At mid-morning, Bingham, wearing bright red-and-white striped pajamas, was wheeled by his brunette wife to Diethrich’s cubbyhole office. There he learned that his first appointment would be with a cardiologist who wanted him to ride a bicycle.
Bingham, gregarious, bluff, overweight, hale-fellow-well-met, was obviously frightened but attempted to mask it with the bravado men use while taking Army physicals. There was a crater from an old football injury on half of his face. The cardiologist, Dr. Gerald Glick, appeared and said the test would take less than fifteen minutes, which put Mrs. Bingham at ease. Quiet, scholarly, Glick seemed the textbook image of the internist. Had it been the Middle Ages, the surgeons would have been out charging about on snorting steeds; the internists would have stayed in a secluded part of the castle reading manuscripts.
Glick led Bingham through a casual, but revealing, question and answer:
Q. “Are you married?”
A. “Happily.”
Q. “Children?”
A. “Two, a boy 19, daughter 21.”
Q. “What kind of work do you do? Is it a sedentary job?”
A. “No. I move around about 150,000 miles a year. I hire and train sales personnel. I guess you’d call me a professor of salesmanship.”
Q. “You were in good health, you were well, until when?”
A. “Until about 1964. I got sick one day and it turned into pneumonia and I got over it and I went back to work full time. One night about midnight I was working and I felt this bad pain. It was like, ummmm, kind of like an upset stomach. Then I got the dry heaves and I couldn’t throw up anything and I couldn’t get comfortable. I spent all night draped over the toilet or tossing around in bed. It never occurred to me that I had had a heart attack, but my wife was worried and she called the doctor and it was a heart attack and they put me in the hospital for six to eight weeks.”
Q. “Did you return to work?”
A. “Yeah. And six months later, I had what they told me was a minor infarction. That was March, 1965. I was hospitalized for only three days. Then these chest pains started.”
Q. “What kind of chest pains? Can you describe them?”
A. “Sometimes it feels like an elephant is standing on my chest, pressing down with his foot.”
Q. “Normally, what would bring them on?”
A. “That’s the weirdest thing, Doc. I could go out and stand in a cold stream all day fishing, or hunting, or car racing—I’m one of the organizers and sponsors of the Phoenix sports car races—and it wouldn’t bother me. But I could walk across my living room and the elephant would step on me again.”
Q. “Some people can work all day and go home and see their wives and have angina pain.”
A. “I don’t have that problem. I like to see my wife.”
Q. “Angina is caused by a simple imbalance between oxygen need and oxygen supply. The heart is not getting enough oxygenated blood, so it is, in effect, crying out.… These chest pains in 1965, were they your last complaint?”
A. “Just getting started. In December, ’68, I had this pain all day long. I was conducting an eight-hour sales class. People told me later I looked bad the whole time. I was taking nitroglycerine tablets but the pain wouldn’t stop. Finally I went to the hospital again for some relief and they slapped me right in ICU and I had an attack there. In the last six months the pains started coming two or three times a week, whereas it used to be only twice a year. My doctor in Phoenix, he told me that the way I live, the speed I go, he said he wouldn’t give me much more hope.”
Q. “Do you smoke?”
A. “Three, four packs a day. But I’m quitting.”
Q. “You’re a little overweight?”
A. “About 30 pounds. This bar in Phoenix put out a card listing all the qualifications to join the coronary club, the things you needed to do to have a heart attack, and I think I met every one of them.”
Q. “Have any other members of your family had heart disease?”
A. “My brother had an attack when he was 35, one month after his wife committed suicide. And I have a sister who’s the family hypochondriac. She has everything wrong with her; she had a heart attack when she was 47.”
Q. “Approximately how long would a normal work day be for you?”
A. “Twelve, fourteen hours minimum.”
Q. “Why did you come to Houston?”
A. “I heard about this new heart attack operation Diethrich’s doing and I checked it out, and it seemed like this was the best place.”
