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by Mimi Swartz

  The four Jarvik-7 hearts implanted at the Humana Heart Institute in 1984 and 1985 were not viewed as successes. Most patients died within a matter of months. The longest survivor was William Schroeder, who lived nearly two years but endured multiple strokes and other debilitating conditions, all of which were recorded by the press. Instead of being a poster boy for the artificial heart, Schroeder became another living argument against medical progress for the sake of medical progress.

  Life magazine’s May 1985 story on Schroeder sported a hopeful cover: DeVries, fit and beaming, posed with a protective arm around him. The patient wore an oxygen tube protruding from his nose, and the distracted smile of someone who wasn’t quite there. The subtitle inside was far less optimistic than previous artificial heart coverage: “The Troubling Story Behind a Historic Experiment.” The story itself was pretty negative too.

  None of this reflected well on Jarvik. It wasn’t exactly his fault that the media had tried to fashion him as another medical superstar in the tradition of Barnard, Cooley, or DeBakey. But Jarvik was ill-suited to the role. Although he looked the part—Jarvik was indisputably handsome, even sexy, especially when photographers enticed him to pose in a motorcycle jacket or shirtless. But his personality didn’t lend itself to the all-access journalism of the time. Up close, Jarvik wasn’t nearly as suave as he appeared, even when he posed as an iconic, eye-patch-wearing man in the Hathaway shirt. By the mid-eighties, his own negatives and the negatives about the artificial heart were overlapping like crashing waves in a gathering storm.

  A case in point was a Playboy profile published in April 1986. It’s hard to believe in retrospect, but at the time submitting to a Playboy profile, like participating in the Playboy Interview, was a mark of distinction, even though everyone knew that the real purpose of the journalism in the magazine was to serve as intellectual cover for all those foldouts of young and very buxom naked women. Still, the exposure was probably irresistible to Jarvik, as it had been for Frank Sinatra, Fidel Castro, Vladimir Nabokov, Ingmar Bergman, Elisabeth Kübler-Ross, Lech Walesa, Jimmy Carter, and so many others.

  But, as many celebrities would soon learn, there was such a thing as bad publicity. “The Rock and Roll Heart of Robert Jarvik” homed in on the subject’s complete obliviousness to normal human conduct, such as Jarvik’s laser-like determination over a weekend with the writer’s family to build a dildo in the shape of a unicorn horn for a new lady friend. As in: “The ovens were heating up for dinner, and we were about to begin when Jarvik insisted that his dildo be baked first…we all stood around for half an hour—my wife, my parents, two of my hungry brothers and I…until Dr. Jarvik declared it finished.”

  This kind of behavior made it increasingly difficult for Jarvik to find colleagues and funding for future projects. Bud was, in essence, the safest and last resort.

  When Bud inspected Jarvik’s device, he had one major suggestion. The pump should go inside the left ventricle, instead of fitting outside the heart and under the diaphragm, like most of the LVADs then in use. That way, there would be less crowding inside the torso and less discomfort—and, more important, less chance of infection. At the time, surgeons had to make something called a “pump pocket” to fit the pumps in, but those pockets were perfect receptacles for bacteria and, eventually, infections.

  But putting the pump inside the ventricle itself created problems of its own. Jarvik’s pump, like Wampler’s, used bearings at either end of the rotor. Wherever a moving part comes into contact with a non-moving part, a bearing is needed as a transition; otherwise, the connecting points will literally grind to a halt. But bearings need lubrication to do their job. The bearings that kept the rotor turning inside Wampler’s pump were lubricated with a glucose solution via a line from outside the body. But you couldn’t have a line like that going directly into the heart if your device was supposed to be totally implantable.

  Jarvik had a solution for that problem: using the blood flowing through the pump to provide the lubrication. This was like declaring that soapy water would work as well as motor oil in a car. It didn’t sound like a workable idea. And, of course, this was in the mid-1980s, when almost everyone still believed that blood was as fragile in a centrifugal pump as an overheated southern belle on the dance floor. Medical experts felt Jarvik’s design, like Wampler’s, was doomed because the bearings would crush the blood as it passed through, destroying red blood cells, and so on until death.

