“I don’t think we’re ready yet,” Cooley had said.
“This man is going to die,” Schnurr replied with passion.
“The dogs have all died on the pump. I’ve done hundreds and they’ve all died. There are still too many problems.”
“To hell with problems,” snapped Schnurr. “This is an opportunity for you to do your first human open-heart case.”
Cooley walked in meditation around the corridors of the hospital for a quarter of an hour. He paced the halls and stood alone for a time on a stair landing. Finally he returned to Schnurr and said quietly and with apprehension, “Okay.”
The man lived but two months and autopsy revealed that the sutures that closed the hole in the heart had pulled out. Cooley’s error had been in placing them too close within the necrotic tissue. He learned to sew them farther away in later operations. He also learned that human physiology behaves with considerable difference on the pump than that of the dog.
“Humans will tolerate this surgery much better than dogs,” Cooley said years later. “Dogs, for some reason, don’t like to have their blood bubbled through the pump oxygenator. And, of course, the dogs we had for experimental purposes in those days were sick animals. They were strays, diseased, they took surgery badly. It was like trying to operate on a human with an acute blood-stream infection.” (A famous article appeared in a medical journal of that period entitled “Man’s Best Friend?” which said, in effect, that extensive experimental work on dogs had held back human open-heart surgery for at least ten years.)
“Are you going to do any transplants?” asked a Houston newspaper reporter of Cooley at a cocktail party in the early winter of 1968. “We might,” he said. “We’re looking into it.”
“What do you think of them?” asked the reporter.
“Like the man who ate the first oyster,” Cooley said, “it took courage.”
Christiaan Barnard launched his world tour, a triumphant torero circling the ring, a newly confirmed celebrity trailing clippings, television cameras, spotlights, applause, and beautiful women. Cooley attended a medical meeting in South America and found himself swept up in the crowds and sirens and motorcycle escorts for Barnard. Reporters mobbed the corridors of the hotel where the two surgeons were staying. Cooley returned to Houston and recounted the scene, adding, almost sorrowfully, “I went there as a surgeon with the largest cardiac series in the history of medicine, and nobody even knew my name.”
By May 1, 1968, eight transplants had been done throughout the world and all save Philip Blaiberg had quickly died. In Bombay, India, a patient lived but three hours with his new heart. In Paris, two days. Shumway’s second try lasted but three and a half days. Kantrowitz’s second, only eight and a half hours. The survival times seemed mainly to be measured in hours and days—not years or decades. The miracle of Cape Town had turned bleak. But there was still that testy dentist with the heart of a young black beating within him. Blaiberg was giving interviews and signing contracts for his memoirs. An agent was touring the magazine bureaus of Europe’s capitals representing both Blaiberg and his wife. The surgeon who transplanted him was signing contracts for his memoirs and dancing with Gina Lollobrigida in Rome.
On May 2, cardiologist Don Rochelle accompanied Cooley to a medical meeting in Louisiana. Rochelle remembers Cooley speaking disparagingly about transplants. “He said he thought they were being rushed into, that they needed more careful study, that the aura surrounding them was in questionable taste.”
Twenty-four hours later, Cooley performed his first heart transplant. Two days after that he did his second. Two days later came his third. Three heart transplants in five days! By the middle of August, he had done ten, more than any surgeon in the world. He was first, undisputably first, and the cameras of Life and NBC and the BBC discovered that there was another hospital and another surgeon in Houston to the immediate left of Methodist Hospital and Mike DeBakey.
The nature of heart transplants is that someone has to die in order for someone else to live. But those who succumb to the two leading killers—heart disease and cancer—would not normally have healthy enough hearts left for transfer to someone else. The optimal donor would be a young, previously healthy and vigorous person who died suddenly in an accident that destroyed the brain—but left the heart intact.
At 3 P.M. on Thursday, May 2, 1968, a fifteen-year-old Houston bride, convinced that her nineteen-year-old groom no longer loved her, took a .22 rifle, leaned her head against the barrel, and pulled the trigger. Exploding fragments of lead tore into her brain. She was taken to Ben Taub Hospital’s Shock Room, where a team of residents and interns quickly determined that there was no young life left to save. The brain waves were flat, but the heart, strong and vigorous, pumped on, sending blood to an unresponsive and unneeding brain.
