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Autohemotherapy Saved My Brother

In 1940, my older brother, Albert, was born prematurely, with a severe case of ichthyosis (skin with scales like fish.)

Due to Albert’s prematurity, at birth his entire body fit in the palm of my father’s hand. Albert had no suckling reflex, and so the pediatrician said there was nothing that could be done to save him. The newborn was doomed.

Based on the above information, I would place the baby’s fetal development at roughly 2/3rds of the way through the second trimester, perhaps at 22 weeks, close to a pound in weight and at most eight inches from the top of his head to his rump. He would have been below the now standard 24 week “age of survivability.” Survival at that stage of prematurity was unlikely.

Dr. Albert S.J. Clarke, an orthopedic surgeon, was my Dad. The infant at risk was Dad’s first child, named after him (Albert Sidney Johnston Clarke III.) Being a physician, Dad was not going to give up on his son without a fight.

Due to Albert’s small size, and the condition of his skin, they were unable to start an I.V., which is the standard of care in today’s medical world. So, as my Mother explained it, as a last resort, Dad withdrew his own blood and injected it into the gluteal muscles of the baby. That blood carried nutrition and sustenance to Albert; e.g., water, minerals, protein, sugar.

That was not as crazy as it seems, since Autohemotherapy was used in the early 20th century to treat dermatological cases, starting in 1913. The following abstract is an example of a 1928 article after the method gained some medical acceptance.

Quoting from the abstract, “Autohemotherapy, first used in dermatologic conditions by Ravaut (1913), closely followed by Spiethoff (1913), consists in the withdrawal of blood … and its injection into the patient’s gluteal muscles, preferably.”

By the 1940’s, Dr. Clarke was no doubt aware of the questionable therapeutic efficacy of the old method, but as a means of delivering fluid and nutrition to an infant otherwise shut-off from the world, there was nothing to lose. Their blood types matched, so in theory, a blood injection would not hurt.

Although the Rh factor was just discovered that year (1940), Albert’s odds of survival were likely assured by the fact that most people are Rh positive.

At the beginning of the 20th century, there was virtually no standard of care for premature infants. Julius H. Hess (1876–1955) published the first book on the subject of medical care for the premature infant in 1922.

In that book, Hess described tube feeding, or gavage, as in the illustration below. However, in the following years, infants often died from aspiration pneumonia induced by early feeding after birth, and early-applied gavage fell out of favor.

A year after my father successfully salvaged my brother, Hess amended his guidance in his 1941 text, writing “Small premature babies (those weighing under 1200 g) were not fed for 24–48 h …. During this time the premature baby receives physiologic salt solution, subcutaneously in the thighs, one to three times daily.”

Obviously, physiological saline solution avoids the risk of incompatible blood reactions, but in the case of that baby and his father-physician, God had blessed them with fully compatible blood types.

I don’t know if Hess had been made aware of my Dad’s lifesaving treatment conducted a year before Hess made his latest recommendation, but that is certainly possible.

I never discussed with Dad the details of his saving intervention, but from what I’ve read about babies with ichthyosis, my brother’s survival and thriving until age 73 is a bit of a miracle. His pediatricians gave him zero chance of surviving his first days. They didn’t know just how determined my Father could be.

Due to my brother’s genetic skin disease, he shed skin in large flakes; his bed sheets were always covered in them. He had to be lathered in Vaseline to keep his brittle skin from cracking too deeply, and bleeding. He also had very poor tolerance to heat because he had few if any functioning sweat glands.

In spite of his disability, Albert was one of the nation’s first Respiratory Therapists. He trained other Respiratory Therapists in west coast colleges, and ran several Respiratory Therapy Departments in hospitals across the country.

With unlimited medical research libraries at his disposal, he discovered on his own that a drug used for treating psoriasis helped him control his own skin condition. As a result, his quality of life in his last decades greatly improved. He fulfilled a dream of remarrying, all made possible by a determined physician willing to take a chance when the “experts” had given up hope.

Dr. A.S.J. Clarke, M.D. in his later years.

Today, thanks to advances in the medical management of premature infants, autohemotherapy is medically unnecessary. In fact, many doubters question its efficacy. However, I have the physical scars from growing up with a rambunctious big brother to prove that, in at least one case, it was a lifesaver.

Where is Pham-lỷ-Täi?

The word “pen pals” was recently in the news.

In the 1960s, students were taught U.S and World History. Long before the days of personal computers and the Internet, we high school students were encouraged to expand our perspective by becoming pen pals with other students around the world.

Of course, back then, the phrase “pen pal” literally meant using a pen to write, preferably in cursive or some reasonable facsimile.

Perhaps it was through the Weekly Reader that I first exchanged mail and photos with a gorgeous blond girl from Denmark. But by far the most memorable, and longest lasting pen pal relationship, was with a student from Saigon (later renamed Ho Chi Minh City.)

Pham-lỷ-Täi was a Vietnamese school boy with precisely written English. He told me that he and his family were Catholic. They lived in Saigon where his father worked for the South Vietnamese government, if I remember correctly.

As we wrote, we exchanged bits of national culture. He sent me a tall doll of a Vietnamese woman in long silk dress and hat (the Asian conical Nón lá). But as the years progressed, our written conversation turned more serious, towards the growing signs of war.

In 1964 as I was nearing graduation from Shawnee Mission East High School, in Prairie Village, Kansas, there were thousands of U.S. advisers in South Vietnam. The August 1964 Gulf of Tonkin incident had not yet happened, so while Pham-lỷ-Täi was uneasy, outright hostilities had not yet broken out.

