by Mimi Swartz
DeVries, in contrast, was a lanky, hollow-cheeked Mormon, gregarious and righteously ambitious in the mold of the heart surgeons of the day. A comer at only thirty-seven, he was already chief of cardiothoracic surgery at the University of Utah medical center. He’d worked with Kolff while in med school, then trained at Duke before returning to Kolff’s exacting tutelage. DeVries had implanted artificial hearts hundreds of times in animals. Now he had a shot at making medical history, joining the pantheon of famed heart surgeons like Christiaan Barnard and Denton Cooley.
But it was Robert Jarvik, creator of this artificial heart, who had the most to prove. Few doubted his inventive genius. But he was, to put it mildly, unconventional. As Bud would frequently suggest, damning with faint praise, “Jarvik was a brilliant machinist.” What he said less often but would be proven true in time was that Jarvik was not good at playing well with others—if, in fact, he played at all. He could be moody, arrogant, and/or inappropriate in his responses. He had an eerie, inopportune giggle.
At thirty-five, Jarvik also possessed an almost feminine beauty—shaggy but shimmering auburn hair, piercing blue eyes—and a restless intensity, a combination that women found irresistible. (And he them.) He had grown up watching his father perform surgery and, like Cooley, had been an inveterate tinkerer. (His uncle, Murray Jarvik, was an inventor of the nicotine patch.) By the time Jarvik graduated from high school, he had already invented an automatic stapler to replace suturing in surgery. While at Syracuse University in 1964, Jarvik considered a career in architecture, and also showed gifts as a sculptor and designer. Then his father developed heart disease, and he switched to medicine.
Gifted though he was, Jarvik had issues, predominantly with rules and structure, which prevented him from finishing med school, even the one in Bologna he was enrolled in after he couldn’t get admitted to any American school. (“I am a medical scientist, not a practical physician,” he declared at one point, a statement few colleagues would dispute.) He finally ended up with a master’s degree in biomechanics from New York University, when Kolff found him and brought him to Utah as a designer in his lab; it was with Kolff’s help that Jarvik finally obtained a medical degree from the University of Utah in 1976. He never completed an internship or residency; instead, he joined Kolff’s artificial organ team full-time.
On Thursday, July 23, 1981, as he was enjoying an evening with friends, Robert Jarvik’s future looked as bright and shining as the desert sky outside Salt Lake, where he made his home. Then his phone rang. It was William DeVries, who had just gotten a call from a reporter. Denton Cooley had implanted an artificial heart in a patient in Houston. The reporter wondered whether DeVries would care to comment. Now DeVries waited for Jarvik’s response.
“Well, that is one of the most interesting things I’ve heard in ages,” Jarvik said in a voice as dry as the desert air.
Kolff, who knew Cooley well and had supported putting the heart in Haskell Karp, was more gracious. “Congratulations,” he telegraphed Cooley, and with Old World panache added, “Well done. Save the patient’s life while you are blazing the trail. Best wishes for your patient, my fellow Dutchman, and for you from all of us in Utah.”
DeVries had a similar reaction. “It would take someone like Cooley to stand up to the review board and the FDA,” he said. In fact, Cooley had gotten around the FDA by declaring the surgery experimental, despite the fact that he had been hounding Akutsu to finish his device for years. But that independence—or insubordination, depending on your point of view—would prove to be the silver lining for the Utah team, at least initially. Cooley’s end run might help them speed up their own approval process, which by then had been dragging on for a couple of years. It stood to reason that with two other “experimental” implants completed, the Utah device looked less radical, more reasonable, more considered, and more responsible.
Like most inventors, Jarvik drew on the past for his design. He cast his net so widely, in fact, that some of his work came from an artificial heart created by Paul Winchell, whose reputation as an inventor was eclipsed by his talent as a ventriloquist—his partner in the 1950s was dummy Jerry Mahoney. At Kolff’s direction, Jarvik also drew on the work of Dr. Clifford Kwan-Gett, who was a member of the Utah team and had worked with Kolff previously on a design for an artificial heart.
