The Struggle to Unearth the World’s First Author

The Struggle to Unearth the World’s First Author

Decades ago, archeologists discovered the work of Enheduanna, an ancient priestess who seemed to alter the story of literature. Why hasn’t her claim been affirmed?

By 

By Elizabeth Winkler The New Yorker

Illustration by Daniele Castellano

Around forty-three hundred years ago, in a region that we now call Iraq, a sculptor chiselled into a white limestone disk the image of a woman presiding over a temple ritual. She wears a long ceremonial robe and a headdress. There are two male attendants behind her, and one in front, pouring a libation on an altar. On the back of the disk, an inscription identifies her as Enheduanna, a high priestess and the daughter of King Sargon.

Some scholars believe that the priestess was also the world’s first recorded author. A clay tablet preserves the words of a long narrative poem: “I took up my place in the sanctuary dwelling, / I was high priestess, I, Enheduanna.” In Sumer, the ancient civilization of southern Mesopotamia where writing originated, texts were anonymous. If Enheduanna wrote those words, then she marks the beginning of authorship, the beginning of rhetoric, even the beginning of autobiography. To put her precedence in perspective, she lived fifteen hundred years before Homer, seventeen hundred years before Sappho, and two thousand years before Aristotle, who is traditionally credited as the father of the rhetorical tradition.

The poem, written in the wedge-shaped impressions of cuneiform, describes a period of crisis in the priestess’s life. Enheduanna’s father, Sargon, united Mesopotamia’s city-states to create what is sometimes called history’s first empire. His domain stretched from the Persian Gulf to the Mediterranean Sea, encompassing modern-day Kuwait, Iraq, Jordan, and Syria, including more than sixty-five cities, each with its own religious traditions, administrative system, and local identity. Although Sargon ruled from Akkad, in the north, he appointed his daughter high priestess at the temple of the moon god in the southern city of Ur. The position, though outwardly religious, was in practice political, helping to unify disparate parts of the empire. After Sargon’s death, the kingdom was torn by rebellion; the throne went briefly to Enheduanna’s brothers, and then to her nephew. In the poem, a usurper named Lugalanne—a military general who possibly led an uprising in Ur—drives Enheduanna from her place at the temple.

“He has turned that temple into a house of ill repute./ Forcing his way in as if he were an equal, he dared approach me in his lust!” Enheduanna says. Cast out of the city, she wanders the wilderness. “He made me walk a land of thorns. / He took away the noble diadem of my holy office, / He gave me a dagger: ‘This is just right for you,’ he said.” The full significance of the usurper’s crime is lost in a literal translation, but the language suggests sexual violation. (The verbs, one translator has noted, are the same ones used elsewhere to convey sexual advances.) It also suggests an incitement to suicide. Giving her a dagger, Lugalanne encourages her to kill herself. “This is just right for you.”

Enheduanna’s salvation depends on her rhetorical skill, but she finds that her powers have dried up. “My once honeyed mouth has now become froth,/ my power to please hearts is turned to dust,” she says. To surmount this block, she appeals first to the moon god, but he ignores her: “My moonlight has no care for me! / He lets me perish in this place of hopes deceived.” Then she turns to Inanna, the goddess of love, sex, and war, offering an extended paean to her glory: “My lady! This country will bow down again at your battle cry!” Enheduanna’s crisis is resolved through such praise, and through the creation of the poem itself, which is called “The Exaltation of Inanna.” In an astonishingly self-conscious passage, the work of writing is compared to the pains of childbirth. “This fills me, this overflows from me, Exalted Lady, as I give birth for you./ What I confided to you in the dark of night, a singer shall perform for you in the bright of day!”

Enheduanna’s nephew eventually put down the rebellion, and Enheduanna was restored to her office. She attributes her rescue to Inanna—“Be it known that you devastate the rebellious land!”—but the poem also suggests that Enheduanna, in exalting Inanna, played a role in Ur’s salvation. Goddess and priestess are closely linked, the priestess being in part the earthly representation of the divine. The poem is political, inscribing the relationship between power and language, but it’s also hauntingly personal.

In addition to “The Exaltation,” two other texts have been attributed to Enheduanna: “A Hymn to Inanna,” which mentions Enheduanna by name, and “Inanna and Ebih,” which has been ascribed to her on stylistic grounds. Her claim is also attached to a collection of forty-two religious poems—hymns addressed to the temples of various city-states. Taken together, the hymns form what the Yale scholars William Hallo and J. J. A. van Dijk called a “major piece of Mesopotamian theology,” uniting the region’s many cults and deities and rendering Enheduanna “a kind of systematic theologian.” The cycle concludes with a postscript: “The compiler of the tablet is Enheduanna./ My King, something has been created that no one had ever created before!”

In ancient Mesopotamia, Enheduanna’s works were celebrated, and were even part of the curriculum in the edubbas, or scribal schools, which trained future priests and civil servants in cuneiform writing and Sumerian grammar. For hundreds of years, students learned by etching Enheduanna’s words onto clay tablets, and about a hundred of these copies of “The Exaltation of Inanna” survive. But since their discovery, in the mid-twentieth century, scholars have fiercely debated Enheduanna’s authorship. Did the priestess really write these works? Is the idea of a woman at the beginning of the written tradition—two thousand years before the golden age of Greece—too good to be true? This winter, an exhibition at the Morgan Library & Museum in New York, “She Who Wrote: Enheduanna and Women of Mesopotamia,” will try to give the priestess her due. “You ask anyone you know and they’ll say the first author is Herodotus or some other man,” Sidney Babcock, the show’s curator, told me. “It’s always amazed me. No one will ever come up with her.”

The city of Ur was first excavated in the eighteen-fifties. But much of it went unexplored until 1922, when a British archeologist, Leonard Woolley, led a joint expedition funded by the British Museum and the University of Pennsylvania. Wooley was drawn to Ur as the Biblical home of Abraham and the ancient pagan kings. (His account of the dig, “Ur of the Chaldees: A Record of Seven Years of Excavation,” alludes to Genesis: “And Terah took Abram . . . and Sarai his daughter-in-law, his son Abram’s wife; and they went forth with them from Ur of the Chaldees.”) Woolley’s great find was the royal cemetery, where his team unearthed the tombs of kings and queens, along with jewelry, weapons, pottery, musical instruments, and other treasures.

