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735: Bloody Feelings

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Prologue: Prologue

Ira Glass

Mitchell was in his 20s when he learned that his mom was getting on a bus or train twice a week and going to a place that would stick a needle in her arm and take a pint of blood. And they would keep the plasma and give her back everything else and pay her $25 or $35 per pint. Again, she'd do this twice a week because she needed the cash. And of course, that is not the kind of thing anybody wants to hear their mom has to do. And it took him a few years, but soon as he had the money to step in and help her out, Mitchell told his mom, don't do it anymore. You know, I'll just give you the money. And she turned him down.

Mitchell

You know, like, don't worry about it. I don't need you to jump in. I'll take care of myself. Even if it's hubris, at least I'm not asking you for anything. She loves that saying-- what does she say? "We do for today what we can't do for forever."

Ira Glass

What's that mean?

Mitchell

It's, I guess, a personal proverb that she uses to trick herself into enduring a crucible. You know? I can do it today.

Ira Glass

What made this especially hard was Mitchell was in New York. His mom was on the other side of the country in Oregon, where he grew up. And he'd call sometimes, and her phone would be turned off. And he would have to reach out to his brothers to find out what was happening and if she needed help and then organize the help.

But talking to her about the blood donations-- and they had a bunch of conversations about it-- led Mitchell to learn everything about it, about the multibillion dollar companies that buy plasma from people like his mom, about the Black doctor, Charles Drew, who invented a way of separating plasma from blood and set up some of America's first blood banks at the start of World War II.

Mitchell

And because we were still in Jim Crow, they would not let Black people donate blood. Like, how symbolic is that that the Black guy that invents this process that helps these hundreds of thousands, if not millions, of people can't even donate blood?

Ira Glass

Mitchell is a writer. He's been on our show before-- Mitchell S. Jackson. And he's written about these conversations with his mom and the places that they led him to. Like, for instance, one day, he got her talking about blood and patriotism. His mom's take on patriotism, by the way, is that anybody who says my country right or wrong, no matter what ugly thing happens here, is basically just like a mom, who sees the best in her kid no matter what terrible thing they do. Anyway, during that conversation, she surprised Mitchell by describing her blood donations as the most patriotic thing she does, even though she does it for the money.

Mitchell

I guess if we kind of think about patriotism in its best light, it's looking out for the next person. She was just thinking, I'm giving a part of me which is sacred to benefit someone else. But I think it's also, too, my mother is one of those people. She really is the mother who will do anything. She's the mother that has, like, $100 in her account to last her the month. And my brother doesn't have food in his refrigerator, and she gives him 80. And this is not a hypothetical. This is a literal. So this is another way of giving.

Ira Glass

Mitchell, as you talk about it, I just feel so struck with all the things that are bundled up in those little pints of plasma. When you tell this story, it's simultaneously your feeling of protectiveness about her and how she's doing, and is she doing OK, and her wanting to be independent of you and her also feeling like she's taking care of other people and also getting money she needs. And also, it's blood, this physical thing that's all compressed in this little plastic bag, you know?

Mitchell

Yeah, it's both symbolic and literal.

Ira Glass

I think it's always that way, maybe because blood is so fundamental, keeping us alive. It's something we all share, part of our insides that we all have actually seen with the urgent color of a stop sign. It takes on so many other meanings in ways that other things in our body do not. There's blood ties and blood feuds and bad blood between people and the blood of the lamb, and Jesus's blood turned to wine. There's the idea of people who are cold-blooded, people who are hot-blooded, and the now discredited notion of how much of this group's blood or that group's blood you have running through your veins.

Today, on our program, we dive into all kinds of stories about blood. Picture please, if you will, right now, you know those elevator doors from The Shining opening up a sea of blood pouring out right here on the radio? But don't touch that dial. There is so much to say. From WBEZ Chicago, it's This American Life. I'm Ira Glass. Bloody stay with us.

Act One: Started From Phle-Bottom, Now We’re Here

Ira Glass

Act One, Started From Phle-Bottom, Now We're Here. So we begin today with a story about literal, actual blood and this joke-- and by the way, hello to all the seven-year-olds in our audience-- why did the nurse bring a red pen to work? In case she had to draw blood. OK, anyway, somebody wrote into our show last summer saying they had a story to tell about being a phlebotomist, a person whose job it is to draw blood for lab tests or donations-- using, by the way, a needle, not a red pen.

Her name is Adele Levine. And she said she was the worst phlebotomist in her whole hospital. One of our producers, Diane Wu, found that intriguing, naturally called her up, and it turns out she is a perfectly fine phlebotomist. But she did get thrown into the job from a different job without a lot of preparation in some of the most extreme circumstances imaginable-- a total fish out of water. Here's Diane.

Diane Wu

I liked talking to Adele about drawing blood because as a newbie, she saw everything with beginner's eyes. She was so into it. She talked about veins in this way that I'd never heard before-- just ardently.

Adele Levine

You have to test the vein, and it should feel bouncy.

Diane Wu

Like, you test it by touching it with your finger?

Adele Levine

Yeah, I would touch it, and it should sort of bounce. So now I'm always bouncing veins, my own veins.

Diane Wu

Wait, now I want to try.

Adele Levine

Oh, do it on the back of your hand.

Diane Wu

OK.

Adele Levine

Yeah, the veins in the front of the wrist are not for us.

Diane Wu

How come?

Adele Levine

I don't know. I didn't go to phlebotomy school. They just told me, that's not for us.

Diane Wu

Adele didn't ever study phlebotomy because she's actually a physical therapist. She had no plans to ever be sticking people with needles and drawing their blood. But when COVID hit last spring, the hospital she worked at cancelled all of her physical therapy appointments and started assigning people to new jobs.

Adele Levine

I really wanted to work on the loading dock. That was what I really wanted to do. I wanted to drive one of those big things around and lift pallets of supplies.

