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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:

WEBSITE | TWITTER | FACEBOOK

About the Book:

 

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

Would you call yourself a born writer?

Not at all.  I went to engineering school in college, and you never have to write in those classes.  Going to law school taught me how to write, and that’s where I gained my passion for writing.

What was your inspiration for Chasing Hindy?

The genesis behind Chasing Hindy came from a surprising source—a hypnotist. When I was in high school, we had an assembly where a hypnotist put a group of volunteers under hypnosis. One of the questions he asked them was what would be the fuel of the future. What fuel would people pump into their tank? Almost without exception they all said, “water!” The hypnotist then told the audience that every time he asked that question he received the same answer.

That was several decades ago, but I’ve always wondered whether that could possibly be true—and why all these people thought we’d all be driving cars that used water. In the following years, I realized that a car wouldn’t run on water per se, but from hydrogen that is extracted from water. The question, of course, is that if we know how to produce hydrogen, why aren’t there hydrogen cars? The answer is quite simple. As an engineer and patent attorney I know the science behind extracting hydrogen from water. The problem is that it takes more energy to do this than to just run a car on gasoline, or even electricity.

But what if somebody invented a way to make it happen? That’s the germ of an idea that led to Chasing Hindy.

Then, of course, is finding an idea for a main character. For me, a good character is far more difficult than finding a story idea. Not only does the character need to make the story line happen, but the readers need to relate to what the character is experiencing. I struggled with such a character for years, and, in fact, rewrote the book several times with other characters that just didn’t seem to work.

What made the story finally click was my discovery of Addy—a patent attorney with a dream to change the world. I decided on a female character (who was also a patent attorney) for several reasons. Perhaps the main reason was that female patent attorneys are in short supply and I wanted to encourage women to enter the profession. So I created Addy to hopefully show what a difference one person can make, and through her experience more women would want to become patent attorneys. What I love about Addy is her determination to make the world a better place, no matter the cost.  But you’ll have to read the book to see what obstacles she must overcome.

What themes do you like to explore in your writing?

I like to take a character through a journey where her innermost beliefs are challenged, and even rocked to the core, in order to see how she will respond. Life is about journeys, and I think every book should take the reader on quest that changes the character and tells an important life lesson.  For example, my last book, Gil, is about transcending opposites and how opposition can be used to open your heart to compassion.

How long did it take you to complete the novel?

Chasing Hindy took me over 15 years and five rewrites.  The reason why is because I could never find a main character that I liked. That all changed when I came up with Addy, whose story I mention above.

Are you disciplined? Describe a typical writing day.

Sometimes too disciplined.  Since I am a full time patent attorney, I take every free minute to write.  It’s usually at five in the morning, on weekends or on a plane.  I love writing on airplanes because there is nobody who can interrupt your thought process.

What did you find most challenging about writing this book?

As I mentioned above, finding a main character was the most difficult.  But explaining how a car can actually run on water was also a challenge.

What do you love most about being an author?

Writing.  As Stephen King is fond of saying, as long as you can wake up and write, life is going to be okay.

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 went with a small press—Koehler Books. Koehler published my last two books, The Vintage Club and Gil, and we’ve had a great working relationship.  As such, I decided to use them for Chasing Hindy as well.

Where can we find you on the web?

I am at http://www.daringibby.com

 

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Andi O’Connor is the award-winning author The Dragonath Chronicles, The Vaelinel Trilogy, and The Legacy of Ilvania. She’s written multiple books, including the critically acclaimed Silevethiel, which is the 2015 Best Indie Book Award winner for Science Fiction/Fantasy, and the 2015 New Apple Official Selection for Young Adult. Silevethiel was also named to Kirkus Reviews’ Best Books of 2013. Andi’s short story collection, Redemption, is a 2014 Kindle Book Awards Semifinalist.

You can frequently find Andi as a ​guest panelist at Comic Cons throughout the country including the Rhode Island Comic Con, Philcon, Conclave, WizardWorld, and Chessiecon. Andi also writes for Niume where she provides writing tips, advice, and insight on her career as an author. You can connect with Andi on Facebook, Twitter, and Instagram. For more information, visit Andi’s website.

About the Book:

Darrak’s adventure concludes with this thrilling finale of The Dragonath Chronicles!  

Following the betrayal of two of his trusted companions and a devastating battle in Mystandia, Darrak’s talents are desperately needed by the citizens of both Earth and Dragonath. Torn with the decision of where his loyalty should remain, he finally decides to confide in Andillrian. Together, they craft a plan they hope will save Darrak’s home planet, but their optimism is short-lived.

