Monthly Archives: November 2008

With all the heart I can muster.

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In 1987 I was working for the local hands-on science museum, Discovery World, and part of my job was to beg companies to donate material to our cause. This was not really a task for which I was a natural choice – I am not really a salesman, and not a fund-raiser. As a matter of fact, due to internal politics I was forbidden from fund raising; I could only ask for “stuff.”

 

We were working on the “Health Is Wealth” exhibit, a compendium of stations, 23 in all, covering many aspects of whole-body health. We were looking for a blockbuster addition to this exhibit, and as artificial heart research was very much in the zeitgeist I was tasked with trying to get one. Being a novice and an innocent, I called up Symbion, the firm formed by Robert Jarvik, the inventor of the first practical, implantable, total artificial heart (TAH); the Jarvik 7. “Hi, This is Nic Bernstein calling from Discovery World museum in Milwaukee, Wisconsin. I am calling because I see that you have just removed a heart from a local man, and we were wondering if we could get that unit to display in our new exhibit…”

 

Yes, I actually made that call, and the response I received was much more polite than you might expect. “Well, we have received that heart from the implanting hospital, Saint Luke’s, but under FDA guidelines we have to disassemble the heart, test the components and then return the whole works to their labs.”

“Oh, well I guess that makes sense… Have you got any suggestions for me as to how I may be able to get one? We would really like to exhibit one, and seeing as a local man just had one, and local interest is high, it just seems like the time is right.”

 

“I tell you what, we cannot give you one, all of our hearts must go to an FDA approved transplant site. But, I can tell you this: There are two sizes of hearts, small, for women, and large, for men. Turns out that the large is really too large to implant into anyone’s chest cavity, so we are only using the small ones. St. Luke’s has a large one that they ordered for training. It can never be used, since it is too big, and since it hasn’t been used, they don’t have to return it to us or the FDA, and they need to purchase a new, small unit to train with. You should ask them.”

 

The next call I placed was to the communications director at St. Luke’s. “Can you give us that training heart that you have? I understand that you cannot implant it, and it would just go to waste otherwise…” I asked. “Tell you what, Nic, I am going into a board meeting right now, let me see what I can do.”

It was all that she would say, and nothing was promised. I put down the phone and waited…

Two hours later the phone rang and it was the communications director form St. Luke’s. “If we were to give you the heart, just how would you exhibit it? How would people see it? I have ten minutes and then I have to get back into the meeting.” she said.

 

I was stuck cold. I hadn’t thought it through this far… “Well, what we would like to do is have a display where the visitor would place their finger into the plesthysmograph that you gave us, and they would see their pulse on the heart monitor you gave us, and then the artificial heart would start to beat in synchronization with their own.” I offered. I was really loading up the stables on this one…

 

“Okay, I think I can sell that,” she said, “I’ll call you back in half an hour.” I was both proud and scared out of my wits. I waited, and worried about what I would say to Eric, my engineer.

 

She called back in 40 minutes and said, “You have your heart! Make us proud.”

 

Shit! Now came the hard part.

 

I made the long trek down the hallway to the lab, and sidled up to Eric at his bench. “I have just had a very interesting conversation with St. Luke’s and I have to tell you about it,” I started. “They are going to give us a Jarvik 7 artificial heart.”

 

“Cool!” said Eric.

 

“But, I told them that we would make it do this…” I said, and went on to explain to Eric what I had told the PR woman that we would do.

 

Eric thought about what I said, and then he said something like “Well, I guess we need to find out about it’s control circuitry.”

 

The next day I called back to Symbion and asked my contact if he could put me in touch with someone in the engineering department. “I heard from Bridget that you got the practice heart!” he shared, “Good play. Talk to this guy…” and he gave me a name and number. A few minutes later I was speaking to the head engineer. I explained what we wanted to do, and asked if we could get plans for their drive systems. It wasn’t going to be that simple.

 

The original Jarvik 7 heart was a bulky, and balky, device which was pneumatically driven. The control cabinet was about 4 feet tall by 2 feet wide, and housed an air pump, and a pair of drive assemblies. The drive controls had a pair of dials on their face, one of which controlled pulse rate and one of which controlled the duty-cycle; the ratio between systoli and diastoli — the amount of time the heart pumped in versus out. These values were hard coded, so to say, and did not vary. In other words, if you had a Jarvik 7, you would get a dialed in pulse rate, say 72 beats per minute, and a dialed in duty cycle, and that was that. There was no variability, there didn’t need to be.