Ur was also, of course, the adopted home of Enheduanna. In 1927, five years into the dig, the excavators discovered the ruins of a temple. Inside, they found the defaced shards of a stone disk—the disk depicting Enheduanna—and, nearby, three other objects naming the priestess: cylinder seals belonging to her servants. Elsewhere in the temple were clay tablets covered in cuneiform script. “Here was definite proof that the priestesses kept a school on their premises,” Woolley wrote. But he missed the full import of the discovery, calling the temple a “nunnery” and a “harem.” Some of the tablets found in Ur were copies of Enheduanna’s texts, but Woolley, intent on Great Man history—political dynasties, Biblical patriarchs—seems to have taken no interest in the priestess, treating her as an inconsequential appendage of her famous father. His book doesn’t even name Enheduanna, referring to her merely as the daughter of Sargon.

In the years that followed, archeologists and looters unearthed other tablets with Enheduanna’s words, in cities such as Nippur and Larsa. But her body of work wasn’t transcribed, published, and attributed to her until the late fifties and sixties. In 1968, the first translation of her writing from Sumerian into English appeared. “We can now discern a corpus of poetry of the very first rank which not only reveals its author’s name, but delineates that author for us in truly autobiographical fashion,” Hallo and van Dijk wrote in their introduction to the translation. “In the person of Enheduanna, we are confronted by a woman who was at once princess, priestess, and poetess.” The pair acknowledged that the picture assembled by scholars might be incomplete. “We still do not know the full extent of Enheduanna’s literary oeuvre,” they wrote, “but so strong is the stamp of her style and her convictions in the poems that can definitely be attributed to her, that it may one day be possible to detect her authorship also in other, less well-preserved pieces.”

While Hallo and van Dijk were noting that Enheduanna might have written more than had been uncovered—Akkad, the capital of Sargon’s empire, has yet to be excavated—others were downplaying her claim. The British scholar W. G. Lambert raised the possibility of a ghostwriter, suggesting that at least one of Enheduanna’s texts could have been authored by a scribe. (Sumerian kings often had scribes compose for them.) “Our emotional response to ancient texts is not necessarily the best criterion of judgment,” he later wrote, in 2001. Other scholars questioned Enheduanna on the grounds that the surviving versions of her work, copied out by the students of the edubbas, date to five hundred years after her death; no copies from her own time survive, and, in a few instances, the texts contain place names and vocabulary that postdate her era. This could simply be the result of changes made in the process of scribal transmission—alterations commonly attend the reproduction of old narratives—but some see it as reason for skepticism. “She speaks in the first person, but that’s not the same as being the author,” Paul Delnero, a professor of Assyriology at Johns Hopkins University, told me. Enheduanna could be a cultic figure honored by later writers, her name invoked in the works to lend them authority.

For some in the field, these claims are quite a stretch. “Why would the scribes look back and find a high priestess and say she wrote the texts?” Benjamin Foster, a professor of Assyriology at Yale, asked me. “There were lots of high priestesses. Why choose her?” Foster is impatient with the skeptics. “There’s a tendency in our field to regard it as a sign of wisdom not to take ancient texts at their word,” he said. “It’s not cool to be excited and emotional. You should keep a detached skepticism. But we have more evidence for her than we have for any other author in ancient Mesopotamia.” Foster, who has “no doubt” about Enheduanna’s authorship, cites the autobiographical content of the poems, the deeply intimate quality of the narrative voice. And then there are the peculiarly female markers of “The Exaltation”—the language of sexual violation, the metaphor of writing as childbirth, even the preference for the goddess rather than the god.

In many ways, the debate has become a battleground for competing theoretical paradigms. In the seventies, when second-wave feminism was booming, there was a push to affirm Enheduanna’s authorship; a similar movement occurred in the nineties. (Erhan Tamur, a co-curator of the Morgan exhibit, told me that doubts about Enheduanna’s achievement flowed from the “patriarchal nature of modern scholarship.”) Meanwhile, postmodern thinking encouraged skepticism, uncertainty, and the irrelevance of the author. Consensus was never reached. Today, many see the priestess not as a vital female poet but, as the British Assyriologist Eleanor Robson has called her, a “wish-fulfillment figure.”

The Morgan exhibition presents Enheduanna without the shadow of these doubts. Specifically, it places her in the context of other Mesopotamian women of the late fourth and third millennia B.C.: workers, rulers, priestesses, scribes, and the female deities to which they all prayed. No major exhibition has focused on women’s lives in ancient Mesopotamia, and the artworks gathered—from London, Berlin, Paris, and elsewhere—build a picture of the economic, political, and cultural power they wielded.

There are images of women herding cattle; making pottery; and working at a loom, their hair flying behind them. There are scenes of women at the temple, directing male attendants. One image shows a man transferring lands to his daughter. (Unlike in many later societies, the women of ancient Mesopotamia could inherit property.) There’s the elaborate headdress of Queen Puabi—uncovered by Woolley in the nineteen-twenties—and her accompanying seals, which identify her not in relation to a father or a brother but in her own right, suggesting that she ruled alone. Of particular note is a statue of a woman with a tablet in her lap—evidence of women’s literacy and engagement with writing. (When it was first discovered, in the early twentieth century, the German scholar Otto Weber reported, “Our specimen carries a tablet on her knees. Its meaning is not clear to me.”) The statue and others like it have been ignored in the academic literature, Babcock told me. “If this was a man with a tablet in his lap, there would be twenty articles about it.” Such artifacts upend long-held assumptions—about literacy as the preserve of élite male scribes, and about Middle Eastern women as being confined to the domestic sphere.

The show also features the disk of Enheduanna; the cylinder seals of her servants; and a tablet inscribed with lines from “The Exaltation of Inanna.” The tablet is paired with intricate engravings that may be illustrations of Enheduanna’s text, showing the gods in their mythological settings. “All of the evidence is there,” Zainab Bahrani, a professor of ancient Near Eastern art and archeology at Columbia University, told me, ticking off the various records that support Enheduanna’s authorship. “If you think about it, it makes perfect sense that an élite woman would be the first poet. She had a comfortable life, space to read and think, a place to write. She didn’t have to work in the fields or fight wars. Why wouldn’t she have been able to write?” Bahrani compares Enheduanna’s poetry to the votive offerings of the time—the statues, sculptures, and other artworks that women gave to temples, inscribed with their names. It was this kind of tradition that may have inspired Enheduanna to identify herself, making a work like “The Exaltation” both a kind of prayer-poem and an offering to the goddess.

