“I was a person who had devoted so many years to becoming technically proficient, to achieving a certain skill, and to be ground down under his heel was frightening,” Diethrich said.
After three months, DeBakey approached Diethrich in the hallway early one morning and said, hurriedly, “You take Room 4 today.” Diethrich’s knees almost buckled. This meant he would be operating alone, with a junior man assisting him. “From that moment on, it was night suddenly day. He respected my judgment. He’d come in and assist me, or I’d go in and assist him and nothing more was said.”
Diethrich never knew what he had done to pass the test because he never understood the rules of the test. Or even if there was a test. Or why DeBakey chose and chose again to seize the Roman candle of youth and shake it and press his hands down on it and snuff out the fires of desire and ambition until the sparks—sodden with tears and sweat—were all but gone. Reporters sometimes asked DeBakey how he dealt with death and he usually replied with a reference to Irving Stone’s novel of Michelangelo, but he invariably mixed up the title. “It is the Ecstasy and the Agony for we heart surgeons,” he said. “To win is ecstasy, to lose is agony.” But was his vision of the business so painful that he chose to sort out those he would permit to enter?
Diethrich had come to believe that only those doctors from outside the Baylor program fell victim to DeBakey’s ire. One night as DeBakey and Diethrich drove to the Methodist Annex and were talking of a resident to whom the senior surgeon had been giving holy hell, DeBakey suddenly stopped and was silent for a while. His hands were on the steering wheel and he clutched it tightly. He began to speak again in a flat, cold voice. “Ted,” he said, “you know, I test people. I see what people can do under fire and under pressure. I must know what these people are made of.”
I dined at the home of a college friend who was now a successful surgeon and who had been through the DeBakey program. How alike the memoirs were becoming! I could almost recite along with him. “He put me through hell’s fire,” said my friend, whose face grew tight as he remembered it. “He used to say, ‘You are so stupid, you must be mentally retarded. Mentally retarded: Anyone who acts like you do must have brain damage. We’re going to take you right into surgery and fix your carotid artery. I don’t think we even need an arteriogram.’ He used to stand me up against the corner and jab those fingers of his into my chest and it was like being stabbed.”
His hand went to his shirt and he searched for an imaginary cavity.
“But now it’s over,” I said. “What do you think of the man?”
“Oh,” he began quickly, “I.…” He stopped. He had formed the syllable “L” with his lips but the word, that automatic word, that easiest word, would not come. “I … like him, I respect him,” my friend said. “He gave me opportunities that nobody else would have. He also built up Baylor in twenty years to where it ranked with Harvard and Johns Hopkins and it took those schools 200 years to get there.”
My friend stopped. He measured what he would say. “But he cannot run Baylor and be a full-time practicing surgeon … and fight the world.… How lonely he must be.”
On the next Sunday afternoon the green phone on the table beside Diethrich’s pool rang and he stopped playing tennis to take the call. It was from the hospital.
“Who was it?” one of the surgeons asked.
“Howard Stapler just checked back in in heart failure.”
“What can you do for him?” I asked.
“Transplant him, I guess,” said Diethrich, and he picked up the ball to serve.
PART TWO
The Transplant Era
“… there ensued what appeared to be an international race to be a member of the me-too brigade. There has not been anything like it in medical annals.…”
—DR. IRVINE PAGE, cardiologist, 1968 winner of the American Medical Association’s award as the country’s “Outstanding Physician.”
CHAPTER 10
One day in the early 1960s at a Saturday morning patient conference at St. Luke’s Hospital there arose the problem of a man whose heart was so deteriorated that it could not tolerate Cooley’s surgery. Otherwise his body was youthful and strong. When all the hopeless avenues of potential treatments had been traveled, someone from the back of the conference room called out, “Transplant him!”
