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Archive for May, 2017

 

 

For over thirty years, World War II veteran and author Burt Hall assessed accountability in government and national security. Now, this seasoned, professional analyst delivers a tough account of what went wrong in our politics and system of government over the past two decades and what we can do about it.
The right wing (not to be confused with Conservatism) has hijacked the Republican Party and wrecked havoc on our nation. It exploited basic flaws in our system to gain power and a series of major setbacks and a weakened democracy have followed.
The Right-Wing Threat to Democracy lays out clearly what the basic flaws in our system are and how they can be fixed. The danger is that an ongoing shift of political power to the very wealthy and suppression of voting rights is silencing the voice of the average citizen.
If elected officials do not fix the basic flaws, the American people have alternatives in our democracy and must take matters into their own hands.
After early careers in the aircraft electronics field and as a CPA, Burt Hall joined the USGovernment Accountability Office (GAO), where he served as group director analyst on national security and other matters. For more than thirty years, he reported to Congress and testified before its committees on behalf of the GAO. Mr. Hall graduated from the Harvard Advanced Management Program and was loaned twice for two years, once to a bipartisan congressional commission and later to the Reagan White House.With Ed Asner, who also contributed to The Right-Wing Threat to Democracy, Hall coauthored Misuse of Power. He coauthored the bestselling book, How the Experts Win at Bridge, with his wife, Lynn.

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Title: Dark Mind: Star Carrier

Author: Ian Douglas

Release Date: April 25, 2017
Publisher: HarperCollins

Genre: Science Fiction/Fantasy

New York Times Bestselling Author Ian Douglas continues his Star Carrier saga as humanity unites against an ancient artificial consciousness powerful enough to exterminate every species it encounters2425. The civil war between the United States of North America and the Pan-European Confederation is over. But before a new era of peace on Earth can begin, humankind must martial its interstellar forces as one fleet to engage in a war against an alien entity in Omega Centauri. Without provocation, it destroyed a Confederation science facility inhabited by 12,000 people, and it must be neutralized before it sets its sights on Earth.

Admiral Trevor “Sandy” Gray of the USNA star carrier America has his own mission. The enigmatic AI known as Konstantin has convinced him that humanity’s only chance for survival is technology found in a distant star system. Now, Gray must disobey orders as well as locate and create a weapon capable of defeating a living sphere the size of a small planet…

Ian Douglas is one of the pseudonyms for William H. Keith, New York Times bestselling author of the popular military science fiction series The Heritage Trilogy, The Legacy Trilogy, The Inheritance Trilogy, Star Corpsman, and Star Carrier. A former naval corpsman, he lives in Pennsylvania.

 

Monday, May 8

Book featured at I’m Shelf-ish

Book featured at A Title WaveTuesday, May 9

Book featured at The Literary Nook

Book featured at Write and Take Flight

Wednesday, May 10

Book featured at The Dark Phantom

Book featured at Voodoo Princess

Thursday, May 11

Book featured at The Writer’s Life

Book featured at Lover of Literature

Friday, May 12

Book featured at Harmonious Publicity

Monday, May 15

Book featured at All Inclusive Retort

Tuesday, May 16

Book featured at The Revolving Bookshelf

Wednesday, May 17

Book featured at From Paperback to Leatherbound

Thursday, May 18

Book featured at Yah Gotta Read This

Book featured at Inkslinger’s Opus

Friday, May 19

Book featured at As the Page Turns

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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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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:

Amazon | Barnes & Noble

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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She belonged to another… But was destined to be his…



Lady Arbella de Mowbray abhors the idea of marrying an English noble occupying Scotland. When she arrives in Stirling, she is thrown into the midst of a full battle between the Scots and the English. Besieged by rebels, she is whisked from her horse by a Highland warrior who promises her safety. But when he kisses her she fears she’s more in danger of losing herself.



The last thing Magnus Sutherland wants is to marry the beautiful English lass he saved. As the laird of his clan, he has a responsibility to his clan and allies. But when Arbella is attacked by one of his own men, he determines the only way to keep her safe is to make her his. A decision that promises to be extremely satisfying.



