by Mimi Swartz
So yes, Billy loved going to the Texas Heart Institute every morning. He couldn’t believe he got to work alongside the men who had been his heroes and mentors, such as Denton Cooley and, now, Bud Frazier. Even so, he needed more. Billy wasn’t unlike a very busy bee buzzing from flower to flower—all that pollen was delicious, but there never seemed to be enough of it. In that regard, he was lucky to have come into his own at a time when the medical profession was in something of a supercharged, if chaotic, phase. The doctor who made house calls or even one who sat at the foot of your hospital bed offering comfort and encouragement—like the iconic TV doc Marcus Welby or even, say, Michael DeBakey or Bud Frazier—was speedily going the way of the VCR and the landline. First there was all the paperwork demanded by the managed care experiment, and soon there would be the all-inclusive concierge care, where for around $2,000 a year, the wealthy could buy the bedside manner. But at the same time, the medical world had expanded in ways that better suited someone like Billy, temperamentally, intellectually, and creatively.
Put another way, the medical and engineering professions were like a couple who were profoundly ill-suited for each other but determined to work together for the sake of the children. Yes, there were myriad inventions that had required joint efforts—the heart-lung machine being one of them—but the engineer and the physician rarely if ever sat down together, and then only when necessary. There were many theories for this conflict. One had to do with different training. Engineers were taught to be “divergent thinkers,” to explore as many answers as possible when looking for a solution—like, say, bringing the astronauts home safely during the Apollo 13 disaster. Physicians, in contrast, were taught to be “convergent thinkers”—to believe that there was only one right answer to the way the body worked and you’d better know it in a crisis.
A somewhat conflicting theory held that medicine was for a very long time more of an art than a science, and engineering was rooted firmly in the concrete. Then too, doctors were sure they were smarter than engineers (and everyone else), and engineers thought they were smarter than doctors (and everyone else).
The rapid expansion and overwhelming intricacies of technology forced them together. With every increase in knowledge about the body, medicine became not just more specialized but more dependent on things that themselves had increased in complexity. Those advances made possible inventions that would have been unimaginable just a few decades ago: artificial titanium hips, flexible and pressure-sensitive artificial skin, micro-rockets that delivered medicine to just the right spot in the body, prosthetics operated from deep in the mind, and so on. No one person—even a surgeon! even an engineer!—could possibly keep up. Yes, Denton Cooley could build a precursor of a heart-lung machine with materials from the hardware store in the 1950s, but by the 1980s, few if any medical professionals could actually make a medical device that could be mass-produced and not only worked electronically—or with lasers or magnets or ten jillion computer data points—but could also pass muster with the FDA. (God help you if you got a pacemaker or a heart valve to market that then developed issues; as Rich Wampler and Robert Jarvik knew all too well, even the hint of a life-threatening problem would damn your invention to obscurity.)
And, then, thanks to the Barney Clark debacle and other medical failures—in particular the IUD—the great enthusiasm of the federal government for funding giant medical breakthroughs had declined significantly. This didn’t mean there wasn’t money to be had; it just meant that most of the money needed for medical research was now coming from private sources, venture capitalists who were more than willing to pour cash into a creative endeavor, as long as they got a huge piece of the action and it met with great success. Which didn’t necessarily mean that it saved lives but rather that it generated hundreds of millions, or even billions, for its investors. Witness the disaster that was the Hemopump. Failure in medicine and medical innovation was as natural as life and death, but it was also not an option.
This was the world in which Billy Cohn came of age.
