by Mimi Swartz
Billy stared down at the metal cylinder Daniel was now balancing lovingly in his hands. It was, he knew, the most highly evolved artificial heart he had ever seen.
“How have you done this?” he asked Daniel.
“It’s just something I came up with,” Daniel answered, but he had an expression Billy knew all too well: the face of a magician who’d pulled off a seemingly impossible trick.
* * *
Daniel Timms carries on his iPhone a photo of a photo, something his mother sent him while he was working far away from home. The picture, which dates to the 1980s, is washed-out, the tropical color of Daniel’s house in the Brisbane suburb of Ferny Hills faded by the years. Still, it’s a pretty archetypal scene, a boy and his father working on a backyard project. The boy, Daniel, is about eight, wispy and blond; his father, Gary, is all sinew and muscle, with a thick beard and a halo of brown curls around his head. They appear to be building a world in miniature—rock walls and waterfalls, mountain peaks eroded by swirling rivers—and something about their postures, the boy’s eager, the father’s calm, tells you a lot about where Daniel came from, literally and psychically.
Like Denton Cooley and Billy Cohn, Timms spent an inordinate amount of time building things in his youth—his father was a plumber by trade, but also something of a mechanical savant who never got the opportunity to go to college. Daniel didn’t grow up wealthy—in that regard he has more in common with Frazier than Cooley or Cohn—but his closeness with his father would always set him apart. He was coached in the most affectionate way to carry the family banner forward toward some form of a better life. Daniel’s mother, Karen, was a high school science teacher and welcomed Daniel to her lab before and after school to check out other students’ projects.
So at an early age Daniel became not just a devotee of scientific inquiry but something of a prodigy when it came to gravity and flow, circulation and currents. His parents saved money for college, and Daniel was headed to Queensland University of Technology with plans to become an engineer. He might have grown up to be another successful Brisbane engineer, spending weekends building mountains and channeling rivers with his own son while his father looked on.
Instead, what happened next was the sort of dramatic event that makes for (and eventually did become) manna to newspaper feature writers. Gary Timms had a massive heart attack at fifty-five, collapsing at home on a weekday afternoon while the sun was shining and the palm trees outside swayed obliviously in the breeze. His life would never be quite the same after that, and neither would Daniel’s.
To be close to a parent who is severely ill is an exercise in helplessness and delusion. Gary Timms’ world constricted: he had little energy for his job, and soon had to stop working. The flesh hung on his once muscular frame, and his face, once brown from the Australian sun, turned ashen. There are grown sons with sick fathers who would content themselves with calling more often or committing to more frequent Sunday visits, but Daniel had other ideas. By 2001, he was twenty-two and working on his PhD, the subject of which, not surprisingly, was heart disease. The field of bioengineering was then exploding. No longer was a bioengineer just an engineer who happened to work with doctors; now a specialist in bioengineering was a new kind of expert who could apply the computer modeling once used to build bridges or skyscrapers to the needs of the body, estimating the reaction of any kind of biological or physiological system to a change in its environment. Modern-day ventilators, pacemakers, and respirators had been updated using this technology, and the implantation of an artificial hip or knee joint, miraculous in the 1980s, was routine by the time Daniel Timms was a young adult.
To Daniel and his father, then, it seemed perfectly natural that they would start working on a mechanical replacement for a diseased heart. In his room one day, Daniel sat down and sketched a device that drew on his extensive knowledge of physics and plumbing. The human body was, to him, just another engineering system; you could make a water pump for a mine, or a blood pump for humans. But if you only focused on one part of a system or a body, you could miss the solution you were seeking. A pump—or the heart—was always part of a larger system. Daniel started drawing, and when he finished his own heart was pounding. “Fuck yeah,” he wrote under the sketch.
