by Mimi Swartz
As of 2004, building an artificial heart from scratch looked like an easier job than making peace between two old and very proud men. That was the year Bud organized a conference on the history of the LVAD at the Texas Heart Institute and invited DeBakey to come. To the astonishment of virtually everyone involved, he accepted, showing up in a wheelchair and, at ninety-six, giving a lucid, engaging talk on his early work with heart pumps from a podium with the Texas Heart Institute logo.
Cooley was there too. He listened attentively but did not go near the stage. DeBakey made no acknowledgment of Cooley either; he gave his talk and left the auditorium immediately.
A year or so later, Cooley nearly lost any chance for reconciliation. DeBakey nearly died of a dissecting aortic aneurysm, which meant that the inner lining of his aorta was falling apart, like old cloth. DeBakey diagnosed his condition alone while in his study. As the New York Times would point out a few months later, no one was more qualified to make that diagnosis; DeBakey had devised the artificial graft used in the delicate surgery that was subsequently applied around the world to repair torn aortas.
Not surprisingly, the prospect of performing that surgery on DeBakey himself turned many of his protégés into ninnies. Nobody wanted to be remembered as the surgeon who lost Michael DeBakey on the operating table. After all, he had a wife, their thirty-one-year-old daughter, two grown sons from his first marriage, and two elderly sisters who remained financially and emotionally dependent on him. Much more terrifying was the fact that he was Michael DeBakey, who had built Baylor College of Medicine and Methodist Hospital and changed the face of national and global health. Operating on him without success was a surefire career-killer.
The risks were enormous: no one in their nineties is an ideal candidate for major surgery. In fact, DeBakey had written sensible instructions years before requesting that no extreme measures be taken to save his life.
DeBakey’s wife, however, was not ready to let go. Proving herself as relentless as her husband, Katrin browbeat Methodist Hospital’s ethics committee into approving the operation when its members were dragging their heels, petrified of making the wrong decision.
After a great deal of soul-searching, DeBakey’s longtime associate George Noon agreed to perform the repair. The seven-hour operation included the use of an updated Dacron graft similar to the one DeBakey had perfected so many decades before, in the 1950s. DeBakey spent several rocky months recovering in his hospital’s ICU, but by the end of 2006, he was back at home in his white brick mansion on Cherokee and soon after was once again speeding through Methodist’s corridors on an electric scooter.
* * *
DeBakey’s near-death experience resonated deeply with Cooley. Driving home from his THI office on a crisp day in January 2007, he turned on impulse onto DeBakey’s street and parked his car. For one of the few times in his life, he was ambivalent. Eventually he got out of his car, stepped to the front door, and rang the bell, and when a startled Katrin answered, he asked to speak with DeBakey. She kept him cooling his heels in the living room for about twenty minutes and then came back to declare that DeBakey was asleep.
“Why don’t you write him a note?” Bud suggested when Cooley told him what had happened. So he did, asking to visit in order to thank DeBakey for the influence he’d had on Cooley’s life and career. “Especially, I am grateful for the opportunity you provided me more than 50 years ago to become established at Baylor and to be inspired by your work ethic and ambition,” he wrote. Cooley asked to pay a call at DeBakey’s convenience. He never got an answer.
Finally George Noon and Bud Frazier stepped in and came up with a scheme. By that time, there had been plenty of fallout from the forty-year-old feud, including the existence of not one but two organizations for honoring the surgeons’ trainees: the Denton Cooley Cardiovascular Surgical Society and the Michael E. DeBakey International Surgical Society. Maybe, the doctors posited, it was time for the Cooley Society to give DeBakey an award for his achievements and throw in an honorary membership. It was the rare superstar surgeon who could turn down a big award, especially from a competitor.