Magnus brings Arbella to his home of Dunrobin Castle in the Highlands. And that’s where the trouble begins… Their countries are at war and they should be each other’s enemy. Neither one considered their mock marriage would grow into a deeply passionate love. What’s more, they were both unhappily betrothed and those who’ve been scorned are out for revenge. Can their new found love keep them together or will their enemies tear them apart? 

September, 1297

Northern EnglandArbella de Mowbray contemplated running away. The forest was conveniently to her left and still thick with leaves. Perhaps she could join a ring of outlaws hidden within the imposing foliage.

She shifted restlessly on her mare, arranging her skirts first one way and then another. The horse responded with an annoyed snort. If only she weren’t with a dozen guards and her father.

“Oh, hush, Bitsy,” she scoffed. The animal had no idea what was at stake here.

Anything would be better than permanently leaving England—and for Scotland! The land of heathens, barbarians… Oh, the horrors she’d heard went on there! The men ate their young. The warriors kept the bones of their victims tied to their beards. The horses were trained to sniff out an English lady and trample her to death. The women were witches. The children ran naked, even in the dead of winter. And the winters, how could she forget? No person of truly English blood could survive one.

She was glad that her maid Glenda had told her all she needed to know of Scotland. Although she could have done without the woman’s tears and fainting when Arbella asked her to join her on the journey. As a result, her old maid was not with her—in fact none of the female servants at Mowbray Manor would accompany her. She was alone, without help. Not that she needed help, but it would have been nice when she arrived in a foreign country to have someone with her from home. And while her father promised her husband would provide a maid, that maid would be Scots.

She would die before the new year—either from frostbite or at the hands of the dreaded Scots.

Now granted, her father said she would be marrying an English baron, but that mattered little. They would still reside in Scotland. And no doubt her baron husband would be just as brutal, if not more so, than the savages she’d heard tales of. Indeed, he would have to be if he kept them all tightly reined in. She knew little of her intended. Never met the man. Never heard any stories. He was a mystery. She discounted the things her father told her. He only honeyed the character of Marmaduke Stewart, hoping to sweeten the horror of her upcoming nuptials.

Arbella shivered, and rubbed her cloak-covered arms, contemplating the forest along the edge of the road. Late in the afternoon, the sun was hidden behind the trees making the road to Scotland chilly. A slight breeze blew, wrenching her hood from her head and pulling a few strands of hair from her tight chignon. Arbella tucked the hair back into the knot and pulled her hood over her ears. She hated the cold. Death might take her before the week was out. She’d no doubt shiver like mad in her new bed since the Scots abhorred warming their homes by fire. Another fact from Glenda. One thing was certain—she didn’t want to die anytime soon.

Eliza Knight is a USA Today Bestselling and award-winning author of sizzling historical romance and time-travel erotic romance. Under the name E. Knight, she pens riveting historical fiction. She runs the award-winning blog, History Undressed. When not reading, writing and researching, she likes to cuddle up in front of a warm fire with her own knight in shining armor. Connect with her at http://www.elizaknight.com or http://www.historyundressed.com. You can sign up for her newsletter at  http://eepurl.com/CSFFD. Follow her on social media at:

 

Monday, May 15

Book reviewed at Warrior Woman Winmill

Book featured at Books, Dreams, LifeTuesday, May 16

Book featured at I’m Shelf-ish

Book featured at Write and Take Flight

Wednesday, May 17

Book reviewed at My Book Addiction and More

Book featured at Voodoo Princess

Thursday, May 18

Book featured at The Writer’s Life

Book featured at A Title Wave

Friday, May 19

Book reviewed at Celtic Dragon Book Reviews

Book featured at The Dark Phantom

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GEORGE FINNEY, ESQ., has worked in Cybersecurity for over 15 years and is the author of No More Magic Wands: Transformative Cybersecurity Change for Everyone. He is currently the Chief Information Security Officer for Southern Methodist University where he has also taught on the subject of Corporate Cybersecurity and Information Assurance. Mr. Finney is an attorney and is a Certified Information Privacy Professional as well as a Certified Information Security Systems Professional and has spoken on Cybersecurity topics across the country.