Thus began one of the more unlikely but not entirely out of the ordinary journeys in modern medicine. It was not long before the shed in the Timms backyard overflowed with molds and models—resembling a tidier, less manic version of Billy Cohn’s man-cave garage in Houston, but a less pristine environment than Robert Jarvik’s. Pressed for space, father and son eventually moved their lathe into the kitchen and, literally, started cooking projects in the family oven. Making slow but steady progress, they then set up a satellite office in the plumbing section of Bunnings, the Brisbane equivalent of Home Depot. In the beginning, they told the truth when passersby noticed the labyrinth of pipes Timms and his father set out on the floor. “We’re trying to build a replica of the body’s circulatory system to help us create an artificial heart,” one of them would explain, looking up from the maze on the floor. But then word spread, and they started drawing a crowd. “We’re building a fish tank,” they started saying.
It was so much better to believe you could solve a problem, or cure a disease, than to sit by helplessly and watch a parent deteriorate. When Daniel wasn’t refining his design, he was reading everything he could about artificial hearts, working as tirelessly as a scholarship student determined to be number one in his fancy prep school. He read about Cooley’s ill-fated implantation of Liotta’s heart, and studied the case of Barney Clark. He immersed himself in the development of left ventricular assist devices, the history of Rich Wampler and his Hemopump.
The world of artificial heart enthusiasts is very small, and it wasn’t long before Daniel was carrying a mental Rolodex of who was doing what around the world. There were people working on artificial hearts out in Tucson, where SynCardia, the company that was previously Jarvik’s Symbion, was making a name for itself with what they called a Total Artificial Heart. The company was doing well: FDA trials were in effect (in 2004, the device was approved as a bridge to transplant), and there were high hopes it could be used as a permanent replacement eventually. But to Frazier and Cohn—and Timms—the SynCardia device was, essentially, the latest iteration of the Jarvik-7 with a power console that could now be carried in a shoulder bag. The company was also working on a smaller version for women and children—Bud Frazier would implant them. But to continuous-flow believers, it was still an old-fashioned pulsatile pump with the same old attendant problems, durability being the most obvious.
A French company called Carmat had also been working on an artificial heart, but it was a complex device, also pulsatile, with myriad moving parts and a completion schedule that remained cloudy. Then there was the great cardiac powerhouse that was the Cleveland Clinic. Supposedly, researchers there were working on an artificial heart, but no one seemed to know much about it. Rich Wampler, too, was working on something in Oregon.
The name that came up most often when Daniel researched the literature was that of Dr. O. H. Frazier in Houston, Texas—he seemed to be the only heart surgeon who believed, like Daniel, that continuous flow was the way to go and that a pulse was something a person with an artificial heart could do without. If Daniel read five hundred papers on the pulseless heart, one hundred of them would be written by the Texas surgeon.
Daniel had never been out of Australia before, but now he began to use his small savings to track down some of the people he read about. In 2001, he took his first trip away from home, heading to Tokyo, where he had already Skyped with a young expert, Nobuyuki Kurita, who was doing unique work in magnetic levitation. Fortunately, Kurita spoke English, the two hit it off, and Kurita was willing to accept the trade Daniel proposed: his expertise in mechanical engineering for Kurita’s expertise in creating a magnetic suspension system. Japanese trains had
been running on such a system, called maglev, for at least a decade. Why couldn’t you put one in the body? After all, Wampler and Jarvik had already used magnetic bearings to keep axial pumps turning. Daniel’s design would just replace the bearings with more powerful, computer-directed magnets that would allow his device to be suspended—fewer parts and less wear.
From Japan Daniel went to Germany, where he spent nearly two years, off and on, studying pumps. And then to Sweden. There were trips to Athens and Egypt to track down particular experts in everything from software design to rotor heights and widths. There were no nights in five-star hotels or meals in fancy restaurants. Not only was he broke, but he had no interest in the high life. Daniel slept on couches and bartered his expertise for some tiny piece of information that might help advance his cause. Somehow, Daniel stretched his small funds to get to lectures around the globe, where he usually sat in the back, ever silent. When he heard Dr. Frazier would be speaking, Daniel stalked him like a bounty hunter, in packed lecture halls, never daring to introduce himself, but always thinking, “One day I will have something to show you.”