Diane Wu

But they didn't need her there. She ended up in phlebotomy, one of the departments of the hospital whose work didn't slow down, and became a total newbie drafted to draw blood for the very first time in the middle of a pandemic. By the way, she didn't want us to name her hospital because they didn't give her permission to do an interview. Adele spent her first few days following different phlebotomists around the hospital, watching closely as they worked. She was so impressed to watch as they performed even the most basic tasks with incredible elegance.

Adele Levine

This one phlebotomist, I just was always mesmerized by the way she put tape on the back of her hand so precisely, always exactly the exact size piece of tape. Another one, she would hold the butterfly needle not by the wings, but actually by the little barrel, which is kind of a harder way to hold it, but she was just real gentle, just the way they could draw blood from the craziest places.

I mean, because hospital patients, they're sick. They're in organ failure. They're really swollen, or their veins are shot. And these phlebotomists are doing crazy stuff, like just skimming the surface of someone's forearm and just getting this tiny little spider vein, you know? Or they're getting blood from the back of someone's thumb knuckle. I think they're total artists.

Diane Wu

Then, suddenly, it was her turn to try. Adele flipped around her hospital badge so no one could see she was a physical therapist, then went and did her first sticks-- that's phlebotomist lingo for blood draws-- in the maternity ward on healthy young mothers who had big, easily visible veins. She made a lot of rookie mistakes.

Adele Levine

I would keep the tube on until it completely filled with blood. And then when I would retract the needle, the blood that was left over in the tubing would spill all over the bed and make a big mess. And then everyone was always yelling at me to retract the needle, retract it. Do it, do it. It's ready. It's ready. I'm like, but it's only halfway full. Just do it! I'm like, OK.

Diane Wu

After about two weeks of this sort of haphazard seat-of-the-pants training, her manager decided she was ready to go in alone. On her first day of working solo, Adele walked in and saw that her assignment was in the ICU, which, at that point in April, was full of COVID patients.

Adele Levine

I got panicked, completely panicked, you know? I mean--

Diane Wu

Why?

Adele Levine

--I was so nervous. I mean, even just going into a COVID room just would fill me with fear, terror.

Diane Wu

It was an incredibly challenging assignment. ICU patients were among the sickest in the hospital, often with multiple IVs and swollen limbs. And phlebotomy was only called in after the nurses there had already tried twice to get blood, but couldn't. On top of that, all the COVID stuff-- the PPE that made it hard to move and see, not being able to bring a full cart of supplies in, the pressure to work quickly and minimize exposure. Adele was terrified and overwhelmed. But she did her best to figure out her own little routine.

Adele Levine

In the beginning, I always used to talk to the patients, even though--

Diane Wu

What would you say?

Adele Levine

I would say-- I'm like, good morning, good morning. This is Adele. I'm from phlebotomy. I'm here to draw some blood. But they're sedated, or I tell them, today's Tuesday. It's April 20. It's a nice day outside. I'd tell them what's on the news or what was going on. And I'd always tell them that they look great, that they were getting better, I could tell.

Diane Wu

How often was that actually true?

Adele Levine

Hardly ever, but I just felt like-- I heard that people, when they're sedated, they can still kind of hear you. So I always felt like I should say something uplifting. I mean, if you want a cheerleading section, I mean, physical therapy is where it's at. I mean, we are so optimistic as a group, you know?

Diane Wu

Adele wasn't doing great at actually getting the blood, though. She was missing something like half of her sticks. She'd get all suited up and prepared to go in the room, try and try and try for 10 or 15 minutes, fail. Then she'd have to go downstairs and mark on the whiteboard the patients that she'd missed so a more experienced phlebotomist could be sent up to try again. She felt like a disappointment, bumbling things up in one of the most serious and urgent parts of the hospital.

Adele Levine

When they would send me to do blood cultures, I would almost always botch it.

Diane Wu

A blood culture is a test for an infection in the blood.

Adele Levine

My first blood culture that I got called to do, when I got to the room, the patient was in a full code. And they were all in there, doing CPR and chest compressions. They were shocking him. I flipped out. I was like, oh my god. I was about to leave, and they're like, no, no. They're like, you stay. They're like, you stay because if he lives, we need those blood cultures. So I stood there. I was waiting, and standing next to me-- we're totally dressed up in all this gear-- was one of the hospital chaplains.

Diane Wu

Oh, wow.

Adele Levine

And we were standing next to each other. She was there because if the patient died, she would need to go in and do last rites. And I got so completely wigged out by that, I started feeling like we were the angel and the devil, just standing side by side. And the patient lived. And the hospital chaplain just flew out of there. And then I had to go in, and I was so rattled by what happened. And then I had to do these blood cultures. It was just-- I didn't get it. I didn't get it.

Diane Wu

Remember, Adele's a physical therapist. Nobody was dying in front of her at her old job. The chaplain never hovered nearby. This was a totally different game. Adele's first week in the ICU was so stressful that she thought about quitting. But she didn't. She kept going. She watched videos about phlebotomy in her free time, practiced getting her sticks over and over, lining up her tubes in the order of the draws, folding gauze into quarters with one hand, readjusting the needle to keep the blood flowing. She started to be able to see veins she couldn't before, to draw blood from more challenging places.

Adele Levine

The first time I got blood off this guy's thumb knuckle, yeah, I just couldn't believe it. I was so proud of myself, or from a really skinny little vein, and I'm just trying to-- I just knew if I could just get a centimeter of blood into the tube, that would be good enough for the lab.

Diane Wu

But even being able to draw their blood well didn't change her patients' outcomes. Lots died. It got to her. She says she stopped looking at their faces when she went in the room, stopped chatting as much with them, too. And as she was leaving, instead of telling them they looked good and she could tell they were doing better, like she used to, she just told them goodbye. Adele told me that dropping into this tunnel vision mode, just going straight for the vein, not looking around, it actually made her better at drawing blood, more gentle.

In the middle of the summer, three months after Adele began drawing blood, the first wave finally started to recede at her hospital. Then she got a text from her physical therapy boss, telling her it was time to come back.

