Not long after meeting with Najarian, I got a phone call from Richard Simmons, who I would later learn was Najarian’s right-hand man. Simmons headed the search committee for the new head of heart surgery. He asked to come out to see me. Simmons got to Stanford when I was in the middle of a heart-and-lung transplant on a patient who, ironically, had been referred to us by the University of Minnesota. The patient was a redo, and I had to work with scar tissue in the chest. It was a long, challenging operation, and I’d been up all through the previous night with the donor. I met Simmons for dinner. We were interrupted several times with calls from the hospital. It was difficult to concentrate on Simmons’s sales pitch. Simmons seemed impressed by my concern for a patient. I found it strange that he thought this was remarkable.
I asked Simmons what it would take to rebuild the program at Minnesota. He said that expanding private cardiac practices outside the university were the main problem. I knew this to be true. After Lillehei’s departure, the university had taken another big hit when Demetre Nicoloff left. Nicoloff had done his residency at the University of Minnesota Hospital under Wangensteen and then trained under Lillehei. He went on to develop the St. Jude heart valve with Manny Villafana, a brilliant pioneer in medical technology. Nicoloff, then an associate professor, implanted the world’s first St. Jude heart valve at the university in 1977. The St. Jude valve went on to become the most commonly used artificial heart valve in the world. A year later Nicoloff performed Minnesota’s first heart transplant. But Najarian refused to promote Nicoloff to full professor and also diverted income from the cardiac center to other areas of the surgery department. Nicoloff left the university in 1979 and founded Cardiac Surgery Associates, which practiced out of several competing hospitals. Nicoloff’s group soon eclipsed the university’s ailing cardiac program.
It’s not unusual for good surgeons to become disgruntled with university practice and its attendant politics. Nicoloff’s history with the university seemed predictable and unimportant. As Simmons explained how Nicoloff had become the university’s main competition, I didn’t pay close attention. I should have.
I agreed to make another visit to Minnesota. Simmons sent me an itinerary for three days of meetings. I drove to the San Francisco airport on a Sunday evening after spending a glorious sunny California day at my ranch in San Gregorio. I made my way to the departure gate for a Northwest Airlines flight to Minneapolis. The waiting area was full of people with pale faces who were carrying heavy coats. I sat there looking at them. And then I got up, went back to my car, and drove to Stanford, where I called Simmons.
“Oh, you missed the plane,” he said.
“No, worse than that,” I replied, “I’m not coming.”
Simmons was not pleased. I told Shumway the next day that I had decided not to go. Shumway said that was fine, and that he was happy if I was. “Onward and upward,” he said.
Shumway once told me that you can tell how good a job is based on who takes it. Over the next year, a number of other candidates looked at the Minnesota job. None took it. It seemed that the challenge was too great, that cardiac surgery at Minnesota was beyond saving. At Stanford, I had been promoted to associate professor and granted tenure. My future was secure. And I loved my work, which now included regular visits from bright young researchers from overseas who came to spend a year or two in the laboratory. We were publishing good papers on the pioneering research we were doing in transplantation and lung preservation. By any measure that mattered to me, I had it all.
And yet I felt dissatisfied somehow. Shumway was only sixty-two in 1985, and unlikely to look for a successor any time soon. There was no longer any way for me to advance. I had plateaued. I was haunted by the words of Matsuo Basho, a seventeenth-century Japanese poet who advised, “Do not seek to follow in the footsteps of the men of old; seek what they sought.” I began to realize that staying at Stanford would not be enough for me.
At a meeting in South America that year, I discussed the Minnesota position with Aldo Castaneda, who had left the faculty at Minnesota in 1972 to become chief of cardiac surgery at Boston Children’s Hospital. Castaneda had done some early work in heart-and-lung transplantation in baboons while he was at Minnesota. He had been the first to demonstrate that primates did not have the post-transplantation breathing problems that showed up in dogs. We had a long talk over lunch. Castaneda thought the situation in Minnesota could be turned around but stressed that it was fundamental that I have complete financial independence for the cardiac unit. He said “fundamental” more than once.
At the end of 1985, a little more than a year after I had backed out of the visit to Minnesota, I called Simmons. I asked him if I could take another look. He was suspicious, but he told me to come. And this time I went.
I had already decided to accept the position. But I had conditions. It was essential for me to have an independent cardiac practice, one that was not controlled by Najarian and the Department of Surgery. I wanted the money we made to stay in the cardiac unit. I had to be able to recruit some new surgeons. Finally, I needed to continue my research and have space in which to do it. What I really wanted was a separate building housing the clinical cardiologists, the surgeons, and the pulmonologists, which I would call the Minnesota Heart and Lung Institute. Simmons seemed to think this was ambitious on my part, but he agreed to all my demands. So did the dean and the chair of medicine—and John Najarian.