* * *
The invention of a pulseless heart might have seemed radical but plausible to people on the cutting edge of biomedical engineering, but back home in Brisbane Timms was not getting much support. He was twenty-two when he took his device to a group at the Prince Charles Hospital in Brisbane, in 2001. It isn’t hard to envision the response of a group of heart surgeons corralled around a conference table while being asked to consider the work of an unknown engineer. One surgeon, after hearing Daniel’s pitch, started pounding on the table like an angry diplomat in a United Nations debate: No artificial heart could ever be made to work without a pulse. Not ever. And who was Daniel to think otherwise?
Meanwhile, Gary Timms was slipping away. In 2004, he needed more surgery, this time to replace a leaking heart valve. He did not improve. The backyard landscapes and the experiments at Bunnings seemed long, long ago. Daniel quickened his pace, living to the beat of an accelerating internal stopwatch. He went without sleep, forgot to eat, took so many planes to so many places that at times he forgot, briefly, where he was and why he had come. He was twenty-seven when his father died in 2006. After the funeral, he hit the road again.
Daniel had the true obsessive’s immunity to rejection. Plenty of people told him how and why his device wouldn’t work—most frequently because no one believed you could have an artificial heart that didn’t also have a pulse. But what he told himself was this: no one ever said stop. That sliver of encouragement was enough. Eventually Daniel befriended a critical care expert at Prince Charles Hospital in Brisbane, a baby-faced, good-natured soul named John Fraser who, if he didn’t understand exactly what Daniel was doing, sensed that the sleepless wraith whom he often heard banging on metal objects in an adjacent office was doing something of value.
He used his influence to get Daniel a job and a lab in the clinical science department, and threw in a new couch covered in black vinyl. It took a very short time for the couch to take on Daniel’s rumpled, weary mien.
Over the next three years, he did not allow himself to doubt. He had no idea, really, whether the device would work, which was admittedly a drawback in what was becoming a constant scramble for cash. The investors he met saw the need for a new approach, but they also wanted a sure thing.
The only sure thing Daniel had to show for those long, hard years was his team. Most of them were young men in their twenties. Drawn from all over the world, they were not always so well versed in English, but they were completely conversant with what Daniel was trying to do. To a one, they fell in line Pied Piper style, connecting via text, email, and Skype, holding up drawings and parts and graphs on the computer screen, making adjustments with clicks of their keyboards. Finally they were ready for short-term animal testing. They tried first in Australia, and then again in Taiwan. Both animals died on the operating table.
The fact that Daniel had been publishing papers on his work during this time, however, had helped him move from a twentysomething tyro to a thirtysomething colleague in the world of pulseless heart assist devices. Instead of sitting in the backs of auditoriums, he was now invited to talk about his work to small, ever more prestigious groups. In fact, the International Society for Heart and Lung Transplantation invited Daniel to come to Paris in April 2009. He realized he would need a suit and a shave.
Daniel was not a natural speaker. He knew exactly what was at stake, but he had an engineer’s emotive range, especially in public, and especially before a group as important as this, a global organization with over three thousand members—surgeons, nurses, anesthesiologists, pulmonologists, and so on, medical professionals who had dedicated their lives to eradicating heart and lung diseases. He practiced his presentation over and over again, hoping to appear relaxed and accessible. Still, on the podium, Daniel fell back on old habits and read his speech to the crowd. He was so afraid of making a mistake that he didn’t notice one person in the audience listening intently: O. H. Frazier.
At the end of Daniel’s talk, Bud got slowly to his feet and turned to address the crowd. “This,” he said, “is going to be the future of total artificial hearts.” Daniel was so shocked that he waited too long to find Frazier and introduce himself after his speech—Bud was already gone.
