“Look at that!” cried Diethrich in alarm. He had slipped his latex-gloved hands gently beneath the now arrested heart. He lifted it and showed the Dutch surgeons that portion of Bingham’s heart that had suffered the infarction. “The whole apex is ischemic,” he said. “I don’t think we can do anything for this guy.”
(“I’d rather die than be an invalid,” Bingham had said. “The only thing I want is a few years of peace. My heart has aged my wife at least a decade. She’s gone through more worry, strain, and stress than I did. It’s ruined us financially. I was eating about $70 worth of pills a month, 24 pills a day for the past three years. All in all, it has cost me $20,000”)
Hans had finished cleaning and leak-proofing the leg vein and brought it to the table in its metal bowl. He stood beside the surgeon and watched. Suddenly Euford Johnson, the bearded, bookish technician operating the oxygenating pump, said sharply: “Dr. Hans, don’t lean on that cable. It’s the patient’s lifeline.”
Hans side-stepped slightly and mumbled something inaudible in German.
“I hope,” said Euford sweepingly, “that you are not resorting to sarcasm.” Majesty and tension are sometimes present in the surgical suites; more often there is the routineness and bickering of any business anywhere. How could it be otherwise? Of 25,000 open-heart operations done each year in America’s 7,000 hospitals, almost 10 percent are done in the two Houston institutes.
The surgeon ignored the sniping behind him and asked for the metal bowl. He clipped off a section of the vein about five inches long and began the most tedious and nerve-clenching procedure known to surgery, surpassing even the almost microscopic work done on the cornea of the eye. The job here was to sew one end of a vein into the aorta, the other end into the coronary artery buried within the heart—bypassing the area of occlusion. The surgeon must put up to twenty stitches across the mouth of the borrowed vein, an area approximately 1/25th of an inch across. It would be easier to sew twenty stitches into the end of a piece of spaghetti and affix it to a ripe pulsating pear. Some surgeons use magnifying loops attached to their eyeglasses so they can better see the infinitesimal sewing field.
If the operation works, the heart has a new piece of plumbing; it is revascularized. Blood begins flowing immediately into the thirsty, threatened part of the heart. Angina pain has been known to disappear immediately. The catch—a considerable one, the object of debate between some cardiologists and surgeons—is just how long the new pipe will stay open and unclogged. Presumably the condition within the body that caused the natural artery to block up will sooner or later repeat inside the new one. But how long?
(“A man can live with this for the rest of his life, they tell me. And hell, life goes on. My kid’s still in college, he needs money, the mortgage payments on the house don’t stop when I have a heart attack.”)
For three quarters of an hour Diethrich sewed. His original plan was to do two bypasses in both the right and left coronary arteries, but he decided after the first was implanted that one would do the job. His mood turned rapidly to elation. “I think it’s going to work,” he said, and moments later, “in fact, it’s going to be fantastic!”
But the surgeon’s pride in his work was academic until Bingham was taken off the bypass pump. Only then would it be known if the heart was going to tolerate the reconstruction. Melody had defibrillating paddles ready in case they were needed. These are two metal disks used to provide a mild jolt of electricity. Sometimes, when a heart has been stopped by the surgeon and then allowed to start, it leaps up and beats in an undulating, erratic, jellyfish-like rhythm called fibrillation. Usually electricity can stop this dangerous rhythm and send it back to normal pulsation.
Diethrich ordered the pump shut off. Bingham’s heart did not hesitate. It began to beat normally. The surgeon smiled behind his mask.
“Incredible,” said one of the Dutchmen. The other made a small bow of appreciation. Diethrich stood beside his patient for a few moments, admiring his creation, then he was off to another patient waiting on another table. Hans Paessler and a resident would sew up Bingham’s chest and escort him to the Intensive Care Unit.
I was hurriedly changing out of the greens into street clothes because I was late to a luncheon appointment. Two surgeons were changing as well, talking as they dressed of the new operation that Diethrich had done. “In five years,” one of them said, “we’ll be doing more of these than hernias.”
