by Mimi Swartz
Mack’s answer was swift, maybe because he was, by nature, a soft touch, or maybe because he wanted to get this lunatic in bloody clothes away from all that pristine furniture. Sure, OK. Mack had his workers fill up a moving truck with the recliners—about twenty at a total retail value of around $10,000—and deliver them to Ben Taub within seventy-two hours, free of charge.
The story might have had a happier, or at least more economical, ending if a hospital administrator hadn’t noted that the recliners didn’t meet the proper government standards for fire retardancy in healthcare facilities and ordered them returned. Mack had to order the correct recliners from Mississippi, which he then sent to Ben Taub—proof, perhaps, that no good deed goes unpunished.
That was that, until 2008, when Mack’s beloved older brother George got very sick with congestive heart failure. He needed a pump—an LVAD—to keep him alive, and the surgeons best qualified to implant it were Dr. Bud Frazier and, yes, a better-rested and slightly longer-of-jowl Dr. Billy Cohn. Mack had not seen him in almost twenty years.
The surgeons were able to give George another few months of life, and then he lapsed into a coma. For six weeks he lay in the cardiac intensive care unit of the Texas Heart Institute, where Bud visited him night and day, on Thanksgiving, and on Christmas. It seemed to Mack that whenever he went to visit his brother, Bud was there or had just left, his large, lumbering frame perched onto the edge of the bed, his silver mane illuminated by the lights of the monitors in the darkened room, pinpoints of blue, red, and green like stars in some lonely alternate universe.
When the time came to take George off life support, Billy played bad cop, showing Linda X-rays of George’s damaged heart, indicating that the machines were the only things keeping him alive. There was no hope. Bud guided the family to the final decision. The toughest one to convince was George’s son, then a soldier on leave from a tour in Iraq, who refused to believe his father would not get better and go home. Bud met the young man by his father’s bedside. “You’re in the army, right?” he asked. Then he took the young man’s hand and ran it up and down his father’s sternum, grinding his knuckle as he applied pressure, the way medics do on the battlefield to test for any sign of pain or consciousness. There was nothing.
“You know what that means, right?” Bud asked. The young man nodded, surrendering.
George McIngvale was buried a few days later, after Christmas 2008. “We fought hard,” Bud told Mack. “There were just too many bears in the woods.”
Mack had never felt so grateful to anyone in his life. “Let me know if you ever need anything,” he told the surgeons. It was that promise Billy Cohn would remember almost four years later.
* * *
This time Billy drove up I-45 in a cobalt-blue, middle-age-crazy Audi R8 and significantly cleaner scrubs. His hairline had receded, but his energy level had not. A model of the Bivacor sat in a video camera bag on the passenger seat of the car.
In the ensuing years, Gallery Furniture had also undergone some changes. A fire set by an angry ex-employee had required a rebuild, and now the place looked like a supersized hamster cage, a sprawling, gargantuan human warren with tunnels and turrets. Several birdcages near the entrance featured parrots and macaws, and toy sports cars—not as nice as Billy’s—that doubled as kid carriers sat parked nearby. There were, as always, red, white, and blue basketballs for the kids, and free slices of cake slumping under a heat lamp. The walls that weren’t covered with photos of Mack—Mack and Linda; Mack and various generations of Bushes; Mack and pro basketball and football stars; and Mack in cowboy garb at the rodeo—trumpeted inspirational quotes, like “The only thing you get for nothing is failure.” Myriad glass showcases displayed everything from Texas memorabilia to the basketball shoes of NBA stars.
And, of course, there was furniture, a dizzying array of it: cowhide rugs, bedroom sets, recliners, mattresses, even the occasional antique dresser. Mirrors and lamps set off by many, many scented candles. Sofas and fold-out sofabeds. Plastic slides in primary colors and mini-trampolines and basketball hoops for the kids’ rooms. You needed a sack of bread crumbs to shop at Gallery and make it back to your car before nightfall.
Except, of course, for Billy, who was oblivious to his surroundings as he announced himself to the crew of salesmen who stood at the ready at the front desk. The bag containing the Bivacor was nearly weightless in his hands.
This time Mack was better prepared to ward off Billy’s appeal. Like Billy, he had become something of a pitch magnet, and because he hated to say no, Mack often brought his wife along to keep him from saying yes to something stupid. Linda McIngvale had been her husband’s adviser and enforcer since they had met in the late 1970s. Her devotion to Mack was not exactly of the Nancy Reagan total adoration variety, but it was just as ferocious—their bond had been forged after Jim had lost everything but Linda in a bankruptcy that had followed a youthful venture into the health club business. Unlike her husband, Linda was naturally ebullient, with long blondish hair and soft brown eyes that belied a mind every bit as sharp and hungry as her husband’s. She wasn’t flashy like a lot of rich Houston women: she usually skipped the makeup and favored jeans and Gallery Furniture polo shirts with her Prada bag.
