The Open Heart Club

by Gabriel Brownstein

“Take it slowly,” said Dr. Freed.

  I took a shower. I stood under the water, and for the first time since surgery, my body actually felt pleasure. My skin, used to alcohol wipes, delighted in the prickling warm water. It was so good to be standing—I felt like me. I felt strong, and I wanted to wash it all off—not just the dressings but the whole experience.

  I toweled myself dry, and there was another one of my dad’s shirts. He’d brought the thickest possible flannel, as if, through the volume of fabric, he could express his love. I put it on. I looked in the mirror. Was that me? Then my heart started beating, a frantic, bass-drum beat. I didn’t know what to do.

  I lay back on the hospital bed. This is okay, I told myself. I am okay.

  The beating resolved itself, and my heart felt normal, and I was faced with a question. Should I tell the doctor what had just happened?

  I guess I could castigate myself. I could say that my behavior was thoughtless and reflexive: that I was doing what I always do, pretending to be healthy when I’m not. On the other hand, I could claim it was calculated: I wanted to get out of the hospital, I wanted to go home, and I didn’t want to undergo any more tests.

  But maybe the truth is that the moment when I started pretending that I was okay was the moment that I really became healthy. Maybe that’s what healthy is, an act we put on when we pretend that we’re not dying.

  32.

  OWEN WAGENSTEEN MADE sure that Walt Lillehei received his salary during his period of convalescence, and in the autumn of 1950, Lillehei went back to work, no longer the easygoing mischievous young man. He had seen war, and he’d been cut open. He was likely to die soon, and after surgery, his head didn’t balance right on his scarred and skinny neck.

  Now there was a prototype heart-lung machine in the University of Minnesota Hospital, the one Clarence Dennis had built based on John Gibbon’s designs. The machine was six feet long and three feet high and had a glass tower arising from its chrome and stainless steel base. Surgery with this device required sixteen professionals: two lead surgeons, two assistant surgeons, two anesthesiologists, two nurses, two technicians, a person in charge of transfusion, someone in charge of blood samples, and four people tending to the machine. Endless moving parts had to be monitored: there were pumps, valves, switches, motors, a flow meter, a magnetized coil of wire, a series of rotating plates, and a reservoir for deoxygenated blood.

  In 1951, the team at the University of Minnesota Hospital gave the machine a try. Richard Varco, who had cut the nodes out of Walt Lillehei’s throat, was the chief surgeon. Lillehei observed. The patient was Patty Anderson, not yet six years old. She had been hospitalized three times in her short life. She was cross-eyed and weak and had been diagnosed with an atrial septal defect (ASD), a hole between the top chambers of her heart.

  The doctors anesthetized Patty at 8 a.m. in surgery’s Room II at Variety Club Heart Hospital, a small space with steam radiators, green walls, white tile floors, and windows that the doctors opened on hot days for ventilation. It took Varco four hours to get down to the little girl’s heart, which was massively enlarged and beating irregularly. Just past noon, they began to connect Patty to the pump. The process took over an hour, with sixteen people in the operating room making sure all was in place. At 1:22 p.m., Varco gave the order.

  “Pump on.” And she was on bypass, her heart and lungs being circumvented and her blood being oxygenated by a machine.

  He made his incision. The heart bled. The suction was inadequate. The pump was working, but there was so much blood, the surgeons could hardly see. Varco felt around the interior of the heart with his fingers. There were holes in the top and the bottom chambers. The valves were deformed. The diagnosis had been incorrect. Varco sutured shut what he could—eleven stitches closed the worst hole—and then sewed shut the sick heart with its malformed valves. At 2:02 p.m., after forty minutes of surgery, Patty was taken off the machine. At 2:45 p.m. she was pronounced dead.

  Elsewhere in the country, surgeons met with similar challenges. In Philadelphia, John Gibbon lost his first bypass patient in the same way Varco had lost his: the pump worked, but the diagnosis was incorrect, and the child died soon after surgery. In May 1953, Gibbon tried again. His patient, Martha Crowley, was an eighteen-year-old freshman at Wilkes-Barre College who had been suffering her whole life with an ASD. When Gibbon sectioned her sternum, connected her to his oxygenator, and opened her heart, he found no surprises, just a hole between the atria about the size of a half dollar. Gibbon kept Martha Crowley on the heart-lung machine for twenty-six minutes as he sewed up the ASD. Satisfied with the closure, he disconnected her from the machine and put her chest back together. Martha Crowley woke up feeling fine. She was cured.

