by Mimi Swartz
But now he had been beaten by a South African surgeon with half his talent. It was untenable.
* * *
Cooley nursed his injured pride for six miserable months until, in May 1968, he saw his chance in the form of Everett Thomas, who was wasting away in a hospital bed at St. Luke’s. Thomas was only forty-seven but had suffered two strokes and two heart attacks. It was clear—to Cooley, at least—that a transplant was Thomas’ only option. It was fortuitous, then, that a fifteen-year-old girl shot herself in the face after arguing with her nineteen-year-old husband, and arrived at St. Luke’s with flat brain waves. Two Cooley associates talked with her parents, who gave permission to donate her heart. It might not have been much of a discussion: Cooley had operated on the poor girl to correct a congenital defect a decade or so before.
Cooley, who was speaking at a medical conference in Louisiana, raced back to Houston on a chartered plane and immediately set up two operating rooms, one for the donor and one for the recipient. He figured that transplanting a heart would be easy, even if he hadn’t done it before. Certainly it would be easier than the tedious, intricate operations he was doing almost daily on the tiny diseased hearts of children. All he had to do was cut out Thomas’ damaged heart and sew in the new one. Then he would unhook the clamps, let the blood pour into the new heart, and, presto, Everett Thomas would be a new man.
When he got into the operating room, Cooley as always worked intuitively, which was just about his only choice. He knew his destination, but there were no maps to show him how to get there. He had a moment of doubt when he removed the vascular clamps and the heart started—but with an irregular beat. Cooley turned to the nurse holding the defibrillator paddles and grabbed them out of her hands, pressing them into Thomas’ chest to give his heart a shock. There was a buzz as electricity traveled from the paddles to the heart, then silence. Cooley stared down at the new heart, willing it to perform. Now it was he, not Thomas, who was barely breathing.
Seconds passed, and then…damned if Thomas’ heart didn’t begin to beat normally, as if it had finally caught the melody of a familiar tune. Cooley had done in thirty-five minutes what had taken Barnard nine hours.
Now it was Cooley’s turn to be the international sensation—again. He could now claim that he had completed the first successful heart transplant in the United States, because Thomas—unlike Barnard and Kantrowitz’s poor souls—was alive and well. Reporters raced to the hospital; one even suffered a broken leg in the crush to get to a press conference. Then came the desperate, in droves. One got to Houston on a jet provided by his congressman. A man from Kentucky demanded Cooley give him a penis transplant. The “waiters,” as they were called, fought for a room in the already packed motels ringing the Texas Medical Center, letting their hopes take flight every time an ambulance pulled into St. Luke’s emergency entrance with its sirens blazing. Cooley didn’t mind the death threats he got from those who believed that transplanting a heart was against the will of God. He was back on top. And he’d heard that when DeBakey got the news, he had canceled his surgeries for the day and locked himself in his office.
The truth was, DeBakey had been dragging his heels with his own transplant team. Finally the Methodist surgeons, desperate to keep up, had to push their chief to make a move. In particular, a talented and ambitious surgeon by the name of Ted Dietrich, who had long been studying the possibility of multiple organ transplants, urged DeBakey to join the march of progress—or be trampled into the dust of obscurity. In fact, they had to do better, which was why, three or so months after Cooley’s triumph, Dietrich and DeBakey went into their operating room and transplanted not just a heart but a lung and both kidneys.
Cooley countered by taking the ever-so-tiny heart and lungs from a brain-dead baby and sewing them into the chest of a two-month-old. The child died fourteen hours later, but in this new, miraculous world of transplantation, the operation was still considered a success. You could build on fourteen hours.
By the end of 1968, there was only one place to go for a heart transplant: Houston, Texas. Cooley had performed seventeen of them, more than anyone in the world. Along with DeBakey, he was now also among the richest surgeons in the world—easily a multimillionaire—and he had turned the Texas Heart Institute into a mecca not just for patients but also for doctors who wanted to learn at the feet of the master.