The trio settled into a leather booth in the sunny Gallery employee cafeteria and Billy took the Bivacor out of the camera bag, holding it up to give the McIngvales a clear view. He explained that it could change the world—“This is the moon shot”—and Mack and Linda could be a part of that. He held the stubby little cylinder in his hands as if it were made of platinum instead of plastic. He opened it up, showed them the one moving part inside, and passed it to them for examination like a prop in a Billy Cohn magic show, which to some extent it was. He threw around terms that made Linda’s head hurt, like “magnetic levitation” and “pulseless technology” and “hemato-something or other.” Mack’s eyes were flat; as he put it, “the ether had worn off” and he had pretty much decided this was a no-go for him. He understood scholarships for needy kids and feeding the homeless. Patriotism he got. He understood a lot about sports, and knew quite a bit about racehorses, because he owned some. But biomedicine? Not his thing. “If you can convince my wife…,” he told Billy, Mack’s way of signaling that he was inching toward the exit.
As a performer, Billy was sensitive to that moment when an audience started checking its collective watch. But he wasn’t going back to the hospital empty-handed. OK, so what if he set up a meeting at the Texas Heart Institute? Give them a tour of the operating room? Introduce them to the boy genius, Daniel Timms? Reluctantly, the McIngvales agreed—mainly, again, to get Billy the hell out of the store. “You want me to go so I can be the one who says no,” Linda said to her husband later.
Two things happened in the next few days. Linda got on the Internet and started reading about artificial hearts. Like her husband, she had only a high school education, but by that time it was fairly easy to find stories on Robert Jarvik and Barney Clark, on SynCardia and Rich Wampler. She noted how many people died of heart disease every year, and noted further how few hearts were available for transplants. She started writing things down and making lists of questions.
During the same period, Billy put in a call to Daniel, who was in Japan—to be exact, he was winding electrical coils by hand to make the motor for the next Bivacor.
Billy was breathless. “You gotta come back to Houston right now,” he said.
As Daniel listened, his expression became one of exasperation and amazement. He was experiencing once more the essentials of Houston entrepreneurship.
Billy was still babbling. “I just went and talked with Mattress Mack,” he said, sounding as if he had literally just left the room, which he probably had. Daniel was still groggy from the fifteen-hour time difference. He had only been in Japan for a few hours and had yet to unpack. In Billyworld, this was a good thing, as Daniel could quickly grab
his bag and hop on a plane back to Houston.
“What’s his name?” Daniel asked, trying to understand through the fog of his jet lag. “Mattress Mack?”
“He really wants to fund us,” Billy explained. He sounded like a child begging his mother for Froot Loops at the grocery store.
Now Daniel was in familiar territory. “I’ve heard this a lot of times, Billy,” he said, returning to the wires in his hands.
Two days later, Daniel was back on a plane, scheduled to meet the McIngvales at the Texas Heart Institute on December 13, 2012.
* * *
The THI conference room could not be described as inviting. It is sprawling and windowless, its walls are covered in manly brown leather baffles. The wood floors are tinted a basketball court yellow and have been buffed to a high, almost blinding gloss. The gargantuan conference table is triangular in shape, echoing the light fixture that seems to hover above. It looks like the set of a Star Trek sequel, though it was actually the hospital brass’ version of an auto showroom.
The McIngvales arrived in their usual dress—jeans and Gallery Furniture polo shirts. Dr. James Willerson, the eager, chatty president of THI, was there along with Dr. Denton Cooley. The ninety-two-year-old Cooley’s skin was blotched and his hair was white, but his voice still crackled with electricity when he spoke. Bud and Billy were in scrubs; Daniel wore his jet lag. Mack would later tell a reporter for the Chronicle, perhaps a little disingenuously, that “there wasn’t no doubt about who was the dumbest person in the room. Hands down.”
People would later disagree about what exactly was said and what was promised, but this much was clear: Mack asked whether a donation from him might save the lives of people who had died like his brother. Willerson, the Grand Poo-bah of THI fundraising, answered in soft, satiny tones that, yes, quite possibly it could. Cooley’s pitch was evocative of the successfully seductive tone he’d used on pretty nurses so many years ago. His eyes locked onto Mack’s when he talked about the artificial heart. “This is my life’s dream and I’d like to see it happen,” he said.
Then Bud spoke, explaining that the device would work. He just knew it. Whereupon Billy and Daniel gave a presentation of the Bivacor, complete with animated slides depicting blood as floating blue and red dots moving in and out of the heart and lungs. Linda had questions, which surprised the men in the room more than any of them cared to admit. How was this device different from the LVAD, or from the artificial heart Robert Jarvik had invented? What about the French artificial heart, the Carmat? Or the one made by the company in Tucson, SynCardia?
Daniel explained that these were all conventional pumps of one sort or another, and that they would break or wear out too soon because they were pulsatile devices, or they were too big for anyone but large men, or they only addressed problems on the left side of the heart. They couldn’t adjust, like the Bivacor, to the body’s need for more blood at certain times. Daniel, like the other salesmen in the room, took her interest to be a good sign. Mack was harder to read, though he had teared up when Willerson had told him the device might have saved his brother.
Gradually, the talk wound around to how a donation might work—some might go to THI and some to the Bivacor. Tax advantages came up.
