by Mimi Swartz
The only person Bud couldn’t and wouldn’t intimidate was, of course, Cooley. When Cooley was too cheap to pay for two rooms at a luxury hotel, Bud agreed to bunk with him and share the cost. When they were in Paris and dining at a very expensive restaurant with the mother of a patient—the actress Olivia de Havilland—Bud picked up the check after Cooley palmed it his way.
But Cooley did reward loyalty and ability, and by 1980 Bud found himself head of the institute’s heart transplant program. If this seemed more like a punishment than a reward, times had changed—again. Barnard’s triumph had been followed by the disasters of the late 1960s, when no one survived what had seemed at first to be an astounding medical breakthrough. No one knew then why the bodies of transplant recipients rejected the foreign organ, or why their immune systems kicked into high gear to fight it. The patients just died, sometimes sooner, sometimes later.
But then, in the early 1970s, a researcher at Sandoz, a multinational drug company, was looking for new uses of shelved drugs. One of those was a product called cyclosporine, which he thought might be used to help fungal infections. But when he gave the drug to mice, they got sicker instead—the drug was tamping down their immune systems. That was bad for the mice, but led to a new line of inquiry: what if the drug could be used to suppress the immune system, which would keep the body from fighting off a transplanted organ? By the early 1980s, doctors were trying it in liver and kidney transplants, and then with heart transplants. Patients lived; or, at least, survival rates increased from a few months to years, maybe even a decade. The miracle drug had literally brought the practice of heart transplantation back from the dead.
Bud saw its use with a twenty-four-year-old woman from Lubbock by the name of Rona Coleman. She had contracted postpartum cardiomyopathy, a rare form of heart failure that can occur after a woman gives birth. Coleman was so sick that her kidneys had stopped working, and she also had a terrible staph infection. Her skin had a ghastly yellow pallor. Her only option was a transplant, which she refused. In and out of consciousness, she managed to write Bud a note: “Let me die.”
Bud talked to Coleman’s husband, who put the decision in Bud’s hands. Bud stalled, hoping a donor would appear. She had two children, along with the newborn, and a husband who loved her.
But then Coleman wrote Bud another note, asking him again to let her go. The nurses on the floor were so furious with Bud that they threatened to get a court order if he didn’t agree to her wishes.
Then a heart magically appeared. Bud did the transplant, and, along with the usual meds and procedures, treated her with cyclosporine. Two months later, Rona Coleman was ready for hospital discharge.
“What do you think about the letters you sent me?” Bud asked her when he went to say his goodbyes.
She looked at him blankly. “What letters?” she asked.
The story became one Bud told over and over again, to interns and patients and friends and family. Few people understood how intently Bud believed in his mission to save his patients, how contemptuous he was of doctors who gave up too soon. He couldn’t give up. Still, people died on his service every day, and they died even after he tried to save them every way he knew how.
Maybe that commitment was one reason Bud could never get too interested in the business side of his work. Other surgeons built hefty private practices; he just couldn’t get his mind—or his psychology—around doing any such thing. He was rich enough. He didn’t have the patience or the inclination to schmooze cardiologists for those all-important referrals. He was quickly bored at fundraising galas. He was an outlier. Yes, he wrote for prestigious cardiac journals, but he was happier reading dark Russian novels and Shakespearean tragedies, which were not exactly watercooler topics among his surgical colleagues in Houston. All told, it was natural that the THI lab became his refuge.
Like everything else at THI—and often in the Texas medical center—the lab wasn’t really set up like other labs around the United States. In the sixties and seventies, Cooley saw research as a distraction from the thrill of surgery and its medical and financial rewards. “Cooley didn’t care what you did,” Bud liked to say. “If you could get paid for it, you could transplant heads.” But on a plane coming back from a conference in Russia, he happened to meet a Harvard-trained African American surgeon by the name of John Norman who tutored him in the importance—for both medicine and fundraising—of research. By the time the plane landed, Cooley had cut a deal with Norman to come to THI and run the lab Liotta had started and never finished. As Cooley would later say of Norman, “I decided I needed this brilliant mind.” Cooley wrangled $2 million from the oil-flush Cullen family for the lab, and Norman started in 1972.
