Can you tell us why middle grade and why this particular book for middle grade?

Yeah.

So I, I do like to jump around.

I am committed to writing in a bunch of different genres and age categories.

Um, part of that is just being able to sustain a full-time writing career.

I want to be able to have many different streams, so I, I had to pick, um, different places that I could write in simultaneously.

So if you aren't aware of how traditional publishing works, if I write a young adult with one publisher, they then have the, um, something called an option clause, where they get to take the first look at my next young adult of whatever.

Can you tell us why you decided to include this sort of foster care situation?

W- what are some of the early examples of humans trying to kind of like replace or augment our bodies with non-human stuff?

Uh, the first one, uh, that I came across was, uh, noses.

Um, there's long been a demand for, um, artificial noses because nasal mutilation, like hacking off somebody's nose, has been a punishment kind of throughout history and globally.

Uh, 'cause it was kind of a, it was a punishment, but it was also a deterrent.

Like, the whole population would see that, you know, your nose has been hacked off, and it's not an appealing thing to have happen.

Um, when did [laughs] we first get the idea that this was a thing that could, that could even happen? What's the history of the hair transplant?

Uh, there was, um, a guy named Okuda, a Japanese physician, and, um, he got very excited 'cause he realized you could take, um...

There's something called donor dominance where if you, wherever you take the hair from, that's how it's going to be.

How does it work?

There are ambitions, yes, but I would say it's in the early phases.

For example, a heart, a heart is a muscular organ.

It's a muscle for the most part.

And to print muscle, you would think, well, it's one kind of cell.

It should be pretty simple.

You load the material and the printer lays down the cells.

The

Right.

And, uh, an agent contacted me and, and said, "You know, you should think about books and, and maybe, like, look at which columns were popular," and those were popular.

And he said, "You should think about a book about cadavers," and I thought, that's a terrible-

Sure.

And then I called this woman who works in a lab that has to do with fat, but turns out it's, it's stem cells from fat.

And I thought, oh, stem cells, kinda interesting.

But then the conversation kind of veered and she told me she had come across a study by a surgeon who r- rebuilt a man's penis using his, his middle finger.

And I, I wondered, where do you, where do you line up on that, uh, argument?

I completely understandThe desire to do it.

Like you, I mean, I, I, I imagine-- I know rationally that there's a lot of false negatives and a lot of false positives.

So even if everything is A-okay, you can't really trust it 'cause maybe the signals weren't strong enough yet for the cancer that is growing in there, but there's also a lot of false positives.

I'm talking about those blood tests.

Um, but the, the blood tests, not the scans.

The scans, though, yeah, everybody has some weird little lump or cyst or irregularity on them that's gonna now require, uh, further follow-up imaging, uh, opening you up and taking a look.

Yes, yes

For example, elephants kill over 400 people a year in India, but Mary Roach, who wrote the book Animal, Vegetable, Criminal, says the general approach is not necessarily violent.

And in this case, I, I spoke to a woman whose shop had been twice damaged, you know, wall torn down, and I said, "How do you feel about these elephants? Do you want them dead? Do you want someone to come in and deal with them and shoot them?" And she said, "No.

No.

We just say namaste and please go away." And part of that is that the elephant is an avatar, if you will, for the deity, Ganesh.

And that's true with monkeys too.

Hanuman is the monkey God.

For those who've never really thought about it, why is this a mystery?

Well, with, uh, with men, uh, orgasm is obviously tied to reproduction.

You know, you have your ejaculation, which delivers the semen, and that is how conception happens, so it's o- obvious what function it serves.

Um, and with women, uh, it, it wasn't so clear.

Um, but there was for centuries this belief that it was tied to conception and that w- the, the contractions, uterine contractions that happen during orgasm, they thought...

There was this belief that they were sucking up the semen, like, delivering it more quickly and, and therefore, and boosting the odds of conception.

You know, as far back as the 1700s, there was this belief that...

What happened?

Oh my God

... weirdly, and this was carried on by Jack Kevorkian in the US and some other people in the US saying like, "Why are we wasting this? This is per- this is perfectly good blood." Uh, and it did...

The weird thing is, if somebody had died suddenly, the blood wouldn't co- coagulate in the same way.

It was actually more useful blood, and I didn't include this in my book.

I'm like, "Ha- really? Do we know that? Did anybody look into that whole violent death means the blood keeps longer?"

Okay, okay.

There's a similar story about the Apollo astronauts because the [clears throat] urine collection device was this condom-ended, you know, it s- slipped on the penis and with a tube, then there'd be a bag kinda strapped to the leg or whatever.

The urine, yeah, it was the urine collection assembly, I think it was called.

I see.

...

The cornea.

There-- No, no one is trans-- No one is transplanting entire eyes.

And the eye, the optic nerve is m- it's really part of the brain, so it's, it would be a...

That's, that's a tricky one to replace.

But the cornea, uh, which is the very, very thin layer o-on the exterior of the eye, which can be removed and can be, um, transplanted.

