The Man Who Touched His Own Heart

by Rob Dunn

  Greatbatch dedicated himself to making what we now call a pacemaker. He set up shop in a small barn behind his house. He needed to shrink the device down and make it suitable to dwell submerged in the juices of the body. Other pacemakers had been built, but they were all enormous, unreliable, typically connected to car batteries, and, unlike Hyman’s gold-plated needle, relied on shocking the entire patient (rather than just the heart). Greatbatch knew he could do better.

  Within two years, Greatbatch had a device he thought was ready to try. On May 7, 1958, Greatbatch went to the Veterans Administration Hospital in Buffalo, where Dr. William Chardack, chief of surgery, connected his device to the heart of a dog. The device was called Tiknik 6 (after Sputnik, which had just launched with a dog as a passenger), and to seal it off from the body’s liquids, it was wrapped in packing tape and plastic. Tiknik 6 was clunky and did not work long. But the next day, Greatbatch built Tiknik 7, which worked for twenty-four hours. It was only then that Greatbatch realized what others already knew: this was a race. Several other labs in the United States and Sweden were attempting to develop a pacemaker that was small and effective enough to be implanted in a human body. Other teams had already built pacemakers that could be plugged into the wall. Greatbatch quit his job in order to dedicate himself fully to the project. This meant that he and his family would have to live on their savings and the food they could grow in their garden. Greatbatch put aside two thousand dollars for research funds. The family’s privations paid off. In 1960, Dr. Chardack implanted Greatbatch’s device in ten patients. In every case, it worked.

  In October of 1960, Greatbatch sold the device to a fledgling company called Medtronic. Medical electronics companies were not yet flourishing. Their success was a possibility, not a foregone conclusion. Medtronic was founded in 1949 by Earl Bakken and his brother-in-law Palmer Hermundslie. Medtronic started in a pair of garages behind Hermundslie’s parents’ house in Minneapolis. But things would change. By the end of December 1960, Medtronic had taken orders for fifty of the Greatbatch-Chardack devices at $375 apiece. In 1963, Medtronic had a net loss of $144,135. Sales continued at about that pace for the next few years, and Bakken and Hermundslie talked about selling the company; they still weren’t really making money. But they had invested so much time in the company, they couldn’t quit (though they could not sustain losses much longer; they were broke). They decided to focus on fewer products and on making those products more perfect; this was an ethos that Greatbatch, the engineer, appreciated. The mission statement became to strive without reserve “for the greatest possible reliability and quality in our products… and to be recognized as a company of dedication, honesty, integrity and service.” In the service of this vision, Greatbatch and Chardack continued to work on new innovations to make their pacemaker safer and more effective. Eventually, this approach, as well as Bakken and Greatbatch’s personal visits to the client-doctors, paid off. In 1963 the company made $72,923. In 1965, $151,108. In 1969, a million dollars. In 1970, two million. Since then, the company has continued to grow, and with it the number of people whose hearts are paced by machines. In 2012 it had a global revenue of $16.2 billion, a number roughly equal to the GDP of Mongolia, Benin, or Namibia.

  With time, Greatbatch’s device was joined on the market by a family of others. All of these devices, including Greatbatch’s, share a basic working principle. They produce a small, regular electronic stimulus that takes over where the heart’s natural pacemaker is failing. How this small shock is delivered depends on the device. In some cases, a wire is run through a vein to the heart. In others, open-heart surgery provides an opportunity to place an electrode and a device directly on the heart. In 2009, more than two hundred thousand pacemakers were implanted in the United States alone. Roughly one in every five hundred adults in the United States has a heart paced artificially by small electrical impulses. What was once unimaginable is now, in many places, ordinary.23

  Greatbatch never imagined that his pacemaker would become permanent. It seemed to him, from the beginning, to be a stopgap, a temporary fix until the natural pacemaker could somehow be restored. He wasn’t a doctor, and so just how that might come about was beyond his reach. Initially, some pacemakers were indeed used as temporary fixes—akin to the heart-lung machine—but it quickly became clear that patients with artificial pacemakers could leave the hospital. They could go about their ordinary lives, with one caveat: the device depended on a battery, a battery that needed to be replaced and recharged.

