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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.

WEBSITE & SOCIAL LINKS:

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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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First Chapter Reveal: The Feet Say Run by Daniel A. Blum

The Feet Say Run

Title: THE FEET SAY RUN
Author: Daniel A. Blum
Publisher: Gabriel’s Horn Press
Pages: 349
Genre: Literary Fiction

At the age of eighty-five, Hans Jaeger finds himself a castaway among a group of survivors on a deserted island. What is my particular crime? he asks. Why have I been chosen for this fate? And so he begns his extraordinary chronicle.

It would be an understatement to say he has lived a full life. He has grown up in Nazi Germany and falls in love with Jewish girl. He fights for the Germans on two continents, watches the Reich collapse spectacularly into occupation and starvation, and marries his former governess. After the war he goes on wildflower expeditions in the Alps, finds solace among prostitutes while his wife lay in a coma, and marries a Brazilian chambermaid in order to receive a kidney from her.

By turns sardonic and tragic and surreal, Hans’s story is the story of all of the insanity, irony and horror of the modern world itself.

FOR MORE INFORMATION:

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First Chapter:

If there is an actual name to this island, it is unknown to us. We have chosen to call it Illyria. We’re not exactly sure where the name comes from. Some book perhaps. But it no longer matters. It has become our own—mythic and melodic-sounding. As though, if we keep calling this place Illyria, keep pretending it has some magical allure, people will want to come. Someone will come rescue us.I am not complaining, particularly. Well, maybe I am. But I probably shouldn’t be. So far fate has proven a fair enough agent. The beaches are sandy, the water clear and turquoise, the reefs plentiful. The island is wreathed in a soothing white foam. On shore there is the shade of palms and palmettos and eucalyptus. At least we think it is eucalyptus. We call it eucalyptus. Maybe it is just some kind of fancy magnolia though. Who the hell knows?

There are fruits in relative abundance—though what they are, we aren’t sure. Some are purple. Others are yellow. Some vaguely sweet, others sharp and abrasive on the roof of the mouth. There is a variety of coconut that grows in conjoined pairs to look like the buttocks of an African woman. We call this ass-fruit. When I offered some to Conrad, he said to me, “I’m not into that shit.” As though I were suggesting something perverse. As though fear of this fetish object outweighed the need for sustenance.

“What shit are you not into?” I asked.

“Ass fruit,” he said. “Ass.”

“It’s not real ass, Conrad,” I said.

“Well, it’s not a real fruit either,” he said.

“What do you think it is then?” I asked.

“A joke,” he said. “A sick joke. Like the rest of this place.”

 

God is playing a joke on us. That is a common theme here. It was funny the first time someone said it. Now it is just annoying, like a child saying, “knock-knock” to you over and over, more and more emphatically, as you refuse, just as emphatically, to ask, “Who’s there?”

The other common theme here is that none of it is real. We all died when the boat went down. And this is all just a dream. Conrad suggests this a couple of times a day, each time choosing a different angle, a different inflection, in a vain attempt to keep the joke fresh. If you suggest, gently, that this joke no longer strikes you as uproarious, Conrad will immediately jump into a long denial that he is joking. “I’m not fucking kidding,” he will tell you. “I really mean it. I think this is all a dream.”

Perhaps Conrad is right. Because honestly, I did not believe, until my current predicament, that deserted islands still existed. I thought these islands were all owned by former tennis pros and former tyrants, or inhabited by caricatures of primitive tribes who sell carved bamboo flutes to flabby tourists in checkered shorts.

If it is a dream, if this is my Land of Oz and I am soon to wake up, then it is curious how, from time to time, little bits of Kansas wash up upon our shores. Whenever we wander further down the beach, away from our settlement, we find Styrofoam packing peanuts, Styrofoam bowls, #3 plastic take-out containers with their familiar, triangular recycle symbols (apparently the previous owners of these containers ignored this particular environmental imperative).

