by Mimi Swartz
The machine was a success from the moment it hit the market: the more expensive ones could copy highly technical car and airplane parts for industry, or medical devices like artificial heart valves and artificial knees to replace worn-out human ones. A 3-D printer for home use could make anything from soap dishes to coffee cup sleeves to doorstops to kids’ action figures to handguns. Prices for these printers ranged anywhere from $125 to $2,500 on amazon.com.
The Bivacor team’s copier was about the size of a dishwasher and cost in the tens of thousands of dollars. Almost as soon as it arrived, someone printed out a mini version of the Eiffel Tower with all the lacy metalwork reproduced in a shimmering, inky black. Within days, it was fabricating plastic Bivacor models in near-infinite variations.
Almost as crucial for symbolic reasons was a tall, narrow glass case just inside the clean lab. It’s the kind you see in jewelry or eyeglass stores, with transparent sides and shelves. The contents would have been completely unidentifiable to a layperson but, for the informed, served as a constant reminder of how rocky and arduous the path of progress can be. In it, an old Liotta pump sat next to a Jarvik-7. The 1985 issue of Life magazine with a cover photo of William DeVries and William Schroeder sat on the shelf above. There was a tiny Hemopump, octopus-like with the tubes still attached, and two LVADs pieced together, similar to what went in Craig Lewis’ chest. Once so radical, these devices were gathering dust now.
But for Bud, the artifacts, the lab, and all the new lab equipment served as a continuation of the path he’d been on since he’d been a med student, squeezing the heart of a helpless boy to keep him alive. He could never quite believe that so many of the things he or a colleague had done by hand could now be done by machine—Robert Jarvik and Richard Wampler had done all their schematic drawings with pen and paper, after all, as no computer software existed at the time to help them hone the size, shape, or efficacy of their devices. Fabrication that had once taken months could now be done nearly overnight—all refinements programmed in, all mistakes repaired.
As usual, Bud converted the near incomprehensibility of such awesome technological progress into a story. He told it to anyone who would listen, but mostly he was telling it to himself. Just back from Vietnam in 1969, the story went, he had headed to West Texas to see his ninety-four-year-old grandfather. When the two got to talking about recent events, Bud’s grandfather mentioned that the moon landing a few months back had never happened. “They faked it,” he insisted. The two men bantered until they were bickering, and then the argument grew heated, as Bud declared he could not believe his grandfather was being so willfully ignorant. Finally the old man gave up: after all, he’d lived long enough to see airplanes soar over the same vast, empty land he’d once crossed on horseback while driving cattle across the Panhandle. “Well, maybe it happened,” Bud’s grandfather finally admitted of the moon landing. “But I’d rather not think about it.”
Sometimes that was how Bud felt too. The Bivacor amazed and thrilled him, but when it came to the minutiae of data points and CAD software, he’d rather leave that work to younger men. Age and experience had taught him that the machines changed, but the heart stayed the same, its most important secrets still tantalizingly close and yet infinitely far away.
* * *
One way to tell when Bud was in one of his darker moods was to check the movies running on his office television. You didn’t want to make too much of things, as sometimes he just left the thing set to Turner Classic Movies for hours, but too many Russian films with English subtitles could be an indicator. Also, he wasn’t by nature a complainer—male heart surgeons, along with aged West Texas grandfathers, were experts at not only denial but compartmentalization—and normally he didn’t have much to complain about, since there were so many people in his life charged with making sure he could save as many lives as possible without distractions. So it was noticeable when he started making cracks about THI management and asking why the once jammed parking lot at St. Luke’s suddenly had an abundance of spaces. It didn’t seem possible that anything could throw him off his game, but it was clear something had.
The trouble had started right around the time Daniel had arrived, toward the end of 2012. Bud’s faith in the Bivacor was unshakable, and the new opportunity to develop it should have, if anything, made him feel a part of something boldly new, a rarity for someone in his eighth decade. But Bud had also lived for more than forty years in a world of his own making, reinforced at every turn by the elite culture of the Texas Heart Institute and, for that matter, the Texas Medical Center. An expert in those manners and folkways, Bud was especially sensitive to any changes in the local atmosphere. He knew too that the world of medicine was perpetually changing—he groused about it, like all doctors—but he couldn’t have perceived how swiftly and relentlessly change could come to his own protected corner of the world.
