Breakthrough!

by Jim Murphy

  Taussig (right) discussing a blue baby operation with a visiting surgeon, 1947. Thomas (background, left) is waiting to advise his colleagues.

  Over the following years Thomas watched quietly as many young surgeons—whom he had helped to train—went on to highly successful careers and fame at other research facilities. Even one of the research dogs, Anna, received more immediate attention than did Thomas. The first animal subject to survive the operation, Anna had an honored place in the lab, where she wandered around freely for nearly fifteen years. She was frequently photographed for magazine articles along with children who had had the operation, and a movie was made about her in 1950. In 1951, her portrait was painted and presented to Johns Hopkins Hospital, where it still hangs today.

  Portrait of Anna by DeNyse W. Turner, 1951. Anna was the first animal subject to survive the experimental blue baby procedure.

  Was Thomas being overlooked because he was African American? At the time, research assistants (no matter the color of their skin) were often overlooked when it came to credit for a breakthrough discovery. Because they weren’t doctors, they were viewed as hired workers who simply followed the instructions of the physician running the laboratory or directing a particular line of research. The assistant might offer a suggestion or an opinion, but, it was assumed, very few took a creative part in formulating or carrying out research.

  There were exceptions, of course. There always are. And Vivien Thomas was a prime example. When Thomas began working for Blalock, he was instructed by the Professor and other surgeons on how to perform various complicated medical procedures and keep accurate records of the results. He was clearly under the careful guidance of others during his first few years. Over time, however, Thomas began doing precisely what Blalock had requested during Thomas’s initial job interview: he got “to the point that he [could] do things on his own.”

  In all likelihood, when Blalock said this he was hoping that he could give Thomas an assignment and that Thomas would carry it out, not needing to continually bother him with questions. But Thomas had been raised by two parents who encouraged problem solving, whether that involved sewing a particularly complicated clothes pattern or finding a way to repair a house. Thomas did exactly the same thing in the laboratory. Shown how to do a surgical procedure, he would master it and then find ways to make it simpler or better. As Dr. Henry Bahnson, a colleague of Blalock’s, recalled, “Dr. Blalock taught Vivien a lot, but Vivien also discovered a lot of new techniques himself and taught them to Dr. Blalock.”

  Thomas pauses during a busy day.

  Even so, many doctors and historians believe Thomas was a victim of discrimination. When discussing the way people behaved toward Thomas after the operation, Dr. Levi Watkins Jr. didn’t mince words: “Vivien was not a co-equal by any stretch of the imagination.”

  Watkins didn’t say or suggest that Blalock was a racist. He did say, “I think the gentlemen both were products of their time.” Blalock may have hesitated to highlight Thomas’s many achievements because he feared a backlash from racially biased colleagues at the school, which would have hindered his research, or from his relatives and neighbors, which might have made him and his family feel uncomfortable and isolated. He also may have worried that letting the world know about Thomas and his miraculous skills would result in job offers from competing research laboratories.

  For his part, Thomas may have hesitated to assert himself, fearing he might be dismissed. There was good reason for Thomas to worry about this; research assistants who had touted their accomplishments often paid a steep price for speaking out. A notable case involved Albert Schatz, a research assistant at Rutgers University in New Jersey. Schatz single-handedly isolated the bacterium that could stop the growth of tuberculosis and led to the creation of streptomycin, the first and only drug back then that could save the lives of millions of TB suffers. But it was the head of the laboratory, Dr. Selman Waxman, who received all the credit and rewards for the discovery, including a Nobel Prize and considerable financial gain. Schatz eventually sued over the slight and won—but he never again worked in a top-level microbiology lab.