The Hellborn’s army has begun the march to war.

With less than two weeks of preparation remaining, their weaknesses become unavoidably apparent. Planning for defeat suddenly becomes as important as planning for victory. Darrak’s insecurities continue until the moment the first arrows begin to fly. He can only hope that help from a few unlikely sources will be enough.

For if they fail, Dragonath will fall.

ORDER YOUR COPY:

Amazon

Would you call yourself a born writer?

Definitely! It comes naturally to me! I’ll even let you in on a little secret: I have absolutely no formal training. I’ve never taken a creative writing class in my life or attended any workshops. I’ve had a few authors and an editor (none of whom had read a word of my writing) tell me that I should get formal education in writing because that’s the way it should be done, and I politely said ‘thanks, but no thanks.’

Here’s the thing, I don’t think I need it. Whatever I’m doing is working for me. I have my own style that just came naturally, and I roll with it. I’ve won six awards to date, and the majority of my reviews are positive. I feel like if I took a formal class or workshop, it would screw with whatever is currently going on in my brain, so I’m content to leave well enough alone!

That being said, I don’t want it to sound like I don’t work to improve my writing. I do! Every author should. I just don’t do it in the traditional manners!

What was your inspiration for CALL TO WAR?

Call To War is the third and final book in a series, so the inspiration came from the previous two books in The Dragonath Chronicles. It picks up right where Awakening ended and deals with the main character, Darrak, essentially torn between two worlds. He’s tormented by the fact that he doesn’t truly belong anywhere but not wanting to turn his back on anyone.

There are some great twists and turns in Call To War, and characters’ secrets are finally revealed, making it all the more exciting. The main conflict is the final battle between Darrak’s supporters and the Hellborn who is seeking to destroy Darrak’s bloodline and claim rule over all of Dragonath.

What themes do you like to explore in your writing?

There is absolutely nothing I refuse to write about, and I have included many controversial topics in my writing such as abortion, religion, rape, abuse, suicide, and global epidemics. Call To War alone deals with rape, abuse, global terrorism, and environmental destruction. I write about these issues because they’re relatable. They’re things that affect many of my readers and can help them think and reflect on their own lives and societies. I’m a huge proponent of talking about and facing issues and learning about both the issues and their consequences. Ignoring something doesn’t make it go away.

How long did it take you to complete the novel?

About a year from writing the first word to holding the printed book in front of me.

Are you disciplined? Describe a typical writing day.

You have to be disciplined to be a writer, even if it’s not what you do full-time. It’s easy to get distracted by other things, particularly if you write at home. I write full-time, so a typical day for me starts at 8 in the morning and goes until 6 or 7 at night. I’ll take the morning to work on marketing, promotion, accounting, organizing personal appearances, and preparing for any upcoming events. The afternoons and evenings are set aside for writing or editing, depending on the stage of my work.

What did you find most challenging about writing this book?

The most difficult thing in writing Call To War was writing the love scene. I’d written rape scenes before, but never a love scene, which was challenging in itself, but the book as a whole is extremely dark and violent, with the characters being in dire situations. A love scene felt right between two of the characters, but writing it, and writing it so it wasn’t out of place with the rest of the story, proved difficult.

What do you love most about being an author?

Touching people in ways I never thought possible. It’s truly incredible to me that my books have helped people get through some of the most difficult times in their lives, and it’s the most rewarding feeling imaginable.

I had one reader write to me saying she had cancer. What got her through her chemotherapy sessions was visualizing my elf city of Silverden from Silevethiel. Every time she went in for treatment, she would picture herself in the world I’d created, and it would help to calm her enough so she could forget where she was and why she was there.

Another woman told me that the relationship between Irewen (a human) and Silevethiel (a lion) perfectly captured the love and friendship she had with her cat. Re-reading scenes from Silevethiel helped her recapture the memory of that bond after her pet’s death.

Hearing such personal stories of how my work has affected people and brought hope into their lives makes being an author tremendously worthwhile. They vanquish all of the frustrations that come with the job and are what make being an author amazing. They’re why I’ll continue to write until my last breath.

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?

My first book, The Lost Heir, was originally published through a small press. I hated the experience and the amount of control I lost. I have since self-published all of my books, including Call To War, and re-released The Lost Heir under my imprint, Purple Sun Press.