WEBSITE & SOCIAL LINKS:

WEBSITE | FACEBOOK | GOODREADS

About the Book:

Once upon a time there was a company that made magic wands, but when they were hacked all the magic in the world couldn’t prevent their data from being stolen. If that company had a chance for a clean start, what would they have done differently? The unlikely hero isn’t a security guy. She’s a business elf who makes it her mission to change the way her company does business from the top down.

Most books on Cybersecurity are written for highly technical professionals, focus on specific compliance regulations, or are intended for reference. No More Magic Wands is different…it takes complex security concepts and puts them into practice in easy to read, relateable stories.

No More Magic Wands is available at AMAZON

Would you call yourself a born writer?

I was drawn to books from the moment I was born.  Some of my very earliest memories are of learning to read and being so excited when I would read books to my parents.  I think that must be how I got the storytelling bug.

What was your inspiration for No More Magic Wands?

One day at work I overheard someone jokingly say they wished they could make one of their security problems go away by waving their magic wand.  Later on, I saw someone who had one of those Harry Potter replica wands in their office and I wondered what it would be like to tell a story about a magic wand company that was hacked.  How would someone who actually had a magic wand go about solving their security problems?

What themes do you like to explore in your writing?

I’m interested in exploring the rules we create when we tell a story.  The characters that we create all have to follow some constraints.  The mini-societies the characters live inside of all have their own norms and the narrative itself requires you follow consistent conventions throughout.  I think when you know the rules, writing the story just follows naturally from there.  I love seeing what happens when you break the rules.

How long did it take you to complete the novel?

It took almost two years.

Are you disciplined? Describe a typical writing day.

I have a full time job, so on most days my writing consists of just taking notes as things occur to me.  Then on the weekend, I’ll spend several hours compiling all of those notes and exploring some of the ideas that I had in more detail.  I like this method because it gives me plenty of time to thinking about those things between the time I took the note and the time I started writing.  Once I was about a third of the way through and had a lot of notes compiled, I took two weeks of vacation to sit down and write every day and got through most of the rest.

What did you find most challenging about writing this book?

Since each fable focuses on a different concept in cybersecurity, it was a big challenge to make the whole narrative consistent.  I wanted to say a lot of things, but I didn’t want it to feel disjointed.  I think the answer, for me, was to have a theme that ran through the whole book.  I didn’t want to have the same characters in every fable.  I wanted you to get the feeling, through the course of the book, that the number of people involved with solving these cybersecurity problems was growing exponentially.  By the end, I wanted it to be believable that cybersecurity was actually something that we can get better at because so often, we in cybersecurity will say that people will always be the weakest link, and I don’t think that has to be the case.

What do you love most about being an author?

The process of writing really helps with my self-confidence.  My favorite thing is discovering those new ideas that just seem to come from nowhere.  There are times when I can’t believe it was me that put that on paper.  It’s a kind of affirmation, for me.  It feels like I am smart enough or clever enough or I’m working hard enough to do really good work.  It’s something that the rest of the world always seems to question or challenge.  Writing answers that question.

Did you go with a traditional publisher, small press, or did you self publish? What was the process like and are you happy with your decision?

I self-published through Amazon, and it was a very smooth and quick profess for me.  I feel like this was a great option for me, and it doesn’t necessarily close any doors.  I think the door to traditional publishing is still open.

Where can we find you on the web?

My blog’s address is www.strongestelement.com or you can follow my No More Magic Wands facebook page.

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Inside the Book:

 

Title: Political Straight Talk

Author: H. John Lyke with Kathryn L. Robyn

Publisher: iUniverse

Genre: Political

Format: Ebook

In writing the Declaration of Independence and the Constitution, our Founding Fathers established a democratic republic with a solid political basis. What they wrote was the political map that future representatives would need to follow to conduct the people’s business in an efficient and effective manner. As long as they faithfully carried out the people’s will, our democracy and republic would function in a way congruent with our forebears’ wishes.