* * *
One of the most frequently repeated stories about Billy—and sometimes not by Billy himself—is that, growing up in the prosperous Memorial section of Houston’s prosperous west side, his mother, Judy, would leave newspaper clippings about Michael DeBakey and Denton Cooley beside his cereal bowl in the mornings. This move could be interpreted as a classic Jewish mother ploy (a Houston Jewish mother in particular), but it might also have been a vain attempt to keep Billy on the straight and narrow. By his admission—not his adoring mother’s—Billy did not apply himself in elementary school, maybe because he had a touch of ADHD and maybe because he was just supremely bored because he was so smart. Or both. It is perhaps notable that his father, an advertising and marketing executive, came to Houston to work for the mildly certifiable Judge Roy Hofheinz to publicize the judge’s new pro baseball team, the Colt .45s (soon to become the Astros), along with the eighth wonder of the world, the Astrodome, the nation’s first indoor stadium. The Dome was, to say the least, a marvel of engineering and a perfect example of Thinking Big, Texas style, but in a good way.
Coincidentally or not—depending on how big a believer you were in Houston’s possibilities—it was during this time that NASA was launching its manned spaceflight missions. During the sixties and seventies, Billy’s parents were friendly with many of the astronauts, some of whom even came to dinner at the house. (“My family is manically extroverted,” John Cohn, Billy’s older brother, explained.) If you were a hypercreative boy in Houston during that time, it was pretty easy to believe you could do just about anything you set your mind to.
In fact, from a very early age, Billy and his brother, John, spent a lot of time unsupervised—their mother and father predated the age of helicopter parenting—and entranced with science experiments that mostly involved blowing things up in bigger and better ways. Their parents were extremely bright: mother Judy had been in Sylvia Plath’s class at Smith, father Hugh was a self-starter who thrived as a marketing and advertising executive in the Mad Men era in Manhattan. “In our family you had to be sharp,” John Cohn said. “To be half a step behind on a joke was almost unthinkable.” Science was in the family genes: Billy’s uncle, Arnall Patz, was the revered Johns Hopkins ophthalmologist who discovered the link between anesthesia and childhood blindness. At every holiday or birthday where gifts were exchanged, the Cohn brothers asked for chemistry sets. They built their own lab in the garage. They became potato cannon sharpshooters.
At this point, you might have expected Billy to take his rightful place in pocket protector nerddom, especially in a white-bread, deeply conformist suburb like Memorial. But several factors worked against that. He was a good-looking kid, blond and blue-eyed, quick-witted—often to the point of impatience—and less interested in book learning than in figuring things out on his own. He was good with his hands: Billy was one of those kids who could master almost anything he tried, who was able to intuit the mechanics of virtually any device he laid his eyes on. And, thanks to a dad in PR, he was also able to communicate to the mechanically challenged just what, exactly, he was doing and why. He was very popular.
Still, his mother worried that Billy was never quite able to settle on anything. In high school, he joined the marching band after teaching himself how to play the trombone. He also taught himself to play the guitar, electric and acoustic, and started playing in high school bands. He liked to draw, so he got himself a job designing and silk-screening T-shirts, and then another decorating cakes at Baskin-Robbins. Mostly he nurtured the nebulous goal of becoming a rock star. The punk scene was coming on strong, and it seemed a good fit for his musical and theatrical gifts as well as his psychological makeup.
Then he got to college at Oberlin. “I quickly saw that I didn’t have to live up to anyone’s expectations, that I didn’t have to follow some already-in-place-plan for my life,” he would say later. On the other hand, Billy
’s first career choice was looking like a non-starter. Oberlin seemed full of musicians with rock-star dreams. Billy aced the MCAT—he had fortuitously completed a double major in biology and chemistry. Then, almost on the fly—he missed most medical school application deadlines—he applied to Baylor and several other med schools, and through what he himself says might have been divine intervention, along with a summer job with his mother’s Baylor-trained doc, he got in. It is safe to say that Billy was the only med student there with a rainbow-hued punk ’do.
As it happened, the challenges and the demands of medicine appealed to him, as well as the intensity—the churning Ben Taub Hospital emergency room, one of the busiest in the nation, was the perfect place for a young, perpetually restless surgeon. As a cardiac surgery resident in 1991, Billy never had time for his mind to wander; the place wasn’t nicknamed the “Houston Knife and Gun Club” for nothing. He was fast and thorough, and soon enough developed the been-through-the-fire Baylor swagger. Toward the end of his residency, Billy won the dubious honor of serving as Michael DeBakey’s last chief resident. DeBakey, in his eighties, finally put his scalpel down in 1993, to the relief of many.
