by James Salter
“We can talk better at the bottom,” he said. He headed for the starting hut but I made one more attempt to engage him. How many times, I asked, had he skied this course? He thought for a moment.
“1952,” he said, “1953 . . .” “Not just the races. All the times. Counting practice.” “Those don’t matter,” he said. The starting hut has no floor; it’s set right on the snow. There is a railing down the middle to create a kind of waiting area on one side. Sailer glides around it and lines up in the gate. There he pauses and looks down the bleak, empty course. They have been working on it all week. Difficult to know what his thoughts are, his memories. He first won the race the year of his Olympic sweep when he won the downhill, normally a matter of hundredths, by 3.5 seconds, the slalom by 4 seconds, and the giant slalom by 6.2 seconds. It was the greatest individual performance ever. Nobody, one authority says, has ever come close to those time differences, especially in giant slalom, not even Stenmark. Killy won by razor-thin margins.
From the starting gate the course goes down sharply to a hard left turn that leads into an even steeper, narrower pitch, a breathtaker called the Mausefalle. After this is another, the Steilhang. Sailer stands with the tips of his skis hung out over nothing. My thoughts are close to panic. I feel as if we are about to step off a precipice.
Sailer turns his head and then offers something for the first time. “How are your edges?” he asks. “Sharp? Because it’s all ice here. If they’re not sharp, I don’t think you’re going to make it.” And he is off. I watch in disbelief as he makes one or two confident turns and goes out of sight to the left at the bottom. My own skis are rented. I push them out over the edge. I had pictured us skiing slowly down the side of the course, shadowing it leisurely. It isn’t going to be like that.
I push off. From the first moment it’s like a car without brakes. On the frozen surface my edges won’t hold. I try to turn, but the skis only clatter. Picking up speed, I can’t make the last turn, fall at the bottom, and get up quickly. Sailer is standing there at the top of the Mausfalle.
“The ice isn’t bad,” he comments as I reach him, “it’s grippy.” When he was racing they used to pre-jump here and go most of the way down in the air. Now they press, holding their skis on the ground and taking the air as it comes. At the bottom it flattens suddenly—it’s called a compression—driving the legs up into the body. There’s no time for recovery. Three quick turns lead into the Steilhang, more difficult still. These turns are very important, Sailer comments, you have to make them correctly to keep up maximum speed. I nod reluctantly.
On the Steilhang is something unexpected: Austrian ski troops at work grooming the course. They are under the supervision of Willy Schaeffler, a former United States ski team coach now in his sixties. I know Schaeffler and am relieved to see him.
“What are you doing here?” he asks. We’ve stopped there beside him. “Toni’s showing me the Hahnenkamm,” I say casually. “Him? He doesn’t know anything about the Hahnenkamm,” Schaeffler says, to my alarm. “He’s forgotten it all.” He laughs at his own joke. Sailer says nothing. After a moment, merely, “Let’s go.” He lets his skis run down the rest of the Steilhang, some twenty or thirty yards, onto a relatively flat road through the woods. It feels like we are going sixty miles an hour. We are probably doing twenty. The tension is beginning to ease, however. The top part is the hardest—perhaps we’re going to make it.
We come to another pitch, not so steep. It’s called the Alteschneise—the Old Cut—and is where Sailer fell in 1958. He points to the approximate spot. He hit a fast place or bump, he doesn’t know which—the course was narrower and rougher then and the skis just went out from under him.
Through the middle section it is relatively pleasant, the sort of terrain that lets you ski fast but doesn’t oblige you to. And it’s less icy. Wonderful skiing.
