REVIEW: Replaceable You: Adventures in Human Anatomy by Mary Roach
From the New York Times best-selling author of Stiff and Fuzz, a rollicking exploration of the quest to re-create the impossible complexities of human anatomy.
The body is the most complex machine in the world, and the only one for which you cannot get a replacement part from the manufacturer. For centuries, medicine has reached for what’s available—sculpting noses from brass, borrowing skin from frogs and hearts from pigs, crafting eye parts from jet canopies and breasts from petroleum by-products. Today we’re attempting to grow body parts from scratch using stem cells and 3D printers. How are we doing? Are we there yet?
In Replaceable You, Mary Roach explores the remarkable advances and difficult questions prompted by the human body’s failings. When and how does a person decide they’d be better off with a prosthetic than their existing limb? Can a donated heart be made to beat forever? Can an intestine provide a workable substitute for a vagina?
Roach dives in with her characteristic verve and infectious wit. Her travels take her to the OR at a legendary burn unit in Boston, a “superclean” xeno-pigsty in China, and a stem cell “hair nursery” in the San Diego tech hub. She talks with researchers and surgeons, amputees and ostomates, printers of kidneys and designers of wearable organs. She spends time in a working iron lung from the 1950s, stays up all night with recovery techs as they disassemble and reassemble a tissue donor, and travels across Mongolia with the cataract surgeons of Orbis International.
Irrepressible and accessible, Replaceable You immerses readers in the wondrous, improbable, and surreal quest to build a new you.
CW/TW – There are a lot of discussions of medicine and science that can get into ick territory if this isn’t your thing. Also many of the ‘replacements’ either come from animals or are tested using animals.
Review
Rereading my previous Mary Roach reviews made me decide to plagiarize myself. “Roach tackles a topic that might at first seem odd but it turns out to be fascinating due to the breadth of her research and investigations plus the knowledge of the people she seeks out to interview.” After finishing “Replaceable You” I can see why it takes her about 3-4 years between new books. There is a lot packed into this one and the research into the research featured in the book is amazing. She is very clear that what is in the book is mostly a primer for the armchair reader experience rather than a deep dive into these subjects and her interest is “drawn to the human elements of the quest.”
I wasn’t too far along in the research for this book when I began to suspect what I now believe: that even the simplest part of the human body defies efforts to re- create it.
Roach traveled from various places in China; to Mongolia; to Tblisi, Georgia; to Mexico City; to the depth and breadth of the US. She talked mainly to researchers and doctors in OR suites, labs, offices, and sterile pig farms. Very sterile pig farms. She spoke with a man whose now deceased wife used one of the last working “iron lungs” for decades and tried to sleep in it as the wife had. Roach lasted about 10 minutes.
Blood is good. Blood heals. Blood feeds the new graft. “You want a nice vascular wound bed.” It’s unusual to encounter freshen, nice, and bed outside of, say, a hotel website. That’s surgery for you.
The initial focus of the ‘replacements’ is on life or death things – new hearts, kidneys, and other organs needed for transplantation or skin grafts for burn victims and ways to minimize or eliminate our body’s negative immune response to them. But also covered are some surgeries for transgender patients, prostheses, hair replacement, joint replacements, cataract surgeries in Mongolia, cosmetic surgeries for that perfect BBL, ostomies, and new and ingenious ways people are trying to ‘print’ organs, extend the life of donated organs, and the process of tissue donation.
It interests me as an example of the remarkable and sometimes surreal adaptability—the agreeableness—of the human body. Here we have an organ that evolved for a specific purpose being drafted into service for a wholly unrelated one. The intestinal tract seems especially agreeable. Colons are recruited to serve as bladders and esophagi. The appendix has stood in as urethral tissue and helped rebuild a voice box.
I find equally remarkable the inventiveness and confidence of surgeons who dream up operations like this one. Who looks at the human digestive tract and thinks, Moist, tubular, stretchy . . . Might that make a reasonable vagina?
Things are being done now that couldn’t be dreamed of even 40 years ago. Things are being dreamed of now that might take another 20-30 years before we might see the clinical trials but when this stuff arrives – and I have no doubt that it will – lives will be saved and changed. While our ethics are much better than they used to be, some will have qualms about how animals are still being used.
Mike and I are down by the patient’s foot, which is Velcroed into a boot at the end of a leg holder, a long rod that Mike moves around by hand. When the thigh bone is no longer connected to the hip bone, a leg defies the constraints of human anatomy. Once the femoral knob, or head, has been removed, the foot rotates freely, owlishly, almost 180 degrees. This creates better access for the surgeon and an arresting visual for the visitor. “Last week a patient asked me what the boot was for,” says the anesthesiologist working the OR today, Kris Kuhl. “I was like, ‘Lady, you don’t want to know.’ ”
Mary Roach comes up with fascinating ideas for books and then manages to get insiders to agree to talk to her, answer her questions, let her into their labs and OR rooms and observe close up. She asks questions I wouldn’t think of, dares to try things I’d think twice about, and even gets previous interviewees to agree to submit themselves to her investigations again. Or pass her on another poor bastard who might not realize what s/he’s getting into.
“So much of science is waiting,” McDonnell says. And when something finally works? “I cannot describe to you the satisfaction!”
Bless the patients who were willing to also give her the inside scoop on skin grafts, ostomies, and the infinite variety of prosthesis now available. Oh, and the waiter – in the Italian restaurant where Roach interviewed a surgeon – who maintained his sang froid and neutral silence in the face of “They say, ‘I’m not going to use it, why the fuck do I want to dilate it?’”
“Are you enjoying your meal?”
“It’s delicious. Thank you.”
Let me just reiterate my content warnings as Roach doesn’t hesitate to take us where some readers might not wish to go. She probes her subjects to learn about their specialties and then tries to turn her notes into descriptions that she and we can understand a bit better. This is a fun ride through the attempts to replicate the amazing things that our bodies do naturally and which we can only, in some cases, still just marvel at. B
~Jayne
You can replace many of your original parts, and the replacements will improve in time, as they have already, in astonishing ways. But the pieces science builds—and grows and prints and scavenges—won’t ever quite equal the ones we start out with. That’s not a complaint, or a condemnation or belittlement of the progress that’s been made. It’s just me saying something we all know but regularly lose sight of. The body’s all-day, everyday achievements—the architectural brilliance of cartilage or tooth enamel, the effortless autofocus of the eye, a heartbeat so committed it persists outside a body—these are the real miracles. That’s where the gee-whiz belongs.
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This sounds fascinating, Jayne, so thanks for your review (even though I’ll likely not have the fortitude to read it!).
@Kareni: I just recently finished watching a Netflix series on the trauma hospitals in London and realized that while I can usually read about this stuff, actually seeing a surgery in progress – up close and personal at times – might be just a bit too much for me. I squint-eyed my way through a few scenes. Although the close up as the microvascular surgeon sutured nerves together was fascinating.
I got my copy today and will be reading this for sure. I always enjoy her books.
I am so grateful to scientists, prosthetic engineers, and physicians. Just … not quite grateful enough to summon the fortitude (to use Kareni’s perfect word) to read this book.
@Misti: @LML: Reading the book makes me very grateful to those trying to engineer replacements and who can look these situations “in the eye” and help these patients.
November 2003 I donated 82% of my liver that regenerate to a family member. Seven weeks later the length of the generate to full length. The thickness was 2 years. I have a high pain threshold and I was release from Toronto General 5 days later. My family member lived for 10 years. My health is good, and intend to live a long life. Last month I turn to 75. I thank you on giving a education well over due