Like Bud, Billy intuited what he was supposed to be in DeBakey’s presence—that is, perfect—and accepted the challenge, even though doing so meant hiding his eight hundred watts under the proverbial bushel while amping up his hypervigilant side. “You had to be smart and you had to be resilient because they would beat you down,” his wife, Mishaun, explained. By then, Billy was accustomed to the abuse and the lack of sleep; now he read and memorized every page of patients’ charts to avoid DeBakey’s passion for humiliation. He became expert at dispensing the “proximity beating,” following DeBakey’s predilection for screaming at whoever was closest to him for whatever went wrong, regardless of who was really at fault.
By the time Billy finished his surgical residency at Baylor, he was certain of one thing: he did not want to go into private practice. The idea of doing the same thing over and over again, day in and day out, was, for him, a form of torture. He applied for and won a coveted fellowship at Harvard Medical School, followed by a full-time faculty position and, eventually, a directorship of Minimally Invasive Surgery at the prestigious Beth Israel Deaconess Medical Center. Unable to give up his rock-star dreams, he also kept playing in bands in his off-hours.
It was during this time that Billy, like Denton Cooley, came to see that his constant tinkering could come to more. He had an unconscious, automatic compulsion that allowed him—drove him—to see and solve mechanical problems. Billy installed a metal shop in the basement of the small house he shared with his growing family in Brookline. (At that point, Billy and Mishaun had two children in diapers. Ostensibly, they weren’t allowed in the basement.)
The first invention he brought to near completion was a portable blood warmer. Unfortunately, no one, even a highly trained engineer, could bring his idea to life at the time because the technology to keep the blood undamaged and at a steady temperature outside a hospital setting did not yet exist. (For hospital operations, blood is refrigerated and then warmed before transfusions for adequate circulation. If you were, say, on a battlefield or even at the scene of a ten-car pileup, a mobile blood warmer could come in handy.) The second didn’t work out either. Billy did not give up. As always, he had another idea.
Every heart surgeon knew by the 1990s that the heart-lung machine had drawbacks. Stopping the heart during surgery was then and remains dangerous, and even patients who recover successfully from an operation can suffer serious side effects that have been attributed in studies to being “on the pump.” (Temporary cognitive decline and personality changes are two side effects.)
But just as it was believed for centuries that no one could or should touch the heart, and later that attempting to operate on it was sure to cause certain death, it was believed as late as 1990 that performing surgery on a beating heart was impossible. “Like cutting a gemstone while you were on horseback,” was the way one journalist put it. But Billy didn’t see it that way. He was part of a new generation of surgeons who were trying to simplify operations that had become, maybe, just too complicated; the goal was to use advances in technology to create simpler and more successful operations. Billy wanted to bypass the bypass, as he put it. (The heart-lung machine, which allowed surgeons to circulate blood outside the actual heart and lungs during surgery, is not to be confused here with the coronary bypass operation, which allowed surgeons to literally circumvent blocked arteries by building new circulatory pathways out of veins taken from the legs, or man-made materials.)
Billy was not alone in his quest—many surgeons around the United States were thinking along the same lines. Like most good surgeons, he spent a lot of time traveling and talking with other doctors about recent advances in the field. On a visit to Johns Hopkins, Billy studied a technique developed by James Fonger, who had found a way to operate on beating hearts while holding them steady with something that looked like a two-pronged salad fork.
Back at Harvard, Billy tried it out, but found the heart still moved too much for his taste. Driving home from a long day in the OR in 1996, however, he had an inspiration. He pulled into his local Stop & Shop and roamed the aisles until he found the kitchen tools, and then started loading up on metal ladles, all sizes, the stronger the better.
