by Mimi Swartz
Lillehei created a technique called cross circulation that from today’s perspective sounds, at best, dicey: he figured out a way to connect the bloodstream of a child to that of his parent during surgery in order to keep blood moving through a young patient’s body while he operated. (The joke at the time was that Lillehei had come up with a surgery that had a 200 percent mortality rate.) By 1955, he had abandoned that procedure in favor of his own version of a heart-lung machine. The list of accomplishments goes on: he was the first surgeon to try what would become a pacemaker, and also trained Norman Shumway and Christiaan Barnard, who would go on to become pioneers in heart transplants.
In the race to cure heart disease, however, Michael DeBakey wasn’t about to be left behind. As early as 1939, he and Ochsner believed in the dangers of smoking, not just as a contributor to or cause of cancer, but to heart disease too. DeBakey also found a way to use a common synthetic fabric, Dacron, as a replacement for blood vessels in the late 1950s. The story was that he went downtown to Houston’s major department store, Foley’s, to buy his usual graft material—nylon—but they were out. A salesperson suggested the substitution of something called Dacron. DeBakey went back to the operating room and found that—yes!—the material made stronger and better blood vessels than what he’d been using. Soon enough, the Dacron graft became the standard and DeBakey got the credit. Never one to miss an opportunity to further burnish his reputation, he restaged his discovery for a widely distributed photograph.
Not coincidentally, DeBakey also became a pioneer in the filming of surgeries, usually starring…himself. People had a right to see what he was doing, he insisted, when criticized for being a publicity hound. He was also a publishing dervish, thanks largely to two unmarried sisters, Selma and Lois, who followed their older brother from Louisiana to Houston just to help him draft, edit, and submit his ever-growing oeuvre to medical journals. DeBakey was the first surgeon with his own in-house PR firm.
So by the time DeBakey made his pitch to Congress in 1962, he had aligned his ambitions with two crucial items in the healthcare budget. First, he agreed that the National Institutes of Health should fund coronary research centers around the United States. In fact, he had the perfect spot: Baylor College of Medicine. The second was a lot grander: Michael DeBakey wanted money to create nothing less than an artificial heart. If that idea struck many as one straight out of a sci-fi comic book, DeBakey was not among them. He was convinced that the idea of building a heart from scratch was not only possible, but perfectly reasonable.
As DeBakey explained in his silky but authoritative Lake Charles drawl: “We are on the brink today of relieving mankind of its most painful and debilitating afflictions….Surely this is not the time to sit back and be satisfied merely to consolidate our gains or to level off our support of these endeavors.” The National Institutes of Health, he said, had “brought American medicine to the forefront of the world. It would be a crime against humanity were we to negate what has been done by proceeding faintheartedly and lacking resolution and the courage of our convictions.”
His pitch worked. Congress voted to expand the NIH budget—from $134 million to $215 million. And they granted permission for a special committee to study the feasibility of the artificial heart—with DeBakey as a member, of course. More important for DeBakey, Baylor College of Medicine was one of several institutions given $10 million in federal funds—about $75 million today—to set up a research facility specifically designed to pursue the development of the artificial heart.
DeBakey knew he could make a device that could change the course of history. After all, the heart was just a pump.
* * *
Even when Bud was a much older and more accomplished man, he could still find himself obsessing about DeBakey. He studied biographies of Joseph Stalin, which offered helpful insights. He gave DeBakey his due—a person couldn’t have built Baylor and Methodist Hospital, much less the Texas Medical Center, into the globally recognized institutions they had become without an indomitable will. Thanks to DeBakey, Bud and his fellow students had endured the toughest, most challenging program of its day. You were the best, like the Marines. So Bud would never say something as mundane as “That guy was an asshole.” Instead, he just told stories.