The restaurant take-out containers are the most distressing. More mockery from The Almighty. More of his levity. Ha ha. We bring them back to our camp and wonder what twenty-first century foods they once held. Pad Thai or Kung Pao Chicken or Shrimp Korma. From some restaurant from the other world. Thank you, God, for delivering us this practical joke. Ha ha. You’re fucking hi-lar-ious.

In truth though, these containers have become invaluable to us. We eat out of them, wash them out at the little pool in Piss Brook, store our meager salvaged supplies in them. If there is truly one thing we should thank God for, it is those non-recycling sinners.

In our first days here, we found a means of killing a dove-like bird that is here in abundance. We creep up on it quietly, then all at once we start hurling rocks at it from all directions. It is the same low-tech technique the Iraqis used for shooting down American planes in our first Gulf War. Just throw up flak in every direction and hope something falls out of the sky. Actually that is something else that I am no longer sure is real. Gulf War I. In my current, delusive state, I am no longer clear whether it really happened, or was some very popular video game, and Gulf War II was just the long-awaited next release, with its improved graphics and better villains and four-and-a-half star rating. Perhaps, since we have been here, Gulf War III has broken out. Or been released.

But back to the doves. With the doves, this method worked once in every ten or twenty tries. Moreover, some of us were hit by rocks. Conrad compared us to a circular firing squad. And for the effort, we each got no more than a single bite of precious meat.

Frigate birds watch us from high overhead—out of range of our stone-age weapons. There are also pelicans and sandpipers along the coves. But the only other bird we have succeeded in slaughtering—a heron of some sort—tasted much like a discarded sneaker might taste. There are also lizards and little pencil-sized snakes, but thus far we have passed on these particular specialites de la region.

So much for Illyria’s fauna. Now a word or two on the topography. The interior has proven rocky, thick with vines, and difficult to penetrate. There is a single volcanic peak in the middle, which we call Mount Piss. We call it this because the streams that run down from it are of a yellowish, sepia color—piss water. This includes our drinking source, the much despised and much revered Piss Brook. It is probably just some dissolved mineral. Iron would turn it orange. Maybe zinc? Who knows. The taste is strong and unpleasant, but it is moderately cool, given our subtropical latitude. It is keeping us alive. Probably, if we could contact the civilized world, we could bottle it and sell it for its curative powers and make great mountains of money.

Our first shelter was rigged out of bamboo and palm fronds. It was set on the beach, and we soon learned there was no way to keep out the sand crabs. They came out in large numbers every evening. It would have been one thing if they scampered in from outside. But it was stranger than that. They just rose up through the floor of sand. They tunneled in, materialized among us, little uninvited sprites, climbed up out of the ground like the living dead and crawled across us as we slept.

“We’re not high enough above the water,” Cole said. “What if a storm comes up?”

“He’s just afraid of the sand crabs,” Conrad said to me, snickering.

“The first really high tide will wash us out,” Cole said, ignoring the snickers.

“He’s right,” Monique said. Although her vote meant little. She is Cole’s lover, and seemingly agrees with everything he says and does. If he becomes the de facto king of our little group of seven, which now seems likely, she will be our queen.

Our next shelter was built just above the beach, using a cliff face for one of the walls. It was roomier, and easier to close off from the creatures. It was quieter too, farther from the surf. But that was worse, in a way. Because now you heard all of the human sounds more precisely. Cole snoring. Gloria talking in her sleep. My own imperfectly muffled farts.

One night, a rain came and our new shelter was tested. At first we just felt a kind of mist, soft and cool, that had found its way through the thatch. But then it got heavier. Droplets.

There were groans. Curses. Aborted snores. Rustling.

And then it was no longer just droplets raining on us. It was the cliff itself. Mud from the cliff started slopping on us. Little shit bombs. Dripping through our roof. It was raining crap. “Fuck!” Conrad shouted. And it was an accusation, directed at Cole, who had chosen this location.

