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Numéros d'urgence

• Standard et urgences

L’équipe médicale

Chirurgie maxillo-faciale, plastique et brûlés - l'équipe médicale, l'équipe chirurgicale.

Pr LAURE Boris – Professeur des Universités – Praticien Hospitalier

• Référent activité Chirurgie plastique et esthétique du visage, Chirurgie de l’orbite et des paupières, Chirurgie de la paralysie faciale et Chirurgie craniofaciale. 
• Centre de compétence craniosténose et malformations craniofaciales rares.
• Mme Picault – 02 34 37 89 54 . 

Dr BONIN-GOGA Béatrice – Praticien hospitalier

• Référent activité Chirurgie maxillo faciale pédiatrique et Chirurgie des fentes labio-palatines.
• Centre de compétence fente faciale.
• Mme Prouteau – 02.47.47.38.21 .

Dr PARE Arnaud – Chef de Clinique Assistant.

• Secrétariat ( prise de Rdv ) : 02.47.47.46.11 .

Dr QUEIROS Chrystel  – Assistant Hospitalier.

• Mme Auzemery – 02.47.47.46.40 .

Dr LAROCHE Julie  – Assistant Hospitalier .

• Secrétariat ( prise de Rdv ) : 02.47.47.46.11

L'équipe de soins

• Mme GATAY Jeannine ,  Cadre Supérieur de Santé du Pôle Reconstruction
• M. CHICARD Christophe , Cadre de Santé encadre l’équipe de soins pour garantir la qualité de votre prise en charge et solutionner tout problème relatif à la gestion de votre hospitalisation. Il est joignable au 02 47 47 81 26.

L’équipe paramédicale ( IDE/AS/ASH ) prodiguent les soins spécifiques au regard des différentes pathologies rencontrées.

Les Secrétaires médicales,  Mme AUZEMERY  et  Mme PICAULT , vous indiqueront les démarches à suivre pour la prise en charge administrative. Vous pouvez les joindre au 02.47.47.46.40 ou au 02.34.37.89.54 du lundi au vendredi de 09h à 12h30 et 14h à 17h.

Une Kinésithérapeute est rattachée au service. Si votre état le nécessite, elle vous accompagnera pour débuter votre rééducation.

Une Diététicienne est rattachée au service. Elle assure une consultation post- opératoire systématique après certaines chirurgies. Sur simple demande auprès des infirmières, vous pourrez aussi la rencontrer.

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Personnel hébergé

M. Boris Laure

Coordonnées.

Avenue de la République 37170 CHAMBRAY LES TOURS

Discipline(s)

un sourire en face

Découvrez nos interventions

Une équipe engagée pour leur redonner le sourire

« Offrons leur un Sourire »

Notre mission

Prise en charge d’enfants atteints de malformations craniofaciales rares : Syndrome de Crouzon, Pfeiffer, d’Apert, Hypertélorisme et fentes craniofaciales rares.

Malformations

Prises en charges, syndrome de crouzon/pfeiffer.

Pour ces syndromes, il est question d’une fermeture prématurée d’une ou plusieurs sutures crâniennes, associée à d’autres malformations. 

Le syndrome de Pfeiffer est une pathologie rare à transmission autosomique dominante  causée par des mutations génétiques des récepteurs du facteur de croissance des fibroblastes FGFR-2. Il associe une craniosténose, une syndactylie (soudure) partielle des mains et des pieds. Ce syndrome présente également des pouces et gros orteils larges et déviés. 

Le syndrome de Crouzon   une malformation craniofaciale congénitale de type faciocraniosténos caractérisée par une fermeture prématurée des sutures coronale, sagittale et lambdoïde, entraînant une croissance anormale du crâne, une hypoplasie maxillaire et une asymétrie faciale. 

La gravité de ce syndrome varie selon les cas. Il est souvent accompagné d’une exophtalmie, une pression intracrânienne élevée et des apnées du sommeil sévères.

Hypertélorisme et fentes craniofaciales rares

L’ hypertélorisme correspond à une distance accrue entre les orbites. Le système de classification de Tessier reste le plus utilisé aujourd’hui pour les fentes craniofaciales rares. 

Il indique la position du processus de fente dans un schéma basé sur l’orbite, et facilite la communication entre les chirurgiens concernant ces conditions complexes. L a prévalence des fentes craniofaciales rares est imprécise en raison de la rareté de la littérature scientifique ainsi que de leurs étiologies.

Syndrome d’Apert

Le syndrome d’Apert est une maladie génétique rare causée par des mutations du gène FGFR2 et caractérisée par une craniosynostose, une dysmorphie craniofaciale et une syndactylie symétrique des mains et des pieds.

Autres craniosténoses complexes

Le service de chirurgie Maxillo-faciale Plastique et Brûlés du CHU de Tours est labellisé centre de compétence pour la chirurgie des malformations cranio faciales rares. L’équipe du Professeur Boris LAURE est en capacité d’opérer tous les types de craniosténoses les plus complexes

Nos spécificités

Une organisation solide.

Nous sommes la seule association en France spécialisée dans ce domaine d’expertise médicale qui est capable de proposer une telle prise en charge de nos patients:

Nous faisons appel à des bénévoles dévouées permettant d’accompagner l’enfant dans ces déplacements : aéroport, hôpital, consultations.