Adele Levine

I was really furious. I didn't want to go back.

Diane Wu

Oh, really?

Adele Levine

I caused a bit of a-- yeah, caused a bit of a-- I guess they couldn't believe it. I said I wasn't going to come back.

Diane Wu

I was surprised to hear this, given how she'd felt completely inadequate for so long when she was there. But it felt like whiplash to her. She'd been thrown from her old job into this one, finally felt like she knew what she was doing. She wasn't prepared to be yanked back out just as quickly.

It's been eight months now since Adele switched back to physical therapy. She still notices people's veins, especially the ones on the backs of their fingers. Those ones, she told me, when someone's really sick, those ones will stay bouncy. They're the last to go.

Ira Glass

Diane Wu is one of the producers of our show.

Act Two: Blood Ties

Ira Glass

Act Two, Blood Ties. So we turn now in this blood episode to blood relatives and the importance of family. Or maybe this story is about the unimportance of family and the meaninglessness of blood ties. At the center of the story are 30 postcards and one of our producers, David Kestenbaum.

David Kestenbaum

I want to start by saying I am one of those people who has never cared at all about family trees, who is related to whom, genealogy, stuff like that. The only family that felt important growing up were the people I saw every day-- my parents and sister, and then, kind of one circle out, grandparents, cousins, the relatives we'd visit with some regularity. Beyond that, they just seemed like people I didn't know. And-- I think this is the scientist in me-- I've always felt like the whole idea of being related by blood, who cares if they have some DNA that I have? It all just seemed kind of dumb.

This was a problem when someone would ask me when my family came to the United States. My great grandparents? I think from Austria or Poland, some from Russia. At various points, it's felt like a thing I should know, just so I could not look like an idiot when that question came up. So I'd ask my parents, who'd tell me. But there weren't a lot of details. No one felt real in it. And whatever my parents would tell me, I'd promptly forget.

Then a couple of summers ago, we were visiting my aunt and uncle. My kids were running around like lunatics. I was sitting on the couch. And my aunt handed me this stack of papers. They were photocopies of 30 postcards. A distant family member had come across them. And they were beautiful, written in Yiddish and the Hebrew alphabet in this meticulous handwriting.

I could read who they were addressed to-- that was in English-- Harry Kestenbaum, 320 Cherry Street, New York, America. Cherry Street is a street I've walked by for sure. It runs under the Manhattan Bridge. The postcards were from his father, Shmuel Mendel Kestenbaum, who was living in a town in Austria-Hungary at the foot of a small mountain. The date on the first postcard? 1904. Shmuel was my great, great grandfather's brother.

There were translations alongside the postcards. A relative had found someone who could read the old Yiddish. So I sat there on the couch and started to read. Again, this wasn't my thing. I honestly didn't expect to get through them. But amazingly, these 30 postcards, they happened to tell a little story with a beginning and an end. You could glimpse a piece of a life through them, of a man living 100 years ago, who had my last name. And I know I just said that shouldn't matter. Maybe I'm wrong. They gave me a feeling I was not expecting to have.

The postcards are only one side of the conversation, Shmuel writing to his son. But his son, Harry, who is 24 at the beginning, clearly wrote back. You can tell because Shmuel writes things like, "You forgot to put a stamp on your last letter, and I had to pay a fine. Signed, your father, Shmuel." I loved that line because I'm not proud of this, but it reminds me of me.

And also, it warms my heart to read a guilt trip on 100-year-old postcards sent across an ocean. You can only write like that to someone who's family. Blood gives you permission to make certain demands, to be yourself in ways that maybe you shouldn't. Quote, "You want me to send you a tallis to America?" A tallis is a prayer shawl. "This is quite difficult. Postage is quite expensive. And did you not buy a tallis for your wedding?"

It seems possible they wrote back and forth constantly. Quote, "I am surprised that you have not received my letter. Why don't you write about your business? Mine is completely in ruin and my income is very bad." Here's what we know about Shmuel when he was writing these. He was divorced, and his two kids, he hadn't seen in years. Harry, because he was in America at 320 Cherry Street.

His daughter was closer to home in Europe, but would never write him back. Quote, "She really does not behave like a child of mine," Shmuel writes. "For three years, I have received from her only printed Happy New Year's cards. When she came to me to invite me to her wedding, I gave her all the money she asked for and went to the wedding. She has not once written about her situation. Since childhood, as you well know, she has become a stranger to me."

Shmuel is on a kind of mission in these postcards. He seems dismayed by how scattered the family has become. And he wants to hold everyone together somehow. He writes about being lonely, having no one to have a heart to heart talk with. Quote, "Please let me know if you intend to return here with your family. Or do you want to take a pleasure trip? I would be very pleased, but the question is if you can do this without any trouble."

In the map of our family, Shmuel is pretty far removed. He's like Pluto out there on a distant orbit. But I felt some tug on me. He asks after my great, great grandfather, who is living nearby in Newark, New Jersey. Quote, "Please write to me about my brother. How is he? He doesn't write to me at all. How are his children? Are they well?"

I was struck by how consistently miserable he seems. Miserable, but also like he hasn't given up hope. He yearns for the family, wants to be with them again. I wondered if it would happen. When Harry's first son gets a little older, Shmuel writes, "Maybe it would be possible for you to send him to me, and I could fulfill the commandment and teach our children and your son's children, as my son's sons are as my own. Your father, Shmuel."

There are all these grandkids being born that he wants to see. When Harry has a daughter and names her after his grandmother, Shmuel writes, "My dear son, you have done very well. You have added the name of my dear mother. I have great joy from this."

But there's also this heartbreaking one. Quote, "At the end of your letter, you didn't send greetings from your son, Yitzchak, which worries me very much. Please disclose the truth to me. May we only hear good tidings." Yitzchak had died of pneumonia at age one.