Transplant him! Sew in a new heart! But where would that heart come from? Someone else would have to die in order to contribute that borrowed heart. “I have an idea,” one of the younger doctors said. “Why not move the patient and the operating room to Huntsville?” Huntsville, 75 miles north of Houston, is the site of Texas’ huge central prison and home of its once-active electric chair. “We could obtain permission from a condemned murderer to use his heart,” the young doctor theorized, “and the night they executed him, we’d be there to take out his heart and transplant it into our man.…”
Nothing came of the bizarre scheme, but the imaginative doctor was not totally hooted down. Talk of transplants peppered American medicine as the decade of the 1960s began. There was scarcely a medical center without at least one transplant research project, if not swapping hearts and lungs and kidneys and spleens and bone marrow and endocrine tissue in dogs and calves, then at least in hamsters or mice. In Mississippi, Dr. James Hardy transplanted the ovaries and uterus en bloc from ten female dogs to ten recipients. Three of the ten not only tolerated the new organs, they later became pregnant and gave birth to healthy litters. In Denver, Dr. Tom Starzl led a team that was slowly moving kidney transplantation out of the realm of rare, audacious surgery—greatly discouraging at first and applicable only in giving a kidney taken from one identical twin to another—onward to where more than 10,000 kidneys would be taken from cadaver donors and implanted in recipients. The kidney transplant would become, in the 1960s, a majestic and routine piece of surgery performed all over America.
But what of the heart? And the brain? The transplanted brain, as far as the state of medical knowledge and expertise extended, was out of the question. Nervous tissue is not regenerative; it would not grow in another system.* The heart was clearly the jackpot of transplantation surgery, and many American surgeons moved in the early 1960s to claim it. At Stanford University, Dr. Norman Shumway and Dr. Richard Lower began a series of transplanting hundreds of dog hearts, refining and polishing their surgical technique that would later become the basis for all heart transplantation. At the University of Mississippi, Dr. Hardy moved toward his historic chimpanzee heart-into-man operation in 1963. And in Houston, Mike DeBakey chose to go for a heart that would not be wrapped in legal, moral, and probably religious brambles. Shrewdly, DeBakey decided to let the others test their hearts from dogs, chimps, and cadavers. His would be plastic and metal. He would build and implant an artificial heart. There was little doubt in his mind that it could be done. He had already pioneered and made common the implantation of plastic patches into veins and arteries, of artificial valves into hearts. It would be the astonishing climax to an astonishing career.
Such an undertaking would require a large sum of money. DeBakey went after it. Always a clever player of the academic game called “grantsmanship,” he had commuted with regularity to the centers of power and money in America—Washington and New York. And he had cultivated important friends—Mary Lasker of the rich and prestigious Lasker Medical Foundation, cardiologist Paul Dudley White, certain congressmen. “Mike does not go to parties unless there is at least a congressman present,” observed a DeBakey watcher, “and preferably that congressman is the chairman of an appropriations committee.” Careful sifting of his invitations and of those who would become his friend paid well. Over the years DeBakey personally raised more than $50 million for his projects, and, in 1962, pulled out a plum that any medical center in America would have relished: a $2.5 million grant to devise and develop an artificial heart. Quickly he moved to spend it and the millions that would follow. He set up laboratories at Baylor, bought equipment, scouted for people. One he hired
was a talented and ambitious Argentine surgeon named Domingo Liotta, a quiet, handsome Latin who spoke English with difficulty but whose mind seemed geared toward the painstaking work of building and discarding scores of models, of experimenting with plastics and rubber and velour, of huddling with engineers to perfect the best possible power source to drive the man-made pump.
A Baylor faculty member described the scene. “DeBakey was ecstatic. He had always adored his hours in the laboratory, tinkering with plastic and metal and pliers and scissors. He would have made a great engineer had he not turned to medicine. His zeal, his enthusiasm inspired everyone. He made each feel that the goal was the most important scientific contribution of our time. It would surpass Curie, it would surpass Einstein.…”
Not surprisingly, the press discovered DeBakey.