  Bud, however, was intrigued. Jarvik might be a pain in the ass, but he was very good at making things—in fact, no one in the biomedical field was better. And unlike Wampler, Jarvik already had a prototype for a pulseless/continuous-flow device. So Bud agreed to give the pump a try in a few poor calves.

  There was, however, a bigger problem: money. Jarvik didn’t have any and wasn’t willing to trust his creation to venture capitalists, given his experience with Symbion. And government grants for an artificial heart, by this time, were about as rare as self-effacing heart surgeons.

  That is when Bud, who had a vested interest in proving the merit of continuous flow, came up with a novel solution. For years his department had earned $2,000 each time someone went to pick up a donor heart for transplantation—in the early days, Bud was the doctor charged with flying to a designated hospital and cutting the heart out of a brain-dead donor. (“It’s a ten-minute operation. You just have to know where to cut and put the heart in an ice pack and get back on the plane.”) Having never been obsessed with money, Bud at first refused it and then just put each fee in a fund for the THI lab and forgot about it. But Cooley’s booming transplant program had been an unexpected boon—by the time Jarvik approached him, Bud had about $50,000 put away. That was enough to use on a few experiments.

  Thus began a process that was slow-moving and not very encouraging. There were no software programs at the time for designing much of anything, much less artificial hearts. Jarvik made the titanium pump himself—doing all the drawing, cutting, sanding, and polishing. His goal was to make something small enough to fit inside the heart but strong enough to push blood through the thousands of vessels in the body.

  Jarvik insisted on scrubbing in on the implantations in the lab. It both amused and appalled the others present to see him peering over the great Dr. Frazier’s shoulder, enjoying the privilege of calling him Bud when the rest of the team wouldn’t dare, suggesting he move the pump up a little, or down a little, or a little toward the left or right. You could almost see the thought bubbles over everyone’s head: Jarvik had never practiced medicine. Jarvik was not a surgeon, much less a THI surgeon. Who did this guy think he was? Bud, though, chuckled and responded like a teacher indulging an eager if misguided child.

  The result of the first animal implant was probably predictable: within three days, the pump froze, and the calf died. A technician in Bud’s lab removed the pump and sent it back to New York, where Jarvik made changes in his design, particularly in the bearings, which he deemed to be the problem. This went on for the next few years. Jarvik would study what he had done before, make more adjustments in the bearings, and send a new pump to Houston. That pump would then go in a calf, and the calf would live a little bit longer, but never quite long enough. Something about the shape, size, or polishing of the bearings was always off. After several years, Jarvik was almost ready to give up on the idea.

  Not that all was lost. By August 1987, Jarvik had divorced his wife and left his two children in Utah to move to New York, where he married Marilyn Vos Savant, a dark-haired stunner who made a name for herself as the Smartest Woman in the World. Vos Savant claimed to have the highest IQ of anyone on the planet, which won her not just the Smartest Man on the Planet but an advice column called “Ask Marilyn” in the Sunday supplement Parade. (You were supposed to ask her tough questions about math and probability, such as “Are men smarter than women?”) She parlayed that success into book contracts for tomes that promised to make reader
s as smart as she was. The couple shared an apartment on the West Side of the city, where Vos Savant wrote and Jarvik had his lab. According to one publication, they spent a lot of time discussing the nature of reality.

  It was the success of the Hemopump in 1988 that finally galvanized Jarvik—specifically, it was Wampler’s discovery that blood could spin at high speeds without damage. By 1989 or 1990, Jarvik had figured out that the difference between a pump that worked and one that didn’t had to do with the way he was polishing the bearings. As it turned out, the difference between a bearing that worked and a bearing that failed was a difference that could only be measured in microns.

  By then, the calves were living eight months with his pump, well past the FDA requirement to begin human trials. Bud noticed that they had gotten so big they were leaving giant hoof prints on the floor of the lab.

