Ticker

by Mimi Swartz

  It probably made a lot of sense at the time. After all, back in the sixties, Michael DeBakey had set a ten-year deadline for the artificial heart. It was quickly decided by various government, corporate, and medical experts that the only way to power such a device—to compete with the natural heart’s 120,000 beats a day for, say, twenty to thirty years or more—was to, literally, go nuclear. At the time, no ordinary battery lasted more than several hours. A short-term internal power source guaranteed a ticket back to the ER for open-heart surgery.

  Enlightened self-interest also played a role. The US government, in the guise of the Atomic Energy Commission, was eager to put a positive spin on what had been a very ugly experiment—the nuclear research that evolved into the weapon that forced the Japanese surrender in World War II. Engineering firms like Westinghouse Electric and McDonnell Douglas were also eager to apply what they had learned in wartime toward commercial use—especially when Uncle Sam was offering to dole out a total of $14 million (or about $300 million in today’s dollars) to pay for the research. Willem Kolff was one of many inventors lobbying for the effort. In fact, just about everyone involved was on board with the nuclear option, including researchers at the Texas Heart Institute.

  The research lab created by Dr. John Norman in 1972—Cooley’s big recruit from Harvard, who lived with his Great Dane in the lab—did a lot of work but came up with very little. Norman’s pump was sponsored by the National Heart, Lung, and Blood Institute, which was competing with another sponsored by the Atomic Energy Commission in an intragovernmental contest. Powered by a thermal converter fueled by plutonium, it was supposed to make the heart run like a steam engine, converting fluid to vapor. The plutonium was secured inside three different capsules to prevent any leakage.

  No adequate power source would emerge from this work, or anyone else’s, partly because there wasn’t really any effective artificial heart or assist device at the time. By 1977, the whole enterprise was dead because the government had withdrawn its support, partly due to financial concerns and partly because the public had become much more skeptical of the artificial heart itself. Even before the frightening, narrowly averted meltdown at the Three Mile Island nuclear power plant in 1979, the nuclear threat that created the climate of the Cold War made the idea of putting radioactive material in the body wildly unpopular.

  Still, some good came out of the research. Experiments done in Houston on the effects of radiation in animals showed that the body could tolerate more than was initially believed. Over a period of four or so years, technicians implanted plutonium capsules in the abdomens of dogs and baboons, and from 1975 to 1977, twenty-one humans wore plutonium-powered pacemakers outside their bodies to determine what kinds of problems, if any, the radioactive material caused. The answer was: not much, unless you counted setting off alarms in metal detectors.

  By the 1980s, nuclear medicine was, in fact, a growing specialty, with new radiopharmaceuticals used for diagnosing everything from heart and kidney disease to tear duct blockages. PET scanners used in imaging and diagnosis make use of a dye with radioactive tracers.

  It may be that the need for a nuclear-powered battery for an artificial heart has already been eclipsed by newer, less threatening technology. In the early 2000s, a completely implantable pump called the Abiocor was developed by a team headed by a Massachusetts aerospace engineer, David M. Lederman, and a PhD scientist, Robert Kung. To Bud’s way of thinking, it was a pretty good device: though pulsatile, the Abiocor had no air compressor and recharged itself wirelessly, sending messages through the skin. The internal battery and a controller that monitored the heart rate sat comfortably near the abdomen.

  As usual, the makers came to Bud for implantation. He put it in fourteen patients in FDA-approved clinical trials in 2001; Time magazine heralded the Abiocor as its Invention of the Year soon after. The longest-living patient, Tom Christerson, survived for 512 days after receiving the Abiocor in Louisville, Kentucky. The most popular patient was a tall, thin African American named Robert Tools, who became a medical celebrity for a time.

  Lederman was optimistic. “There is no reason a person should die when their heart stops,” he told CBS News. “If the person’s brain and the rest of the body is in good shape, why should people die?”

  It was a good question, and the answer in the case of the Abiocor lay, once again, with money and human frailty more than medical progress.

