Friday, August 18, 2017

Excerpt reveal: Beautiful Mess, by John Herrick


Beautiful-Mess-Low-Resolution-Color-Book-CoverTitle
: BEAUTIFUL MESS
Genre: Fiction
Author: John Herrick
Website:  www.johnherrick.net
Publisher: Segue Blue
Find out more on Amazon
About the Book:
Protagonist Del Corwyn is an aging relic—an actor who climbed from errand boy to Academy Award nominee; who kept company with Hollywood’s golden era elite; who even shared a close friendship with Marilyn Monroe. But now, Del Corwyn is facing bankruptcy. Humiliated and forced to downgrade his lifestyle and sell the home he’s long cherished, Del is destined to fade into a history of forgotten legends—unless he can revive his career. All he needs is one last chance. While searching through memorabilia from his beloved past, Del rediscovers a mysterious envelope, dated 1962, containing an original screenplay by Marilyn Monroe—and proof that she named him its legal guardian.  Seemingly overnight, Del goes from bankrupt, washed up has-been to the top of Hollywood’s A-list. But the opportunity to reclaim his fame and fortune brings a choice: Is Del willing to sacrifice newfound love, self-respect and his most cherished friendship to achieve his greatest dream?
Beautiful Mess follows one man’s journey towards finding love and relevance where he least expects it—and proves that coming-of-age isn’t just for the young.
About the Author: A graduate of the University of Missouri—Columbia, John Herrick explores themes of spiritual journeys and the human heart in his works. Herrick’s debut novel, From the Dead, hailed as “a solid debut novel” by the Akron Beacon Journal, achieved Amazon best-seller status, while Herrick’s second novel, The Landing, was named a semifinalist in the inaugural Amazon Breakthrough Novel Award contest. Herrick’s nonfiction eBook, 8 Reasons Your Life Matters, received over 160,000 downloads and landed at #1 on Amazon’s Motivational Self-Help and Christian Inspiration bestseller lists.  His third novel, Between these Walls, garnered high critical acclaim, including Publishers Weekly’s prediction that “Herrick will make waves.” John Herrick is a native of St. Louis. Visit him online at: www.johnherrick.net
Connect with the Author on the Web:
BEAUTIFUL MESS
JOHN HERRICK
EXCERPT
            Arnie’s cheeks turned rosy as he grinned at Del. A wide, toothy grin. The discoloration of enamel betrayed a long-entrenched penchant for red wine. He rolled the script and slapped it against his palm.
“Do you realize how many people would dry-hump a flagpole to get their hands on this?” exclaimed the agent. “We’re talking history here! Hollywood’s best-kept secret!”
Del felt a bittersweet quiver in his gut but suppressed it. His life was about to become interesting again.
Arnie paged through the screenplay further, scanning the dialogue. Several minutes ticked past. Del savored the silence which, in this case, was the sound of power.
“Have you read this, Del?”
“I have.”
“Pretty deep shit in here. Dark shit, the kind that scares the hell out of you.” Arnie skipped to the screenplay’s midpoint and read some more. “And talk about explicit. The profanity, the sexual content, everything.”
“She made herself vulnerable, no doubt.”
“Damn, Del. This woman must’ve been more fucked up than we thought.”
Del winced. “Arnie, cut it out.”
“Sorry, I forgot you two were pals.” The agent shook his head in an absentminded manner, his mouth hanging open as he read further. “No wonder she didn’t show this to anybody else. Can you imagine how people would have reacted to this in 1962? The film would’ve been X-rated—if ratings had existed back then—and gotten banned from theaters. People would’ve protested outside. This script would’ve ruined Marilyn Monroe’s career.”
“But today—”
“—it’ll resurrect it.”
The men stared at each other for a moment, sizing each other up.
“But why you?” Arnie asked at last. “You said you two were buddies, but she knew tons of people. For all intent and purposes, she bequeathed it to you without realizing it. One of her final acts before she died. Why did she put this into your hands?”
Del shrugged. “I never betrayed her.”
He made his way toward a mini-fridge Arnie kept behind a bureau door and helped himself to a bottled water. He took a swig and began to pace the room, piecing the puzzle together with each stride.