En savoir plus

L’enfant séjourne dans une famille d’accueil. L’association assure toutes les dépenses liées à l’hébergement et ses besoins.

Prise en charges médicales

Nous travaillons avec le Pr Boris LAURE  du CHRU de Tours et son équipe.

Parce qu’il ne tient qu’à vous de leur redonner le sourire

Afin d’offrir un sourire à nos patients, nous avons besoin d’être bien entouré

ÉQUIPE MÉDICALE

La prise en charge de nos patients nécessite un plateau technique lourd, avec une équipe pluridisciplinaire craniofaciale spécifiquement formée à ces malformations.

Nous travaillons avec le Pr Boris LAURE du CHRU de Tours et son équipe.

FAMILLE D’ACCUEIL

Nos familles d’accueil s’engagent à nos côtés en hébergeant nos patients tout le long de la prise en charge et de la convalescence.

La participation des bénévoles est indispensable pour le fonctionnement quotidien de notre association.

Ce n’est que par la générosité de nos donateurs que nous pouvons offrir un sourire à ces enfants atteints de malformations craniofaciales rares.

NOS DERNières interventions

Nos partenaires

Effect of Beta-blockers on Extracranial Arteriovenous Malformations

• Sarah Chastanet Maxillofacial and Facial Plastic Surgery Department, University of Tours, Trousseau Hospital, CHRU Tours, FR-37000 Tours, France
• Annabel Maruani
• Boris Laure
• Denis Herbreteau

Abstract is missing (Short communication)

How to Cite

• Endnote/Zotero/Mendeley (RIS)
• Wounds, vascular disorders and connective tissues
• Inherited diseases and malformations

Copyright (c) 2022 Sarah Chastanet, Annabel Maruani, Boris Laure, Denis Herbreteau, Aline Joly

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License .

All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.

Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.

About ActaDV

Acta Dermato-Venereologica publishes high-quality manuscripts in the field of Dermatology and Venereology, dealing with new observations on basic dermatological and venereological research, as well as clinical investigations. Each volume features a number of Original articles in special areas, as well as Short communications to stimulate debate and to disseminate important clinical observations. Acta Dermato-Venereologica has rapid publication times and offers personal publication services. Learn more >>

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• v.102; 2022

Effect of Beta-blockers on Extracranial Arteriovenous Malformations

Sarah chastanet.

1 Maxillofacial and Facial Plastic Surgery Department, University of Tours, Trousseau Hospital, CHRU Tours, FR-37000 Tours

Annabel MARUANI

2 Department of Dermatology

Boris LAURE

Denis herbreteau.

3 Radiology and Medical Imaging Department, Center of Reference of Vascular Malformations MAGEC-Tours, Bretonneau Hospital, University of Tours, CHRU Tours, Tours, France

Extracranial arteriovenous malformations (AVMs) are rare congenital high-flow anomalies caused by abnormal vascular development during embryogenesis. Post-zygotic mutations have been evidenced in several recent cases ( 1 , 2 ). AVMs most commonly affect the head and neck (47.4%) and the extremities (28.5%). Although present at birth, they are commonly not apparent or asymptomatic until later in life. They may grow because of hormonal changes (puberty, pregnancy), and their natural history can follow 4 stages according to the Schobinger classification: (I) quiescent stage, (II) lesion becomes warmer and larger with a thrill, (III) destruction process, such as ulcers, haemorrhages or bony lytic lesions, (IV) heart failure complication that might be life-threatening, due to intense flow ( 3 , 4 ). The diagnosis of AVMs is suggested by physical examination and requires, for confirmation, vascular imaging studies, including Doppler ultrasonography, magnetic resonance angiography or arteriography ( 1 , 4 ).

Current therapeutics for AVMs are limited, and multidisciplinary management remains challenging. When possible, the best curative treatment combines embolization and complete surgical resection. In case of embolization only or partial resection, the rate of growth flares is high ( 3 ). Other treatments, such as radiotherapy, thalidomide or mammalian target of rapamycin inhibitors have been tested, without significant positive outcomes ( 3 – 7 ).

Propranolol is a non-selective beta-adrenergic blocker indicated for several conditions, including complicated infantile haemangiomas ( 8 , 9 ). However, it is not efficient in decreasing other vascular tumours. Properties of propranolol (vasoconstrictor, antiangiogenic and pro-apoptotic effects, along with its inotropic properties leading to a decrease in arterial pressure) could be interesting in AVMs. Only a few data are available in the literature ( 10 , 11 ). The aim of the current study was to investigate the efficacy and tolerance of systemic beta-blockers in extracranial AVMs.

A retrospective monocentric study was conducted at the University Hospital of Tours, France, which is a reference centre for vascular malformations. Inclusion criteria were extracranial AVM confirmed by magnetic resonance imaging (MRI) and treatment with a systemic beta-blocker between January 2012 and May 2020, as well as consent for data collection. Exclusion criteria were: intracerebral AVMs and patients who received beta-blockers for an indication other than the AVM. All data were extracted from patients’ medical records (demographic data, data on the AVM and beta-blockers, imaging). Patients were followed-up at consultation or contacted by telephone to collect self-reported outcomes. The primary endpoint was the patient’s overall perception of treatment efficacy on a numerical scale from –100 to +100 (–100 being a harmful treatment and +100 being a high efficacy of the treatment). A score >0 was considered a positive effect. The secondary endpoints were: ( i ) changes in pain and changes in volume, self-assessed by the patient from –100 to +100; and ( ii ) changes in radiological volume of the AVM when radiological imaging was performed before and after initiating beta-blockers, with a centralized interpretation (DH). The images were compared in terms of in pre- and per-treatment volume. The final endpoint was tolerance data. Statistical analyses were descriptive (% for qualitative data, means and standard deviation (SD) for quantitative outcomes).