  The Abiocor was never powerful enough to serve as a permanent replacement for the heart, because the membranes weren’t strong enough. Most patients got about five months of life from its use. The pump was also complex—it had lots of moving parts—and very large, about the size of a grapefruit, so the only people it would fit were very large men. And it came with a $700,000 price tag. Even so, the Abiocor could have been used as a bridge to transplant for a limited population, but Lederman wasn’t interested. He couldn’t make enough money on a market that small, and the Abiocor vanished from cardiac history, apart from a starring role in a 2009 movie called Crank: High Voltage.

  In the movie, Jason Statham plays a man whose real heart is removed by Chinese mobsters and replaced with an artificial one, played by the Abiocor. Static electricity is supposed to keep the heart’s battery going, so the Statham character tries to keep himself charged at first by rubbing against as many people as possible to create friction, and then by having sex with an amenable stripper. It sounded a lot more appealing than partnering forever with a battery pack.

  18

  THE DREAM OF ETERNAL LIFE

  The LVAD floor at St. Luke’s wasn’t what anyone would call a happy place: a lot of the patients were aged and bedbound, barely conscious in darkened rooms. One middle-aged patient was on hiatus from his nursing home, propped up in bed with socks tumbling down his ankles, his mouth wide open in what looked to be a nearly perpetual slumber. Others looked pretty good, chatting with relatives in various languages while they waited for whatever surgery or tune-up they needed. Bud knew a great many of them from years past—he’d operated on them, or consulted on their cases, and the recognition would light up their faces and his.

  The people swarming around the dimly lit nursing station were another matter. In 2017, they didn’t know Bud and he didn’t know them, a situation that had been all too obvious a few nights before, when a woman named Sharon Stone had reached him by phone in his office, trying to get a sick friend from Beaumont, Texas, admitted to St. Luke’s.

  Bud asked about her friend’s history and condition, and about the woman’s relationship to the patient. “He was my manager,” she told him. Bud asked what business she was in. “You may have seen me in some movies,” she said.

  Time had not slowed him down much, even if he was closing in on seventy-seven. “Well,” Bud said, laying the Texas on thick, “if you are the Sharon Stone I’m thinking about I guess I’ve seen a lot of you.”

  The story gave Bud a chuckle over the next few days, but his clever comeback was not the punch line. The punch line was that when he called to check on the patient after finding a cardiologist to admit him in the middle of the night, the nurse on the cardiac floor refused to give him any information because she didn’t know who he was. “This actress in Hollywood knows more about me than a nurse in my own hospital,” he said, shaking his head.

  Indeed, his presence on the LVAD floor had become, literally, academic. Bud had a new job leading rounds once a month for medical students, interns, residents, nurses, surgeons, and anyone else who cared to attend. The diversity of the group today would have been unimaginable when Bud was their age: there were a number of women present, and the number of white men in attendance was decidedly small. Asian, Middle Eastern, African, and African American—they all listened with varying degrees of attention. Most of them weren’t yet alive when Robert Jarvik put a heart in Barney Clark—“Jarvik was a great machinist but he didn’t know anything about medicine…”—much less wh
en Denton Cooley stole the heart from his nemesis Michael DeBakey, and they probably didn’t care.

  LVADs, like any number of former medical miracles, had gone the way of the space shuttle; the glamour and drama of open-heart surgery was gone. Much surgery now could be done with small incisions and even smaller scopes and tools. No one had to come to the Texas Medical Center to get an LVAD; any good city hospital had a specialist who could put one in. Even so, it was a point of pride with Bud that the work had started here and that, as he often said of the continuous-flow devices and told the students now, “not one had pumped to failure.” The machines outlived their human hosts. Maybe the pumps couldn’t restore a sick person to his or her previous, active life—patients were still attached to hoses and batteries and countless medications—but they lived, which to many was enough.

