I’ve seen Richard Holbrooke on the news since the Vietnam War. I didn’t quite appreciate how decent and exceptional a man he was until his death yesterday.
Heart problems continue to alter history; this is a major loss for the Forces of Good. Sometimes history is decided by the slimmest of margins, as are our lives. This changes the margins.
Wikipedia has already revised their entry about him:
Richard Charles Albert Holbrooke (April 24, 1941 – December 13, 2010) was a top-ranking American diplomat, magazine editor, author, professor, Peace Corps official, and investment banker.
He was the only person to have held the position of Assistant Secretary of State for two different regions of the world (Asia from 1977 to 1981 and Europe from 1994 to 1996). Later, Holbrooke was the Special Representative for Afghanistan and Pakistan under the Obama administration.
From 1993 to 1994, he was U.S. Ambassador to Germany. Although long well-known in diplomatic and journalistic circles, Holbrooke achieved great public prominence only when he, together with former Swedish prime minister Carl Bildt, brokered a peace agreement among the warring factions in Bosnia that led to the signing of the Dayton Peace Accords, in 1995.
Holbrooke was a contender to replace Warren Christopher as Secretary of State but ultimately lost when President Bill Clinton chose Madeleine Albright. From 1999 to 2001, Holbrooke served as U.S. Ambassador to the United Nations.
He was an advisor to the Presidential campaign of Senator John Kerry in 2004. Holbrooke then joined the Presidential campaign of Senator Hillary Rodham Clinton and became a top foreign policy adviser; Holbrooke was considered a likely candidate for Secretary of State in a potential Clinton administration or as a senior diplomat under Barack Obama.
On January 22, 2009, Holbrooke was appointed as a special adviser on Pakistan and Afghanistan, working under President Barack Obama and Secretary of State Hillary Clinton. He served until his death on December 13, 2010 due to complications of a torn aorta. (Source)
(from the Google Health)
Aortic dissection most often occurs because of a tear or damage to the inner wall of the aorta. This usually occurs in the thoracic (chest) portion of the artery, but may also occur in the abdominal portion.
The aorta has different branches through which blood flows. An aortic dissection is classified as type A or B depending on where it begins and ends.
* Type A begins in the first (ascending) part of the aorta and typically moves to another part of the chest.
* Type B begins in the last (descending) part of the aorta and moves down the abdomen.
When a tear occurs, it creates two channels: One in which blood continues to travel and another where blood remains still. As the aortic dissection grows bigger, the channel with nontraveling blood can get bigger and push on other branches of the aorta.
An aortic dissection may also involve abnormal widening or ballooning of the aorta (aneurysm). (Source)
December 13, 2010
Interview with Cardiologist Gordon Ewy
I’m joined by cardiologist Dr. Gordon Ewy. He is director of the University of Arizona’s Sarver Heart Center in Tucson.
And, Dr. Ewy, explain what happens exactly when the aorta tears.
Dr. GORDON EWY (Director, University of Arizona Sarver Heart Center): Well, when it tears, blood from inside of the aorta gets into the walls of the aorta, and then it can rapture out of the aorta, and you lose a lot of blood. Or it can stay in the walls and as it dissects along, it can occlude various arteries from the head to the kidneys, to wherever the tear travels.
BLOCK: And what are the causes of an aortic tear?
Dr. EWY: Well, there are certain inherited conditions that weaken the aorta, and it runs in families. And then there’s also conditions like atherosclerosis or high blood pressure that contribute to it.
BLOCK: Mmm. And would this be something that comes on suddenly, or would it be gradually building up over time?
Dr. EWY: Well, it can be very sudden. I mean, you can rapture, tear and leak out into various parts of the body very quickly.
BLOCK: And for somebody experiencing an aortic tear, what would the sensation be? What would it feel like?
Dr. EWY: Usually, it’s pain. They describe it as a sort of a ripping, tearing-type pain, but it doesn’t have to be. It’s just pain.
BLOCK: How common is this? How many people suffer aortic tears?
Dr. EWY: Well, it’s maybe 10,000 Americans a year.
BLOCK: What we know about Richard Holbrooke here is that he had two operations. The first one lasted 20 hours through the day Friday and overnight, and then he had a second surgery yesterday called a fenestration that took seven hours. What does that tell you, that timeframe that we’re talking about?
Dr. EWY: Well, it tells me that it’s a very serious condition. It wasn’t a simple tear. I think, that clearly he had a lot of complications, you know? It could have – and this is pure speculation – blocked off some of the arteries that they had to reattach and repair.
And it can be a very simple procedure, where sometimes the dissection is still within the aorta, and they go in and just cut it so that the blood goes back into the aorta, and that’s it. Or it can be extremely complicated depending on, you know, where the tear is, whether it affects the heart, the vessels to the head, the vessels to the various parts of the body.
BLOCK: Mmm. And if it were a simple dissection, how long might that take?
Dr. EWY: An hour.
BLOCK: An hour. And…
Dr. EWY: So you know this was not simple.
BLOCK: Hmm. Dr. Ewy, as you think about recovery after a tear like this and surgery like this, what would your concerns be? What would you be looking for?
Dr. EWY: Well, it’s very hard to tell because we don’t know what vessels or – were involved, and, therefore, what organ is involved. If it involved the carotid, he’d have a stroke. If it involved the renal arteries, he could have kidney failure. If it cut off some of the branches to the chest, it can be a very, very serious problem.
And that’s why, you know, of course, anybody that has a family history of that, hypertension or high cholesterol, you know, we monitor the aorta. Once the size of the aorta, particularly the area around in the chest, gets greater than five centimeters, then we start watching them very carefully and try to repair it before it ruptures.
BLOCK: Well, Dr. Ewy, thank you very much for talking with us.
Dr. EWY: Any time.
BLOCK: That’s Dr. Gordon Ewy. He’s director of the Sarver Heart Center at the University of Arizona in Tucson.