Scientists have traditionally shied away from the flashbulb; DeBakey welcomed cameras and notebooks into his cloistered world. In 1963 he agreed to perform a heart-valve operation on the first live worldwide satellite television broadcast via Early Bird. The carefully scripted program opened with mariachis (Mexican street bands) playing in Mexico City, thence to an oom-pah-pah concert in Essen, Germany, and on to Operating Room 4 at the Methodist Hospital of Houston, where TV cameras, placed and rehearsed by Michael DeBakey, were actually within the surgical suite, two scuttling sideways across the tiled walls, a third in the glass dome for overhead angles. “Now here is where you zoom down, at just about eleven o’clock,” said DeBakey in rehearsal to the camerman on high. “Can you visualize it correctly?” The cameraman nodded. DeBakey hurried about his staff, cautioning his assistants not to get their heads in the way. Two hundred million people watched DeBakey at his best.
Three years later he permitted a Life magazine photographer and reporter to wait in Houston off and on for almost a year until a suitable patient turned up to receive a left ventricular bypass, half an artificial heart. Their first attempts at devising an entire pump had been discouraging, so Liotta and his staff had created the ventricular bypass and had proved its efficiency in animal tests. In 1966, such an implantation in a human being was a dramatic and newsworthy piece of surgery. Although the case that Life photographed was not a happy one—the patient died two days after surgery—the ten-page color spread firmly established DeBakey as the leading searcher for an artificial heart. A shower of criticism fell on him from his peers for his courtship of the press, for his inviting journalists into the operating room, for his news conferences and television appearances. Characteristically, DeBakey paid small heed to the complaints. He acted, he said, to inform the public about the progress made with federal funds—the people’s money, he emphasized. “The people have a right to know what we are doing with their tax money,” he said. And if Mike DeBakey became, coincidentally, the most famous surgeon in America, then it was a by-product over which he had no control.
DeBakey’s shadow was so enormous in the period 1960–67 that Denton Cooley worked in relative darkness. His name appeared on scores of medical papers adjoining the senior authorship of Mike DeBakey, and the world of medicine pronounced their names almost as if a hyphen joined them. But the relationship that had begun as polite and professional in 1951 became, by 1960, stiff and chilly. There was never a dramatic break, only a gradual moving away, an erosion. Cooley simply found it more and more difficult to get operating-room space for his own cases at Methodist. One member of the Baylor surgical faculty remembers getting to the hospital before sunrise and making up imaginary names and procedures and filling them in on the blackboard to reserve space for DeBakey. Cooley also fretted at the traditional academic custom of the chairman of a department adding his name to all papers written by the men beneath him. This is done to facilitate indexing in medical libraries of the thousands of scientific papers that are written every year, and to emphasize the responsibility the chairman has for the work that goes on beneath him.
“Denton felt that every time he did something important,” said a surgeon of that era, “Mike got credit for it. Denton had become the best heart cutter in the world and nobody outside the medical societies knew his name.” He’d certainly never been on television before 200 million people.
Cooley’s gifted hands were turning up hundreds of thousands of dollars in surgical fees for the Baylor department, yet every time he asked for something—he complained to a friend—be it a piece of equipment, a resident to assist him, a secretary to handle his records, “there was a hassle with Mike.”
“There were a thousand little things between them,” said one observer, “but basically it was the incompatibility of two enormous egos. Denton flat got tired of sucking hind tit. One day after some bickering over something—a valve replacement, maybe a coarctation, I forget which—Denton said in a quiet little voice that hardly anybody heard, ‘Okay, Groucho, have it your way!’ Mike had a mustache then and looked a little like Groucho Marx. And Denton left and went across the way to St. Luke’s and, in effect, never came back.”
When Cooley began working alone at St. Luke’s and Texas Children’s, it was the first time in his life that he had been without a dominant male figure. “He was never close to his father, nor was he close to Mike,” said a boyhood friend, “but both were strong, glamorous over-powering objects. Those of us who knew Denton figured that he had to see if he could make it as his own man.”
