"Mrs. Heinlein and I spent 1976 and - 77 on blood drives all over this nation. We crisscrossed the country so many times we lost track. It was worthwhile; we recruited several thousand new blood donors - but it was very strenuous. By the end of '77 we badly needed a rest, so we took a sea voyage. She and I were walking the beach on Moorea, Tahiti, when I turned my head to look at a mountain peak - and something happened.
"I balanced on my left leg and said, 'Darling, I'm terribly sorry but I think I've had a stroke. Something happened inside my head and now I'm seeing double and my right side feels paralyzed.'
"Mrs. Heinlein half carried me, half dragged me, back to the landing - got me back aboard.
"A shipmate friend, Dr. Armando Fortuna, diagnosed what had happened: a transient ischemic attack, not a stroke. When we reached California, this was confirmed by tests. However a TIA is frequently a prelude to a stroke.
"Remember that spin-off, computerized - axial tomography? That was done to me to rule out brain tumor. No tumor. The neurologist my physician had called in started me on medication to thin my blood as the clinical picture indicated constriction in blood flow to my brain. This treatment was to continue for six months.
But in only two months I was failing so rapidly that I was shipped to the University of California Medical School at San Francisco for further diagnosis. Remember the image enhancer and that dog at the University of Arizona? I said that dog was not hurt. They did it to me, with no anesthesia; it did not hurt.
"The catheter goes in down here" - witness points at his right groin - "and goes all the way up and into the aortal arch above the heart. There three very large arteries lead up toward the brain; the catheter was used to shoot x - ray - opaque dye into each, in succession. The procedure took over two hours ... but I was never bored because the image enhancer included closed - circuit television of the fluoroscopy with the screen right up here" - witness indicates a spot just above and to the left of his head - "above me, where the radiologist and his team, and the patient - I - could see it.
"How many people ever get a chance to watch their own hearts beat? Utterly fascinating! I could see my heart beating, see my diaphragm rise and fall, see my lungs expand and contract, see the dye go up into my brain... see the network of blood vessels in my brain suddenly spring into sharp relief. It was worth the trip!
"They spotted what was wrong; my left internal carotid was totally blocked. So the left half of my brain was starved for oxygen, as it was receiving only what leaked over from the right side or from the vertebrals where the network interconnected, principally at the Circle of Willis under the brain.
"But this is your speech center" - witness touches left side of skull above ear - " your word processor, the place where a writer does all his work. No wonder I was dopey - could not write, could not study, could not read anything difficult.
"My left internal carotid is still blocked; the stoppage is too high up for surgery. So they sent me to Dr. Chater at Franklin Hospital, who moved my left superficial temporal artery to feed the left side of my brain. This operation is pictured on pages 62 and 63 of the April 1978 Scientific American, so Twill omit grisly details; if surgery interests you, you can look them up there.
"The procedure is this: Scalp the patient from the left eyebrow, going high and curving down to a spot behind the left ear back of the mastoid. Cut away from the scalp the temporal artery. Saw a circular hole in the skull above the ear. Go inside the brain into the Sylvian fissure, find its main artery, join the two arteries, end to side. The left anterior lobe of my brain is now served by the left external carotid via this roundabout bypass. Dr. Chater did the hookup under a microscope with sutures so fine the naked eye can't see them.
"Check by Doppler ultrasound to make sure the bypass works, then close the hole in the skull with a plate that has a groove in it for the moved artery. Sew back the scalp - go to lunch. The surgeon has been operating for four hours; he's hungry. (The patient is not.)
"They placed me in a cardiac intensive - care room. When I woke, I found in my room a big screen with dancing lights all over it. Those curves meant nothing to me but were clear as print to the T.C. nurses and to my doctors - such things as EKG, blood pressure, respiration, temperature, brain waves, I don't know what all. The thing was so sensitive that my slightest movement caused one of the curves to spike.
"I mention this gadget because I was not wired to it. "Another space - technology spin-off: This is the way Dr. Berry monitored our astronauts whenever they were out in space.
"Colonel Berry had to have remote monitoring for his astronaut patients. For me it may not have been utterly necessary. But it did mean that I was not cluttered with dozens of wires like a fly caught in a web; the microminiaturized sensors were so small and unobtrusive that I never noticed them - yet the nurses had the full picture every minute, every second.
"Another advantage of telemetered remote monitoring is that more than one terminal can display the signals. My wife tells me that there was one at the nursing supervisor's station. Dr. Chater may have had a terminal in his offices - I don't know. But there can't be any difficulty in remoting a hundred yards or so when the technology was developed for remoting from Luna to Houston, almost a quarter of a million miles.
"Space spin-off in postoperative care: a Doppler ultrasound stethoscope is an impressive example of microminiaturization. It is enormously more sensitive than an acoustic stethoscope; the gain can be controlled, and, because of its Doppler nature, fluid flow volume and direction can be inferred by a skilled operator. Being ultrasound at extremely high frequency, it is highly directional; an acoustic stethoscope is not.
"It generates a tight beam of ultrasound beyond the range of the human ear. This beam strikes something and bounces back, causing interference beats in the audible range. It behaves much like Doppler radar save that the radiation is ultrasound rather than electromagnetic. Thus it is a non invasive way to explore inside the body without the dangers of x - ray ... and is able to 'see' soft tissues that x - ray can't see.
"Both characteristics make it especially useful for protecting pregnant mothers and unborn babies. I am not departing from the call; babies unborn and newly born, and mothers at term must be classed as 'temporarily but severely handicapped.'
"Doppler ultrasound was used on me before, during, and after surgery.
"After my convalescence I was again examined by computerized axial tomography. No abnormalities - - other than the new plate in my skull.
"This brain surgery is not itself a spin-off from space technology ... but note how repeatedly space spin-offs were used on me before, during, and after surgery. This operation is very touchy; in the whole world only a handful of surgical teams dare attempt it. Of the thousand - odd of these operations to date, worldwide, Dr. Chater has performed more than 300. His mortality rate is far lower than that of any other team any - where. This is a tribute to his skill but part of it comes from his attitude: he always uses the latest, most sophisticated tools available.
"I was far gone; I needed every edge possible. Several things that tipped the odds in my favor are spin-offs from space technology.
"Was it worthwhile? Yes, even if I had died at one of the four critical points - because sinking into senility while one is still bright enough to realize that one's mental powers are steadily failing is a miserable, no-good way to live. Early last year I was just smart enough to realize that I had nothing left to look forward to, nothing whatever. This caused me to be quite willing to 'Go - for - Broke' - get well or die.