Bud was twenty-three when he started at Baylor in 1963. DeBakey was as selective of his students as he had been in picking the faculty and staff, which came from the likes of Harvard and Johns Hopkins. There were only seventy-five in each class, and they came not just from Texas colleges and universities but from the best schools across the country: Duke, Pomona, Princeton, Stanford. “Everybody in my class wanted to be either a surgeon or an internist,” Bud recalled. “We had one guy that wanted to be an ophthalmologist, but he always had to explain himself when he said he was going to be an ophthalmologist, because that wasn’t a real doctor.”
Bud figured he would try surgery. He had a lab partner who developed a tremor in his hands, and so Bud ended up doing all the operating for both of them. Within a few weeks, he knew he had found his calling. While others struggled, he knew, in some deep-seated, intuitive way, that he could do it. It wasn’t just that his hands were good, or that he had near-perfect recall for the body’s anatomy, or that he wasn’t afraid when he picked up a scalpel. Bud was like a novelist who understood his story without seeing it on the page; he just knew where he was supposed to go.
Like all Baylor students, he quickly learned that his chief was a mixed blessing. It was best to steer clear of DeBakey as much as possible; only the clueless or heedlessly ambitious asked him questions. You were never supposed to interrupt DeBakey’s ostensibly brilliant train of thought. When DeBakey drove his white Maserati to the doors of Baylor at the 5:00 a.m. start of his workday, he wore custom-made royal-blue scrubs; interns waited anxiously to park his car. Greeting him with a sunny “Good morning” was a risk few took. Riding with him to nearby hospitals could be a career ender. God forbid if you pushed an elevator button that slowed his progress when he was on it.
Baylor docs in training were zombies a lot of the time: once DeBakey’s students started working with real patients in their third year, they were expected to take call every other night—to be in the hospital all night and all the next day, while still responding competently to any emergency. It was a lot like combat, which, given DeBakey’s military experience, made—some—sense.
On the other hand, DeBakey wasn’t around that much, because he was so often off in DC to lobby for something, or in Europe teaching other surgeons some new technique or checking up on a former patient like the Duke of Windsor.
When he was in Houston, DeBakey was a regular if unpredictable presence in his small but active cardiovascular lab, located in the original Baylor building in what was then called the hospital’s “Jewish Wing,” because it existed thanks to the largesse of Houston’s wealthiest Jewish donors. As with so many things DeBakey created, it was devoted to excellence, but the high quality was maintained by a group of people who were, well, odd. A medical degree—or any medical training—was not a requirement, partly because there were no hospital committees then governing medical school labs, partly because DeBakey ran the place, and partly because that was how things went in Houston.
The most valued member of the team may have been a brilliant machinist from New York City by the name of Louis Feldman, a sweet, soft-spoken immigrant originally from Eastern Europe. He and DeBakey were devoted to each other because the self-taught Feldman could fabricate anything DeBakey requested, and that was not easy. There were two black assistants named MC and Fred—their last names have been lost—who performed most of the animal surgery. There was a heart valve expert by the name of William C. Hall, from the University of Kansas, who loved nothing more than making and baking molds for artificial heart parts in his kitchen at home on weekends. Another key staff member was Domingo Liotta, an Argentine surgeon who was both florid and brooding, but like
Hall obsessed with the creation of artificial organs. DeBakey had enticed Liotta to Houston from the employ of Willem Kolff at the prestigious Cleveland Clinic, a coup at the time because, for people who followed such things, Kolff was considered the father of the artificial organ field. A Dutchman who fought in the resistance during the war, he’d gone on to invent the first dialysis machine—an artificial kidney. With various associates, Kolff had begun implanting prototypes for an artificial heart in dogs in the 1950s; one lived for what was then the miraculous period of nine hours.
There was also an assortment of interns and medical students rotating in and out, not the least among them a tall, goofy country boy who went by the name of Bud.