A total of 12 patients were eligible and 7 were included (5 men; 1 patient was not followed in our centre, 2 received beta-blockers for another condition than AVM, and 2 refused to participate). The median age was 55 years (range 20–67 years) and the median age of discovery of AVM was 17 years (range 0–56 years). Characteristics of patients and AVMs are shown in Table I . In 4 cases, beta-blockers were the first-line treatment for the AVM. Beta-blockers (propranolol in 5 cases and atenolol in 2 cases) were started because AVM progressed slowly, which did not justify a more invasive treatment, or because other treatments were too risky ( Table I ). The initial dosage regimen ranged from 7 to 80 mg per day for propranolol and 25 to 50 mg for atenolol, with a median duration of 25 months (range 14–36 months); treatment was still ongoing in 4 patients.

Characteristics of patients, arteriovenous malformations (AVMs) and beta-blocker treatment

Regarding overall improvement, treatment with beta-blockers was significantly effective, with a mean ± SD overall improvement in self-assessed efficacy of 39.0/100 ± 34.0. The treatment was considered successful in 5 of 7 cases. Mean ± SD self-assessed effects on pain and reduction in volume of the AVM were 6.4/100 ± 10.2 and 21.4/100 ± SD 26.5, respectively. Two patients reported a benefit in self-perception of pulsation of the AVM, which was described as an annoying symptom. Pre- and per-treatment imaging was available for 4 patients and showed, in all cases, no difference in volume after beta-blockers.

Five of 7 patients experienced side-effects: brady-cardia, Raynaud’s syndrome, tiredness, reduced libido, sadness and chilliness ( Table I ). One patient discontinued beta-blockers because of a cough related to treatment.

This study of 7 patients with extracranial AVMs shows that beta-blockers (propranolol and atenolol) were associated with no reduction in volume of the AVM over a median of 14 months, but also with no progression. However, patients perceived an overall improvement, in AVM size and in symptoms. These positive symptomatic effects are probably due to the non-selective constriction of the vascular structures by beta-blockers and consequently decrease the flow within the nidus, thus reducing the symptoms (redness, pain, pulsatility, volume), more than to specific effects on apoptosis of endothelial cells, as observed in infantile haemangiomas ( 9 , 12 ). However, side-effects, although not severe, are frequent (5 of 7 patients in the current study) and might limit treatment observance.

To our knowledge, this is the first study to report effects of beta-blockers on extracranial AVMs. Two case reports have been published. One reported a 19-year-old woman with AVM on her right lower limb that partially decreased after 5 months of propranolol, then recurred after discontinuation of treatment ( 10 ). The other was a 23-year-old woman with a lower lip AVM, which recurred after surgical excision. Propranolol allowed for stopping the progression of the AVM ( 11 ).

The main limitations of this study is the small number of patients, but the condition is very rare, the absence of control group and the bias inherent to retrospective studies.

In conclusion, this study supports that beta-blockers are not effective in reducing the volume of extracranial AVMs, but may be of interest in stabilizing the lesions and decreasing symptoms. The best curative option for AVMs is large surgical excision after embolization, but this can rarely be performed. All other options are not efficient, are only slightly efficient, or have a high rate of recurrence ( 3 – 7 ). Therefore, beta-blockers could be integrated in the therapeutic strategy for management of AVM because they have an acceptable safety profile. Perspective studies will focus on therapies targeted to molecular results for AVMs, but data on the effectiveness and safety of these drugs are not yet available ( 13 ).

Surgical Management of Hypertelorism: The 3D Animated Technical Note

Affiliations.

• 1 Department of Maxillofacial and Plastic Surgery, Burn Unit, Trousseau Hospital, Tours, France.
• 2 School of Medicine, University of François Rabelais, Tours, France.
• 3 Department of Pediatric Neurosurgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France.
• 4 Department of Pediatric Maxillofacial Surgery and Craniofacial Surgery, Clocheville Hospital, Reference Center for Rare Craniofacial Malformations, Tours University Hospital, Tours, France.
• PMID: 36217221
• DOI: 10.1097/SCS.0000000000009014

The hypertelorism surgery is a complex procedure requiring a long learning curve. Even though the box osteotomy technique is well described in literature, its representation is generally based on texts and illustrations that do not really give a 3-dimensional or a dynamic point of views. The authors present a 3-dimensional animated video, Supplemental Digital Content 1, http://links.lww.com/SCS/E561 showing the craniofacial osteotomies and focusing on the critical points to correct hypertelorism.

Copyright © 2022 by Mutaz B. Habal, MD.