Glick put down his notebook and instructed Bingham to remove his pajama top and climb onto the white, Dutch-made cycling contraption. EKG leads were attached to his arms, and they in turn led to a monitoring device.
“We’re going to measure your stress level,” said Glick, in response to Bingham’s inquisitive look. “We want to see at what level you begin to tire. We’ll want to test you again three months after the operation.…”
Bingham interrupted. “Then I’m going to have the operation?”
“If you have the operation, then again in six months, then in a year.”
While Glick checked the leads, Bingham talked on. “I told my doc in Phoenix that I wanted to come down here and get it over with. If I waited six months, then I might be dead—or chicken out.”
He tested the pedals of the bicycle. “I could have brought my Honda and saved you all this trouble.”
“But a Honda does all the work for you,” said Glick. “Now just pedal normally and keep it up as long as you can.”
Bingham began enthusiastically, moving the indicator up to 40 revolutions per minute. But after two minutes and 38 seconds he began to tire visibly, panting for breath, perspiring heavily.
Q. “Why did you quit?”
A. “I ran out of gas.”
When Bingham left the room to go to another part of the hospital for his coronary arteriogram, the catheterization procedure, which can determine with remarkable accuracy exactly where the occlusion is occurring in the arteries, Glick wrote down his data. “Patients like Mr. Bingham think surgery is a great cure-all,” he said, “that everything is fixed and that they can go back to leading the same old lives again at the pace which brought them here for surgery in the first place. I personally feel it is far too early to pronounce this new operation as salvation.”
I remarked that many cardiologists seemed to be skeptical of the surgeon’s activities.
“Not skeptical,” he replied, “merely watchful. There have been so many of these great operations touted by the surgeons. There was one called the poudrage, which consisted of opening up the patient’s chest and sprinkling talcum powder around the heart. The idea was that the powder would agitate the heart and cause it to form new sources of blood supply. It did no good at all, but it was popular for a while. Then there was one which was nothing but a mock operation. The patient arrived sedated at the operating room and there was a sealed envelope on the stretcher. The surgeon opened it—may I have the envelope, please?—and there were instructions from the internist on whether to do anything or not do anything at all. The patient never knew. He only knew that he had undergone a major operation on his heart by a great and famous surgeon. Strangely enough, it sometimes worked. The patient would find himself walking up a hill, a climb that would have given him terrible angina previously, and he would tell himself, ‘I’ve just had an operation by a celebrated surgeon, so I won’t get nervous and I won’t have any heart pain.’ This mock surgery pointed up the supreme importance of the doctor-patient relationship. If a patient has total confidence in his doctor, then often he is going to feel better, even if the doctor doesn’t do much of anything—or nothing at all.”
The Gypsy prince was better and receiving his family. I was escorted in by his son, a cheerful, corpulent copy of the father. About ten, he seemed as normal as any child that age when he spoke in English, but when talking with his father he slipped easily into Gypsy patois, an ancient language composed largely of Romanian a
nd other mid-European dialects. Only then did a somewhat haughty cloak envelope him, he being of royal birth within the clan and heir to the throne or family roofing business or trailer, or whatever.
“This is my father,” he said.
The stricken prince wafted one heavy arm in the direction of a chair. He was sipping orange juice and occasionally turned his head to watch the softly clicking monitor behind him, measuring his heart rate, and moving in steady, reassuring peaks and valleys.
“Perhaps we can arrange something,” he said, answering an unasked question. “I have an incredible story which you could use. But it must wait until tomorrow.” He spoke rapidly and quietly to his son in the Gypsy patois. “My son will introduce you to members of my family who will talk with you.”
Two days after the bicycle test, Bingham was scheduled for surgery. The arteriograms had shown a definite blockage in the upper right coronary artery and quite probably the left; the flow of blood was severely reduced and there was no flow at all into one portion of the heart, which revealed an ischemic part from one of the past heart attacks. Diethrich had cautioned Bingham that the operation carried a fairly high risk, but that results on other people like him had seemingly been good. Overall, the mortality rate was less than 10 percent, but Bingham’s heart loomed dangerous. He did not hesitate. “Cut,” he said. “That’s what I came here for.”