The first three hearts Jarvik designed never reached the animal testing stage. A fourth, called the pancake heart, had flatter sides than the Liotta or Akutsu heart but, like these hearts (and the Kwan-Gett heart, for that matter), worked with air pumped into the device through plastic tubes from an external compressor. Inside, razor-thin rubber membranes sat atop one another, forming a diaphragm that opened and closed with the force of the air. A graphite lubricant was used to keep the surface flexible; another substance was used to prevent life-threatening clots.
The first hearts Jarvik made with this design were too big for humans; they were designed to operate in calves. Eventually he made a smaller heart that came to be known as the Jarvik-7. (Kolff liked to name his devices after students and assistants who worked on them, a tribute that would come to rank high in the No Good Deed Goes Unpunished chronicles.)
All told, the Kolff team completed more than 360 animal experiments. Over time, the life span of the calves (and a sheep or two) extended from a few weeks to several months. A calf named Abebe lived for six months in 1977. One named Alfred Lord Tennyson lived nearly nine.
The most obvious problem with the Jarvik-7—though others would be discovered later—was the air compressor. This heart was a shotgun marriage of man and machine: a patient would be tethered to a device the size of a dishwasher for the rest of his or her life. This was, after all, supposed to be a permanent artificial heart. Like most compressors, it also made a lot of noise, constantly. This didn’t bother Kolff, who pointed out that there were thousands of paraplegics and quadriplegics in the United States who had adapted to much worse.
But this aspect had bothered the university’s Institutional Review Board, the ethics committee charged with supervising any human testing and that first step in winning FDA approval. Under the tightened FDA rules formulated in the 1980s, the Jarvik-7 was classified as an investigational device, which meant its use posed “a potential for serious risk to the health, safety, or welfare of a patient” and was of “unproven safety and efficacy.” In a classic example of words coming back to haunt the author, Jarvik himself had written an article for Scientific American in January 1981 stating that no artificial heart, including those he was still working on, was ready for human implantation. The review board raised lots of other questions too, about many of the problems that had plagued experimental artificial hearts all along: the incompatibility of various biomaterials, the durability of various parts, the frequency of infection, and, yes, that pneumatic console. Further, the board wasn’t impressed with the life span of the calves with Jarvik-7s: they preferred a life span of two years instead of nine months. (Future regulators would rescind such a requirement once longer survival rates showed that calves outgrew their artificial hearts in about ninety days.)
While they waited, the team tested the fit in human cadavers, and even tested it in brain-dead patients.
In addressing the doubts of the review board, the Kolff team posited that some of the problems might be more common to calves than humans, and that the infection rates probably came from bacteria in the animal lab. More to the point, federal funds for artificial heart creation were running out or being shifted elsewhere. Time was running out. They had to move.
After many revisions over the next six months, the review board finally gave consent to proceed in February 1981. The FDA gave tentative approval the following fall. But then no patients could be found who matched their stringent criteria. This person had to be nearly—but not completely—dead from heart disease. It was a requirement that would plague many human trials: who could tell if an operation f
ailed because the patient was too weak to survive surgery, or because a device just didn’t work? In June 1982, the FDA loosened the rules, but still attached some pretty serious strings: the patient had to be terminally ill with congestive heart failure and unsuitable for a transplant. In other words, have no choice but to try a machine for a heart.
There were some dissenting voices among cardiac surgeons about the wisdom of moving ahead. Cooley was one of them. It must have galled the Utah surgeons that as they were finally closing in on government approval, Cooley wrote an article for American Medical News, claiming that “the artificial heart is not ready for elective implantation and cannot even approach the expectation of cardiac transplantation today.” He had a point: with the success of the immunosuppressant cyclosporin A, more and more transplant patients were making it with their new hearts. A Palo Alto group was reporting a 70 percent survival rate.