Once in his basement in Brookline, Billy started pounding the ladles flat and adjusting the angles until he had one he liked. Then he cut a one-inch square right in the middle. Billy had a hunch that he could treat the heart like an egg in a basket by pressing the flattened ladle against the heart to hold it steady while he repaired the area visible through the window in the middle of the device.
Over the next few months, he tried his invention out on dogs and sheep, refining his design so that he was able to stabilize the beating heart to a greater and greater degree. Finally, in 1996, a patient gave his informed consent to let Billy skip the traditional heart-lung machine in favor of surgery with something that looked like a kitchen spatula. Fortunately for everyone, the operation was a success. The surgery went faster, and the patient made a faster recovery. There were more refinements—eventually Billy’s creation looked like two spatulas held together with a retractor that clamped on the chest—and within the year, Billy Cohn had sold the Cohn Cardiac Stabilizer to Genzyme Surgical Products, one of the many medical device companies now ringing the Boston area as the field of bioengineering—building new body parts, in essence—was exploding. Billy would later describe his invention as having “all the complexity of a Happy Meal toy,” but in the next few years it was put to use in sixty medical centers and more than 200,000 operations.
Along with his patent, Billy Cohn got a profile by Jerome Groopman in the New Yorker in 1999, with the headline “Heart Surgery, Unplugged.” He was finally a rock star. So it was only natural that he would want to play with the coolest band in the world.
* * *
Cooley had set up Surgical Associates of Texas in the early 1970s, a private practice of surgeons who maintained operating privileges at St. Luke’s Hospital, the Texas Heart Institute’s base of operations. He had not only perfected the coronary bypass operation by then, but was also thriving with his surgical assembly line. And if for some reason Cooley couldn’t do the actual surgery, patients knew they were in good hands with one of his colleagues. That is, if anyone told them that had been the case.
This system made THI docs some of the richest in the world. A bypass operation cost around $60,000 back then, with most of it going to the surgeon. Being a member of the Texas Heart team at this time was the equivalent of getting a ticket punched at Harvard: it couldn’t guarantee a hefty income for life, but it sure made it easier to get one.
At the top of the food chain, of course, was Cooley. He’d received the National Medal of Technology and Innovation from President Bill Clinton in 1998; he played golf with top-of-the-line Hous
tonians like former president George H. W. Bush and his secretary of state, James Baker. He was the old family friend George W. Bush turned to in 2000 to reassure himself that Dick Cheney was up to the rigors of campaigning as the Republican vice presidential nominee, despite his history of three heart attacks, bypass surgery, and two cardiac catheterizations. (Cooley was confident enough to give the OK without personally examining Cheney, who subsequently received an LVAD for his heart disease in 2010.) When the Denton Cooley Society held its annual meeting, they didn’t go to the medical center’s Marriott; they met instead in London, Hawaii, Puerto Rico, or Sun Valley. The meetings were underwritten by drug and device companies, and not just because Cooley himself was famously cheap—the companies wanted in too. The board of St. Luke’s went to great lengths to make sure Cooley was happy: when a new medical office building opened across from the hospital, board members gave Cooley his own private apartment.
But just about everyone in Cooley’s orbit became the medical equivalent of a master of the universe. Even someone like Bud Frazier, whose income was (somewhat) limited by his commitment to research and an inability to care about getting really rich, still managed to indulge himself with rare books from a London dealer, and to save his beloved Anderson Fair music venue from extinction.
If you were a part of the THI team, you had the opportunity to indulge every whim, assuming you had time to do it. And of course, there were nurses and secretaries and all sorts of other attractive women who were more than willing to take a spin in whatever fancy car you chose to show off. Or join you for fancy dinners, or just meet you in one or another hospital call room. There were surgeons who indulged in ritalin and coke, and more. And there was the occasional hiccup: the wife of one of Cooley’s associates shot and killed her husband in their River Oaks mansion, claiming he had abused her. She got off. “I don’t know about you,” Cooley joked to a colleague after visiting the scene on the day of the murder. “But I’m going home and hiding my guns.”