  John Gibbon had spent two decades building his heart-lung machine, and he was the first doctor ever to perform a successful bypass surgery. But Gibbon was a quiet man and not inclined to draw attention to himself. It took him a year to publish the results of his successful operation, and when he did so, he put the paper in a tiny journal, Minnesota Medicine, where very few of his colleagues would read it. He never announced his success at a medical conference. He operated on two more patients. Both of them died. After those two deaths, he seemed to lose interest. Gibbon never again used his heart-lung machine. As a friend of his observed, “The others were taking the risk and killing babies, and he didn’t like that.”

  To be crowned the king of heart surgery, you had to be more than just inventive and successful. You had to be comfortable playing with life and death. You had to be a daredevil and a showman. Walt Lillehei’s head didn’t balance right on his neck, but otherwise he was strong. He was ready. He was going to make his bid for the crown.

  33.

  WE WERE A crowd on the plane from Boston to New York when I was released. Marcia, Eliza, I, my parents. And our friend Hannah, who, along with my sister-in-law Sharon, had come all that way to support Marcia. I was in a wheelchair. On the way to board the plane, there was a little lip in the floor where the mouth of the tunnel met the door of the plane. The flight attendant asked if I could stand, and I almost laughed. Of course, I could stand. Who did she think I was? I didn’t really need a wheelchair!

  I walked down the aisle to my seat, and Hannah said something—I cannot remember her words exactly—about my being not exactly ill. This confused me. I was not ill. I had just had heart surgery, that was all. Otherwise I was fine. It wasn’t really that big a deal!

  Back in Brooklyn, with my clothes on, I looked like a perfectly ordinary citizen, maybe a little stiff, like I’d hurt my back or something. In the mirror in the morning, my chest was different. The hair was all gone, and so was the scar I’d had since I was five. It had been excised. In its place was a thin line that had already superficially healed. It looked like a tracing with a stylus, and that made my shaved chest look like it was made of clay.

  I wasn’t allowed to pick up a gallon of milk or a pot of boiling pasta on account of the fragility of my still-knitting chest bone. I wasn’t allowed to pick up my daughter, which frustrated little Eliza and frustrated me too.

  I refused to go back to Dr. Rosenbaum. His diagnosis had proved correct, even prescient. He had saved my life. He was the doctor who had grasped the situation most quickly. But despite that—because of that?—in my head he had transformed into some kind of hobgoblin. All my rage and fear, all my fury about my own weakness and vulnerability, had been transferred over to this doctor who had intervened and told me the truth about my condition and what I had to do about it. He had gone as far toward saving my life as I’d allowed him to, and I could not forgive him for it. I went for my postsurgical checkup to an internist, an old man who was a friend of the family and wished I would see a real specialist in congenital heart disease but agreed to look at me.

  I took a cab up to his office on East 39th Street. I got there early and walked around in the January sun. It was my first time out alone in the city after heart surgery, and I felt scared and uns
teady. I didn’t know if I was feeling okay. But I thought I was feeling okay. I kept checking my pulse, checking my balance. Was I lightheaded? Lethargic? Was that normal after heart surgery?

  Dr. Nachtigall’s old EKG machine was built into his wall. Its wires attached to the skin with old-fashioned suction cups. It took him a very long time to read the results. He made phone calls to Boston. I was in heart flutter, he said. My atria were beating too rapidly. I needed to go to a cardiologist and have it checked out. So I got on a plane the next day and went back to Boston, where they cardioverted me, which is to say, they put a kind of camera down my throat (that hurt), knocked me out for a minute, and then shocked my heart so it skipped back into its normal rhythm. Then I booked a plane back to New York City.

  “This is stupid,” said Dr. Freed, about as gently as a person could say such a sentence. But still I didn’t go back to Dr. Rosenbaum. I really didn’t want to see him. My anxiety was all out of proportion with what had actually taken place. Why? All you armchair psychologists in the audience, sing it with me: facing Marlon Rosenbaum meant facing my mortality.