But come it did. The ever-growing cost of medical care was causing titanic shifts in the profession and its attendant businesses; sensible people knew that preventive care was the best path forward in all healthcare, including that for heart disease. But preventive care wasn’t profitable. Research and innovation were nice too, but they were expensive and the payoff slow and unpredictable; the big money was in really sick people who had to be hospitalized. In turn, the best hospitals, of course, wanted the best doctors to attract patients. All of these theoretical issues soon became grim realities for Bud and the stellar career he had built for himself in Houston.
The first sign of trouble occurred when a new CEO of one particular Houston hospital chain began aggressively picking off some of the best heart surgeons at THI: with Cooley aging out, there were plenty of midcareer surgeons who were open to offers of more money and spiffier new facilities down the road. Other longtime colleagues and staffers chose retirement over adapting to a change that was surely coming. The next chief of cardiovascular surgery could not probably command his own photographer, for instance. Bud wasn’t the kind of guy to stand in anyone’s way, but suddenly there were fewer people to work with and jaw with around St. Luke’s. That he had recruited and mentored so many of them meant that Bud couldn’t help but take the departures personally. They didn’t want the life he had led—the hospital as home, the drama and exhaustion of twenty-four-hour days, saving the lives of others as the ultimate proof of their own value.
But that was just the beginning. Baylor Medical School, where Bud had been on the faculty for more than three decades, came under new management after a spate of inept leadership in DeBakey’s wake. (One recent former president married his second wife in Las Vegas after his abrupt departure. The two wore matching gold lamé jumpsuits for the ceremony, resulting in a viral photograph that delighted the Baylor docs who had been suspicious of his competence and intent during his tenure.) The decline of Baylor, of course, meant a decline in Bud’s own currency, like any other doctor on the faculty. He was incensed when the new president accepted a $100 million-dollar gift from the owner of the local NFL franchise to build yet another hospital. Bud hoped the money would go to medical research, but research didn’t pay.
Now Baylor too had a hospital to fill with stars, and its leadership began working overtime to lure, and then muscle, the Baylor doctors who had been working around town to move into the new facility. The Texas Heart Institute surgeons were high on their shopping list. With another potential exodus on the horizon, Bud began referring to the new place as “that empty hospital” or “that hospital with no doctors.”
But the biggest shock came in May 2013. Rumors had been circulating for months that the Episcopal Diocese of Texas, which had founded St. Luke’s in 1954, had decided to get out of the hospital business, particularly with the anticipated changes coming under President Barack Obama’s Affordable Care Act. Like a lot of people in and around the Medical Center, Bud was hoping for a merger with DeBakey’s beloved affiliate, Methodist Hospital. St. Luke’s and Methodist w
ere both the medical equivalent of five-star hotels, after all; the combination of their cardiothoracic teams would mean Houston had more than a fighting chance to recover some of the former glory it had been losing over the years to the Cleveland Clinic, which was now the leader in heart health in the United States.
Instead, the diocese shocked both the medical community and the community at large by selling St. Luke’s to the highest bidder, a Colorado conglomerate called Catholic Health Initiatives, or CHI, which had $2 billion in hand and was eager to move into the Texas market. Initially, it wasn’t clear whether THI was part of the deal or not; since its inception in 1962, the Institute had never been owned or governed by St. Luke’s. A simple affiliation—the Texas equivalent of a handshake deal, in essence—had worked to the mutual benefit of both for decades. St. Luke’s got the considerable income generated from the surgical stars at Texas Heart Institute, while the doctors at THI got access to the high-dollar patients streaming in the door. Everyone was happy.