  In the end, the responsibility for Thomas’s initial lack of recognition was Blalock’s. Blalock was not just a respected and honored researcher; he was the head of both the surgical and research departments at Johns Hopkins and, after the blue baby operation, the most powerful surgeon in the world. He had worked for many years with Thomas, had seen him grow intellectually, and knew precisely what Thomas had contributed to his own success. Blalock could have pushed his talented research assistant’s career forward with little trouble, and he could have fended off any criticism hurled at him. But he didn’t. Instead, Blalock was, like too many people in positions of power, happy to allow an unfair situation to drift along, possibly hoping it would correct itself somehow, but not willing to create any problems that might unsettle his world. Dr. Bahnson sadly admitted, “The race issue was quite a concern, as you know, and Vivien was slow to get credit. He got a fair amount, but perhaps he should have gotten more credit earlier.”

  Dr. Levi Watkins, the first African American to be accepted at and to graduate from Vanderbilt’s School of Medicine, became the first black chief resident of cardiac surgery at Johns Hopkins. He had worked closely with Thomas during the 1970s. For a very long time, Watkins felt that Thomas was “the most un–talked about, unappreciated, unknown giant in the African American community. What he helped facilitate impacted people all over the world.”

  Students in the last operative surgery class with Vivien Thomas (background, right) before the Hunterian Laboratory was torn down, 1955.

  Recognition did eventually begin to flow Thomas’s way. In July 1951—seven years after the first blue baby operation—Dr. Raymond A. Heimbecker wrote a paper on his own blood circulation research and referred to Blalock and Thomas as co-contributors to the project (that is, they advised him on how to carry out his research and on what to test). “Heimbecker,” Thomas reported with genuine surprise and delight, “thought my contribution to the project warranted the inclusion of my name. . . . This was the first paper on which my name appeared . . . with that of Alfred Blalock.”

  Thomas was always proud of the students he helped train. Among them was Dr. Levi Watkins, the first African American to graduate from Vanderbilt’s School of Medicine and the first black chief resident of cardiac surgery at Johns Hopkins.

  Blalock could have had Thomas’s name removed from the paper, but he didn’t. In fact, he felt it was a wonderful idea that Thomas’s name be included. More recognition came to Thomas in the years to follow, including an honorary doctorate from Johns Hopkins. He would eventually be made head of the laboratory, responsible for teaching the surgical techniques he had perfected to new generations of young doctors, many of whom became world-famous heart surgeons.

  One such student was Denton Cooley, who had participated in the first blue baby operation and became the first surgeon to successfully implant a completely artificial heart into a human. Cooley always admired Thomas and had great praise for his teacher’s brilliant skills. “Even if you’d never seen surgery before,” he told a reporter for Washingtonian magazine in 1989, “you could do it because Vivien made it look so simple. There wasn’t a false move, not a wasted motion, when he operated.”

  Thomas received what was probably his biggest honor in 1971. A painting of him was commissioned by a Johns Hopkins group called the Old Hands Club, an association of former students who had gone on to highly successful careers. The painting was going to be done by Bob Gee and presented to Johns Hopkins with the understanding that it would hang in the laboratory where Thomas had created surgical techniques and tools and taught hundreds of students. On the day of the presentation, Thomas, in keeping with his shy nature, told his wife and family that something nice was going to happen to him that day, though he didn’t say exactly what.

  Portrait of Blalock by I. Hunter Parsons, 1945.

  But this would be a m
oment when even Thomas was surprised. When the painting was presented to the president of the hospital, Dr. Russell Nelson, he told the hundreds of guests assembled, “Well, we are very honored to accept this.” He then turned to Thomas and with a smile added, “Vivien, I think you should hang on the wall with all of your colleagues. You are going to be right there in the Blalock Building along with the other great Hopkins surgeons.”

  Portrait of Thomas by Bob Gee, 1969.

  There was a momentary pause as everyone assembled on the lawn that day—surgeons Thomas had trained in years past, young students he was still training, nurses who had seen his surgical skills firsthand, even a number of janitors—took in what had been said. Then as one they stood to cheer the tall, humble man standing on the platform.

  Even though he never operated on a human, his portrait hangs in the great hall of the Alfred Blalock Clinical Sciences Building, shoulder to shoulder with those of other internationally famous surgeons, including his friend, associate, and creative partner, Dr. Alfred Blalock.