Cooley’s staff had sent word to Ben Taub that the senior surgeon would appreciate knowing if a potential donor heart turned up, even though the senior surgeon had not yet committed himself with any enthusiasm to a transplant program. Cooley had done but one practice operation, on a cadaver. (“I’ve done more heart surgery than anyone else in the world,” he would say months later to a reporter who inquired how prepared he had been to begin transplants. “I didn’t see the value of spending a lot of time in the laboratory putting sutures in dog hearts.”) When the news of the girl’s suicide reached St. Luke’s, two of Cooley’s associate surgeons, Grady Hallman and Robert Bloodwell, urged that a transplant take place. The donor heart was across the street and a likely recipient was in the house.
Everett Thomas, a certified public accountant, had come to Houston to see if Denton Cooley could replace three of the four valves in his heart. At 47, Thomas was terrified that another heart attack would take him permanently from his wife and three sons. He had been stricken with scarlet fever during World War II, and had fought the disablement created by his weakened heart for twenty years. He moved to Phoenix for the climate, and took jobs that he could do without strain. Despite his efforts, he had had two heart attacks and two strokes. His heart was failing so severely that the blood supply to his liver was drastically reduced. His liver was swollen and his lungs were not functioning at full capacity and fluids collected in them.
When Cooley returned from the medical meeting in Louisiana, he was told by his associates of Thomas’s grave condition. Thomas was scheduled for possible triple-valve replacement on May 3. Cooley was one of the few surgeons in the world who would attempt a triple-valve, but the procedure bore the highest of risks. Cooley also was told that the heart of the bride who had shot herself was available for a possible transplant. The dead and the barely living had come together. Cooley had not sought the situation, but there it was, waiting for his decision. Without committing himself to a transplant, Cooley walked the corridors of the hospital alone. Finally, he made an unexpected call to Thomas’s room. Cooley spoke quietly, almost hesitantly. He told Thomas of his extreme heart condition as revealed by the cardiograms and x-rays. He said he would open his heart and examine the valves. “If it seems like I can put in prosthetic valves, then I’ll do so. But, on the other hand.…”
Cooley’s voice trailed off. Thomas and his wife looked at the surgeon anxiously. Cooley began again. Had Thomas and his wife been reading of heart transplants? Both nodded their heads. There was the possibility, Cooley said, of attempting a heart transplant on Thomas, if his natural heart would not tolerate replacement valves. There was, he said, a donor heart available. He did not reveal the identity of this heart. Would Thomas and his wife talk over this possibility and let him know within the next few moments? He smiled and left the room hurriedly.
Helen Thomas recalled the moments that followed:
“We had come to Houston with nothing on our mind but a valve operation. We had not even thought of transplants.… Dr. Cooley eased us so gently into the idea. We knew that he was not waiting for the opportunity to become a hero, he already was one, so we told him to do what he thought best. He assu
red us that he would.
“When he left the room, Everett and I talked. Personal things—what a good life we had had, what we were going to do if.… We weren’t optimistic, we weren’t fatalistic. We just felt confident that everything would turn out all right … whatever that might be. Faith is the big thing. We have to have complete faith in our God. If you allow yourself to worry, then that is not complete faith. Just before Everett went to sleep from the drugs, he took my hand and told me, ‘Don’t worry about me. If anything happens, you’re the one who’s going to have troubles. Me, I’m just going to sleep. If I wake up, then everything will be okay.’”
The first heart transplant in Houston was carried out so smoothly that most of the hospital did not even know it was occurring. “It was the quietest one we ever did,” recalled Mrs. Ruth Sylvester, supervisor of the operating-room nurses. “All the ones after that we had a hundred medical students and every doctor in the city wanting to watch.”