I am extremely happy with my decision to switch to self-publishing; however, it takes a great deal of work and money and can at times be quite frustrating. I essentially follow the process of a traditional publisher and hire editors, a cover designer, a printer, and a distributor so it is done professionally and available to all major stores/retailers, libraries, indie bookstores, and distributors. The best compliment I had when I was still unsure of whether I’d made the correct decision to self-publish was before I’d re-released The Lost Heir. Someone thought that was the self-published book and Silevethiel, the first one I’d actually self-published, was the one that had gone through a traditional publisher. It was at that moment I knew I’d made the right decision.

Where can we find you on the web?

Website: www.andioconnor.net

Twitter: www.twitter.com/oconnorandi

Facebook: www.facebook.com/oconnor.andi

Instagram: www.instagram.com/andi_oconnor

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Title: THE DISCOVERY
Author: Louis Kraft & Robert S. Goodman MD
Publisher: Createspace
Pages: 311
Genre: Legal Thriller

In THE DISCOVERY by Robert S. Goodman and Louis Kraft, a young obstetrician/gynecologist delivers a premature baby after attending a dinner party. The child survives the delivery, but complications lead to a malpractice lawsuit two decades later.

In 1952, a pregnant seventeen-year-old gives birth in a Los Angeles hospital. Two nurses attend to the young woman while they wait for the doctor on call to arrive for the delivery. Dr. Harry Chapman arrives at the hospital clearheaded but with alcohol on his breath. The premature baby is born blue and placed in an incubator. The nurses turn the oxygen to the level recommended to pediatricians for preemies the year before to prevent blindness. When the baby’s color doesn’t change, Harry instructs the nurses to turn the oxygen up to maximum. They protest, but Harry insists that the nurses comply to save the baby from brain damage or death.

In 1972, Greg Weston, a twenty-year-old paralegal meets a young woman who works with a renowned pediatrician. When she questions the attractive young man about his blindness, Greg reveals that his adoptive parents told him he was born blind. After agreeing to see the doctor Gail works for, Greg becomes aware that his blindness may have occurred as a result of physician error. Greg requests his medical records from the hospital and the adoption agency, and he finds that the hospital records tell a different story about what took place after his birth. In both records, Dr. Harry Chapman is indicated as the doctor who delivered him. Greg shares his findings with a partner in his law firm, and they build a case against Dr. Chapman based on fraudulent changes in the hospital records, which allows the statute of limitations to be thrown out.

After Harry receives word that he is being sued, his attorney advises him that the malpractice insurance he carried in 1952 will not cover even a fraction of the multimillion-dollar lawsuit. The stress and uncertainty of the case, along with the accusation of fraud, breaks Harry, leading him down a road of depression and alcohol dependence. As Harry’s wife, Helen, watches her husband deteriorate, she makes an unthinkable choice to put an end to the plaintiff’s case.

In THE DISCOVERY, the authors connect the lives of two individuals across two decades, exposing vulnerabilities, bitterness, and frailties. As the case moves forward, a key witness’s testimony alters the lives of both men.

In writing THE DISCOVERY, Goodman and Kraft’s intentions were to offer readers multidimensional characters with real-world problems and to bring awareness to the severe affect malpractice lawsuits can have on physicians’ professional and personal lives.

The Discovery is available at Amazon.

Book Excerpt:

An hour later Martin pulled into Harry’s driveway and parked next to Sid’s car. Harry, who rode shotgun, swung the door open and ran to the front door, where he fumbled with his keys. Sid opened the door and waved him inside.

“You seem like a man in a rush,” Sid said.

“Only to those who peer out of windows!” Harry pushed past Sid and rushed into the living room. He didn’t see Helen and moved into the kitchen. No Helen. Harry ran to the family room, but it was empty. He looked at the bar.

“Thirsty?” Sid said from behind him.

Harry ignored the comment. “Where’s Helen?”

“In your bedroom.”

Harry crossed to the couch in front of the TV set and slumped into it.

Sid sat next to him. “From a man in a hurry, it appears that you’ve suddenly run out of gas.”

“Look, pal, I know a hell of a lot more than you do.”

“Really? You don’t say, Harry. Well, I’ve got news for you. You don’t know your ass from a hole in the ground!”

Harry glared at Sid, as he formed a fist.

Sid smirked. “Go ahead and swing away.”

“What’s going on here?” Harry said as he relaxed his hand.