In the doctor’s dressing room I changed into a scrub suit and slipped green paper booties over my street shoes to ground them from producing sparks in a room where volatile fluids and oxygen would be used. Dr. Arthur Beall was talking with Dr. Reed, the young resident on duty in the Intensive Care Unit, the latter complaining mildly that he was losing weight and strength from the 30 days and nights he was spending there. Beall, a tanned, slender Baylor surgery professor with a marvelous Georgia drawl, could muster scant sympathy.
“In the old days,” he said, recalling fifteen years before when he had been a resident under DeBakey, “The Professor had only one resident per 90-day period; he only wanted one because he didn’t want a lot of people passing the buck, and we did everything. You only have ICU to worry about. My intern would throw cold water on my face at 5 A.M. and drag me out of bed, and I’d see 120 patients by seven o’clock. Then I’d go into surgery and first assist the Professor on about ten cases, which lasted all day, and in between I’d be slipping out and running ICU, working up new patients, making afternoon rounds from five to six, making secondary rounds after that to answer all the questions they couldn’t ask DeBakey, writing medication, writing discharge reports, and getting to bed at 3 A.M. Only to get hit with that ice water at five. The average resident in my day lost twenty pounds.”
Reed was listening in the manner of a child hearing his father tell of walking to school ten miles in the snow.
“The only thing that saved us from going batty,” said Beall, who was not nearly done, “was the hospital telephone operator. When the Professor would go out of town, we’d slip home and see our wives for a few minutes, and if DeBakey called in from out of town, the operator would recognize his voice and put the call through direct to our home. He wouldn’t know where we were talking from. One night this kid was home visiting with his wife and he got a call from the hospital saying that there was an emergency and he took off fast, only lived a few blocks away. It was shortly before midnight when he left and at 12:01 A.M. exactly, just before he reached the hospital, he got broadsided by a drunk driver. The next thing he knew there was a photographer there and the next morning his picture was on the front page of the paper because it was the start of Safe Driving Day and his was the first accident that day in Houston. Readers probably thought the young doctor looked so pained because of the accident, but the truth was he was imagining what DeBakey was going to say to him.”
“Is that right?” said Reed.
Arthur Bingham had been sedated in his room, his chest hair shaved down to his belly button and his toupee removed. One of the EEG technicians who would monitor his brain waves explained the reason for the latter: “The toupee might get bloody, and because I have to stick three or four electrodes on the side of his head and if the toupee fell off during surgery, so would they.” The brain waves are watched anxiously during surgery because it is possible for the patient to survive the operation but become the living dead if the brain’s appetite for oxygenated blood is interfered with. More than a dozen probes were being stuck into Bingham—one in his neck, another for intravenous fluids, one to measure arterial pressure, one for venous pressure, a Foley catheter in his penis to remove and measure urine, one for temperature. He was beginning to take on the familiar look of the mechanical man when Diethrich entered the suite at 10:20 A.M., about half an hour after the preliminaries had begun. Ted looked down at Bingham, lying nude on the table. “He’s a big brute, isn’t he,” said the surgeon to no one in particular. “He’s got very bad heart disease.” Two visiting surgeons from Holland had come in with Diethrich and he went over to explain the patient’s case history and what he was going to attempt to do.
The anesthesiologist had Bingham well under by now, with a respirator machine breathing for him. He had been given 10 cc’s of Innovar, a “miracle” narcotic. “The beauty of this stuff,” said the anesthesiologist, “is that it does not bother the integrity of the cardiovascular system at all. Nor will it depress the heart muscle. The only danger is that too large a dose given to a college-age kid might make him think fuzzily for a couple of weeks.”
“Do patients ever remember anything about their operations?” I asked.
