Ticker
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More Acclaim for Ticker
“A fast-paced, utterly riveting tale of the decades of effort that have gone into developing an artificial heart. The characters, many of whom dedicated their lives to this quest, are captivating, and their rivalries are the stuff of legend.”
—Bethany McLean, coauthor of All the Devils Are Here and The Smartest Guys in the Room
“A remarkable journey through the harrowing world of heart surgery, as a brilliantly gifted and eccentric team of doctors work to develop a complete artificial heart to save the thousands of patients a year whose hearts are failing.”
—Bryan Burrough, author of Public Enemies, The Big Rich, and Barbarians at the Gate
“An exciting, propulsive, and at times surprisingly tender account of the swashbuckling surgeons and inventive geniuses who are working to achieve one of the greatest medical breakthroughs—the development of the artificial heart. Mimi Swartz has done an outstanding job and uncovered the human story behind the triumph of technology.”
—Jennet Conant, New York Times bestselling author of Tuxedo Park and 109 East Palace
“Who knew that the story of the artificial heart was such a rip-roaring one, with one larger-than-life character after another, and plot twists galore? In Ticker, Mimi Swartz has told that story with verve and elegance, and brought those characters to vivid life. A wonderful work of nonfiction by a wonderful nonfiction writer.”
—Joe Nocera, Bloomberg News columnist and author of Indentured: The Inside Story of the Rebellion Against the NCAA
Copyright © 2018 by Mimi Swartz
All rights reserved.
Published in the United States by Crown, an imprint of the Crown Publishing Group, a division of Penguin Random House LLC, New York.
crownpublishing.com
CROWN and the Crown colophon are registered trademarks of Penguin Random House LLC.
Library of Congress Cataloging-in-Publication Data
Names: Swartz, Mimi, author.
Title: Ticker : the quest to create an artificial heart / Mimi Swartz.
Description: New York : Crown, [2018] | Includes bibliographical references and index.
Identifiers: LCCN 2017058910 | ISBN 9780804138000 (hardback) | ISBN 9780804138017 (ebook)
Subjects: | MESH: Frazier, O. Howard. | Cohn, Billy. | Heart, Artificial | Surgeons | United States
Classification: LCC RD598.35.T7 | NLM WG 169.5 | DDC 617.4/120592—dc23 LC record available at https://lccn.loc.gov/2017058910
ISBN 9780804138000
Ebook ISBN 9780804138017
Cover design by Christopher Brand
Cover photograph: The Voorhes
v5.3.1
ep
To my father, husband, and son
Who taught me the most important lessons of the human heart
Diseases desperate grown
By desperate appliance are relieved,
Or not at all.
—WILLIAM SHAKESPEARE, Hamlet, Act 4, Scene 3
“How about my heart?” asked the Tin Woodman.
“Why, as for that,” answered Oz, “I think you are wrong to want a heart. It makes most people unhappy. If you only knew it, you are in luck not to have a heart.”
“That must be a matter of opinion,” said the Tin Woodman. “For my part, I will bear all the unhappiness without a murmur, if you will give me the heart.”
—FRANK BAUM, The Wizard of Oz
CONTENTS
Cover
Title Page
Copyright
Dedication
Epigraph
Prologue: THE TIN MAN
1: THE WIZARD, 2015
2: HOW HARD COULD IT BE?
3: THE MAKING OF A SURGEON
4: A TOUR OF HELL
5: THE WAR AT HOME
6: THE PURLOINED HEART
7: EXPERIMENTS
8: BARNEY WHO?
9: THE PRISONER
PHOTO INSERT
10: THE WILDERNESS
11: SYNCHRONICITY
12: THE KING OF DISTRACTION
13: HEARTMATES
14: THE AUSTRALIAN GUY
15: MATILDA
16: THE OCCUPATION
17: THE POWER SOURCE
18: THE DREAM OF ETERNAL LIFE
Acknowledgments
Notes
Selected Bibliography
About the Author
Prologue
THE TIN MAN
The kids fell in love with him first. Craig Lewis lived three houses down, a tall, solitary beanpole of a man with a copper-colored golden retriever named Shogun. He looked to be in his late thirties, and Linda Sanders knew from neighborhood gossip that he had one marriage behind him, just like she did. Back then, Shogun seemed to be his constant companion. Craig had taught that dog to do just about anything—of course he could sit, stay, fetch, and hunt, but he also knew how to play hide-and-seek with even the canniest kid. That was why, as soon as Linda Sanders’ children heard Craig’s pickup pull into his driveway in the early evenings, they were out the door—Leslie was eight and Eddie six, two towheads on the run, raising small clouds of dust as their feet slapped the parched summer grass. “Don’t wear out your welcome!” Linda warned to the screen door they slammed behind them. The sky would turn dusky and the shadows grow long before she’d give up waiting for their return and head down after them.
The last light of day was at her back, heating her neck and shoulders, and the hot, damp closeness of a Houston summer took her in its seasonal embrace. There were people who swore it always cooled off at night here, but Linda knew better. She’d lived all her life in this tattered north Houston neighborhood, and she knew what changed and what didn’t, or couldn’t.
