by Mimi Swartz
Then too, enough had been learned about heart disease by that time to suggest that preventive medicine—Stop smoking! Start jogging! Eat less meat, more vegetables!—was a much better option than heroic, Hail Mary measures once a crisis set in. Bernstein noted in his article that the artificial heart “represents a triumph of skilled physicians and technology over illness and nature. But such triumphs can be costly and shortsighted.”
On the other hand, people continued to die in record numbers from heart disease. And the number of available hearts for transplants remained stuck at twenty-five hundred per year, while tens of thousands waited in desperation for a rescue that wasn’t coming. These were the facts that troubled Bud a lot more than the cost of implants or the bioethicists who thought he was in league with Dr. Frankenstein.
Bud believed his patients needed something new; he just wasn’t sure what that would be. All he knew was that he was ready to abandon air-powered pumps, not just for LVADs but for any future total artificial hearts he might devise. Yes, air-powered pumps paid the bills in his lab, and could keep a patient alive for a few years. But once the machine started to falter, those patients would wind up either back in surgery for replacement parts or back on the transplant list; so far, no air-powered device could equal the natural heart’s ability to beat 115,000 times a day.
In addition, the current pumps were too big. No one had come anywhere close to inventing a device that could fit inside a woman’s chest, much less that of a child. To Bud, the answer seemed obvious: someone had to come up with something different. A machine that kept the blood flowing through the body but didn’t have a pump that wore out. Something that would flow continuously, without a break, for who knew how long. Maybe longer than the life of the patient it was implanted in.
Bud began talking about the issue with friends and colleagues, but also in public, at medical conferences, and in papers he wrote for medical journals. There were researchers and engineers who were abandoning air-powered pumps for centrifugal pumps, which forced blood through the body with a spinning instead of a pulsing action. But spinning blood at high speeds was well known to create one dangerous side effect, a condition known as hemolysis, in which red blood cells fall apart, leading to anemia and then more serious problems, like kidney and heart failure. Once again, blood destruction was looking like a barrier to success.
Another side effect of a centrifugal device would be that the patient wouldn’t have a pulse, something no human being had done without since emerging from the primordial ooze. Bud’s attitude was, so what? Who said you really needed it?
The answer was: the entire medical profession. Or, at least, that segment of the medical profession that studied such things, which included many of Bud’s esteemed colleagues. They had tolerated all of his mumbling and grumbling, the rotating library of Penguin classics in his coat pocket, and the Boys’ Life stories about his childhood in West Texas because Bud was a world-class surgeon. He was the one you wanted in the OR, whether you were transplanting, implanting, or just trying to keep some unlucky soul from dying in your very hands. But now, it seemed, Bud’s colorful imagination had gotten the better of him. Now he was going on and on with all this pulsatile-versus-nonpulsatile nonsense. It was ridiculous. No self-respecting surgeon was going to waste time on a scheme that probably ensured his or her signature on a patient’s death certificate.
What followed was a personal trial for Bud. Now forty-eight, he was keeping pace with Cooley to maintain the Heart Institute’s backbreaking surgical schedule. And it was Bud, not Cooley, who was running the ever-expanding research lab down in the basement.
He had worked tirelessly to get himself to the pinnacle of his profession. The perks weren’t what they had been in DeBakey’s or Cooley’s heyday—even in those pre-Kardashian days, magazine editors were rapidly losing interest in putting doctors on their covers unless, like the bearded, avuncular, Harvard-trained Andrew Weil, they were sporting some new, natural, organic, life-extending cure for who knew what. Still, Bud was doing pretty well: he traveled around the world, sometimes with Cooley and sometimes without, performing surgery and lecturing on the latest techniques. He knew the best restaurants in Paris, Riyadh, and God knows where else, and he had a whole entourage of minders who allowed him to focus exclusively on saving lives. The best medical journals clamored for his papers. He lived just a few blocks from Denton Cooley in a more modest but elegantly appointed home in River Oaks, and his son and daughter went to the best private school in Houston. As with so many doctors of this time, home life was something Bud mostly did without. There is a story that Rachel Frazier tells about this period that is illustrative: for some unfathomable reason, Bud had to make a run to his home in the middle of the day. Colleagues at THI would have been surprised that he found the place at all, but he managed to unlock the front door with his key and headed upstairs. There he ran into the family maid of many years, who took one look at the shambling, shaggy-haired intruder and screamed in terror. She had never seen Bud before. Still, to most small-town Texas boys—and a lot of big-city Texas boys—Dr. Bud Frazier looked like he had it made.
Until he boarded that pulseless heart train. Then, as Bud put it to a writer for Popular Mechanics many years later, “I was like Robinson Crusoe doing magic tricks for the goats.” The man who had once won virtually all medical debates using the latest scientific data suddenly found himself trying to score points with—a feeling in his gut. This was not a good spot for a man of medicine. Oh, he argued that all the other organs operated with continuous flow; that was one point. And blood flowed continuously at the capillary level—it didn’t need a pulse to keep moving there. But that was all he had. He just believed you could make a heart with continuous flow instead of a pulse. Bud had no scientific proof that humans could do without a pulse or a heartbeat, while the opposition had the entirety of medical history on its side.