  One advantage of having my cardiologist in Boston was that it located all my troubles, psychologically, two hundred miles away. In New York City, I wasn’t a heart patient anymore. But my denial came with its inevitable backlash: I kept wondering if I was in heart flutter. I kept pressing my fingers to my jugular vein, shutting my eyes, trying to figure out if my heart was in a normal rhythm. When I had been in heart flutter, I had thought everything was fine. Now that my heart was beating normally, I worried that it fluttered.

  Marcia went back to work before I did. My mom hung out in the apartment with me and baby Eliza. The whole ordeal of my heart surgery was as psychologically painful for my mother as it was for me—maybe more so. She was both anxious and exultant to see me well. She lit a tuna melt on fire in the toaster oven. I grabbed a box of salt and dumped it on the flames. What made her feel terrible made me feel good. Putting out a fire, I was a little bit less of an invalid.

  My mom was there when the literary magazines started calling. People wanted to print the stories I’d sent out in the fall. This was new, and this was fun, and my mother was tickled to play my secretary when the Northwest Review or the Hawai’i Review called. These were journals with tiny circulations—Was that the right word? Did they have “circulations” or just print a bunch of copies?—but it felt nice. My sternum knit itself back together. I was allowed to lift packages again. I went on the happiest grocery shopping trip of my life, delighting in lifting things off the shelf, putting things in the cart. Picking up two bags and carrying them home to the apartment. Holding my daughter in my arms. She ran to me. Up, up, up! I put her down, and she wanted me to pick her up again. Marcia and I were very ginger rekindling romance. There were weird tricks and hitches in my chest, like someone was plucking guitar strings in there. I called Michael Freed about it, and he said the symptoms I described didn’t sound like a real worry. So much had been cut and sewn and moved around in there, it could be anything.

  Still wondering if I was in heart flutter, I went for a run. I think it was my second or third time jogging after surgery, a rainy April day. I didn’t go very far. Maybe a slow, gentle mile, maybe less. My heartbeat accelerated, and that felt good. But then, when I stopped running, my heart didn’t slow. I walked back toward our building in the drizzle. I rested, but the fast heartbeat didn’t stop. I went up the stairs—we lived on the third floor of a row house—and I paused at each landing. But my heart was still going like I was running.

  I came home. Marcia said, “Lie down for a minute.” I did and the heartbeat normalized, but when I stood to get a glass of water, my heart sped up again. I lay down again. It slowed. Marcia made me call Dr. Freed. He took my call. He went through it all with me very carefully, the jog, the heart rate, and how I felt. Any dizziness? How long had it taken to resolve itself? How was I feeling now?

  He paused and mulled it over. “If it happens again, call me.”

  It did happen again, toward the end of summer. I was in the hall of our building, looking down the central stairs. I had Eliza in my arms. On the floor below was our neighbor’s babysitter, and she was talking to me, innocuously, about the babies growing and about the weather.

  I was smiling and pretending to enjoy our conversation, but really I wanted to get back into our home. She talked to me about the little toy poodle she took care of along with the little girl and how the poodle thought that it was her main job, as if it were the baby and the baby were the dog. As she chattered, my heart started going BANG BANG BANG BANG BANG.

  I said, “All right,” hoping it meant, simultaneously, “Enough of this” and “Good-bye,” but the woman downstairs wanted to tell me more about the toy poodle’s eating habits and how the little poodle liked to play.

  Eliza was fussing. My heart kept going BANG BANG BANG BANG BANG BANG. I said, “Got to go!” I went into the apartment, put Eliza down, and lay on the couch and waited for the banging to pass. When it did, I reached toward the phone, but I didn’t pick it up or dial. I knew I was supposed to call Dr. Freed. But I didn’t.

  Instead, I read to Eliza, Where the Wild Things Are. In Max’s room, a forest grew.

  34.

  ROBERT GROSS HAD some success with the atrial well. Doctors were also able to repair some atrial septal defects with hypothermia alone. But to get deeper into the heart, they needed to perform bypass surgery—to oxygenate the blood with a machine while they operated on the heart.

