by Mimi Swartz
Bud was also an absentminded child—his mother wrote lists on his hand with a ballpoint pen when she sent him to the store, so he couldn’t lose her instructions—but thanks to her sharpness also became a shrewd assessor of things. He knew, for example, that he had to win fights to protect his reputation, and so he fought, and won most of the time. It would become a point of pride that his grandfather’s cousin and namesake had been a mean, ornery gunfighter in the Rio Grande Valley. He passed on dubious bits of wisdom to Bud like “It’s hard to kill someone with a knife, you just gotta shoot ’em, that’s it.” For balance, Bud’s great-grandfather on his mother’s side had been a sheriff. “He killed a number of villains and one Mormon,” Bud explained.
Stephenville was not a hotbed of liberalism. No one in town was surprised when the Baptist minister smashed a “sinful” pinball machine with an ax, its death sentence determined by the racy kick of a mechanical cheerleader attached to the flippers. But it was one of the several incidents that indicated to Bud that his days in his hometown were numbered. A football scholarship got him to the University of Texas in 1960, with big plans to play for the legendary Darrell Royal. Then he tore a hamstring first semester, and ended up a history major. Bud embraced big ideas as only a person from a small world can. On an early date with a pretty redhead from Houston, he spent a long time—maybe a very long time—discussing the nature of infinity.
In truth, he had no idea what he wanted to do with his life. He made excellent grades without really trying—Bud was the kind of student who could usually cram for a test the night before and ace it, partly because he had something of a photographic memory. He thought about becoming a Methodist minister, and then maybe a dentist, or a lawyer, or a teacher, and then dismissed them all. “I just wanted something that didn’t require me to lie, cheat, or steal,” he would say. “And I didn’t know anything about the world as a twenty-one-year-old.” He was reading a lot of Chekhov at the time and liked the author’s descriptions of doctors’ lives. That’s how Bud decided on a medical career.
He hadn’t taken any undergrad pre-med courses but managed, once he put his mind to it, to finish all the required work in a year. Then, without much more thought, he decided on Baylor College of Medicine, not because it was then one of the best programs in the country but because it was in Houston. The redhead who had listened so patiently to his soliloquy on infinity was now living there. Her name was Rachel, and he was in love with her.
* * *
Michael DeBakey had landed in Houston about twenty years earlier, in 1948. The city had around half a million people, some of whom had far more money and ambition than clear-eyed direction—at least beyond the notion to be, somehow, “great.” The largest city in Texas, Houston was home to the nation’s swiftly growing oil business, which was fueling the booming postwar economy. Smoke from the refineries smudged the sky above the south end of town, while the port of Houston, already the second-largest in the country, was clogged with tankers ferrying petrochemicals all over the world. Tudor-style mansions the size of small castles lined the leafy streets of neighborhoods like River Oaks and Shadyside. If some of the civic leaders were in the mold of Edna Ferber’s crass, shrewd Jett Rink, other prominent Houstonians were fiercely determined to create a modern, sophisticated city out of…not much. Partly by design and partly by accident, they created a place that was less hidebound and more open to opportunity—at least for white men—than any other in the United States. In Houston, success mattered; family pedigree or a high-toned college education did not. The oilman’s optimism set the tone: failure was just an unlucky bump on the road to getting really, really rich. It was also important that Houston was seen to be going places, instead of being just another hick Texas town. The city was ripe for a man with dreams and ambitions the size of DeBakey’s.
It wasn’t a perfect fit. DeBakey was from Lake Charles, Louisiana, the favored son of Lebanese Christian immigrants who had prospered there. Houston was not very diverse back then—minorities mostly consisted of blacks and Hispanics—and the ruling class tended to be white and members of the Baptist or Methodist church. DeBakey was small in stature, highly educated, and quite worldly. He sported a tiny, fussy mustache. At the time of his arrival in Houston, he somewhat resembled a Vichy-regime villain in a World War II movie. There was nothing of the down-home, never-met-a-stranger veneer Texans in general and Houstonians in particular so valued. DeBakey had his charms, but he applied them mostly to those who could help him accomplish his goals.
He was nothing if not focused. DeBakey’s parents believed him to be a genius, and he didn’t question their assessment: valedictorian of his high school class, he finished college at Tulane after just two years. Still, it is possible to believe that being the smartest, littlest, and, maybe, oddest kid in your elementary school wasn’t easy. He read the encyclopedia; he played the saxophone; he grew vegetables in his father’s garden. This was the American South. “Mike got beat up on his way to school and on his way home,” a friend told Life magazine. Some kids would have been defeated. DeBakey was galvanized.
He stayed at Tulane to get his medical degree and at twenty-three became responsible for one medical advance: he adapted an older device called a roller pump for use in an early version of the heart-lung machine, a crucial invention that decades later would keep patients alive during cardiovascular surgery. He finished his internship and residency in the bedlam that was New Orleans’ infamous Charity Hospital, where he became the protégé of one of the South’s most prominent physicians, Alton Ochsner. Ochsner’s motto was “early to bed, early to rise, work hard, and publicize”—a maxim DeBakey would take to heart.