However, about the time I left home for college in September, the letter chain was broken, and fighting began in earnest.

As history revealed, the war did not end well for either American and allied troops (Australia, New Zealand, and other forces), or the people of South Vietnam. Democracy was crushed. For well-educated Christians in government service, the consequences were more dire.

Communists seek out the best educated and most pious people, and kill them. That is what communist revolutions invariably do. Indeed, it is a sobering exercise to research the numbers of national citizens killed by Mao, Stalin, and Pol Pot’s Khmer Rouge. There were literally millions of citizens killed in each communist revolution.

I was in Army training in 1975 with a Cambodian officer at the beginning of the genocide of the Cambodian people by the Communist Khmer Rouge. Our class of American Officers urged the young man to stay in the country, fearing he would be killed if he returned home. But sadly, out of duty to his nation and to his family, he refused to stay in the U.S.

There is no doubt that his skull is one of the many skulls found in Pol Pot’s killing fields.

Pham ly Tai’s fate was less certain. Did he take up arms to lead the defense of his country? Did he perish in combat? Did he perhaps escape by boat, like my family physician, Dzung Nguyen, did as a child?

Was his family perhaps given diplomatic escort out of Saigon on the last American helicopters out?

I don’t know. If anyone does know, I would greatly appreciate hearing, one way or the other.

However, my fear is that like my Cambodian officer friend, duty kept Pham-lỷ-Täi home to face the onslaught.

For a long time, I had forgotten about my old pen pal. However, many decades later I was on a Taiwanese airline, Eva Air, headed to Taipei and eventually, Bangkok. This particular Eva Air flight had an odd Hello Kitty theme, inside and out. It catered to children. Strangely, I found myself surrounded by youngsters from Vietnam returning from Los Angeles and Disney World during their summer break.

In the seat next to me was a young lady from Ho Chi Minh City, and across the aisle were her female classmates. She no doubt noticed I was an American male of an age which could have placed me in Vietnam during the war. Apparently, that worried her. So, as the flight leveled off at altitude, my seatmate broke the ice by asking in her best English only one sentence.

“Are you mad?”

Seeing real concern in her eyes, and sensing a memory of things she might have heard about the war, I answered, “No, I am not mad.”

There were many more things I could have asked, such as, “Are you mad?” But her English was faltering, and my Vietnamese was non-existent. What I was thinking at that point was far too complex to speak simply. So, my answer, “No, I am not mad,” was the only way I could answer her curious question.

For sure, I could not be mad at a child who was not even alive during the Vietnam war. She and her friends had nothing to do with what happened to her countrymen, and ours.

From a different perspective, I wondered how my friends who were in combat in Vietnam would have answered. But I suspect, being good men and women all, they would not have held a grudge for half a lifetime. War is hell, but only the Communist leaders directed the killing of those who opposed them, for political purposes. The children are innocent.

I thought about telling that girl, maybe fifteen years of age, how I used to have a friend in Saigon, a boy about her age. If Pham-lỷ-Täi lived, perhaps he would have a granddaughter about her age. I wished, insanely I suppose, that the girl in the seat beside me was one of his granddaughters. If so, then I would know he survived.

But, for some reason, I did not ask her.

It’s strange the things you think about when crossing large oceans.

Once in Taipei, I was pleasantly surprised to see my former seatmate with her school friends looking my way, all smiles and giggles. They seemed to be pleased to meet an American of my generation who was not mad at them.

Of course I was not mad at a child. I never could be.

But I did remember a Vietnamese boy I knew a long time ago. He seemed to be a natural leader, a potential politician with strong ethics, a young man who would face death to save his country from communism.

So, I still wonder, what happened to my pen pal, Pham-lỷ-Täi?

The Basic Chemistry of Nitrogen Dioxide

“The U.S. President was on the phone with the President of China when a video from the International Space Station came in from the NASA feed to the Emergency Operations Center. A huge burnt-orange cloud was covering the entire southern Pacific, extending all the way up to Hawaii and down to New Zealand. This was no ordinary nuclear explosion.”

The recent deadly explosion in Beirut, and the science fiction thriller, Atmosphere, book 3 of the Jason Parker Trilogy, both involve a toxic, brownish-orange gas, nitrogen dioxide. Of course, one involvement is fictional, and the other, sadly, is not.

From the first chapter of Atmosphere, we find a description of the effects of a gamma ray burst hitting the Earth. “Rampaging winds began spreading toxic nitrogen dioxide clouds around the planet, and within days, the earth was fully affected.”

Considering the violence with which nitrogen dioxide is associated, the way it is created is relatively simple. Some chemists will no doubt claim that the following discussion is too simplistic, but I’ll let them fill in the blanks, if they so choose. As advertised, this is just the basics.

Given enough energy, and localized temperatures on the order of 3000°C, nitrogen molecules (two atoms of nitrogen, N2) combine with oxygen molecules (two atoms of oxygen, O2) to form a chemically unstable gas, nitric oxide, NO.

In chemical terms, N2 + O2 → 2NO

If the searing NO gas is cooled rapidly in the presence of oxygen molecules, the toxic, brownish-orange gas, nitrogen dioxide, is formed.

2NO + O2 → 2NO2.  (This is really nasty stuff!)