Ahead is the last big pitch at the Hausberg. It’s the final test of the race and has a brutal compression at the bottom, where many racers have fallen and more than a few have ended their careers. Just before reaching it we see someone else on the course, a stocky figure in a blue ski suit who is gazing down the mountain almost pensively. It’s the Austrian coach, Kahr, known as Downhill Charly—the Austrians have a proprietary feeling toward the event which they regard as their exclusive domain. Kahr and Sailer exchange a few quiet words like a couple of fishermen. The sun has just come up and is casting a shadow down at the bottom where, Kahr points out, the racers will be at their maximum speed, eighty-five or ninety miles an hour. One thing the two of them agree on: the snow is perfect. We go down the final steep pitch together. It’s challenging but fairly wide. There is room to turn, and the compression is nothing because we cross it at an angle and at reasonable speed. The long straightaway to the finish is like applause.
True to his word, in a little restaurant at the foot of the slope Sailer talks about racing, what it was to be a great racer, what it takes to win. There are things you can learn from the coaches and things you can’t learn. “Energy,” he says. “Will.”
We talk for half an hour. He seems very different here, almost amiable. He was the son of a roofer. He became a great champion, knew all the glamour, and now he is back in his hometown. They are cheering for others now. When he looks back on it, the races, the fame, the records that in all probability will never be equaled, when he looks back on all of that, what does he think of, I ask? He reflects for a moment.
“Well, I think it was a good thing to do it. Sport makes character,” he says. I walk back to the hotel. It’s barely nine o’clock. The early skiers are walking past me up toward the cable car. The day is beginning to take on winter brilliance, the snow sparkling, faces animated and bright.
“Did you do it? Did you go down with Sailer? How was it?” It will be true one day even if it isn’t now. “The greatest run of my life,” I say and go upstairs and back to bed.
The New York Times
November 7, 1982
At the Foot of Olympus: Jarvik, Kolff, and DeVries
When Robert Jarvik, the designer of the artificial heart, came to Salt Lake City in 1971 to go to work at the Institute for Biomedical Engineering which is part of the University of Utah there, he and his young wife were able to drive west with all of their possessions loaded in the back of their car. The Institute itself was then four years old, Jarvik was twenty-five, and Willem Kolff, for whom Jarvik over the next decade was going—unbeknownst to him at the time—to design and build a whole series of artificial hearts, was sixty. Neither man had met the other, they had only talked on the phone. When Jarvik arrived, Kolff called him into his office, which was in an old, converted World War II barracks, and told him simply that his job would be to make an artificial heart.
“That’s all he said,” Jarvik recalls. He doesn’t remember precisely how he went about it. His only preconception was that it “ought to be heart-shaped,” so the first heart he made was shaped like that.
Jarvik did not invent the artificial heart. There were many models before his. The search had been going on for about forty years and in the imagination of men much longer. The problem is quite simple: the heart, as many authorities have observed, is merely a pump. But what a pump. “This moves of itself,” as Da Vinci wrote, “and does not stop unless forever. Marvellous instrument invented by the supreme Master.” Governed by a faint electrical impulse, by glandular action, and by a dictum called Starling’s Law (the volume of blood pumped by the heart depends on the volume returned by the veins which dilate in times of emotion or stress to increase the flow to the heart and hence its output), this most crucial organ is entirely muscle, weighs less than a pound, and beats tirelessly over 3 billion times between birth and death, unnoticed, uncared for, while we eat, dream, love, and pray. In an age of tremendous scientific discovery the heart has remained a kind of holy grail.
Although he had never built an artificial heart or even considered th
e problem, Jarvik was nevertheless a good choice for the job. The son of a Connecticut doctor, he had shown an aptitude for making things since early childhood and in high school he designed a surgical stapler, an instrument like a pair of graceful scissors meant to be held in one hand and to save time by clipping closed severed blood vessels during an operation. He continued to think about this device for years. The first time she went out with him in college, Elaine Jarvik recalls, he was talking about it. The history of the stapler is in a way the history of his life, connecting the various segments of it in a remarkable manner.
Unable to get into medical school in the states, Jarvik and his wife—they were married the day before they left—went to Italy where he entered the University of Bologna. He spent two years there. It was a difficult period. Neither he nor his wife spoke much Italian and they led what they describe as a hermetic existence.