In 1929, the same year that Woolley published “Ur of the Chaldees,” omitting Enheduanna’s name, his countrywoman Virginia Woolf published her essay “A Room of One’s Own.” Searching her shelves for books by and about women—books that were not there—she observed that history “seems a little queer as it is, unreal, lop-sided. . . . history is too much about wars; biography too much about great men.” She suspected that the women who had written had left their work unsigned. Woolf did not live to learn of Enheduanna, but she articulated the longing for a lost literary tradition.

For today’s writers, Enheduanna has become a personification of creative power, regardless of the academic debate. In the West, she’s inspired poetic works like Alice Notley’s “The Descent of Alette” (1992) and Annie Finch’s “Among the Goddesses” (2010). She’s a particularly compelling figure for Iraqi artists—a woman who speaks to their modern experience of mourning, exile, and displacement. (After the poet Amal al-Jubouri fled Iraq, in 1998, she published a collection titled “Enheduanna, Priestess of Exile.”) She’s even left a mark on the field of astronomy, winning recognition as an early female observer of the skies. Her temple hymns describe the measuring of celestial movements: “In . . . the priestesses’ rooms/ That princely shrine of cosmic order/ They track the passage of the moon.” These observations likely formed the basis of calendar-keeping, one of her temple responsibilities:

The true woman who possesses exceeding wisdom,

She consults a tablet of lapis lazuli,

She gives advice to all lands. . . .

She measures off the heavens,

She places the measuring cords on the earth.

Somewhere in those temple rooms, it is possible to imagine the woman of wisdom setting aside her lapis-lazuli tablet, finished with the day’s measuring, and turning to her own project. She searches about for her reed stylus. Then she raises her instrument, pauses to mutter to herself, and starts to press her words into the clay. ♦

Even Life Saving Treatments Come to an End

Even Life Saving Treatments Come to an End

By Daniela J. Lamas NY Times

Dr. Lamas, a contributing Opinion writer, is a pulmonary and critical-care physician at Brigham and Women’s Hospital in Boston.

Francia Bolivar Henry was going to be the miracle patient. A pastry chef in her 30s with a captivating smile, she was funny and kind, loved Missy Elliott and chocolate souffle. Even as she battled a life-threatening disease, trapped in the intensive care unit while hooked to a machine that had taken over the functioning of her lungs, she found moments of joy. Once you met her, it was hard not to believe that she would beat the odds and survive.

That‌’s what struck me when I cared for Ms. Henry in the intensive care unit one weekend late this past spring. She had been admitted to Brigham and Women’s Hospital in Boston, where I work as a critical care doctor, more than a month before, with a collapsed lung that would not reinflate and severely low oxygen levels. Though for years she had suffered from sarcoidosis — an inflammatory disease that can affect the lungs — it was still a shock when the doctors told her that the damage was so extensive that a transplant was her only option.

After all, she had been working right up until the lung collapse. She and her boyfriend of four years were making plans for the future: ‌He was waiting for the perfect moment when he could propose to her with a “big old ring.” He thought they would have time.

But ‌‌here she was, now on the ventilator with a tracheotomy tube in her neck, able to communicate only by mouthing or texting. Still, on the morning I met her, she greeted me with a bright smile and told me she was guiltily hoping that a holiday weekend would mean a better chance of transplant offers. Later that day, I watched as she walked laboriously through the unit, ventilator tubing trailing behind her, ’90s rhythm and blues playing from her smartphone. She would walk every day, no matter how much it exhausted her. She knew that if she became too weak, she could be taken off the transplant list.

Weeks passed. She waited, her family visited, she walked. But without a transplant offer, she began to suffer complications and became sicker. Her lungs worsened, and despite deep sedation and paralyzing medications, even the ventilator was not sufficient. Her only chance to stay alive long enough for a transplant was another machine that would completely take the place of her destroyed lungs, a device called extracorporeal membrane oxygenation, or ECMO.

Surgeons would place two catheters the size of garden hoses in the large vein in Ms. Henry’s neck. One catheter would siphon the blood out of her body, run it through a machine next to the bed that would add oxygen and remove carbon dioxide, before returning the blood to her body through the other catheter. In contrast to the ventilator, which still uses the lungs somewhat, this machine takes the lungs out of the equation entirely.

Though it has been used for lung and heart failure for decades, ‌‌ECMO came into the public eye more recently during the first wave of the pandemic as a last-ditch intervention for the sickest patients with Covid-19, whose lungs were so destroyed that they needed time on lung bypass to recover. Since then, ‌‌its use has increased in patients waiting for heart or lung transplants, and for those with respiratory failure because of pneumonia or asthma, a trend that is only anticipated to continue. At my hospital we now have a dozen machines, up from five before the pandemic.

But the decision to begin ECMO is a complicated one, because life on the machine is fraught with danger. Once on the machine, Ms. Henry knew that at any moment, she could have a life-threatening clot, a devastating hemorrhage or a stroke. While those on dialysis for the kidneys or with a ventricular assist device for the heart can live at home for years, as of now there is no such technology for destroyed lungs. While on ECMO, patients cannot live outside the I.C.U. They need constant monitoring, often daily blood transfusions, and the longer they wait, the more complications they face.

Though we increasingly push the boundaries‌‌ with ECMO, it’s ‌not designed for ‌‌long-term use. That’s why doctors talk about the machine as a bridge rather than a destination. It is either a bridge to lung recovery or to transplant if recovery is impossible. This very fact is remarkable.

