by Mimi Swartz
Cooley had to make a decision: to let his patient go or to try Liotta’s artificial heart. Quietly he asked that the device and the console be brought in, while he started cutting out what remained of Haskell’s heart. “Have St. Luke’s and Mrs. Karp ask for a donor as soon as possible,” he ordered. Scour the country, stat.
The operating room, so silent and grim, now sprang to life. Someone wheeled in the command console. A scrub nurse came in bearing a steel bowl in both hands, like an offering. Inside was something white and translucent, with small cuffs blossoming at the top and connections for tubes extending from the bottom. No one noticed when Cooley’s secretary tiptoed out of the observation gallery. Her pace quickened to a trot and then a run as she headed for St. Luke’s public relations department, to tell them that Cooley was implanting an artificial heart for the first time in history.
Even for a surgeon as gifted as Cooley, the implantation didn’t go easily. The device was stiff, and the material used on the cuffs designed as connectors from human muscle to plastic kept blunting the needle where he tried to sew it in. Cooley worked intently on one side at a time, stitching the left atrium of Karp’s heart to the corresponding artificial side. Then he did the same on the right. Then he threaded the two narrow plastic drive lines that pumped pressurized carbon dioxide under the skin, through the heart cavity, down through the abdomen, and into the console.
“Okay, Domingo, let’s see how well this thing works in a human being,” Cooley said, standing back for the first time in hours. A technician flipped a switch, and within a few seconds a reddish cast became visible inside the plastic. Blood was flowing toward the mechanical heart. A few people began to whisper prayers. Liotta thought the time was right: he ordered the operator of the heart-lung machine to start weaning Karp off the pump. After a few minutes, Cooley told him to stop entirely. The surgery had taken forty-seven minutes, but Karp had been on the pump for a risky two hours. No one knew whether he would make it or not, and if he did, what condition he would be in.
But then Karp’s new heart began to work. His chest began to rise and fall on its own. It seemed then as if he was breathing for everyone in the operating room.
Within fifteen minutes after Cooley had closed his chest, Karp was conscious, able to move his fingers and toes on command. His organs appeared to be functioning normally.
For once, Cooley could not maintain his composure. With damp eyes, he shook the hand of the man operating the power console, and then found Liotta. Liotta would recall Cooley’s words to him for the rest of his life, though maybe something was lost in the translation: “Domingo, we administered to Baylor University the biggest enema; it will be remembered in years to come.”
7
EXPERIMENTS
One of Bud Frazier’s most beloved spots on earth sits five floors below his book-strewn office and two floors below ground level inside St. Luke’s and the Texas Heart Institute. To get there requires a change of elevators—only one goes to the second basement—and a mastery of the hospital’s nearly indecipherable maze of color-coded hallways. The door to this place is always locked, and anyone who makes it through has to sign in. This is the THI’s research lab. Cooley put Bud in charge of it in 1981.
It’s the kind of place that would make a PETA volunteer apoplectic, one reason its location remains, if not secret, at least unadvertised. Science isn’t always pretty, metaphorically or literally. The only light here comes from the grayish white of fluorescent tubes. The walls are an institutional green; along with two spacious operating rooms, there are calves and goats and sheep and pigs, some sleeping and grunting in pens, some hooked up to tubes and monitors and held in place in what resemble milking stanchions. To the uninitiated, it does look like an undesignated circle of animal hell, but of course that is not how the people who work there see the place, because they have seen the results of the animal sacrifices: at best—though not always, because failure is such a regular occurrence—patients lived because they died. The lab is living proof of science and medicine at one of the most painful crossroads.
For Bud, the lab is a sanctuary—“the best in the world,” he is prone to say, even though it might have some competition after some forty-plus years. But it is indisputably the scene of four decades of disasters and triumphs in the war against heart disease, especially when it comes to implanted devices. Maybe for this reason, Bud shows a mournful gratitude toward the animals here, especially the calves, who remind him of his childhood in West Texas. “They are sweet animals,” he says wistfully, positioning himself by a stanchion and scratching the ears of some doomed bovine.