There's one postcard where Shmuel seems truly joyful, like he finally had a really good day or something. September 12, 1907. The entire postcard is a blessing that he composed himself in Hebrew. The translator was really struck by the poetry of it. "May the rays of your good fortune shine on your head, and may you always be a fulfilled person, love and peace in your home, all of you healthy and complete, your tents free of fear, blessings nested in your house, and success shedding its light around you."

But making my way through the stack of postcards, one thing after another seems to go wrong. He eventually does make contact with his daughter, Harry's sister, and visits her, but he still seems worried. Quote, "I hope there will be peace for some time." He writes about a fire that cost him a lot of money, a dealer he sends cotton wool to, goes bankrupt. Quote, "Business is very bad, as credit has been stopped, and many people have gone bankrupt. Thank God the fear of war has passed. May God bring us better times." That postcard was from May 27, 1913. When I read it, I was like, wait, what do you mean the fear of war has passed? Isn't World War I about to happen?

Here's a postcard from a little later. The stamp had been removed, so some words are missing. But this part was intact. Quote, "The Russians plundered. We went on foot. Therefore, we took nothing with us. We were like a herd. We closed the house and left everything. We left all our property. Everything was plundered, and the house was destroyed. May God give us strength and harden our body. Is this our fate? Instead of sleeping in our bed, we slept on the ground." That postcard was sent from a town 60 miles from his home.

There's a big gap after this. The next postcards are from years later. He's back in the town where he started. Quote, "I received the package you sent. It contained two pairs of trousers, two pairs of underpants, four undershirts, one skullcap, one napkin. I can't know if anything is missing since I don't have a list of its contents. The Lord will reward you for the mitzvah of honoring our father. And your reward will be great." This was postcard number 27 of 30. There weren't many left.

Shmuel writes that he had heard that Harry might make a trip back home. Quote, "This would give me much joy," he writes. And also, "Do you have papers for my journey to America?" I was excited that they might all get together, but postcard 29 doesn't mention any travel plans. Quote, "It's been three months since I have written you. I am desperate not to have received an answer. This is very unusual. Please write immediately." The last postcard, number 30, is about a prayer shawl. And that's it.

Shmuel Mendel Kestenbaum died some time after that. He was probably 69 or 70 years old. Reading along, I was somehow stupidly expecting a happy ending. But I don't think there was one for him. It doesn't seem like Shmuel ever got to see his son again after he left at the age of 20 or got to meet Harry's kids, his grandchildren. And just that idea that you could spend so much of your life waiting for a thing to happen, and then one day, you don't even know it's coming, but it's your last day. And it never does.

I do feel some connection to Shmuel. I'm not sure I really understand it. You could say it's because we're related by blood. It certainly is a strange experience to read your own last name on a 100-year-old postcard. It sticks with you-- Shmuel Kestenbaum. I keep thinking about the postcards. In them, Shmuel never writes about the past. He's always asking about the people who will come after him-- his son, his daughter, their kids. he cared about the future. I do, too. I care more going forward than backward. There is a happy ending to Shmuel's story. It just came much later. It's me and all the family and the giant tree that grew around him.

Ira Glass

David Kestenbaum is our show's senior editor. Coming up, one of the greatest deployments of fake blood in the history of fake blood. Also, fixing a human blood pump and a fibroid speaks in English. That's in a minute from Chicago Public Radio when our program continues.

Act Three: Stage Fright

Ira Glass

It's This American Life. I'm Ira Glass. Today's program, Bloody Feelings, stories about blood in all its liquidy meanings, blood as metaphor, blood as the actual stuff moving through our veins. We've arrived at act three of our show. Act Three, Stage Fright.

So there's this condition. It's called vasovagal syncope. And it's basically fainting in reaction to certain stimuli. It's triggered by all kinds of things-- exposure to heat, stress, and the sight of blood. And it turns out that the blood, it doesn't even need to be real blood to get that response. One of our producers, Bim Adewunmi, remembers one bloody Shakespeare production that, at its height, had scores of people fainting, night after night. Here's Bim.

Bim Adewunmi

Back in 2006, I was a year out of university, trying very hard to be a writer and working at a bookshop in central London. I was also almost always broke, so broke, in fact, that I don't think I could afford more than one visit to see a West End show the entire year. What I did do a lot of, though, was read theater reviews. 2006 was the year of Michael Sheen and Frank Langella in Frost/Nixon. It was the year Avenue Q came to the West End, the year of Wicked's London debut. And all I could do was dream of going to see them.

So naturally, the review page was the first place I read about a play that was getting rave reviews, but was apparently so grisly, so bloody, audience members were fainting. The play was one of Shakespeare's least loved plays, Titus Andronicus, three hours of muscular, bloody theater that, as one audience member quoted in the paper put it, had people "dropping like flies." I was thrilled at the idea of theater being powerful enough to fell even sturdy London theatergoers. I was jealous. I wanted to go. I wanted to see if I could withstand it. In the 15 years since, I've often thought about the source of that production's power-- about the blood.

Lucy Bailey

I mean, at one point, we had 43 people, one show, 43 people fainted.

Bim Adewunmi

43?

Lucy Bailey

That was our max.

Bim Adewunmi

All these years later, I was thrilled to talk to the director, Lucy Bailey. Because I wanted to understand how she'd done something so extraordinary.

Lucy Bailey

Once I came into the auditorium and the usher said, all the schoolgirls came and they all fainted.

[LAUGHTER]

And they're all in this box. We put them all up there. So I came in, looked in the room, and all these sort of very pale girls, all sitting there, [LAUGHS] having been fainted and being taken out. I used to say to the ushers when I came into see the show, and how many people today?

Bim Adewunmi

Just to be clear-- no one fell and hit their head or got seriously injured. They were simply overwhelmed. Lucy just hadn't foreseen the fainting. To give you a picture, the Globe is an open-air theater, a mostly faithful recreation of Shakespeare's original, with just under half of its audience standing close to the action on the stage. And the Globe is used to fainters-- the combination of standing and the sun probably. During Titus, when a person fainted, the ushers would wind through the crowd with an unfolded wheelchair and then take them out of the arena. Later in the run, there was a St. John's ambulance parked nearby.

