Ticker

by Mimi Swartz

  In those days, Daniel did all the prep work himself—making sure the device was ready to go, along with the software program that ran it—because there wasn’t any money to bring in any of his far-flung team members to help him run an experiment. This situation proved particularly inconvenient when Steve Parnis sauntered into the lab and asked what time tomorrow Daniel would have the Bivacor ready.

  “What are you talking about?” Daniel asked. He was sitting on a metal stool, surrounded by coils and casts and machine parts of indeterminate use to a layperson. “I’ve got, like, five days.”

  When it came to THI work habits, no one ever put much of a premium on communication—especially communicating about scheduling, because schedules changed so often. Parnis was one of those poor souls charged with making order out of chaos. “No,” he explained, “you’ve got to have it ready tomorrow so we can sterilize it.”

  Unlike the old days, there are now many regulations controlling the ethical treatment of lab animals, some dictated by the US government via the FDA, and some THI’s own. One of them is that you don’t put a nonsterile device in an animal you intend to wake up—a chronic case—because otherwise you might be sentencing the animal to a painful, deadly infection. This information was familiar to Daniel in a general way, but he hadn’t reached that specific crossroads as yet.

  “Sterilize it for what?” Daniel asked, which was a perfectly legitimate question, because he had been thinking that, like all previous experiments, this one was to be acute. But here was Steve, talking like a reasonable person but using words that changed the game entirely.

  “We can’t put it in the animal unsterile if we’re going to wake up the animal,” he said slowly, as if he were talking to a child.

  “Wake up the animal? What are you talking about?” Daniel asked. When he was alarmed, his speech picked up speed. It was doing that now.

  It seemed that Billy and Bud had decided they should try to wake up the calf. Why not? They’d learn a lot more a lot sooner.

  At times like these, Daniel revealed a nimbleness that was not always so apparent. In other words, he knew there was no point in arguing. “How long have I got?” he asked, in the tone of a condemned man. It usually took him about five days to prepare for an implantation.

  A day and a half or so, Steve told him.

  The next thirty-six hours were, for Daniel, a period of frantic activity followed by excruciating separation anxiety. He had always been able to keep the Bivacor device within easy reach, and now it had been whisked away, into some sterilizer, all alone. Daniel could think of nothing to do with himself with the free time. He didn’t, for instance, visit any Houston tourist sites, like the slowly moldering Astrodome, aka the Eighth Wonder of the World, or the enormous port that included the Houston Ship Channel. The world-famous art at the Menil Collection or a performance by the Houston Grand Opera did not come to mind, nor did it occur to him to strike out for one of Houston’s infamous “men’s clubs,” souped-up strip joints that were designed to imitate fancy frat houses or nineteenth-century English smoking rooms. He couldn’t even take in a movie or go out for a burger. All he could think about was, “What if it doesn’t work?”

  That terror lingered and deepened on the morning he found himself in front of his computer console in the lab’s operating room, wearing blue scrubs and a mask over his face, so that only his bloodshot blue eyes were showing.

  There was a crush as word had spread about the upcoming implantation. People in scrubs already had their cellphone cameras at the ready, flouting all sorts of security rules. The light over the operating table was almost blinding, and brought a little heat to a room that felt like a sub-zero day in Juneau. A TV monitor was already focused on the patient, virtually invisible beneath a sky-blue drape except for the brown hoofs that stuck out from the large bovine body on the operating table like small piers awaiting the crest of a gigantic wave. The calf had no name, because in the world of animal research, it was considered bad luck to name an animal before she survived an operation. She was good-sized, about 130 pounds, and lying on her side. The entrance to her heart lay open like a crater, its circumference ringed with the garish yellow of Betadine antiseptic solution. Parnis had come in earlier and opened the chest, and now he was preparing to remove the heart and connect the calf’s major arteries to the heart-lung machine that would keep her alive until, they hoped, the implanted Bivacor could take over.

