Traveling with Lee Sandlin

Lee Sandlin died earlier this month. What a tremendous loss. He was a fantastic writer, and I was lucky to make his acquaintance. Here’s an obit by Michael Miner in the Chicago Reader, the longtime home for his singular brand of narrative nonfiction.

A celebration of his life and work was held recently at Chicago’s Sulzer Library and his wife, Nina (@nsandlin) — a good friend of mine from our days together at the late, great American Medical News —  asked me to contribute some thoughts. Here they are below. I post them here principally for the opportunity to share a bit of Lee’s writerly genius, and to encourage you all to read as much of his work as you can, as soon as possible.


To read is to place your trust in the hands of another, typically a stranger. When you read, the general rule is that most of what you know, what you believe about a subject, what you feel and hear and see in the mind’s eye, is shaped by your guide, the author. There was no better guide than Lee Sandlin.

The road he led you down may have been full of pit stops and detours, but every one was worth all the while. In a world where the written word is defiled by inattentiveness and, worse yet, artlessness, he kept a great faith with himself and with his readers. And, boy, did his prose show you how to go. In “Wicked River,” he wrote:

There were no beacons or lighthouses or channel buoys on the river then; there were no official markers of any kind. Here and there someone would occasionally paint a warning or an arrow on a prominent rock to alert voyageurs to danger — but these were often the work of pirates, to trick boats into going aground. Nor were there any reliable maps. In that era, mapmaking, even at its best, was a mixture of supposition, obsolete or garbled information, and pure fantasy; the first rule of travel in the American interior was that only a fool trusted a commercial map.

But the voyageurs didn’t care. What did they need a map for? The land was so wild it was essentially impassable; anyone who didn’t go by the river didn’t go at all. In effect, the river served as its own map. A voyageur who needed to consult it had only to climb the nearest hill. There the route was unfolded, in all its blue-misted splendor: the great dragon tail of the river uncoiling through forested valleys and across the tallgrass prairies and into the vast shrouded swamps, glittering with ten thousand sunflecks, blurred by drifts of drizzle, blazing with reflected herds of brilliant cumulus, on and on toward the horizon. As far as the eye could see, the river was the only road.

I would give a pinky finger to write sentences so pure, so authoritative, so precise, so true. I feel lucky to have read them, and doubly fortunate to have had the opportunity to share with Lee how much they meant to me, thanks to my friendship with his lovely wife, Nina.

One could call writing like Lee’s majestic, or lyrical, those book-review workhorse words. Posh! I say. When we see nonfiction writing like this again (as will surely be rare), I suggest we call it Sandlinesque. That will be a true compliment. Thank you, Lee, for letting us travel with you. On and on, toward the horizon!

Massive transfusion: a question of timing, detail, a golden ratio

Here it was, the kind of massive postpartum hemorrhage case for which the team at Duke University Medical Center had spent months preparing. The multidisciplinary group had agreed on which laboratory tests would be done in such a case, determined which blood products would be delivered, and decided which members of the OB team would be sent racing to retrieve the potentially life-saving package.

For the two labor-and-delivery nurses designated as runners, the quickest way to get down to the blood bank was the elevator. The elevator was working, but the nurses’ badges did not allow them access to it.

“They had to run all the way down the hall, then all the way down the stairs. It took much longer,” says Evelyn Lockhart, MD, a pathologist who specializes in transfusion medicine and led the Duke team in implementing a massive transfusion protocol for postpartum hemorrhage.

“It was a surprise to us all,” Dr. Lockhart says. Fortunately, the only harm associated with the inaccessible elevator was a couple of winded nurses. That is because the elevator flap came as part of a simulation, and no woman’s life was in danger. It turned out that access to the elevator was restricted to emergency department personnel. That changed soon enough, before any real-life obstetric massive transfusion protocols, or MTPs, were initiated.

The story illustrates an essential truth in the world of massive transfusion, experts tell CAP TODAY. While a randomized clinical trial likely to be published could help answer persistent questions about which blood component ratio can best reduce the mortality rate in massive transfusion cases, experts say that fine-tuning the timely communication, processing, and delivery elements of the MTP are just as essential as determining what “golden ratio” of blood products to prepare.

My cover story from the December issue of CAP TODAY. Read the whole shebang.