  Then they faced another hurdle. FDA trials, as Wampler had learned, were expensive and risky. Jarvik would need to pay for personnel, testing, and so on. But unlike Wampler, he continued to refuse to work with any venture capitalists. A solution seemed to come from the federal government: the Small Business Administration, under George H. W. Bush, was giving out loans to encourage growth, including loans to companies that made medical devices. Jarvik was nothing if not a small businessman, and so he applied.

  Unfortunately, the person charged with approving the loans in the medical field was Michael DeBakey, who was not a member of the Robert Jarvik fan club. Even though members of his committee recommended funding the pump, DeBakey turned the Jarvik application down flat.

  Then something really odd happened. DeBakey—who had never reopened his artificial heart lab after the Cooley/Liotta betrayal—came out with a pump that was also continuous flow, with bearings lubricated by blood. According to DeBakey, the device had been developed over a period of years with the help of NASA engineers. But to people around THI at the time, the DeBakey pump was strikingly similar to Jarvik’s—and debuted very soon after Jarvik had submitted his detailed schematics to DeBakey’s committee for the small business loan.

  Jarvik was so upset that in a phone call he told Bud he was thinking of suing.

  DeBakey, however, wasn’t rattled. “I don’t know what stage his device is in,” he told a reporter around that time. “I’m sure that he’s trying to compete too.”

  DeBakey certainly moved faster. He arranged to have his pump implanted in a patient in Europe in 1998. (By this time, inventors were doing their testing outside the United States because FDA requirements had become so constraining that it was virtually impossible to adhere to them.) Bud was not impressed with some aspects of the design, and indeed, with more implantations, the pump caused an excessive number of strokes. If that wasn’t bad enough, the company formed to market the pump was bought by a hedge fund that was soon embroiled in a financial scandal—and not long afterward abandoned DeBakey, his company, and his pump.

  This should have given Jarvik some satisfaction—along with the fact that his pump worked a lot better than its supposed twin. Bud implanted it in a middle-aged woman named Lois Spiller in 2000, who thrived—Jarvik had even added a dial that could be adjusted to increase blood flow. “When I get tired I just turn those numbers up and I can walk some more,” Spiller told her surgeon, Bud Frazier.

  But fate intervened again. Cardiologists and surgeons did not like the Jarvik 2000 because they didn’t want to work with Jarvik. Meanwhile, Jarvik hadn’t kept good enough records to submit to the FDA to complete his trial, and Bud’s records were destroyed in a Houston flood in 2001. So the Jarvik 2000, a fully implantable heart assist device, has yet to be approved for use by the government. Bud calls it, “the longest FDA trial in history.”

  There was, however, another pulseless, implantable device that seemed to hold a lot of promise around that time. Bud’s old partner Vic Poirier of Thoratec had been working with Rich Wampler on a new iteration of the Hemopump, called the HeartMate II. In 2008, it won FDA approval as a bridge to transplant, and two years later it was approved for long-term use.

  As Robert Jarvik told a reporter in a slightly different context, referencing DeBakey, “If you compare it to a prize fight, who throws the punch first is not so important as who’s there at the end and who throws the punch last.”

  12

  THE KING OF DISTRACTION

  One of the few things Billy Cohn loved as much as working as a Texas Heart Institute heart surgeon was Halloween. If he were self-aware—and he could be, at times—he might have noted that celebrating the holiday on a grand scale allowed him to combine many of the things he loved: magic, performance, and making something with his preternaturally active hands. A person with normal levels of time and creativity would have to sacrifice something to prepare for what was, for Billy, a suburban-scale spectacle, but he possessed one of those minds that could either (a) contain many thoughts, plans, and ideas at once or (b) move so fast it just seemed that way. Billy was a raffishly handsome man with a nasal Houston twang—blue-eyed, reddish-blond hair thinning into a precise widow’s peak, a sharp nose, and a cock-of-the-walk stride. He favored inky black cowboy boots with his scrubs, and was best taken at face value.