The delays in implanting the Jarvik-7 continued. In something of a reverse beauty contest, it took seven months to find an appropriate volunteer, even with the softened restrictions. As a headline in People put it, “Utah Surgeon William DeVries Seeks a Patient Who Could Live with a Man-Made Heart.” Psychiatrists were brought in to examine the prospects, along with other medical personnel; the team of evaluators determined that the perfect patient should have the risk-taking, adventure-seeking “right stuff”—the term popularized in Tom Wolfe’s 1979 book about NASA’s test pilots and the first astronauts. They actually used some of NASA’s screening procedures for astronauts to look for the right heart patient.
It was as if they were trying to cast a Hollywood film about American grit in the face of adversity, and maybe they were: during the search for the ideal candidate, the PR department of the University of Utah started gearing up for the significant attention they assumed would come in the wake of the surgery. They too took some cues from the NASA playbook, including the decision to provide 24/7 availability to reporters. And why not? The implantation of an artificial heart would be at least as important to humankind as a trip to the moon.
Finally they found their man: Barney Clark, a sixty-one-year-old Seattle dentist for whom the phrase “salt of the earth” seemed to have been invented. He was a tall, solid-looking fellow with a broad, open face, soft blue eyes, and a pugilist’s nose. Until he developed heart disease, Clark had been a successful dentist and an avid golfer. He was self-made: he had grown up in rural Utah, and the family’s modest income crashed precipitously after Clark’s father, a traveling salesman, committed suicide. As a result, Clark and his mother became extremely close; he started helping with finances at the age of eleven, and grew up determined to make her proud.
The evaluators saw it as a plus that Clark had flown combat missions in World War II and had received two Bronze Stars. He had worked hard to put himself through dental school, and then worked even harder to build his practice. He had a loving wife, Una Loy, who resembled her husband in her nearly boundless optimism. They had three devoted, well-adjusted children.
Clark was, in short, a brave, thoughtful man who worked hard and wanted very much to please. In one interview, he worried “about making a fool of either myself or the university project.” Before signing an eleven-page consent form, he grinned at the doctors present and said, “There sure would be a lot of long faces around here if I backed out now.” He understood that he was agreeing to become a human guinea pig, and hoped that his agreement to participate would serve humanity down the road.
But, of course, he was also dying. He was too sick to walk across a room or lift an arm to brush his teeth. He had severe tachycardia—a rapid heartbeat that prevents the proper flow of blood to the rest of his body. His heart was only pumping one liter per minute, with 5–7 being the norm. A transplant wasn’t an option: Clark was too old, according to medical criteria at the time. He was out of choices, except for one wildly improbable alternative. No one will ever know what Clark wished for more: to be of service in his last days, or simply to extend them regardless of the price.
DeVries implanted the Jarvik-7 on the night of December 2, 1982, under the gaze of just about the entire world. Despite the university’s planning, its PR department was totally unprepared for the onslaught of print and television reporters, who came like thundering hordes, expecting yet another triumphant American success story.
Clark did well in the first twenty-four hours following surgery. His color returned, and he happily recognized visitors. Una Loy was deeply relieved: “I kept telling him how much I loved him and how happy I was he was still with us,” she told the press. “I said, ‘I’m so thankful. I thought because you have an artificial heart you might not still love us.’ ”
But by the next day doctors discovered some emphysema. Somehow, despite all its research, the evaluation committee appointed to select the first patient to receive a Jarvik-7 had failed to catch Clark’s chronic obstructive pulmonary disease—a condition that was on their list of disqualifying illnesses. Now Clark’s condition required a short trip back into surgery. At first he recovered nicely, and was even taken off the critical list. His dental experience came in handy as he joked with the nurses about their inability to correctly brush his teeth. He offered to buy them a round of Cokes.