It’s been known since at least 1911 that the temperature of an electrical arc (6000° – 8000°C) is enough to cause N2 and O2 to form NO. If the hot gaseous NO is then rapidly cooled, NO2 results.

In the science fiction novel, NO2 was created high in the atmosphere by a cosmic burst of high energy gamma rays (GRB) colliding with nitrogen molecules in the presence of oxygen. Lightning also creates nitrogen dioxide, although in relatively small quantities. But if you increase the energy and the quantity of nitrogen and oxygen, “a huge burnt-orange cloud” would be formed.  

According to current estimates, that is exactly what happened in Beirut.

Apparently, an industrial fire caused the thermal decomposition of large quantities of ammonium nitrate, which energetically broke down to form massive quantities of nitrogen gas, oxygen and water.

2NH4NO3 → 2N2 + 4H2O + O2.

The resulting high temperature N2 and O2 instantly combined to form the toxic burnt orange cloud of nitrogen dioxide, as seen in the above photo.

The exact mechanism of NO2 formation likely differs among the progenitor sources (GRB, lightning, explosion), but the basics should be the same.

What happened to the poisonous cloud of NO2 after it formed? Unlike what would happen in the upper atmosphere during a GRB, near the surface there is enough moisture for the NO2 to quickly combine with water to form nitric acid.

3 NO2 + H2O → 2 HNO3 + NO

Nitric acid rain would not be pleasant, but would not be as bad as nitrogen dioxide.

So, imagine if you will, a cosmic event (a GRB) far more violent than any man-made explosion. Imagine the entire atmosphere turning into a cloud like that in the photo above. Arguably, that is what would happen after a devastating GRB from within our galaxy.

Actually, that toxic nitrogen dioxide cloud would be the least of the planet’s troubles. It would be a very bad day on Earth.

The good news is that such an event would be very unlikely.

But then again, this is 2020.

Pendelluft—The Beast Within

It was dark, the only light coming from the red glowing numerals of my digital alarm clock. I hadn’t set it to alarm—I needed to sleep as long as I could.

It was also quiet in my bedroom, quiet enough for me to hear my breathing as I lay still, trying to sleep. The breath sounds were rhythmic and calming, breathing in with a hiss, and out with a coarser and louder “huh,” endlessly repeated.

I had just been released from our local hospital after five days on oxygen, diagnosed with “respiratory failure” of unknown origin. The medical term for unknown origin is “idiopathic,” but that word added no clarity to what had happened.

What had happened has been described in a previous blog post, a post that correctly warned that if the illness that almost killed me was any indication, we should NOT expect COVID-19 to abate during the hot and humid months in the American South.

Whatever virus I picked up in Thailand in July, seemed to have a predilection for the hot and humid summer weather of Florida. In other words, it had made itself right at home in my lungs. The result was a puzzling but treacherous case of silent hypoxia, or as some have called it, happy hypoxia. In that regard, my respiratory failure was every bit as inexplicable and potentially deadly as COVID-19.

Thankfully, my viral infection had not yet reached the level of transmissibility of COVID-19. Otherwise, my wife of fifty years would certainly have been affected as she sat by my side for those long and frustrating days in the hospital.

But now, it was time for celebration. By sheer willpower and some tricks of the respiratory physiology trade, I had gotten myself discharged from the hospital. But that’s another story.

At home once again, my finger-tip pulse oximeter showed I was oxygenating reasonably well on air (in the low 90 percentile), but I was not back to normal (the high 90s). My lungs still had some healing to do before I could claim I was 100% normal.

As I now lay quietly as night enveloped me, entering almost a meditative state listening to my breathing, I noticed a strange sound. Alerted, I listened more intently. And what I heard scared the hell out of me.

There was something alien in my body. I couldn’t feel it, but I could hear it. When I breathed in, it breathed out. When I breathed out, it breathed in. It was clear as day, something was breathing in my chest, and it wasn’t me.

I had a monster in my chest.

At times like that, it is hard to be objective. But with years of training as a scientist, I forced myself to collect data and analyze the results before, well, FREAKING OUT!   

The first thing I noticed, was that the asynchrony between my breathing and the other’s breathing, was invariant. They were 180 degrees out of phase, and that never changed.

Professionally, I’ve dealt with probability my entire scientific career. So, if there were in fact some other living thing in my chest, the odds that it would never change its breathing rhythm seemed unlikely. Unless—it was waiting for my lungs to have a full “tidal” breath” before IT took a breath.

Of course! That is exactly what I would do if I was in some giant’s chest. I’d wait until their lungs were full before I’d steal air from them. After all, how else could I, as a little monster, breathe?

But wouldn’t X-rays at the hospital have shown its presence? Well, yes, and no. They didn’t do an MRI. If IT was soft bodied, and growing, it might not have been detected. And going an analytical step further, that could explain why my arterial oxygen saturation levels were not back to normal. IT was stealing oxygen from me.

My heart rate was increasing, which was the last thing I wanted it to do. The more blood I sent the thing, the faster IT would grow. I had to stay calm. But how?

I began thinking about physiology text books. That would put anybody to sleep. But that was also the magic moment. That was when I put a name on the creature in my chest.

I called it, Pendelluft.

Until that night, Pendelluft had been to me of little more than academic interest. I’d read about it, but I knew it is primarily found in patients with chronic obstructive pulmonary disease (COPD); which I do not have. I’ve also never been a smoker or asthmatic.

I knew of the diagrams which explain it, but I never thought that I would be able to hear it, in my body, and especially without a stethoscope.

