The narrative delves deeply into Junger’s medical condition, explaining that he had an undiagnosed condition called median arcuate ligament syndrome (MALS). This rare anatomical variation, occurring in roughly two out of 100,000 people, caused his celiac artery to be compressed by a thick bit of gristle called the median arcuate ligament. This compression forced blood through smaller arteries that had dilated over time to compensate, creating a workaround that allowed Junger to remain unaware of the problem his entire life; Junger compares his body’s adaptation to traffic rerouting around a blocked freeway. One of these arteries developed an aneurysm that ruptured, causing Junger’s life-threatening internal bleeding. Junger notes that small aneurysms in this area are just as deadly as large ones, with about half of known cases diagnosed only after rupture, and a quarter of those patients dying during treatment.

The text offers a meticulously detailed description of the catheterization procedure performed by Dr. Dombrowski. It explains how the doctor initially attempted to access the ruptured artery through Junger’s groin, navigating upstream against blood flow. When this approach failed due to the complex twists in Junger’s vascular system, Dr. Dombrowski tried entering through Junger’s left wrist. The narrative emphasizes the innovative and persistent approach required, describing how the doctor used various catheters, including a cobra-headed guide catheter and a shepherd’s crook, to navigate the “tortuous” arteries.