And sure enough, on October 27, 2007, DeBakey drove his motorized wheelchair into the THI auditorium in the sunlit Denton A. Cooley wing to accept the honor. This time Cooley did speak to DeBakey, and DeBakey said he would treasure the award and find a place for it in his library. Ostensibly he meant the one he was then building at Baylor to house his papers and inventions, including various heart pumps, a replica of the sewing machine upon which he had made the Dacron graft, and an actual-sized reproduction of DeBakey’s operating room from the 1960s.
More reconciliations would follow. DeBakey invited Cooley to the ceremony in which he received the Congressional Gold Medal from President George W. Bush in April 2008. (Cooley, a multimillionaire, opted to share a hotel room with Bud.) And then, a month later, the DeBakey International Surgical Society gave Cooley a lifetime achievement award and honorary membership.
The most meaningful rapprochement, however, probably took place away from the public eye. DeBakey had expressed an interest in watching one of the implants Bud and Billy had been working on with the tandem artificial heart. In December 2007, Bud invited him to the operating room in the animal lab, when they were trying an experiment with two of DeBakey’s old Micromed pumps.
He agreed to come, as did Cooley. It was the first time the two had been in an operating room together in decades, even though this one was used for animals. Cooley walked in under his own power; DeBakey was in his wheelchair, and someone draped him in a paper surgical gown and mask. The two men positioned themselves in the back, chatting quietly and amiably, watching on one of the monitors as Bud worked. They were like retired quarterbacks evaluating a game that was just the same and yet completely different from the one they had played for so long.
DeBakey died in July 2008, just a few months shy of his 100th birthday. Thousands came to a viewing when, at the request of Katrin, he lay in state at Houston’s City Hall—the first time the building was put to that use in its seventy-year history. In his coffin, DeBakey was dressed in his white coat and royal-blue scrubs, along with a cloth surgical cap and a mask pulled down under his chin.
Riding back from the event with Bud, Cooley was pensive. He told Bud he wanted his funeral in his childhood church on Main Street. He said he’d be just fine in a blue serge suit. “I don’t want anything elaborate,” he said.
* * *
“You can operate on really sick people but everything has to go right,” DeBakey told Bud many years ago. The warning came back to Bud in March 2011 as he prepared Craig Lewis for surgery.
Bud had followed all the FDA procedures for emergency use: in the space of about 48 hours, Bud and Billy’s team filled out countless federal forms, and more for the HeartMate II’s manufacturer. They had won permission from the hospital to proceed with the operation, though that had turned out to be more difficult than Bud had anticipated. The review board was wary: lawsuits, sanctions—any number of things could go wrong if the operation went bad, which it was likely to do. One administrator pointed out the obvious: the doctors hadn’t even done one implantation in a person, which was, of course, the point. With Craig Lewis’ chances diminishing by the second, however, the hospital administration finally agreed to let Bud proceed.
So on a sunny spring day in 2011, when a lot of Houstonians were enjoying blooming azaleas and sweet Gulf breezes, Bud stood in the Texas Heart Institute’s largest operating room. Unlike virtually everyone else circling around him, he was calm. He figured the two HeartMate IIs would work in Lewis’ chest at least as well as they had worked in the calves. He had been here many times before, or at least that’s what he told himself.
A heart-lung machine had already taken over for Lewis’ ailing heart. He was draped from head to toe, except for a chasm where an associate had opened up his chest, so that his diseased heart s
at exposed, barely beating, the color of rotting meat. There were so many tubes and wires coming in and out of his body that a less experienced surgeon might have been terrified of tripping, but Cohn and Frazier moved about effortlessly and economically, never quite standing up to their full height as they focused on the patient on the table. Billy, as usual, was responsible for cracking the jokes. Bud chuckled whether he found them funny or not.
He began by cutting out virtually all of Lewis’ diseased heart. His hands, encased in yellow gloves, grew redder with blood by the minute as he snipped away at the arteries and veins holding Lewis’ heart in place, until finally he lifted the diseased organ out of Lewis’ chest, casually handing it to a nurse, who unceremoniously put it in a cooler for pathology. And then Frazier and Cohn began stitching their artificial heart into Craig Lewis’ body, a process that would take about nine hours. Frazier could feel the crowd of doctors and nurses leaning into the skylight in the viewing area above him. But he never looked up, not once.