It’s easy to see how he was irresistible to Cooley: Norman had been deeply involved in experimental organ transplants—he and his team had used a pig’s liver to keep a human patient alive for nearly three weeks. He had also been working on what were then called partial artificial hearts—what would come to be known as left ventricular assist devices, or LVADs. They were the coming thing: Richard Nixon had not been as entranced with total heart replacements as LBJ, and so the artificial heart program was being both scaled back and retooled.
Norman never made Houston home, even though he would stay there for almost a decade. He traveled back to Boston on weekends to see his wife and daughter, making a temporary home for himself with his Great Dane, Yonnie, who eventually bit one of the anesthesiologists. Since the lab was already packed with outraged baboons, pound dogs, and calves used in heart-related experiments, this assault was probably just one in an ongoing series of small and fruitless rebellions against the human race.
Norman brought one item of great value with him: an LVAD he had been working on with another doctor in Boston. The device had been fabricated by Thermo Electron, a company in Waltham, Massachusetts, that had been the first recipient of a federal grant to work on an artificial heart back in 1966. It wasn’t a medical device company but an engineering firm focused on thermodynamics and creating nuclear power sources for space probes. They knew how to make pumps, and the heart, after all, was just another pump.
The company successfully competed against several others for NIH artificial heart grants by promoting a nuclear power source for an artificial heart—a pump driven by a miniature steam engine heated by a kernel of plutonium covered with a lead shield. Working with Norman, Thermo Electron had already reached the animal trial stage: Norman had brought a baboon who had been implanted with an experimental plutonium power source—basically, a super-battery that might eventually be applied to drive medical devices inside the human body. “Fred,” as he was known to his colleagues, enjoyed watching game shows and soap operas on his black-and-white TV. Even so, he was reported to be very, very mean.
Only a certain kind of person could find paradise in this kind of workplace, and Bud Frazier was that kind. At first the lab was just a respite from the pressures of the operating room—Bud would occasionally rescue a particularly irresistible lab dog and take it home to the consternation of Rachel, or he would practice reciting Shakespearean soliloquies on a comely technician.
But the lab was also one of the few places in the world at the time where Bud could focus on his particular obsession: devices that either aided or replaced the human heart. Pretty soon he was putting the machines in lab animals and, thanks partly to Dr. Norman, working with a Thermo Electron engineer by the name of Vic Poirier, a man as self-created as Bud.
Small, intense, and bespectacled, with a thatch of brown hair and a brushy matching mustache, Poirier was hyper where Bud was laconic. He had an entrepreneur’s mindset: when the shrinking space program convinced him that he was going to lose his job on a NASA project, Poirier bought himself a physiology book and a medical dictionary and talked his way into a position at Thermo Electron, as part of a team working to develop an early artificial heart. It wasn’t long before Poirier became
obsessed with the havoc heart disease was wreaking across the United States. It also didn’t escape his notice that LVADs, which he believed might sell for around $50,000 each, could result in a market worth about $2 billion a year.
Soon enough, Poirier and Frazier became the Mutt and Jeff of heart assist devices: one didn’t have the slightest grasp of engineering principles, and the other had learned about medicine from reading textbooks. But somehow, together, they started making progress. Throughout the 1970s, they inched forward, through bench testing (refining the design before animal experiments) and then by successfully implanting their device in calves, until finally they thought they had something ready to put in a person.
These trials were no longer the kind of seat-of-the-pants experiments of Bud’s early days in DeBakey’s lab. By the 1970s, problems with pacemakers and intrauterine devices had caused the FDA to increase regulation of medical devices, with complex machines like heart assist devices being among the most highly regulated of all.
The challenges of developing an assist device were not so different from that of a total artificial heart. The two biggest problems had never changed: a man-made pump had to have the endurance of a real heart, meaning it had to be strong enough to pump five to eleven liters of blood per minute all day, every day. Then there was the blood itself: if it wasn’t moving, it was clotting, and clots that lodged in the wrong places could block circulation, and kill.