That was the good news. The bad news was that by the end of that year, only four of DeBakey’s ten transplanted patients and three of Cooley’s were still alive. Everett Thomas, who was tethered to the hospital for so long that Cooley had found him a job as a trust officer at a nearby bank, died after seven months, the longest survivor. Other surgeons around the world were reporting similar failure rates, and had started talking about a moratorium on transplants, first privately and then publicly. It was commonly believed the patients were dying of rejection—their bodies wouldn’t accept the heart of another human. No one knew why. Maybe the whole thing had been a crazy idea from the start.
Many in the press thought that way. “Transplants, Apollo Both Misguided?” asked a story by Judith Randal in the Washington Star in 1969. “Many people see, in the proliferation of heart transplants and in the space race, efforts to keep up with the Joneses rather than a concern for doing our own thing.” The story went on to suggest that most Americans would prefer a cure from cancer over a Mars landing.
Meanwhile, Cooley saw that with every death, the public was becoming less and less willing to donate their own hearts or those of their loved ones. He knew that the drop-off in donors would mean they would never be able to understand what was going wrong. Hoping to change minds, he starred in a television commercial for the Living Bank and declared his own willingness to be a donor. But nothing helped. “I can respect, if not agree with, the contention of some people that the spirit or the soul or what have you resides in the heart,” he would write. “But it was impossible for me to in any way agree with those otherwise enlightened people who chose to relegate the viable organs of their loved ones to dust when those same organs would have provided hope for people who were dying in wait. It was frustrating as hell.”
* * *
Cooley brooded in his private office, the one conveniently situated among his six operating rooms. It was a cramped, spare place, probably because Louise Cooley hadn’t applied her decorating skills as she had upstairs, in her husband’s baronial public suite. Down here, it was that pinkish-green fluorescent lighting that set off the photo of his transplant team with a quote from André Gide: “Man cannot discover new oceans unless he has the courage to lose sight of the shore.” Cooley, now forty-eight, was stymied, a feeling he ranked alongside introspection on the scale of useless mental states. A different kind of man would have been distracted by all the turmoil that had taken place outside the hospital in 1968—the race riots, the ongoing Vietnam War, the assassinations of Martin Luther King Jr. and Robert F. Kennedy, the student protests around the world, the beginnings of the women’s movement, the Soviet invasion of Czechoslovakia, Jacqueline Kennedy’s traitorous marriage to Greek shipping magnate Aristotle Onassis. But Cooley wasn’t drawn to dinner-table debates. He was a Nixon man. He believed in the war in Vietnam. He saw no parallels in the rebelliousness that was sweeping the United States and the powerful internal pressure that pushed him to go his own way. Hippies in Haight-Ashbury? He grew his sideburns a little longer, that was it.
The only event that did galvanize Cooley was the proposed launch of Apollo 8 in December. American astronauts, running second to the Soviets, were finally going to orbit the moon—just as Kennedy had pledged in 1962. But Cooley knew better than most that DeBakey’s simultaneous promise to eradicate heart disease with a mechanical heart was going nowhere. Cooley knew this because he knew his nemesis. Mike DeBakey wasn’t a risk taker.
Then, on a sweltering day in July, Cooley was replacing an aortic valve on a middle-aged man when the man devel
oped “stone heart,” a rigor-mortis-like condition when an already damaged heart literally begins to harden and die in the surgeon’s hands. Everyone in the room understood. The look of defeat could be seen in their eyes, visible between their caps and masks. No donor heart was waiting in an ice chest nearby, and there certainly wasn’t time to retrieve one, assuming one could even be found. And, of course, no artificial heart existed that could keep the patient alive until a real replacement could be transplanted. Cooley’s patient had run out of options, and so had he.