Another splat. Another curse. And then we were all up, groaning and cursing our miserable fate—surely the world’s very last castaways, on what is surely the world’s last desert island, somewhere mysteriously out of reach of our GPS-bound, cell-towered, trawler-traversed global village.

Maybe Conrad was right. God, that sadistic little prick, was playing some kind of joke on us. God was the house cat and we were his mouse and he was taunting his mouse over and over, carrying it and dropping it and picking it up again, half-swallowing it and regurgitating it and kicking it like a soccer ball, before finally disposing of it.

So it’s shitty metaphor. What can I say?

We got up in the middle of the night, abandoned the shelter, huddled together on the beach. We were sunburnt and bitten, chilled and miserable. Hungry, filthy, greasy-haired, exhausted. Tears mixed with the downpour; our pathetic, mortal cries with the thunder of heavens.

After a while the rain stopped. We sighed, calmed, leaned against one another. Relief. Then it started again. There were no more tears by then. Just silent misery. Half-sleep. Each of us with his or her own private thoughts. My thoughts were of Dawn. (I am capitalizing Dawn not as a statement about the mystical meaning of sunrise. In fact I am not referring to the sunrise at all. I am referring to one of our company, Dawn, the youngest in our party—a nineteen-year-old girl who had won my sympathy. But I am getting ahead of myself.)

When Dawn finally came (sorry, this time I am referring to the sunrise), we straggled up and pretended—as one does on a red-eye flight when the lights pop on—that we’d actually had a night’s sleep. Only there was no stewardess, no orange juice and coffee, no magical, mile-high toilet to whisk away the miserable night’s rumblings in a screaming blue swirl.

Just another day here on Illyria.

This is my question about aboriginal peoples. Did they always feel as short of sleep, as exhausted and worn out, as we always feel? Or did they find a way to sleep through all of those night sounds and crawling things, hunger pangs and gas-emitting neighbors?

Our third shelter was set on a long, flat rock, above the waves and a half-mile down the beach. It is interesting how quickly one develops a sense of home. Just moving that half-mile seemed unsettling. An unwelcome abandoning of the familiar. We filled empty ass-fruit shells with sand and carried them up to our rock to soften the floor for sleeping. And by adding more overlapping layers of thatch than we had before, by covering it with a paste made from clay and eucalyptus sap, we managed to keep dry inside. We called our new residence Versailles.

By then, the inevitable had happened. Cole was our leader. We hadn’t exactly chosen him, and he had never asserted his authority directly. It just happened.

Was he wiser than the rest of us? More generous? Had he provided for us in some impressive way? No. He possessed what Human Resources questionnaires refer to as leadership qualities. And most of us, let’s face it, are natural followers.

It started with his suggestions. We should do this. We should do that. We should set the shelter closer to the brook. The women should gather the fruit. “You!” he would say, narrowing his eyes at Andreas, “Work on finding firewood.” It was as though he had been waiting all his life to play this role, to have the chance to tell someone to gather up the firewood. And of course it was natural to direct his first order to Andreas, who had been in his employ on the yacht before it went down. And then from there it was easy to direct “suggestions” to the rest of us.

We are a pack of primates. And Cole is our alpha male. Tall, burly, handsome in a bushy-browed sort of way. Real estate developer in his previous life. Resourceful man of the jungle in our present life. Dipshit in both lives.

With his background in real estate, so he insinuated, it was only natural that he should oversee the construction of the shelters. And though the connection seemed tenuous, nobody challenged him. Conrad, who in our previous life was Cole’s cousin, despises him. For myself, I dislike him as well, but more or less indifferently. I see that he is only of average intelligence, perhaps slightly more self-centered than what might be considered average. He is lacking in irony, introspection, humor, really anything that might make one actually like him. But I am too old to worry about these things. I have seen too much of humanity—and at its very worst. Let someone else figure it out. Just tell me what you need me to do and leave me alone and don’t ask me any questions.

