Ticker

by Mimi Swartz

  But it also marked another step in the deterioration of the relationship between the powerful Baylor chief and his equally ambitious protégé. Relations had grown so testy that everyone from scrub nurses to international socialites began to feel as though they had to choose sides. Mary Lasker wrote of one particular evening when Cooley and DeBakey made a joint appearance: “Denton Cooley, another surgeon from Houston, was there, who was very attractive but didn’t have the big statesmanlike quality that DeBakey has….Cooley is a fantastically skilled surgeon that Princess Lilian [of Belgium] also took a great fancy to, but he is strictly parochial Texas as far as politics or health insurance goes.”

  Parochial or no, the census at DeBakey’s most prized Baylor affiliated hospital, Methodist, was exploding. Its popularity was certainly due to DeBakey’s reputation, but now also to Cooley’s. A silent battle for hospital beds and operating rooms between Baylor’s biggest stars naturally followed. Tired of DeBakey’s bigfooting and always eager for more room for more patients, Cooley quietly moved most of his operations out of DeBakey’s reach without abandoning the Texas Medical Center. His first perch was Texas Children’s Hospital—Cooley did perform surgery on children and infants, after all—and then, in 1960, he moved to St. Luke’s Episcopal Hospital nearby.

  * * *

  Cooley began building a world in his image. He populated his formal office at St. Luke’s with stunning nurses and secretaries, leggy and mostly blond, who called his patients “sweetheart” and “darlin.” They wore short skirts and sometimes took notes using ballpoint pens topped with artificial daisies. The residents who assisted were also uniformly attractive—virile Texas good ole boys—as if Cooley were assembling his team by way of central casting.

  When he wasn’t operating, Cooley spent most of his time in a small, cluttered, windowless office near Operating Room 1. Every day, he made quick work of the same disciplined lunch—a cup of yogurt or soup and half a sandwich—and thought about what he wanted.

  Cooley felt the pressure: People were dying because advances in treating and curing heart disease weren’t coming fast enough. And the number of sufferers was going up, particularly for middle-aged white men. For those whose hearts he could not repair, he had nothing. There were only two answers: someone had to come up with a way to transplant a heart from one person to another, or someone had to come up with a mechanical replacement for the heart.

  A mechanical heart, Cooley thought, just wasn’t feasible. He’d heard scuttlebutt from Methodist that DeBakey believed that if a damaged heart was just given a rest—helped along with a mechanical pump—it would eventually cure itself, a premise Cooley found absurd. Other heart surgeons, however, were not so sure. The brilliant surgeon Adrian Kantrowitz, who had devised his own heart-lung machine, had also worked with a colleague at Maimonides Hospital in Brooklyn to transfer some muscle from a dog’s diaphragm into its damaged heart. That healthy muscle was able to take over 25 percent of the heart’s pumping action, thanks to an electric booster from the natural pulsations, transferred via radio signal. (The dog, named Ruff, was a mutt who was later named Research Dog of the Year by the New York Academy of Sciences for his contribution to medical progress.)

  Cooley was far more interested in the second option, transplantation. Yes, there were problems of tissue rejection, but those, he believed, were no big deal. He was more frustrated by psychological barriers. Transplants raised all kinds of questions with—to him—varying degrees of looniness among the public: Could a person still get into heaven with the heart of another? Would a man become more feminine if he received the heart of a woman? And so on. It infuriated the preternaturally pragmatic Cooley that so many people still believed the heart was the center of the soul, and that tinkering with it or putting it into the chest of another person was deeply, spiritually wrong. To him, it was spiritually wrong to withhold lifesaving treatments. On this point, Kantrowitz agreed: “You know, the heart…people say it’s the seat of the soul, or the organ of love,” he said. “I don’t know much about the soul, and as for love, there are better organs for that. No, it’s a pump.”

  Kantrowitz, as well as Norman Shumway at Stanford, was already experimenting with heart transplants in animals, but Cooley and other surgeons knew there was a legal issue to be resolved before any heart was transplanted between human beings. The legal and medical definition of death at that time included the lack of a heartbeat. But when it came to transplanting a heart from one person to another, a non-beating heart was useless. Death itself had to be redefined before doctors could start transplanting hearts. If, for instance, a lack of brain activity could also be used to define death, then Cooley would head for the operating room free and clear. Until then, he was stuck.