When Bud returned to the Texas Medical Center to finish the residency the draft and the Vietnam War had so rudely interrupted, he found himself in the middle of the escalating war between DeBakey and Cooley.
DeBakey had learned about the Karp surgery like just about everyone else. On April 4, 1969—the day of the operation—he had flown to Washington for a meeting with fellow members of the Artificial Heart Myocardial Infarction Advisory Committee of the National Heart Institute. Though there are some rumors he might have been tipped off that night, DeBakey’s own account reports that he was alerted the next morning at the meeting, when members of the committee surrounded him. They had read about this great cardiac leap forward in the papers or heard about it on the news. They couldn’t wait to talk about it! DeBakey listened—desperate to hide his shock, no doubt—and realized that the heart Cooley had used “was similar to that which we had developed in our laboratories.” On purpose or by accident, Denton Cooley had found a brilliant way to embarrass his nemesis: in front of his peers.
Once DeBakey returned home, he fired virtually everyone in the lab, added more locks to his office doors, and appeared to have given up on the creation of a total artificial heart. A period of cardiac repair stasis set in at Methodist. Meanwhile, Cooley was turning the Texas Heart Institute—literally a stone’s throw to the south—into a heart surgery colossus. Bud had missed the Karp episode in its entirety, and so maybe underestimated its importance. He arranged to work at THI after finishing his general surgery residency. He wanted to specialize in cardiothoracic surgery, and do more research on heart support devices.
It did not occur to him that a simple transfer would be perceived by DeBakey as a betrayal on the scale of Benedict Arnold’s. But once DeBakey got word that Bud was intending to move to the Cooley camp—no matter what his reasons or his future intentions—DeBakey cut him dead. Even Bud’s kindhearted mentor Stanley Crawford would scoot away when Bud approached, afraid that DeBakey would fire him for being seen anywhere close to Frazier the Traitor.
On the upside, Bud soon found he had moved from a capricious dictatorship to an elite fraternity. The Texas Heart Institute at that time was like no other institution in the world. If DeBakey was a brilliant manipulator of the vastly expanding medical/governmental complex, Cooley was someone who gave the appearance of bucking it at every turn. Thanks to the continued rise in heart disease, the breathless media coverage of potential surgical cures in the likes of Time and Life magazines, and a declining public interest in space after the moon landing in 1969, heart surgeons were gaining on the astronauts as the new American heroes. The problem was, most heart surgeons didn’t look or act like the astronauts. DeBakey was no one’s idea of a cover boy, and neither were Adrian Kantrowitz in New York and Norman Shumway at Stanford.
But Cooley was good looking and soft-spoken, with a veneer of shyness that gave cover to his voracious ambition. (“A successful cardiovascular surgeon should be a man who, when asked to name the three best surgeons in the world, would have difficulty deciding the other two,” he once said.) He embodied certain mythic characteristics thought to be deeply embedded in the American DNA, qualities that were even more pronounced in the Texas archetype—independence, individualism, and self-determination. Then too, Cooley had no aversion to making a lot of money. DeBakey had to run a me
dical school and ride herd on a hospital while attending to his own patients, while speaking worldwide and racing back and forth to influence policy in Washington. Cooley was learning to love the limelight—he met the Pope at a well-publicized meeting in 1969—but he loved building THI more. And he loved performing the diciest, most demanding heart surgeries more than that. Sure, there were other stars in the firmament, but to play on Cooley’s team meant not only that you were fighting on the front lines against heart disease but also that you had the freedom to operate, literally and metaphorically, without constraints.