  Thomas had seen his dream of becoming a doctor evaporate because of a terrible economic collapse; he had been forced out of necessity to take a job that did not pay very well; he had been the target of discrimination and had been excluded from socializing with colleagues in public. Even so, he stayed true to the lessons he learned from his hard-working parents—he not only worked steadily and conscientiously day after day, year after year, but he did so with an eye to perfection. And doing this made him legendary.

  Yet Thomas always remained perfectly grounded. He even managed to have a sense of humor about his portrait, saying, “It took quite some time for me to become accustomed to ‘meeting myself’ each morning in the Blalock lobby.” He would then make his way to the laboratory, his sanctuary for over thirty years. As for his growing fame, Thomas took his usual practical approach, one that stressed community involvement over his own ego. “As for me,” he wrote in a letter to a colleague in 1975, “I just work here—I much prefer to leave [my place in medical history] to be expressed by you and others with whom I’ve worked. I’ve thoroughly enjoyed the role I have played and only tried to be me.”

  After decades of standing in the background unnoticed, Vivien Thomas received his honorary Doctor of Laws degree in 1976.

  And by being himself, Vivien Thomas helped save thousands of lives and helped change the course of medicine forever.

  A rare moment for Thomas, when he wasn’t setting up an experiment, analyzing the results of an experiment, or teaching surgical techniques to students.

  Acknowledgments

  I WANT to thank the following individuals and institutions for their generous help and encouragement: Dr. Michael A. Parziale of the Summit Medical Group for describing in detail what it is like to cut into a human chest and what a surgeon then encounters; Dr. Vincent P. Laudone of Memorial Sloan Kettering Cancer Center for describing the difficulties of performing intricate surgery in such a small, tight space as the human chest; Dr. Florence J. Grant of Memorial Sloan Kettering Cancer Center for discussing the difficulties involved in using the open drop technique to administer anesthesia; and archivists Jolie Braun of the Duke University Medical Archives, Ken Hoge of the Texas Heart Institute, and Timothy Wisniewski of the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions for providing information and helping me to secure images.

  Source Notes

  Preface

  xi Descriptions of operating room 706 and the tension of those taking part in the surgery are drawn from Thomas, 99–100, and Stoney, 68–69.

  A description of Eileen Saxon’s medical condition, plus details about the operation, can be found at www.neonatology.org/pdf/bluebabyoperation.pdf. Another interesting look at the operation can be found in Steve Catoe’s blog, Adventures of a Funky Heart!, tricuspid.wordpress.com.

  xi–xii “I took . . . die”: Stoney, 68–69.

  xii “Bill . . . days”: Stoney, 68.

  1. In the “Dog House”

  1 Information about the Hunterian Laboratory and its shabby condition came from Thomas, 55–56 and 190–91, and Stoney, 162.

  “drab hospital-green”: Thomas, 55.

  “[Dr. Blalock and I] . . . ‘dog house’”: Thomas, 55.

  1–2 “Baltimore . . . fill them”: Thomas, 57.

  2–3 “individual dwellings . . . room”: Thomas, 57.

  Baltimore and prejudice are discussed passionately in Wilkerson, 8–11, 31, 37–45, 76–78, 398, and 408. Additional information came from Richard Paul Fuke, “Blacks, Whites, and Guns: Interracial Violence in Post-emancipation Maryland,” Maryland Historical Magazine 92 (Fall 1997), 326–47, and Christopher Phillips, Freedom’s Port: The African American Community of Baltimore, 1790–1860 (Champaign: University of Illinois Press, 1997).

  3 “There was . . . anyplace else”: C. Fraser Smith, quoted in Partners of the Heart, Act II.

  4 “congested . . . grassless”: Thomas, 57.

  “Many . . . suitable”: Thomas, 57.

  6 “I would . . . challenge”: Thomas, 56.