At just twenty-seven, with his father’s financial backing, DeBakey headed to prestigious surgical fellowships in Strasbourg and at the University of Heidelberg, further distinguishing himself from run-of-the-mill American doctors. He then returned to Tulane, where he joined the surgical faculty. It was there that some of his most distinctive characteristics became apparent. While DeBakey’s colleagues admired his skills in the operating room, he earned the nickname “Black Mike” because he was so imperious. Ochsner was always quick to forgive his interns a mishap or two—he was given to teachable moments—but DeBakey could never let go of the slightest infraction. He made scenes, embarrassed underlings in public for tiny errors, and fired residents on the spot for even less. Yes, a mistake in surgery could mean the difference between life and death, but some errors—like interrupting DeBakey when he was deep in thought—did not seem to warrant exile from the Tulane garden. Except to DeBakey.
On the other hand, DeBakey’s decisiveness served him well when he left New Orleans to join the military in 1942. He secured a job as a member of the Surgical Consultants Division in the Office of the Surgeon General of the Army, and by 1945 was the director. DeBakey proved himself a relentless and visionary master of organization. Seeing too many soldiers dying on battlefields, he helped create the first mobile army surgical hospitals, for which he received the prestigious Legion of Merit. He lobbied tenaciously for better medical care for veterans, especially improvements in what was then known as the Veterans Administration hospital system, and for increased medical research, seeing in this new patient pool an opportunity to improve public health on a wider scale. During his years in the military, DeBakey also became a master of strategy, tactics, and politics; he was expert at managing his superiors and dictating to (sometimes terrorizing) subordinates. He was fearless in the face of opposition when he knew he was right, and in DeBakey’s mind, he was always right.
Prominent Houstonians had started building the Texas Medical Center in 1943. Over the next few years, they used their wealth to supplement the best hospital, Hermann, with a cancer hospital, a navy hospital, and a limestone-faced main building for a medical school—Baylor College of Medicine, which had spent its first Houston years in a repurposed Sears Roebuck store. The medical center, such as it was then,
sat on the edge of a large city park at the south end of town. Deer still grazed there, sometimes serving as dinner for urban hunters.
The board had a grand vision: to build the biggest and best medical center in the world. (This was Texas, after all.) To achieve this goal, the members needed a leader who could make this happen out of little more than thin air. It wasn’t long before they set their sights on DeBakey, who after the war was back at Tulane as the chief of surgery. But DeBakey wasn’t interested. He toured what passed for the Baylor campus and then wrote a three-page letter explaining why he could not possibly take the job. Baylor, he wrote, was a “third-rate” medical school. It had no full-time faculty. General practitioners taught surgery because Baylor had no board-certified surgeons. Even worse, Baylor had no affiliated hospitals where students could get hands-on training. And so on.
Ochsner urged DeBakey to reconsider. “They have big plans and they don’t have anybody there that knows what the Hell to do,” he told his protégé. Besides, DeBakey could always come back to Tulane if things didn’t work out.
And so in 1948 he went, with his young wife, Diana. DeBakey’s father bought the young couple an impressive white Tudorish mansionette on Cherokee, a locale that was a short walk down oak-lined Main Street to Baylor. Dr. DeBakey did not like being too far from his patients.
He wasn’t met with open arms. Houston’s established physicians were not an open-minded, generous lot, and they resented DeBakey from the start. They had no intention of sending him any of their patients for his surgical practice. He was arrogant, they said. He wasn’t nice. He talked to them like they were children. DeBakey quit at least once, abandoning the med center to work in a decrepit hospital downtown, determined to build his reputation on his own. Eventually, however, he was lured back to Baylor—with more money and more power, including the title of chief of surgery. Even though no one asked outright, DeBakey accepted the charge of transforming Baylor into one of the country’s best medical schools, and the Texas Medical Center into the largest in the world.
It was a good time for ambitious plans. John F. Kennedy defeated Richard Nixon in 1960. Just forty-three, he was the youngest president elected in American history. If, in retrospect, the success of Kennedy’s brief tenure—a thousand days before his assassination in November 1963—is subject to debate, no one can argue the inspirational power he had over the American people. Eisenhower may have been part of a generation that led the United States to victory in World War II, but JFK, young and startlingly handsome, Harvard-educated, sophisticated, and possessed of great wit, made Americans, especially young Americans, feel that anything was possible.
That was never truer than on a hot, sunny day, September 12, 1962, when the president spoke to an exultant Houston crowd of 35,000 at the enormous Rice University stadium in Houston, Texas, thirty miles or so from the headquarters of the four-year-old National Aeronautics and Space Administration. The location was not coincidental. Nor was it coincidental that the United States was scrambling to keep up with the Soviet Union in the race to conquer outer space.
Leaning into the lectern, JFK made a passionate pledge that was a clarion call for a new era: the United States would put a man on the moon within the next eight years. “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard,” the president said. “Because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win.”