It's not surprising. The blood in context and in quantity is inescapable. And it's supposed to be. Titus Andronicus is one of Shakespeare's earliest plays. And there's a lot of young man swagger mixed in with the poetry of the writing. Set in ancient Rome, the play was written to speak to some of the fascinations of the Elizabethan era. It's about war and revenge and an over-the-top grief that clouds good sense and moderation. Innocents get slain. Brutes revel in their savagery.

Blood is shed in really horrible ways-- ritual sacrifice, slit throats, mutilation, sexual assault, plus a memorable cannibalistic pie. It's a play that's drenched in blood. And it often gets written off as a flurry of unsubstantial bloodlettings because of that. But Lucy knew the blood mattered to the play. One of the first things she had to figure out was how to make the blood look real. In an ironic twist, to make the blood look like the real thing, they had to fake it.

Lucy Bailey

If you see a lot of stage blood, it often doesn't feel very real, even if it's quite accurate, the color of blood. But blood is quite bright. And somehow that bright blood in theater terms makes you go, oh, yeah, yeah, that's just theater blood. We sort of looked at how we would make it unreal in order to make it more real. In other words, we darkened the blood.

Bim Adewunmi

Lucy also had to figure out how to make the blood move so it would deliver the most impact. So she turned to another expert-- the fight director.

Lucy Bailey

You talk to him about if you're wounded in this way, how does the blood behave? Where does the blood come? Why is it coming out of the corner of the mouth? Why is it coming from the nose? What's the journey of the blood?

Bim Adewunmi

For Tamara, who the audience love to hate, there's a very careful spurt of blood when she gets a giant fork in the guts. When Titus loses a hand, there was more than one source of blood, a spurt from a syringe, then a slower ooze out of his arm. To make the intense experience more immersive, Lucy and her designer, Bill Dudley, focused on the space itself. They wanted to make it feel oppressive, make the audience participate in the blood sport.

They achieved this by giving the Globe a temporary velarium roof, which reduced the sunlight and created shadows. And then they filled the space with incense. They moved some of the action off the stage and into the crowd to create a sort of theater of chance. The idea was to make it feel like a temple of death. They have to strike a delicate balance-- too little blood and atmosphere, and you don't bring the audience along. Too much, and it feels like a parody.

Lucy Bailey

It's like a huge contract, isn't it, between the audience and the play and the players. The audience, given any chance, want to believe. So as long as you do everything to suspend the disbelief, then you keep that contract. But as soon as you break that contract and do something that shows them the mechanics or overacts, overplays your cards, over-eggs it, too much blood or under-eggs it, too little blood at the moment, where they're going, sorry, I don't believe that.

Bim Adewunmi

And one of the places they decided to underplay happens in the very first bloodletting in the play, when Titus sacrifices Alarbus.

Lucy Bailey

It happened very quickly in how we did it. And it was so fast. And then they saw the blood. And then we're pulling him, and they don't have time to dwell. So we did a very deliberate thing. We really were shocking with it.

Bim Adewunmi

The audience sees a flash of red, and then he's gone almost immediately. Maybe the blood made them faint, but it wasn't just the fact of it that caused them to fall. It was what was happening between the people on stage, the feelings they were experiencing. One of the most shattering moments in the play comes after Lavinia, attacked and mutilated, is brought to her father and unwrapped. The dark viscous blood seeps through the bandages at her stumps and pours slowly from her mouth. Even Titus, a war-hardened general who's done his own share of killing, is reduced in that moment to an anguished and helpless father.

Lucy Bailey

His precious daughter still bleeds, and he can't stop that bleeding. To have your life's blood bleed, your kin, the blood that is your blood, and to see it bleeding and to understand how those wounds were made pushes the brain to a point of madness.

Bim Adewunmi

As Titus himself says in that scene, it was my dear, and he that wounded her have hurt me more than had he killed me dead.

Lucy Bailey

It's a girl who's still alive, but bleeding and causes so much internal bleeding to her father, both in the heart and the brain. So, in a way, he suffers a kind of brain bleed.

Bim Adewunmi

The entire play is tied together by that ribbon of grief. Parents lose children. Brothers turn on each other. Innocent bystanders are collateral damage. And all the blood is in the service of that raw feeling. The language is hysterical and violent. And it goes on for five long acts. The audience gets pulled into the hysteria because they have little choice. By the halfway point in Act Three, they're so far gone that they drop at the idea of violence.

Lucy Bailey

We used to have people fainting on a word. So when Aaron came and said that he wanted one of them to chop off their hand, you could almost guarantee that somebody would faint when he said chop.

Bim Adewunmi

When Aaron says the word here, there's no actual chopping happening-- he's just saying it. But it was enough.

Lucy Bailey

You could see the audience sort of gird themselves. And then he'd say chop, and somebody would go.

Bim Adewunmi

One of the things I was curious to talk to Lucy about was how it felt to be the architect of all this feeling. What was it like to do this to an audience again and again?

Lucy Bailey

I have to be honest, it was completely thrilling. We had not expected this response. Audiences tend not to be vocal, so this kind of fainting was a sort of sign of audience involvement, I think. I think the whole effect to see the astonishing effect it had on people to the extent that people were sick, they fainted-- they even urinated. They lost control of--

Bim Adewunmi

Wow.

Lucy Bailey

--their whole body, was to do with this cumulative feeling, a combination of things, not just one thing. It was such an affirmation that something about the play was working.

Bim Adewunmi

Eight years after that first production in 2014, Lucy revived Titus Andronicus at the Globe. It was a different cast. And once again, audiences flocked to see this difficult, bloody play. This time, though--

Lucy Bailey

The audience didn't faint as much. I mean, they really didn't. And yet, everything we did was, I think, palpably the same, if not better. And I think that was because people came psychologically prepared. So it was very much harder to get that contract going that you're so involved in this that you're going to faint.

