The Best American Science Writing 2004by Dava Sobel, Jesse Cohen (Editor)
Jennifer Kahn's "Stripped for Parts" was selected as the lead story of this year's Best American Science Writing because, as Dava Sobel, best-selling author of Longitude and Galileo's Daughter, reveals, "it begins with one of the most arresting openings I have ever read." In "Columbia's Last Flight," William Langewiesche recounts the February 1/b>/b>/b>
Jennifer Kahn's "Stripped for Parts" was selected as the lead story of this year's Best American Science Writing because, as Dava Sobel, best-selling author of Longitude and Galileo's Daughter, reveals, "it begins with one of the most arresting openings I have ever read." In "Columbia's Last Flight," William Langewiesche recounts the February 1, 2003, space shuttle tragedy, along with the investigation into the nationwide complacency that brought the ship down. K. C. Cole's "Fun with Physics" is a profile of astrophysicist Janet Conrad that blends her personal life with professional activity. In "Desperate Measures," the doctor and writer Atul Gawande profiles the surgeon Francis Daniels Moore, whose experiments in the 1940s and '50s pushed medicine harder and farther than almost anyone had contemplated. Also included is a poem by the legendary John Updike, "Mars as Bright as Venus." The collection ends with Diane Ackerman's "ebullient" essay "We Are All a Part of Nature."
Together these twenty-three articles on a wide range of today's most current topics in science from biology, physics, biotechnology, and astronomy, to anthropology, genetics, evolutionary theory, and cognition‚ represent the full spectrum of scientific writing from America's most prominent science authors, proving once again that "good science writing is evidently plentiful" (Scientific American).
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The Best American Science Writing 2004
Stripped for Parts
The television in the dead man's room stays on all night. Right now the program is Shipmates, a reality-dating drama that's barely audible over the hiss of the ventilator. It's 4 am, and I've been here for six hours, sitting in the corner while three nurses fuss intermittently over a set of intravenous drips. They're worried about the dead man's health.
To me, he looks fine. His face is slack but flush, he breathes steadily, and his heart beats like a clock, despite the fact that his lungs have recently begun to leak fluid. The nurses roll the body from side to side periodically so that the liquid doesn't pool. At one point, a white plastic vest designed to clear the lungs inflates and begins to vibrate violently -- as if some invisible person has seized the dead man by the shoulders and is trying to shake him awake. The rest of the time, the nurses consult monitors and watch for signs of cardiac arrest. When someone scratches the bottom of the dead man's foot, it twitches.
None of this is what I expected from an organ transplant. When I arrived last night at this Northern California hospital I was prepared to see a fast-paced surgery culminating in renewal: the mortally ill patient restored to glorious health. In all my preliminary research on transplants, the dead man was rarely mentioned. Even doctors I spoke with avoided the subject, and popular accounts I came across ducked the matter of provenance altogether. In the movies, for instance, surgeons tended to say it would take time to "find" a heart -- as though one had been hidden behind a tree or misplaced along with the car keys. Insofar as corpses came up, it was only in anxious reference to the would-be recipient whose time was running out.
In the dead man's room, a different calculus is unfolding. Here the organ is the patient, and the patient a mere container, the safest place to store body parts until surgeons are ready to use them. It can be more than a day from the time a donor dies until his organs are harvested -- the surgery alone takes hours, not to mention the time needed to do blood tests, match tissue, and fly in special surgical teams for the evisceration. And yet, a heart lasts at most six hours outside the body, even after it has been kneaded, flushed with preservatives, and packed in a cooler. Organs left on ice too long tend to perform poorly in their new environment, and doctors are picky about which viscera they're willing to work with. Even an ailing cadaver is a better container than a cooler.
These conditions create a strange medical specialty. Rather than extracting this man's vitals right away, the hospital contacts the California Transplant Donor Network, which dispatches a procurement team to begin "donor maintenance": the process of artificially supporting a dead body until recipients are ready. When the parathyroid gland stops regulating calcium, key to keeping the heart pumping, the team sends the proper amount down an intravenous drip. When blood pressure drops, they add vasoconstrictors, which contract the blood vessels. Normally the brain would compensate for a decrease in blood pressure, but with it out of commission, the three-nurse procurement team must take over.
In this case, the eroding balance will have to be sustained for almost 24 hours. The goal is to fool the body into believing that it's alive and well, even as everything is falling apart. As one crew member concedes, "It's unbelievable that all this stuff is being done to a dead person."
Unbelievable and, to me, somehow barbaric. Sustaining a dead body until its organs can be harvested is a tricky process requiring the latest in medical technology. But it's also a distinct anachronism in an era when medicine is becoming less and less invasive. Fixing blocked coronary arteries, which not long ago required prying a patient's chest open with a saw and spreader, can now be accomplished with a tiny stent delivered to the heart on a slender wire threaded up the leg. Exploratory surgery has given way to robot cameras and high-resolution imaging.Already,we are eyeing the tantalizing summit of gene therapy, where diseases are cured even before they do damage. Compared with such microscale cures, transplants -- which consist of salvaging entire organs from a heart-beating cadaver and sewing them into a different body -- seem crudely mechanical, even medieval.
"To let an organ reach a state where the only solution is to cut it out is not progress; it's a failure of medicine," says pathologist Neil Theise of NYU. Theise, who was the first researcher to demonstrate that stem cells can become liver cells in humans, argues that the future of transplantation lies in regeneration. Within five years, he estimates, we'll be able to instruct the body to send stem cells to the liver from the store that exists in bone marrow, hopefully countering the effects of a disease like hepatitis A or B and letting the body heal itself. And numerous researchers are forging similar paths. One outspoken surgeon, Richard Satava from the University of Washington, says that medicine is only now catching on to the fundamental lesson of modern industry, which is that when our car alternator breaks, we get a brand new one. Transplantation, he argues, is a dying art.
Few researchers predict that human-harvested organs will become obsolete anytime soon, however; one cardiovascular pathologist, Charles Murry, says we'll still be using them a century from now. But it's reasonable to expect -- and hope for -- an alternative. "I don't think anybody enjoys recovering organs," Murry says frankly. "You tell yourself it's for a good cause, which it is, a very good cause, but you're still butchering a human."The Best American Science Writing 2004. Copyright © by Dava Sobel. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.
Meet the Author
Dava Sobel is the best-selling author of Longitude and Galileo's Daughter. A former New York Times science reporter, she has contributed articles to Audubon, Discover, Life, and The New Yorker. She has also been a contributing editor to Harvard Magazine, writing about scientific research and the history of science. She lives in East Hampton, New York.
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