“Many people aren’t aware of this,” Del said, “but her emotional state took such a dive, she was forced into a mental institution against her will for a brief period. That event left a permanent scar. Toward the end of her life, she didn’t trust many people, especially since people she trusted betrayed her and sent her to that place. Once she escaped, she feared the day would come when they’d lock her up again.
“This script exposed some of the inner workings and torments of her mind. What if authorities used it as evidence of a dangerous mental condition and sent her back to the one place she feared most? It was Joe DiMaggio, another ex-husband, who worked to get her out of there—and she barely made it out. If they had recommitted her, she would have lost her freedom forever.”
“But something must have prompted her to give this script to you, Del. If she was so paranoid, why did she risk giving the script to anyone? Why didn’t she keep it to herself?”
“She mentioned possible trouble ahead but didn’t go into detail.”
“You’re telling me Marilyn Monroe was a psychic?”
“Of course not. More like intuition. A sense that something was about to happen.” Del returned to his seat and crossed one leg over the other. He interlinked his fingers across his knee. “And she was right. A few months later, she died from a barbiturate overdose. Some speculated it was accidental, but the amount of drugs in her system were so high, it was hard to believe it was anything but suicide.”
Arnie tapped a pen against a legal pad. Del’s heart stirred. The memory of her death threatened to bring tears to the resilient man’s eyes.
Del leaned forward and locked eyes with his agent.
“For Marilyn, this script wasn’t about business. It wasn’t about fame.” Solemn, Del added, “This script is my chance to bring Marilyn Monroe back to life, one more time—on her own terms. To position her as a serious artist, the way she craved people to view her.”
“Your sentiment is honorable. That said, this revelation will set in motion a feeding frenzy.” Arnie paused, and Del caught a glint in his eye. “And I know you, Del. You like the cameras, the adoring fans. You want a career comeback—and this is the best ticket you’ll ever get.”
“Arnie—”
“All I’m saying is this: I don’t doubt your motive to honor Marilyn Monroe’s memory, but once we set this in motion, you’ll get caught up in the whirlwind. I’m warning you now because I don’t want to have to dig you out of a guilt complex later.”
“I’ll be fine, Arnie. Trust me.”
His agent regarded him for a moment, then nodded in resignation. “In that case, we need to set a plan in motion. How do we release the news of this discovery? How do we consider contenders? Where do we set the minimum bar for a deal? We get to call the shots here. They’ll need to play by our rules, and this script needs to be on strict lockdown.”
“Agreed.”
“In that case, the first thing we need to do is establish its authenticity. I’ll get the proof lined up and we’ll keep it in our back pockets. Next, we’ll hold a press conference to announce the existence of the screenplay—but let the press speculate about whether it’s authentic. We’ll hem and haw for a while, tease them a bit, make them think they have us cornered.”
Del didn’t want to look like a fool in public, regardless of how temporary or intentional, but he was willing to hear the rest of the idea. He stroked his chin and clasped his hands upon his chest. “And what happens next?”
“Then, when attention is at its peak, we release the evidence. It’ll be good for another round of marketing. So instead of releasing the evidence at the first news conference, we’ll get twice the bang for our buck.”
“Makes sense to me.” Del felt much more at ease. He exhaled and took a swig of water. The bottle’s thin plastic crackled in his grip.
“We’ll need some time to strategize this while the thumbprints are verified. I know a guy who can get it done under the radar. Meanwhile—and I’m sure you know this, but I’ll stress it anyway—don’t breathe a word of this until the day of our big announcement. Not to the media, the studio people, producers—not even to the chef at your sushi restaurant. The element of surprise will strengthen our bargaining position. Agreed?”
“Agreed.”
Arnie exhaled, as though in relief, and scratched his bald head. His fingers left behind red streaks. “This is big, Del.”
Del’s pulse increased with anticipation, yet he maintained his composure. He finished his water and crumpled the bottle.
‘Big’ didn’t do it justice.
This wasn’t just Marilyn’s final chance.
It was Del Corwyn’s, too.