Bim Adewunmi

Modern theater is mostly a quiet affair-- polite applause, gentle chuckles. Usually when people leave a play in the middle of a performance is because it's bad. They're not feeling what they're supposed to be feeling. With Titus, they were checking out because they were feeling too much.

Ira Glass

Bim Adewunmi is one of the producers of our show.

Act Four: There’s No ‘Us’ in Uterus. Oh, Wait...

Ira Glass

Act Four, There's No Us in Uterus-- Oh, Wait. So about 30 million Americans have fibroids. And if you don't know what this is, fibroids are these muscular tumors that grow on or in the uterus. We don't know what causes them or why they affect people of color at higher rates, especially Black people. In fact, we know so little about them that Vice President Kamala Harris introduced the Uterine Fibroid Research and Education Act last August back when she was still senator.

Almost always, fibroids are benign. Like, they don't turn into cancer. But they still cause problems-- pain, discomfort, and then there's the blood, which, of course, is what our program is about today. Fibroids can make periods heavier or longer or more erratic. Doctors can be dismissive. Surgery's expensive and carries risks. And even after surgery, fibroids can come back, new ones.

Neena Pathak went back and forth about getting surgery. Her fibroid didn't bother her at first, but over time, it grew bigger and caused more and more discomfort. And she began to think about her fibroid like a careless partner, making her life miserable. She even imagined confronting the fibroid, in the relative safety of a therapist's office, with a question-- should we stay together? She made this into a one-act play starring three characters-- woman, fibroid, and therapist. And we present now the world premiere of her play.

Therapist

Well, then, let's get started. Tell me why you're here today.

Fibroid

Mm, like I had a choice. She dragged me here.

Woman

Don't be an ass. Please?

Fibroid

I'm not. I'm a fibroid.

Therapist

Talk to her.

Fibroid

OK. We only ever do what you want to do. You dragged me here.

Woman

Well, I'm just trying to figure out whether we should be together anymore.

Fibroid

You told me I could stay with you.

Woman

Told you, you could stay with me? You never even asked!

Therapist

I want you both to try making I statements.

Fibroid

I was told that I could stay with-- wait, can I not say you at all if I'm making an I statement?

Therapist

You're doing fine. Would you like to respond?

Woman

I mean, at first it wasn't so bad. I barely noticed you, to be honest. So I didn't really mind that you were around. But then your pile of stuff just kept getting bigger and bigger. I just-- I felt steamrolled. And now you act like you own the place.

Fibroid

Like I own the place? I have one small room where I keep my things, one bloody room. Everything I eat, everything I breathe, it's all yours. All you. And I certainly don't appreciate you relitigating the past.

Woman

What do you mean, relitigating the past?

Fibroid

I mean, I have already apologized for this. I'm sorry I moved in without your explicit permission. You never said it was bothering you, so I just assumed it was OK. But I can't keep apologizing over and over for something I can't undo.

Woman

I just-- I did say it was bothering me. You just didn't listen. And I'm not asking you to apologize over and over. I mean, I'm pretty easygoing. I don't like making a big deal out of stuff. I'm 35 years old. Isn't this kind of what being a grown-up is all about? When things don't go my way, I suck it up, you know? Roll with the punches. And honestly, I could still live my life.

Therapist

Remind me then, what brings you here today?

Woman

Well, I mean, I'm fed up. You take up more space every day. You damage my property. You're totally oblivious to how your actions affect anyone but you.

Fibroid

OK, you know what? Fine. Try and kick me out then. And look, I wasn't going to bring this up, but someone has to-- I thought you wanted kids. Surgery is serious business, you know? What if it doesn't work? There's a chance you could lose your uterus. There's a chance you could never have a baby. There's a chance you could die. Just putting that out there.

Woman

A slim chance. And thanks.

Fibroid

That stuff happens. Just saying.

Woman

I don't know if I want kids. But if I do, I think having them without you would be a better option.

Therapist

Have you gotten yourself checked out?

Woman

Well, I've talked to some specialists, but they mostly just told me not to worry, that this situation's harmless.

Fibroid

The experts agree you're making a big deal over nothing.

Woman

That's the thing. It's not nothing. It's like, I used to be fun. Now I'm this compressed anemic version of myself. Because I'm always thinking about you. I'm always planning around you, never sure when you're going to open the floodgates.

Fibroid

The bloodgates.

Woman

That's not funny.

Fibroid

There will be blood.

Therapist

Let's take a deep breath. I want you to look at each other.

Fibroid

Ugh.

Therapist

Just work with me here. One at a time. Is there something one of you wants to say that you haven't yet said?

Fibroid

Mm, yeah. What we have, it's not so bad. No relationship is perfect. Sure, we have some unpleasant little blowups every month, but you know what else is unpleasant every month? Paying rent. Doing laundry is unpleasant, and that's once a week. Doing dishes every day, unpleasant. But that's life, baby. Could be worse. And very well may be worse without me. As they say, it's the fibroid you know. Do you really want to be 35 and alone?

Woman

OK, no. I think I've been lying to myself and pretending that everything's OK. And I know you say it could be worse, but it could be better. That's why I want you out. I'm kicking you out.

Fibroid

But it can't possibly be worth the risk.

Woman

Well, I don't know what else to tell you. I just, I need to try. And you miss 100% of the shots that you don't take.

Fibroid

Oh, god, I hate when you do that voice.

Woman

Absence makes the heart grow fonder.

Fibroid

Jesus Christ.

Woman

Be the change you wish to see in the world.

Fibroid

Oh, come on. You don't know what life will be like without me.

Woman

Oh my god. I'm going to wear white pants again.

Ira Glass

The woman was played by Sohina Sidhu, the fibroid by Kate Arrington, and the therapist by Jena Friedman. Casting help from Harrison Nesbit. Neena Pathak wrote this play in part at the Third Coast Radio Residency at Ragdale. Neena, by the way, in real life decided to have her fibroid removed, and she's doing fine.