“We’ll all be blind, too,” said the other.
At 3 A.M. the next morning, while the Gypsy’s family slept fitfully on the chairs and floor of the sixth-floor waiting room, Prince Thomas suddenly seized his chest, gasped, and collapsed into unconsciousness. The floor nurse had peeked in on him minutes before and he had been resting calmly. On her next check, she was shocked to see the EKG monitor leaping erratically. The peaks and valleys had turned into erupting rockets. She paged Santiago, the Argentine surgical fellow on night duty, who came running into the room within 30 seconds. Instantly, Santiago saw that the Gypsy’s heart was fibrillating. He worked on the huge body for more than an hour, jolting it again and again with the paddles—350 milliamps of electricity. He slammed his palms into the clammy, cooling chest, he plunged adrenalin into the heart, he fought until his forehead was drenched with sweat.
“He’s not coming back,” Santiago said. “The heart is completely arrested.”
“He was fine earlier,” said the nurse. “He drank his juice and talked to his family.” She gestured with her head to the waiting room.
With a towel, Santiago wiped off the Gypsy’s chest and head, then walked quietly down the hall. The clan knew. During the failing hour, one of the brothers had heard the clatter of running feet and the emergency cart rolling toward the prince’s room and had followed. He had peeked through the crack of the door and saw the drama. Santiago had whirled and asked him to go away. Now the clan was sobbing and moaning in exotic grief. One ancient woman sang a dirge.
The brother demanded that the lights in the dead prince’s room be left on until dawn, until the sun itself could wash the Gypsy, until an absent member of the tribe could be found to perform the rite of pronouncing death and transferring responsibility of the tribe to the little boy. Santiago nodded in agreement. He also permitted two of the old women to enter the room with lighted tapers and sit beside the body.
Early the next morning, Jerry Johnson asked the Gypsy’s brother for permission to do an autopsy.
“What happened to my brother?” was the answer.
“Well, he died during the classic danger period I warned you about—that week to ten days following a heart attack. A piece of his heart probably infarcted, or ‘died.’ It was almost a rupture of the heart.”
“But what caused his death, exactly?”
“We won’t know exactly until we do a post.”
“No. No. It’s against our custom.”
“Then,” said Johnson, not pressing the point as ordinarily he would have done, “we’ll never know.”
That afternoon Santiago was in the bullpen recalling the experience. “Frankly I was scared to death,” he said. “In my country, had this happened in the middle of the night with only one small doctor and one little nurse, the whole family would have turned on us.”
“The Gypsy shouldn’t have died,” said a doctor on DeBakey’s staff, later. “He shouldn’t have left Kansas or wherever it was in the first place. He should have been slapped in a coronary-care unit there where they could watch him 24 hours a day rather than on a postoperative floor, and he should have been admitted under the care of a cardiologist. Certainly not a surgeon.”
CHAPTER 3
After a quarrel with her estranged husband, followed by a yelling argument with her mother for an entire afternoon, a 23-year-old pregnant Houston cocktail waitress named Elizabeth Dagley locked herself in the bathroom in mid-April, 1970, shook out 50 Valium tranquilizer tablets into her hand, took every one of them, swallowed something else from another bottle s
he found in the medicine cabinet, and lay down to die. Her mother discovered her and phoned for an ambulance, which rushed the girl to Ben Taub General, the charity hospital for Houston and Harris County, named after DeBakey’s friend and benefactor. Ben Taub is located in the Texas Medical Center, connected by tunnel with the Baylor College of Medicine, and but a few hundred yards away from Methodist and St. Luke’s Episcopal hospitals.
At first glance, Taub’s Emergency Room seems a carnival of suffering, violence, and delay. At the admitting desk, mothers stand with feverish children slung whimpering over their hips, alcoholics tremble with DTS, children who have fallen out of trees or stepped on nails or pulled pans of boiling grease onto their heads, wait to be treated by an exhausted but usually efficient team of residents and interns from adjoining Baylor. Some women have learned to wait until after 10 P.M. to bring their sick children in, knowing that the pediatric clinic closes at that hour and that in the turbulence of the Emergency Room, they can often get by without paying, and can almost always get faster service. One of the duties of the poor is to wait.