  After about an hour, a tech arrived in blue scrubs and a paper gown, her face obscured by a mask and the obligatory, universally unflattering paper cap. She was carrying a metal bowl filled with sterile solution in which the Bivacor floated, as if it were an offering, or, maybe, the $40 entrée at one of Houston’s most exclusive restaurants. That is, if an entrée looked like a small metal cylinder with a few curved protrusions and an encircled heart logo stamped on its side. This sample was made mostly of plastic, because there wasn’t any money or time to use titanium, the metal that would one day be used for fabrication. This was just a trial; the plastic would break down under stress, everyone knew, and the calf would die. The question was how long it would live before that happened.

  Daniel’s only job was to keep an eye on the Bivacor’s console, which monitored blood flow, oxygen levels, and so on while sending operating instructions to the mechanical heart.

  When Parnis was done, someone picked up the receiver from a wall phone and put in a call upstairs to Drs. Frazier and Cohn, who arrived looking a lot more relaxed than their Australian colleague. A tech crowned Billy with a light over his cap. Bud’s burnt-orange University of Texas T-shirt showed yet again under his scrubs. Billy wore cowboy boots, while Bud had switched to some sort of clogs because of his aching knees. He had been putting off surgery for at least a year by that time, trying to ignore the pain but not really succeeding.

  The implantation itself was relatively straightforward, given the magnitude of what it was supposed to do. Once the heart had been removed, the surgeons attached two fabric cuffs to the atria, the upper chambers of the heart that would be allowed to stay in place. They sewed two more cuffs onto the pathways to the lungs that would serve as connectors to tubes leading into the Bivacor. They connected the tubes to the device, and so on. It occurred to Daniel that this current iteration didn’t seem much more advanced than something made in a backyard shed. He’d done all the wire prep and all the honing of the rotors himself.

  This went on for a couple of hours, until Billy looked up from his work. His eyes met Bud’s, both expressions expectant behind the men’s masks. The heart was in. It was time to click the key on Daniel’s keyboard and see if his invention was anything more than another well-designed but ultimately unworkable pipe dream. Daniel’s fingertips were damp, and his breath shallow and humid beneath his mask.

  Click one: levitation. Good, he thought, the impeller was suspended in its housing, floating on the flowing blood. Click two: rotation. Great, the Bivacor was beginning to spin, pushing the blood in one direction toward the lungs, and in the other outward into the rest of the body. The numbers in front of Daniel on the console looked good. The blood flow was five liters, a good amount for a calf. She was breathing fine. And the only sound coming from her chest—from the place where her heart should be—was a whispery, whirring whoosh of the blood being directed to the right places by a furiously spinning disc.

  The fastest and most palpable pulse, in fact, was the one rushing through Daniel’s temples. About three hours had passed. If the gods were on their side, the animal would wake up from the operation, and maybe even stand. That’s all they needed to keep going.

  The rest of the surgery—closing the chest, as in a human transplant—took another hour or so, and then the calf took a gurney ride to the animal ICU for recovery. The packed operating room emptied in an instant.

  In the hallway outside, Bud snapped off his gloves and mask and threw them in the trash. T
hen he put on the white coat he had taken off to operate. He was pleased—he thought things had gone pretty well. He was already thinking ahead. “If this animal stands up,” he said to no one in particular, “I’m going to take the result and I’m going to present it at the next International Society for Rotary Blood Pumps conference.”

  Of course it was too soon to tell, but Bud and Daniel strolled into the ICU for one last look at the calf before going their separate ways. About thirty minutes had passed since they had finished. She lay in a bed of hay in a small pen, resting quietly. Nearby, a couple of pigs snorted; a goat stood quietly in a stanchion. One of the vets and a small group of techs bustled about, checking on other animals, looking at monitors, recording results on clipboards.

  Bud and Daniel had been standing there for about five minutes when the calf opened her eyes sleepily and then began to roll back and forth, slowly at first, and then boom! She was standing on all four legs. She blinked at the world around her with mild interest, including the two men staring back, openmouthed, unbelieving.