  Between 1951 and 1955, by Walt Lillehei’s count, there had been eighteen attempts at cardiac bypass surgery at four different hospital centers. Only one patient had survived, John Gibbon’s. The mechanical oxygenators, to Lillehei’s mind, had too many moving parts, too many possibilities for disaster. He thought about babies in the womb, the way a fetus survived when dependent on its mother’s cardiovascular system. He wondered, What if another person took the place of the heart-lung machine? What if the blood of the child went into its mother to be oxygenated, and then the mother’s oxygenated blood went back into the child as it lay upon the operating table? Could a child survive surgery dependent on a parent’s body? Lillehei called his idea “cross-circulation.”

  Before approaching a human subject, he tried his technique out on dogs in the lab. His machinery was store-bought: beer-keg tubing and a $500 dairy pump called a Sigmamotor T-6S that could move multiple streams of liquid in several directions. Lillehei anesthetized two animals and laid them out on separate tables. Then he connected the donor dog’s femoral arteries and veins to the subject dog’s aorta and vena cava. He tied off the subject dog’s heart. He operated. During the surgery, one heart beat for two animals.

  With cross-circulation, Lillehei was able to perform bypass operations inside his dog subjects’ hearts. The results were consistent over months of experimentation, and he proposed using his new procedure on children.

  Dr. Cecil Watson, chairman of the Department of Medicine at the University of Minnesota, was appalled. With two patients instead of one, the risks of infection were doubled, as were the risks of brain damage. There were so many possible complications: The difference in size between the two bodies raised all kinds of questions of blood-flow rates and quantities of anesthetic. What would knock out the parent would kill the child. They could both die. “A two-hundred percent mortality rate!” said Watson.

  Lillehei had studied his animals thoroughly, during and after cross-circulation, then had euthanized them and autopsied the bodies. His team had checked for changes in the dogs’ carbon dioxide and hemoglobin levels, blood pressure, and pulse. Postoperatively, they’d microscopically studied samples of the animals’ livers, kidneys, hearts, lungs, and brains. The results were overwhelming. Cross-circulation, if carried out correctly, would do no damage at all to either parent or child. Owen Wagensteen looked over the data and supported Lillehei in his fight against Watson.

  The first patient was a one-year-old boy, Gregory Glidd
ens, the eleventh child of Lyman and Frances Gliddens from Hibbing, Minnesota. Lyman worked in the Masabi Range iron mines. The Gliddens had lost a previous child to congenital heart disease, and Lyman was willing to serve as his tiny son’s artificial heart.

  The surgery was slated for March 26, 1954. Lillehei’s first case of the day was a routine hernia operation. Then he turned his attention to cross-circulation. Two beds were squeezed into Room II of the Variety Club Heart Hospital, the room in which Richard Varco had tried to perform his bypass surgery. The anesthesiologist used cyclopropane, the same explosive gas Robert Gross and Betty Lank had used in Boston in 1938. A mask attached to a black bag was put over Gregory’s mouth, and then the doctor squeezed the bag, measuring out the dose. Lillehei sectioned the boy’s chest, and when the doctors had a clear view of the heart, the boy’s father, Lyman Gliddens, wobbly with drugs, groin shaved, was brought into the operating room.

  The doctors put Lyman under. They didn’t want him moving or panicking during the surgery. Lillehei attached canulae to the major arteries and veins in Lyman Gliddens’s groin. Then he attached them to his clean beer-keg tubing. Similar tubes connected to the dairy pump, and these went into little Gregory’s heart.

  “Pump on,” said Lillehei.

  The Sigmamotor T-6S began to churn. The rate of flow had to be carefully calibrated. Too slow, and Gregory would die. Too fast, and the blood would flood Gregory’s tissue.

  Lillehei found the ASD and sewed it up. He made sure there were no leaks and no other holes. He removed Lyman and Gregory from the pump and closed the chest cavity. Everything seemed perfect until little Gregory, in the recovery ward, developed an infection in his chest. No doses of antibiotics, no suctioning of the lungs, no massaging of the heart seemed enough to save the child. Days after surgery, Gregory died.

  Lillehei was undaunted. He was sure that cross-circulation worked, and he found another patient: Pamela Schmidt, a four-year-old with a ventricular septal defect (VSD), a hole between the big bottom chambers of the heart. Pamela was sickly, weak, short of breath, and coughing up blood. On account of the hole in her septum, she had suffered chronic infections and been hospitalized four times for pneumonia.