As it happened, Linda had brought along their checkbook. Well, hell, they had a little extra money at the time, and this sounded like a pretty good deal. She reached into her purse, took out her checkbook, and wrote out a check for $2.1 million. It was all the cushion they had, unless they wanted to sell a racehorse or their tennis club.
Later, while the McIngvales were waiting for the hospital valet to deliver their car, Billy tried to get Linda to watch him do a magic trick. He took five one-dollar bills and counted them out in his palm. Then, chattering away, he turned them over and counted them out again, and then caressed the bill on top with a slow stroke of his palm. When he showed Linda the money again, Ben Franklin was grimacing back at her from five $100 bills.
“I hate card tricks,” Linda snapped. Card tricks were like drinking too much caffeine, she thought—if she saw one during the day, she’d stay up all night trying to figure out how it was done.
“I don’t do anything,” Billy told her, grinning so wide his molars sparkled. “It’s magic.”
16
THE OCCUPATION
Two million dollars may not have sounded like a lot of money to some people in 2012, but to Daniel Timms, it was as if his well had come in. After years of sleeping on couches, traveling with little more than a backpack, and communicating with his far-flung associates via Skype, he suddenly had a home for himself, his invention, and his team. His group was composed of fifteen or so mostly young, sunlight-deprived men from around the world, with heaviest representation from Japan, Germany, and Australia. There were hardware engineers to work on the machining of the Bivacor, software engineers who worked on the programming and interface of the device and the operating console, electrical engineers who worked on electrical components for the same, and experts in magnetic levitation charged with making sure the impeller inside the device spun at the proper velocity and in the proper spot. There was even, on occasion, a female veterinarian Daniel had worked with in Brisbane. Essentially, it was a team with everyone but the human medical experts, who came courtesy of THI. The Heart Institute had also arranged for the team’s visas and paid for their transportation to Houston. It was the first time they had all been able to meet and work face-to-face in a single place.
Most of them settled in the dorm-like apartments near the Medical Center—the kind that featured fancy gyms, washers and dryers in each unit, party rooms, free Wi-Fi, and landscaped pools, everything that a single guy without a mom or girlfriend needed to function effectively. Thanks to Jim McIngvale—not for nothing was he called Mattress Mack—their apartments came completely furnished, free of charge.
The same was true of their workspace at the Texas Heart Institute, though that task was a lot more complex. Daniel’s team got two rooms adjacent to the subterranean animal lab, one a clean, sterile space and one a conventional “dirty” space for more routine work. Up to that point, the Bivacor, such as it was, had been made elsewhere, and (compared to future models) fabricated of plastic, designed for a short life span for both the device and the animal who would host it. The prototype needed to last just long enough for testing purposes and, maybe, to impress a few investors.
There was a long way to go before Daniel and his team could produce something that would pass muster with the FDA. Not only would they have to create a finished machine—its design “frozen,” in industry parlance—they would also have to prove that it could be manufactured and marketed on a mass scale without any hiccups, or worse. That is, they would have to avoid the kind of production and usage problems that had plagued the Hemopump. The process would not be cheap: the average cost of bringing a device like the Bivacor to market had also been steadily rising, largely due to the ever-increasing caution of the FDA and the relentlessness of plaintiffs’ lawyers. All told, Daniel would eventually need to come up with about $75 million just to get the agency’s approval. McIngvale’s contribution, then, was the first big drop in a very deep bucket.
Still, the team was off to a good start. The basement space, built in the seventies and looking pretty much like a high school chemistry classroom, with fluorescent lighting and battered wood cabinets, was swiftly upgraded to the twenty-first century. Along with all sorts of computers and electronic devices with multiple gauges that looked mysterious, the battered, black-topped tables now hosted mock circulation loops, a series of tall, narrow plastic cylinders and piping connected to computer terminals. When everything was switched on, they pulsed and bubbled with fluid, resembling fancy tablescapes for an oil field equipment gala. In fact, they were miniaturized replicas of the human circulatory system. Many calves would be spared, and money saved, thanks to the machines: the loops were a first line of defense, e
nabling the engineers to see how adjusting the pump’s speeds and pressures would work inside the body. There were loops for the left side of the heart and for the right.
Computers with specialized software for drawing models and producing the specific calculations to build them had also been on Daniel’s shopping list, and now here they were. They would be used to refine the design for, among other things, the impeller, that part of the centrifugal pump that directed the way the blood spun on its path. (Imagine the center of an old-fashioned washing machine, but instead of swishing and agitating dirty clothes, the impeller spins blood to the proper destination.) What worked best to prevent clotting, for instance? Should the impellers be taller or shorter, wider or narrower? A combination of both? How tall should each be and how far apart should they be spaced to make sure the blood couldn’t clot in between? Did one shape work better for the left side of the heart and another for the right? Now the engineers could design and redesign to their heart’s content without making a dent in the bovine population of Texas.
More calves would be saved, thanks to the machine in the adjacent “dirty” room, the crown jewel of the new lab: a 3-D printer. An invention of the 1980s, it stacked layers of a fluid that turned solid when it came in contact with ultraviolet light, duplicating whatever it “saw” into a replica in three dimensions.