But Cooley, his gloves coated crimson, wouldn’t stop. He had one last idea; he ordered an associate to the lab, who returned with an anesthetized sheep, ready for surgery. In an adjacent operating room, they cut out the animal’s heart, and soon enough Cooley was sewing it into his patient before anyone in the room could really fathom what was happening.
In 1969, there were no plaintiff’s lawyers squatting in the hospital lobby, no rules guiding what a surgeon could or could not do in an emergency. As Cooley saw it, his job was to save lives. If the sheep’s heart lasted even a few hours, maybe he could find a human heart donor, and a crazy idea wouldn’t seem so crazy.
Finished, Cooley plucked off the clamps and waited for the blood to start flowing into the heart, causing it to turn that familiar, robust pink. Instead…nothing. The sheep’s heart shrank and then shriveled, and Cooley could do nothing but watch his patient go.
A few months later, he told a group of reporters that he had begun to work on an artificial heart.
The only problem was, Cooley didn’t have one. He just had an idea of one. The person who actually had an artificial heart was Domingo Liotta, who had been working on his own while DeBakey pushed for the heart assist devices—the LVADs—in the Baylor lab. A taciturn, somewhat dour man in public, Liotta was privately a bit on the baroque side, especially when he took to the page. As Liotta would later write of Cooley’s sudden interest, it was “not needful to express my full conviction of this wisdom.”
In fact, Liotta was feeling like a jilted lover. Initially, the great Michael DeBakey had been willing to do anything for the researcher he had enticed from Willem Kolff’s lab, the Argentine immigrant who was certain he could build an artificial heart. DeBakey eased Liotta’s visa woes and ordered any equipment Liotta desired. He got Liotta an appointment as an advanced research fellow in cardiac surgery through the American Heart Association, which doubled his pay. DeBakey even stonewalled the dean of the medical school back in Argentina, who wanted Liotta back. His presence in Houston was crucial to medical progress, DeBakey insisted.
But gradually DeBakey seemed to lose interest in Liotta and his grand plan. The more work they did, the more DeBakey saw that he had profoundly underestimated the complexity of the heart and the biomedical challenges of building a successful replacement. In fact, these were problems that would remain for decades to come. The main issue was with the blood, which, like the heart, had a particular way of doing things. If an artificial heart couldn’t push the blood through the body evenly and fast enough, it would pool and form clots, eventually blocking pathways and causing a stroke. But if a pump pushed blood through the body too fast, its delicate red blood cells would break up from the stress, depleting the blood of crucial oxygen. This too could be fatal.
Once Liotta started implanting his device in calves, DeBakey became even less interested. The heart was made of hard plastic and was about the size of a honeydew melon, with two chambers; they looked a little like two flattened-out versions of the planet Saturn. An air compressor about the size of an upright piano was supposed to power the pumping action. But it just didn’t work very well: out of seven calves, only one lived—for forty-four hours. DeBakey got a look and described the lone survivor as “a cadaver from time of implantation.” So it wasn’t very surprising that DeBakey started backpedaling on the total heart he had once promised would be ready by 1969. Now, he said, it looked more like 1972. Or maybe 1973.
Then too, President Richard Nixon didn’t share his predecessors’ passion for a high-tech war on heart disease. Prevention was becoming the new buzzword—maybe the government should be urging people to eat less, smoke less, and exercise more instead of funding weird experimental devices. Besides, prevention was a lot cheaper.
DeBakey, with the distant early warning system of a bat, decided to focus solely on the left ventricular assist device, which, after all, had worked at least once: on Esperanza del Valle, the grateful hairdresser from Mexico. He had spent the following year implanting a few more, with mixed results—though as time went on, the LVAD experiments looked a lot more promising than heart transplants.