  Bud’s own life had become significantly restricted in the last few months as well, and not just because of his health. Over the decades, both the hospital and Baylor had tried to rein in Bud’s save-everyone-and-damn-the-costs tendencies. In this increasingly litigious, prohibitively expensive, and data-driven age, Bud’s willingness to take big risks for those with the least chance of survival was no longer viewed as a plus. He could exhaust the blood bank with complex surgeries; if his patients had no insurance, the hospital had to eat the bills, including their extensive hospital stays. And, again, there were the numbers: Whenever Bud operated on the sickest of the sick—the least likely to survive—he endangered the hospital’s mortality statistics, which were becoming ever more crucial for federal reimbursements. (His success rates with patients who were not so close to death were excellent.)

  The times caught up with him, not just economically but physically. Depending on who you ask, Bud either asked to operate less because of his back or his knees, or the hospital tried to ease him out of the operating room. Baylor brought in a much younger man from the Northeast who was supposed to take control; at least he now had most of the titles Bud had always been so proud of. He was a small, pale New Yorker who had trained, among other places, at the prestigious Columbia Presbyterian. He also wore a yarmulke—far from normal headwear in the med center, even in 2015—and was exceedingly deferential to Bud, treading lightly, as if he were almost embarrassed to be nearby. It didn’t work; it was like sending in the waterboy to give instructions to the star quarterback.

  But Bud was more and more alone. He lost Cooley near the end of 2016, in November. Bud’s mentor had slipped into a depression after his wife of seventy years had died the month before, and though Cooley had been frail for a number of years, at ninety-six he had quickly grown frailer, his voice softer and his blue eyes rimmed in red. Still, Cooley continued to show up at his office every day, just as he had for decades, though now his hours were shorter. Bud made a point of stopping in regularly, sometimes just to trade a story both had heard a thousand times before, or to complain about the latest indignity by some bean-counting hospital administrator. Cooley, in fact, still had an appetite for any bad news having to do with Methodist Hospital. But then he missed one day at the office and then another, and then he was gone.

  The memorial service was held at his family church, a massive stone structure with soaring ceilings lit with glorious stained-glass windows, one of which was in honor of the daughter Cooley had lost to suicide. Bud came in with Rachel just before the service started and looked around in confusion, as if trying to find his usual seat next to the man he had loved for so long.

  * * *

  Billy left in the spring, moving into a new office in an old Nabisco cookie factory that had been repurposed to house the spanking-new Johnson & Johnson Center for Device Innovation. The problems and politics at THI/CHI had infuriated him, particularly when some administrators and board members asked why they shouldn’t have a piece of present and future inventions. This was a new era; in Cooley’s day no one would have dared to suggest such a thing. Billy’s new gig seemed like a good one, though he worried that people would lose respect for him because he wasn’t doing much heart surgery and, at the same time, that J&J would have issues with his eccentricities. But meeting and greeting corporate types fit his personality pretty well—it wasn’t so different from performing magic tricks—as did hosting seminars for would-be inventors and entrepreneurs. They hoped that his advice or potential influence could land them the chance to develop and sell their product or their company to Johnson & Johnson. At one event, he was cornered by not one but two people who had invented what they believed were better, more user-friendly tests for stool samples. (“No shit!” Billy responded, meeting them.)

  If Bud, Billy, and Daniel were still a ways from putting the Bivacor in a person, they had to be ready, just in case the emergency opportunity arose, as it had with Craig Lewis. They often met at MITIE, Methodist Hospital’s Institute for Technology, Innovation, and Education, which had the best morgue in the med center, a sun-washed room on a high floor of yet another new building. It looked more like a state-of-the-art spacecraft than the grim, dank morgues of television detective stories.