“Don’t ask me; ask your wife.”

Surprised, Harry leaned back on the couch. “What are you talking about?”

“I sure as hell know!”

“Tell me!”

“Nope. You want to know, you talk to Helen.”

“She won’t talk to me.”

“Maybe she will.”

“Tell me!”

“I promised Helen that I wouldn’t repeat what she told me. To anyone.

Harry had no idea what Sid spoke of and glared at him. “You know, sometimes you are a real pain in the ass.”

“And you’re a complete schmuck. Look Harry, you had better talk with her.” Harry didn’t move. “Now!”

Allen leaned into the room. “Is everything okay?”

“Yep,” Sid said, “couldn’t be better.”

“Then join us.”

“Soon.” He turned back to Harry. “For the last time Harry, get upstairs and talk to Helen.”

Harry stood but then glared at Sid.

“Harry, use your heart when you listen to her.”

“What are you talk—?” Suddenly frightened, Harry ran to the staircase and leaped up the steps two at a time. The door to their bedroom was closed. Harry opened it and stepped into the room. It was empty, but then the door to the bathroom opened and Helen appeared. Her hair was wet and dangled over her shoulders. She had an oversized towel wrapped around her body.

“What do you want?”

Meet the Authors

Author/historian Louis Kraft has focused his energy on producing work that highlights racism and the human experience of people who have put their lives on the line to prevent war. He has written articles for magazines, including Research Review and Wild West, as well as fiction (The Final Showdown) and nonfiction (Gatewood & Geronimo) books. Kraft returned to fiction writing when he collaborated with Robert S. Goodman on The Discovery.

Robert S. Goodman, MD has been in private practice since 1966, specializing in internal medicine. During his fifty-plus-year career, Goodman has been involved in hospital politics and served as chief of staff at Encino Hospital Medical Center. Dr. Goodman’s experience testifying as an expert witness in defense of hospitals and doctors contributed to his interest in writing The Discovery.

Visit their website at www.readthediscovery.com.

 

 

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U.L. Harper is a speculative fiction/horror author, influenced by magical realism. A former journalist from Long Beach, California, he now resides in the evergreen state of Washington with his wife. He is a soon-to-be father, and an avid Dodgers fan.

His latest book is the speculative fiction/horror/magical realism novel, THE SECRET DEATHS OF ARTHUR LOWE.

WEBSITE & SOCIAL LINKS:

WEBSITE | TWITTER | FACEBOOK

About the Book:

While in the process of bringing his wife, Sandra, back to the living, Arthur journals about moments from his past that changed him.

During the journal writing, he rediscovers how, as an orphan, his ability to animate objects and people to life may have ultimately destroyed the lives of the few who grew close to him. The old stuffed teddy bear that helped him assemble puzzles when he was a child might have been too much of a secret for his adoptive mother to keep. His friend Quincy, who had abilities similar to his, might have been scared away by Arthur’s abilities. And his grade school teacher is still harboring a secret about his biological father that she can only hope to be true.

Once Sandra is alive again, things become more complicated. She claims Arthur is not who or what he thinks he is. Her ire shines a spotlight on the insidious but most likely true, unspoken nature of their relationship.

In the meantime, a mysterious smell envelopes the community—a stench so heinous it can be fatal. As the number of deaths from the stench mounts, Arthur must decide who to animate back to life and who remains dead.

The Secret Deaths of Arthur Lowe is available at AMAZON.

Would you call yourself a born writer?

In my opinion, I’ve always been in a process of becoming an author. It’s how I observe things, and how I read. It’s always been there. As a matter of fact, I have two middle initials and can’t think of another reason to have them accept for a writing name. My middle names are Uriah Lejan. U.L. So, yeah, I was born as a writer, I suppose.

What was your inspiration for The Secret Deaths of Arthur Lowe? A number of things, including how Arthur was originally going to be a super hero. After that didn’t work, his relationship with his wife is what did it for me. It was going to be a love story, but it turned into something else.

What themes do you like to explore in your writing?

For some reason, I like to talk about depression. The core of most of my stories are the worst things that have happened to the character and how they deal with it. The latest is no different. Arthur deals with worst case scenario more than once in his life, and everything is actually about how he handles it.

How long did it take you to complete the novel?

I’ve been writing this one for a while. It’s had many iterations, and I’m not talking about just drafting. It was originally being outlined as a comic book. It did nothing but change since then. Let’s say three years and some change. Up to this point, these are the hardest 210 pages I’ve done. Then somebody comes along and reads it in few hours. I guess that’s a good thing.