• Hypertelorism* / surgery
• Osteotomy / methods

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Opinion The Ezra Klein show

Salman Rushdie Is Not Who You Think He Is

Credit... Andres Kudacki/Associated Press

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Produced by ‘The Ezra Klein Show’

• April 26, 2024

Salman Rushdie

[You can listen to this episode of “The Ezra Klein Show” on the NYT Audio App , Apple , Spotify , Amazon Music , Google or wherever you get your podcasts .]

I feel as if I’ve always known who Salman Rushdie is. He sat in my consciousness as the author of this eerie-sounding novel called “ The Satanic Verses, ” a novel so somehow dangerous, he had to go into hiding after Ayatollah Ruhollah Khomeini, the supreme leader of Iran, said Rushdie and anyone involved in its publication should be killed for blaspheming Islam.

In August of 2022, more than 30 years after the fatwa, a fanatic with a knife attacked and tried to kill Rushdie. He survived, though he lost an eye. His latest book, “ Knife: Meditations After an Attempted Murder ,” is about the attack and its aftermath. But it’s also about his life. It’s about his marriage. It’s about his children. And it’s about the invention of other versions of him that became more real in the world than he was, other versions of him that almost got him killed.

This is what I now understand after reading “Knife,” what I now understand after I went and read, for the first time, “The Satanic Verses”: I have never known who Salman Rushdie is. And maybe not just him. How many people out there do I wrongly think that I know?

Rushdie and I talked for an episode of my podcast. This is an edited transcript of our conversation.

Ezra Klein: I want to begin with a story you mention a little bit offhandedly in the book: “The Shadow” by Hans Christian Andersen.

Salman Rushdie: I think it’s my favorite story of his. It’s about a man whose shadow gets detached from him and goes away.

For many years, he loses his shadow. The shadow has traveled the world. The shadow is quite sophisticated and cool and in some ways is more interesting than the man. The shadow returns and the man and the shadow spend some time together. Then the man meets this princess, who he’s very taken by and interested in. And the princess decides that she prefers the shadow to the man, and actually the shadow manages to persuade her that he’s the real thing and the man is the echo or the phony or the shadow.

And in the end, the shadow manages to arrange for the man to be executed. So the shadow takes over the life of the man.

So what did that story mean to you?

It meant to me that a thing that happens — more and more often, I think — is that a shadow self can separate itself from the person and end up becoming, in some way, more real than the original person. People believe the shadow and don’t believe the self.

If I’d asked you in 1986, to describe how you understood yourself, what would your capsule sense of Salman Rushdie have been?

The ’80s were a very good decade for me. It began in 1981 with the publication and success of “Midnight’s Children,” which was important to me for a number of reasons.

First of all, because it was my first literary success, and there’s nothing quite like first success. And secondly, it financially allowed me to begin to live as a writer, rather than having to work in advertising, which I’d been doing.

It also deeply reconnected me to India. I had worried, living in London, that I was kind of drifting away from those roots. The novel was a very conscious attempt to try and reclaim them. And that was actually what made me happiest about the reception of the book — was the way in which it was received in India.

What was your public reputation at the time?

I had become identified as one of a rising group of British-based writers. Writers like Ian McEwan and Kazuo Ishiguro and Martin Amis and Angela Carter and Jeanette Winterson. I also had become perhaps a little bit more politically engaged than some of the others. So I had written and done things on television about racism in England and postcolonialism, the remnants of the empire, and so I was also associated with that kind of subject. Then came “The Satanic Verses,” and it changed everything.

When you began writing “The Satanic Verses,” what kind of book did you think you were writing?

I was writing these three stories. One was about a character named Gibreel, which is the Indian version of Gabriel, who was a movie actor who’s losing his mind and arrives rather dramatically, as a result of an airplane explosion, in 1980s London, at a time when the race relations situation was quite tense. This was the period of Margaret Thatcher’s government.

I guess what I thought I was doing was thinking about what happens to people when they migrate from one culture to another and how much of their identity is brought into question by doing that. They’re suddenly in a language that isn’t their first language, and they’re in a community that doesn’t know them. They very often are surrounded by belief systems different from their own. They face all these challenges.

And I remember thinking I should try and make the novel itself that kind of challenge. And so the question of religious belief becomes one of the subjects of the book — Gibreel having these dreams about the birth of a religion. And I thought I’d made sufficient distance, because in the novel and in his dreams, the religion is not called Islam and the prophet is not called Muhammad and the city is not called Mecca. All this is happening in the dreams of somebody who’s losing his mind.

I thought, you know, this is what we call fiction. Some people took it the wrong way.

What is the actual story you tell in the book that causes the offense?

Well, of course, the people who attacked the book had not read it. So there’s that.

There is a well-known story that is in many of the traditions of Islam. To put it simply, there were three very successful popular winged goddesses in Mecca at the time whose temples were at the gates of the city. This is a big trading city, so people would come and go through the gates, and they would make offerings at these temples — or, put it another way, they would pay taxes.

The families that ran these temples were very wealthy and powerful in the city. And so the theory is that the Prophet was offered a deal, and the story goes that he comes down from the mountain and recites some verses which accept the status of these goddesses at the level of the angels. And then it seems as if there was a lot of opposition to his statement from amongst the new faithful.

And after a short period of time, he rejects those verses, and he says that the devil spoke to him in the guise of the angel and that these were satanic verses which should be expunged from the Quran, which they were, and replaced by other verses in which he discounts these goddesses.