Act Five: Un-Break My Heart

Ira Glass

Act Five, Unbreak My Heart. So for our last story about blood today, we go right to the source, the machine that keeps blood pumping and flowing inside of us, and to somebody whose job it is to make sure that machine works well. Producer Sean Cole talked to this man and also watched him work. A warning-- if you are squamous about people's insides, this story has a lot of that.

Sean Cole

My favorite fun fact about blood is that it has a protein in it that's also found in eggs-- albumin. Something about that just strikes me as poetic-- the complex machine of the human body and a thing it eats for breakfast sharing the same ingredient. I learned about this fact from a heart surgeon, Dr. John Elefteriades, or Dr. E.

About five years ago, I drove up to Yale New Haven Hospital and talked with him about this one technique he employs called deep hypothermic circulatory arrest, AKA the deep freeze. Often, he has to do such radical plumbing work on the heart and its arteries that his team cools the patient's body down to 64 degrees Fahrenheit and then warms them back up again afterwards. He compares it, in one way, to making egg lemon soup. You don't want the egg to curdle.

John Elefteriades

And it curdles when the cook is in a hurry. It has to simmer at a very low level in order not to curdle. Well, that's because of the albumin and the egg. And the bloodstream is full of albumin. So that if we warm too fast, we'll basically get scrambled eggs in the bloodstream.

Sean Cole

That is so gross.

John Elefteriades

That's catastrophic. So warming takes one hour. We have to warm very slowly. As long as our heating bath is no more than 10 degrees warmer than the blood, the blood won't curdle. We won't get scrambled eggs.

Sean Cole

Dr. E is an expert on this deep freeze method. He's been described as one of the best doctors in the country, a giant of cardiothoracic surgery. When we met in 2015, he'd been at Yale for more than 30 years and done about 7,000 open heart operations at that point, including maybe 300 transplants. He dramatically lengthened the lives of the jazz musician Dave Brubeck and the writer Robert Ludlum. For a long time, he did one major operation and then maybe one smaller procedure almost every weekday.

He offered to let me watch him perform the deep freeze, to watch him take a patient and literally suspend their animation. That's what cooling them down does. They're not dead, but they show no signs of life anymore. So that he could reach into their body, disconnect a crucial organ, and fix it with his hands. It's like he's a master illusionist, fooling death with this high stakes version of misdirection. I was like, yeah. Yeah, I'm in.

John Elefteriades

I was thinking that the sound of opening a breastbone might be interesting for you.

Sean Cole

The procedure I observed was a three-hour aortic graft and valve replacement. I got to the OR early, about 7:30 in the morning on a Thursday, all gowned up with a mask and scrub hat. The team was already prepping the patient for sedation. Dr. E and I stood several yards away in the corner so he could go over the case with me. The patient had an aortic aneurysm. You may know-- I didn't-- the aorta is the largest artery in the body and shaped like a candy cane. An aneurysm just means that part of it, the curved part at the top in this case, had become swollen, stretched, like a balloon filling with air. So the wall of it was too thin.

John Elefteriades

See, unlike many other diseases, it doesn't have any symptoms until it ruptures. So the first symptom is usually a rupture or death.

Sean Cole

Death seems like it's more than a symptom.

John Elefteriades

Yes.

Sean Cole

It seems like it's a conclusion.

John Elefteriades

It's a conclusion. Yeah, that's very well stated, yeah.

Sean Cole

The patient was still awake at this point, eyes wide open, listening to one of the anesthesiologists. He had a brown mustache and a beer gut, looked nervous, leaning toward afraid. Within minutes, he was unconscious. And they were painting his naked body all over with an iodine baste, taped his eyes shut, and then they swaddled him completely in plastic and blue surgical sheets, which made the whole thing feel much more impersonal. Dr. E seems to care a lot about his patients. But this is when I began to understand how automotive his work is-- managing the proper function of this motor with its valves and chambers and sparks, propelling a person's blood. Finally, they made the first incision.

Sean Cole

And they're opening him up now and opening a femoral artery down by the pelvis. It's a lot of blood.

And Dr. E was right. The sound of them sawing open the breastbone was-- I guess we can go with alarming.

[SAWING]

Then they inserted the chest separator. It's like a reverse vice. Instead of squeezing things together, it spreads them apart. While I watched on a wall monitor, the circulating nurse, Patty LaFond, came over and explained to me that they were slicing open the pericardium, this kind of protective sac around the heart. I didn't know it came with that extra bit of packaging.

Sean Cole

And is that the liver?

Patty Lafond

No.

Sean Cole

That big part.

Patty Lafond

Lung.

Sean Cole

That's the lung. Wow.

Patty Lafond

You can almost see it expand and contract with breath.

Sean Cole

She was right. I watched the lungs expand and contract with this placid rhythm that made me think of ocean waves rolling in and out. It was earthly, and it was familiar. And then things got a lot more intense.

Holy crap. Holy, holy smokes. Oh, boy. Cutting tissue, cutting tissue open. Sort of like pushing the lung to the left. Now, whoa. They've broken through to the heart, which is beating. It's sort of jumping like a fish in his chest.

Like an angry fish trying violently to escape. But even that's too terrestrial a description for what this looked like. It looked alien, like a creature in a sci-fi movie with no familial relationship to humanity. It was startling, almost frightening. And I will never forget it. To think that same thing, essentially, is also inside of me and Dr. E and all of you and everyone. But when you see it, you think, that thing is not to be trusted.

Just then, Dr. E asked me if I wanted to come up top.

Sean Cole

Yes, please.

He meant onto the stool just behind the blue drape that separates the sterile area where they were operating from the rest of the room. So I was standing almost exactly above the patient's body, looking down into it. And being that close, this felt like I was looking at something so fundamental and ancient. And I felt like this is not something a regular schmuck like me is supposed to see. If your guts are exposed and I'm there, it usually means something's gone really wrong.

Sean Cole

I didn't realize that hearts were so big.