“I didn’t go to class very much,” he says. “It was kind of an intolerable situation. It was very, very crowded.” For the anatomy course the students would begin to gather in a courtyard an hour before class.
When the gates were opened everyone would rush into the building and down a long corridor lined with display cases containing thousands of skulls. “I refused to run. After a while I just stopped going and stayed home and studied.”
He worked on the stapler there, however, and also when he returned to the States. He had come back still hoping to get into medical school here. Although Bologna was the oldest university in Italy with a medical school dating back to 1306, there was virtually no lab work—they couldn’t obtain cadavers—and his father had arranged to have him do dissections at NYU. Jarvik showed the stapler to various people there, including a professor interested in biomechanics who promptly offered him a fellowship.
“I took it hoping that it would lead me to medical school at NYU,” Jarvik says. “I got on the waiting list that year but I didn’t get in.”
He got a master’s degree in biomechanics, and the next summer an executive of a surgical instrument company that was interested in the stapler, having failed in an attempt to help Jarvik get into Duke, called someone he knew in Utah, a Dutch doctor named Kolff who was head of a biomedical institute there. The idea was to have Kolff hire Jarvik. As a resident of Utah, he would have a better chance to be admitted to medical school there. The executive even offered to pay Jarvik’s salary but Kolff, who was struggling to get his institute established, did not seem interested. Finally Jarvik called himself to plead for the job. He was advised to return to Bologna and get his degree. That was not what he wanted, Jarvik said, he wanted to work for Kolff.
“Do you have a car?” Kolff asked unexpectedly.
Jarvik said he had a Volvo.
“Oh, I see my administrator through the window,” Kolff interrupted, adding, “How much money do you want?”
Jarvik pictured a man just walking past Kolff’s window who would in a few seconds be gone, together with Jarvik’s chances. “A hundred dollars a week,” he said hastily.
Kolff told him to hold the line for a minute. In fact the administrator was sitting in an adjoining office with a glass window between him and Kolff. When he came back on the line, he said, “OK. When do you want to start?”
It was the Volvo, Jarvik is convinced. If he hadn’t had a European car he wouldn’t have gotten the job.
Willem Kolff is a unique figure in medicine. Tall, white-haired, paternal, and shrewd, he is best known as the inventor of the artificial kidney. This was in the Netherlands in 1943, during the German occupation. Kolff, who had graduated from medical school at Leyden five years earlier, was working in a small municipal hospital in Kampen, a town on the Zeider Zee, legendary, as he says, for its fools. A young patient of his slowly died of kidney failure, going blind first, and Kolff, deeply disturbed by the event, set out to try and devise something to help such cases. A man of wonderful energy and imagination, in Kolff these qualities are matched by an equally great compassion. His father was the director of a tuberculosis sanatorium with immense concern for the welfare of his patients, which Kolff feels he inherited. In his youth he didn’t want to be a doctor because he didn’t think he could bear watching people die. The example of his father’s dedication, however, finally swayed him from his original conviction to become a zookeeper.
Kolff’s first kidney machines, designed to remove waste products from the blood, were rotating drums wrapped with tubes of cellophane. The patient’s blood circulated through the tubes and impurities were drawn through the permeable cellophane into a surrounding solution. Of the first fifteen patients the artificial kidney was tried on, only one survived, and that one might have done so anyway, Kolff admits. In 1945 there was finally an indisputable success, a sixty-seven-year-old woman who was saved. It happened to be a woman who had been a Nazi sympathizer and much hated, but she was a patient and Kolff treated her.