Linda could see from the flattened grass that her kids had literally beaten a path to Craig’s door. It was natural that they’d go looking for a man to replace the one who’d left them. Craig was handy, that was for sure: when Eddie dragged his broken bike to his door, he fixed the chain, cleaning it up with WD40. He let Leslie draw in his old sketchbooks. If the kids were talking about the moon or stars, he would haul out his telescope and let them look through it at the night sky. Once, when Linda’s air conditioner broke down—the worst thing that could happen in the middle of a Houston summer—Craig came over and fixed it for her, no charge.
A slight woman of twenty-seven, Linda had a smile that was both knowing and tentative. Her thin brown hair fell lank below her shoulders. Like this street—small frame houses guarded by rusting cyclone fences—she could have been pretty if she fixed herself up, but who had the money or the time? She had been divorced for several years and was barely making ends meet as a clerk at an auto parts store. She lived with the kids in a tired two-bedroom house she rented from her mom, its sunny yellow hue fading to a peaked sunrise. Home improvements were out of the question: Leslie and Eddie were always needing new shoes, school clothes, tetanus shots, whatever. Every day seemed like the one before it: get up, get the kids out the door to school, get them home, do homework, feed them dinner, then give them baths, put them to bed, and get up and do it all over again. She was in her late twenties, going on forty-five.
Maybe that’s why she found Craig’s place such a comfort. Her front yard could have been mistaken for a small daycare center, with the kids’ toys and bikes scattered all over the place; his was manicured and trimmed. Wanting to get out of the sun, she pushed his door open, something Craig had told her she
was welcome to do.
Neat as a pin inside and out, she thought. Craig was a project manager for the city—he had walked away from community college just shy of graduation because he didn’t see the point, he had told her. The engineers with the big degrees started calling him for advice after his first few months on the job anyway. He was teaching Leslie to fold clothes—he towered over the little girl as they did that funny laundry waltz in the living room with the sheet getting smaller and smaller between them. Leslie was giggling, the corners of the bedsheet clutched between her stubby fingers. Linda looked around for Eddie, scanning the glossy wooden floor, the sofa still peppy and full from disuse, the walls lined with bookcases filled with volumes on engineering and medicine and oil field equipment. No sign of him.
She looked at Craig quizzically, and he met her gaze, and for just a moment she caught a twinkle in his eyes. Then he turned away. “Shogun, find Eddie,” he said to the dog, who had been sitting, attentive, as if waiting for the command. In a flash Shogun dashed into the kitchen, where he skidded to the front of a cabinet door. Then, with a sigh, he dropped to the ground, beating his tail on the hard floor, moving his eyes from the handle to Craig and back again, waiting. Craig bent over to take the final fold of the sheet from Leslie, and put a finger to his lips. Then he stepped toward the dog and threw the cabinet doors open to reveal Eddie, crouched over like a beach ball.
“I’ll spoil your dog if you’ll train my kids,” Linda told him. She shooed them toward the front door, patting them between their shoulder blades both to hurry them along and to claim them as hers.
That was how Craig and Linda started spending time together. She’d rent a video and then pass it on to him, since they were good for two days. If she made extra for dinner, she’d take him a plate. Once, the kids locked her out of the house and she had to go to him for help to get back in. Craig came down, took the sliding door out, put it back in, and then gave her a stick to put at the base to keep robbers away. He was around so much, in fact, that Linda’s mom started including him when she dropped by with ice-cream sandwiches.
Taking the kids home, she thought that nothing makes a man more handsome than acting in a fatherly way with kids. Linda decided to do a little investigating. She found out that he was dating someone. Well, he’d never said anything to her about it, but that was that.
* * *
Then Linda met a man and moved with him and the kids to Seattle for nearly a year before she realized her mistake. When she moved back to her mom’s house, Craig had disappeared. She tried to find him—babbling to the new tenant in his house about Shogun—but didn’t have any luck. One night, she was playing pool and who should walk into the bar but Craig himself. They made a date to catch up. He invited the whole family to his new house and rented a video of the original 101 Dalmatians. The kids had never seen it, he remembered. He also remembered that they loved his chicken-and-egg fajitas, which he loaded onto their plates before they all sat down on the couch to watch. “Craig, can you marry my mom?” Leslie asked. Well, Linda thought, if he had any interest, two pushy kids could put an end to things before they started.
That was okay, she told herself. After Seattle she had put her heart on the shelf, deciding to raise her kids alone. But then Craig bought the kids roller skates, and they all went skating in the park. He took them fishing. But the thing Craig loved most was to go out to dinner and then hit the Brown Book Shop, his favorite place in the world. It was where all the engineers and doctors and lawyers bought their technical books for school, a homely spot just north of the medical center, with fluorescent lights and stacks and stacks of books, a place he could lose and find himself at the same time. “Baby, these books don’t have any pictures,” she’d tease. She thought Craig was the smartest man she’d ever met.
They got married at the courthouse on October 15, 1993. She was thirty, he was thirty-six. “Should we bring the kids?” she asked the night before. “Of course,” he said. “I’m marrying them too.” Their wedding gift to each other was a hand-cranked ice-cream maker.