Ditto the total artificial heart. Yes, DeBakey had hired Liotta to work on one, but now he ordered Liotta to work exclusively on LVADs. When Liotta tried to complain, DeBakey refused to return his phone calls or answer his memos; when Liotta showed DeBakey a model of an artificial heart he was refining, DeBakey, exasperated, demanded Liotta put it away and never show it to him again. After all, he was busy running Baylor—DeBakey consolidated his power by becoming president in 1968—and lecturing around the globe, and providing comment to newspapers and television programs, and tending to his own surgical practice, and proofing the articles his sisters wrote under his name for journals. He never seemed to sleep, and neither did his sisters, who kept the DeBakey grandeur machine functioning a lot more effectively than Liotta’s phony heart.
Liotta licked his wounds and, in secret, convinced a few members of DeBakey’s team to improve on his prototype. By September 1968, he had one—but not for DeBakey. At some point after Cooley’s unfortunate sheep heart transplant (for which Liotta had been present), he and Cooley had started talking about a collaboration. Cooley had listened to Liotta’s complaints, and attributed the failure of Liotta’s artificial heart in the calves to DeBakey’s slowness as a surgeon. With the help of a new team, he and Liotta agreed to work on a heart of their own. They came up with something…much like the original.
That both Cooley and Liotta were members of the Baylor faculty and that Liotta’s device had been developed at Baylor with a National Heart Institute grant wasn’t troubling to them. Of course they would have to fabricate a new heart and a new console so that this heart wouldn’t be confused with the Baylor heart. And it was understood that the device would be used only in an emergency and only temporarily, until it could be replaced with a human heart. “Neither of us felt a need to ask Mike’s permission to proceed,” Cooley explained later. “After all, he’d already said that he wanted Domingo to work on the LVAD project.” More to the point, Cooley and Liotta were required to submit their plan to a Baylor committee for approval, a committee DeBakey ran. His history of previous denials suggested to Cooley that he would turn this project down as well. So Cooley and Liotta came to the mutual decision that it would be better to ask for forgiveness than permission. Or, as Liotta would write in his memoir: “Cooley and I moved forward in the accomplishment of the risky decision…venturing under the influence of the clear and always fascinating summons of medicine. We disregarded our already renowned careers and paid no attention to the threatening surroundings that were growing at the University.”
* * *
The Illinois couple who collided with Cooley’s new plan were named Shirley and Haskell Karp. Haskell, forty-seven, was a man of very modest means—at home in Skokie, he worked in a print shop as the price estimator, while Shirley was a homemaker and mother to their three young sons. Haskell was quiet and wry behind his horn-rimmed glasses; she was wide-eyed, raven-haired, and a little high-strung. They had come to the Texas Heart Institute in desperation, like so many of Cooley’s patients—other doctors had sent Haskell home to die. His heart was so weak and damaged that it could stop beating at any minute.
Cooley saw things differently. He had a voice that was both soft and hard, a homey Texas accent that, combined with his radiant confidence, could almost always make bad news
a little easier to take. Haskell, he told the couple, had an aneurysm on the left ventricle that was one source of damage; another was destruction of heart muscle from previous heart attacks. The solution was simple. “What you need is a new heart!” Cooley announced. He promised to try to repair the heart first, but if he couldn’t, a transplant was the only option. To keep Karp alive until he could find a donor, he had a new device he could try, something that could tide Haskell over at least until he could find the human heart to replace it with. Something that would serve as a bridge to transplant—a bridge heart, kind of like a bridge loan. The Karps signed the release Cooley gave them. They were hopeful.
On April 4, 1969, Haskell was wheeled into the operating room. Cooley opened his chest, got a good look at the left and right ventricles, and knew right away that this patient’s was the worst-looking heart he’d ever seen. The inside wall was covered in scar tissue. It reminded Cooley of a battered, deflated basketball. He cut away as much scar tissue as he could, hoping that repair would save the heart, but then there wasn’t enough left to function. When Cooley released the clamps, he got blood flow, but only a faint, irregular heartbeat. Electric shocks and manual massage did no good, and neither did an injection of drugs. Haskell Karp was going to die, probably in the next few minutes.