Patients like Ms. Henry, who would have died without the hope of transplant, are given a second chance at life. But it is a strange second chance, lived under the shadow of an almost intolerable reality‌‌: If transplant or recovery is not possible, then ‌the machine ‌‌becomes what we refer to as a “bridge to nowhere” and ‌has to stop. ‌Doctors make this clear when patients or, more often, their family consent to start ECMO. But can anyone truly understand that unthinkable possibility in the heat of the moment, when they or their loved one cannot breathe and would grasp at any chance at life, as was the case for Ms. Henry? And even if they could, what could they possibly do with that information?

‌Once the sedating medications were stopped, and she woke up on ECMO in June, Ms. Henry‌ was determined to do whatever was necessary for her make it to a transplant, and to continue to find moments of happiness while waiting‌. Though her voice was gone, silenced by the trach tube, her smile was still there. It was what endeared her to even the most hardened nurses, who told her they loved her at the end of their shifts. When she turned 34, the nursing staff took her up to the hospital roof, lung bypass machine and all, so that she could feel the sun on her face. She listened to music. Her boyfriend and her parents visited. They all believed that the new lungs would come and that the suffering would be worth it in the end‌‌.

But the lung bypass machine can be deceptive. Patients can appear relatively stable, but they are on a razor’s edge. This was the case with Ms. Henry and as the summer wore on, complications started to cascade. By August, she bled, fluid accumulated around her heart, and she was in pain. She was taken off the transplant list, then put back on and finally, when it became clear that even if she survived the operation, she was unlikely to ever leave the hospital, the transplant team made the gut-wrenching decision to take her off the list permanently.

When Ms. Henry learned this news, she let herself sit in the sadness of it for about an hour. And then she did her best to move forward. At first there were hopes that, however unlikely, another transplant program might feel differently about her chances and would take her on. For a brief interlude, a program in Florida seemed possible. Her boyfriend readied the car to head south, Ms. Henry searched online to help her mother find apartments, while her mother prepared to tap into her retirement to pay for the air ambulance that insurance would not cover.

Then this option fell through. And even though her doctors made call after call throughout the country, trying to find another program ‌‌ — and each day she walked, determined to be as ready as she could if someone said yes ‌ — one by one, transplant programs throughout the country said no.

“We called every center we knew. She was a young lady and we all wanted to give her a chance,” Dr. Nirmal Sharma, the medical head of lung transplant at Brigham, told me. “But as she became even sicker, the writing was on the wall.”

By the last weekend in August, more than four months after Ms. Henry was first admitted to our hospital, the narrow window of possibility closed, a reality we often know only in retrospect. Realizing that there would be no perfect moment, Ms. Henry’s boyfriend had proposed to her. The engagement ring sparkled on her finger as her doctors delivered the worst news imaginable. Ms. Henry was too sick. There would be no transfer, no hope of transplant. ‌Which left her in one of the most dreaded realities in modern medicine, awake and alert, ‌because of a life-prolonging machine that had now become a bridge to nowhere.

‌This scenario does not occur often and when it does, it plays out behind closed doors. But as our medical technology races forward — creating ethical quandaries like this one — we need to examine cases like these, to ask tough questions about our responsibility to our patients and what it means to do no harm.

These are the questions that faced the doctors and nurses when a similar tragedy played out about seven years ago at Boston Children’s Hospital. A 17-year-old with cystic fibrosis was on ‌ECMO, waiting for what would be his second lung transplant‌. While he waited, his doctors discovered that he had developed a cancer that can occur in patients who’ve already received a transplant. This meant that he was no longer a candidate for new lungs.

Some of the medical team argued that they should keep ECMO going indefinitely, ‌‌so long as it was giving the boy an acceptable quality of life. Others said that it should stop right away, that there was no logical reason to continue. The teenager ‌had deferred decisions to his parents, who found the idea of determining the day their son would die to be unbearable.

“When I’ve encountered situations like these, there are always people who say, quite reasonably, that we are not here just to keep people alive on machines,” said Dr. Robert Truog, who directs Harvard Medical School’s Center for Bioethics and practices as a pediatric intensive care unit doctor. “But then I think, why not? Why not go until it can’t be done anymore or he or his family tell us to stop?”

Ultimately, the medical team in concert with the boy’s parents decided on a third path that would allow them all to take a less active role in the timing of his death. When the part of the machine that brings oxygen to the blood needed to be replaced, as it inevitably would, they would not replace it. They would withhold this further medical intervention, rather than actively withdrawing anything ‌‌ — a path that would lead to the same outcome in the end but, I imagine, would be somewhat less intolerable for those involved. About a week after this decision, the oxygenator failed, the boy lost consciousness and ‌died.

Though this case occurred years ago, the conversations today are much the same. If transplant is off the table, the machine should stop. But as the use of ECMO continues to increase, including for patients who are bridging to lung transplant, I want to understand why we as a medical community have determined that these machines should not continue indefinitely. This question might seem limited to this one machine, this one scenario. But here at the forefront of modern medicine, we will inevitably find ourselves facing other profoundly difficult questions and unimaginable realities like this one. And the way we respond gets to the very heart of what it means to be a doctor caring for a patient.

Now, when it comes to ECMO, it’s essential to acknowledge that this machine is inherently different from a ventilator, which patients can and do stay on indefinitely. ‌‌It is the riskiest and most labor-intensive mode of life support we have, and in many cases, when a patient will never wake up again or interact meaningfully with their loved ones, continuing ECMO serves only to prolong a life ‌‌without quality. For these patients and their families, more time on lung bypass means only more suffering‌. The greater ethical challenge comes in cases ‌‌where ECMO could enable a patient to continue a life that could be perceived as acceptable when compared with the alternative of death, for days or weeks or maybe even longer.

“There’s this mentality that ‘this can’t go on,’ and I question the ethical soundness of that,” said Dr. Kenneth Prager, the director of clinical ethics at Columbia University Irving Medical Center, who has faced many of these cases as an ethics consultant. “Why can’t it? Especially when we consider the considerable resources expended on numerous non-ECMO patients with no chance of survival who may spend weeks or months in the I.C.U. at the insistence of their families.”

‌The ECMO machine itself is a scarce resource‌‌; not all hospitals have access to these machines, and those that do might have only a handful. This raises other ethical quandaries. If we were to continue patients on ECMO even after they are declined transplants, then should we offer the machine to ‌other people who are not transplant candidate‌‌s to prolong their lives?