 

I was crestfallen. How were we going to synchronize a Jarvik 7 to the visitor’s heart if the control unit was fixed? Well, we soon discovered that was not going to be an issue as we were not getting the control unit, just the heart. I called the engineer again. “Well, I can tell you that you need this amount of pressure to cycle the heart, and that you need this amount of resistance, and back pressure, but beyond that, I don’t know what to say…” “We want it to track the visitor’s heartbeat” I said. “Well, if you get that to work, we would love to see what you’ve done, ’cause that’s way beyond anything we’ve done.” Oh goody.

 

Well, long story short, Eric did it. He built an analogue computer which performed quadrature upon the output of the plethysmograph and drove the parallel pneumatic drives to the heart. A week or two later our heart arrived, and we had to put it to the test. A heart pumps against a load; in the body that load is provided by the arteries and the miles of blood vessels and veins. In our test, as we had yet to construct our hydrostatic tanks, we simply immersed the heart into a bucket, “more than six inches deep,” we were told. I handed the heart to Jerry, a Bible thumping shop guy, after first connecting it to the pneumatic tubes. I placed the plethysmograph onto my finger and Jerry plunged the heart into the bucket, and we turned on Eric’s drive unit. The heart started to pulse, and Jerry yanked his hand out of the water and ran to the other side of the shop spewing oaths in his wake. I grabbed the heart to keep it from surfacing, and had the most bizarre experience of my life. I was holding my own heart under water, it seemed, as it beat in perfect synchronization with mine, and with a firm and resolute rhythm.

 

We had done it! We, a small and underfunded science museum in Milwaukee, Wisconsin, had designed and built the most advanced artificial heart drive system in the world! We made minor adjustments to the system after that, and ultimately we were unable to allow the visitor to experience that eerie, out-of-body, sensation that I had of holding my own heart in my hands, but we had to protect the heart.

 

We did send all of our design materials off to Symbion. We never heard if they used any of them, but in the ensuing years the dream of a totally-implantable artificial heart (TAH) gave way to the more pragmatic ventricular assist device, the intra-aortic balloon pump, and similar heart pumps, assists, etc. All of these new generation of heart savers share the quality of tracking the patient’s own heart rate, systoli and diastoli. Whether or not our work was used, we laid the path.

 

Tonight, as I write this, my friend Tom is having a pair of ventricular assist devices installed into his chest cavity. If all goes well they soon will help his heart, his scarred and stricken heart, and pulse and pump blood though his veins. I do not claim anything in this, but I would like to think that in our own way, due to our own imperatives, we showed a generation of heart surgeons and clinical engineers that it was important to consider the patient’s own heart, their own pulse, when designing the systems by which we would keep them alive.

Mostly, however, I have to write this because I really want Tom to live and I have to do something with my fingers while he lays on that operating table and has this generation’s best and brightest install a piece of machinery into his chest to keep him alive long enough for me to tell him to his face how important he is to me.

What Will Retirement Look Like

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A few years ago I was having coffee with a candidate for whom I was consulting. He put down the opinion pages of the newspaper and asked me what I thought of George F. Will. “I like his baseball writing,” I offered, “but on politics he is drifting rapidly towards irrelevancy.” Little did I know how right my dismissive words would prove.  And how soon.

Among the lessons of this election past is that there is no “conservative” movement left in the USA, at least nothing that a core conservative like William Buckley or Mr. Will would recognize.  The biggest threat to the conservative movement of Messrs. Will and Buckley was always the hearty embrace they gave to the Reagan coalition of religious fundamentalists and disaffected “Reagan Democrats,” those aging, white social-conservatives with whom Lee Atwater expanded the “Big Tent” Republican party of the 1980s and whom Karl Rove beguiled into sticking with an incompetent President Bush in 2004.

The problem with basing the coalition on these people is that while the by and large do not trust government they do at least like to be governed, and they like that government they have to function with some level of competency.  Over the past eight years the Republican party has proved itself to be singularly incapable of governing, whether a state, or a country, and these big-tent Republicans have deserted that tent just as quickly as they deserted an incompetent Democratic party of 1980.  The movement conservatives, by hitching their fate to that of an incompetent party have doomed themselves to the political wilds for the foreseeable future.

Mr. Buckley, through the grace of time, was saved the embarrassment of watching his own son bolt the last vestiges of the movement with his very public endorsement of Barack Obama, and subsequent ejection from the magazine Buckley himself had launched.  Will, on the other hand, soldiers on, a potent and frequent scold for the movement he loves, but which has left him behind sounding like just another old warrior who doesn’t realize that the war is over, his side lost, and the rest of the world has moved on to the next match.

You can read Will’s latest silent scream over here. While you’re at the Post, check out David Broder’s weighty analysis of recent voting trends and the sad fate it bespeaks for the GOP.