An illustration of the mechanism of Pendelluft from a humorously named web site, Deranged Physiology.

After I explored the medical literature, I’m not sure anyone in the medical field thinks it possible for a patient to hear his own Pendelluft. But it must be true, since the monster never reared its ugly head, and my arterial oxygen level regained its expected normal value only after the “monster” faded away.

 According to a 1985 paper in the Journal of Applied Physiology, the experimental evidence and theoretical aspects of Pendelluft are attributable to varied pulmonary (lung) airway resistance and compliance (the opposite of stiffness), and were first described in a classic paper by Otis et al. in 1956.  

I was pleased when I read that one of my mentors, Dr. Arthur Otis, the one time Department Head of the Physiology Department at the University of Florida School of Medicine, had done the pioneering research on the subject.

However, I found no reference to breath sounds until I came across the 2012 article in the journal Pulmonary Medicine. That study used very complex instrumentation and statistical methodology to detect Pendelluft.

I have to admit that I smiled when I read that 2012 article. I was questioning how much money was spent on that very elaborate medical investigation. Arguably, it was fine work and contributed nicely to the field.

But, I wondered, did they try asking the patient, “Do you hear a monster in your chest?”

For what it’s worth, I did.

And it was scary as hell.

Warning Order

“Consider this a warning order.”

The voice on the other end was from the Pentagon. That was the last thing I’d expected to hear on Saturday morning, March 21st, 2020.

On October 1, 2018, I had happily retired after forty years of Federal service. I had remained engaged with the Naval Sea Systems Command and the Navy Experimental Diving Unit as their one and only Volunteer Scientist Emeritus, until I received that call.

Within 90 minutes, I had been reinstated with full security clearance and told to pack my bags.

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The next day as I was flying on government orders in an almost empty plane to New Hampshire, I had no idea that the company I was sent to help would begin a ventilator design effort from scratch, that same day. I also couldn’t imagine that the resulting ventilator would receive FDA approval 41 days later. 

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 The company, Wilcox Industries, in Newington, New Hampshire, has for twenty years built hybrid self-contained breathing apparatus (SCBA) for the military. In fact, twenty years ago, with full Navy support, I helped them design and test their first Scout (now Patriot), life-support system for Tier One operators. But when the COVID Task Force phoned me, Wilcox had no experience with medical devices, especially ventilators. But with the can-do attitude so typical of military support manufacturers, they were willing to learn. In fact, no one I met at Wilcox questioned that it could be done.

In the middle, Jim Teetzle, CEO of WilcoX Industries
Jim Teetzel (center) and Gary Lemire showing me the latest Hybrid Patriot 5510 Life Support System.

 All it took was the drive and leadership of Jim W. Teetzel (center of the photo), a brilliant engineer, businessman and CEO who holds more patents than he can probably remember, young engineers who never considered failure being a possibility, a nimble supply system that provided needed parts within 24 hours, and the magic words which opened every door. Those words were, “COVID Task Force.”

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Through the Wilcox network of friends and family, patient ventilation circuit parts almost magically appeared, as did the world’s best mechanical Test Lung.

Michigan Instruments Training Test Lung

There was nothing I asked for that did not appear almost as soon as I requested it.

Most important for me was the opportunity to teach by showing, by taking pieces of patient tubing circuits and arranging them in a way that would work with a totally new ventilator concept, the Patriot SAVR (Synchronous Automatic Ventilating Resuscitator.)

Mechanical Engineer, Nick Mercurio, "The Magician."
The Mechanical Engineer, Nick Mercurio, who I call “The Magician,” is working his engineering magic.

Our tasking from the COVID Task Force was not to produce multiple copies of existing sophisticated ventilators that cost as much as a nice car, but to have all hands engaged in producing small, cheap ventilators built to exacting engineering and medical standards. The proof that Wilcox accomplished that goal was the hard won stamp of approval from the Federal Drug Administration (FDA.)

Software Engineer, Jansen Habriel, "The Wizard."
The Software Engineer, Jansen Habrial, or the “Wizard,” makes the SAVR do things I never could have imagined.

While we want Americans to have the finest medical care money can buy, to include BMW-priced ventilators if the need arises, the fact is that during a world pandemic there simply are not enough of those deluxe models to go around. In the most populous nations of the world where per capita income is low, the availability of hundreds of such ventilators are a luxury few if any outlying hospitals can afford. However, low-cost ventilators like the Patriot SAVR fill that need.

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Wilcox is blessed with a retired Marine Corp Colonel, Kevin Dodge (on the left side of this photo), Jim Teetzel’s Chief Strategy Officer. Dodge not only has the experience of managing production and testing programs as complex as that for the V-22 Osprey, but has an understanding of the need for strategically placed world markets.

Together, Jim Teetzel, Kevin Dodge, the “wicked” smart Executive Director of International Programs and Lebanese-born Roula Assadi, and Jim’s senior engineers (Nic Goupil, Gary Lemire, Stan Carter) and their Maestro of Quality Assurance, Lorena Grol, have succeeded in turning a small but wealthy Arab nation into a manufacturing center for the Middle East and North African Region, as well as the huge Indo-Asian continent.

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A photo of the first Patriot SAVR Q made overseas by the Barzan Industrial Group in Doha, Qatar. It is being held by John Bousquet, one of the young designers from Wilcox Industries.

Considering the tactical pedigree of this ventilator, and the company which built it, I foresee that eventually every U.S. military medic or independent duty corpsman will have one or more of the Patriot SAVR units available at their aid station, just in case any Patriots need saving.