After six days, however, Clark began having seizures and soon became semicomatose. Then one of the artificial mitral valves fractured, and he was rushed back into surgery. Again, Clark seemed to recover. But now, in addition to the noise of the artificial heart compressor, which emanated a constant click-whoosh-click-whoosh, Clark had to communicate with a tube in his throat and a respirator over his mouth. Still, he remained for the most part alert and cheerful, the hospital darling.
Over the next three weeks, though, Clark became increasingly disoriented and delusional, or displayed what the psychiatrists observing him described as a “flat affect.” Then he got better—he was able to walk with a rickety gait, and even use an exercise bicycle. Una Loy would report a “joyful” Christmas with the family. But soon after, Clark became so despondent that he asked to be allowed to die. Then he became lucid again, with no memory of his request. The psychiatrists noted that “even during periods of significant despair, the patient remained cooperative, compliant, and attempted to render any self help within his capability.”
By eight weeks, Clark had had three more surgical procedures and was diagnosed with “significant organic brain syndrome,” which meant that he was suffering from dementia caused by a medical instead of mental disease. He was also suffering from, among other things, renal failure, pneumonia, gout, painfully swollen testicles, and an ulcer. “There is continued diminution of interest in his surroundings,” the psychiatrists wrote. Clark put his situation succinctly: he felt he had “no life to live.” Una Loy felt she was losing him. It was as if her husband had put up a wall between them, one she could not breach with her love.
And then, as he had in the past, Clark rallied. The light never returned to his eyes, but he could clearly describe feeling, as his wife had sensed, that he was being closed in by impenetrable walls. At other moments Clark imagined himself walking out of his hospital room, and even outside. At his most lucid, he worried about becoming a burden to his wife when he went home, and he worried about his growing hospital bill, which would eventually hit $250,000—about $700,000 today. As Una Loy wrote, “The days pass and we are still trying to climb a big hill.”
In truth, no one really knew how or what Clark was feeling. Because of the brain damage, the respirator, and the tangle of tubes and wires snaking in and out of his body, he had no way to effectively communicate. Even when suffering from sepsis, renal failure, pneumonia, and gastroenteritis, he was true to his nature, keeping up a good front. “I’m still trying,” he struggled to tell visitors.
Death finally came the night of March 24, 1983, as a light snow fell, visible through the windows of the surgical intensive care unit where his nurses could be seen openly we
eping. He had lived 112 days with the Jarvik-7 in his chest.
Clark’s funeral was a national event, with fifteen hundred people attending. Kolff gave a eulogy. Someday, he said, as many as fifty thousand Americans a year might live with artificial hearts, and “their borrowed days, weeks and years will be a precious gift from Barney Clark and Una Loy. He taught us that the artificial heart does not hurt, that its noise is manageable. Most of all, he taught us that it did not destroy his spirit and his ability to love.”
An autopsy showed that the device had worked well. The Utah team believed they had a winner.
* * *
Their victory, however, was short-lived. Thanks to the aggressive PR efforts of the university, and probably its inexperience with the new phenomenon of media circuses, the entire world had either seen video of or read about every detail of Clark’s surgery—as well as the minute details of his agonizing decline. So what was supposed to be a PR and fundraising boon turned into a massive PR disaster.
Initially, the Clark narrative was that of a medical miracle with lots of good guys, including the “Lincolnesque” surgeon DeVries, the hot, motorcycle-jacketed Jarvik, and Clark himself, who was cast as the “avuncular astronaut.” (Hadn’t Ed White been tethered to the mother ship when he became the first American to walk in space in 1965? Hadn’t Neil Armstrong been tethered to a portable life support unit when he took his first step on the moon in 1969?) Though Clark and his family were largely shielded from the media—save for the reporter who snuck into the hospital in a laundry basket—the hospital hosted twice-daily press conferences in the basement to keep journalists and their audiences abreast of virtually every breath Clark took. News bulletins interrupted regularly scheduled programs. Jarvik and DeVries were, of course, magazine cover boys.