Close to the Sun

by Stuart Jamieson

  The patients named here were identified in the news media at the time, together with their progress. Those who were not identified publicly are referred to only by first names, which have been changed, as have their physical characteristics. Names and physical characteristics have also been changed by others who are identified only by their first names.

  To my daughters,

  Alexandra and Victoria.

  “I warn you to travel in the middle course, Icarus, if too low the waves may weigh down your wings, if you fly too high the fires will scorch your wings. Stay between both.”

  —Ovid

  Close to the Sun

  Copyright © 2019 by Stuart Jamieson

  All rights reserved. No part of this book may be used

  or reproduced in any form or by any electronic or

  mechanical means, including information storage and retrieval

  systems, without permission in writing from the publisher.

  For information, please contact RosettaBooks at

  marketing@rosettabooks.com, or by mail at

  125 Park Ave., 25th Floor, New York, NY 10017

  First edition published 2019 by RosettaBooks

  Interior photographs come from the personal archive of the author.

  Cover design by Mimi Bark

  Interior design by Alexia Garaventa

  Library of Congress Control Number: 2018950744

  ISBN-13 (print): 978-1-9481-2232-0

  www.RosettaBooks.com

  Printed in the United States of America

  Contents

  Foreword

  Part One: Africa

  Chapter One: Starting Over

  Chapter Two: Bulawayo

  Chapter Three: Whitestone

  Chapter Four: Serondella

  Chapter Five: In This Way You Become Immortal

  Chapter Six: An Unspoiled Land

  Part Two: The Cutting Edge

  Chapter Seven: London

  Chapter Eight: Another World

  Chapter Nine: In the Bush Beneath the Moon

  Chapter Ten: Tiger Country

  Chapter Eleven: The Difficulty of Not Self

  Chapter Twelve: A Matter of Life and Death

  Chapter Thirteen: Mr. Lennox Would Like to Know What the Problem Is

  Chapter Fourteen: The Beating Heart

  Part Three: America

  Chapter Fifteen: Nobody Threw Instruments on the Floor

  Chapter Sixteen: Blood and Air

  Chapter Seventeen: Winning Hearts and Minds

  Chapter Eighteen: On My Own in a Cold Place

  Chapter Nineteen: Exile

  Chapter Twenty: California Calls

  Chapter Twenty-One: The Long View

  Postscript

  Bibliography and Suggested Reading

  Foreword

  One of the most significant scientific advances of the past century is the ability to perform surgery on the human heart. Cardiac surgery ranks in importance with space travel, computers, antibiotics, control of communicable diseases, and other major breakthroughs made during the twentieth century.

  In his memoir, Dr. Stuart Jamieson presents a vivid account of his experiences as a member of the so-called second generation of cardiothoracic surgical pioneers. In a highly engaging and readable manner, he describes the background and formative influences that led him to choose a surgical career. Like many other creative individuals, he had a fascinating early life that did not necessarily prepare him for his later professional accomplishments. Of particular interest are the stories he tells about the adventures he experienced during his developmental years in southern Africa.

  Dr. Jamieson’s surgical career was marked by a new, aggressive approach to the treatment of cardiopulmonary disease. Because of his interest in heart and lung transplantation, he helped introduce many technical modifications in these procedures. He also helped pioneer strategies for overcoming tissue rejection, which had previously impeded favorable long-term outcomes. One of the most important breakthroughs to which he contributed was the early use of the immunosuppressant drug cyclosporin, which substantially improved the results of transplant procedures. Perhaps the most significant of his many accomplishments, however, is the operative procedure he devised to solve the difficult problem of pulmonary embolism. That operation is among the most challenging and complex of all cardiopulmonary procedures. His results with it are unequaled.

  This book includes intimate insights into the lives of pioneers in heart surgery and transplantation, weaving the history of heart and lung surgery into Dr. Jamieson’s own history. With its generous illustrations and human interest stories about both patients and physicians, Close to the Sun should appeal to medical professionals and the general public alike. Complex medical situations have been made easily understandable to laypersons.