For doctors like me, the primary question should be not one of resources but instead our duty to the person in front of us. A bridge to nowhere means that we know, with no uncertainty, that this patient will not survive hospitalization. Acknowledging that fact, how do we minimize not just physical pain, but also emotional suffering?

On one hand, I wonder whether we should we leave the question of whether the machine stops and the timing of that to the patient and family‌. But deferring the decision of when to say enough to a devastated patient and beleaguered loved ones could itself be a kind of cruelty.

Then again, for some patients, maybe the greater cruelty is forcing them to come to terms with what is essentially a death sentence. ‌In cases like these, we often involve services like palliative care to help with difficult conversations over time and work with our hospital ethicists to develop policies and procedures. But here in the netherworld that our interventions have created, there are no clear answers.

I cannot know what was in Ms. Henry’s mind that August afternoon. A few days before, she had asked her longtime nurse, Stephanie Christian, what would happen if the last transplant programs declined her. Ms. Christian knew that without the goal of transplant, ECMO would end and with it, the blood transfusions that were necessary to keep her patient alive. It would be days, she said, as gently as she could. Ms. Henry had allowed herself to cry then, but when the news came on Sunday, there was not much more to say. She knew what was ahead, perhaps she had made her peace with it, but she wanted time for her goodbyes and to make the days she had left as good as possible ‌ — for herself and, maybe even more so, for those who loved her.

She was going to have a wedding.

Just two days later, Ms. Christian helped her patient into the wedding dress that she and Ms. Henry’s best friend had picked out at the mall the day before. Ms. Henry wore a wig with a veil that obscured her ECMO catheters. The dress camouflaged the chest tubes. For the first time in months, she stood unassisted as she and her fiancé, Justin Henry, exchanged vows. There was a wedding playlist. A first dance. She beamed. “Somehow you didn’t even see the tubes, and she didn’t look sick,” Mr. Henry remembers. “I cannot believe how perfect it was. Perfect and so messed up at the same time.”

It must have been harder because she looked so joyful, so alive on her wedding day and even the next, when the doctors and nurses stopped by her room to say their tearful goodbyes. Always one to take care of others, Ms. Henry offered them tissues. And then, three days after the wedding, after a hard night at the maximum of what ECMO could offer, she asked to have her makeup done and to get dressed in something nice. It would be her “going away party.”

When she was ready, the medical team started to lower the support on the lung bypass machine while Ms. Christian dosed her patient with medications for pain and anxiety. The family sat at the bedside, listening to Ms. Henry’s playlist ‌‌ — Rihanna and Missy Elliott, among others ‌‌ — and telling stories. Her oxygen levels dropped. Her eyes closed. She woke up once, to smile and to offer a regal little wave to the people who loved her. And just as the sun set that evening, Ms. Henry died.

Nine Paralysis Patients Walk Again

Nine Paralysis Patients Walk Again Thanks to Newly Identified Neurons

 Ruairi J Mackenzie  Technology Network

A new study has identified nerve cells that are altered in response to a spinal cord stimulation technique proven to restore walking ability in people once thought to be permanently paralyzed. The study involved restoring movement in nine patients with severe spinal cord injury before examining damage at a cellular level in a mouse population. This analysis revealed that two populations of neurons in the lumbar spinal cord were prioritized in response to the stimulation. The research is published in

Nature. Stimulation solution

Spinal cord injuries disrupt the communication systems between the brain and neurons in the spinal cord that direct movement. Over the last five years, scientists have developed systems that utilize electrical stimulation to help individuals recover from the paralysis that often results from such injuries. These interventions, which have been enhanced further in combination with motor rehabilitation, have changed lives but remain largely unexplained.

In a new paper, a research team at the Swiss Federal Institute of Technology Lausanne (EPFL) working with Jocelyn Bloch, a neurosurgeon at Lausanne University Hospital demonstrated the effectiveness of their technique, termed epidural electrical stimulation. In a clinical trial, a further nine patients saw their walking ability immediately improve after the stimulation was switched on. Some of the patients were able to retain improved motor function even after the stimulation was silenced.

This latter finding suggests that lasting changes are being made to the function of neurons in the spinal cord that underlie these incredible recoveries. Study leader Grégoire Courtine, a neuroscience professor at EPFL, and his team decided to examine in detail what was happening in their patients’ spinal cords.

Zeroing in on recovery neurons

The team were surprised to note that overall activity in the spinal cord actually decreased in response to the stimulation, suggesting that the response was being driven through smaller subpopulations of neurons rather than an en masse effort.

To tease out the groups of neurons responsible, the team worked with mice that had received similar spinal cord injuries. They created maps of gene activity in the mice’s spinal cord neurons, allowing them to track the neurons that were preferentially targeted by the stimulation treatment. “Our model let us observe the recovery process with enhanced granularity – at the neuron level,” said Courtine in a press release.

They settled on a group of excitatory lumbar interneurons, expressing a gene called Vsx2, that were critical to the mice’s restored walking ability. Interestingly, the same neurons were not needed by healthy mice to walk without stimulation.

The team used advanced light-based stimulation techniques to show that when the Vsx2-expressing neurons were deactivated, mice with spinal cord injuries were no longer able to walk. Mice that had these neurons deactivated chronically were also unable to gain any initial benefit from the stimulation.

A first step towards tackling paralysis

The authors acknowledge that walking is additionally controlled by numerous neural populations throughout the brain and spinal cord; those neurons’ locations and connectivity will have to be unearthed in future research.

Nevertheless, this is an important first step in the process, says Bloch. “Our new study, in which nine clinical trial patients were able to recover some degree of motor function thanks to our implants, is giving us valuable insight into the reorganization process for spinal cord neurons.”

“This paves the way to more targeted treatments for paralyzed patients. We can now aim to manipulate these neurons to regenerate the spinal cord,” added study co-author and EPFL researcher Jordan Squair.

Are Trees Talking Underground? For Scientists, It’s in Dispute.

Are Trees Talking Underground? For Scientists, It’s in Dispute.

By Gabriel Popkin NY Times

Melanie Jones, a biologist at the University of British Columbia, Okanagan, examines a forested area of her campus. Dr. Jones and her colleagues are part of a skeptical reaction to the theory of the “wood-wide web.”