Tuesday, August 1, 2017

A Wanted Man by Robert Parker

Title: A WANTED MAN
Author: Robert Parker
Publisher: Endeavour Press
Pages: 307
Genre: Crime Thriller
It’s down to fathers and fatherhood.

Ben Bracken, ex-soldier, has just got out of Strangeways.

Not by the front door.

With him, he has his ‘insurance policy’ – a bag of evidence that will guarantee his freedom, provided he can keep it safe – and he has money, carefully looked after by a friend, Jack Brooker.

Rejected by the army, disowned by his father, and any hopes of parenthood long since shattered, Ben has no anchors in his life.

No one to keep him steady.

No one to stop his cause…

The plan: to wreak justice on the man who had put him in prison in the first place.

Terry ‘The Turn-Up’ Masters, a nasty piece of work, whose crime organisation is based in London.

But before Ben can get started on his mission, another matter is brought to his attention: Jack’s father has been murdered and he will not rest until the killers are found.

Suddenly, Ben finds himself drawn in to helping Jack in his quest for revenge.

In the process, he descends into the fold of Manchester’s most notorious crime organisation – the Berg – the very people he wants to bring down…

This action-packed and fast-paced story will keep you turning the pages. Manchester is vividly portrayed as Ben races around the city seeking vengeance.

ORDER YOUR COPY:

Amazon


Chapter One:
My two years in prison ended just how they started – with a stabbing. As soon as Craggs drove the makeshift dagger into Quince’s belly and the recreation room filled with prison staff waving batons, I was moving. I knew they would arrive quickly, and I knew that the door would swing shut just slowly enough for me to slip through. The place erupted in noise and violence, but I didn’t look back. I haven’t done since.
Now, I am running. I can feel my mind bathing in the electric warmth of adrenaline. People are looking at me from a bus waiting at the traffic lights and I try to rein in my stride just a touch. If only they knew what I knew, they might understand why I can’t adopt a more leisurely pace. I need to keep moving.
Hello, Manchester, it’s me, Ben Bracken. I am back. It’s nice to see you, my adopted home town. I’m just sorry it’s under circumstances like these.
I’m arrowing right into the heart of the city, right into the bustling centre, with the sole intention of hiding in the urban congestion. I’m familiar with the city, its quirks, crevices and people, and I know just what to do when I get in there.
The suit I wear, a gigantic, ill-fitting grey coverall of stinking, sweat-soaked canvas, was the chief warden’s only moments earlier. As is the shirt, which will soon be dripping with both our sweat, at this rate. I took both from him as I left the prison – I couldn’t very well come out in my prison issues – and left him there on the steps of the prison in his underpants. He is such a nasty, vile shit of a man. He absolutely deserves it.
He shouldn’t be bothering me for a while, which is thanks in full to the contents of the only item I carry, hanging off my shoulder: a tattered green duffel bag. I can scarcely believe what is inside, but as insurance policies go, this one is ironclad. And I know that as long as it is safe, I am safe with it.
I cross the road and head north towards the Printworks, an entertainment oasis from where I can easily head to my destination, the Northern Quarter. But first, I need to make a call. And the Printworks has a bank of payphones.
It is mid-afternoon, just about 3:45, I think. Thursday. Cold, late October. The city has that quiet afternoon throb about it. The long-lunchers have all gone back to work
by now, hiding boozy excesses on their breath with too much gum, and the early leavers haven’t quite summoned the courage to sneak for the door just yet.
It feels so good to walk on these streets again, for so many reasons. It is a surrogate home now, and after all the travelling it’s still one of the only places on earth where I feel comfortable. I was sent overseas as a soldier, one of Her Majesty’s loyal hounds, setting right the wrongs others had perpetrated against human rights and democracy. A ten-year career mainly stationed in Iraq and Afghanistan saw me reach captain. I was the pride and joy of my family, the ‘Toast of Rawmarsh’ they used to call me back in my home village in Yorkshire. Such memories become more vague all the time. Then I had to make a very difficult choice, which was my undoing. I was cast out, ripped of my purpose, medals and duty, viewed as scum by my peers, dishonourably discharged and sent home in disgrace – and hated by the society I gave everything to protect.
That same society changed a lot in the decade I was away fighting for it, and now I barely recognise it. It now strikes me as an ideal dining out on its rich history. Yet somehow my sense of duty remains. I can’t help it. I don’t believe in My Great Britain anymore, nor even trust it to do the right thing for the people on her shores... But it’s like we were married, Britain and I, long since divorced – yet I’m still inexplicably devoted to my bitch of an ex.
The Printworks is just ahead. I cross the street again, bobbing between the cars, and head in via a side entrance. The Printworks, once the largest printing house in Europe, is now a cavernous converted warehouse, filled with bars, restaurants, cinemas, and a bank of cash machines and payphones. I head straight to the nearest phone and check the pockets of the suit. Two twenty-pence pieces and a ten. Perfect. Thanks, guv’nor. Picking your pocket felt damn good. I know I could call the number reverse charge anyway, but that doesn’t stop me from enjoying getting one over on Chief Warden Harry Tawtridge just one last time.
I dial the number I’ve committed to memory for this very moment. Three rings, then the call is answered not with words, but with silence. I know he is there, though. Bob ‘Freckles’ Froeschle got out three weeks before me, although his exit carried Her Majesty’s consent. This moment was rehearsed, and I feel a buzz at putting our prep into practice.