Several times each night and double that on weekends, people whose lives have been very nearly destroyed by bullet or knife or cars or their own hand are brought dying to Taub’s Emergency Room and hurried into one of two Shock Rooms. A team of fifteen doctors and nurses swarm over the victim and within seconds have intravenous fluids started in both arms, an airway, if needed, jammed down the throat, bleeding stopped, vital signs measured, and on the most desperate occasion have cracked the chest for emergency surgery. Every city should have Shock Rooms like these, manned by round-the-clock teams, but they are an enormous expense to equip and operate; most hospitals settle for those Emergency Rooms that are all too often staffed by a nurse who is somewhere else in the building when a case comes in and who has to telephone the doctor “on call.” Translated, that often means he is at home. Sick people die every day while the nice woman from Admitting is asking questions about Blue Cross and putting a plastic identification bracelet on their arms.
When Elizabeth Dagley was wheeled into the Taub Emergency Room, no questions were asked. The ambulance driver shouted “OD” as he pushed the stretcher through the doors and a resident directed the stretcher to the room in Emergency where overdoses are treated. Two or three suicide attempts come in each night, but unless there is great loss of blood, they do not have to go to the Shock Room. Elizabeth, woozy but still conscious, confessed that she had taken 50 Valiums. “Anything else?” asked the tired young doctor. Elizabeth shook her head negatively. She was given a drug to make her vomit and her stomach was washed out, a messy, smelly process. A tube was rammed down her throat into her stomach and water was pumped down, 50 cc’s at a time, then drawn back up with a suction machine, repeated over and over until the water came up clear. An intravenous was put in her arm to flood the body with fluids and step up urination, to pass out tranquilizers that might have reached her kidney.
But within a few hours, Elizabeth fell into a coma and started turning blue—symptomatic of barbiturate poisoning. She had also taken, it turned out, a hefty dose of phenobarbital but had not told the doctor about this. It was attacking her liver and brain. “There are two kinds of suicides,” observed one of the residents. “Those who mean it, and those who don’t. This old gal obviously meant it, or else she would have told us about the phenobarb.” Elizabeth stayed in a coma for four days and on the afternoon of the fifth, her brain waves went flat. After a few hours, she was pronounced “brain dead” by a staff neurologist.
When a young, previously healthy, and—that curious medical term—“well-nourished” person dies, the nearest relative is routinely asked to consider donating organs to potential recipients who might be waiting. Elizabeth’s distraught mother agreed and telephone calls quickly poured out to hospitals and medical centers in the area.
Did Galveston need an eye? A cornea? No.
Did Dallas have anybody worked up and waiting? Parkland Hospital there could use a kidney. Could Houston do tissue typing and fly it up?
Someone remembered that Howard Stapler was across the street at Methodist waiting for a heart; Ted Diethrich was notified. He felt Elizabeth’s heart was worth studying for a possible match. He hung up the phone and hurriedly instructed his research nurse, Kem, to prepare the cardiac preservation chamber.
In 1967, when transplantation of hearts was still confined to dogs, Diethrich had found some research money and persuaded the Grumman Aerospace Corporation to put engineers to work constructing a machine about the size of a kitchen dishwasher. The idea was to remove both heart and lungs from a donor, put them into the chamber, bathe them with a cooling mist, keep them under constant monitoring, and preserve them alive and healthy until they could be transplanted into a recipient. The chamber had to be small and portable so it could be flown anywhere in the world. Several dog hearts had been kept alive for more than 30 hours, and on one occasion, in late 1969, a human heart had lived within the chamber for almost two days. As a test, Diethrich even chartered a Lear jet and flew the chamber successfully to a hospital in San Antonio. To see the suspended organs pulsating within the chamber—the heart beating from its natural pacemaker—seemingly floating in the mist, was to think of the lab in a horror film. Diethrich took a lot of kidding as Dr. Frankenstein. He saw his project in a different light. “This is outer-space medicine,” he said.