On the first day of December, 1967, Dr. James Nora faced the unpleasant task of telling a young couple that there was nothing surgically available for their newborn child. The infant had been delivered with a hypoplastic heart, an unusual condition in which the left side of the heart is underdeveloped, coupled with atresia of two valves. “The only thing to do would be to change hearts,” Nora speculated. “Someday it might be feasible, perhaps—someday in the future. If the child can live that long, we could do it.”
Twenty-four hours later, a bulletin flashed across the world from Groote Schuur Hospital in Cape Town, South Africa:
The first human-to-human heart transplant in history was done last night by a team of doctors at the Groote Schuur Hospital. The name of the patient, as well as the donor, are being withheld by hospital authorities.
The heart transplant team was led by Professor Christiaan Barnard in a dramatic all-night operation—the first of its kind in medical history. Messages of congratulation are pouring in from around the world.…”
The parents of the doomed baby hurried up to Nora in a corridor of St. Luke’s. That far-off “someday” had arrived with breathtaking suddenness. Could Cooley transplant the heart of someone else into their baby? “I don’t know,” said Nora, surprised as was everyone else in Houston at the Cape Town bulletins. “I’ll see.” He found Cooley outside surgery. “You want to get into the transplant business?” asked Nora. Cooley nodded his head affirmatively and said, “Sure.”
Five months would go by and the child with the hypoplastic heart would die before the transplant era would begin in Cooley’s surgery. While surgeons around the world hurried to join the list and the headlines of those who attempted the procedure, Cooley held back. He seemed to have little enthusiasm for transplants. In speeches he publicly congratulated Barnard on the breakthrough, but warned against haste in pronouncing the operation as a cure-all for heart disease.
Three days after Barnard transplanted a heart into Louis Washkansky, Dr. Adrian Kantrowitz became the first American surgeon to attempt—and fail—in the procedure. He installed a new heart in the chest of a newborn child, but the infant died six and a half hours after the operation in Brooklyn’s Maimonides Hospital. A month later, in Stanford Medical Center, Dr. Norman Shumway attempted his first; the recipient lived but fifteen days. Shumway’s near decade of intense research in transplantation, and the knowledge obtained from swapping hundreds of animal hearts, had made him the preeminent figure in the field. One of the ironies of the transplant era was that had Shumway been the first—had the hands of Shumway been the first to lift a heart from a dying body and put it into a livi
ng man—then the medical world would have said, in effect, “Of course Shumway did it. He was eminently qualified to do it. He has done more research on the procedure than any man in the world and we have read his papers and heard his speeches and if any man must try it, then Shumway is he.…”
But Christiaan Barnard was first, and few had even heard of Christiaan Barnard, and the world was not accustomed to dramatic breakthroughs occurring in South Africa. If a heart transplant could be done by an obscure surgeon at the bottom of the world, then it must not be all that difficult. Barnard, moreover, was blessed with good fortune. His first transplant lived but eighteen days. But his second, the dentist Philip Blaiberg, would live for almost two years.
“As long as Blaiberg was alive,” said Bob Leachman in Houston, “he was Columbus setting out for the New World. Until he proved otherwise, we could believe there might be a New World.”
Denton Cooley had not actively participated for many years in the Baylor research program. In the decade of the 1950s he had been instrumental in improving and perfecting the heart-lung bypass machine and in testing the many artificial valves that the laboratories conceived for use in human hearts. But when he shifted his career to St. Luke’s and Texas Children’s, he seldom if ever went near the labs. He had, in fact, become skeptical of the value of doing extensive practice heart surgery in dogs. Twelve years earlier, in 1956, he had been pushed—reluctantly—into his first open-heart operation in a human being. A Houston cardiologist, Dr. Sidney Schnurr, had a 58-year-old male patient who had suffered a severe heart attack, followed by a rupture of the septum—creating a perilous hole in the heart. Schnurr urged Cooley to put the man on the then infant and unpredictable bypass pump, stop his heart, and sew up the hole.
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