So that’s the episode about a possible temptation and then the rejection of the temptation. I came across this story when I was at university, when I was at Cambridge. One of the things I was studying was early Islamic history. And I remember thinking, you know, good story. That was 1968. Twenty years later, I find out how good a story it was.

To the best of your understanding now, why does the fatwa happen?

Well, there’s a political reason why it happens, which is that chronologically the moment in Iran at which it happened was very soon after the end of the Iran-Iraq war, in which essentially a whole generation of young Iranian people had died for no gain.

The revolution was probably more unpopular and in greater danger at that moment than at any other moment. And I think, frankly, Khomeini was looking for a way of rallying the troops, and unfortunately, I became it.

People involved with the book in other countries were attacked and killed, which is something I did not know.

The worst thing was the Japanese translator of the book, who was a college professor who was actually a specialist in Islamic history and art, was murdered one night near his office on campus in Japan. My Italian translator was attacked at his residence and fortunately survived. My Norwegian publisher was shot several times in the back while getting up in the morning to go to work. He also miraculously survived.

I felt horrible, because they felt like proxy attacks. They really wanted me. They couldn’t get at me, so they got at them.

And I remember calling William Nygaard, who is my Norwegian publisher, to apologize to him. And he said, “Salman, don’t apologize. I’m a grown-up. I knew that I wanted to publish ‘The Satanic Verses,’ and I’m very happy that I did.” And then in a kind of wonderfully publishing way, he said, “Guess what. I’ve just ordered a very large reprint.”

I guess in publishing, that is the best revenge.

There’ve been occasions where I felt myself in the company of really brave people. I think if you’ve just been shot three times in the back and your reaction to that is to order a reprint, that’s courage.

I hadn’t read “The Satanic Verses” until preparing for this show with you. I think I’d always assumed it must be a pretty extreme and offensive piece of literature. And then I went and read it, and it’s not. It’s a very fun, stuffed, manic, exciting, imaginative novel, but it’s nothing like what I had assumed.

I can’t even tell you how many times that people who, like you, have finally got around to reading the book, have said to me, “Well, where’s the problem? Where’s the dirty bit?” And the other thing people say to me is, “Who knew it was funny?”

That was actually my first reaction. I didn’t expect the tone of the book at all. It’s very funny. Before “The Satanic Verses,” people thought my books were funny. People would write about me as a funny writer. After “The Satanic Verses,” for a long time, nobody wrote about me as a funny writer. It was as if, because the thing that had happened to me was not funny — that it was dark and obscurely theological — I must be dark and obscurely theological.

The characteristics of the attack were transposed onto the person being attacked. And that other me, who was funny and antic and interested in mythology and fantasy and politics and history — that person vanished.

In a way, the biggest damage that the attack on “The Satanic Verses” did to me was not physical danger. It was the damage to people’s thinking about my writing. A lot of people, I think, who might have enjoyed the book and might have enjoyed my books in general have been put off by the shadow of the Islamist attack.

But it was almost universally true that the people who attacked it did not read it. I remember seeing a television interview, when I was still living in England, with one of the leaders of the Indian Muslim protest against the book. The television reporters asked him if he’d read it, and he said this rather wonderful thing. He said, “No, I don’t need to walk in the gutter to know that it contains filth.”

So that was the kind of attitude: You don’t need to read it. It’s just bad.

We’ve talked a bit about who the public Salman was, before the book. And as I understood you describe it, you’re a postcolonial writer. To an extent, you’re a man of politics, a man roughly of the left, critical of Thatcher. Who emerges now?

Well, what happens is that entire self that had been how I was seen and how I thought of myself for a decade was just erased overnight. It’s as if it didn’t exist. And what was created instead was this irresponsible, selfish, arrogant, bad writer and bad person who had deliberately set out to offend the great world religion and only just about deserved to be protected from harm. Only just about.

It was very shocking. First of all, I had been quite a vocal critic of the Margaret Thatcher government, and that was the government that had to offer me protection. So on the one hand, there were accusations of hypocrisy. And then there was a very upsetting literary strain to the hostility. Writers I wouldn’t expect — John Berger, Germaine Greer, John le Carré. One of that group said nobody can insult a great world religion with impunity. As if to say: If you do that, then you don’t deserve to be safe.

I remember being very surprised to find Jimmy Carter on the side of the detractors. That was almost more shocking to me than the Islamic attack, because I thought, you know, the Iranian regime is a tyrannical, authoritarian regime, and if it behaves in a tyrannical, authoritarian way, it’s not entirely surprising. But to have Western artists and intellectuals doing that was very, very upsetting.

And in India, too. My family was originally Kashmiri. And I’ve written a lot about Kashmir. I wrote about it in “Midnight’s Children,” and I wrote about it in “Shalimar the Clown.” And I now know, because a kind of jihadist mind-set has increased in Kashmir, that if I were to go there, I might not be safe. And that feels horrible. The place from which my family comes is a place to which I can’t safely go. Both my parents are buried in Karachi, Pakistan, and there’s no way I can ever go and visit their grave.

Obviously you do not like the version of yourself that was created that was worthy of being murdered. What is your relationship to the more sainted public version of yourself — the symbol?

I feel like a working artist, and I would like to be known and judged by the work that I make.