‘The package will be there from midnight tonight, and I’ll cover it with you as agreed,’ I say. ‘Thank you. I am grateful.’
I hang up. Job done. The insurance policy is almost there. The last strand of the escape plan executed to perfection. I am pleasantly surprised. I’m used to responding to instructions ordinarily with violence. Not this time: I’d used my brains and hadn’t laid a finger on anybody myself. I’m inwardly pleased, which is a damn sight better than the bitterness and anger I was stuck with before.
I know I shouldn’t but I find myself popping another coin. I dial again from recollection, having called Kayla’s house countless times when I was on leave. Before prison, before everything changed.
A voice answers, but it is not Kayla, it is a young boy. ‘Hello?’ he says, not a care in the world.
‘Joshua?’ I say.
‘Yeah, who’s that?’ he replies, playing along. I can feel myself ready to bottle it. So much for being ruthless and decisive.
‘Tell your mum it was Uncle B. Tell her, Uncle B sends love to you all, that includes you, Joshua. And tell her I’m going to do my best.’
‘Umm, ok.’
What the hell am I doing?
‘Bye, pal,’ I say, before hanging up. I wish I had more in me to say, but I don’t know
how to say it.
I owe that family so much, more than they will know, but I also know that hearing
from me will hurt. It was a selfish gesture to call, damn it all. But they need to know I’m thinking of them. Of him – of Stephen, the man I killed. Joshua’s father and Kayla’s husband. Because if I forget about them, none of what I broke out to achieve will mean anything.
I leave the booth and crack on with something I’m far more comfortable with.
I see a bar opposite, Waxy O’Connors. An Irish bar. I would bloody love a pint, perhaps a cold pint of Guinness. I haven’t touched a drop of alcohol in twenty months now – the length of my stay in Strangeways. I could easily pop in for one, and head into the Northern Quarter after, but my remaining thirty pence probably wouldn’t get me much in there save for a bag of pork scratchings, and I’m almost gagging in this filthy suit anyway.
I use the front exit of the Printworks, passing the Big Issue sellers, and head left, up towards the Northern Quarter. Within a couple of moments, I’m running again, inhaling
the cold, grey air that only Manchester ever really seems capable of providing. It’s like an elixir and I gulp it down.
Between a pair of streets I see the entrance to an alleyway that I recognise. Above the mostly garish shop fronts, the second floors of the buildings are still all set perfectly in the 1940s. It gives the Northern Quarter away immediately: Manchester’s little piece of Manhattan. Movie crews come in to shoot period-set New York films here because it’s cheaper, and it’s a nice little corner you can always head to for a warm welcome, a cold beer, and a good atmosphere.
Damn. The beer popping into my head again. I wasn’t expecting to only be out of the nick for twenty minutes and already be thinking about having a beer. But it signified freedom to me when I was inside, and I certainly have that freedom now. I’ll get my chance. Besides, I’m nearly there. Church Street.
The street is very quiet, and a scrappy alley cat slinks along the pavement, pausing to look at me with that look all cats give humans: how’ve you managed to get this far with just one life compared to my nine? It leaves me to it and I walk up to the glass doors of an apartment complex nestled between two businesses. I call up to the fifth-floor flat I have been to only once before.
A female voice answers. ‘Hello?’
‘It’s an old friend. Last time I saw you, you were in your nightclothes,’ I say, keeping an eye on the street.
The intercom is quiet for a moment, presumably while a decision is being made. I hope she recognises either my voice or the occasion I was alluding to. She should do.
‘Please come straight up,’ she says.
The door buzzes open, and I enter and head for the lift. I am not expecting anyone to be looking for me, at least not quite yet, but I don’t want to stay here long. I’m convinced I’ll be ok, and my previous captors will leave me to it, because it is simple: if they reveal I’ve escaped, I break out my insurance plan. The authorities would come crashing down on that prison like a ton of bricks, and the disgraceful, corrupt management of that facility would be dragged into the light. So I would imagine that for all intents and purposes, Ben Bracken is holed up in his cell, patiently living out the remaining fifteen years of his sentence.
Fifteen years – that should be enough time to get more than a few things done.