She felt as though she had married a man who could do anything. When he spied her recipe cards scattered in a kitchen drawer, he made Linda a recipe box out of soft yellow pine. He and Eddie built a boat together. Craig couldn’t do anything halfway: first the garage and then the house began to fill up with his projects. When he got interested in chemical reactions, he bought himself a used centrifuge. He’d been a welder back in the day; now he bought himself an anvil and a forge.
Easter came. It was the prettiest time of year in Houston, when the air was still cool, the skies were a clear baby blue, and the azaleas bloomed in a riot of pink and purple and white. Before she married Craig, Linda had always planned egg hunts for her kids, buying them fancy baskets and hiding clues in plastic eggs that led them to the treasure—more plastic Easter eggs filled with quarters. That was not enough for Craig. He sent her out to buy something called a landscaping compass. The night before Easter, once the kids were asleep, he took a flashlight and spray-painted a grid in the yard. The next morning, he had the kids find their eggs by looking through the compass and following coordinates.
That was how it was for seventeen years.
“I think there might be something wrong with my heart,” Craig told her one morning while he was getting dressed for work. He said it the way he said everything—calmly, like she shouldn’t worry. It was September 2010; Craig was fifty-three and had never had a sick day in his life. His dad had lived to ninety-one, and his mother was still fit at eighty-nine. He could outrace the kids on bike rides no matter how fast they pedaled. But now he couldn’t sleep; he was waking up nights to the pounding of his heart, like it was going to jump out of his chest. Craig made an appointment with a cardiologist, who didn’t find a thing.
So Craig went back to doing what he’d always done, which at that time meant going to work during the week and keeping himself busy on weekends installing hardwood floors in their living room. But instead of staying up reading late into the night, he’d fall into bed early, exhausted.
“I’m tired,” he told her.
“Well,” she said, “you should be tired. I’m forty-seven and I’m tired.” But really, she wasn’t tired, and she didn’t think he should be either.
* * *
By October, the heat was beginning to recede, giving way to that sweet, gentle coolness that can make even the most jaded Houstonian feel grateful. But Craig’s racing heart continued to keep him up at night; he reminded Linda of a zombie sometimes when he got himself ready for work. Then the rash appeared. It started near an ankle, winding up his body like a snake: angry scabs of dark red that seemed to erupt from something deep under the skin.
On Thanksgiving Day 2010, Linda got up before dawn to put in the turkey, and heard Craig wheezing in bed. He had caught the cold Leslie had brought home from school, and hadn’t been able to sleep at all for the last few days. Linda walked back into their bedroom, took one look at her husband’s ashen face, and stripped off her nightgown and threw on a T-shirt and jeans. “We’re going to the emergency room,” she declared.
The highway was nearly empty owing to the holiday, and Linda flew past the billboards, pine trees, and downtown towers without a glance, craning her neck for a first glimpse of the Texas Medical Center. “You all right, baby?” she asked, but Craig wasn’t up to talking. The fifteen-mile trip to St. Luke’s Hospital was a blur.
In the emergency room, a doctor put a stethoscope to Craig’s chest and didn’t seem too worried. Probably bronchitis. They should see a pulmonologist just to rule out the beginnings of asbestosis or emphysema. Craig and Linda left with a referral and a round of antibiotics. Craig ate his turkey late that night, in bed.
Over the next few days he rallied. The color came back into his cheeks, and he got out of bed to attend to some of his projects. But then the antibiotics stopped working, and his symptoms came back wor
se than before. Linda called the doctor at St. Luke’s again, but this time he was not quite as reassuring. “I think something more is going on,” he said carefully. He prescribed another round of antibiotics—stronger ones—and urged Linda to get Craig to a pulmonologist as soon as possible. Certainly right after the holidays.
Then, just after Christmas, Craig asked her to take a look at his ankles. Looking down at the swollen flesh, Linda was reminded of the book of Job, which she’d studied in Sunday school. The swelling in his legs was getting worse every day, and by New Year’s Craig couldn’t walk. This time he went to St. Luke’s by ambulance, and late that night he went into respiratory failure.
St. Luke’s was a private hospital—Craig had good insurance through his job with the city—so the waiting room in the ER where Linda sat was almost empty when a doctor came to find her. He was wearing scrubs, and Linda could tell by the stony look on his face and the speed of his stride that he was angry.
He started yelling at her from six feet away. “How can you say your husband doesn’t have heart problems?” he demanded.
“He doesn’t,” she said. But her voice wasn’t as firm as she would have liked. She was confused.
Craig had septic shock and double pneumonia, and worse, his heart was barely beating. How could she not have known? Why had she waited so long to get him to the hospital? Seeing the confusion on her face, the doctor took a long, slow breath and softened his voice.
“Maybe he didn’t tell you?” he asked.
Linda listened, trying as hard as she could to pay attention even though her mind was racing. Craig was very, very sick, he began. He had only a fifty-fifty chance of making it through the night. The doctor promised to do whatever he could to keep him alive, but he wasn’t sure that he could.