5:30 pm pdt . san francisco bay

colleen . thought of you many times today . walking in Muir Woods where you and I walked . going back and forth across the Golden Gate Bridge, shrouded in fog on the way into the city, sunlit and shining on our way back to Mill Valley . perusing a Dutch exhibit at the de Young Museum in Golden Gate Park, seeing Vermeer's Girl With a Pearl Earring hanging in a room by itself

i fell in love with this 1654 painting called The Goldfinch by Dutch painter Carel Fabritius

missed you

Heave The Anchor Short

The fog of the week in Johns Hopkins hospital is slowly lifting and I am prepping to set sail.  It’s been rocky seas.  Chelsea is able to stay with me for a while and that is a major help, physically and emotionally.  The organization and assessment of home care is underway.  The health care service, Holy Redeemer will serve as my anchor for now.  Caring for Nellie, gaining strength and endurance and returning to being as independent as I possibly can are the big goals.  Specifically, I want to be able to walk 400 feet in 6 minutes when I return to UPMC on May 13^th.  Oh, and 5 additional pounds would be a bonus.  Training began today.  It’s depressing to see how quickly my body has weakened.  I have to admit that I let my fatigue and feelings of defeat win out over the more important need to move the body.  Now, the starting point is farther behind than it should be.  Yes, I’m going to start where I am but I wish I had reached out sooner for help getting me back to my “mat”…or as the ship’s captain might order, “head to the eye of the wind”.

This is a replica of the  fast sailing, Baltimore Clipper that first appeared after the Revolutionary War and remained a favorite until after the War of 1812. 

Home

This bird is finally home but I’m not singing a sweet song yet.  Once again, thanks to Mignon for keeping everyone up to date.  I have my feeding tube, aka Nutri-Nellie.  I’m awaiting a nurse to show me how to use this set up.  I remember how freaked I was when I got the pacemaker but I managed to get used to it.  People say it’s easy.  Yeah, sure!  It does not look it to me.  George, a friend of mine just arrived home with his and apparently he’s a happy camper.  Not me, I’m nervous as hell and dreading the Moo-Moo look.  Makes me wonder what style George got?  Or, maybe George has some cute nurse filling his.  Given this and my recent hospital visit, I question whether or not I’m up for the challenges that lie ahead.  That being said, Valerie Harper said in her book, I, Rhoda, “Life is amazing.  Stay as long as you can.” It’s the “tude”, right Suze.

Med School Anatomy, Sorta

Given the title of this post, I suspect absolutely no one is going to give it a read. No worries. Except for bleary-eyed med students, I'm probably the only creature in LA right now, at 9:30 pm, who's got the anatomy of the heart and lungs on her mind, and wants to write about it too. So feel free to ditch.

A few days ago I posted a black & white drawing that I really love of a bird atop a pair of lungs and the handwritten words "The Love Between Two Lungs." 

My primary focus was on the bird and the lungs, secondary the dangling heart that I figured must represent "the love between." The artist's positioning of the heart between the lungs struck me as odd. Recently, I chided my friend, alias Larry, about not knowing we each have two lungs. But now I find I have been similarly clueless about where the heart lies inside us. I kinda sorta thought it was somewhere close to the left lung but on the lung's outer side. Where the heart resides exactly I didn't know and didn't even realize I didn't know. 

Whenever Colleen and I talk about the pulmonary artery connecting the right side of the heart to the lungs, I have always assumed that the lungs have a single pulmonary artery only. No, I've just learned. The lungs have two pulmonary arteries, one for each lung. During those discussions, I have also vaguely imagined the heart beating somewhere north of the lungs. Wrong.

For the past few days the image of the bird, the lungs, and strangely positioned heart nagged at me. So I went Googling and found out not only where my heart is but also that it only weighs about 9 ounces. It makes up less than 0.5% of our total body weight.

Voila:

The heart isn't "outside" the lungs, nor is it located on the left of the left lung. Rather, it's almost dead center in between them. I say "almost" because 2/3 of the heart is left of the midline of the body (think sternum or spine) and 1/3 of the heart is on the right. 

How could I have not known this?

The Pledge of Allegiance comes to mind. From kindergarten on, we recited the Pledge of Allegiance at the start of every school day. We each put our right hand on our heart, or what we thought was our heart. Every kid's hand, including mine, was placed somewhere below the left clavicle and to the left of the sternum. As an adult, I somehow came to know that the heart was not located in that upper left quadrant of the torso, though I continued to think it was somewhere in that vicinity, only lower. I never, not once, thought about it's proximity or relationship to the lungs.

(The size of the lungs in this illustration surprised and stunned me. More on that to follow.)

This next, purposely distorted diagram nicely illustrates the fact there there are two pulmonary arteries (in blue):

This last illustration gives us an idea of what pulmonary hypertension and an enlarged right heart look like:

Colleen's pulmonary hypertension--all pulmonary hypertension--affects the left pulmonary artery only because the fibrosis or hardening in her lungs makes pumping blood into them more difficult for the right heart. As a consequence, the pulmonary artery swells under the pressure of blood unable to course through it swiftly and, also, the right heart swells or enlarges as well. The inelastic lungs become somewhat like a dam. Everything behind it backs up.

.....

If you're still reading, did you know that the lungs are as big as these images show them to be? Our lungs take up almost all of our chest space and, along with the heart, sit inside our ribs for protection. 

The size of adult human lungs vary greatly. But the average length is 10 to 14 inches and they weigh an average of 2 to 3 pounds! (Remember that the heart, by contrast, only weighs on average 9 ounces; the size of the heart is only, approximately, the size of a fist.)

.....

Now that Colleen is in full throttle exploring the possibility of a lung transplant, I want to be as un-vague as possible about all aspects. Until now, I had given little thought to the organs of the lungs themselves. If Colleen has lung transplant surgery, the donor lungs will likely be somewhere around 10 inches long. And in order for the surgeon to attach these new lungs into Colleen's body, to make them hers, he (and we're pretty sure it would be a "he") has to work around the heart situated right in the middle of things.

I'm glad to know this.

Yours,
The Professor

She's back home at the Point

Bye Bye Baltimore Tomorrow -- For Real

Colleen should be home by late afternoon tomorrow (Thursday). This probably goes without saying, and Colleen didn't ask me to say this, but let's all be cognizant of how much she needs to rest and get stronger. Colleen's eye is back on Pittsburgh now; on the Selection Committee saying an unqualified yes to putting her on the lung transplant list, sooner rather than later, because her ill-defined "small window" sounds a lot like "soon." So we all, myself included, need to exercise discretion regarding long phone calls and protracted visits. Unlimited amounts of love? Not a problem. Over and out. Mignon

Bye-Bye Baltimore?

If they don't let Colleen out tomorrow afternoon, Dawn & Sandi are going to have to go down and break her out of her 9th floor window. Otherwise, there's no telling what mayhem might ensue. 

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This just in: Colleen tells me that 6-10" of snow are predicted for Baltimore tomorrow; high winds and rain predicted for the entire Jersey coast. If and when Colleen learns she's free to go home, she'll phone Sean, who'll be ready and waiting to head down to Maryland to get her. What will all that snow do to the freeways? Stay tuned.