Happy Hypoxia – A 2018 Warning

“Happy hypoxia,” or more properly, silent hypoxia, has been one of the most puzzling signs and symptoms of patients presenting to Emergency Rooms with COVID-19. The patient’s arterial oxygen saturation can be in the fifties instead of the normal values in the upper 90s, and yet the patient can be cheerful, fully coherent, and even chatty. Normally, with that low an oxygen concentration in the blood stream, a patient would be in severe respiratory distress.

I experienced silent hypoxia after a visit to Thailand in July of 2018, which makes me wonder: was there a coronavirus lurking in Southeast Asia in 2018 that later mutated to become the killer SARS CoV-2? Did I have SARS CoV-1.5? 

Summertime was everything you would expect in Thailand. It was warm and humid, but not uncomfortably so. I had twelve hours ahead of me in the Bangkok Airport waiting for my return flight to Taiwan, then the long leg across the Pacific to Los Angeles. Eventually, I would make my way back to my home in Panama City, Florida, which would also be hot and muggy. No surprises there. 

What was a surprise, was that a young lady wandering the airport asked if she could interview me for the Thai Ministry of Tourism. She had official looking IDs, and a load of interview questions. I wasn’t interested, and I was busy, I offered, already tired before the twelve hours of dead time even began.  

In truth, I wasn’t that busy, but felt it best not to mingle. I seemed to be the only person not speaking Thai, except for that young lady. Surprisingly,  she had no detectable accent and could pass for a Southern California blond.

After a couple of hours, she returned when I could no longer claim to be busy. She had a simple, youthful attractiveness and an unassuming manner. So, tiring of the boredom of waiting, I allowed her to sit beside me while she started running down her list of tourism related questions. 

She wanted to know why I came to Thailand. It was to give a talk at a medical and scientific conference on sports medicine. My subject was “Oxygen,” a fact that would soon become ironic. I discovered later that my travel, ostensibly paid for by the Thai Sports Authority, was bankrolled by Beijing. But I didn’t know that at the time. 

For 45 minutes the questions continued. They were business-like, the type of questions I would expect from a Tourist Bureau. But one thing caused me concern, her occasional hacky cough. She insisted it was nothing, and I was not alarmed. I thought no more about it as I finally boarded the plane for the first leg of my long journey home.

Eight hours after my arrival in Panama City, I felt ill as I lay in bed, trying to sleep after being exactly twelve hours time-shifted. I felt sicker by the minute. Jet lag doesn’t do that.

By morning, I had suffered chills and sweats, and my physician son insisted I be taken to the closest Emergency Room. As we neared the ER I felt I was going to vomit, and I leaned into a trash can that my wife brought for that purpose. 

The next thing I heard was her screaming at me.

I yelled back, completely confused and annoyed. “Why are you yelling at me?”

“I thought you’d died,” she said. “You sighed, threw your back into the seat, and your arms were stiff and shaking.”

Apparently I had passed out from a drop in blood pressure.  (I had not yet thought about hypoxemia.)

As I was being monitored in the ER, I felt OK. I conversed with my wife, and was half-joking and half-irritated at my unexpected welcome home event.

After awhile, I began to pay attention to the finger tip pulse-oximeter that was monitoring my arterial oxygen saturation. The reading was slipping lower than I had ever seen before, but neither the nursing staff nor the attending physician seemed the least bit concerned. My wife and I continued to chat. I was not in any discomfort, and ignored the monitors until I caught sight of the updated pulse-ox reading. It had plummeted down to a horrifically low 55%. 

I told my wife to alert the nurse. They finally started me on a nasal cannula with oxygen. (For those who know, that was an incredibly delayed reaction.) I also knew enough to realize I should be almost stuporous, yet I wasn’t. I was content, except for my circumstances.

Within a few minutes, an ambulance transported me to a real hospital. Being aware of my overseas travel, they assumed I had a pulmonary embolism, which if detected, would have required immediate surgery. But after a perfusion scan, nothing abnormal was revealed. 

After settling into a room, I had zero desire for any of the food they brought me. It was all tasteless, and remained that way for two days.

Initially they kept me on 3 liters of oxygen per minute by nasal cannula, which still wasn’t bringing my oxygen saturation above 84 percent. That was a problem.

At the urging of the CDC, the nursing staff came to my room fully gowned and face-shielded, and stuck that infamously long sampling swab up my nose. They tested me for the most recent viral illness in Southeast Asia at the time, the H7N9 Bird Flu virus of 2017. The results were negative.

In spite of my growing displeasure with being in the hospital, and not tolerating the taste, or lack thereof, of their food, I was happy and chatty with the nursing staff. But neither I, a respiratory physiologist, nor the medical staff could figure out what was wrong. My X-rays showed some consolidation in my lingula, a small lobe in the middle of my lungs, but that was not enough to cause hypoxia of the level I was experiencing. 

After a while, I began to get a few signs of pneumonia in my lower lung lobes, but not enough to cause any discomfort, or difficulty breathing. While physicians clobbered the growing infection with antibiotics and steroids, I remained happily hypoxic.

After five days in the hospital, and slowly watching my oxygen saturation rise, a respiratory therapist snuck behind me and turned off the oxygen. My saturation remained low, at 88%, but it didn’t drop further. 

That meant, I would remain on air until discharge. That encouraged me enough to call for a walking test, walking down the hospital corridor breathing nothing but air. Unfortunately, I failed that test, and was sent back to bed.