And you had an endless supply of patients. The heist—though Cooley didn’t call it that—of the Liotta heart had not hurt Cooley’s reputation with patients, even if it caused consternation among his peers. By the early 1970s, a seemingly infinite stream of heart patients were flooding into the Texas Heart Institute every day, clamoring to be saved; forty-six hundred people had heart surgery at THI in 1974. Like DeBakey, Cooley’s patients came from up and down the economic spectrum and from all parts of the world—a little girl from Vietnam; the Iranian prime minister’s deputy chief; Zeppo Marx; Hall of Fame Yankee pitcher Whitey Ford; and so on. Patients arrived by private plane from the Middle East, or by airlifts courtesy of the Dutch government, or by pickup truck from some innocuous blue-collar suburb of Houston. Cooley became a favorite surgeon of a roving band of genuine Gypsies, who never seemed to leave the hospital without taking something that wasn’t theirs. Bud kept a copy of a Houston Chronicle classified ad for a heart-lung machine, assuming they had been the culprits.
The US government flew in poor kids from all over the country. Not for nothing had Cooley cultivated the Heart Institute’s affiliation with Texas Children’s Hospital next door when he’d been a Baylor professor. Both heart surgery and his own career had had its beginnings with previously impossible operations on children; now, no one was better at operating on the smallest hearts than he.
For all these reasons, Denton Cooley was not only world-famous but rich beyond his wildest imaginings. Free of Baylor, he no longer had to donate a portion of his earnings to the school, as DeBakey required. A multimillionaire when it meant something to be one, Cooley was now richer than even some of his wildcatter buddies. To his colonnaded, antebellum-style mansion in River Oaks and his Cool Acres ranch on the Brazos, he added a house in Galveston, and a “ski shack” on the San Jacinto River where he took Christiaan Barnard waterskiing. He gave tours of THI to the aged Charles Lindbergh. Louise Cooley became a regular on the social scene and in the society pages. With her husband so often occupied at the hospital, her walker was the society hairdresser of that day, whose name was, yes, Lyndon Johnson. Partly because Cooley was busy and partly because he was famously cheap, family vacations often happened in tandem with speaking engagements and honorary events, like meeting the Pope.
But Cooley couldn’t operate on everyone—forty cases were a daily average for his team; one day Cooley did fourteen alone, “and they were all tough cases,” Bud noted. A gifted surgeon elsewhere might do one tough case and two easy ones, in comparison. To be one of Cooley’s chosen associates, then, was equal to being a knight of the Round Table. Cooley was unquestionably their chief. He never seemed to lose his temper. If he was disappointed in a surgeon’s work, he just became more distant. But you had to keep up. “Cooley didn’t teach you anything but you learned a lot,” Bud often said. He was the kind of leader who simply assumed that others would do what was expected, and in large part they did, his associates evolving from a team of acolytes into something more akin to a restless, ambitious group of young men determined to make their own reputations in the wake of their leader.
This was possible because Cooley set up assembly-line surgery at THI. There were eight operating rooms designed around a central pod where other surgeons opened and closed for him, and where, given the teeming census, one of Cooley’s chosen might perform an actual valve repair or coronary bypass while Cooley himself worked on a more difficult case next door. So an associate could wind up doing almost as much surgery as the great man himself, perfecting his skills and publishing his own discoveries while enhancing the status of THI and Houston too.
The space program may have been providing less inspiration in Houston as it shifted toward the humdrum shuttle voyages by the late seventies and early eighties, but the oil boom was on. In an interesting and fortuitous (for surgeons) series of coincidences, the stress of success—and then failure, when the dreaded oil bust of the mid-eighties set in—made for still more surgeries and still more donations from grateful patients. It was a badge of honor to have Denton Cooley’s home number in your personal phone book. Even more prestigious to recover—and then lose to him at golf.
But whatever the rewards, there was a price to be paid. The patients who came to the Texas Heart Institute in its earliest days were desperately ill, as were the children at Texas Children’s Hospital next door. On Bud’s first day, he watched Cooley reassure an angelic six-year-old girl that he would unzip her chest, fix her heart, and then zip her right up again. She never made it off the operating table, and neither did two other children that same day. “Today was a bad day,” Cooley told his troops, “but tomorrow will be better.”