It was against this backdrop—a national hunger for new ideas, for innovation, for new global power—that eight months later, in May 1963, Dr. Michael DeBakey made an appearance before the Senate Committee on Health in Washington, DC. No one could argue that, on first sight, he shared JFK’s charisma. He was fifty-five; small and slight, he wore thick, horn-rimmed glasses and his dark, coarse hair was brushed back from his receding hairline. He had a nose a toucan would envy. But DeBakey, like JFK, had a gift for oratory and persuasion. And he had passion to spare.
He sat confidently before a group of rapt senators, many of whom he knew by name, many of whom he had treated, or he had treated their wives or fathers or uncles or some other great-aunt’s second cousin twice removed. DeBakey remembered them by name too—all of them. He was introduced as the professor and chairman of Baylor’s Department of Surgery and as a former member of the National Heart Institute Advisory Council, but DeBakey was by then much more: he was arguably the most famous heart surgeon in the world, a nationally renowned adviser whose opinion was sought on everything from the design of heart valves to public health to the vicissitudes of Washington politics. He advised senators and the president on countless medical issues, including the dangers of smoking long before others would concur.
In the process, the self-made surgeon from Lake Charles now had a vast, ever-expanding network of contacts to Get Things Done. The Houston oilmen who had helped fund Baylor introduced DeBakey to their pals in Congress and the White House; DeBakey’s fellow officers from his wartime years—he had achieved the rank of colonel—were now dispersed around the country, most of them in positions of power as well. DeBakey was also a winner of the Lasker Award in 1963, American medicine’s most prestigious prize, given to physicians who made outstanding advances in clinical medical research.
Winning the Lasker Prize was not entirely coincidental. DeBakey had become a crucial member of philanthropist Mary Lasker’s circle. Lasker was a Radcliffe-educated powerhouse whose second husband, Albert, owned an ad agency that at one time had the job of getting more women to smoke cigarettes. Soon enough, though, the pair changed course and created a substantial fund to support medical research. By the time of Albert’s death in 1950, Mary had organized a group of high-minded and politically savvy operators determined to make the US government improve the health of its people. In the process, Lasker and her cohorts became experts at the kind of public relations–driven, pay-to-play lobbying that exists today. DeBakey and Sidney Farber, the Nobel Prize–winning cancer researcher from Harvard, were Lasker’s go-to experts when she needed a physician to browbeat government officials and marshal public opinion; in particular, when she needed someone to explain why the money appropriated for medical research just wasn’t enough. At this, Lasker and her cohorts were extraordinarily successful: the budget for the National Institutes of Health went from $460 million between 1946 and 1961 to $1 billion five or so years later.
Attitudes had changed since the US victory over the Axis forces in 1945. The economy was strong and growing. The American triumph in World War II had validated our greatness. Science had not only helped to win the war with the deadly success of the Manhattan Project but also saved us from humiliation in the Cold War–dominated space race. Yes, Russian Yuri Gagarin was the first person to orbit the earth in 1961, but after a few false starts astronaut John Glenn caught up in 1962, and made the journey around the world two more times. So why couldn’t Americans cure cancer and heart disease? And why shouldn’t the federal government pay for the research?
* * *
The question wasn’t rhetorical for Michael DeBakey. He had zeroed in on heart disease as his life’s work. Trained as a general surgeon—there wasn’t any heart surgery when he was studying medicine—he saw that now the biggest rewards lay in uncovering its mysteries.
He had some stiff competition. During the early twentieth century, heart disease research was the siren’s song for ambitious men of medicine. Technological and medical discoveries that would change its detection and treatment followed with breathtaking swiftness. In 1929, a German named Werner Forssman proved it was possible to X-ray the heart by inserting a catheter filled with dye through the veins and directly into the heart—what would come to be known as the common practice of cardiac catheterization. (He was fired for trying it on himself.)
Even so, operating o
n the heart itself was still inconceivable. No one had any idea how to keep a patient alive and breathing while a surgeon cut into the organ. Then, in 1937, John Gibbon began experimenting with a machine that would keep the heart and lungs operating during surgery, an accomplishment that Leo Eloesser would describe in Milestones in Chest Surgery as “among the boldest and the most successful feats of a man’s mind.” Within two decades, it would become possible to operate on the heart and lungs of a human being without killing him—as long as you could get in and out really, really fast. Too much time “on the pump” created new sets of problems, the worst being that sometimes doctors couldn’t wean a patient off of it.
While Gibbon was at work on his machine, a surgeon named Robert E. Gross operated for the first time on the heart of a child, to correct a congenital defect. In 1949, the first portable heart monitor was put to use; the first pacemaker followed a year later, and two years after that, in 1952, the first artificial heart valves were implanted.
But the most important advances of that time were achieved by a dashing Minnesota surgeon by the name of C. Walton Lillehei. In 1952, he performed the first surgical repair of the heart, using a new technique, hypothermia—lowering a patient’s body temperature to the point where he was barely alive. Lillehei would go on to become the most influential heart surgeon of the next decade or so, not just for his innovations but because he was a person who made it hard to tell where boldness ended and recklessness began.