About that time, a pulmonologist came by and told me I had a good bit of atelectasis (collapsed alveoli or lung sacs) in my lower lobes. Finally, something I could fix. I knew what to do.

I wore out my incentive spirometer over the next couple of hours, and then called for another walking test. The Respiratory Therapist chided me…I would just fail again, she said. But I do love a challenge. With her by my side, I moved slowly down the hall, refusing to talk, and that time my oxygen saturation did not drop. 

Due to that walking test, I was discharged from the hospital with an oxygen saturation of 92% and returned home to fully recover. (That is in itself an interesting story which I’ll write about next.)

However, the point of this post is that as I read about COVID-19, I’m finding that physicians are puzzled about some of the same bizarre symptoms I experienced in 2018,  notably  a silent hypoxia. I was never “short of breath” as would be expected with an arterial saturation in the fifties. 

From my studies of respiratory physiology, I knew that what had happened to me in 2018 should not have happened, according to the text books. I did not have the SARS virus identified in 2017. But viruses mutate constantly. Could my symptoms have been the signs of a predecessor or cousin to COVID-19? Could it have been an unrecognized COVID-18?

When lungs are not filled with fluid from rampant pneumonia, the most likely way to become hypoxic breathing air is through something called ventilation-perfusion (V-Q) mismatch. A pulmonary embolus can cause massive V-Q mismatch, and can quickly kill if untreated.

However, a recent Science article suggested that COVID-19 might cause microemboli resulting in silent hypoxia. It seems reasonable that enough microemboli, if that’s what it was, could have caused my symptoms in the summer of 2018 without being detected on a pulmonary perfusion scan. 

And that worries me for the current pandemic. Summer heat and humidity might not kill this virus. It certainly didn’t kill the virus that I presumably caught from a pretty young girl with a “nothing” of a cough in late July of 2018. It may have been nothing for her, but it was sure something for me.

None of my friends at the medical conference got sick upon returning home. I was the only one spending 45 minutes less than a foot away from that coughing girl. I feel pretty confident where I got it. My only question is, did I pick up a version of coronavirus that was beginning to mutate towards the destructive potential of SARS CoV-2 which erupted just over a year later?

I will provide an update on the results of my antibody test for COVID-19. That could prove interesting. 

Bubble Submarines Resurface After Fifty-Two Years

A December, 2019 article in the New York Times has the catchy headline, “Bubble Subs Arise, Opening Eyes to the Deep Sea.”

From my perspective, it’s always great when anything about the deep sea attracts the attention of major newspapers. In general, well researched and written publications on the subject are hard to find. A happy exception is biologist Bill Streever’s latest book, In Oceans Deep.

Click photo to go to the Amazon page.

Streever’s excellent book has much to say about free diving, Navy diving, and even one-atmosphere diving suits (wearable submarines, if you will.)

But back to the NYT. William Broad’s article on mini-submarines is both colorful and informative. I urge you to read it if you have even the slightest interest in the undersea world.

Click photo to link to the NYT article.

However, just as the title of this blog post is deliberately hyperbolic, tongue in cheek, the NYT article is a bit misleading. Just because the technology may be new to the New York Times, it doesn’t mean it’s truly new. Bubble Subs have not actually risen of late. They, and the concepts behind them, have been around for a long time.

To prove my point, this blog post republishes the most interesting parts of an article I penned in the Georgia Tech Engineer way back in 1967. It’s called The Depth Challenger. The article is a little technical, which is the norm for an engineering school magazine, but it was also written to appeal to a diverse student body.

Artist’s conception of a 56-in diameter sphere mounted on its 16-foot maneuvering sled.

The article begins with a short piece of descriptive prose.

A brittle star, its arms twitching, spreading across the firm, grey mud, stops as a tracking light sweeps over and beyond it. An instant later the light returns and fixes on the animal as the whirring bubble slides in close over­head. The sphere hovers briefly then moves off, circling, finally disappearing below a canyon rim. When minutes later the bubble settles to rest on the soft canyon floor, cameras clicking, the two men inside sit gazing, peering, with four miles of water above their heads. These men are new frontiersmen – the oceanographers.

One of the greatest problems preventing our full utilization of the ocean’s potential is the inability of re­ search devices to withstand the enormous pressures exerted by deep water. At four thousand feet, the sea exerts one ton of pressure on each square inch of surface. At thirty-five thousand feet, the pressure is more than seven and a half tons per square inch. To date, nothing has been developed with the ideal requirements of 1) withstanding deep sea pressure, 2) containing man for extended periods of time, and 3) enabling direct visual observation.  However, a solution to these problems may soon be met by glass submarines. H. A. Perry, research materials engineer at the Naval Ordnance Laboratory of Silver Springs, Maryland, is currently researching the feasibility of transparent submarine hulls. Perry states that glass provides a unique degree of buoyancy and safety in deep submergence hulls.

To test his original hypothesis, Perry and other NOL scientists set sail in 1964 aboard the Navy research vessel Gillis with a cargo of 95 hollow spheres provided by Corning Glass Works and the Pittsburgh Plate Glass Company. Once over the Puerto Rico trench, these spheres were lowered to depths of 300, 7000, 1400 and 2100 feet. Pentolite-charges were set a fixed distance away and detonated. If no leakage of the sphere occurred, the charges were moved closer until the glass finally failed. At this point, a “critical distance” was defined.  As depth increased, the compressive strength of the glass also increased. With metal hulls, the results are just the opposite.