Having said that, I was involved in the free speech issue before anything happened to me. I was working with the British branch of PEN, trying to defend various writers in trouble in various parts of the world. A lot of writers’ organizations really stood up for me. And I was very grateful for that.

So that became a part of how I saw myself. I have to say a secondary part because I still think the person who sits alone in a room and makes things up is who I really am.

How did your writing change under this pressure?

I tried to not let it change. I remember thinking very consciously quite early after the fatwa and all that — of course, there was physical danger, but there was also artistic danger. There were ways in which this attack could destroy me as an artist. It could frighten me, and so then I would not write anything risky.

I would write safe little frightened books, or it would fill me so much with anger and a desire for revenge that I would write revenge books. And I’ve told myself that both of those would be the destruction of my artistic independence and whatever quality I have as a writer, it would destroy. I think probably the — one of the greatest acts of will that I’ve ever performed in my life was to try and not let my writing be knocked off track by the attack on “The Satanic Verses.”

You moved to New York in 2000. And that becomes another shadow self that you talk about in [“Knife”], where you develop a reputation. I think you call it Salman the party animal.

A party boy, yeah. And I’m truly not.

Would you own it if you were?

I actually don’t really like big parties. I’m sociable, that’s true. But I like to see my friends one at a time so we can actually talk to each other.

When I started living in New York, I realized that it wasn’t so much a question of me being frightened, as people being frightened of me, because of the threat of danger hovering over them. Like a dark angel over my head. And I thought, “If people can see that I’m not being scared, then maybe they’ll stop being scared.” So I deliberately embarked on a policy of public visibility, going to places where I knew I’d be photographed and where, you know, The New York Post would write about me. And it worked, because after quite a short period of time, people thought, “Oh yeah, he’s around and about, and it’s fine.”

It kind of went too far that I turned into this social butterfly, which, in my view, I’m not really.

I’m going to try something a little tricky here. I don’t, in any way, want to trivialize the violence, the terror you’ve lived through.

I was struck with the thought that, for decades now, you have lived the most extreme possible version of a very modern condition, in which little scraps of yourself — scraps of things you’ve written or echoes of interpretations of things you’ve written — ricochet around an internet or a world and create this other version of you that people begin to believe in.

This happens in a very small and much less terrorizing way to people all the time on TikTok, on Facebook, on X. They say something, and soon a version of them emerges that is more real to other people than they are. Do you think this is a more common thing?

I agree entirely with how you describe the creation of false selves by this new weapon of social media. I’ve often thought that if these things had existed in 1989, I would have been in far more danger because the speed with which material can be transmitted is so much greater and the way in which groupthink can be created and mobs can be created would have enormously escalated the danger.

At that time, the most sophisticated method of transmission was the fax machine, and that kept the lid on it to some degree — until Khomeini blew the lid off.

I know that there are two or three graphics containing absolutely false quotes from me — things I’ve never even come close to saying — which keep cropping up. People keep retweeting them and repeating them. And even though I have once or twice said, “Look, I never said this,” that doesn’t stop it. It just keeps going. So there are quotes ascribed to me, you know, views ascribed to me, which I don’t hold, which are actually antithetical to things that I think. But they’re out there.

I think, to some degree, it’s always been the case, before social media, that there’s a disconnect between the private self of the writer and the way in which they’re publicly perceived. Various writers — Günter Grass, Jorge Luis Borges, Graham Greene — they all had this sense of there being a public self, which wasn’t quite them but which was how they were seen. And I had a kind of magnified version of that, and social media certainly helps to magnify it.

I know people who have gone through public scandal who didn’t deserve it, who hadn’t done the thing or there really was no thing.

One thing I’ve noticed is many of them go through a period — sometimes don’t even get out of the period — of believing they must somehow deserve it. They almost have to believe they did something deserving of it for their reality to make sense to them. Did that happen to you?

Yeah, right at the beginning, I began to believe two things. First of all, there was a kind of category mistake about “The Satanic Verses,” which was being treated as a work of polemical fact, whereas actually it’s a work of imagination and fiction. If I could just explain that this is not fact, this is fiction, people would say, “Oh, yeah, we get it now.” And that was kind of foolish. And then I thought if I can just explain in interviews and essays and so on who I am and what I thought I was doing and why I believe it to be completely legitimate, the people would again go, “Oh, gosh, we made a terrible mistake.”

About a year or a year and a half into the story, when I was very, very depressed and didn’t see how it would ever end, I thought maybe what I have to do is to reach out to the Muslim community and try and apologize. And I did, and it rebounded very hard in my face.

And actually, my sister, whom I love and is closer to me than anybody else in the world, called me when she heard me making these apologias. She said, “What the hell are you doing? Have you lost your mind?” And I thought, you know, “Yes, I have. I’m behaving in a deranged way.” And that felt to me like hitting rock bottom.

I hate that this is true about culture right now. I don’t know that I’ve ever seen it be the case that apologizing — whether the person did something or did not do something — helps. Because what apologizing seems to me to do now is it gives people the license to believe that it was all justified in the first place.

That’s why there’s a crazed power to people like Donald Trump, who exist in a world without, I think, personal shame. Because they don’t apologize, they’re able to keep the instability of the different realities coherent: I never lost the election. I never did anything wrong. I never did any of it.