  Waiting was not Cooley’s strong suit. He distracted himself with another big idea: a hospital devoted entirely and exclusively to solving the myriad problems caused by heart disease. Raising money from his Houston pals wasn’t likely to be a problem. That kind of hospital would be a surefire moneymaker, given the prevalence of heart problems. At St. Luke’s, Cooley was already doing three or four times as many surgeries as Methodist was doing, saving lives and throwing off cash like those early Texas gushers. But something else was eating at him: Cooley had heard that DeBakey was planning to build a special cardiovascular unit of his own, without including him.

  In fact, DeBakey was on his way. He wasn’t impressed with Cooley’s access to the fortunes of rich Houstonians—DeBakey had tapped them too. That’s how he got Methodist Hospital built as a showplace. But there wasn’t much reason to go begging when he had access to millions for Baylor research projects from the National Institutes of Health.

  Transplantation, however, was not high on DeBakey’s list. Like Cooley, he had seen that the mere suggestion of the surgery inspired all kinds of public hysteria, and he wanted nothing to do with settling such ridiculous questions.

  Besides, he was already under pressure on another front. DeBakey’s image had appeared on the cover of Time in 1965 with the headline “Toward an Artificial Heart.” But now the man who had promised a mechanical heart to Congress in 1963 had become diverted by another idea: a “half heart” that would assist the left side of the heart. After all, most of the action was there: the left ventricle did all the heavy lifting, pumping blood to the rest of the body. (The right side is responsible only for pumping blood to the lungs.)

  Like Kantrowitz, DeBakey was following a small body of new research that suggested a damaged heart could eventually return to normal with proper care. In July 1963, for instance, DeBakey’s associate and Bud’s mentor, Stanley Crawford, implanted a device designed to assist the pumping action of a damaged left ventricle; the patient lived for four days, enough time to incentivize the inventors, who declared the surgery a success because the pump was not the cause of death. “The pump was still working when he expired,” noted DeBakey associate Domingo Liotta, who had devised the machine.

  DeBakey also used federal grants to establish a joint task force with Rice University, located just across Main Street from the medical center. Rice engineers were then known to be some of the best in the world; they worked in the oil fields, and, in the early sixties, as the space program flourished, at NASA. This new team upped the weirdness factor in the labs—Rice engineers were known to be very smart but somewhat limited in social terms. These were the guys who seemed to have been born wearing pocket protectors.

  For the next three years, this team continued its work on what they called a left ventricular assist device, LVAD for short. They didn’t have much luck. DeBakey tried eight surgeries, and only two patients survived. (No doubt this pleased Team Cooley, who liked to claim that DeBakey was just too slow in the operating room. Heart surgery was a young man’s game, and he was in his fifties.)

  Then, in August 1966, DeBakey’s team put an LVAD into a tiny thirty-seven-year-old woman from Mexico. She’d had rheumatic fever as a child
and had been declining with heart disease for five years. By that point, she was spending most days in bed. But not only did Esperanza del Valle Vasquez survive the surgery; she also began to thrive. In just over a year, she was back at work in her Mexico City beauty parlor. Esperanza—the name means “hope” in Spanish—would live another six years, her life ending prematurely not because her heart failed but because of an auto accident. A widely disseminated photo—courtesy of Team DeBakey—shows Vasquez very much alive post-op, with tubes from the LVAD dangling just below her collarbone; her smile is radiant as she grasps DeBakey’s hand and gazes worshipfully into his eyes. Soon after, Baylor signed contracts with a Los Angeles company for the manufacture of sixty-two LVADs.

  Advantage, DeBakey. The editors at Life magazine—a masthead full of middle-aged white men who had or surely were developing heart problems themselves—were desperate for exclusives with the great doctor. (It didn’t hurt DeBakey’s press that he made a habit of meeting reporters in blood-spattered scrubs.) Though Houston cardiologists were quietly sending their patients to younger DeBakey associates like Stanley Crawford and George Noon, DeBakey’s patient roster was packed with the rich and famous—from out of town.