(As a side note, a few years later I set sail on the same vessel, by then renamed the RV Gillis, for a research cruise to the Puerto Rico Trench.)

Apparently, the deeper a glass submarine dives, the safer are its occupants; that is, down to an optimum depth of about 21,000 feet where the compressive strength diminishes until buckling finally occurs at a theoretical depth of 55,000 feet. However, the deepest part of the ocean, the Challenger Deep, is a trench descending to only 35,888 feet, so the theoretical limit for glass spheres poses no problem. It will be noted, though, that the compressive strength of conventional spheres at relatively low pressures is in itself rather low. The chances of a mariner surviving an accidental collision on down to a depth of several hundred feet is nil. Obviously, there is a need for either foolhardy scientists or “pre-compressed hulls.”

The full article with illustrations can be read here.

Bubble-Sub-1

In my opinion, the epitome of bubble submarines has been the Johnson Sea Link, pictured here. This revolutionary bubble submarine started operations in 1971, with upgrades in 1972, just a few years after I got wind of it.

Ocean on Top

When I was a graduate student, I found Hal Clement’s science fiction novel in the Florida State University Bookstore. I had just completed a summer in the U.S. Navy-sponsored Scientist in the Sea Program in Panama City, Florida. Being an avid diver, and a burgeoning scientist, my imagination was captured by Clement’s book.

I read his book shortly after it was published in 1973, but after graduating and moving, I lost the book. Unfortunately, I also forgot the book’s title and the author’s name. Yet I still felt a deep connection with the story, and for that reason, I spent decades looking for it, without success.

Recently, my luck changed. While browsing the Wikipedia topic on liquid breathing, I found the source I had long been searching for. “Hal Clement’s 1973 novel Ocean on Top portrays a small underwater civilization living in a ‘bubble’ of oxygenated fluid denser than seawater.”

There it was, at last. And best of all, that bubble turned out to be perfluorocarbon, an exotic, heavier than water, transparent liquid. In reality, filling a person’s lungs with it, is not as murderous as it would seem.

I was ecstatic: could this really be the book I’d been seeking for decades? Being on travel at the time, I searched for an Audible version of the book. Again, I was in luck: there was a version narrated by Tom Picasso. (Thank-you, Wikipedia and Audible, for providing instant gratification!)

With a bit more research, I discovered that “Hal Clement” was the pen name for Harry Clement Stubbs. I ordered two copies of his first edition, one of them signed with both his pen name and real name.

Harry (Hal) Stubbs passed away at age 81, in 2003. Born in 1922, Stubbs was an early leader in the “hard science fiction” genre, where science fiction is infused with scientific facts and logic.

Harry Clement Stubbs, aka Hal Clement.

The original version of his story was a Magazine serial version, copyrighted in 1967 by Galaxy Publishing Corp., for Worlds of If.

First publication.

While the publication of the 1973 book version of Clement’s story might have been influenced by the Energy Crisis of 1973, , the date of the original publication, 1967, suggests that Clement was simply prescient. I would be surprised if in the 1960s, a science fiction writer of ordinary skill could have envisioned the global Energy Crisis of 1979.

Yet, here it is, the publisher’s summary of Ocean on Top: “Aquatic Enigma – The world’s energy was limited… and with overpopulation and a high level of technology, the Power Board had virtually become the real government of the world. Power was rationed, it was guarded, it was sacred. Thus, when three of the Power Board’s agents disappeared at sea, and there was evidence that something irregular was happening to the energy quota in that area, it was cause for real alarm.”

In 1979, while I was stuck in long lines waiting for gas in Maryland and Washington D.C., I vividly remembered the premise behind the book whose title evaded me. What a curious prediction that author had made, a prediction that in part had come true.

Of greater interest to me in 1973, as a newly fledged Navy-trained science diver, was the book’s prediction of the consequences of contemporaneous U.S. Navy-funded work on liquid breathing by human divers. In the 1970s, Johannes A. Kylstra was the primary researcher working on that project in the hyperbaric laboratory at Duke University.

Some critics say Ocean on Top was not the best of Clement’s works. Arguably, that honor belongs to his earlier Mission of Gravity(1954). However, if you are curious about the prospects of forsaking the land and living under the sea, his 1973 book raises some interesting points. One is that it posits the divergence of humans into two races; air-breathing humans and liquid breathing humans.

Promo image for the movie, Aquaman.

It also predicts, convincingly, some of the communication difficulties such a human divergence would cause. After all, our anatomical speech apparatus is designed for working in air, not fluid.

Perhaps it was the subliminal memory of Clement’s little book that influenced the storyline in the recent work, Atmosphere, Book Three of the Jason Parker Trilogy. After all, liquid breathing was an exciting science and science fiction concept back in the day, and surely worth a resurgence in this century, based on modern science.

I say “modern science” for two reasons: the first is because liquid perfluorocarbon is now instilled in lungs for medical treatment. Secondly, thanks to new molecular engineering technology like CRISPR-Cas9, we now foresee how genetic engineering can potentially lead to a divergence of the human species.

If Hal Clement was still around, I have no doubt he’d be writing many more science fiction novels about a future that just might be more realistic, and with more immediacy, than we think.

Cover for the second edition.