The likelihood that Cooley would transplant a heart caught his staff off guard, most of whom had gone home for the day because it was 6:15 P.M. when Thomas gave his permission. In truth, no one was fully prepared except the surgeon. Mrs. Frances Chandler, an operating-room head nurse, remembers being summoned back to the hospital and driving there at high speed. “I wanted a policeman to stop me so I could tell him I was on my way to do a heart transplant,” she said. Mrs. Sylvester, the operating-room supervisor, had been to the beauty parlor and was leaving for a three-day holiday in Mexico when her call came. She hurried to St. Luke’s, arriving just after 7 P.M., and immediately began dispatching orders for the scores of tasks that had to be done before the operation could begin.
The most urgent was finding some place to put the patient in—provided he survived the surgery. The Recovery Room was out of the question; totally sterile conditions could not be observed there unless Thomas was the only patient in the room. Cooley did not intend to stop doing other heart surgery just because there was a transplant on his census, nor did the other surgeons who used the crowded facility. There had to be an area close to the surgical suite so that the patient could be rushed back into the operating room quickly, if that became necessary. Mrs. Sylvester came up with the idea of taking one of the operating rooms and converting it into a private recovery room. Cooley agreed. Even as he operated in Room 1, orderlies were taking the standard equipment out of Room 6, cleaning it, sterilizing the walls and floors, bringing in a recovery bed, sterile sheets, monitoring equipment, and every emergency drug Mrs. Sylvester could think of.
Cooley wanted the entire procedure photographed with both still and movie cameras, in both donor and recipient rooms. Mrs. Sylvester called the hospital electrician to make sure there was ample electrical power to accommodate the equipment. The movie photographer would sit on a platform above the operating table and shoot down into Thomas’s chest cavity.
Thomas and the girl shared the same blood type, but beyond that there was no time for the more sophisticated tissue typing, which would come with later transplants. Jim Nora had made arrangements to take a sample of blood from both donor and recipient, place them in a specially prepared kit, and fly them to Dr. Paul Terasaki in Los Angeles. There the scientist had facilities to quickly compare the antigens living in white blood cells. Antigens are genetic protein substances that are so tiny as to remain unseen. They aid the body to reject foreign material. Terasaki had discovered at least thirteen antigens (there could be scores more as yet unknown to science) and had devised a method to match up antigens from different blood specimens. He then graded the match from A (blood from identical twins) down to D, the poorest match.
Nora drew blood from Thomas and the girl and dispatched it to Los Angeles, but it was not until the next day—well after the operation was completed—that he learned from Terasaki that the tissue typing was a C match, not good, but, as it would turn out in the months to come, not the worst of those transplants that Cooley would do.
Nor was there time to manufacture ALG, the promising new immunosuppressive drug, which Nora wanted to use in the event that Cooley ever did a transplant. With the operation about to begin, Nora telephoned his friend Dr. Tom Starzl in Denver and asked if he could borrow some, then dispatched his secretary, Nan O’Keefe, in the middle of this frenetic night, to fetch it. Miss O’Keefe, terrified of flight, rode to and from Denver in a thunderstorm, her face white, the precious serum in a styrofoam box clutched between her trembling knees. A plane had crashed the day before and that was the only thing on her mind.
The body of the fifteen-year-old child bride had been transferred from Ben Taub to St. Luke’s and placed in Operating Room 2, where a team of doctors and technicians huddled about her. Ironically, Cooley had operated on this same girl to repair an arterial defect when she had been nine years old. Because of their respect and admiration for the surgeon, the girl’s parents and her husband gave rapid permission for the transplant. As the ventilator breathed for the technically dead girl, she was given four pints of blood to maintain an adequate pressure. The danger was that the heart would stop if the pressure sank too low, and if the heart stopped it could begin to deteriorate before it was excised and taken across the hall to Room 1, where Thomas would lie.