  On a personal note, I recall being asked many years ago by the British Heart Association to give an invited lecture at the Brompton Hospital. Arriving at Heathrow Airport, I was met by a bright young surgeon who introduced himself as Stuart Jamieson. He was then a registrar at the Brompton Hospital and had been assigned to escort me during my visit. We enjoyed the first of many enjoyable conversations. I was impressed by him at the time, and that excellent impression has continued over the years. I am proud of our friendship.

  Denton A. Cooley, MD

  Founder and president emeritus

  Texas Heart Institute

  Houston, Texas

  PART ONE

  AFRICA

  CHAPTER ONE

  STARTING OVER

  The plane from Cape Town was crowded. Most of the passengers were white and appeared well-off, dressed in crisp khaki and headed home from shopping in South Africa for the essentials they could no longer find in Zimbabwe. I’d heard that in the years since the civil war had toppled white rule in the country formerly known as Rhodesia, it had become nearly impossible to buy anything that wasn’t made there. Now a trip to the store for toothpaste required international travel. We flew over dusty plains and bouldered outcroppings. As the plane traveled into Zimbabwe and made its descent, I saw that the airport at Bulawayo, which I remembered as a grand place, was little more than a crumbling airstrip in the middle of a scrubby field. We landed, pulled up to the terminal, and got off at Gate 5—an amusing conceit, as it was the only gate. Inside I noticed a few game heads on the walls, forlorn reminders of a different time.

  The lines in the immigration area were long and slow. The thump of papers and passports being stamped echoed monotonously. When I at last reached the front, I handed my passport to a young black officer in a starched uniform. He looked at it for a long moment and then up at me.

  “You were born here, in Bulawayo?” he asked.

  “Yes,” I answered.

  “Welcome back, sir,” he said, stamping my passport and waving the next in line forward.

  I rented a car and drove through town, which took only a few minutes. After thirty years, everything looked familiar but in disrepair. The streets were crowded with people. AIDS had begun its hollowing out of the population, and nearly everyone I saw was either young or old. There was nobody in between, and nobody seemed to have anything to do. A little beyond the edge of town opposite the airport, I came to our old house. It looked more or less as it had, though it was now surrounded by a high wall. A steel gate guarded the entrance to the driveway. A sign of different times. As I looked the place over, two young boys tore around the property on small motorbikes. I remembered how my father often spent his weekends perched on a low stool weeding the lawn, looking smart in his bush hat and listening to the cricket matches on a transistor radio. Presently, a Mercedes swept up to the gate. An impatient-looking white woman honked the horn, and a gardener ran
over to let her in before going back to his watering.

  I headed for Whitestone, the boarding school I had gone off to as a young boy. The dirt road was now tarred, and houses stood in rows on either side where the bush had once crowded in. There were children in the schoolyard, both black and white. This I’d expected, though the fact that half were girls brought me up short. Whitestone had been a boys’ school in the grim English tradition when I’d attended, run by incompetent instructors whose ignorance and cruelty were thought to be the best sort of influence on the leaders of the future. This had been a torture then reserved for whites only. I’d hated every minute of it. The students no longer wore khaki but were now smartly turned out in crimson jackets with a bird embroidered on the front pocket. The school itself appeared little changed. I ruefully contemplated the motto over the door: Veritas Omnia Vincit. Truth conquers all. It’s a concept that’s easy to believe until you’ve lived long enough to see through it.

  Farther out of town, I stopped in at Falcon College, where I attended high school, “college” being an English term for secondary school. Falcon was located on the site of an abandoned gold mine, whose plain stone buildings had been converted to classrooms and dormitories. I remembered the swelter of classes beneath those corrugated iron roofs as the African sun burned its way across the day. Now there was air-conditioning. And just as at Whitestone, the school was fully integrated. Students went about campus in mixed groups, seemingly oblivious to race. They proved a point I would not make out until years later, when a classmate wrote about it in the Falcon newsletter. Falcon had become a color-blind oasis in the heart of Africa, a living model for what some had once hoped all of Rhodesia could become. That was not to be.