John Elefteriades

Now one thing I tried to convey in the different writings for the general public is the beauty of the body, the internal beauty of the body. It just takes my breath away every single day.

Sean Cole

It's funny. I don't think beauty is the first word I would have thought of in this moment.

John Elefteriades

Uh-huh. Yeah, this is not the most beautiful heart.

Sean Cole

They hooked the patient up to something called the heart-lung machine. A big part of these procedures is outsourcing the work of the heart and the lungs to this big boxy kind of robot with rotating drums in it. This is how they pull off the grand illusion, tricking the body into operating without the heart. They send the patient's blood to the machine. It oxygenates and pressurizes the blood and also cools it and then sends it back to the kidneys and the liver and the lungs, all the organs.

John Elefteriades

And you can see that we meticulously remove all bubbles. Because bubbles could cause a stroke.

Sean Cole

Bubbles from the blood.

John Elefteriades

Yeah, bubbles from air in the blood. We remove them all very carefully. So you see now, Sean, that the heart has collapsed because we've taken all the blood out.

Sean Cole

Dr. E clamps off the aorta right above the aneurysm. That takes the heart out of the circuit. They also send a supercold paralyzing fluid to it called retrograde, or retro for short. So the heart isn't even trying to contract anymore. Now the patient's vital signs have almost totally ceased. No pulse, of course, because his heart isn't beating, very little brain activity.

But it looks like this particular patient isn't as bad off as others. So they don't end up having to cool him all the way down to 64 degrees. When they do that, it means zero brain activity, no signs of life whatsoever. And when the patient's that cold, they actually turn off the heart-lung machine, which means no blood flow to the brain, so no oxygen. Under those conditions, it's a race against time. They have 45 minutes to an hour to operate before the brain starts to die.

Meanwhile, this patient's heart has been beating for more than 62 years since before he was born-- is still. Most of us, when our hearts stop, it'll mean they're never going to start again. And that'll happen to this guy eventually, too, of course. But this is just a timeout for the heart, a break. I like to think of it as a mini vacation after a lifetime of constant labor in the pump house.

John Elefteriades

Now he's opening the aorta, and you're looking inside, Sean. Now you can see the cavernous dimensions of that aorta.

Sean Cole

It's huge.

John Elefteriades

Yeah, we could give it a zip code.

Sean Cole

Now they set about the actual mechanical work they're in there to do. First, they replace the aortic valve, which is all calcified. And then they swap out the bulgy part of the aorta with a synthetic tube. And after about 2 and 1/2 hours, they're pretty much done. And it's time to bring the patient back to life. Dr. E calls for the official de-airing maneuvers-- that is, evacuating any excess air out of the heart before they let it fill back up again with blood. And suddenly, it's like he's a movie director on set, complete with lots of industry terms I didn't understand.

John Elefteriades

OK, so let a little blood flow through the heart. Run some retro for de-airing. And we'll take a half dozen nice valsalvas please.

Sean Cole

Valsalvas are deep breaths. The anesthesiologist can actually control the motion of the patient's lungs. Next, Dr. E needs to unclamp the aorta to put the heart back into the circuit.

John Elefteriades

Low flow for the clamp. The aorta is unclamped back up slowly. Valsalva down, retro off. All the flow to you. Red on, green on, warm all the way.

Sean Cole

Retro, again, is that paralyzing fluid. So they turned that off. Red and green are both drainage tubes. And that's just what color they are. And warm all the way means back to the world of 98.6 degrees. No scrambled albumin.

Sean Cole

So now the heart is starting to beat again.

John Elefteriades

It is. That's a good observation.

Sean Cole

At this point, the patient's heart, the violent thing I was so afraid of in the beginning, is much more docile. It looks more like a big chicken breast to me now. Dr. E says that probably means I'm getting hungry, which I was. I'm not someone who tends to seek out intense experiences. I'm not really adventurous. I don't dream about traveling to faraway places.

But looking inside of another human being like that, watching a group of people open him up, fix what's wrong, and close him again, felt as unusual and unlikely as visiting the moon. It's a place I've probably never visit again. And I didn't even know the guy. I didn't even meet him or say hello. I hope he's doing OK.

Ira Glass

Sean Cole is one of the producers of our show. Dr. John Elefteriades has a memoir about his career as a heart surgeon. It's called Extraordinary Hearts.

[MUSIC - "HOW CAN YOU MEND A BROKEN HEART" BY AL GREEN]

Credits

Ira Glass

Well, our program was produced today by Bim Adewunmi. The people who put our show together today includes Elna Baker, Susan Burton, Dana Chivvis, Sean Cole, Aviva DeKornfeld, Chana Jaffe-Walt, Andrea Lopez Cruzado, Tobin Low, Stowe Nelson, Katherine Rae Mondo, Nadia Reiman, Ari Saperstein, Alissa Shipp, Laura Starcheski, Lilly Sullivan, Christopher Swetala, Matt Tierney, and Diane Wu. Managing editor, Sarah Abdurrahman. Senior editor is David Kestenbaum. Our executive editor is Emanuele Berry.

Special thanks today to Aleks Kalininskiy, Besima Majetic, Sergio Lopez, Leon Gold, Alanna Thiede, Angelina Mosher-Salazar, Josie Rourke, Melanie Belkin, Shelby Howick, and Mark D'Antonio. Mitchell S. Jackson's book where he writes about his mom's blood donations and so much more is called Survival Math.

This American Life is delivered to public radio stations by PRX, the Public Radio Exchange. Our website, thisamericanlife.org, where you can listen to our archive of over 700 episodes for absolutely free. Thanks, as always, to our program's confounder, Mr. Torey Malatia. You know, he is counting down the days till Memorial Day.

Woman

Oh my god. I'm going to wear white pants again.

Ira Glass

I'm Ira Glass. Back next week with more stories of This American Life.

[MUSIC - "HOW CAN YOU MEND A BROKEN HEART" BY AL GREEN]