Stapler was not notified this stormy April late afternoon that the heart of a “technically dead” cocktail waitress was being considered for him. Twice before his hopes had been aroused, twice before the match had been deemed too poor to attempt. The results of heart transplantation during the years 1968 to 1969 had been so disappointing that only the best matches of donor and recipient were even being considered now. One of the other facts that nagged at Stapler’s doctors was his morale: his decade of pain and sickness had left him addicted to morphine, had made him listless, had gravely depressed him.
The room was almost dark, and outside, rain swept against the windows in sheets. Stapler was dozing in his chair, a Western paperback open in his lap. When the door opened and the crack of light fell across his face, he opened his eyes. I started to leave, apologizing, but he called out. “No, no, come in. I’m not asleep. I was just reading.…” He held up the book. “I like the kind of stuff Ike used to read,” he said. “And he fooled a few heart doctors in his time, too.”
He got up slowly and eased his thin, unused body into the bed, gesturing for me to take his chair. He found a cigarette and lit it with a I-know-I’m-not-supposed-to shrug. “I was thinking of my home,” he said. He did not turn on the light for a while and there were only the voices of two strangers and the glow of his cigarette in the room.
“It’s a small town in Indiana, sort of an artists’ colony, real rustic, the new buildings aren’t very popular there. Even the new bank looks a hundred years old. We’re old fashioned there. My kids read about juvenile delinquency and student protest and they say, ‘Daddy, what’s that?’”
There was an accordion-file folder of family pictures beside his bed and next to it, a stack of Polaroid color photographs. He dealt them out on the bed in front of him, a man playing solitaire with the images of his children. I wanted to tell him that two floors below men and women were preparing to study a dead woman’s heart to see if it could fit into this ghostly white body. Instead I asked if he would tell me the history of his illness. His eyes almost brightened; for a few moments, as he spun his tale, they lost the film that had grayed them. He knew his story well, he had exact dates, hours, minutes of his multiplying catastrophes. It became apparent that his heart was the dominant factor of his life. It was his occupation. It was his obsession.
“On January 16, 1961,” he began, “I was driving down the highway. I was in sales and promotion for heavy industrial equipment. Nice day. No ice on the road. I had both hands on the wheel and suddenly pain shot down both of them. I stopped the car and got nauseated and opened the door and vomi
ted. I drove on after a while and I must have stopped a dozen more times. I finally got to a hospital in Franklin, Indiana, and four days later—a Sunday morning—I had a second heart attack. I spent four months there. They let me go back to work on July 1, and exactly thirteen days later I had a third heart attack in an Indianapolis hotel. This time I knew what was happening, so I drove myself to the Methodist Hospital. By April, 1965, I had had seven heart attacks.
“I went to one of the specialists in Cleveland and he examined me and condemned me to die. He gave me six months, a year at best. He said if I ever ran a dozen steps, I would meet my Maker. Well, you can imagine how many different doctors I must have talked to from 1961 to 1965, and I kept noticing that all of them would tell me different things. I started reading the medical journals and asked pretty good questions, and some of the damn doctors—pardon my French—didn’t even know what I was talking about, much less know how to answer my questions.
“One afternoon in November, ’65, I’d been to a cardiologist in Indianapolis and I’d picked up my heart catheterization report and I was driving down the I-65 and got a little tired so I stopped off at a roadside park. I was reading the cath, trying to figure out what it meant, and somehow—I’ll never know the reason—the name DeBakey flashed into my head. I had a $10 roll of quarters in my pocket. I decided to go for broke and call him. I found a pay phone and dialed Houston. He answered the phone himself. I gave him my case history while all the while dropping quarters in the phone. When I was down to fifty cents, he told me to come right on down to Houston.
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