One device they came up with was designed mainly to save patients in postoperative shock following heart surgery (known as postcardiotomy shock), something that could take over the heart function while the heart itself took time to rest and recover. If that plan worked, the thinking went, maybe the same device could be used to keep patients alive while they waited for a transplant.
What they developed aped the structure of the normal heart, at least in a fashion. An air compressor that looked a little like a lectern on wheels powered the machine; a drive line extended from that console into the body via the abdomen. Attached to the left side of the heart, the inner workings of the actual device were encased in a long, narrow titanium alloy shell that looked like something more at home as part of a kitchen sink. Inside, a two-chambered pump used something called a pusher plate to draw compressed air into a chamber on one side of the device and then push it out again through the other as the air was released. This pulsing action pushed against the heart itself, literally pushing the blood through the heart and out into the aorta and the rest of the body.
Eventually Frazier, working with Cooley and Norman, implanted the LVAD in twenty-two people from 1975 through 1980. Every one of them died. Many of the patients were hopeless from the get-go; they were just too sick.
A second device worked poorly because neither Bud nor the engineers working alongside him could regulate the airflow, so the pump wore out in a few months instead of lasting the two years Bud hoped would make the device useful for a patient waiting for a transplant. Then too, the pump still wasn’t powerful enough to keep the blood flowing at a consistent rate, so the danger of fatal clots loomed large.
Bud brooded on these problems constantly: when he was transplanting hearts, when he talked with Poirier, and at night when he was alone in the lab, letting the dogs out of their cages and rolling with them on the floor.
It was a less than happy memory of Dr. DeBakey that helped him solve the problem. Once during his residency, he had had to call DeBakey to see a very sick patient whose leg had grown cold after heart surgery, a sure sign his blood wasn’t circulating and a blockage had formed. It was the middle of the night, and Bud was so tired that he forgot the first law of dealing with his chief: never ask DeBakey a question. Actually, he wasn’t asking DeBakey, he was talking to himself, but DeBakey overheard him wondering aloud why the blood kept clotting. He whirled around and punched Bud in the chest. “Listen to me,” DeBakey hissed as he kept punching. “When blood stops moving it clots. When. Blood. Stops. Moving. It. Clots. Is that too hard for your pea-sized brain?” So what was stopping the blood from moving now?
Bud looked at drawings, looked at the device, and talked with Poirier again and again. The airflow issue was improved thanks to Bud’s early experience with tuberculosis patients at the Veterans Administration hospital. There, he had met a drunk who liked to frequent local bars and bet patrons he could hold his breath underwater longer than anyone else. Who could resist? Soon enough, someone brought out a bucket of water, money was collected, and two guys—the drunk and his mark—had their heads underwater. But while one man turned blue, the vet released a valve that opened a tube in his chest to the air, allowing him to breathe from this secondary location. Needless to say, he always won as long as he kept changing bars.
Maybe, Bud thought, there was a way to vent the airflow and lessen the pressure, so the pump wouldn’t wear out so fast. The engineers went to work, and on the next incarnation of the LVAD, there was a tube that vented air back to the outside through the chest.
They tried the new, improved pump on patients who were waiting for, but weren’t expected to live until they could get, a heart transplant. The first two died. But the third, a Miami police officer, made it. Yes, it was hard to locate his actual body what with all the tubes and wires coming in and out. And yes, the patient could not be separated from the very large operating console, which gave him the look of an oratory contest winner in a mental hospital. But he lived. Not only that, the device kept him alive and reasonably healthy until he got his new, human heart. After that, he went home. It would take more than a decade before a version of that pneumatically powered device, christened the HeartMate I, was approved as a bridge to transplantation by the Food and Drug Administration, the first time an LVAD made it across the finish line.