Shortly before midnight Cooley drank a cup of coffee hurriedly, and with no tension showing, went to the scrub basin. As he cleaned his hands and arms with the disposable soap sponge and his nails with a pointed orange stick, he looked ahead through the glass wall and saw Thomas lying on the table with the anesthesiologist putting him under. Behind Cooley, in Room 2, the girl’s heart was rapidly failing. At 12:10 A.M. Grady Hallman called out. The donor heart had stopped and closed chest massage was not bringing it back. Cooley nodded, went hurriedly into Room 1 and opened the heart of Thomas. He saw and felt with his gloved fingers the deterioration of the three valves, calcified and weak. The heart muscle had large sections of scar tissue and a dull gray patch of ischemia, or dead tissue. “There was no doubt that the heart needed replacing,” said one who had been present in the room. “But it goes without saying that it would have been considerably anticlimatic to call everything off at that point and just put in three valves.”
Word was sent across the hall that Cooley was proceeding with the transplant. Hallman and Bloodwell practically had their scalpels poised. Quickly the girl’s chest was opened and the heart exposed, a heart enlarged from the congenital condition, but because of that better suited to fit into a much larger chest. Several months later, in conversation with a visiting scientist from California, Hallman would recall that eerie moment: “You are the one who makes the final blow and takes out the heart and this is a peculiar feeling the first time you do it.… I guess just like an executioner who has to pull the switch on the electric chair because it’s his job. It bothers him the first time, but the more times he does it, the less it bothers him.… It was upsetting to me personally the first time I did it, but the more I did it the easier it became.… But the first time you feel as if you are killing the patient.…”
Robert Bloodwell removed the entire heart, put it into a stainless steel pan, covered it with a sterile green cloth and carried it the ten feet across the hall to Room 1. Other surgeons believed—and still believe—it is necessary to immediately cool the donor heart and keep it cooled until it is transplanted into the recipient. Cooley had decreed this was not necessary, that a heart could remain in transplantable condition for up to an hour at room temperature.
At 1:01 A.M., Thomas’s natural heart was taken from him and put into a container for pathology. The heart-lung bypass machine was working for him. For a few frozen moments, there was the astonishing sight of a man on an operating table, a living man, with nothing but a cavity in the place where his heart should be. Characteristically, Cooley cut the normal operating time for a transplant in half by using a different technique. Others had stitched in a new heart from the outside, having first attached the left atrium of the heart to the base of the left atrium purposely lef
t in place from the patient’s old heart. Once this was sewn in place, the technique had been to flop the new heart over to stitch in the right atrium. Other transplanters had left a portion of the back walls of the recipient’s atrial chambers, painstakingly cutting out the donor heart to match up with these walls—fitting two jagged puzzle pieces together.
Instead, Cooley reasoned, he could remove the entire heart from the donor, make a bold incision across each atrial chamber to open it up, and suture the new atrial chambers onto the recipient’s atrial walls from the inside. This technique would also provide enough tissue to make up for any difference between the old heart and the new one. In essence, Cooley would be able to sew faster, and perhaps more important, would not have to flop the new heart about so much as had been necessary before. The less handled, Cooley thought, the less danger there was in damaging it.
By 1:32 A.M., the heart that at dawn the morning before had beat within the chest of a troubled new bride was now sutured into the chest of a weary and frightened accountant from Phoenix. Cooley looked at his work for a few seconds, then said softly that he was going to take Thomas off the bypass pump. Clamps that prohibited blood from flowing into the new heart were removed. Twenty people in the room craned their necks to see what would happen. Frances Chandler, a nurse, held her breath. Another nurse said a silent prayer. Cooley’s hands, holding the defibrillating paddles, were suspended a few inches above the borrowed heart. At least one observer thought his hands were trembling—slightly. Suddenly blood rushed into the arteries of the heart and filled them with the substance of life. Instantly the heart began to fibrillate. Cooley slapped the electric paddles down; one shock stopped the erratic rhythm and sent the heart into a normal, smooth, amazing beat. “Thank God!” someone cried. There was a unanimous whoop inside the operating room. Cooley broke into a wide grin and shook his head as in momentary disbelief. When he had begun his career as a surgeon twenty years before, it was unthinkable to invade the human heart and operate within it. Now he had accomplished the ultimate. It was, he said later, the supreme moment of his life.
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