So there never needs to be a moment where the people who are on their side have to reconcile the sort of admission of wrongdoing. Whereas the people who try to come out and be decent people about it suffer.

Shamelessness is the great public weapon of our time. If you really have it — and yes, of course, he does in spades — you can do what he’s done, which is to spend a lifetime getting away with it. I mean, not just since he’s been in politics, but way before then. I mean, getting away with it is his great skill.

And the tool that he uses is absolute lack of shame. And I mean, I would put, in a miniature way, ex-British prime minister Boris Johnson in the same bag. Absolute, I mean, total liar in everything he says and does and totally shameless about it and gets away with it. Until he didn’t.

We live in this age where you have an algorithmic global community. And communities discipline through shaming each other and eliciting shame in each other. That’s a supercharged dynamic in modern life. So if you happen to be immune to it, it’s a superpower.

This is maybe a function of being almost 77 years old, but I really go less and less toward social media. I barely use it, and every time I go there, I kind of wish I hadn’t. So I think maybe I’ll just, whatever years are left to me, manage to do it without being a part of the modern world.

Let’s go quite a bit forward in time. It’s 2022, before the Chautauqua event where the attack happens. At this point, who are you to yourself? And who do you think you are at that point to the public?

I genuinely thought that the risk was in the past. I had 22 years of evidence for that, so it wasn’t unreasonable to believe that. But at this point, I had more or less completely regained, let’s say, the life of a writer, where I was doing everything that writers get asked to do. I was doing book tours and literary festivals and lectures and readings and all of that. Especially after near sequestration, it was very pleasant to be back in the world.

Where are you on Aug. 12, and what happens?

I was in New York City. On Aug. 11, I had flown up to do an event at the Chautauqua Institution in western New York. My friend Henry Reese had been running an asylum program in Pittsburgh. He had a whole little street of houses which he made available to writers from various countries who needed a safe place. Chautauqua had invited Henry to come and talk about that, and he asked me if I would come and have the conversation with him.

We had just come out onstage. The Chautauqua Amphitheater is a very large space. And there were probably something like 1,500 people there. Henry and I came out and were introduced by someone from the institution. We were sitting in chairs on the stage. Almost the moment the introduction was over, I saw this man approaching rapidly from my right. He came sprinting up the steps and attacked me.

You write , “This is as close to understanding my inaction as I’ve been able to get: The targets of violence experience a crisis in their understanding of the real.” What do you mean?

I mean that we all live in a picture of the real. We all have a sense of how things are, and that sense of how things are is our reality. And then when something calamitous happens, somebody arrives in a picture of school with an assault rifle.

Somebody arrives in a church with a gun or in a shopping mall, you know. Everybody in those locations has a picture of what they’re doing. If you’re in a church, you’re there for reasons of belief and worship. If you’re in a shopping mall, you’re there to shop. If you’re in a school, you’re there to be at school.

And that’s how you see the world. And the explosion of violence into that picture destroys that reality. And then you literally don’t know the shape of the world. And very often, I think, people are paralyzed and don’t know what to do. How do you act in a moment when the thing that’s happened isn’t a part of the narrative you think you’re in?

And that’s what happened to me. I thought I was frozen.

The attack was a knife attack. And you write that “a gunshot is action at a distance but a knife attack is a kind of intimacy.” What’s intimate about it?

There wasn’t even an inch of space between him and me. He’s not shooting from a distance. He’s right up in my face, sticking a knife in me. And then, of course, I fell down, and he was on top of me.

So that’s about as intimate as you can get, to be underneath somebody who’s on top of you. I mean, there are other occasions when that happens, and those are more pleasurable.

Some of the book is about trying to understand the attacker. What do you know about him?

I know very little. There have been just a couple of newspaper reports on which I base my knowledge of him. What seems to be the story, as far as I can piece it together, is that his parents were of Lebanese origin. They moved to the United States, and he was born and raised in Jersey. His parents separated. His father went back to Lebanon. His mother stayed in New Jersey with himself and his sisters.

Until he was approximately 19 years old, he was a kid growing up in Jersey and had no criminal record. And then at about that time, he chooses to go to Lebanon to visit his father. His father lives in a village which is very near the Israeli border and is a very strongly Hezbollah village with billboards of Hezbollah heroes around the streets. His mother says that when he first got there, he really didn’t like it, he wanted to come home right away. But he stayed.

He came back a month later and, according to his mother, had completely transformed, was a different person and was now angry with her for not having taught him properly about religion. His mother’s house in Fairview has a basement, and he went and sequestered himself in the basement, lived separately from everyone else, playing video games and watching YouTube videos.

Essentially, he lived a pretty solitary life for something like four years, between his visit to Lebanon and his decision to attack me. And somehow, in that period of time, he becomes the kind of person who can commit murder.

At a certain point, he sees something on Twitter from the Chautauqua Institution, announcing their program of events, and he saw that I was listed on the program and decided to make his plan.

The idea that he could become someone who could murder seems, in some ways, less improbable than that you could end up as his target. This is somebody born after “The Satanic Verses.” And you’re just not there anymore. There’s a lot that has happened — the war on terrorism, the invasion of Iraq. How does he end up focusing on you?

This is what I don’t know. I can guess that while he was with his father in this very Hezbollah-dominated village that somebody might have mentioned my name as a bad guy, anti-Muslim, and it maybe was triggered by his seeing something on social media about my upcoming talk. But I don’t really know.