  But then something happened thousands of miles away, on the other side of the world. On December 4, 1967, a Cape Town surgeon by the name of Christiaan Barnard took the heart of a brain-dead young woman who had been hit by a car and sewed it into the chest of a fifty-five-year-old man named Louis Waskansky, who lived an astounding eighteen days.

  Long before the age of social media, this news rocketed around the world, making headlines, interrupting television programs. It didn’t hurt that Barnard was made for television: he had the twinkling blue eyes, the broad, sparkling smile, and the quick, seductive wit of a seasoned pol or a Hollywood star—yet another heart surgeon who gave healthy women palpitations. And now he was the hippest, hottest heart surgeon on earth. Unlike his colleagues in America, Barnard had not been hamstrung by silly laws about death determination, or any dithering about the spiritual qualities of the heart.

  He had just gone and done it.

  6

  THE PURLOINED HEART

  Today, heart transplants seem almost as routine as hip replacements. Anyone invited to observe transplant surgery at the Texas Heart Institute, for instance, would notice that Bud operated with all the drama of a dentist doing an annual cleaning. Ordinarily, the procedure takes around four hours—far less time than it takes to fly from New York to Paris. Hospital stays last about two weeks. The total cost ranges from $780,000 to close to $1 million, but, of course, very few people pay out of pocket. Medicare chips in, and most hospitals happily offer any number of plans to help a patient finance a new heart.

  Even so, there is always a moment or two during surgery that would remind even the most jaded soul—at least, one who isn’t a surgeon—that something pretty profound is going on. The first occurs after the patient has been laid out on the operating table and his body draped in paper; the only flesh visible is the chest, stained a brilliant yellow from the antibiotic wash. There aren’t that many people in the room: a couple of docs, a few nurses, the perfusionist who connects the patient to the heart-lung machine, and the anesthesiologist, who makes sure he stays under and stays alive.

  Then a surgeon—sometimes a younger associate—opens the chest, so as not to waste the time of the higher-priced expert, like Bud, who will do the real work. He makes the incision, cutting through tissue and muscle, pulls open the ribs with a retractor, and there it is: the heart, a spectrum of the most vivid shades of brown, red, yellow, and the palest blue, beating in its lair, bobbing on a tide of blood. If the heart is diseased, it might beat more faintly, or it might be covered by a layer of bright yellow fat, or it might be supersized because it’s grown too large with muscle trying to compensate for its inability to pump enough blood.

  Still, it is a living heart—that is, until the operator of the heart-lung machine flips a couple of switches and the machine takes over its business. (Today, the bypass machine is about the size of a small central air-conditioning unit on wheels, with myriad dials and gauges, along with tubes and vats for circulating and oxygenating the blood.) Once that happens, the heartbeat slows and then finally stops.

  Enter Bud Frazier. He wears tired pale green scrubs with one of his even more tired burnt-orange UT Longhorn T-shirts underneath. Strands of curly white hair resist the confines of his surgical cap, and there are bright lights attached to the rims of his operating glasses. He leans over the patient and starts clipping away with his big, football player’s hands until he reaches familiar terrain. He cuts the heart loose from its moorings. Then he lifts it out and hands it to a nurse who readies it for the pathology lab with about as much ceremony as a beleaguered husband taking out the trash. Bud has already turned back to the patient on the table, who now has an empty cavity that to a layperson might appear as dark and infinite as outer space, but to the surgeon just represents intermission.

  Next, a nurse reaches into a Styrofoam cooler—the kind you would take on a picnic—and pulls out the new heart, which has been wrapped in plastic and packed in ice. She hands it over. Maybe it came from someone who died in a car accident, or a knife fight, or some other horrible fluke that causes grief to his or her family and a compromised joy for the recipient. The heart is a little pale from lack of circulation. That paleness contrasts with Bud’s gloves, bright blue and now flecked with red blood turning brown in spots where it’s dried. He takes the heart in his hands and eases it into the empty space, and then keeps pushing and prodding with some force, until he likes the position. Then he goes to work, sewing the donor heart in place, connecting it to the pulmonary artery and the aorta, and the atria—the circulatory system’s main entrances and exits.