Bud busied himself elsewhere. In 1981, Norman had headed back to Boston without Yonnie, who preferred life with the THI janitor. There was really only one person to take over the research lab: Cooley tapped Bud to run the place. Now, when Bud wasn’t transplanting hearts in the OR, he was running artificial heart research at the premier heart hospital in the world. He was forty-one. Everyone knew if you needed to get something done, Bud Frazier would do it, no matter how hard or seemingly impossible.
8
BARNEY WHO?
Going to an American Society for Artificial Internal Organs conference with Bud Frazier is like going to the Oscars with Jack Nicholson or the Super Bowl with Joe Namath: he’s a celebrity, but of the éminence grise variety. There’s always a Leonardo DiCaprio or a Tom Brady who might be younger and sexier, but even they have to pay homage to the person who paved the way. Here, that means frequent allusions to a phrase popularized in the seventeenth century by Isaac Newton: “If I have seen further, it is by standing on the shoulders of giants.” It’s a medical and scientific bromide, despite equally common if less public accusations of stealing and/or refusing to give credit where it’s due.
ASAIO is the reality-based organization for the sci-fi fantasies that have given rise to so many comic book heroes like Iron Man, as well as the career of Lee Majors, who played the Six Million Dollar Man in the 1970s TV hit. These are the folks who really believe that it’s only a matter of time before all of our organs can be replaced with mechanical devices. Willem Kolff, not surprisingly, was the founding president in 1955, nearly a decade after inventing the first dialysis machine and two years before he put that artificial heart in a dog.
John Gibbon, the inventor of the first heart-lung machine, was a member too, as were Adrian Kantrowitz, who invented the balloon pump that was a precursor to the artificial heart, and Cooley. Today, members include everyone who is anyone in the world of artificial organs, which means a lot of mostly anonymous people working on everything from pacemakers to dialysis machines to heart-lung machines, from new biomaterials to artificial cells and beyond. Work on organ replacement was, like so much else, the sole purview of white men for most of the twentieth century—Bu
d, a past president, wears under his name tag a blue ribbon designating him as a “pioneer”—but the crowd at the San Francisco Hyatt for the 2016 conference skews young and international. There is even a smattering of women, mostly young, but including Kantrowitz’s widow, Jean, a sharp, charming wonder who at ninety-two has no noticeable replacement parts. Everyone wants to talk to Bud, especially the younger folks, and they listen indulgently when he launches into one of his shaggy dog stories (Uncle Mule figures prominently), only occasionally glancing sideways at one another.
Bud is in his element, his ostrich-skin boots shined to a glistening ebony, his beloved Borsalino tipped at a rakish angle on his head. He tries to downplay his delight with all the attention—“It’s like being a whore in the Klondike,” he says—but also surveys the size and mix of the crowd in the plush, chandeliered ballroom with wonder. “There’s hardly anybody here from the seventies,” he says. “When I started out it was all the kidney people. I used to know everybody here.” Sometimes he dozes through presentations, only to awaken to study a slide—“Poor goats,” he says, glancing at a research presentation before returning to his nap. Other times he’s like a sniper who has just put his victim in the crosshairs. Presentations that vex Bud start with a muttering monologue in his seat and then, inevitably, wind up with an extended soliloquy at the microphone during the Q&A session. There, in his West Texas drawl, Bud proceeds to reduce the most confident speaker to a sputtering mess. “What’s your survival rate?” he demands of an inventor of children’s heart pumps, sounding almost DeBakeyesque.
At least, that’s how it goes until Bud runs into Robert Jarvik, with whom he has worked off and on for much of his professional life. Jarvik was born in 1946 and was probably the last medical media star after his artificial heart kept Seattle dentist Barney Clark alive for 112 days in 1982. Jarvik is six years younger than Frazier but looks a lot frailer. He is pale and wan, and has the careful walk of someone for whom a fall could be disastrous. His blue eyes are red-rimmed and a little rheumy, but his gaze remains level and piercing, especially when he is explaining his latest heart pump. These days, Jarvik may not be a household name to anyone under forty-five, but he has continued to work on the artificial heart and various assist devices. When Bud sidles up to his booth in the basement of the Hyatt, Jarvik brightens considerably.