It’s heartening to know that nobody will be looking for me, but still, taking care keeps you alive. Care means I should keep this visit fairly brief. Especially while I still carry the damn insurance policy under my arm.
The flat’s at the end of the corridor, and the door is ajar. I knock and push it open a touch.
‘Hello?’ I call out.
The door is slowly pulled open, to reveal a beautiful woman staring at me, her eyes filling a little, her hand creeping up to cover her mouth. She has shoulder-length brown hair, eyes wide as side plates and browner than melted chocolate, and I instantly recall the last time I saw her. Bruised, frightened, and in a very bad way. Her name is Freya, and last time I saw her, I saved her life.
‘I stink. I really smell bad,’ I say, holding my hands up, but she is on me before I can say anything else.
‘Ben,’ she whispers, throwing her arms around me. I’d been nervous about what welcome I might receive, but that has been quickly put to bed.
‘I’m sorry for dropping in out of the blue,’ I say, hugging her back. I’m genuinely glad to see her. We both went through a lot that day, and we haven’t seen each other since I sent her scampering down an emergency staircase in her nightie.
‘What the hell are you wearing?’ she asks, wrinkling her nose and smiling.
‘You don’t like it? It’s always a bit hit and miss when you buy suits off the rail.’ She lets me go, and we enter the apartment. It is as nice as I remember – warm wood
floorboards under an open living space, bare brick walls, and vast floor-to-ceiling windows, which overlook the low rooftops unique to this end of town. If I ever were to settle down anywhere, it would be in a place like this.
‘Tell me to get stuffed, or whatever you like, but I wondered if I could trouble you for a change of clothes, fifteen minutes internet access and, if you are feeling especially generous, a shower?’
Freya smiles and dabs at the corner of her eyes with the sleeve of her dark jumper. ‘Of course,’ she replies.
I love seeing her like this – doing well, and safe. Then, I notice a glitter on her hand
that makes me catch my breath.
‘The wedding ring... You and Trev?’
‘Yes,’ she says, looking at the ring. ‘After what happened, we... didn’t see any reason
to wait anymore.’
I find myself beaming. Everything I did, and the reasons I had for doing it, has been justified. I feel new strength – new steel in my resolve. I feel reinvigorated.
‘We wanted to invite you,’ she says softly.
‘Don’t be daft – I can be tough to pin down.’ I smile. ‘I’m thrilled for you both. Were you ok after what happened?’
She sighs, looking pensive, but she retains the slight fundament of a smile.
‘Yeah. It took some time, but we both got there.’
‘That’s great, Freya. I mean that.’ I need to get down to it. I’d love to reminisce but
with any luck there’ll be less pressing times. ‘Freya, I’ve just got out of prison – kind of. I don’t believe that anyone is after me, but I don’t want to put you in a difficult position – and I already have, just by being here. I need to keep moving but I need help, and yourself and Trev are my best bet. I’m afraid I’m not supposed to be out of prison. But I am. And I don’t want it to come back to bite you.’
Freya takes a step towards me and puts a hand on my shoulder. That warmth again.
Trev is a lucky man, but it was nearly so different. Two years ago, he got home late from his IT job to find the apartment ransacked and Freya missing. A nasty piece of work called Keith Sinfield was running a child sex ring from a flat in the biggest high- rise at the other end of the city, and by accident his laptop, from which he conducted the whole operation, ended up in Trev’s possession. Sinfield kidnapped Freya to force the return of the laptop.
Trev called me. Truth be told, when the phone rang I was being sick into a bin at a crummy budget hotel on the other side of town, on the bottom end of a self-pity bender, but I helped get her back. It was a messy one.
‘After what you did for us, we will do anything we can to help.’ She turned me and gave me a little push. ‘Hit the shower, and I’ll get some of Trev’s clothes together. He’ll be home soon after five, so if you can wait that long, please do, he’d love to see you. Bathroom’s second door back there. We owe you our lives, Ben.’
I have spent what feels like a lifetime undertaking grim tasks and never getting a word of gratitude in return. Receiving it now renders me awkward, overwhelmed and grateful.
Freya leaves me to it, and I head for incredible luxury: a real, private shower, in freedom. Such a simple thing, but a signifier of so much. It feels like a new dawn, a symbol: to wash away my previous life, all its mistakes and sadness, and start afresh.