  My father was a doctor. He had sided with the liberals in Rhodesia. They favored an orderly transition away from white minority rule. The exclusion of blacks from the colonial government was wrong, he believed, and would end either well or badly. White rule did end, though not while my father was alive to see it, and not in the way he hoped it would. Rhodesia became Zimbabwe in a cataclysm of bloodshed and terror. Its black citizens, most of them uneducated and possessing no knowledge of the outside world, were ill prepared for liberal, Western-style democracy. The concept of “one man, one vote” is fair enough. But when the average person cannot read or write, does not know that the oceans and continents exist, has no idea even that there are other countries, other people—then the idea of self-rule falls down, because a vote is going to be for sale. And they were. Zimbabwe is a country now run by a corrupt, authoritarian black government that exploits its citizens more brutally than the white government ever did. That is Zimbabwe’s history and its torment.

  I’d come back to Africa to see all this for myself, but also because I’d recently experienced a calamity of my own. I’m a heart surgeon. My career had taken off in the pioneering days of heart transplantation, a life-saving operation that I’d helped make routine. At a young age, I’d been given my own cardiac center at a major university in America and turned it into the world’s busiest heart-transplant hospital. And then, abruptly and unjustly, I was forced out, my reputation in tatters. I’d been a success in every way except at perceiving the envy that gnawed at the people I worked with. I loved what I was doing and assumed that everyone around me did, too. I was wrong.

  One of my favorite stories when I was growing up was the Greek myth of Daedalus and his son, Icarus, who escaped their confinement on the island of Crete by flying away on wings Daedalus fashioned from branches of willow bound with wax. Daedalus, fearful of the hazards of the journey and seeing his son’s rapture at the prospect of flight, warned Icarus to fly safely above the sea, but not so near the sun as to melt his wings. Icarus ignored this advice to stay on the middle course, instead soaring high into the sky. And when his wings melted, he fell into the sea and was lost.

  The lesson of Icarus is that excessive pride or self-confidence can be fatal, though I never saw it exactly that way. To me Icarus was not foolish, but bold. Wanting to do something great isn’t hubris, to my way of thinking, but neither is it entirely safe. Extraordinary achievement does not lie along the middle course. Heart surgery is not for the timid, and in the beginning every breakthrough carried immense risk. Doctors and their patients flew not just close to the sun but directly at it. For me it was intoxicating. True enough, when I did fall, it was a long way down. I’d lost almost everything. But soon I’d be ready to go up again. My visit to Africa was a prelude to starting over.

  I have always enjoyed heights, the thrill of pioneering achievement, despite the risks.

  CHAPTER TWO

  BULAWAYO

  My story begins in a place and in a way of life that no longer exist. In a sense, I am homeless, cut off from the world I knew growing up in the heat and dust and stark beauty of southern Africa. And yet that Africa lives in my memory. Since I have left, I have traveled to all parts of the world and operated on paupers, presidents, and princes. But in the cold still of the dawn, wherever I am, my mind falls quickly back to those early mornings on the Zambezi River. In whatever country in the world I find myself, a part of me is still there.

  I reminisce over the early cool dawns on the river. The mist lay still on the water and crept along the riverbank. Cape buffalo browsed in the bush, hulking black shadows that moved noiselessly among the trees, pausing now and then to stare balefully in my direction as they chewed. They breathed clouds of steam in the morning light. There was a peace then that I never since have achieved.