* * *
Relatives of patients are not allowed to watch operations, so the first glimpse Linda Lewis got of her husband was the next morning when she entered his hospital room. He was sitting up in bed, surrounded by monitors, tapping away on his computer.
One of the doctors examining Craig beckoned her closer. “Want to hear it?” he asked, guiding her toward the bed. Linda leaned in and put her ear to Craig’s chest and waited. Then she shifted her body, so that she could press just a little harder. There was almost nothing to hear. No thump-thump; just a faint whirring somewhere way down deep inside. She was hearing the sound of the first nonpulsatile artificial heart ever put inside a human.
Over the next few weeks, Craig Lewis once again became the person he’d been before the illness began to claim him. He greeted Linda with a broad smile and a wave. He asked for ice cream. He worked on his laptop. He graciously accepted a visit from Cooley and other heart surgeons from around the medical center, who entered his room stunned to see what Bud and Billy had done.
But amyloidosis is fatal, and the disease continued its steady, devastating march through Lewis’ body, picking off his organs one by one. Five weeks after the surgery, he was gone. Linda’s only consolation was that her husband’s death would have value going forward. “If it didn’t help Craig, it would help somebody down the line,” she told Bud.
Before she took her husband’s body home for burial, a pathologist removed his man-made heart. Bud ran some tests on the mechanics, and it continued to work well, spinning and whirring cheerily like a kid’s toy. It might still have been working in Lewis if not for the amyloidosis. The patient died, but in many ways the operation was a success.
14
THE AUSTRALIAN GUY
When pressed for time, Billy Cohn lapsed into irritability, and he was often pressed for time due to the chaotic nature of his surgical career and the persistent urgency of his own internal state. This may have been why, in September 2011, he was annoyed that his secretary had put a name on his calendar he did not recognize. Who the hell was Daniel Timms?
Billy was working on all sorts of things at the time, including a safer, easier device for catheterizing dialysis patients, and improvements to the twin turbine artificial heart that had gone into Craig Lewis. He and Bud had also more quietly put that same device in a dying woman, after her husband begged them to give it a try. Really, it was far too late for such a procedure—Bud was always one for a Hail Mary pass—and she died on the operating table.
Still, the attendant publicity of the first operation had made Cohn, along with Frazier, a celebrity in worlds far beyond their fields of expertise—they were a media hit on everything from CNN to Al Jazeera, which featured an X-ray of Lewis’ artificial heart looking like a set of Siamese-twin spark plugs in his chest. Billy and Bud gave a TEDMED talk, which was the 2012 equivalent to getting on the cover of Life magazine.
Billy was inclined to think of all publicity as good publicity—he loved being a star, so there wasn’t much downside. But, since Lewis, his office had been flooded with calls from other self-described medical innovators. Someone wanted to show him a special device that would power the heart through a fitting in a shoe, for instance. Then there was the guy with the power source that he promised mysteriously floated in a giant rotating sphere. Billy offered his opinion to as many inventors as patiently as he could, but sometimes he listened while rearranging papers and gadgets on his desk and checking his email and his texts.
He had not expected the meeting with this Timms character to go any differently. “Another crackpot with a backpack full of crap,” was the way he put it to himself. Yes, a brief meeting with Bud and another colleague was slowly emerging from his memory—something about an Australian guy who was doing some interesting things in the field of rotary pumps. Maybe this guy had an answer to some problems they’d been having with blood clots in their own pumps. Sure, Billy thought. Whatever. Maybe Timms’ ideas would be cool, maybe they would be goofy.
Timms himself was goofy, though he probably seemed less so to the likes of Billy and Bud. He was a man who was otherwise engaged: Timms came into Billy’s office looking like someone who hadn’t slept in months—because he hadn’t—his hazel eyes red-rimmed, his jeans torn, his shirt untucked, and his stubble much closer to an eight o’clock shadow than a five o’clock.