About the Author

Robert Parker is a new exciting voice, a married father of two, who lives in a village close to Manchester, UK. He has both a law degree and a degree in film and media production, and has worked in numerous employment positions, ranging from solicitor’s agent (essentially a courtroom gun for hire), to a van driver, to a warehouse order picker, to a commercial video director. He currently writes full time, while also making time to encourage new young readers and authors through readings and workshops at local schools and bookstores. In his spare time he adores pretty much all sport, boxing regularly for charity, loves fiction across all mediums, and his glass is always half full.

His latest book is the crime/thriller, A WANTED MAN.

WEBSITE & SOCIAL LINKS:

WEBSITE | TWITTER | FACEBOOK

Sunday, July 30, 2017

Chapter reveal: The Prom Dress Killer, by George A. Berstein


ThePromDressKillerprintcover5.5x8.5_BW_30018mar2017

Title:  THE PROM DRESS KILLER
Genre: Mystery/Suspense
Author: George A Bernstein
Publisher: GnD Publishing
Find out more on Amazon
Beneath the blazing sun and sizzling streets of Miami, a cold-blooded killer is at work.  His victims?  Young, auburn-haired women—four, so far—kidnapped and murdered.  These victims show no signs of trauma, but all bear the distinct hallmarks of a serial killer.  And this serial killer leaves behind a sickening calling card:  each victim is found clad in a prom dress.
Homicide detective Al Warner is on the case but this killer has left shockingly few clues, leaving Warner with more questions than answers.  Why were these girls taken…and then killed?  Is this psychopath intent on killing redheads, and why?  What, if anything, connects the victims?  Why were the bodies arranged in peaceful repose, wearing prom dresses?  How does that square with his leaving these carefully-arranged bodies in dark alleyways, discarding them as if they’re trash? And how long until this killer strikes again?
Sadly, one question is answered quickly when promising young attorney Elke Sorenstan captures the killer’s deadly attention and becomes the fifth victim. All signs say the killer is escalating—and that can mean only one thing:  the killer is bound to strike again, and soon.  With the stakes mounting and every tick of the clock marking that fine line between life and death, Al Warner doggedly pursues the ruthless killer before another victim falls prey. Warner’s worst fears are realized when newly-minted Realtor Shelly Weitz finds herself in the wrong place at the wrong time.  Al Warner will have to act fast: the clock is ticking in this deadly game…and Shelly Weitz is dangerously close to dancing with the devil himself—a dance that will surely be her last.  But as Detective Warner gets closer to stopping the madman behind these murders, he’ll risk losing everything—including his life.
A mesmerizing Miami mystery that ratchets up the suspense from page one, The Prom Dress Killer will leave readers breathless. Resplendent with pulse-pounding action, nail-biting suspense and unexpected twists, turns and surprises, The Prom Dress Killer is an outstanding new mystery that takes readers on a high-octane quest to catch a killer.  George A Bernstein has crafted an eerily real, masterfully- plotted mystery that delivers thrills and chills from beginning to end.
George photo
About the Author: A native of Chicago, George A Bernstein is a retired president of a Chicago manufacturing company. After leaving Chicago for South Florida, George started a world-wide fishing and hunting tour service, Outdoor Safaris. He is a world class fly-fisherman who has held 13 IGFA World Records and authored the definitive book on fly-fishing for pike and musky, Toothy Critters Love Flies.  He and his wife of 57 years, Dolores, live in South Florida. George is also the author of two previous Detective Al Warner suspense novels, Death’s Angel and Born to Die. He is currently at work on the next Detective Al Warner novel, as yet unnamed.
 www.suspenseguy.com / http://facebook.com/georgeabernstein /                                    https://plus.google.com/114243818981488647845/ /                             http://twitter.com/georgebernstein
Chapter 2
“What d’ya got, Jack?” Al Warner asked, settling his lithe, hard muscled six-foot frame on the corner of his ex-partner’s desk.
“Not much, Al. The criminalists swept the entire area of the parking lot, but they didn’t come up with anything.” Jack Harris flipped through his notebook, shaking his head.
“We know for sure she was snatched in the lot?” Warner asked.
“Yeah. Security cameras picked her up, entering from the library. There’re two cams on every deck, but unfortunately, Miss Williamson was parked where there was no real coverage, and we never saw her leave.”
“Terrific!” Warner said, his fingers gently probing the spot at the back of his skull, more itchy than tender now, under the mat of thick curly black hair.
“That whack on the noggin still bothering you, Al?” Jack asked.
“Nah, not really. Just habit. Good thing I got a hard head.” Warner picked the crime scene report from Harris’ desk.
“Yeah, lucky for you. Not so lucky for the guy who beaned you … or his two nasty partners.” He grinned, delivering a little punch to Warner’s arm. Harris marveled at the steel hardness of his friend’s forty-year-old body.
“Easy, there, bud,” Warner said, his lips ticking upward. “So no video of the snatch …?”
“If it was one. I ain’t so sure.” Harris stood, coming around the desk.
“The third redheaded gal to go missin’ in the last three months? No longer a coincidence, Jack.” Warner self-consciously dropped his hand from another visit to his itchy scalp.
“If it’s the same perp,” Warner continued, “which now seems damned likely, we got five, maybe six days to find her alive. This guy’s got a timetable, and he sure doesn’t waste much time between vics. He drops one in an alley and has usually swiped the next within two weeks, max.
“Did the cameras at least pick up auto traffic in and out? We need something, Jack.”
“Sure, they got every vehicle coming and going. Problem is, we don’t have an exact timeline when she went missing. She left the library at about five p.m., and we got no shot of her leaving the garage.”