I remember saying to my editor at Random House that if I was to write a story in which somebody, by his own admission, had read only two pages of somebody’s writing and seen a couple of YouTube videos and then would to decide to murder that person, my editor would say to me, that’s not convincing. It’s not enough motivation.

You say in the book that your attempted murder seemed undermotivated, which is one of the funnier — I mean, darkly funny — lines I’ve read in a while.

I was thinking about Iago and Othello, that the only thing that happens to Iago is that he’s passed over for a promotion. That’s it. That’s his beef. And because of that, he decides to destroy the lives of two people, Othello and Desdemona.

And I often wondered, “Is there such a thing as a person who is simply evil, just a bad guy, doesn’t need much of a motive?” And the reason that doesn’t quite work in this case is because, prior to his visit to Lebanon, he was a perfectly nice person. The transformation is what’s interesting.

There’s a way in which he’s trying to kill some other version of you. He doesn’t actually know anything about you.

No, he didn’t do any research. He seemed, in a way, very uninterested. I guess he’d heard from people he was influenced by that I was some kind of demonic figure. There is a very effective degree of demonization that has taken place across the Islamic world, in which there’s a lot of people who grow up thinking that I’m a kind of boogeyman. On the other hand, his own family were not like that. They were not fanatics. They were perfectly secularized American citizens. So I don’t know where he got it from.

The core of the book is this imagined dialogue between the two of you. And one thing you say to him in this imagined dialogue is, “I know that it is possible to construct an image of a man, a second self, that bears very little resemblance to the first self, but the second self gains credibility because it is repeated over and over again, until it begins to feel real, more real than the first self.”

You imagine saying this to him, almost as a way of helping him understand what he was doing. You’re creating his shadow self — a version of him that is now more real in the world than he is. Tell me about that.

I included this anecdote about Samuel Beckett being the victim of a knife attack, and he almost died. In his case, he actually did go to confront his attacker in court and said to him, “Why do you do it?” And all the man was able to say was, “I don’t know, sir. I’m sorry.”

And I thought, “That’s useless.” Even if I was permitted by his lawyer to have a meeting, I probably wouldn’t get an apology, because there’s no indication of any remorse. I would get some form of sloganized answer, which wouldn’t answer this hole in my understanding of him. But how can somebody with so little knowledge of a person agree to murder them?

So I thought, maybe the best way to do this is to use my skill of imagination and storytelling to try and get inside his head and at least create a character that I can believe might do something like this. Whether it’s his real character or not actually becomes secondary.

I took the book as a very deep, intense assertion of the reality of your actual self. The book is physical and intimate and graphic about your rehabilitation and your hospital stay. It felt to me like a deep insistence that the Salman Rushdie who mattered was the one who actually lived through all this.

Well, I hope that people read it that way, because I’ve rarely in my life felt so deeply physically connected to my body as I have in this last year and a half. It was such an incredibly physical thing that happened, both the attack and the recovery and the psychological ramifications of all of that.

I always think publishing a book is a little bit like undressing in public. But this one really is. The memoir form was more or less invented by Rousseau in his confessions. And ever since then, I’ve always thought the principle of the autobiographical memoir is: Tell as much truth as possible. If you’re not going to tell the whole, naked, unvarnished truth, don’t write the book.

Did trying to write this self-portrait change your sense of yourself?

That’s a good question. No, I think it in some way clarified it.

One of the questions I ask myself in the book is: Given that you’ve been, by great good fortune and medical skill, given a second act that you weren’t supposed to have, how are you going to use it? What will you do with that gift of time?

And the reason why so much of the book is about love and family is because that’s what’s right at the front of my head now. In whatever time I have left — I hope it’ll be a while — that’s what I want to focus on. That and work and, frankly, nothing else.

Look, this is the 22nd book. If there aren’t any more books, that’s OK. The priority now is to lead a life of loving and being loved. That’s what I think this thing has taught me.

I think that’s a nice place to end. So then always our final question: What are three books you would recommend to the audience?

I would recommend “Don Quixote” — for many people, the first great masterpiece in the novel form. There’s now a wonderful new translation of it by Edith Grossman, which makes it very accessible to English readers. Previous translations were, frankly, a little dull. But this one is fantastically vivid and alive.

“One Hundred Years of Solitude” is one of the most joyful books ever written. From the first sentence, you are plunged into this world of magic.

And of the three great masters of the 20th century — Joyce, Proust and Kafka — we live in Kafka’s world. So I would probably say “The Trial” or “The Castle.”

Salman Rushdie, thank you very much.

You can listen to our whole conversation by following “The Ezra Klein Show” on the NYT Audio App , Apple , Spotify , Google or wherever you get your podcasts . View a list of book recommendations from our guests here .

This episode of “The Ezra Klein Show” was produced by Annie Galvin. Fact-checking by Michelle Harris. Our senior engineer is Jeff Geld, with additional mixing by Isaac Jones. Our senior editor is Claire Gordon. The show’s production team also includes Rollin Hu, Kristin Lin and Aman Sahota. Original music by Isaac Jones. Audience strategy by Kristina Samulewski and Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. And special thanks to Sonia Herrero and Mrinalini Chakravorty.

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