The guy wasn’t much on pleasantries. Timms started taking things out of his scuffed, soiled, seemingly bottomless backpack—notebook, laptop, red and blue connector tubes, et cetera—and placing them on Billy’s desk. Unlike many people, he seemed unafraid that he might be swallowed by the Billysphere. Timms was chattering in an Aussie accent about two cars with two engines linked together on the same highway, trying to make some kind of point.
Finally Timms pulled out something wrapped in an old T-shirt. It looked like it had been made by a hobbyist during the midcentury modern period but was in fact a model for a new kind of artificial heart: a small plastic cylinder, about three inches in diameter, with stubby protrusions. Timms put his hands to either side of the prototype and twisted it along a seam, opening it like a jar of shoe polish. Inside was something new and different: unlike so many of the heart pumps Billy had seen, this one was centrifugal, round instead of long and narrow.
To explain how it would work, Timms popped open his laptop and showed Cohn an animated film. It was pretty simple: Inside was a rotor that was suspended courtesy of an invisible but powerful magnetic field. Magnets, reminiscent of the bearings suspended in Wampler’s and Jarvik’s design, directed the spinning of the rotor, which was two-sided; it could simultaneously spin blood in two directions, to the body and the lungs. There was no pump, so there was no pulse, though one could be built in if necessary. It seemed to work as simply as two lanes of the same superhighway. Well, thought Cohn, lots of things work perfectly in animation that don’t work so hot in real life.
Timms continued to talk at a speedy clip, as if he was afraid Cohn would start rearranging the doodads on his desk at any minute. This artificial heart had a lot of advantages that other devices currently in development did not. Most important, it could automatically adjust blood flow to a person’s needs.
This promise stopped Billy cold. If Timms was right, he had managed to do something that had never been done before. Ever. A normal heart pumps according to the body’s physical needs. That is, when you get up from a chair, or dash up a flight of stairs, the heart pumps harder to keep the blood flowing, according to what is known as the Frank-Starling Law. The same thing happens if you get up too fast after a nap—you get dizzy—or sit too long with one leg tucked under. The heart knows that some part of the body needs more flow, and gets it done. No artificial heart had ever come close to doing anything like that.
Billy, who had a tendency to slump back in his chair and wiggle one foot when he was only mildly interested, was now sitting up straight and actually listening. The heart
that he and Bud had put in Craig Lewis flowed at a constant rate. Some changes could be made with manual controls with the HeartMate II, but they’d never been able to come up with a pump that could automatically adjust blood flow to the body’s needs. In fact, clots had killed several calves in their experiments and probably would have killed Lewis if he had lived long enough. Now here was this kid—who was not even an MD, much less a heart surgeon—who appeared to have solved the problem.
This is crazy, Billy told himself. But the more Timms talked—he didn’t really need to draw much breath to continue—the more Billy began to suspect that Daniel Timms was the farthest thing from a crackpot there was.
Billy had a gift for knowing whether something was workable or not. He also knew enough about artificial heart technology to be able to see the device’s other advantages (though Timms went on to enumerate them). This heart was smaller than any other artificial heart he’d ever seen—that meant it could be implanted in women and children, not just oversized men, who made up the vast majority of patients willing to try such devices in the past. Also—and this was important—Timms’ heart, with just one moving part, was a lot less fragile. Craig Lewis’ device had more than fifty moving parts, any of which could break at any time, causing a life-threatening disaster. Imagine, for instance, a car that had only one moving part under the hood. It was that revolutionary.
And this heart could go and go; designed so that no part touched the sides, there was far less opportunity for wear and tear. Timms figured his machine should last five to ten years. Yes, one drawback was that it was currently powered outside the body with a battery pack, but so was every other heart assist device. Timms, however, was already working on plans to implant the entire system inside the body; a patient would eventually be able to regulate himself just by pressing a button under his skin.