Now, however, THI found itself in the situation of a spoiled mistress whose sugar daddy had suddenly skipped town, to be replaced with a stern Catholic priest. Bud was as shocked as anyone to learn that no one had been looking too closely at the books for St. Luke’s or THI: both had been operating under massive debt—$20 million in the case of THI, whose president at the time, James Willerson, had been doling out massive amounts of cash to attract and keep medical heavy hitters from all over the United States. Willerson, who had been an enthusiastic presence during the Bivacor presentation to the McIngvales, had become particularly infatuated with the latest, edgiest trend in cardiac advances, stem cell research: finding a way to teach a damaged heart to regenerate healthy cells and repair itself.
It didn’t bode well that both Denton Cooley and Bud Frazier learned of the St. Luke’s sale the way most ordinary Houstonians did—by reading about it in the newspaper.
* * *
For Bud, all this change meant that by early 2014, walking from the parking garage into St. Luke’s and the Texas Heart Institute was like entering territory controlled by an occupying army. CHI was eager to put its stamp on its new purchase, and set about doing so by unveiling the obligatory multimillion-dollar rebranding campaign for the new entity, CHI St. Luke’s Health. Now there were cheery billboards, full-page newspaper ads, and banners in the hospital’s public spaces declaring “the dawn of a new era in health” and urging new and old patients to “imagine” all sorts of things related to wellness, as opposed to scary things like heart disease.
Another campaign followed several months later, called “Living Proof,” which was supposed to tout CHI’s new, deeper affiliation with Baylor. This campaign featured the cardiologists and heart surgeons from the Texas Heart Institute (many of whom were also Baylor professors) showing off their innovations, along with the patients who were “living proof” of their success. Bud was prominently featured in print ads and TV commercials, talking about transplants and LVADs with all his medical titles prominently highlighted—Professor of Surgery at Baylor, Chief of Transplant Services at Baylor St. Luke’s Medical Center, and Director of Surgical Research, Texas Heart Institute. He held a Bivacor in his hand, though most people probably had no idea what it was. “Why trust your heart to anyone else?” the ad asked.
But CHI’s commitment only went so far. Historically, the chain had been devoted to community healthcare, with little interest—despite their ad campaign—in surgical innovation or research. Nor was it a chain of big spenders: the once pristine stairways of St. Luke’s grew grimy and spotted with trash. Bud tried to interest the new leadership in the storied history of THI by giving them copies of a 1973 Cooley biography, but these people were not interested in any legacy but their own.
Then there was the fundraiser in honor of Bud’s thirty years of service in the spring of 2014. There had been a big blowout on THI’s fiftieth anniversary in 2012, a black-tie fundraiser in Cooley’s honor. Lyle Lovett played a set, and James Baker III delighted the crowd with jokes about Cooley’s tightness with a dollar. Texas governor Rick Perry showed up, and there were video tributes from former presidents Bill Clinton and George H. W. Bush. Bud’s, in contrast, had a thrown-together quality. He had never expected a big bash like Cooley’s, but he had hoped his three decades would be recognized in a way that acknowledged the importance of his accomplishments at THI. The venue was elegant enough—another luxury hotel ballroom. And Cooley was present, along with a few hundred friends and colleagues. But many of the people Bud was closest to couldn’t get tickets because the room was small or because the notice had been short. There was a fight over who would get the majority of the money raised that night, CHI or THI. There was little reflection of the rich and varied life Bud had brought to bear on his practice. There was no music from Lyle Lovett—who probably would have shown, given that Bud had kept the folk music venue that gave him his start from going under. There were no words of praise from writers he admired and had become close to, like Mary Karr or Larry McMurtry, whom Bud had advised on his heart problems. Not even a video from Dick Cheney, though Bud had consulted on the implantation of his LVAD. There were no appearances, either, from people Bud had helped in far-flung places like Afghanistan and the Middle East. In his introduction, the head of CHI talked mostly about the company’s goals. His speech had all the intimacy of a eulogy delivered at a funeral by a minister who didn’t know the deceased.