  Finished, Bud stands back for a minute and waits; so does everyone else in the room except for the perfusionist, who is busy with his dials and switches again. He is the only person who isn’t staring at the chest of the patient. He’s weaning the patient off the machine.

  And then it happens: the new heart begins to take on a richer color as it fills with blood. It begins to beat, searching for and then finding a normal rhythm, settling into its new home. The associate steps in again to close up the chest. Bud exits, snaps off his gloves, unties his gown and cap, pushes a hand through his hair, and goes back to his office, where he checks his messages, watches a little on Turner Classic Movies, or, maybe, takes a nap.

  Bud has never believed a heart transplant to be a cure-all. He will tell you that a person is really just exchanging one set of medical problems for another. Pain gets traded for medication and constant monitoring, though you get the chance to walk around the block, go out to dinner, or on a good day hit the mall. As a younger surgeon, Bud had been skeptical of the value. But now his son and daughter have children of their own, and the idea that his kids’ lives could be cut short—that they wouldn’t live to see their kids grow up, as he has—is something he prefers not to imagine.

  * * *

  Bud was rescuing wounded boys from Central Highlands mountainsides when Christiaan Barnard performed the first human heart transplant. Some years earlier, Barnard had come through Houston for some training with DeBakey, but, the story goes, no one had been particularly impressed with his abilities. (Getting heart surgeons to praise one another is like asking the same of trial lawyers. It rarely happens.) Now, as news of Barnard’s success circled the globe, there was a lot of gnashing of teeth and rending of garments among the small community of American heart surgeons. In 1968, the concept of brain death was finally accepted in the United States, partly with the proof of flat brain waves provided by the EEG machine, but thanks also to ratification of a definition by the 22nd World Medical Assembly, and by an article that appeared defining irreversible comas in the Journal of the American Medical Association by a group from Harvard Medical School that may or may not have been influe
nced by Barnard’s triumph.

  Anticipating the official go-ahead, Shumway at Stanford and Kantrowitz in New York had been racing each other to be the first to transplant a heart, and were caught flat-footed by the events in South Africa. Cooley wasn’t happy about it either. He sent Barnard a telegram: “Congratulations on your first transplant, Chris. I will be reporting my first hundred soon.” But it was Kantrowitz who crossed the finish line next by transplanting a heart from an eighteen-day-old baby into one who was two days old—and died within hours.

  The biggest surprise—after Barnard’s success—was DeBakey’s reaction. He had been skeptical of transplantation because of all the sociological problems it caused—and because he had spent years publicly and privately touting mechanical replacements for the heart. Now he made a hairpin turn and swiftly organized a transplant committee at Baylor. Once again he snubbed Cooley, even though Cooley was still a prominent member of the medical school faculty and even though he was, and not solely by his own admission, a leader in the field. (In 1967, for instance, the International Surgical Society gave Cooley its highest honor and called him “the most valuable surgeon of the heart and blood vessel anywhere in the world.”)

  “Maybe it’s immodest of me,” Cooley wrote in his autobiography, “but I thought that since I was the most experienced heart surgeon in the world, I was the one best qualified to perform transplants in Houston.”

  Still, DeBakey’s snub left Cooley free to proceed on his own. His Texas Heart Institute had fast become a reality. Ground had been broken in 1967 on a building connected to St. Luke’s Hospital, a contemporary high-rise of coffee-colored brick well stocked with state-of-the-art operating rooms. (Some would have glass-domed ceilings, so that visitors on the floor above could watch the surgeries.) Yet another grateful Cooley patient from the oil business had donated the initial $5 million, with more flowing in from other locals as well as thankful patients from around the globe. Now Cooley didn’t have to fight DeBakey for beds or funds. (“Denton just got tired of sucking hind tit,” was the way one colleague put it.) He was where he most liked to be: in the land of the free.