mark is married and has two adult children and two grandchildren.

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