  Greatbatch could not fix the natural pacemaker of the heart, but he thought he might be able to produce longer-lasting batteries; the ones used at the time lasted only two years under the best of circumstances. So he went back to his tinkering barn in Buffalo and got to work. Greatbatch explored a lithium-iodine battery that had been invented by another group of researchers a few years earlier. Immediately, it seemed to offer promise as a long-term solution, with one problem. The lithium-iodine battery had a tendency to explode. Greatbatch tweaked the design again and again and eventually produced a battery that would last far longer than two years and would not explode. Greatbatch founded a company (Greatbatch, Inc.) to produce the batteries. The company succeeded beyond his wildest expectations, and today almost every pacemaker has a lithium-iodine battery.

  Greatbatch never stopped inventing things. He pioneered other medical implants, worked on efforts to develop a helium-based fusion reaction to make power, and even invented a solar-powered canoe. In total, he held patents for 325 inventions, and even as he aged, he continued to tinker. At seventy-two, he took a 160-mile trip on the Finger Lakes of New York in his solar-powered canoe. The canoe held him up and powered him along much as his pacemaker did and does for millions of people around the world.

  Greatbatch died in 2011 at the age of ninety-two, having extended the lives of people in every country. But even as he approached death, he wished for more, telling an interviewer on the phone, “I’m beginning to think I may not change the world, but I am still trying.”

  When surgeons looked at the successes of Greatbatch (and, earlier, Gibbon), they came away with the sense that if the oxygenation of the body and the beating of the heart could be replicated, perhaps the same might be true of the entire heart. Eventually, this would yield attempts to create an artificial heart, perhaps one that would even pulsate (heart-lung machines do not). But the heart-lung machine, and an increasing understanding of the ways in which the heart’s electricity might be manipulated, also engendered an alternate approach, that of taking the heart out of one person—a heart that already had its own beat and pump, a heart with no need for batteries—and putting it in another, using electricity to bring it back to life or keep the pace. This was not the next step either Gibbon or Greatbatch had had in mind, and yet it was an approach made possible by Gibbon’s heart-lung machine, which could keep a body without a heart alive, and a better understanding of what it took to pace a fumbling heart. To most physicians and researchers, the mere idea of heart transplants seemed simultaneously mad and heroic. There were historical precedents for transplants (albeit not of the heart), but they came as much from myth and strange experiments as from modern medicine. The Egyptians, Phoenicians, and Greeks all had myths about creatures composed of half of one species and half of another. Pegasus, for example, was a horse with bird wings, and the Minotaur had the head of a bull and the body of a man. Historically, a Chimera was a mix of a goat, a lion, and a dragon, but in the modern use of the word, these mythical beasts were all chimeras assembled out of pieces.24 The first suggestion of a more literal transplant occurs in roughly AD 400, when two brothers, Cosmas and Damian, grafted the healthy leg of a very unlucky Ethiopian man onto the body of a man who’d lost his leg to gangrene.25 In the 1760s, John Hunter, a Scottish surgeon, transplanted a human tooth onto the head of a rooster. He also transplanted the testes of one rooster onto a chicken. Later, in the early 1900s, the French surgeon Alexis Carrel (1873–1944) and the physiologist Charles Guthrie
(1880–1963) designed experiments in which they transplanted organs from one animal to another. They transplanted each organ to the outside of the recipient organism’s body, leaving the organ to dangle attached from its veins. If any dog needed an extra heart, Carrel could do the job, at least temporarily, giving it one that dangled from its neck vein. Invariably, Carrel’s dogs died when the new hearts and other organs were rejected by the recipients’ immune systems.26 One could have taken from Carrel’s experiments the lesson that the immune system was a major obstacle to transplants and that it was of supreme importance. Instead, history marked Carrel’s experiments as evidence that heart transplants might be possible in humans. Inspired by Carrel, experimenters tried more earnestly, if no less outrageously. The intent of such procedures was sometimes to transplant the attributes of one organism into another. In 1916, John R. Brinkley, a Chicago surgeon and charlatan, began to transplant bits of testes from cadavers into men who wished to be more virile, including himself and an editor at the Los Angeles Times. The idea spread and came to include donor tissue from other species as well, including goats, wild pigs, and even deer. Thousands, perhaps tens of thousands, of these transplants were performed.27 More often, transplants were attempted to replace a damaged body part or organ so that the body, restored piece by piece, might live on and on.