My American Story

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Ballot Box

28th. February 1953

Dear Professor Lederberg,

Dr. Clive Spicer, who recently spent some time under you, has informed me that there might be a vacancy in your department for a graduate English student.

Such a project interests me very much and I would, if it is still open, like to offer myself as a possible candidate. Would you be so ‘kind as to let me have some further details  about it?

A. Bernstein

—

Thus began my American Story.

In 1953 my father bridled under the strains of life in post-war England. He had trained for a career in medicine, but after years as a corpsman during the Battle of Britain he had seen too much death. He had administered last rights in muted voice too many times and for too many faiths to ever face a career of dealing with patients, so he settled for research and teaching.

The post-war years had already taken him around the formerly occupied countries of Europe to help rebuild the medical establishment and treat the distressingly high rates of fevers and infections. He was released from service in 1948 after service as Emergency Lieutenant, War Substantive Captain, Substantive Captain, and finally mustered out in 1959 as Captain, the rank he carried to his death. The rank he would much rather never had taken.

My father, to put it direct, was eager, no fast, to get out of Britain and her post-war shock of austerity and deprivation. He had suffered already too much of that. Many tales are told of the Brits steadfastness and stolidness, in the face of Hitler’s unending siege, and indeed my father had witnessed his own home being destroyed by a V2 “buzz-bomb” and the virtually complete destruction of his country’s financial system. He wanted out, and NOW. He was tired of the straight jacket that England had become for him. He wanted the dream, the dream that had motivated so many emigrants from so many countries who flocked to the United States in those years.

I am having a little difficulty at present with the Bank of England in trying to arrange for the transfer of some of my Sterling assets to the U.S. I think that they will agree but time is running rather short…

The British were loath to let their citizen’s hard assets leave their shores. Indeed my mother, in 1977, fully 14 years after his emigration, had to fight to get the last of his bank notes released.
But I digress. Dad did get out, and he came to America, and met my mother in that lab in Madison, and they wed in December of 1954 and moved back to England when my father’s visa expired in 1955. They started a family, bought a modest semi-detached home, and finally, in 1963, moved back to the United States when he got a position at Marquette University.

On June 20, 1968, one day after his 46th birthday (I have just turned 46, so this is significant to me), and just two weeks after Bobby Kennedy’s assassination, my father received his naturalization papers from this United States, his United States – He was a Citizen of these United States! He celebrated the fourth of July that year with an uncharacteristic enthusiasm.

He voted that November 4th for Hubert Humphrey. A Labour Party regular all his life in England he could not have done otherwise.

My own political awakening, born in 1968 when my parents hosted Students for McCarthy, came into its fullness in 1972 with the campaign of George McGovern. I was young, only 10 years old on election night, but I was a dedicated foot-soldier for McGovern, having distributed thousands of pieces of literature for him in some of the toughest wards of the city.

I still remember that election night, sitting in the local McGovern headquarters on Oakland Ave. and watching the polls come in.

I must digress here for a moment. Many of my friends these days know that I always watch the polls come in. For many reasons this is a remnant of that first election night I witnessed. I implicitly trust the democratic system, but I equally implicitly distrust the physical manifestation of that system.

My father came to the McGovern office at 8:00 to collect me and take me home. The next day was a school day and I could not be allowed to stay up all night. I was reluctant to go, to say the least, but I did.

In the car, on the way home, I looked at my dad and asked if he had voted. “Yes,” he said. ” Who for?” I demanded. He paused. “Nixon,” he said. “How could you do that, Dad?!? You know how hard we all worked on the McGovern campaign. How could you?”

“For once in my life,” he said, “I wanted to vote for a winner.”

We never spoke of this again.

—

In the summer of 1974 we were camping in Indiana when Richard M. Nixon resigned the presidency of the United States of America. The first ever to do so. My mother couldn’t wait to call her brother John who had been a big organizer for Nixon in his home state of Virginia. I just had to sidle on up to my dad and …

… and say nothing. I wanted to ask him how he thought about his winner now, but I knew how he felt, and he didn’t need his snot-nosed kid to rub it in.

—

I am listening to Bruce Springsteen sing “Born in the USA” on the Hi-Fi right now. I can always appreciate that song even if I cannot identify with it. I was not born here, but this is my country as surely as it was my father’s, or my maternal grandfather’s – a seventh generation American.

Much has been made this year of early voting, and I have endured innumerable entreaties to vote early myself. I have done this in previous elections, but I shall not, will not, this year. This Tuesday, November 4th, marks the 40th anniversary of my father’s first vote as a naturalized American citizen. On that day I will cast my own ballot, proudly, for another son of an immigrant. And I will smile at my father’s memory, for I know that he would have voted the same way – for a winner.