When Heat Pumps Become Killing Machines

Heat pumps have been a boon for efficient residential heating and cooling, at least in those regions of the country where winter temperatures do not consistently hover in the frigid range. In the southern United States, whole house heat pumps are arguably the most efficient way to heat and cool a house. Outside temperatures rarely fall below twenty degrees Fahrenheit, and even at 20°F, there is plenty of ambient heat available to heat a well-insulated home.

Owners of heat pumps have probably noticed that in the summer, heat removed from the home is released into the outside air. Heat coming off the outdoor unit, the actual heat pump, is hot. On the other hand, they may not have ventured out on a winter night to see how cold the exhaust from a heat pump is when it is in “heat” mode. But cold it has to be. Compared to a temperature of absolute zero, winter air is hot as hades. A heat pumps works by extracting some of that heat and sending it into the house to warm the house occupants.

But you can’t get something for nothing. Once the pump extracts a portion of the heat from cold outside air, that outside air must become colder.

Into this thermodynamic saga enters a non-native lizard called the Cuban or Brown Anole. The lizards are invasive, which means they are decimating the native Green Anoles which have long existed in the South Eastern United States. The Cubans are larger, more aggressive than the Greens, and reportedly feed on young Green Anoles. 

Cuban Brown Anole [Anolis sagrei]

However, they have a weakness. As you might expect for any species originating in Cuba and the Bahamas, they don’t like the cold. Whereas Green anoles range as far north as the Carolinas, the Browns do not. In fact, after a cold night in the Florida Panhandle I found a Brown Anole hard frozen on my doorstep. Perhaps he sensed warmth seeping from under the front door, and was trying to get in the house. Well, he didn’t make it.

The Greens, on the other hand, apparently shelter on or underground in leafy areas to survive the occasional cold dip.

This image has an empty alt attribute; its file name is Anole-Green-cropped.jpg
Green Anole (Anolis carolinensis)

As the outside temperature begins to drop in the late fall and winter, heat-seeking tropical lizards can be found warming themselves on top of the outdoor heat exchanger of our AC unit. When the proverbial nip is in the air, owners of well-insulated Florida homes plagued with high humidity, continue to run their air conditioning until late in the season.

For the Anoles, that is both a boon and a risk; it can prove to be a dangerous warming strategy. If frightened by the sudden appearance of a homeowner, Anoles run. When in their panic they fall into the running fan, the attempted evasion does not end well.

But the greatest insult is a thermodynamic one, which comes when the outside temperature drops even lower. Naturally, that chill makes the warmth from the heat exchanger even more attractive to the lizards. That is, until one of the human occupants decides it’s time to turn on the heat.

Thermodynamics being what it is, that switch almost instantaneously turns a warming source of air from the AC unit into a frigid blast of air.

Which explains why one morning after turning on the heat, I discovered the freeze-dried carcass of a Brown Anole clutching tightly to the grill of the AC unit. Apparently, the already chilled tropical lizard had what little strength it had left suddenly sapped by the high velocity blast of cold air. It died in place. (I have spared you the photo I took at the time.)

There is a moral to this story I believe.

As we grow cozy with new technology we don’t understand, while basking in the warmth and seduction of advanced engineering with its seemingly miraculous capabilities, perhaps we should remember this little lizard. It had acquainted itself with the bright side of thermodynamics, without realizing there was a dark side. Likewise, with the throwing of a switch, seemingly magical technology could be our undoing.

A serving of Artificial Intelligence, anyone?

Phobos, Chariot of Fear

Phobos

The title of this posting is no hyperbole. The “Chariot of Fear” is the ancient Greek personification of the mythological God Phobos, described by the ancients as horror riding his chariot across the night sky.

In reality, the diminutive moon Phobos, almost skimming the surface of the warrior planet Mars, is a potentially innocuous place to visit assuming you have a pressure suit and oxygen to breathe. Like Earth’s much larger moon, there is no atmosphere on Phobos. There is also no appreciable gravity.

NASA and Japan are planning a joint unmanned mission to the moons of Mars in 2024. The joint venture is called the Martian Moons eXploration Mission, or MMX. Those unmanned missions may be a prelude to later manned landings since NASA has considered landing astronauts on Phobos before landing on Mars, due to the lack of atmosphere and ultra low gravity of that moon.

Using the Hubble telescope, NASA generated a short video of Phobos as it orbits around Mars.

NASA video made from 14 Hubble Space Telescope images.

While researching a new novel, I was looking for a view of Mars from Phobos. Using the astronomy software Starry Night Pro 8, I found it.

Further more, I was able to make a 3 minute video of Mars going through an entire rotation, sped up of course some 150 times.

While the above video is aesthetically pleasing because of the background stars and the entirety of Mars being in the field of view (FOV), in reality Mars is too far away in this simulation. As the NASA movie suggests, the surface of Mars is much closer (about 6000 km away from Phobos), and thus in reality Mars fills a quarter of the celestial horizon as seen from Phobos. In other words, from Phobos the FOV of Mars is about 45°, which yields a more accurate view as shown in the following video, also made using Starry Night Pro.

Mars at a realistic distance.

The shadow of Phobos can be seen racing across the surface of Mars, to the left of center of the Martian equator.

From a writer’s perspective, thanks to affordable but sophisticated astronomical simulation software and a bountiful database of space objects and trajectories, both near and far, there is no longer an excuse for science fiction writers not getting their scenes setup correctly, assuming their stories are based on the observable universe.

As for the unobservable universe, well that’s where this thing called imagination comes into play. In an imaginary universe, there’s no fact checking allowed.