Looking back, Bud figured that he was able to survive his sentence with DeBakey for two reasons: the prior abuse he had put up with from his football coaches, and the good manners his parents had stressed. They had taught him to keep his head down, work hard, and (mostly) respect his elders. Bud quickly understood, for instance, the dangers of asking DeBakey any questions, so he didn’t. Baylor’s motto was “see one, do one, teach one,” which from today’s perspective sounds like a recipe for a lawsuit. It worked well at the time because there was (a) less to learn and (b) the punishment for slipping up in even the smallest ways got you fired. DeBakey made experienced residents stand in the corner when they displeased him in the operating room. He fired a nurse who was just a week away from her retirement when she was too slow following orders.
When Bud slipped up—and everyone did—he braced for the public shaming. The smooth Louisiana inflection DeBakey used in normal discourse—such as there was—would become a hiss, and the list of sins could go on for what seemed like an eternity. Once, Bud got the time wrong for a procedure and ran late. “Of course, if you cared, you would have been there early,” Bud would recall, in an admirable imitation of DeBakey’s voice, and with the same accuracy with which he recited Shakespearean sonnets. “If you cared, you would have had to learn something. But of course, to do that, you’d have to care. But obviously you didn’t care…” and so on. Other times, DeBakey would just cut to the chase with the favorite, “You’re either stupid or you don’t care.” Often, DeBakey added a punch to the chest with one of his strong, bony knuckles. Anger management training had not yet come into being.
Bud took cover under the tutelage of another Baylor surgeon named Stanley Crawford. Crawford was a stocky, soft-spoken Alabaman, who had come to Baylor from Harvard Medical School and Massachusetts General Hospital. His expertise was heart disease and heart surgery, but he loved nothing more than operating on weekends in the small suburban hospitals ringing Houston, oil refinery towns with deceptively pretty names like Baytown and Deer Park. The patients were mostly blue-collar workers and their families—Houston was a blue-collar town then—people of modest means and, compared to the patients on DeBakey’s service, modest problems.
So, on Saturday mornings around 6:30 a.m., Bud would leave Rachel and their cozy cottage in the Montrose area and travel the few miles to Crawford’s spacious home in River Oaks. They’d go out for a big breakfast and strong coffee somewhere, and then start “doing cases,” as Bud puts it. Often, the only other doctor in attendance would be a family practitioner; itinerant surgery, as it was called then, is now illegal. But here was how Bud learned to be a surgeon, assisting Crawford in taking out gallbladders and repairing small-bowel blockages, whatever was needed. Crawford never raised his voice; he was exacting but patient. There was no other place on earth Bud would rather have been.
Even so, he had already decided to specialize in heart surgery. The death toll from heart disease was skyrocketing in 1963: every day another patient at Methodist died because the doctors had so little to offer. There was one patient in particular whose terrified, pleading expression would stay with Bud for the rest of his life. He had worked up a medical history for one of DeBakey’s growing list of international patients, a seventeen-year-old Italian boy who was only a few years younger than Bud himself. Med students who did the workup also got to scrub in on the patient’s surgery. Bud was there for what he expected to be a routine replacement of a damaged aortic valve. The kid was thin from his illness but handsome, with dark eyes and thick black hair; optimistic about the surgery, he was eager to go back home. His mother was with him.
The surgery went fine—Bud held and retracted, nothing glamorous, but still exciting for a student. That night, though, the boy’s heart stopped—this sometimes happened, inexplicably, with aortic valve disease. The only way to save the boy was to use a procedure that had first been tried just two years back, in 1961—to reopen the chest and manually massage the heart to restart it.
A resident cut the boy open again, then turned to the strongest person in the room: Bud. He showed Bud how to reach into the boy’s chest and squeeze his heart, mimicking the pumping action of a healthy organ. Around that time, the sedated boy woke up and locked eyes with Bud. The nurses sedated him again, but the boy kept his gaze on Bud and tried to reach for him, to hold on. Minutes passed. Bud’s hands cramped, and then the pain began radiating up his arm. He kept going.
DeBakey strode in, took one look at the scene, and ordered Bud to stop. Experience told him that too much time had passed, and that they were not going to be able to restart the boy’s heart. But Bud kept squeezing and releasing, until finally a resident had to shove him aside. As soon as Bud let go, the boy slipped away. He could hear the mother sobbing in the waiting room when DeBakey went out to give her the news.