What did you make of it, Mary, that they have their own vocabulary?

Bolus.

Bolus formation.

You are, first of all, you're taking your food apart, you're grinding it up, taking it apart, and then you need to reassemble it in the swallowable state, which is a cylindrical bolus, which is one of my favorite words.

And it does it without us thinking about it.

The cheeks.

If you st- if you try to think about it, if you try to pay attention, it's, it's very, very...

I tried, because I, this is what I was doing for two years.

I was, like, trying to pay attention to m- my bolus formation.

Yeah.

... and, and, uh, you can find examples of it in nature, you know, those shells like that and the design of sunflowers on a sunflower plant.

I mean, it, it turns up everywhere apparently.

Anyway, so this guy wrote this (laughs) paper.

Uh, there were a couple papers.

One was on the perfect calf, and one was on the perfect proport- buttock proportions.

But it seems a lot like a conversation we have in so many other areas, which leads us towards, is it going to be misdirected in some way for people using it for immortality, for wanting to live an extended lifetime beyond two, three, four, five hundred years of age?

Yeah, I, I don't think that's gonna come from replacement bits.

It's called Replaceable You by non-fiction author Mary Roach.

Fairly far along in the process of writing this book, I was like, "Is there anything that we humans have built or designed or cooked up that is 100% perfect or- or pretty much just does what the original part does?" And I thought, "Okay.

The tears.

How about tears? Have we got a perfect artificial tear?" You know, and I found this guy who works for Tear Lab, and he's spent decades working on tears, and we got onto a Zoom call, and I said, "Okay, so artificial tears?" He's like, "Yeah.

They'll help for an hour or two, but they kind of wash away the good stuff." So we don't even have ...

We can't really even replace tears.

From hair, to pig organs, to her experience visiting a burn unit at a hospital in Boston.

Third degree burns are really tough because the cells that would regenerate from below, like on a second degree burn, those are destroyed, so the body tries to heal by contracting.

Okay.

This is way off in the future, but people are starting to look at it.

The term is chimerism.

In other words, a chimera being, you know, part, two different creatures in, in one.

So this would be, uh, you would take a pig, uh-... m- blastocyst, say? It was that, like, tiny cluster of cells.

And you would edit it such that it's not going to produce, say, a kidney, and then you're introducing, um, pluripotent human cells that could grow into a kidney so that this pig would literally be growing a human kidney within its body.

And that kidney could then go to a person as a human kidney would.

Would you explain how 3D printers are being experimented with now?

I see.

The cornea.

There, no, no, no one is tran- no one is transplanting entire eyes.

In the eye, the optic nerve is m- it's really part of the brain, so it's, it would be a re- uh, that's the, that's the tricky one to replace.

But the cornea, uh, which is the very, very thin layer on, on the exterior of the eye, which can be removed and can be, um, transplanted.

There are certain diseases, Fuch's dystrophy is one of them, where, uh, a corneal transplant is the, uh, the most common treatment for that.

So, uh, and it's, it's a, it's a tremendous gift, uh, and, and there's a, uh, there's a big need, uh, because, uh, you know, they don't always take, sometimes several efforts are need- are needed before one takes, um, they're, they're getting much better at it, at taking a thinner and thinner layer, uh, of the cornea.

What did you make of it, Mary, that they have their own vocabulary?

What are they? How are they used? Where are they, Mary?

Sure.

Well, uh, in Chengdu, I was visiting researchers who were working on, um, xenotransplantation, which is genetically editing a pig, in this case, so that its heart is less reactive so that, uh, you're knocking out a protein called the alpha-gal protein that causes a very, very vigorous rejection from humans.

So, so they're doing that.

But in the course of my visit and my conversation with these researchers, they mentioned work, uh, that a colleague was doing called chimerism.

Uh, the...

A chimera, if you're familiar with the word from mythology, it's, uh, it's a, a b- a, a being that is two parts at once, two different creatures at once.

We're talking about pigs teaching us things or taking-

How does it work?

Uh, there are ambitions, yes, but I would say, uh, um, i- it's in the early phases.

(laughs) Uh, for example, a heart, a heart is a muscular organ.

It's a muscle for the m- most part.

And to print muscle, you would think, "Well, it's one kind of cell.

It should be pretty simple." Uh, you load the material, and the printer lays down the cells.

But in fact, you need to consider, um, what's th- you know, how are those individual muscle cells aligned? Because it depends on what the function of that muscle is.

Yes.

What does that mean, Mary? Good evening to you.

Good evening, John.

Thank you for having me on.

The, the difference is an important one because with a second-degree burn, the body regenerates skin from below.

And so the skin regenerates in a way that's, um, you know, it appears as new skin on the surface of the burn.

But with a third-degree burn, those regenerative cells are destroyed and so the body tries to heal in a different way.

It tries to contract and pull together to cover that wound, and when it pulls like that, it causes the kind of hallmark disfigurement that you see with victims of severe burns.

She's many years after the original accident and you had dinner with her, and how is she today?