Bud had a slight proclivity for aggrievement, and now he could be seen and heard complaining extensively around the Texas Heart Institute about the lack of support for his idea among his peers. He was like a very large, wounded animal. Maybe a woolly mammoth. There were people who fled when they saw Bud coming down the hall, even if he appeared to be engrossed yet again in that dog-eared copy of Hamlet. Bud simply could not believe that his colleagues had turned on him. He wrote more papers on continuous flow. They were summarily rejected.
It just didn’t do to slack off when a breakthrough was on the horizon, even if Bud was one of the few people who realized it. Serving on the National Heart, Lung, and Blood Institute’s prestigious advisory board was a help. The NHLBI was the third-largest institute within the National Institutes of Health. Soon enough, Bud found himself sitting next to Michael DeBakey, who had not spoken to him in eleven years. But by then DeBakey had mellowed to some extent: he was seventy-seven and still running Methodist Hospital like a military dictatorship. And he was still performing surgery, much to the dismay of several associates. But after being widowed in 1972, he remarried in 1975 to a stunning German actress by the name of Katrin Fehlhaber, whom he’d met at a party at the home of comedian and grateful patient Jerry Lewis. A sometime painter, Katrin journeyed to Houston to paint DeBakey’s portrait and stayed. Maybe ten years of marriage to a beautiful woman thirty-four years younger had softened DeBakey; at any rate, he reached out to Bud at the end of a presentation. By way of rapprochement, DeBakey pointed out an error of omission in Bud’s speech, reminding him that “inattention to detail was the hallmark of mediocrity.” With those words, Bud was forgiven all. It was a DeBakey form of forgiveness.
Moreover, it became clear that the two needed each other. The head of the NHLBI was a Reagan administration appointee named Claude Lenfant, a spindly, balding Frenchman who was not a fan of the artificial heart. His stated reasons made perfect sense. He wanted to put more healthcare dollars into prevention, and believed that left ventricular assist devices were a better bet than
a total artificial heart. Lenfant believed that successful research on that front would lead to more discoveries for a total artificial heart down the road.
But there was another rationale making the rounds at the time, which was that Lenfant’s own plan for an artificial heart had suffered an early death at the hands of Willem Kolff. Whatever the truth—maybe a little of both—the artificial heart looked like it was heading for the junk heap of bad ideas.
Something else happened around that time that convinced the American people that bold experiments weren’t such a great idea: on January 28, 1986, the space shuttle Challenger exploded seventy-three seconds into its tenth flight, killing all seven crew members aboard, including the first civilian to venture into space, a thirty-seven-year-old teacher named Christa McAuliffe. The disaster occurred in the late morning; like the Kennedy assassination, people spent the next few days glued to their television sets in horror and mourning, watching the rocket break into pieces again and again. (One study showed that about 17 percent of the country saw the launch, and the news spread to 85 percent of the population within an hour.) The shuttle program was mothballed for nearly three years, while a special commission appointed by President Reagan investigated the cause, and found the once heroic NASA culture severely wanting.
So maybe it wasn’t surprising that the artificial heart—another technological gamble—would find its future threatened at around the same time. In May, Lenfant, acting alone, abruptly canceled the program, around the same time the Texas Heart Institute and four other institutions were due to receive approximately $22 million in NIH research contracts.
Maybe Lenfant should have thought things through a little more carefully. His action ignited a congressional battle that raged over the next few months like a wildfire out of control. Like so many political battles, this one had the veneer of high-mindedness—medical innovation that could save future lives versus medical innovation that took dollars away from other healthcare crises—with pragmatic, mostly economic concerns lurking underneath. Funding for the burgeoning AIDS crisis, too long ignored by the federal government, was certainly a factor.
Lenfant had a strong ally in the New York Times, which published a May 1988 editorial calling the artificial heart the “Dracula of medical technology” (“During its 24-year life this Dracula of a program sucked $240 million out of the National Heart, Lung and Blood Institute. At long last, the institute has found the resolve to drive a stake through its voracious creation”). That summer, the Times published an even more damning piece called “The Promise That Failed”: “Our need to vanquish death has brought to center stage a new cultural archetype: Dirty Harrys with scalpels who have little patience for bureaucrats and ethical subtleties,” wrote the author, Ralph Brauer, a conservative analyst with the Hubert Humphrey Institute of Public Affairs. The glamour of heart surgeons was fading fast: Ben Casey had morphed into Clint Eastwood’s Hollywood detective who challenged bad guys to “make my day” by giving him an excuse to shoot to kill.
The pounding from the Times—and support for Lenfant—continued into July: “The artificial heart represents medical technology at its most mindless.” And so on.
Two senators had the power to reverse Lenfant’s decision, because they controlled the committee that oversaw funding for the National Institutes of Health: Ted Kennedy and Orrin Hatch, a Democrat and a Republican, who also happened to represent two states, Massachusetts and Utah, that had universities and companies with major investments in artificial heart R&D. That was how Bud wound up in Kennedy’s office, essentially arguing against his boss at the NHLBI. Bud didn’t dislike Lenfant—in fact, he was rather fond of him. He loved imitating his French accent. But Bud didn’t like rules changed by fiat, especially when he felt the person making the rules didn’t know what he was talking about and didn’t try to find out by consulting anyone who was actually working in the field or who happened to be on his advisory committee. Like Bud Frazier.