  I remember, too, our summer home, a cottage called Serondella, on the Chobe River, a tributary of the Zambezi. I learned to water ski on the Chobe, a perilous enterprise on account of the crocodiles and hippos with which we shared the river. And I remember our home, Raigmore, in the town of Bulawayo, Southern Rhodesia, where I was born in 1947. My parents named the house for the place in Scotland where they met during the war. It was a sprawling one-story home, painted white, with many windows and an encircling veranda that looked out over several acres that were ours. The windows had bars on them for security—everyone’s did—though I don’t remember ever feeling this was necessary. The house had no air-conditioning and a fireplace that was unneeded except for a few weeks in the cooler months. There was a guesthouse in the back, and behind that were the servants’ quarters. My father had a large study that was lined with books and maps on which he marked the routes of many of Africa’s pioneering explorers. In the evenings after dinner, he would sit in his study alone with his pipe and read about the history of Southern and Central Africa. He seemed to know everything about the part of Africa that we called home.

  My mother delivered me at the Lady Rodwell Hospital, which stands to this day, sun splashed in crisp, colonial whitewash with a red slate roof, though I doubt that it is still strictly a maternity hospital, and certainly it is no longer exclusively for whites. Surrounded by palm trees and a neatly kept lawn, Lady Rodwell was adjacent to Bulawayo General Hospital, one of the hospitals at which my father worked and where he later died. There was no hospital then for blacks.

  We moved to Raigmore, in a suburb of Bulawayo called Hillside, when I was still a young child. I had an older brother, Chris, who’d been born in England, and eventually a younger sister named Margy. My earliest memories are of the gardens at Raigmore. The large lawns were lush during the rainy season from November to February, the Rhodesian summer. The rain came in thunderstorms, torrents that lasted a few hours, after which the sun reappeared and the air was clear and fresh. Jacaranda trees lined the flower gardens, which contained flame lilies, orchids, and hibiscus. In the winter months, the rain ceased. Sometimes the grass withered from lack of watering, but it always recovered when the rainy season returned.

  My favorite tree was a marula in the lower garden in the front of the house. Although there were no elephants in Bulawayo—the only wild animals routinely encountered there were snakes—everyone in that part of Africa knew that elephants love to eat the fruit of the marul
a tree. In late summer, when the fruit has fallen to the ground and turned a soft yellow, elephants have been known to eat so much that the fruit ferments in their stomachs and they get drunk. Elephants can be dangerous, and tend to be more so when inebriated, but it is a great sight to see an elephant barely able to stand, or see one careening drunkenly through a grove of trees, shearing off branches as it goes. Many years have gone by since I enjoyed a marula, but the bittersweet taste is still fresh on my tongue.

  Like many of the white families in Bulawayo, we had a swimming pool. There was also a tennis court. It was seldom used but was an object of fascination for me, as it required the constant attention of our gardeners. The court had an earthen surface, not clay, but dirt from giant anthills that was saturated with used engine oil and then pressed flat with a huge roller made of steel and concrete. It took two gardeners to pull it, and it was a mystery as to how the unwieldy contraption had come to be kept within the walls and wire netting surrounding the court. The only answer had to be that it was there first. Despite the continuous labor invested in maintaining the court, in truth its greasy, uneven surface was never satisfactory for the tennis. We weren’t much interested in playing, anyway, in the heat and sun, and eventually it was paved over.

  I did use the tennis court for another purpose, however. I learned to shoot on it. There was a solid stone wall at one end that was an ideal backstop for target practice with a pellet gun my father bought for us. I must have been six or seven. I discovered that I had a talent for shooting. I could hit anything with that gun, even dragonflies as they flew around the swimming pool. Being a good shot was important in Africa. One day it would save my life.

  Bulawayo sits on a plain, in the southwestern quadrant of what was then Southern Rhodesia, between the equator to the north and the Tropic of Capricorn to the south. It is some four thousand feet above sea level, with a moderate climate that is never cold and rarely sweltering. It is a young city, a town, really, that was barely fifty years old when I was born. Its history before then was bloody, and began when it was first colonized not by white Europeans, but by an invading force of black Africans coming north out of South Africa, which was then known as the Cape Colony.