From Ted Lasso to TED Talks, the theory of the “wood-wide web” is everywhere, and some scientists argue that it is overblown and unproven.

Justine Karst, a mycologist at the University of Alberta, feared things had gone too far when her son got home from eighth grade and told her he had learned that trees could talk to each other through underground networks.

Her colleague, Jason Hoeksema of the University of Mississippi, had a similar feeling when watching an episode of “Ted Lasso” in which one soccer coach told another that trees in a forest cooperated rather than competed for resources.

Few recent scientific discoveries have captured the public’s imagination quite like the wood-wide web — a wispy network of fungal filaments hypothesized to shuttle nutrients and information through the soil and to help forests thrive. The idea sprouted in the late 1990s from studies showing that sugars and nutrients can flow underground between trees. In a few forests, researchers have traced fungi from the roots of one tree to those of others, suggesting that mycelial threads could be providing conduits between trees.

These findings have challenged the conventional view of forests as a mere population of trees: Trees and fungi are, in fact, coequal players on the ecological stage, scientists say. Without both, forests as we know them wouldn’t exist.

Scientists and nonscientists alike have drawn grand and sweeping conclusions from this research. They have posited that shared fungal networks are ubiquitous in forests around the world, that they help trees talk to each other and, as “Ted Lasso”’s Coach Beard articulated, that they make forests fundamentally cooperative places, with trees and fungi united in common purpose — a dramatic departure from the usual Darwinian picture of interspecies competition. The concept has been featured in numerous media reports, TV shows and best-selling books, including a Pulitzer Prize winner. It even shows up in “Avatar,” the highest-grossing movie of all time.

And the theory could be starting to influence what happens in real forests. Some scientists, for example, have suggested managing forests explicitly to protect fungal networks.

Justine Karst, a mycologist at the University of Alberta, during a visit to Bunchberry Meadows near Edmonton. She was worried when her son came from 8th grade and told her trees talk underground.

But as the wood-wide web has gained fame, it has also inspired a backlash among scientists. In a recent review of published research, Dr. Karst, Dr. Hoeksema and Melanie Jones, a biologist at the University of British Columbia, Okanagan, found little evidence that shared fungal networks help trees to communicate, swap resources or thrive. Indeed, the trio said, scientists have yet to show that these webs are widespread or ecologically significant in forests.

For some of their peers, such a reality check is long overdue. “I think this is a very timely talk,” said Kabir Peay, a mycologist at Stanford University, about a presentation Dr. Karst recently gave. He hoped it could “reorient the field.”

Others, however, maintain that the wood-wide web is on firm ground and are confident that further research will confirm many of the hypotheses proffered about fungi in forests. Colin Averill, a mycologist at ETH Zurich, said that the evidence Dr. Karst marshaled is impressive. But, he added, “the way I interpret the totality of that evidence is completely different.”

Most plant roots are colonized by mycorrhizal fungi, forming one of Earth’s most widespread symbioses. The fungi gather water and nutrients from the soil; they then swap some of these treasures with plants in exchange for sugars and other carbon-containing molecules.

David Read, a botanist then at the University of Sheffield, showed in a 1984 paper that compounds labeled with a radioactive form of carbon could flow via fungi between lab-grown plants. Years later, Suzanne Simard, then an ecologist with the British Columbia Ministry of Forests, demonstrated two-way carbon transfer in a forest between young Douglas fir and paper birch trees. When Dr. Simard and her colleagues shaded Douglas firs to reduce how much they photosynthesized, the trees’ absorption of radioactive carbon spiked, suggesting that underground carbon flow could boost young trees’ growth in the shady understory.

Dr. Simard and colleagues published their results in 1997 in the journal Nature, which splashed it on the cover and christened the discovery the “wood-wide web.” Soon after, a group of senior researchers criticized the study, saying it had methodological flaws that confounded the results. Dr. Simard responded to the critiques, and she and her colleagues designed additional studies to address them.

Over time, the criticisms faded, and the wood-wide web gained adherents. Dr. Simard’s 1997 paper has garnered almost 1,000 citations and her 2016 TED Talk, “How trees talk to each other,” has been viewed more than 5 million times.

In his book “The Hidden Life of Trees,” which has sold more than 2 million copies, Peter Wohlleben, a German forester, cited Dr. Simard when describing forests as social networks and mycorrhizal fungi as “fiber-optic internet cables” that help trees inform each other about dangers such as insects and drought.

Subterranean forest research has continued to grow, too. In 2016, Tamir Klein, a plant ecophysiologist then at the University of Basel and now at the Weizmann Institute of Science in Israel, extended Dr. Simard’s research into a mature Swiss forest of spruce, pine, larch and beech trees. His team tracked carbon isotopes from one tree to the roots of other nearby trees, including different species, in an experimental forest plot. The researchers attributed most of the carbon movement to mycorrhizal fungi but acknowledged they had not proven it.

Dr. Simard, who has been at the University of British Columbia since 2002, has led further studies showing that large, old “mother” trees are hubs of forest networks and can send carbon underground to younger seedlings. She has argued in favor of the view that trees communicate via mycorrhizal networks and against a long-held idea that competition between trees is the dominant force shaping forests. In her TED Talk, she called trees “super-cooperators.”

But as the wood-wide web’s popularity has soared both inside and outside scientific circles, a skeptical reaction has evolved. Last year, Kathryn Flinn, an ecologist at Baldwin Wallace University in Ohio, argued in Scientific American that Dr. Simard and others had exaggerated the degree of cooperation among trees in forests. Most experts, Dr. Flinn wrote, believe that groups of organisms whose members sacrifice their own interests on behalf of the community rarely evolve, a result of the powerful force of natural selection among competing individuals.

Instead, she suspects, fungi most likely distribute carbon according to their own interests, not those of trees. “That, to me, seems like the simplest explanation,” she said in an interview.

Even some who once promoted the idea of shared fungal networks are rethinking the hypothesis. Dr. Jones, one of Dr. Simard’s co-authors in 1997, says she regrets that she and her colleagues wrote in the paper that they had evidence for fungal connections between trees. In fact, Dr. Jones says, they did not examine whether fungi mediated the carbon flows.