* * *
Billy Cohn wasn’t thrilled with the changes at Texas Heart Institute either, but he kept himself occupied, or, as was so often true in Billy’s case, overly occupied. Throughout his medical career, he had always been as interested in making things that made surgery easier and safer as he had in actually operating on people. By 2014, in fact, he had close to eighty patents awarded or pending. He continued to win major prizes too, including a highly coveted silver Edison Award in 2013 for the SentreHEART LARIAT, a tiny, magnetized loop that could be threaded through the body via cardiac catheterization to tie off a small, useless protrusion of heart muscle thought to be a danger to those with an irregular heartbeat. (Billy, of course, fretted that he hadn’t won the gold.) Like many other inventions created by Cohn, this one reduced the need for open-heart surgery. Billy was also spending a lot of time in Paraguay, where he was working with a team to create an easier, nonsurgical entry port for dialysis patients.
When he wasn’t inventing—or even while he was inventing—Billy served on the board of several medical device companies, and was busy creating others. The failure of his early reality show was long forgotten; Billy had evolved into an innovation evangelist, a brilliant spokesperson and salesperson not only for his own devices but for the Texas Heart Institute. He knew how to reduce the arduousness of invention to a lively after-dinner speech; in fact, he could make building a total artificial heart sound like a simple matter of buying the right stuff at Home Depot and putting the pieces together over a weekend. It didn’t matter whether he was performing in front of a high school or college science class, a tiny if adoring women’s club, or a major inventors’ organization; Billy strutted and pivoted and paced across the stage, as excited and flamboyant as a medical Mick Jagger.
“We can’t afford to take care of our sick,” Billy preached. “The key to fixing all our healthcare problems is…innovation.” He’d move on to cite the great inventors—Thomas Edison, Nikola Tesla, et cetera—and tell the hoary story about DeBakey and his trip to the department store to make the Dacron graft that changed heart history. (It was always new to someone.) You had to notice unmet needs. You had to ignore the naysayers (“Just because everybody tells you it won’t work…do it anyway”). You had to recognize your frustrations: “There’s always an opportunity to mitigate frustration,” he’d say. Why, he invented a foot pedal for his refrigerator door because he hated trying to open it when his hands were full.
What Billy didn’t say is that it also helped to be Billy, whose determinat
ion matched his stratospheric IQ and boundless curiosity, as well as his unceasing, perpetually powered drive.
These qualities did not go unnoticed beyond THI. Most medical innovation these days comes from enormous multinational corporations like Medtronic and Johnson & Johnson, who have the billions required to bring multiple products to market—and to buy smaller companies that develop them. It so happened that in 2014 Billy was on a plane to Tel Aviv for yet another medical conference, and he found himself seated next to an old friend, Bruce Rosengard. Rosengard, a tall, supremely confident heart surgeon and inventor, was Johnson & Johnson’s chief science and medical technology officer. On that particular day, he had a pressing problem. The corporation wanted to put an innovation center in the Texas Medical Center and build relationships with the local hospitals. The TMC was visited by about ten million patients a year, many of whom might be interested in participating in clinical trials for new medicines and new devices. But Rosengard hadn’t been able to find the right person to head the venture. He needed someone dynamic. Someone who was a great medical innovator, but who also knew all the players in Houston.
By the end of the flight, he was pretty sure he had his man.
17
THE POWER SOURCE
By the beginning of 2016, a sense of urgency to try the Bivacor started overtaking just about everyone but Daniel Timms. “I’d put it in a patient today if I could,” Bud would say. He was that sure. He would have done an emergency implantation, like the kind they had done on Lewis, as winning FDA approval for an emergency, lifesaving experiment took almost no time at all. They could work out the bugs afterward.
Bud had been around this particular engineer-versus-physician mulberry bush before: guys like Daniel wanted to make a pump that would allow a patient to play a mean game of tennis, while Bud knew that lots of folks just wanted to be able to walk across a room. Of course, the FDA only gave you two shots at experimental use—that’s one reason he was no longer working on the twin HeartMate device. That and the fact that Bud was so sure Daniel’s Bivacor would work infinitely better.