  In other words, the Great Halloween Extravaganza of 2013 didn’t take away from Billy’s very busy life as a surgeon and inventor, or, for that matter, from his obsessive sidelines as musician and magician. Billy played trombone in a number of bands around town, usually on weekdays in the late evenings, often after surgery. He was also a master of card tricks, punctuating many a slow (for Billy) dinner with his favorite sleight of hand, converting five one-dollar bills into five $100 bills. Billy was also married and a father of five children, each of whom in some way reflected their father’s energy and/or talents, as if his personality had been fractured into his progeny like a beam of light shot through a prism. In contrast, Billy’s wife, Mishaun, a stay-at-home mom who is also a card-carrying member of Mensa, displayed an uncanny ability to go along to get along, the only way a person could probably live with Billy for any extended period of time.

  The Cohn mansion in the once modest but now substantially upgraded neighborhood of Bellaire resembled Tara from the outside, including the obligatory columns and porticoes. Inside, it looked a little like the place had been recently ransacked, with several generations of toys and games and electrical equipment throughout. Things went missing, like the top to the toilet tank. This made repairs easier when the thing kept running, because you could just reach in and pull the float up by hand.

  Billy’s workshop out back, behind the expansive patio and pool and the vintage Jaguar with leopard-spotted upholstery parked under the porte cochere, was in a similar state. There were metal shelves and pegboards that looked post-implosion, with countless hanging and tangled wires and tubes, adhesives, straps, and other assorted unidentifiable (to anyone but Billy) objects. Creations, partial and complete, dangled from pegboards. A poster for a new kind of surgical needle Billy had invented featured a multiply pierced hipster with the caption “Too Many Holes?” He could have been Billy, back in his punk-rocker phase.

  The workshop was the place Billy retreated when he needed to focus, and he needed to focus for Halloween. This year’s concept had been percolating in his mind for quite some time—a week or so. The Bellaire house had a sprawling front lawn, punctuated at the curb by two large oaks. A distance of about twenty feet separated the house from the trees, a span that suggested to Billy some form of transport. Aerial transport.

  Coincidentally, Billy had come across one of his nineteen-year-old daughter’s abandoned dolls. Its silky yellow hair had turned ratty from affection and overuse, and suggested at least one encounter with, maybe, electrocution. The doll’s white lace dress, once pristine, starched and neatly banded with pink satin, was now dingy with age, the color of bad teeth.

  Over the next few days, Billy added bright red stains and mud-colored spots to the dress
. He painted the top half of her face deathbed white, while the bottom half he made as red as arterial blood. Ditto her right arm. He fiddled with her body, moving the arms and legs up and down until the doll assumed the position of a superhero flying through the air. He strung wires from the trees to his front door, and motorized the whole thing with a remote-control box he adapted from one of his sons’ toy cars. By Halloween, his creation was ready to go.

  Like virtually every Billy Cohn invention, this one was a big success. Here they’d come, the wide-eyed, mega-coddled innocents of Bellaire, the ones whose mothers walked them into school every day and baked gluten-free classroom cookies. Or the kids in Freddy Krueger masks and polyester Disney princess costumes from the apartment complexes in nearby Gulfton, chattering away in Spanish. They’d skip up the Cohn driveway, their sacks already open, greedy for candy, and then—out of nowhere—this screeching doll would swoop down on them, grazing their tiny scalps like a hungry, furious, completely crazed madgirl.

  It did take a while to calm the kids down, but then they went scrambling through the house to Cohn’s second-floor balcony to watch the next bunch of kids get tachycardia.

  A cynic could suggest that Billy was creating his next generation of patients. Or that, despite his 24/7 schedule, he still couldn’t keep himself busy.

  * * *

  A lot of surgeons are satisfied just to be surgeons. Or even highly specialized surgeons, like neurosurgeons or cardiothoracic surgeons, Billy’s chosen field. Most such super-specialists are happy enough to stand over a fully anesthetized human body and sew up a ruptured aorta while the seconds tick away and a life hangs perilously in the balance. Every damn day that kind of doctor gets up and at least tries to save a life—and the riskier the practice, the likelier the loss. Looking deep into the eyes of the desperate turned grateful, even worshipful—for most, that’s enough. That and the exhilaration of beating the odds. Again.