Have you been-

With transplanting pig organs?

With xenotransplantation in America.

Oh.

Well, it's just very new.

Right now, we have, uh, um, there are fewer than 10, I believe, uh, kidney and heart trans-... xenotransplants.

Um, this month, the, the, trial, uh, eGenisis has a pig kidney trial underway just starting, uh, either this month or last month.

So it's, it's very new.

Yeah.

Yeah.

You can take hair from pretty much any part of the body and move it elsewhere.

And the thing about that is that it will retain the characteristics of where you took it from.

This is the basis of a hair transplant.

You take it from the sides or the back and that hair doesn't fall out.

It's not sensitive to testosterone.

Is that the gist of what happened? That you emailed the person you lost your virginity to?

That, like, the whole body is better than some incomplete body, and you know, as I, as I was reading it, I was thinking that culturally, like, in other ways, we do accept m- body modification all the time, Botox, collagen, rhinoplasty, and then sometimes we don't at all, and I wondered what you m- you made of that.

Well, we, I think we accept it if it's, um, making us, quote-unquote, "more attractive" or more cutting edge or trendy.

I think we don't accept it as much when it's perceived as a disability.

There are studies that look at limb salvage surgery.

In other words, let's keep the foot, but let's just do surgery after surgery after surgery and try and get it to the point where it's almost as good as new.

Versus let's be realistic, this is unlikely to get to 100%, let's amputate now, uh, and the person will ultimately be better off in terms of discomfort and f- function.

And time and again, things land on the side of amputation, but I think because it feels drastic, you know, no matter how problematic that foot has been, it's you, you know? It's you, and it's, now it's gone.

What was your favorite replacement from the book?

... where you go, "Wow, lucky me"?

Oh, for sure.

Yeah, for sure.

I, so many of those moments.

I remember when I was reporting for Packing for Mars, I was up in the Arctic on Devon Island, which NASA uses as a, an analog for the Moon and Mars, and I had a week there when I didn't really need the whole week, so I just talked to a lot of people thinking, "I don't know, see what they do, these researchers." And there was a guy who studied, he was a suit guy, and he was working on creating an escape suit.

So this would be a suit where if something goes wrong, either as the spaceship is going up or the capsule is coming down at any different altitude, and it's really tricky because depending on how much atmosphere you have, you know, your parachute has no air to unfold, or you're gonna burn up, so it's a very tricky suit to create and system to create.

Anyway, he's explaining it all to me, and I'm like, "Eh, maybe I'll write something about this.

Wow.

(laughs)

Well, okay, so, um, I...

The, the company that was, uh, involved in the stem cell-derived follicle project needed some follicles for study.

They needed to understand, you know, what is going on in every stage of development of hair follicles.

They need to basically... 'Cause they're reverse engineering this thing.

So, uh, they, uh, they worked with a hair transplant surgeon nearby, uh, Dr. Chafoo, and they had, uh...

When someone was coming in to get a hair transplant, they would say, "Hey, would you donate some for science?"... and when I was there interviewing Dr. Chaffoo for another chapter, the hair transplant chapter, I volunteered to, uh, donate some h- hair follicles, and w- while this was going on, I asked if they wouldn't mind taking some hairs from my head and transplanting them to my leg, and the reason (laughs) I wanted this done, I wanted to have a living example of what's called donor dominance, and i- in hair transplants, this is why hair transplants work, because the hair at the sides and the back of the head are not sensitive to testosterone like the hair on the top of the head, so you can take follicles from the back and sides, put them up at the front, at the top, where the person is losing their hair, and they will now stay there, and they will behave like they did on the back or the side of the head.

So describe what the anesthesiologist's job was before the surgery.

Mm-hmm.

It's being blown in there.

Whereas, uh, um, negative pressure, which is an iron lung, uh, it's done by vacuum.

Like, you pull out the...

You pull the air out of the tube, and then, the lung...

The, the ribcage expands, and that pulls in the air.

Anyway, (laughs) so I found a guy who's-...

(laughs)

[laughs]

Sure.

A xenotransplantation, I mean, this work has been going on about 30 years at least, and it is just now, over the past year, year and a half, are actually being used in humans.

So pig organs are the ones that are being used.

I mean, th- pigs' hearts are, are similar, especially a smaller pig, smaller size, kind of a, a good match for the human heart.

And by now, there are fewer than 10 xenotransplantations into humans.

There is one man, Tim Andrews, as far as I know, is, is still alive.

What are people working on to solve the issue of rejection while also not destroying our immune system?

Not even that

Not even that.

Not even that, yeah.

The only thing I think, the, the transplant that I think works the best is one that I addressed in a, in a previous book, which is the fecal microbiome transplant.

I think that's a, that's a situation where the one that you have, uh, is, is, uh, has been invaded.

You've got-You know, C. diff running loose in your gut.

And so take someone else's microbiome, and now it's all, they're encapsulated.

Okay, it sounds like from this particular story that there is no, like, agreed-upon successful procedure for these circumstances.