Heart installation requires special tools, some knowledge
8:32 a.m. Chuck Reynolds's blood no longer contains the potassium that prevented both hearts from beating. His body temperature has bottomed out at 31.1 ° C; his blood is now being warmed in the bypass machine. Just 188 minutes after the first cut, recovery has begun. Only nine people are in the OR, making it seem empty -- 12 or more people were present earlier in the operation.

8:40 a.m. Orange wires are emplaced on the new heart and connected to an external pacemaker. The device will ensure that the new heart beats quickly enough; it will be removed in a week or so if all goes well.

8:45 a.m. After an erratic start, the new heart starts beating inside a new body. Although it's not yet pumping blood, the beats get stronger and more organized with each passing minute.

9:15 a.m. The clamps are off, and the new heart is beating regularly, supplying blood to a body that has wanted a good blood supply for years. Despite just 90 minutes' sleep the night before, Starkey drops back in to check on his patient.

9:27 a.m. Reynolds starts sweating; his temperature passes 34 ° C. With the tension in the room receding, Sanju Balaram, the cardiac surgery fellow who helped Cochran, allows that "cutting a heart out and replacing it is not that hard." The hard part, she says, is deciding when a patient is sick enough to transplant -- and controlling the immune system afterwards. Indeed, downgrading the immune attack on the new heart (which is, after all, a foreign body) is critical. The goal is to dampen the immune response without shutting it down entirely, which would expose the patient to opportunistic infections like those that afflict AIDS patients. Most heart transplant patients take dozens of pills a day after the surgery. Later, Starkey, in an interview, notes that anti-rejection meds are adjusted after the operation to find a fine line of reduced but effective immune function.

9:50 a.m. The new heart "looks good," says Cochran, stretching his back after more than four hours of surgery. Mary Jensen, an OR nurse, wonders that surgeons can stay focused and on their feet for 10 to 12 hours at a time when it's needed. "I don't know how they do it," she says. The next hour is devoted to mop-op operations. Counting sponges. Removing tubes. Cauterizing bleeds. Installing tubes to allow the exit of blood and fluids, which will be removed in a week or so.

10:43 a.m. The spreader clamp is removed and heavy stainless-steel wires are passed between the ribs to rejoin Reynolds's sternum.

Forget nylon thread -- to sew the breastbone together, surgeons use heavy stainless steel wire. Wrinkles on skin are from the protective plastic coating placed before surgery.

The wire-twisting is akin to the way a farmer's builds fences, but it does pull the chest together and seize it tight.

11:15 a.m. The wires are twisted, and stitching of the skin begins. The operation has closed, in several senses, a gaping wound.

Chuck is still completely anaesthetized, but he has a new heart, and it's pumping blood.