  Greatbatch compared his efforts to pace the heart of a dog with the Russians’ shooting a dog into space. The men who sought to transplant hearts did not think of Russians floating in space, nor were they particularly interested in dogs. They compared themselves to the American astrophysicists who were, at the time, talking about actually landing a man on the moon, alive.

  7

  Frankenstein’s Monsters

  A thing of immortal make, not human, lion-fronted and snake behind, a goat in the middle, and snorting out the breath of the terrible flame of bright fire.

  —HOMER, THE ILIAD

  Richard Lower’s life was one of repeated successes. He had been trained at Stanford Hospital in San Francisco, where he met the man who everyone would come to believe had the best chance of performing a successful human heart transplant, Norman Shumway. Shumway would become Lower’s mentor, and Lower, for his part, became Shumway’s right-hand man, a surgical resident to his attending surgeon, an assistant professor to his professor. Together they would pioneer heart transplants, not as freak-show oddities but as medical realities.

  There were many barriers to heart transplants. Some of these had been overcome before Lower and Shumway began their work, through the development of angiograms and heart-lung machines, which allowed broken hearts to be visualized and operated on, respectively. Others were known but not yet circumvented. But most were not yet even known; they were the Odyssean challenges to emerge during the journey. Shumway and Lower would travel toward and deal with these barriers using dogs, though that was not originally their intention.

  Lower arrived at Stanford in the fall of 1957. By the summer of 1958, the two men had begun to do experimental surgeries together. They started by trying to develop new ways to keep both the heart and the body alive for as long as possible during surgery. In the fifth-floor lab of the Stanford-Lane Hospital, the two had access to a heart-lung machine and they could use it to operate for long periods on dogs. Dogs have the misfortune to have hearts similar in size to those of humans, and so they were the preferred animal for heart experiments. The pair’s first really newsworthy experiment was a kind of endurance test. The two could already clamp off a dog’s heart and sustain its body on a heart-lung machine, as could surgeons working on humans. The next step was to keep the heart itself alive. They tried to do this by cooling the heart down to about 28 degrees centigrade, since the cooled heart required less oxygen. And it worked. The heart was alive but disconnected from its dog; the dog alive but disconnected from its heart. Shumway and Lower found they could keep a dog’s cold heart alive on ice for ten minutes, and then twenty, and then eventually as long as one hour. This was a breakthrough that seemed as though it would allow any surgery they could imagine, a breakthrough very early in their collaboration, a breakthrough suggestive of the great possibilities that lay before them. The next step was to try for even longer times, but before this happened, the two men got bored.

  Some people doodle when they are bored; some eat. Not Shumway and Lower. To take the edge off the tedium, the pair decided to see if they could completely remove a heart from a dog and then put it back in the same dog. In the previous trials, the hearts were clamped off from the bodies but still attached. This was something more, a test of what was possible. As they attempted it, they encountered problems, problems that soon fascinated them both and drew them deeper in. The first problem was that the dog’s aorta was very short and its heart was brittle; there was little to sew back together when replacing the heart, and what was there was hard to manipulate.1 It was a mess. Blood clots formed, and the first twenty dogs on which they tried the procedure died. But then a few lived, and, as they did, Shumway and Lower were emboldened. They were no longer just killing time. The hobby transplants became a goal in and of themselves. At some point it became clear they were working toward doing transplants of a heart from one dog to another. Inasmuch as Lower and Shumway cared about dog hearts only to the extent that they were models for human hearts, they were working toward the transplants of a heart from one human into another.