So it was for all those reasons that Bud left his wife and two small children at home in the Montrose around five-thirty every morning and returned late at night. Sometimes he took his daughter, Allison, on early-morning rounds, the tiny girl with silky blond hair and stars in her eyes grasping her father’s hand as they strode down the halls. Surgery dominated the Frazier family dinner conversations, with Bud spinning ongoing mealtime dramas from his life-and-death cases. But many times, Bud didn’t make it home at all—Cooley and DeBakey had their differences, but superhuman endurance was the one thing they had in common. The 24/7 workweek was just as de rigueur at Texas Heart Institute as it had been at DeBakey’s five-star, high-pressure Methodist Hospital.
Bud learned. He became a stellar transplant surgeon, but he was also the only surgeon at THI who volunteered for that particular duty in the early days. Most of his colleagues begged off: too many patients died, either waiting to get a heart, or while they were being operated on, or after they got one. They just couldn’t take it. Bud could, for reasons he did not choose to examine. If he had done so, he might have examined his eagerness to please at all costs, his passion for virtuous sacrifice, and his boundless love for the action of the hospital, which was so much more dramatic and rewarding than ordinary life. Even if he was sleeping in his office instead of going to Todd’s basketball game or going out for Mexican food with Rachel, Bud could be there, waiting for something to happen that might just challenge everything he had. He never had to ask whether he was doing good. He knew he was.
Once, after a couple of drinks on an airplane, he asked Cooley how he dealt with the pressures of being a surgeon, of losing patient after patient year in and year out. What was his secret, Bud wanted to know? Cooley looked at him squarely. “To kill with impunity,” he deadpanned. Bud got the joke: you just got on with it. The failure of one save would eventually produce rescue somewhere else.
By the early 1980s, he was also reaping the enormous rewards bestowed on the heart surgeons of his day, especially those at the Texas Heart Institute. By that time, St. Luke’s was doing more pump cases—heart surgeries with the heart-lung machine—than in all of Western Europe, 5,000 alone in 1981. Not only was Bud publishing papers in the most prestigious journals, he was invited to demonstrate his techniques in places like Russia and the Middle East. He spoke often at medical conferences that always seemed to be held in garden spots from Tahiti to Florence to Tokyo. He dined at a royal function in London with Princess Anne, and at another colloquium politely turned down a threesome with Christiaan Barnard and his beauty queen lover.
And Bud, like so many of his peers, developed an antipathy to being challenged. He could fight back with a fury that, in such a lar
ge man, could be intimidating, if not downright frightening. He once showed up at a deposition in DeBakey-style bloody scrubs. The lawyers cringed when Bud launched into what an attorney would later describe as an opening statement, something about Bud being the only person standing between the patient and God, and how dare they interrupt his work for something as insignificant as a lawsuit, and so on. In general, Bud fostered a deep and abiding antipathy to anyone who knew nothing about medicine but still felt it was fine to impinge on his dire day-to-day routine. Lawyers were at the top of his list.
The disagreements would become more frequent over the years, and were not just limited to lawyers. When patients begged Bud for their lives—and they did beg—he couldn’t say no, no matter how risky or experimental the procedure. Wasn’t THI’s reputation that they treated the sickest of the sick? Hospital administrators worried that he was treating people who should have been allowed to die. Bud wouldn’t hear of it. Forms, permissions? Those were for other people to worry about. His job was to save people. If the hospital wanted to help, they could give him more personnel in the operating room, which he asked for repeatedly. “As noted, we have no night coverage for transplants or LVADs,” he would write one administrator. “I’m here at least two to three nights a week….We are also the only hospital in the country without a [critical care specialist] in the ICU.” Bud didn’t worry about his numbers, the mortality statistics that were sometimes lower at St. Luke’s than at places like Stanford or the Mayo Clinic. He argued that they didn’t take the risks he did—they followed in his wake, once he had perfected a technique. He had a certainty and an authority the administrators lacked, and so they went along, even as medical costs were escalating, even if they disagreed. There were colleagues who warned Bud that he could wind up in political hot water. He ignored them too.