Our next construction project was a dove coop. Gloria, our kindly widow (yes, dear reader, it goes without saying that our group is made up of “types,” a microcosm, as it were, of humanity at large, and that one of these types, inevitably, must be our kindly old lady), had the ingenious idea of raising doves rather than just throwing rocks at them.

“Good plan,” Cole said, nodding wisely, and somehow managing, in his nod, to demonstrate the importance of his judgment. His ratification.

It was a big step for us. Our move from a hunter-gatherer society to an agrarian economy. But it was something else also. A recognition that we might be here for a while. That we had to plan for a future. And for me it was a recognition of this:

I am done running. I am here now. There is nowhere left to go.

 

With great effort, we caught three of these birds alive—surrounding them and dropping a heap of branches on them. We put them in our coop.

“What if they’re all the same sex?” I asked.

“I don’t think they’re all the same sex,” Cole said.

“Why not?”

“That one looks like a girl.”

“Why do you say it looks like a girl?” I asked, wondering if Cole had noticed a wiggle to its tail, a shape to its figure.

“It’s more colorful,” Cole said.

“The male birds are more colorful than the females,” I said. I am no John James Audubon, no Roger Tory Peterson, but I believe I am right in this.

“Either way,” Cole said.

We turned the birds over, looked around their tails, but could find no conclusive evidence of maleness or femaleness. Then one morning Conrad called us over. Two of the doves were dead. The third, the apparent victor, seemed to have been bloodied.

“Maybe they were all males,” I said.

“Or maybe with doves it’s the girls that do the fighting,” Cole said.

I was skeptical of this, caught Conrad’s eye.

“Just because the males are colorful, doesn’t mean they’re girly,” Conrad said.

“So much for doves being symbols of peace,” I said.

“Unless of course they aren’t really doves,” Dawn offered up.

We all looked at her. It was rare for Dawn to speak up among the group.

“True,” I said. Because it’s not as though Dr. Doolittle is here with us and can just ask him if they are doves. Or Crocodile Dundee. Or whomever. What we know, or think we know, about the rain forest, we have learned from the packaging on our health supplements and our beauty aids and our enviro-friendly paper towels. The TV shows that bring wild nature into our living room. Here, high in the cloud forest, the spectacled monkey is tending to her young. The little ones will need to learn much if they are to survive the harsh winter. Actually, scratch that. No harsh winters in the cloud forest. But you understand my point.

Though bloodied, the dead doves still had meat on them. We brushed off the ants and flies, washed the corpses off in the stream, put them on the barbeque spit.

In the next days, we caught more doves. This time we observed the brush they pecked at in the wild and brought them piles of it. And we separated the doves into pairs that appeared to be of opposite sex. And lo! Dove eggs started to appear. Like magic. Like Easter eggs. Like…actual…eggs!

In time, one of this second set of doves died too. This time though, apparently, it was from natural causes (strange phrase: natural causes. Because what could be more rooted in nature than being pecked to death?) But we nonetheless had eggs. And while we ate some, we left some of them alone. And one day we witnessed the miracle we had dreamed of, but never quite believed we would see—a little beak pecked through one of our eggs, pecked its way out into the world. Within a couple of weeks we had a little collection of chicks. We had done it! Our poultry farm had been born!

Again we returned to our construction. Our next project was a little shelter along a rocky outcrop, to protect us from the sun when we were fishing and crabbing. And then Cole and Monique decided they wanted to sleep in privacy. So we built a second shelter alongside Versailles that we called Fontainebleau.

“Why,” Conrad grumbled, “should we be putting all this time into another shelter just so that dirtbag and that douchebag can go at it in private?”

I wondered what you get when you mate a dirtbag and a douchebag. There must be a good punch line. Please write me if you think of one. 1 Delirium Terrace. Illyria. Earth. 02483-7676. to insure proper handling, be sure to include a self-addressed, stamped envelope. And a life raft.