As it turned out, that episode would change everything for Bud. If the simple pumping action of his hand could keep someone alive, he figured, there should be some kind of machine that could do it longer and better. It would have to be something a tech could pull off the shelf and a surgeon could implant, a machine that would run almost perpetually inside a human chest. An artificial heart.
4
A TOUR OF HELL
“It’s too painful and it’s really not that important,” Bud says about his military service. Still, his one-year tour in Vietnam does come up every once in a while. He likes going to author readings, and if the author is a veteran, Bud is likely to add his own commentary at some length, during the Q&A session for which he has often arrived late. He is a fan of Viet Thanh Nguyen’s “The Sympathizer,” for instance, but took umbrage at Nguyen’s meditation on war, “Nothing Ever Dies.” “That guy was never in combat,” he snorted, providing a capsule review.
Bud’s personal philosophy of war is that young men are sent to fight because old generals need something to do. On this subject he likes to quote the cynical old saw from a probably mythical general who told his troops: “Boys, this is a bad war, but it’s the only one we’ve got.”
Exhibit A is a DVD entitled Bud Frazier’s Holiday in Vietnam, made for a biographical film about his life that was never produced. Frazier tends to watch it leaning way back in his office chair, with his hands on his belly, the look on his face not quite readable—wonder? pride?—as he watches a version of himself from more than fifty years ago, sporting a buzz cut and deep dimples when he grins. Then as now, he has a sly look in his eyes that suggests more than a passing acquaintance with and deep affection for absurdity.
The silent, one-hour video is a collection of clips that span the time from November 1968 until the end of 1969, when Bud’s tour was up. Judging from the content, he seems to have spent the year ministering to villagers, especially apprehensive children, and learning karate from the Korean soldiers his unit was supposed to be training. In the video, he works for his black belt by practicing complex spins and high kicks that land perilously close to the chin of his instructor. There Bud is, tall, tanned, and impossibly buff—his grown daughter, Allison, would later tease that he was never that thin. There are shots of boat rides up and down a stunning coastline lined with white sand beaches and palm trees, the jungle-covered mountains in the distance. In other scenes, Bud p
laces his stethoscope on the chests of wary children while a gaggle of villagers wearing paddy hats surround him, pushing forward to be next in line. Bud was twenty-eight when he was drafted—just in the middle of his residency in general surgery. Still, in those moments, the lanky, easygoing West Texan disappears. His body grows tight and coiled, as if he is dispatching all his concentration to the fingertips holding his stethoscope in place. The surgeon he will become is plainly visible, his confidence and concentration amid the chaos almost palpable.
Bud was drafted as part of the Berry Plan, a federal program that was supposed to address the shortage of doctors in the military by offering plum assignments. The government asked medical draftees to list their top three preferred placements. Bud was no dummy; he requested surgery jobs in Hawaii, San Francisco, or Germany. The officer in charge started laughing when Bud told him he hadn’t requested Vietnam.
Still, Bud figured he had a way out. One of his closest friends from medical school was from the Texas-Mexico border near Del Rio, the son of a wealthy radio station owner who ran one of the cuckoo, buy-our-autographed-pictures-of-Jesus channels that proliferated back then. He’d also grown up accustomed to the kind of hazy legality that was part of life on the border, so he convinced Bud he could bribe his way out of Vietnam. The guy knew a guy—an officer in Washington, DC, they could talk to. When they got their meeting, they headed for the nation’s capital. In a result that could only shock a pair of twentysomethings, that officer also started laughing when they made their offer.
Bud’s next sidestep was to follow the advice of a returned veteran who was running the Baylor charity hospital at the time: Bud should apply to become a flight surgeon, because he would make an extra $100 a month and would get training in aerospace medicine. This sounded like a great idea, so that’s what Bud did.