  7 “I did . . . told”: Thomas, 59.

  7-8 “Who the hell . . . give it to him”: Thomas, 60.

  9 “frightening . . . person”: Arthur F. Raper, The Tragedy of Lynching (Chapel Hill: University of North Carolina Press, 1933), 36–37.

  “In everyday . . . brutal”: Wilkerson, 42.

  10 “Dr. Blalock . . . of him”: Thomas, 16.

  “I told . . . the hall”: Thomas, 16.

  10–11 Several works were consulted for Alfred Blalock’s early history, including A. McGehee Harvey, Alfred Blalock: 1899–1964 (Washington, D.C., National Academy of Sciences, 1982), 49–52; H. William Scott, History of Surgery at Vanderbilt University (Nashville: Vanderbilt University Medical Center, 1996), 52–58; and Mark M. Ravitch, The Papers of Alfred Blalock, vol. I (Baltimore: Johns Hopkins Press, 1966), xv–xxi.

  11 “apologized . . . to work”: Thomas, 16.

  “We had . . . mistakes”: Thomas, 17.

  11-12 “The day . . . other”: Thomas, 60.

  12 “[Johns] Hopkins . . . fortress”: C. Fraser Smith, Partners of the Heart, Act II.

  13 “Trash cans . . . dusted”: Thomas, 62.

  “was . . . too”: Thomas, 62.

  “Knowing . . . situation”: Thomas, 63.

  “no intention . . . here”: Thomas, 63.

  “Good Lord . . . already”: Thomas, 62.

  “I answered . . . later”: Thomas, 62–63.

  14 “had . . . happen”: Thomas, 63.

  2. The Professor and His Assistant

  16–17 A concise description of Blalock’s and Thomas’s work on shock at Vanderbilt is in Harvey, 52–56. Thomas details this work as well, 14, 21–26, 33, 38, 66–68, and 75–77.

  The various forms of shock and their symptoms are discussed by Eugene A. Stead in “Circulatory Collapse and Shock,” Textbook of Medicine, vol. I (Philadelphia: W. B. Saunders, 1967), 587–90.

  18 “I want . . . can’t do”: Thomas, 10.

  19 “I want . . . around”: Thomas, 10–11.

  “To me . . . months”: Thomas, 11.

  Thomas and Blalock had a long history regarding Thomas’s salary, documented in Thomas, 11, 18–19, 44, 65–66, and 181–82. Before the surge in medical research after the blue baby operation, no one at a research laboratory made a great deal of money, not even the director. In addition to being African American, Thomas had two major obstacles to overcome in order to earn a fair salary. First, he had come to Vanderbilt as an unskilled janitor and was paid accordingly. Second, he sought employment at the beginning of the Great Depression, when millions of people were losing their jobs. Business owners felt that anyone working for them was lucky to be earning a regular income and weren’t very generous with starting salaries or subsequent annual raises.

  Thomas grumbled about his wages frequently, and Blalock grumbled about his assistant’s frequent requests and occasional threats to resign over his low salary. B
lalock had to get permission from senior administrators in the university to increase Thomas’s wages, which he eventually always did. Thomas always felt his contributions to Blalock’s research should result in a higher salary, but he never suggested that Blalock was taking advantage of him because he was African American.

  Background information on Thomas and his upbringing is from Thomas, 3–8.

  “Our parents . . . expectations”: Thomas, 5.

  “excellent seamstress”: Thomas, 4.

  20 “My father . . . carpentry”: Thomas, 6.

  “So we . . . Saturdays”: Thomas, 6.

  “I . . . embarrass you”: Thomas, 7.

  21 “my father . . . old”: Thomas, 6.

  22–23 Blalock and a fellow doctor, J. W. Beard, described their very careful research methods in two journal articles: Archives of Surgery 22, no. 617 (April 1931), and the Journal of Clinical Investigations 11, no. 311 (March 1932). Thomas elaborated on Blalock’s research techniques and his training in Thomas, 23–29.