“Well,” I said, “the next shelter we build after that could be for you.”

“Yeah,” Conrad said, “but it’s not like there’s anyone I’m likely to be screwing.”

“Well don’t you want to be able to pleasure yourself in private?” I asked.

Conrad looked uncomfortable at this, but said nothing.

“And won’t it be nice to be rid of them?” I asked.

Personally, I was relieved when Cole and Monique moved out. It had grown tiresome, those nights they waited until they thought everyone was asleep and then started moving and rustling, whispering and slurping. And then those guttural sounds, like a pair of native frogs. Only nobody was ever really sleeping during their nocturnal choruses. We were all just pretending we were asleep. All too uncomfortable to say anything about it. To interrupt them.

“I think it actually turns them on,” Conrad used to snarl. “They know we know they’re going at it. And they know we know they know.”

“It’s difficult,” I say.

“I’m saying something next time.”

And he did. A couple of nights later we started to hear it again. Unmistakable. Rustle. Breath. More rustling. Sighing. Frog calls.

“Hey Monique,” Conrad called. “Can I get some of that?”

Suddenly the sounds stopped. Silence. The whole shelter went silent. Pretended to sleep. Like even Monique and Cole were asleep and the only one awake was Conrad and nobody had heard anything at all—the grunting or Conrad or anything. Monique and Cole frozen in flagrante delicto. A final rustle. Monique discreetly slipping off her little pole of Cole. Then more silence. Everyone pretending sleep. Until we actually were asleep. One by one. Like in that children’s story.

 

Goodnight Cole.

And goodnight Pole.

And goodnight, o empty soul.

Goodnight stars.

And goodnight air.

Goodnight misery everywhere.

 

Two days later Cole began organizing work on Fontainebleau. He must have waited an extra day so it wouldn’t be as obvious why he was doing it—that it was related directly to Conrad’s comment. Since we were all pretending we had never heard it.

Bit by bit, Cole has seemed to be developing the island. I imagine that, if a rescue ship ever comes, while the rest of us are celebrating, weeping for joy, he is going to take them for a tour, show them all the improvements, try to sell his development for a profit.

For Conrad, the last straw was one morning when Cole put up a great big bamboo cross over our little encampment.

“It’s embarrassing,” Conrad complained, pulling me aside.

“Embarrassing before whom?” I asked.

Conrad thought about this. “What would a pilot flying over us think, looking down and seeing that?”

“I don’t know,” I said.

“They’d think we’re…we’re fucking missionaries.”

“I haven’t noticed any planes,” I said.

“Well, it’s still embarrassing.”

“I have given up on embarrassment,” I said. “At my age it is pointless. I am who I am. Let the pilots think we’re missionaries then.”

“We’re castaways!” Conrad said, as though asserting membership in some privileged class.

“Doesn’t it strike you as odd,” I asked, “that we are a thousand miles away from civilization, and you have brought with you to this place that one absurdity of living in a society. Self-consciousness? Embarrassment?”

Conrad didn’t hear me, though. He looked off in disgust. “What gives him the right? He just does whatever he wants. Without asking anyone. After all that shit about making decisions as a group. I knew it was all bullshit.”

“Just think of it as a couple of big sticks,” I said. “It doesn’t have to be a crucifix. It doesn’t have to mean anything.”

“It crosses the line,” Conrad said. “You know what it is? It’s state-sponsored religion. How does he know we all believe? How does he know some of us aren’t atheists? Or Jews? Or Hindus?”

Conrad, in his past life, was a labor lawyer or something. An advocate of some poorly-paid group, or class, or underclass. “You don’t look like a Hindu,” I told him.

“That’s stereotyping,” Conrad said.

I considered this, puzzled, but didn’t pursue it. “Maybe you should talk to him about it,” I said.