For their recent literature review, Dr. Karst, Dr. Hoeksema and Dr. Jones rounded up all the studies they could find that made claims about either the structure or the function of such underground fungal networks. The researchers focused on field studies in forests, not lab or greenhouse experiments.

In an August presentation based on the review at the International Mycorrhiza Society conference in Beijing, Dr. Karst argued that much of the evidence used to support the wood-wide web hypothesis could have other explanations. For example, in many papers, scientists assumed that if they found a particular fungus on multiple tree roots or that resources moved between trees the trees must be directly linked. But few studies ruled out alternate possibilities, for instance that resources could travel part of the way through the soil.

Some experimenters, including Dr. Karst and her colleagues, have installed fine meshes and have sometimes added trenches or air gaps between seedlings to disrupt hypothesized fungal networks and then tested whether those changes altered growth. But those tactics also reduce how much soil a seedling can directly gather nutrients or water from, or they alter the mix of fungi growing inside the meshes, making it difficult to isolate the effect of a fungal network, Dr. Karst said.

The researchers also found a growing number of unsupported statements in the scientific literature about fungal networks connecting and helping trees. Frequently, papers such as Dr. Klein’s are cited by others as providing proof of networks in forests, Dr. Karst and colleagues found, with caveats that appeared in the original work left out of the newer studies.

“Scientists,” Dr. Karst concluded in her presentation, “have become vectors for unsubstantiated claims.” Several recent papers, she notes, have called for changes in how forests are managed, based on the wood-wide web concept.

Dr. Karst said, “it’s highly likely” that shared fungal networks do exist in forests. In a 2012 study, Dr. Simard’s team found identical fungal DNA on the roots of nearby Douglas fir trees. The researchers then sampled soil between the trees in thin slices and found the same repeating DNA segments known as “microsatellites” in each slice, confirming that the fungus bridged the gap between the roots. But that study did not examine what resources, if any, were flowing through the network, and few other scientists have mapped fungal networks with such rigor.

Even if intertree fungal networks exist, however, Dr. Karst and her colleagues say common claims about those networks don’t hold up. For example, in many studies, the putative networks appeared to either hinder tree growth or to have no effect. No one has demonstrated that fungi distribute meaningful amounts of resources among trees in ways that increase the fitness of the receiving trees, Dr. Hoeksema said. Yet nearly all discussions of the wood-wide web, scientific or popular, have described it as benefiting trees.

Others, however, remain convinced that time will vindicate the wood-wide web.

While how ubiquitous shared fungal networks are and how important they are to tree growth remain open questions, Dr. Averill of ETH Zurich said the title of Dr. Karst’s presentation — “The decay of the wood-wide web?” — incorrectly suggests that the very concept is faulty. Instead, he hopes scientists will build on the tantalizing clues gathered so far by looking for networks in more forests. Indeed, members of Dr. Karst’s team have generated what Dr. Averill considers some of the most compelling evidence for the wood-wide web.

“It’s very clear that in some forests in some places, different trees are absolutely connected by fungi,” he said.

Dr. Klein of the Weizmann Institute said his team has placed its speculation about a network on firmer ground by using DNA sequences to map fungi in a 2020 follow-up study of the same Swiss forest and a 2022 lab study using forest soil. (Dr. Karst and her colleagues said that in their view, even those studies did not truly map fungal networks in a forest.)

And while Dr. Klein agrees that scientists still need to improve their understanding of why trees and fungi are moving all that carbon around, he is more optimistic than the Karst team that some of the bolder claims will be borne out.

“If you ask me if in the future, we will be showing that trees actually can communicate, I would not be surprised,” he said.

Dr. Simard, the University of British Columbia scientist who has studied the wood-wide web, says that mapping fungal networks in forests is challenging, but other methods convinced her they are common.

Dr. Simard agreed that few real-world fungal networks have been mapped using DNA microsatellites because of the difficulty in doing such studies. Kevin Beiler, the graduate student who led the field work for the 2012 study with Dr. Simard, “spent five years of his life mapping out these networks,” Dr. Simard said. “It’s very time consuming.”

In spite of those challenges, she said, studies published on other forests using other methods have convinced her that shared fungal networks are common.

“The field of mycorrhizal networks has been sort of plagued by having to keep going back and redoing these experiments,” Dr. Simard said. “At some point you have to move to the next step.”

Comprehensive field studies of the type Dr. Hoeksema seeks would be a heavy lift for most university scientists working on typical grant timelines, Dr. Simard said. “None of these studies can do everything all at once, especially when you’re working with graduate students,” she said. “You have to piece it together.”

And while Dr. Simard has for years called for forest managers to consider her findings, she said she was not aware of any forest being managed solely on behalf of fungal networks. Neither was Mr. Wohlleben.

The new critique is the latest flare-up in a decades-old debate about the role of fungi in forest ecosystems, said Merlin Sheldrake, an independent mycologist whose book “Entangled Life” was referenced in the “Ted Lasso” episode that alarmed Dr. Hoeksema. Scientists have long struggled to interpret intriguing but fragmentary shreds of evidence from the invisible underground realm.

Since Dr. Karst gave her talk, she, Dr. Hoeksema and Dr. Jones have submitted a paper to a peer-reviewed journal. And lest you worry that a less webby woods could feel a tad drab, the researchers maintain that there’s plenty of intrigue even if it turns out that trees aren’t whispering secrets to each other via subterranean fungal channels.

“The true story is very interesting without this narrative put on it,” Dr. Karst said. The forest “is still a very mysterious and wonderful place.”

Highly processed foods are linked to early death, a new study finds

Highly processed foods are linked to early death, a new study finds

Around 57,000 premature deaths in Brazil in 2019 were associated with consumption of ultra-processed food, according to new research.

By Aria Bendix NBC News

A growing body of evidence suggests that consuming too much highly processed food — items like hot dogs, chips, soda and ice cream — can have consequences beyond obesity and high cholesterol.

A study published Monday in the American Journal of Preventive Medicine estimated that in 2019, the deaths of around 57,000 Brazilian people between the ages of 30 and 69 were attributable to the consumption of ultra-processed food. That amounts to more than 10% of annual premature deaths in Brazil among that age group.