  A few seconds passed before Daniel had the presence of mind to race over and grab his laptop, tapping into Skype as fast as he could to connect with his team, to show them the first living animal with a Bivacor instead of a heart. From Germany and Japan and Australia they stared goggle-eyed at their screens, clapping for what, if you didn’t know what was going on, looked like a normal calf gazing back at them.

  “Well,” Bud said, allowing himself a small, wry grin, “I guess I’m going to conclude my talk with the device.”

  They named the calf Matilda, and she survived for a total of six hours with an artificial heart made of plastic, whirring and spinning in her chest.

  * * *

  It was on that day that Billy knew what he had to do. The Bivacor had worked as he’d known it would. But Billy was a closet fretter, and its very success instilled a new fear: there was nothing tying Daniel to Houston except some newly won loyalty, and in the high-stakes world of medical devices that was no guarantee. Any company with a lot of cash could get wind of the Bivacor, and Daniel and his team could decamp. Then someone else would get all the credit for a discovery Billy was already comparing to a moon shot. But instead of from Houston, it would be launched from Cleveland or France or Tucson or somewhere else. Billy had to find more money, and fast.

  The problem, as he and the whole THI team knew, was that funds for new medical devices were not easy to come by. In DeBakey’s day, all you had to do was put on some fancy dog and pony show—after you’d cultivated friends in high places, of course—and millions in US government research funds could be yours. But those days were gone. And the bet-on-a-sure-thing mentality that governed public research had seeped into private giving as well. The venture capital types only wanted to invest in something they knew would pay off big-time—the second generation of an already successful drug was the kind of investment opportunity that really appealed. Private philanthropy too was drying up; the typical Houston givers wanted their names on opera halls and hospital donor walls. No one named a medical device after its investors.

  Even in Houston, risk had become, if not a dirty word, then one that was more comfortably buttressed with lots of backup promises and mitigating assurances. Investors wanted proof, tests, predictable and successful outcomes. Whatever happened to those crazy Texas wildcatters, the ones willing to punch zillions of dry holes in the ground until they came up with a gusher? They had gone the way of leaded gasoline.

  But then a name started muscling its way into Billy’s consciousness: Jim McIngvale. Billy couldn’t call him a close friend, exactly, but he did at least know him. Of course, just about everyone in town knew him, but by a slightly different name.

  All cities have local celebrities, the kind of wealthy and colorful types whose fame never quite extends beyond local borders but thrives within them. Such a person was McIngvale, who was better known by his professional nickname, Mattress Mack. Think Crazy Eddie by way of Mississippi to Houston—with a bankruptcy thrown in for good measure—and you might have some idea of the person Billy had targeted: Mattress Mack had made a fortune selling what was essentially boomtown furniture—aspirational furniture, furniture for all the blue-collar workers who made Houston what it was when it was still a town of oil field workers and long-haul truckers, and then, later, furniture for all the immigrants from Zacatecas and Saigon and Mumbai and Karachi and Eritrea when oil started climbing again in the 1990s. Mack, as he was known to just about everyone, was a short, slight man with jug ears and an indeterminate southern accent whose frenetic energy in public belied a shrewd mind and a shy reserve—or simple exhaustion—in repose. He was one of those 24/7 obsessives—“entrepreneurs” in local parlance—that often seemed to make up at least 80 percent of Houston’s population. Mack believed that customers who made around $50,000 a year should be treated as well as hedge fund kings, which meant that once you walked into a Gallery Furniture store, you didn’t have much chance of getting out without buying something. And so what if you couldn’t afford it? Instant financing was always available with same-day delivery of your $2,500 American Heritage bedroom suite!