“Right in the middle of the camp!” Conrad exclaimed, still smarting. “That’s the problem. It’s like…government fucking property. He should have put it up somewhere else. In front of his shelter.”

From what I can tell, the Sovereign Nation of Illyria is about evenly divided between Republicans and Democrats, three of each with one independent—your humble chronicler. We have no social safety net, no taxes, a total lack of laws that would make a libertarian proud. On the other hand, our foreign policy is aimed at peaceful coexistence with our neighbors. And we consider ourselves to be pro-environment. For example, there is no peeing in Piss Brook. Strictly enforced. And we have started husbanding our excrement for the precious resource that it is, and putting it to use it in our farming experiments. You see how this place is the very inverse of our past life? Civilization in negative? Here our very stools—the quintessential waste product—are a measurable portion of our net worth.

It is remarkable how seamlessly our political disputes have moved from our former life into this one. Cole and Conrad still argue about tax policy, for example. And what to do with illegal immigrants. Although, should we die here, as I assume we will, it is unlikely any of this will ever matter again. You see the absurdity, the futility of these arguments we engage in? We have no problem of illegal immigration on Illyria. Nobody has shown up offering to do our laundry or to bag our groceries.

I find myself wondering: if a mutiny were to occur, with whom would my loyalty reside? True, I don’t like Cole. I don’t respect him. Only I don’t think Conrad would be a very good leader. Of course, Conrad and Cole are not the only two possibilities to lead us. There is Andreas—shy, handsome boy of twenty who had been the deckhand and cabin-boy on the yacht. He is bright and level-headed, from what I see, and the only one of us who does not appear to be suffering, who seems to see this as just an extension of his summer, a further break from college. What comforts does one need, after all, at age twenty?

Or perhaps we should try a matriarchal structure, like the Samoans had. Choose Gloria, chattering old lady, as our chieftain. Gloria is perhaps seventy, a widow, grandmother to a dozen grandchildren. She smiles when she speaks of them. The oldest is a lawyer with the Justice Department. The next oldest has a very high grade point average at Temple University. She had been knitting a sweater for her youngest grandchild when the boat went down, and somehow the wool made it onto the lifeboat. She washed it out and dried it and has continued with her project.

One night I am next to her by the fire as she holds the sweater up, imagines her grandchild inside it, considers the proportions.

“Very handsome,” I say.

“Yes,” she says. “Too bad he will never have it.”

“If you believe that,” I say, “then why continue with the sweater?”

“Well, I have to do something,” she says.

“Of course.”

“You have children? Grandchildren?” she asks.

“I have a son.”

She looks understandingly into my eyes, as though she knows what I feel. Only how could she know? “He must be suffering at losing you,” she says.

“I haven’t seen him in thirty-five years,” I say.

“Oh,” she says with a start, and politely changes the subject. “I think it must be harder on the young ones. I mean, we’ve had our time. Right?”

I have to admit I resent slightly Gloria’s intimations that we have something in common in our accumulated years. That we must share the same values. I must be as good, as upstanding, as resigned to death as she is. Gloria worked as a cafeteria lady in a local elementary school, was our cook on the yacht, and is our cook again on the island. She has a stocky stature, and I always imagine her in her white cafeteria uniform, arms folded under her shapeless, megalithic breasts, looking out over the children. The hairnet and sagging stockings, the cakes of flour-white make-up.

She has a slap-your-hands-together, let’s-get-down-to-business kind of spirit about her, is chipper in a way that I find unnervingly mindless, as though she is dealing with the seven-year-olds at her school, and—aside from some greater understanding of responsibility—is much at their level. I see her helping out on some field trip, there in the back of the bus, happily, even joyously, singing Ninety-nine bottles of beer on the wall with the children. I can safely say that nobody here on the island has warmed to her in a way that I imagine the singing children might have.