In wartime Holland things had to be made out of whatever was available. A local enamel factory built the tanks and the permeable membrane was sausage skin. This unorthodox approach is typical of Kolff. In Cleveland where he went a few years later to join the staff of the Cleveland Clinic, he used washing machines and fruit juice cans in the construction of more advanced models. Today there are more than 50,000 patients in the U.S. and 200,000 worldwide whose lives are dependent on the artificial kidney, and the list of Kolff’s prizes and awards for this and other accomplishments fills nearly three pages, but he is still, because of his pragmatic methods, taken perhaps less seriously than he might be. Not an active surgeon, he is treated lightly by the star performers with their powerful egos. A tinkerer and an individualist, he has few champions in the bureaus of government where grant money is found. “I make gadgets,” he says, looking out over his horn-rimmed glasses. “I’m not considered scientific.”
In 1957, Kolff and an assistant named Tetsuzo Akutsu put the first artificial heart in the Western world into a dog which lived for an hour and a half. In the beginning the concept was so bizarre and outside the scientific mainstream that papers describing experiments were not even accepted by medical societies. But research continued and over the years Kolff found coworkers whom he managed to inspire and keep. The atmosphere in Cleveland was too conservative, however, and in 1967 he decided it was time to leave. He asked a friend where he could find a good, regional medical program and the answer was Utah. Encouraged by the medical school, the university, and the governor, he moved there, leaving behind everything he had built up during seventeen years, including a farm he loved.
In Cleveland, according to Dr. Clifford Kwan-Gett, who came with him to Utah, they had money but no space. Every time someone walked to the elevator, he had to move his chair. In Utah they had space but no money. “It took about three years to get going,” Kolff agrees. He now has 120 people of different disciplines, doctors, engineers, social workers, and electronic specialists and a budget of over $5,000,000. Almost all of this money comes from government grants and contracts. About 20 percent of it goes to the artificial heart. Kolff’s own salary is less than that of a mediocre shortstop: $63,000 a year. He has never made a penny from the artificial kidney—he never even bothered to take out a patent on it.
The artificial heart has come almost full circle. From obscure and dubious beginnings it advanced to a stage where, stimulated by testimony of the famous Houston surgeon, Dr. Michael DeBakey, Congress made it a national objective. For a feverish decade in the late ’60s and early ’70s, the National Institutes of Health coordinated the efforts of research centers and blue-chip technology corporations to build a device that would be as marvelous as the Apollo ship of the space program, except this would be for a voyage inward, to the center of man.
It had been estimated that up to 50,000 people a year might be recipients of artificial hearts, but delays, failures, and waning optimism in the nation at large finally caused the NIH to lower its aim and deemphasize the program. Kolff is not one
to be discouraged by mere shifts in policy, however. He has gone doggedly on. More than any other man’s, the heart is his. He finds a way around delays and cautious decisions. He has recently developed, despite government indifference, a portable artificial kidney which represents a considerable advance over bulkier models. It can be worn by the patient.
“The government now spends through Social Security more than one billion dollars a year on end-stage renal disease, but if I want ten thousand dollars to build a better artificial kidney, I can’t get it.”
Kolff begins his days with an 8 a.m. meeting of his staff. Around a long table sit a group of men and women, some in white coats, some in plaid shirts and jeans. In a mild voice with a slight accent, Kolff begins without fanfare.
“How are the calves?” he asks.
One of the sheep, it turns out, is having ventricular fibrillation. This is discussed for a minute or two, then the subject changes to the vacuum-molding method of making hearts. A short lecture on an electric motor they are interested in is delivered by an engineer. There is mention of microcircuits, custom chips with 1,700 gates, and a new microprocessor.
“Do we have seven thousand dollars for this new computer?” Kolff asks.
“Well, we can probably find it somewhere,” Jarvik replies. “It depends where we look for it.”
If they fire the lecturer whose name is Jeff, it is suggested, they could probably get it from his salary.
“Barely,” Jeff says, unperturbed.
There is talk about a two-by-five-inch emulator card which can do everything the chip does until the chip is available. Kolff is sitting on the edge of the table in a business suit and hiking boots.
“You call it an emulator card,” he asks, making a note.