Then, at a Singapore conference in 2011, he met a man named Steve Parnis, who was about Daniel’s age but balding and far more gregarious. Parnis, it turned out, was from the Texas Heart Institute and had been following Daniel’s work with interest. Daniel would also soon learn that Parnis was part of Frazier’s seat-of-the-pants operation. Bud carried on the tradition of DeBakey and Cooley, hiring expert oddballs—or oddball experts—who didn’t necessarily have documentation for their expertise. After Dr. Norman’s departure, Bud upgraded by hiring trained veterinarians to work 24/7. Over time, the place began to resemble the snazziest animal ICU, with the pigs and calves getting better care than a lot of humans who couldn’t get into St. Luke’s. Bud also partnered with a Croatian immigrant named Branislav Radovancevic, known as Brano, a much beloved researcher who never managed to get his US medical degree. And then there was Parnis. He wasn’t an MD or a veterinarian, but by that time had been performing operations on animals for more than twenty years in the THI lab under Bud’s direction. As such, Parnis was pretty up to speed on artificial hearts.
He and Daniel talked about continuous flow for at least an hour; from a distance, they could have been mistaken for two guys obsessing about craft beers or Super Bowl contenders. In parting, Parnis offered the Texans’ typical farewell: if Daniel ever made it to Houston, he’d be happy to show him around. Who knew? Maybe he had something to teach Frazier and Cohn.
As it turned out, Daniel was going to be in the United States in a few months, at a conference in Louisville. He’d love to stop by, Daniel said casually, never letting Parnis know how desperate he was to get to Houston.
15
MATILDA
Billy Cohn was good at a lot of things, but one of the things he was very good at was raising money. “Show me a homeless guy and I’ll get five bucks out of him,” he liked to say, which may not have been politically correct but was reflective of the source. At this particular time—the spring of 2012—he couldn’t get Daniel Timms and his device out of his mind.
There were not very many people who understood, intuitively and intellectually, what Daniel had done, but Billy was one of them. He realized that Daniel Timms had come up with something so much better than anything Billy himself could have ever invented, even though Billy had come up with a design for a magnetically powered artificial heart several years earlier and still had the file on his laptop. But here was the thing: Daniel had actually made one. As inspired as Billy was, he was not an engineer. And Daniel was a generation younger, which meant that he had been able to ride a wave of technological innovation to an answer: advances in magnetic l
evitation were part of it, but also the simplest, most obvious things like Skype, which had allowed a diverse team of experts to work together even when they were thousands of miles apart.
In other words, Billy Cohn, no stranger to genius himself, was pretty sure that Daniel Timms’ device had solved many of the problems that had held Bud and him back with their twin HeartMate IIs. Daniel—with the help of the medical team at the Texas Heart Institute, of course—could be on his way to inventing the first true artificial heart.
After their first meeting in early 2012, Daniel became like a magpie building a high-tech nest, flying off to Taiwan or Brisbane or God knows where to pick up a paying engineering gig and/or a little more knowledge, and then circling back to THI to put this newest discovery to use. Oblivious to the intense interest of the women hovering around him—the nurses, the techs, the receptionists, all of whom were standing at the ready to provide relief from his labors—Daniel did what he had always done, which was to work around the clock in his singular, solitary role as keeper of the Bivacor, the name of the device he had created.
No one in their right mind would describe Daniel as flexible, but he was slowly learning the THI way, which, when it came to experimentation, was still governed by the old THI ethos of try first and then figure out what went wrong and how to fix it. Daniel’s first lesson occurred in the early summer of 2012, on a hot June day with temperatures he would probably have been oblivious to. He had flown into Houston with his usual encumbrances—the Bivacor in his backpack and not much else—and started to get ready for another of what had become a series of implantations in calves. All of the experiments to this date had been of the “acute” variety, which in medical research argot meant that the animals were short-termers: the scientists tried one thing or another but the animal never woke up from its drug-induced slumber. In this case, a calf would be allowed to live under observation long enough to confirm the success or failure of some new modification—some refinement of the Bivacor—that is, if they could wake the animal at all. In med language, this would be a “chronic” experiment because the animal got a stay of execution.