Has Gloria considered me as a possible object of romantic interest? Clearly, I am not capable of this, not merely because we have nothing particularly in common, but because my heart already belongs to another.

I have yet to say much of myself, so let me offer a few words here. I am a man in his eighties. My name is Hans. The hairs on my head have been reduced to a few scattered strands, sparse as the hairs on a coconut or the hairs on a testicle. I am a refugee, a wanderer, a retired refrigerator salesman, human organ dealer, warrior on the wrong side of history. I am in love with a nineteen-year-old girl. I am speaking, of course, of the aforementioned Dawn.

Dawn, Dawn, Dawn.

Dawn is Cole’s step-daughter. Of course, if the others knew my feelings for her they would be shocked. Or if they weren’t shocked, they would at least feel obliged to pretend to be shocked.

And yet it is true. I am in love with a nineteen-year-old child. And what of it? Why should such feelings be wrong in an eighty-five-year-old and not in a twenty-year-old? At what age does it become wrong to love? Wrong to yearn for youthful beauty? Or do you doubt that I am capable? Let me say that I have been assured by professionals, by those who should know, that I have the genitalia of a much younger man. My erection is as firm as a senator’s handshake. So should I not endeavor to contribute my genes to our little colony before I expire? Should our gene pool include only those offspring of our alpha male, as though we were a troupe of gibbons? Do we really want five Cole juniors for the next generation, five male models, admiring themselves in the reflection in the cove, wondering who is the fairest of them all? Or worse still, all vying to be the leader, dividing up the island, buying and selling their beachfront real estate?

I did not choose this predicament. I am sleeping just a few feet away from a beautiful nineteen-year-old girl. Am I not still a man?

 

It was not supposed to end like this, with us huddled together on a beach somewhere, wondering who is going to die first. How did I find myself on this excursion, after those years ensconced, alone, in my villa by the sea? I was living the life of a recluse, an old salt, an old masturbator, when one morning, on a day just like any other….

Scratch that. I am not ready to tell about that. We will get there. In due time. But now I see I must go back further. I must say something more of myself.

About the Author

Dan Blum

Daniel A. Blum grew up in New York, attended Brandeis University and currently lives outside of Boston with his family. His first novel Lisa33 was published by Viking in 2003. He has been featured in Poets and Writers magazine, Publisher’s Weekly and most recently, interviewed in Psychology Today.

Daniel writes a humor blog, The Rotting Post, that has developed a loyal following.

His latest release is the literary novel, The Feet Say Run.

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Book Spotlight: Miracle Man by William R. Leibowitz & Win Books!

Title: MIRACLE MAN
Author: William Leibowitz
Publisher: Manifesto Media Group
Pages: 385
Genre: Thriller

REVERED REVILED REMARKABLE

The victim of an unspeakable crime, an infant rises to become a new type of superhero. Unlike any that have come before him, he is not a fanciful creation of animators, he is real.

So begins the saga of Robert James Austin, the greatest genius in human history. But where did his extraordinary intelligence come from?

As agents of corporate greed vie with rabid anti-Western radicals to destroy him, an obsessive government leader launches a bizarre covert mission to exploit his intellect. Yet Austin’s greatest fear is not of this world.

Aided by two exceptional women, one of whom will become his unlikely lover, Austin struggles against abandonment and betrayal. But the forces that oppose him are more powerful than even he can understand.

Miracle Man was named by Amazon as one of the Top 100 Novels of 2015, an Amazon Top 10 thriller, an Amazon bestseller and an Amazon NY Times bestseller.

FOR MORE INFORMATION:

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Book Excerpt:

A tall figure wearing a black-hooded slicker walked quickly through the night carrying a large garbage bag. His pale face was wet with rain. He had picked a deserted part of town. Old warehouse buildings were being gutted so they could be converted into apartments for non-existent buyers. There were no stores, no restaurants and no people.

“Who’d wanna live in this shit place?” he muttered to himself. Even the nice neighborhoods of this dismal city had more “For Sale” signs than you could count.