“We had one woman who was a poet and who claimed later to have total recall of everything—of the adhesive tape we put over her eyes, or being able to see the lights, anyway, of hearing the music come over the Muzak, of what Dr. DeBakey had said. She even wrote a poem about it. But I never believed her, she just had a good imagination. Besides, we also give patients a drug called Scopolamine, which produces retroactive amnesia. Bingham here won’t remember a thing; the next few hours are wiped out of his memory.”
“Okay, everybody?” Diethrich’s boyish Michigan tenor broke through the murmurings and the canned music. “Let’s go.” He glanced at the wall clock. It was 10:27.
Diethrich first cut into the fleshy inside part of the upper thigh, probing around about an inch from the surface until he located a large, sturdy-looking vein. He pulled it out, stubbornly, like wrestling a fish worm from the earth, and handed it to Hans Paessler, a young German doctor spending a non-credit year watching and helping out in Houston. Paessler dropped the vein into a metal dish and began flushing saline solution through it, both cleaning it and at the same time searching for tiny holes to sew up and make sure it was a leak-proof vessel.
Now the surgeon took a scalpel and sliced into the chest, from the neck to the point just above the navel, about fourteen inches in all. For a few unpleasant moments there was the acrid odor of searing flesh in the operating room as he cauterized the tiny blood vessels that fed the skin. Smoke rose from the wound. Melody, Diethrich’s scrub nurse, had the electric saw ready without being asked. The day before, she had scrubbed for Diethrich and the entire two-hour procedure was a mute, exquisite suite for four hands. Not a word had passed between them. “After you’ve done enough of these,” said Melody, “you learn to stay at least one jump, if not two, ahead of your surgeon.”
As a medical student at the University of Michigan, Diethrich had formed a surgical instruments company and invented the electric saw that he was now preparing to use. Placing the cutting edge at the top of the long incision, he gave a firm nod to the circulating nurse, who switched on a power source. Some surgeons use the saw and shake not only the patient, but the table, vibrating like a riveter working forty stories up on a naked skyscraper. But today the saw chomped smoothly through the tough breast bone.
Retractors were put in place to push back and hold the rib cage open, Diethrich snipped the pericardial sac, and the stricken heart was bared for all to see.
An awesome sight! Almost gold, with patches of mauve and plum, there were criss-crossings of blue and black—a canvas of such color and form that DeBakey has been known to pause at this point of the operation and cry, almost religiously, to students: “Isn’t this beautiful! Come and see the human heart!” On this morning Diethrich stopped as well, peering intently at the fist-sized object, a heart contracting and expanding almost indolently, annoyed, perhaps, at its first public exposure, a heart that had begun to grow and beat when the now massive Arthur Bingham had been but three weeks formed in his mother’s womb and not yet as large as a thimble.
“I don’t know what we can do,” said Diethrich, who was rarely pessimistic.
(“Before I came down here,” Bingham had told me, “I went through a two-week period of thinking that I was not going to make it. I set things right with my business. I signed ‘pending’ contracts, made ‘pending’ deals, the ‘pending,’ of course, meaning my upcoming death.”)
Suddenly the heart seemed gross, threatening. Surely the surgeon would not invade it. He would sew the chest closed and.… But the moment passed. Diethrich began again, inserting the transparent tubes that would hook up the patient to the heart-lung oxygenating machine four feet from the operating table. This is the machine that gave birth to open-heart surgery in 1955. For the first time it allowed the surgeon to travel into the unknown, to, in effect, stop the heart, cut into it, and repair its defects.
The average human contains almost five quarts of blood, which is drained out through the tubing, flowing into the bypass machine, where it is oxygenated (the work of the lungs), passing back through tubing into the body. The cycle takes 40 seconds and is repeated continuously until the surgeon is finished and removes the clamp from the aorta—the “big pipe,” largest blood vessel in the body. This allows blood to flow once again into the coronary arteries and nourish the heart muscle, provided, that is, the surgeon has not made a fatal blunder while working in its depths.
Hearts Page 4