Are you disciplined? Describe a typical writing day.

I’m not disciplined. I can get sidetracked by most things. I don’t really keep a schedule. I just make sure I get whatever I’m doing done in a timely manner. A lot of times when I’m being professional and writing because it’s the time of day for me to write, man, I have to change all that up anyway. I’m far more focused after say the second draft. Then the timing makes plenty more sense, and from there I still don’t have a schedule, but I write for longer periods of time. I become aggressive with the storytelling at that point.

What did you find most challenging about writing this book?

Most challenging? From a technical standpoint, retaining tension. Because a lot of it is told in flashback it’s easy to release tension, which I didn’t necessarily want to do. So how I do that is pretty interesting, I think. From a character angle, creating sympathy for Arthur and another character became a chore. They’re not obviously people to root for, no matter how interesting. Then there are the women in the story. These are strong women, but they don’t come from a place of strength.

What do you love most about being an author?

Um, right now there are no obvious pluses. However, I do like the process of writing. You know, getting a glass of whiskey and some chocolate, turning on some bebop jazz, going to the screen and just killing it.

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. I really wanted an agent but I just don’t think this story or any that I do have easy to find markets. For instance, Arthur Lowe is not a horror story, but beta readers definitely said that can be the case. It dips into magical realism but that’s not at its core. The tone is of literature, but when you get into, man, it’s just not that. On the other hand, I the process was fantastic. I had my beta readers all ready to go. I paid a proofreader. Paid the cover artist, who I’ve used for years now. That went really well. The revision process was profound as usual. The marketing seems to take a bit of leg work and a few dollars but, oh well.

Where can we find you on the web?

I actually don’t mind if you email me ulharper1@gmail.com. @ulharper is my twitter handle. And on facebook, search for the U.L. Harper fan club. My new website will be here shortly. Got to get that done.

 

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Freda Hansburg is a psychologist and Tell On You is her debut trade thriller.  She self-published the suspense novel Shrink Rapt and co-authored two self-help books, PeopleSmart – a best-seller translated into ten languages – and Working PeopleSmart.  Freda lives in the South Carolina Lowcountry, where she is working on her next novel and her Pickleball game.

Her latest book is the thriller, Tell On You.

WEBSITE & SOCIAL LINKS:

WEBSITE | TWITTER | FACEBOOK

Would you call yourself a born writer?

Yes and no.  Yes, in that I’ve been writing all my life.  Everything from poetry to journalism, advertising to scholarly articles, fiction and nonfiction.  No, in the sense that people become and remain writers by doing the ongoing work of writing.  There’s no gene that gives you a free pass.

What was your inspiration for Tell on You?

As a psychologist, I’ve listened to many, many stories.  I don’t break patient confidentiality, but will acknowledge that some of the situations people shared inspired me to weave this dark work of fiction.  I also wanted to zoom in on a marriage in crisis and explore how a couple weathers the storm.

What themes do you like to explore in your writing?

I like to prowl the dark corners of the heart.  I’m drawn to characters who are dangling off a precipice, hanging on by their fingernails, and then are forced to let go.

How long did it take you to complete the novel?

Tell on You took about two years and went through five drafts.  A big improvement from my earlier, self-published thriller, Shrink Rapt, which took eight years and heaven knows how many drafts.  Maybe I’m getting the hang of it.

Are you disciplined? Describe a typical writing day.

I generally get my exercise and chores out of the way and sit down to my writing in the early afternoon.  I’d say I’m moderately disciplined and when I’m in the zone, I’m a demon.

What did you find most challenging about writing this book?

Creating a deeply flawed protagonist.  Driven by his infatuation for his beautiful 16-year-old student, teacher Jeremy Barrett does some incredibly stupid, irresponsible and even unethical things.  The challenge was to make him human enough for the reader to follow his journey.

What do you love most about being an author?

Two things.  One is becoming so lost in the flow of writing that, when I look up, I have to remind myself what day it is.  The other is having readers tell me:  “I loved your book.  I couldn’t put it down.”  It’s wonderful to bring people pleasure.

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?

After self-publishing my first thriller, I went with Micro Publishing Media, a small hybrid press, this time around.  It was a much better experience, bringing me access to amazing talent for cover art, book design, promotional trailers, etc.  Now we’ll see how the sales go.

Where can we find you on the web?