He was disgusted with himself and disgusted with her, but they were too young to be burdened. Life was already hard enough. He shook his head incredulously. She had been so damn sexy, funny, full of life. Why the hell couldn’t she leave well enough alone? She should have had some control.

He wanted to scream-out down the ugly street, “It’s her fucking fault that I’m in the rain in this crap neighborhood trying to evade the police.”

But he knew he hadn’t tried to slow her down either. He kept giving her the drugs and she kept getting kinkier and kinkier and more dependent on him and that’s how he liked it. She was adventurous and creative beyond her years. Freaky and bizarre. He had been enthralled, amazed. The higher she got, the wilder she was. Nothing was out of bounds. Everything was in the game.

And so, they went farther and farther out there. Together. With the help of the chemicals. They were co-conspirators, co-sponsors of their mutual dissipation. How far they had traveled without ever leaving their cruddy little city. They were so far ahead of all the other kids.

He squinted, and his mind reeled. He tried to remember in what month of their senior year in high school the drugs became more important to her than he was. And in what month did her face start looking so tired, her complexion prefacing the ravages to follow, her breath becoming foul as her teeth and gums deteriorated. And in what month did her need for the drugs outstrip his and her cash resources.

He stopped walking and raised his hooded head to the sky so that the rain would pelt him full-on in the face. He was hoping that somehow this would make him feel absolved. It didn’t. He shuddered as he clutched the shiny black bag, the increasingly cold wet wind blowing hard against him. He didn’t even want to try to figure out how many guys she had sex with for the drugs.

The puddle-ridden deserted street had three large dumpsters on it. One was almost empty. It seemed huge and metallic and didn’t appeal to him. The second was two-thirds full. He peered into it, but was repulsed by the odor, and he was pretty sure he saw the quick moving figures of rodents foraging in the mess. The third was piled above the brim with construction debris.

Holding the plastic bag, he climbed up on the rusty lip of the third dumpster. Stretching forward, he placed the bag on top of some large garbage bags which were just a few feet inside of the dumpster’s rim. As he climbed down, his body looked bent and crooked and his face was ashen. Tears streamed down his cheeks and bounced off his hands. He barely could annunciate, “Please forgive me,” as he shuffled away, head bowed and snot dripping from his nose.

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The Story Behind ‘Little Girl Gone’ by Margaret Fenton

The Story Behind the Book

LGGcoverHello everyone!  I’ve been asked to write about the story behind the story, so here goes.  First, please allow me a little background.

Little Girl Gone is the second in the Claire Conover mysteries, and is the sequel to Little Lamb Lost.  Claire is a child welfare social worker in Birmingham, Alabama.  In Little Lamb Lost, Claire gets to work one morning to discover that one of her tiny clients is dead.  Michael was just two years old, so how could he have died?  Soon the police arrest his mother, who has worked so hard to get sober, get her life stabilized, and get him out of foster care.  Claire is convinced his mother had nothing to do with Michael’s death and sets out to prove it.  Claire also meets a handsome computer scientist and a sexy reporter who help her in this mission.

When it came time…

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The Story Behind ‘The Bronx Kill’ by Philip Cioffari

The Story Behind the Book

CioffariCoverColorI should say first that stories don’t come to me all at once. They arrive in fragments, over time. That is especially true of my latest novel, The Bronx Kill. I had the title first. A number of years back—ten or more—I was perusing a map of the Bronx, where I lived into my twenties, and came across the name. The Bronx Kill is a channel of water (so named by the early Dutch settlers) that runs between the Harlem River and the East River in the southernmost tip of the Bronx. I knew immediately it would become the title of a book I would write one day. No story came with the name; that would take another decade to materialize. But that name cried out to me. What a set-up for a double or triple entendre. I loved titles with multiple levels.

Unrelated to this discovery—or so I…

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