The authors say their study is the first to estimate the impact of ultra-processed food on the risk of early death.

The study used calculations from a previous analysis, which compared the relative mortality risk of people who consumed large amounts of processed food to those who ate relatively little of it. The authors applied that model to Brazil's population and level of ultra-processed food consumption. From there, they estimated the number of premature deaths that might have been prevented if people between the ages of 30 and 69 had eaten less of that type of food. The researchers focused on this age group because the World Health Organization considers death from noncommunicable disease to be premature at those ages.

Eduardo Nilson, a nutrition researcher at the University of São Paulo and the study’s lead author, said he believes "it is very likely that heart disease is among the main factors" contributing to these premature deaths. Diabetes, cancer, obesity and chronic kidney disease may play a role as well, he said.

Foods that are "ultra-processed" contain more artificial ingredients than those that just have added salt, sugar or oil. They usually have very few whole ingredients and contain flavorings, colorings or other additives. Instant noodles, frozen pizza and store-bought cookies typically fall within this category.

In Brazil, Nilson said, the ultra-processed foods that contribute the most to daily calorie intake are mass-produced breads, cakes and pies; margarine; salted crackers; cookies; meat products like ham, hot dogs and hamburgers; pizza; and sugar-sweetened beverages.

Nilson and his collaborators estimated that if all adults in Brazil ensured that ultra-processed food made up less than 23% of their daily calories, the country might see around 20,000 fewer premature deaths per year. Most Brazilians are already below that threshold, but a quarter of the country's adult population gets up to 50% of its daily calories from ultra-processed food, Nilson said.

In the U.S., ultra-processed food makes up around 57% of daily calories, on average. Based on that, Nilson believes the U.S. could expect even more premature deaths associated with this type of food.

Many previous studies have linked ultra-processed food to other negative health outcomes, including a higher risk for diabetes, cognitive decline, heart disease and cancer. An August study found that people in Italy who consumed ultra-processed food in large quantities had a higher overall risk of death.

Maura Walker, an assistant professor of nutrition at Boston University who wasn't involved in the new research, cautioned that this study did not show that ultra-processed food consumption directly caused premature death — only that there was an association. But the connection makes sense, she said.

"It’s likely that these ultra-processed foods are just one factor that’s leading to things like hypertension, poor blood lipids, higher waist circumferences, and that’s actually how they’re linked to mortality," Walker said.

She added that ideally, people could swap out ultra-processed foods for more fresh fruits and vegetables, but that's not always possible in food deserts where people rely on one supermarket or dollar store for groceries.

Ultra-processed foods can often be identified by their long list of ingredients, many of which you wouldn’t normally find in your own kitchen.

But not everything in this category is harmful, according to Dr. Walter Willett, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. For example, whole grain bread and whole grain breakfast cereals are sometimes considered ultra-processed, but they are also sources of dietary fiber, which can lower the risk of heart disease or cancer.

Willett also said that there may be little benefit to replacing ultra-processed foods with certain items, such as more red meat or foods cooked in a lot of butter. Consuming too much red meat in particular may increase a person's risks of diabetes, heart disease and certain cancers.

For that reason, Willett said, it's important to focus on avoiding particular foods that are significantly associated with a risk of premature death. Soda, for instance, is linked to around 184,000 adult deaths per year worldwide.

"In general, there's no question that Brazilians and Americans and a lot of other people are eating way too much junk food," Willett said. "Collectively, they add up to a big chunk of preventable mortality."

couple jailed for murdering teenage son

Sebastian Kalinowski: couple jailed for murdering teenage son

Agnieszka Kalinowska and Andrzej Latoszewski sentenced to 39 years for torturing boy to death

 Robyn Vinter London Guardian

Sebastian Kalinowski, who died in August 2021. Staff at his school described him as a ‘lovely boy’. Photograph: West Yorkshire police/PA

A woman and her partner have each been sentenced to 39 years in prison for the “horrific” murder of 15-year-old Sebastian Kalinowski.

Agnieszka Kalinowska, 36, and Andrzej Latoszewski, 38, were convicted at Leeds crown court in July of murdering Kalinowska’s son at their home in Huddersfield in a prolonged campaign of physical abuse amounting to torture.

Sebastian died after contracting sepsis, brought on by the injuries from hundreds of punches, kicks, whippings and stabbings over months.

Though they were not a whole-life term, the judge, Mrs Justice Lambert, said the sentence “may be the equivalent” as the pair would be in their late 70s when eligible for release.

Lambert also issued each of them a nine-year child cruelty sentence to run concurrently with their murder sentences.

Sentencing Latoszewski, she said: “There are times when it seemed to me that you had lost awareness that you were actually hitting a human being and not your punchbag.”

Video footage captured by cameras Latoszewski had installed in their home in order to control Sebastian showed prolonged beatings, with the teenager crying and screaming. Sebastian was also stabbed with a needle multiple times by Latoszewski and Kalinowska.

The boy was forced to do exercises such as push-ups and to sit facing the wall for hours.

The footage also captured Latoszewski, who used steroids, parading around the house and looking at himself in the mirror between assaults, while Kalinowska sat watching TV.

Other evidence shown to the court included text messages where Kalinowska asked Latoszewski to come back and “beat the shit” out of Sebastian. The pair also discussed how to torture him without leaving marks on his body.

He died of sepsis on 13 August 2021, caused by 23 rib fractures, after Kalinowska and Latoszewski waited two-and-a-half hours to call an ambulance after finding the boy unconscious.

The pathologist found 81 injuries on Sebastian’s body. Dr Michael Parsons said some of his injuries would normally be seen only in car crash victims.

The evidence in the trial was so distressing that jurors were discharged from jury service for life by the judge, who said their service had been “beyond the call of duty”.

After the sentencing, the lead investigator on the case, DCI Tony Nicholson of West Yorkshire police, described it as “without doubt the most harrowing case I have experienced in my 29 years as a police officer”.

He added: “Latoszewski and Kalinowska abused this boy in a manner which was wicked and evil, and we may never know why they chose to act in this inhuman way.”

Staff at Sebastian’s school described the teenager, who came to the UK in 2020 from Poland, as a “lovely boy” who was “shy”, “quiet” and “always pleasant.”