  Founded in 1981, Mack’s I-45 store was on its way to being the single largest furniture emporium in the United States, and McIngvale was much beloved because of his early, turbocharged TV ads, in which he clutched wads of cash, jumped up and down, and, in a Mississippi-on-meth kind of accent, promised that he would “save…you…muh-neeee!” Sometimes McIngvale squeezed himself into a baby crib for the occasion. Supposedly he’d used his last $10,000 to make his first crazy TV commercial in the oil boom years of the early 1980s, another reason Mack was locally beloved in a town where there was no shame in losing it all—as long as you made it back. And, of course, Mack was generous in uniquely local ways: he treated the homeless to a (branded) massive Thanksgiving dinner, and he bought the grand champion steer at the charity auction sponsored by the Livestock Show and Rodeo. When the Rockets won their first NBA championship in 1994, Mack paid for the welcome-home party and waved to his grateful public from a float in the victory parade. He stationed what he called the world’s largest Christmas tree outside one of his stores during the holidays.

  Billy had met Mack in what was, for both of them, typical fashion. He was twenty-nine, finishing his fourth year of residency at Baylor and working as a surgical chief resident at Ben Taub Hospital, the huge charity hospital and trauma center that had just reopened in a spanking-new building in 1990. Ben Taub was legendary in Houston—the city had never been known for its generosity to the poor, and its public hospital had for decades been a pretty good example of a twentieth-century Bedlam. Thanks to a lack of public health clinics, most of Houston’s poor used Ben Taub as their doctor’s office, sometimes waiting days to be seen for common ailments. The hospital was also the only twenty-four-hour psychiatric facility in the city. But most important, Ben Taub was a level one trauma center. There was only one other in this city of 2.5 million, which meant that if you were stabbed or shot or in a horrific car accident, the ambulance was likely to take you there, where your chances of survival were the best in town. The place was staffed with Baylor-trained interns—DeBakey’s shock troops—including, of course, Billy Cohn, who found himself perfectly at home. Operating on six to eight stab wounds a night, often without sleep, was his idea of nirvana.

  But there was one big problem inside the gleaming new hospital: a shortage of furniture. Houston’s glorious new monument to public healthcare had no place to put sick and injured patients who were awaiting transfers or X-rays or whatever. There were not enough gurneys, and there were not enough chairs for the people who had brought patients in to wait comfortably, away from the fray. Some crime victims found spots on hard plastic chairs, where they tried not to bleed on the brand-new vinyl flooring, but those who could move wandered off in search of more comfortable perches, and the staff, including the surgeons, lost precious hours
roaming the hospital trying to track them down.

  It was during such a search that the sleep-deprived Dr. William Cohn happened to catch a commercial on television of a man jumping up and down like one of Ben Taub’s AWOL psychiatric patients. He seemed to be trying to sell recliners, because, he said, he had too many of them.

  Soon after, without a nap or changing clothes—Billy did take a minute to throw a respectable white coat over his bloodstained scrubs—he got into his Toyota Celica and, jittery from sleeplessness and a jumbo-sized iced coffee, drove out of the Medical Center and headed north, past the gleaming towers downtown, and onto the congested lanes of I-45. The scenery was pretty squalid, a Houston hash of billboards and pawnshops and massage parlors and strip centers. He pulled off the freeway and into a place that looked like a giant circus tent. This was Gallery Furniture.

  In the takes-one-to-know-one department, the meeting between Mattress Mack and Billy Cohn was something like Prince encountering David Bowie, or maybe P. T. Barnum meeting up with Wild Bill Hickok. Both were most comfortable operating at Mach speed, and both understood perfectly the uses of theater. (Mack’s wife, Linda, often said that the two men lived by the same motto, which she described as “Shoot, ready, aim.”) Mack listened patiently to Billy’s rambling, somewhat incoherent plea. The county had run out of money, or maybe it was the city. Sick people were roaming around the hospital because there was no place to sit down in the waiting room. Ditto people with dying relatives. And, by the way, the interns had no place to sleep. Could Mack maybe possibly help them out with some recliners?