So now Bud happily joined the fray, arguing democracy versus federalism—probably at length—with a pretty young aide in Kennedy’s office. Bud was joined in the trenches with Robert Jarvik, who took on Lenfant and the Times, claiming, essentially, that both were un-American and maybe murderers too. “There is practically no Government money available for new concepts that can apply the extensive knowledge we have gained,” Jarvik wrote in response to one of the negative editorials. “Thus the Government’s program is barely limping along while heart disease remains our No. 1 killer. Dr. Lenfant’s lack of urgency and leadership is disgraceful.”
His arms sufficiently twisted—by congressional heavies more than by Jarvik and Frazier—Lenfant backed down in mid-July and restored the funding. “We felt the Heart Institute better eat a little crow rather than risk the future budgets of all the institutes,” an NIH official confessed, not for attribution.
Bud Frazier went back to the THI, and back to work, his coffers replenished.
* * *
It was a credit to Bud’s obsessiveness—or his West Texas stubbornness, or his sometimes fritzy connection with the real world—that he persisted with his faith in continuous flow, despite the opposition from his colleagues. But there was another reason as well. In 1986, at a medical conference, two radically different men had approached him who supported his idea. In fact, they had been working independently on pulseless devices themselves. One was an engineer and heart surgeon by the name of Richard Wampler; the other was Robert Jarvik. Jarvik didn’t know Wampler, and Wampler didn’t know Jarvik. Wampler knew Frazier pretty much by reputation alone, while Jarvik and Frazier’s relationship was like those couples who couldn’t live with or without each other. Yes, most heart surgeons and cardiologists were pretty sure Frazier’s pulseless heart notion was nuts. But everyone also knew that if you had wanted to explore something new in terms of the human heart, Bud was just about the only researcher to see, which was why Wampler and Jarvik sought him out.
Like Denton Cooley, Richard Wampler had always been an irrepressible tinkerer, the kid who fixed broken lawn mowers in his neighborhood in Bloomington, Indiana. When he was a boy, Wampler’s beloved grandfather died of heart disease. The sense of helplessness he felt at his grandfather’s bedside, while the doctors and nurses were shocking him with paddles trying to save his life, spurred him toward a career in medicine and also toward the belief that an artificial heart was not just possible but necessary. Maybe, he thought, he was the person who might be able to invent it.
Wampler was not a world-beater in the conventional sense. A classic midwesterner with soulful blue eyes, he was unflappable and wry. He also had a sense of adventure and a sense of obligation that found him in a small Egyptian village called El Bayad in 1976. Wampler was on a volunteer mission to help villagers improve their water supply. One day he saw two men using a submersible pump to draw water from Nile canals into their fields for irrigation. Because he was an engineer, and an expert on pumps, Wampler recognized this long tube with an internal, narrow corkscrew as an Archimedes’ screw. Named after the third-century Greek mathematician, it worked like a plumber’s augur. With the turn of a crank, water could be scooped from a lower place and forced to flow upward to another spot.
Not many people would have thought that such a pump might be useful in treating heart disease, but most people did not see the world the way Wampler did. Like Bud’s, his mind rarely strayed far from the idea of fixing damaged hearts. And like Bud, he had come to believe that the current iterations of heart pumps weren’t good enough. Even with recent improvements, they were difficult and tricky to implant, and therefore dangerous: a surgeon had to open a patient’s chest and cut into the heart and the aorta to attach them. That glimpse of the Archimedes’ screw suggested to Wampler that something much smaller could be implanted, eliminating the need for the potentially debilitating heart-lung machine and open-heart surgery. Wampler didn’t envision a permanent replacement for the heart or any of it
s parts—just something that could temporarily take over some of the functions of a weakened heart’s pumping action. Other surgeons were beginning to look into continuous-flow pumps as well, like Leonard Golding at the Cleveland Clinic, but mostly the field was wide open, kind of like a plot of land in outer space.
Wampler went back to his home in Northern California and began designing and building a prototype for a new kind of heart pump—one that could help the heart move blood through the body by spinning instead of pumping. Initially, Wampler set up shop in the family kitchen, and began casting prototypes out of wax, like a jeweler. Fairly soon after, Wampler quit his job as an emergency room doctor and founded a medical device company that included a handful of aerospace engineers. He convinced them to work with him on a rotary pump, a device commonly used in everything from oil to milk production—anything that keeps liquids spinning continuously.
Wampler’s group reflected his personality: they were true believers, dedicated, open-minded, and not in the least preoccupied with the business side of the enterprise. At least two hard-and-fast medical truths suggested that success was probably not in the cards: the first was the as yet undisputed belief that blood was very fragile and that spinning it at high speed would certainly destroy it, like fruit in a blender. The second was the conventional wisdom that heart disease could not be reversed. Once there was severe damage to the most vital of all organs, the end was ensured.