My website is www.fredahansburg.com

On Facebook, www.facebook.com/FredaHansburgAuthor

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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.

WEBSITE & SOCIAL LINKS:

WEBSITE | TWITTER | FACEBOOK

About the Book:

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 begins 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:

Amazon | Barnes & Noble

Would you call yourself a born writer?

I was certainly a born daydreamer, and I suppose that translated into wanting to write stories.  But there is also a craft and that took some time to acquire.  My early writing efforts have thankfully been lost to the ravages of time.

My first passably decent piece of prose was actually letter I wrote to in college to a girl who I was interested in.  It was a long, rambling, comic description of a train ride I was on, and it was something of an “aha” moment about how to inject life and wit into descriptions of the everyday world around you. Thinking back, it is not really surprising that my best early bit of prose was born of an effort to impress a girl.

What was your inspiration for The Feet Say Run

My previous novel, Lisa33 was an avante-garde sex comedy set on the internet.  I had received a large advance for it, but in the end the publishing experience was quite disastrous.  I wanted to get as far away from it as possible.  A harrowing war story set in Nazi Germany was surely about as far from an internet sex farce as one could get.

Of course, there is more to it than that.  I had grown increasingly interested in the idea of literary fiction that also made for a gripping page-turner.  And I was drawn to the idea of telling a big, epic tale of human comedy and tragedy, of cruelty and compassion and blindess and brilliance, through a single, long life.  Gradually, from these disparate threads and ideas, the book began to take shape.  I honestly never had a moment where I decided, “I am going to write another novel.”  I just began poking around.  And then I was in too deep, immersed, and – to borrow a war metaphor – there was no retreating.  The only way out was forward.

What themes do you like to explore in your writing?

I like going for the big ones:  love and hate, cruelty and compassion, sex and sorrow and death.

Many readers, survivors of Literature 10, seemed conditioned to ask, “what is does your book mean”? .  Yet few novelists go around planting hidden meanings, symbols, like so many Easter Eggs, waiting to be discovered.  (Perhaps some modern poets make a habit of this, but if you ask me, it’s a pretty annoying habit.)  In my own experience, what a good novelist wants to say, in almost every case, is pretty much right there in the story itself:  What it feels like to be alive, to have this odd thing we call consciouness, to have this or that extraordinary experience, to be alive in this time in history and in this particular place.

In The Feet Say Run the plot is intricate and involved, but what it says is not: That humans are capable of extraordinary cruelty and kindness, stupidity and brilliance; that life is chaotic and complex;  that this sturdy-seeming thing we call civilization is in truth desperately fragile.

How long did it take you to complete the novel?

I worked on it on and off for six years.  I was working for most of that time, and dropped it for months at a time.  But it was still a pretty ambitious project.

Are you disciplined? Describe a typical writing day.

I am driven, but not terribly disciplined, and have no particular pattern.  I have no particular pattern. I am neither nocturnal nor diurnal. I’m an omnivorous reader and a restless scavenger as a writer.  Whatever I am doing, in the back of my mind I am thinking about how I need to get back to my book.

What did you find most challenging about writing this book?

It is narrated by a German who grew up in the Nazi era.  As a Jewish writer from Long Island, this took a lot of research as well as a leap of faith.  That I made my narrator an essentially sympathetic character also greatly worried me.  Would I be attacked as apologist for Naziism?  But so far I have now found readers and reviewers who have had trouble with this.

What do you love most about being an author?

I truly love the writing process.  It is the best puzzle, the most intriguing brain-teaser, the most intricate and joyous daydream, all rolled into one.   Of course, getting feedback and feeling that I’ve entertained and communicated is gratifying as well.

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?

My first novel was with a traditional publisher, Viking, and The Feet Say Run is with a small press, Gabriel’s Horn.  My Viking experience was very mixed – mainly because my hopes had been raised to high.  Gabriel’s Horn has been all positive.  They found me after I’d posted a couple of poems on a public website, we started a correspondence and they asked what else I wrote.  So they really found me, rather than the other way around.   In a way I feel I have had the extremely rare experience of having been “discovered,” forgotten, and then once again “discovered” – with no awareness that I was already a published writer.

Where can we find you on the web?

I have a humor blog, “The Rotting Post”.  It has nothing to do with my serious writing, but there is a tab on with some more about my books, and an email address.   And of course, The Feet Say Run is out there on Amazon and Barnes and Noble, etc.

 

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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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