What in the world happened?



H. John Lyke, a board-certified psychologist and professor emeritus at Metropolitan State College of Denver, and the author of multiple political psychology books, suggests that ever since George Washington retired as captain of our ship of state, subsequent presidents and members of Congress have failed to use the sailing chart of the Constitution. Instead, they’ve chosen to pursue their own and their political parties’ self-interests.



Lyke uses psychological principles to explore the reasons why our government has fallen so low, and in the voice of a kind but determined therapist, he offers simple and viable solutions to get us back to following our map.


Guest Post:

Why Bother Writing about Politics?
 Writing about politics is a strange thing. For one, ongoing events make your work obsolete the minute you type the last period. This has certainly been true for John (H. John Lyke) and me, the co-authors of Political Straight Talk: A Prescription for Healing Our Broken System of Government. In fact, the book started (before I even got involved with it) as a blog that John used to keep his previous book, What Would Our Founding Fathers Say?—How Today’s Leaders Have Lost Their Way, current and relevant. Once what was being called “gridlock” in Washington, DC, was clearly not going to loosen up, he knew he had to put those blogs into a new book. Now we find ourselves scrambling with blogs again, trying to keep PST current and relevant.
Because of this terrible speed of being in our time (apologies to Milan Kundera), we don’t approach political writing in quite the same way as other news junkies tend to do. We focus on what John calls “the simple truths of life,” those values that make up a human being’s integrity—virtue, empathy–compassion, and being of service—as well as the psychology of the players and the electorate. These things are universal truths. These things our Founding Fathers held in the forefront in their dealings with one another, though they submerged them in their dealings with those they saw as different: the Native Peoples, the enslaved people abducted from Africa, white men who did not own property or worked for others, and all women in general. As the new government got settled and we developed as a country, the struggles of these groups, as well as the immigrants arriving in waves from all over the world, to achieve the same status of liberty and justice that was promised to all, in the Constitution, would become the history of the progressive movements.
That brings us to today. Events impact these things, but these things don’t themselves change. So that’s how we approach our political writing. We look at the values written down by the Founders and promulgated (or opposed) by today’s politicians and contrast them with the subtext, what values are actually being promoted by the actions of our past and present leaders. Consequently, we find ourselves digging into a complex web of psychological process that affect all of us—how we might think we believe one thing but actually believe something else, as revealed in our behavior.
When we started writing like this—for John, over 15 years ago, and for me when I started working with John around five years ago—no one else was doing it. Now we see the words we use—ego defense mechanisms, narcissism, cognitive dissonance, empathy, compassion, public service, and the like—becoming more and more common. We hope we helped to add that piece of awareness to the national discussion of what keeps the country running well for everyone—or doesn’t, as the case may be.
Please visit the book’s website at www.lykeablebooks4u.com to see what’s happening now. You can find our blogs there as well. And please join us in the discussion to make this a country we can become proud of if you have never been or again if you once were. Mind you, we will ask you to reflect deeply into your thoughts and report honorably on how you feel and why.




Meet the Author:


Dr. Lyke earned his master’s degree in clinical psychology at Temple University in Philadelphia and his doctorate at Michigan State University. He is a board-certified psychologist and professor emeritus at Metropolitan State College of Denver, and was a clinical psychologist for the State of Colorado for many years. He has written the political psychology books The Impotent Giant and What Would Our Founding Fathers Say: How Our Leaders Have Lost Their Way, and co-authored a psychology self-help book, Walking on Air without Stumbling. He lives in Denver and has three grown children and four grandchildren. To find out more, please visit lykeablebooks4u. com, where you can read more about him as well as follow his current and archived blog posts.



More important to John, however, is that you join the discussion at lykeablebooks.wordpress.com, where the blog originates and you can post your comments.

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