“Let’s review the tapes, startin’, say, at four-thirty, through about six. Look for the same vehicle comin’ and goin’ durin’ that time. He had to drive in and out. Maybe we’ll get lucky,” Warner said.
“Okay, boss, but he coulda followed her there and just waited for her to come back.”
“Good point. So look for her arrivin’ about three p.m. ID the next three or four vehicles behind her, and then look for one of them leavin’ right after we think she was snatched.”
“That’s kinda thin, boss … and it’s gonna give me a lot of sore eyes.”
“What else we got, Detective? Put one of the techs on it, if you’re gettin’ too old,” Warner said with a mischievous grin.
“Shit, you think I’d leave something like that to some nerd punk. I got a bottle of Murine.”
“Yeah, I figured. So get your lazy ass in gear. Let’s try to find this gal before the sands run out. I’m gonna zip by the parkin’ lot again, just in case we missed something. Her car been towed to the lab?”
“Yep. The Tech boys are about done.” Harris had returned to his desk, tilting his chair back. “I thought you might wanna take another peek at the scene. It’s still taped off, all the markers in place, and we got two full-time blues on the spot, so nothing gets disturbed.”
“Okay. Give me a copy of your interview notes of the lot’s attendants, and get on that film ASAP.” His voice raspy, he leaned forward, balancing on his arms, fingers spread like claws braced against the top of the desk.
“I don’t want a third pretty young corpse, all dolled up in a fancy prom dress, lyin’ in an ally somewhere. Not the goddamned Angel of Death, all over again.” Warner’s face contorted, as he slammed his fist down hard enough to spill the pencil container.
“Easy, boss.” Harris pushed away from his desk. “We’re doing the best we can, with what little we got.”
“Well it’s not fuckin’ good enough.” Warner straightened, catching himself from reaching for his last head wound again.
“I’m goddammed sick and tired of serial-killers around here. Three in the last three years is three fuckin’ too many! Let’s get this bastard before this last gal becomes his third vic, and before he takes a fourth.”
“We’re doing what we can, Al. He’s gotta make a mistake soon. I just hope we can do it this time without ya catching a bullet or rock off the noggin. Ya gotta stop playing those sympathy cards.”
Warner glared at the smaller man, but couldn’t contain his laughter, bubbling up, erupting like a ruptured dam … which in a sense, it was.
“Goddammed little shit! You always know how to cool my fuse when it gets too hot.”
Harris grinned. “Someone’s gotta chill ya out. You’re the best cop I know to solve these things, if ya don’t get too emotional about the vics. Never knew a detective who cared as much as you do, boss.”
“Thanks for the bucket of cold water, Jack. I get too wound up and I could miss something. Can’t afford to do that, ’cause this perp’s on a serious mission. I’m pretty sure bodies of pretty young redheads are gonna keep pilin’ up if we don’t nab ’im soon.
“Anyhow, get on that film, and get one of the techies to help. Two sets of eyes are always better. I’ll be back in a couple of hours. I‘ll wanna go over the patrol canvas reports, too.”
“Gottcha. Is Doc Guttenberg working on a profile?”
“Not yet. I’ll see Eva tonight and see if she can come up with something that might help.”
“Right. That’s real tough duty!” Harris grinned. “At least you two getting together is one thing good coming outta the last caper.”
Warner smiled. “Always lookin’ for the silver lining, huh.”
“Gotta be some perks in this job. I’ll call ya if anything comes outta those videos.”
Warner nodded, scooping up the file from Jack’s desk and heading out of the Miami-Dade Homicide Department. Something had to break, but time wasn’t on his side.
It never was, with a nut out there, killing innocent victims. Three years ago, it was teenagers. A year later beautiful young women … almost including Sharon. Now this nut— just sixty days after he snagged the perps with all those SIDS infants dying … and him taking a small boulder on the noggin in the process.
It’s redheaded women this time, meticulously groomed and dressed to the nines. Each was smothered, dying peacefully while apparently in a chloroform daze. It looked like the Unsub didn’t want them to suffer, but that seemed at odds with him laying them out in dark alleys like so much trash.
He hoped Eva could come up with something other than the killer seemed conflicted over his vic’s care. If nothing else, the lovely doctor would at least manage to drain off his tension.
He grinned, in spite of his anger. How was he so lucky to have that beauty love him? He thought briefly of Sharon, fleeing to Buffalo after her near deadly encounter with the Angel of Death. And then the blonde angel, Casey, consumed by the SIDS deaths of all those baby boys. That case eventually brought him to lovely Dr. Eva Guttenberg … and how lucky was that!
Will love last this time? He didn’t give it freely, and was too hard-case to receive it back very often. He was using up a lifetime of opportunities, and he didn’t want to screw this one up.
Unlocking his gray Dodge Charger coupe, he slid in, tossing the file on the passenger seat. He lingered, eyes focused on some distant, invisible spot, fingers tap-dancing on the leather cover steering wheel, considering the current serial lunatic.
This psycho wants something specific from these girls, and when they can’t feed his need, he discards them, cleaving to some unique, personal ritual, and looks for another. The fact they are in their twenties and redheads of similar size and build has a special meaning, but so far nothing has conjoined these gals except age group and hair color.
He sighed, firing up the engine, enjoying the rumble of its power.
“Better figure it out soon,” he mumbled, “or more bodies are gonna start pilin’ up. We’re one or two redheads away from city-wide panic.” Shifting gears, he drove out of the police lot, shaking his head.
They needed a break … and soon.

Wednesday, July 26, 2017

Surgeon's Story by Mark Oristano


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:

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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.