— I wouldn’t be
surprised if the body belonged to the delivery man with the strange
limp. You never did see him leave the house.
— What about the gardener? He was there too.
— Too tall. Even the primitive forensics of the mid-twentieth
century would have determined that.
At the Star Trek: The Motion Picture press conference, Leonard Nimoy was questioned about his reluctance to turn to the role of Spock.
“We’ve had a long and complicated relationship, Paramount and myself, for the last couple of years, and probably the thing that took the most time was the fact that the mail service between here and Vulcan is pretty slow. It’s not really a matter of reluctance. We had a lot of details to work out. There have been periods of time when the Star Trek project was moving forward and I was not available. For example, last summer we had come to what I felt was an understanding about doing the movie. I went off to do Equus on Broadway. During that period of time, the concept changed to a TV series. It was difficult then to get together because there was a question of availability. When the project turned around and I was available again, we started talking immediately.
“It has been complicated; it has been time consuming. But there was never a question of reluctance to be involved in Star Trek on my part. I’ve always felt totally comfortable about being identified with Star Trek, and being identified with the Spock character. It has exploded my life in a very positive way. The Spock character has always been part of my life. I have never tried in any way to reject that. I’m very proud of the fact that I’m associated with the character. And I look forward to playing the character because I certainly wouldn’t want either one of two things — anybody else playing it, or Star Trek happening without it.”
Nimoy’s book I Am Not Spock had come out three years prior to his being hired for Star Trek: The Motion Picture. While the book’s title was certainly confrontational to many Trek fans, the actual contents spend a great deal of time discussing how he approached the role and how he and Spock are alike and dissimilar.
In a 2012 interview with Star Trek: The Magazine, Nimoy discussed how the book had gotten its name:
“I made a big mistake in the early ‘70s when I wrote my first book about my Star Trek experiences. I wrote a chapter in that book about how I was identified in an airport by a lady who introduced me to her child as Mr. Spock. This child looked at me and did not see Mr. Spock. So I wrote a chapter about the difference between myself and the character in an effort to give the readers some insight into how an actor goes about building a character. It’s partially from him or herself and it’s partially from using elements of other people we may know. I called that chapter, ‘I Am Not Spock,’ meaning simply that I’m an actor who portrays Spock and this is how I go about doing it.
“In the same book, I said if I was given a chance to identify with any character on television, I would choose Spock. I admire him, I like him and I respect him. I would rather be identified with Spock than any other character on television. But the mistake I made was in using that title, ‘I Am Not Spock,’ as the title of the book. People assumed I was rejecting Spock and Star Trek but they didn’t read the book. If you read the book, you’ll find quite the opposite.”
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If you haven’t seen “Journey to Babel,” the whump plot kinda
goes like this: Sarek has a heart condition that needs a surgery that Bones has
never done. The surgery requires copious amounts of blood, which they don’t
have in stock, and Spock, who happens to contain the kind of blood they need,
doesn’t have enough of it to give. They can give Spock a drug that could allow
him to produce the blood, but it could also kill him, and if he dies or is
severely incapacitated, he can’t play a particularly critical role in a
mission, which Kirk has already been tapped out of because, well, he’s been
In my opinion, this was a fantastic episode. Not only did it
explore something pretty interesting about Vulcan anatomy and bring up potential
limitations in providing medical care to such biological diversity as Starfleet,
but it also looked at the state of the art of very real human heart surgery in
the late 1960s.
To set some background, when this episode was written, open-heart surgery (surgery where the
internal structure of the heart is directly visible and the heart is not
beating) had only been possible for
about 16 years. Because of this advance in surgical technology, heart
surgery as a whole had very recently gone from barely being able to open a hardened
valve or repair a very small hole from a birth defect, to venturing into
coronary artery bypass graft (CABG) procedures, repairing major birth defects
(including something called Tetralogy of Fallot, where there are four
structural problems with the heart at birth), and even dabbling into human-to-human
heart transplant (the first few done in South Africa in 1967).
These new open-heart procedures
were still largely experimental, and mortality rates were as high as 10-30%,
making them quite dangerous as well. Still, given that the heart had been
almost regarded as taboo in surgical circles until that point, it would have
been very exciting to hear about any successes at all.
Surely Ms. Fontana assumed that by stardate 3842.3,
humans would have heart surgery pretty much down pat. By making it Sarek who needs the surgery, and the blood-producing drug being
originally for a different species, Bones gets to play the role of an
experimental surgeon using improvised technology, reflecting the same emotional
weight that would have accompanied the concept of heart surgery when the
episode was aired.
Here’s my explanation
of what happened:
instrument readings, [Sarek] has a malfunction in one of the heart valves. It’s
similar to a heart attack in a human. But with Vulcan physiology, it’s
impossible to tell without an operation.” –Dr. McCoy
I want to give McCoy the benefit of the doubt here. For the
purposes of this post, I’m assuming there is a quirk of Vulcan cardiac anatomy
where one of the heart valves is supplied by its own personal artery. In
Sarek’s case, this artery became blocked, causing a heart attack that then only
affected that one valve.