  Calf studies told them a lot, but in order to save a person, they had to know how the device would best fit in a human body. Hence their presence in the morgue. They wore scrubs but no masks or caps—this wasn’t a sterile atmosphere. The corpse was laid out on a table, barely visible under a light blue paper sheet that slipped and revealed various parts of the body as Billy and Daniel hovered over and around the chest cavity. This was someone who had lived a good long time. His skin had the pinkish-gray pallor of the dead kept in cold storage, and he looked to have been a big man in life. His mottled, shaved head was massive, as were his thighs, which happened to be the spot where his legs ended, the skin tucked back in on itself where his knees should have been. His stubby fingers peeked out from beneath the drape whenever someone brushed against it; occasionally his penis and scrotum appeared as a furry, listless heap. Maybe he had been a bank president, or maybe he had been a greeter at Walmart; in this state all anyone could discern was that he had been generous enough to let a couple of guys use what he left behind for medical research.

  They opened the chest with a quick flick of the scalpel and spread the layers of muscle aside. Daniel put the Bivacor in, feeling around for familiar guideposts, shifting and shoving it this way and that, looking for the way the machine would or might better connect to various parts of the body. Long ago, Jarvik had insisted that the only way an artificial heart would be successful was if the person hosting it could forget that it was there. Hence this exercise. How deep should it go? What was the best, most precise angle to connect to the body? Should they change the angles of the tubes protruding from the device to better direct the flow of blood?

  They took measurements, calling out numbers to an assistant who recorded them on a yellow pad. It wasn’t so different from buying a custom suit, and in some future, maybe closer than Bud’s grandfather would want to imagine, the artificial heart would be made that way: programmed to size before it was even manufactured, a perfect fit, just like the custom-made cowboy boots Billy and Bud wore as a tribute to a lost, limitless world.

  The calf experiments continued too, as the team moved closer to formal FDA trials. Jim and Linda came occasionally to watch, as did surgeons Bud had worked with over the years. Former patients came too.

  One of those was Ally Babineaux, twenty-nine. Her trouble had started in 2008 when Ally, a fierce college athlete, collapsed after a rowing contest. She got a diagnosis of strep throat at her college medical center, but instead of bouncing back like she always did, Ally got sicker and weaker. She went to several more doctors, but no one could tell her what was wrong—she just kept fainting. Maybe she was working out too hard, one doctor suggested. Maybe she was dehydrated. Maybe it was her gallbladder.

  More time passed, and was lost, before Ally’s parents insisted on taking her to St. Luke’s, where doctors finally diagnosed her with viral cardiomyopathy, a
disease of the heart muscle that can be fatal. She was in the prime of her life: a beautiful Texas blonde with flashing brown eyes and the toughness of a pit bull. Ally was also engaged to be married at the time; suddenly she wasn’t sure whether she should be planning her wedding or her funeral. Finally her cardiologist laid out the best options for survival: a transplant or an assist device. The transplant waiting list numbered in the thousands, and besides, Ally didn’t want one. A pump could come out when she was better, she thought, and she would be whole again.

  That was when she met her surgeon, Bud Frazier, an odd duck who used nothing more than his hands to measure how and where he was going to cut and where he was going to place something called the HeartMate II inside her body. Maybe because Ally was the same age and had the same name as his daughter, or maybe because she was such a fighter, arguing with her healthcare team, or maybe for all those reasons, Ally became one of Bud’s favorites. He checked on her at all hours, and answered her (sometimes angry) phone calls, and would rush to her room when she became agitated or delusional. But she survived, marrying at twenty, a vision in a lacy white gown, with Bud watching quietly from a back row. People magazine wrote a story, christening Ally the “Bionic Bride.”

  But a year or so later, her health began to fail again, just months after she had begun to feel strong enough to consider taking her pump out. This time no machine could save her, because too much of her heart was damaged. Her only hope was a transplant. Ally moved back into St. Luke’s as first her kidneys and then her liver shut down. She spent months in the hospital just waiting, too sick to leave, battling depression, sometimes on a respirator, off and on dialysis. No one was sure she would survive. But she did, walking out of the hospital with a new heart in 2011. Ally had to have a second transplant in 2014 after the first resulted in a case of arterial sclerosis—the arteries in her new heart began to clog, something that sometimes happens to young female patients. That hospital stay lasted 178 days.