  Shumway and Lower worked quietly. Public attention did not seem of benefit, and, anyway, no one else seemed to be working on heart transplants, not seriously, and so they had the leisure afforded by a lack of rivals. In an era of competition, of the space race (Sputnik had been launched the year prior) and scientific races more generally, neither Shumway nor Lower felt the urge to do great things merely for the sake of being first.

  In 1959 Shumway and Lower were ready to perform their first heart transplant out of one animal and into another. In theory, it might be easier than putting a heart back into the same animal from which it had been removed (there would be more tissue to work with). But theory and practice are very different in the laboratory. At that point, Shumway, and with him Lower, had been offered the opportunity to move to Stanford Hospital Center in Palo Alto, California. The position came with strings and caveats, but it also came with a big new lab, and so he took it, and they moved their dogs and ambitions down the road.

  In Palo Alto, on the big day, a healthy but wild-eyed dog was chosen to be the recipient. Another was chosen to be the donor. Both were anesthetized. The animals were then cooled. Shumway prepared everything, and Lower got ready to do the surgery. Carefully, Lower cut the heart out of the recipient dog and put it to one side. After that, he removed the heart from the donor, each step taking just a few minutes. He then sewed the donor heart into the recipient dog. Shumway was given the honor of shocking the heart, to bring it back to life. The heart began to beat. The heart-lung machine was unhooked. The whole process took less than an hour; the two men had just transplanted the very first heart. There had been some precedent, when Alexis Carrel and Charles Guthrie had transplanted a puppy heart onto the neck of a dog, but the dog’s original heart had remained inside it, and the dog died after just two hours. This was the real thing.

  The next day the local newspapers carried the story: “Stanford Surgeon Switches Heart in Dog—It Lives.” Shumway was thirty-six years old and Lower just thirty; they were still wild-eyed, ambitious boys. By 1962, they had performed four successful transplants; each of the recipients lived many months.2 Success followed success for the two. In 1963, Lower left Stanford to run his own laboratory at the Medical College of Virginia. But even across the country, the two planned to spend the next ten years, longer if necessary, working together to perfect their method, dog after dog, so that they might figure out how to make transplantation safe for humans. They still needed to find a way to prevent the recipient body from rejecting the donor heart; a way to keep a heart beating in the new body for decades rather than just hours or days.


  To the extent that they compared their work to anyone’s, Lower and Shumway likened their project to the quest to land men on the moon (this seems to be a favorite analogy among pioneering surgeons). The race to land a man on the moon was about technology as much as it was about discovery or progress. The heart transplant came to have a similar flavor, one of progress. That the goal was valuable was unquestioned by those struggling to attain it.

  But while the quest to land a man on the moon was one model for the race to transplant human hearts, there was also another, one often suggested by journalists who wrote about heart transplants. It came from literature, from a story by Mary Shelley. Shelley lived more than a century before the first attempts at heart transplants, but the ethos of inevitable (and hence good) progress was the same one with which she had grown fascinated. The key moment for her inspiration was in the spring of 1816. Mary and her husband, Percy Bysshe Shelley, had gone with Lord Byron; Byron’s then lover, Claire Claremont; and Byron’s physician to two adjacent houses on Lake Geneva in Switzerland. Rain kept them confined indoors, where they were left to talk and write.

  One night, as the rain pounded outside, Mary was sitting around with these friends telling ghost stories. At first, they read from Les Fantasmagoria, a French translation of a German book of horrors, and then Byron proposed that they should each compose a horror story. Mary did not tell a story at first, and it might have stayed that way, the tall tales left to the big boys. Then, on June 21, 1816, she listened to a conversation between her husband, Percy, and Byron and it got her thinking about different sorts of ghosts, those of science and progress. Percy mentioned that Erasmus Darwin (1731–1802), Charles Darwin’s grandfather, had written about using science to bring dead animals back to life.3 Mary listened intensely. The idea was titillating and horrifying. Bringing things to life? It got her mind spinning. In a time before the essence of life was understood, one could realistically imagine Erasmus Darwin surrounded by dead animals that he was trying, one after the other, to reanimate.