The heart has four
open spaces, or “chambers” inside it. Heart valves
allow blood to flow in only one direction between two chambers or from a
chamber to an artery. A dead or dying heart valve may become “leaky,” allowing
blood to flow backwards as well- a condition called regurgitation. When regurgitation
gets bad enough, it results in heart failure (see linked post above).
Before we could keep the body alive during open-heart
surgery, something called closed-heart surgery was the only option. In closed-heart
surgery, the heart is still beating, but a small opening is cut in the heart
muscle, allowing a small instrument or the surgeon’s finger to enter a heart
chamber. Since the surgeon couldn’t see what they were doing, this technique
was limited, but it was found to be very helpful during WWII, when surgeons
needed to remove shrapnel that had ended up in a heart chamber, thereby preventing
it from moving around in the chamber, getting stuck, and blocking the flow of
blood to the rest of the body.
(This also happens to be my new theory as to where Tony
Stark’s shrapnel is/was- the electromagnet was meant as a stopgap measure to
keep the shrapnel from blocking something/entering general circulation until
Tony could get it removed surgically).
Later, this same technique was used to open hardened heart
valves. It worked, but only for people who didn’t already have a problem with
regurgitation. For people who did, like
Sarek, true open-heart surgery was required to remove the defective valve and
place either an artificial one or a transplanted one in its stead in order to
prevent or treat the resultant heart failure.
In the episode, Spock
recommends Bones perform a “cryogenic open-heart procedure” in order to repair
Sarek’s malfunctioning valve. Open-heart surgery predates the cardiopulmonary bypass or “heart-lung”
machine by several years. Since the heart had to be stopped to perform
open-heart surgery, the surgeon only had about 4 minutes to open the heart, do
what needed done, close, and restart the heart before brain damage occurred.
This was obviously insufficient for complicated procedures. It was found that
by cooling the body to 81F, the patient’s oxygen needs were lowered and the
surgeon could extend this time to 10 minutes- still short, but slightly more
reasonable. This was called the “hypothermic approach,” and the “cryogenic”
procedure described in the episode seems to be a more extreme fictional version
Bones says that the
procedure would require “tremendous” amounts of blood. Today for a human, this
is not necessarily the case, especially if the patient has normal
hemoglobin/red blood cell counts going into the procedure. If blood is needed,
it may be one unit, or a unit of packed red blood cells. I was unable to find
anything on how blood products were used in open-heart surgery in the 60s, but
I’ll give it to the writers that use of blood then would have been more routine,
as open-heart surgical procedures were not as refined.
If an open-heart surgery-needing patient today does not have
sufficient red blood cells to survive the procedure, they may be given iron
supplements and/or a hormone called erythropoietin,
which tells bone marrow to produce red blood cells. In 1968, erythropoietin was in only very early stages of research, and
would not go on the market for more than a decade.
To me this makes it
impressive that a writing team would choose to incorporate such a similar drug
in the episode (they do credit it as being “experimental” though, which lines up to what it would have been on earth).
Also, if anyone is thinking of getting me a “congrats on
your new nursing career” present, I would totally accept an electronic copy of Davis Drug Guide saved to approximately 35 brightly colored floppy discs. I would lay them out on my desk just like this:
Jim Kirk has been in desperate situations before. I mean Tarsus was a bitch. Frank had been pretty shit. The whole Vulcan thing was a frigging mess from start to finish. Not to mention, you know, dying. But none of that compared to holding the person he held dearest, who was choking and spluttering on blood, as he died.
He’s cradled in his arms, the same position they have spent rare nights in their rooms, cradling each other as they watched a holo-movie. The position is familiar, and it’s muscle memory that has his arm pulling his lover tighter. The way his hair smells is the same as it’s always smelt.
But, he can’t fool himself. He can smell the acrid stench of blood. He can feel it drying uncomfortably on his skin. He can feel stuttered breath against his neck. He can feel it all. But he can’t see it. His eyes are squeezed so tight shut that he’s seeing pops of colour erupting behind them. He won’t open them. He hasn’t opened them since he took us this position. To open them is to accept the situation. He won’t ever do that.
Chekov has gone to get help. Spock will not stop until they are back aboard. Scotty will do everything he can to overcome the communication issues.
But he can not be captain. He can not be a leader, a fighter or anything else. All he can be is a desperate and terrified man. Because he knows- oh god he knows- that Bones is bleeding far too much, has been unresponsive for far too long, for everything to be alright. He knows that if he opens his eyes he has to accept the reality that Bones will never open his.
So he squeezes them tighter. He rocks. He pleads with whatever God is up there.
And he pretends he doesn’t notice when he can’t feel Bones’ breath on his neck.