When I got home, I wrote to Najarian agreeing to go to Minnesota on the understanding that I would found and lead a new entity, the Minnesota Heart and Lung Institute. I specified that my cardiac surgery group needed to be financially independent of the Department of Surgery. I asked that no promotions of existing faculty be put through before I took up the post. He wrote back agreeing to all of it. I got ready to leave Stanford.
Before my departure, the dean of the medical school at Stanford sent for me. I hardly knew him. I had never been to his office and wondered why he wanted to see me. On entering the room, my trepidation increased when I saw the vice president of the university sitting there. They invited me to sit down. The dean asked if there was anything he could offer to make me stay at Stanford. I told him I didn’t think so.
“What about Shumway’s job?” he said.
I was taken aback.
“What does Dr. Shumway think about that?” I asked.
“We haven’t talked to him about it yet,” he responded.
“This conversation’s going no further until he’s in the room,” I said and walked out.
I found Shumway in his office. I told him what had just happened. It was inconceivable to do otherwise. He was furious and stormed off to confront the dean.
I never had another conversation with the Stanford administration.
Saying goodbye to Stanford, and especially to Shumway, was hard. He had been like a father to me. He said again how happy he was for me and how he looked forward to what I would accomplish at Minnesota. He showed me the letter that Matt Paneth had written to him in 1977 asking if he would take me on.
“I don’t know if you can afford to take him,” Paneth wrote, “but I will tell you this: You cannot afford not to take him.”
I drove out of Palo Alto. I was the new chief of cardiac surgery at the University of Minnesota and a full professor. I was going to open the new Minnesota Heart and Lung Institute. I was thirty-eight.
I thought three days on the road in my loaded-down Honda Civic would give me time to get used to the idea of being in Minnesota. The Civic was something of a joke at Stanford. Everybody in Shumway’s group drove some kind of high-end sports car, except for Ed Stinson, who drove a truck. Craig Miller had once asked me to park at the far end of the lot outside the cardiac surgery offices so as to not let the side down.
I spent the night in a motel in Needles, a small town in the Mojave Desert and the last stop in California before crossing the Colorado River into Arizona. I left California with a pang the next morning and drove on through Arizo
na, New Mexico, Texas, Oklahoma, Kansas, and Iowa. It was a surprise to find that the highway in many places was lined with billboards advertising for Jesus. I covered more than two thousand miles in two days. I did stop in Tombstone to visit Boot Hill, its famous cowboy cemetery. I liked the idea of men who fought and died with their boots on—not flat on their backs in a hospital, something with which I was all too familiar. I figured I’d be in for a fight in Minnesota and believed I was ready for it. I had no idea.
I bought a small town house a block from the hospital, to be close to my patients. I moved in, and the next day, in early March 1986, I was at the hospital. Some of the patients waiting on the Stanford list for heart-and-lung transplants who lived closer to Minneapolis than Palo Alto had come with me to Minnesota, with Shumway’s blessing. There was work to do.
My arrival in Minnesota, 1986. With Walt Lillehei (left), who did the first open-heart operations using cross circulation in 1954, and F. John Lewis (center), who did the first open-heart surgery in the world on Jaqueline Johnson in 1952.
One patient who came with me to Minnesota was a twenty-eight-year-old woman named Barbara. She had been a marathon runner, but now had pulmonary hypertension—high blood pressure in the lungs. It’s like putting your thumb on the pulmonary artery. It forces the heart to work harder and harder to pump blood to the lungs, and it becomes enlarged and then progressively fails. Then the kidneys and liver begin to fail. The patient wastes away. The cause of this type of pulmonary hypertension isn’t known. Today we can treat it with drugs, but back then a heart-and-lung transplant was the only hope. Barbara arrived in Minnesota with her husband. They were looking for a place to live and I had a guest room on the lower level of my town house, so I invited them to move in with me. It wasn’t a good decision. Every night when I came home—if I did come home—they’d be waiting expectantly, wanting to know if a donor had been found. They’d already waited several months, and she was fading.
One night I happened to be at home. Barbara’s husband ran up the stairs crying and told me she had collapsed. I went down and found her in bed, on her side. I turned her over, and it was obvious that her heart had stopped. That’s what happens in the end with this disease. The heart simply cannot continue to work against the pressure in the lungs and it arrests. And once it does, there’s nothing to be done. You can’t restart the heart because the problem that caused it to stop is still there. But I commenced CPR anyway, mostly to make the husband feel that something was being done, though I knew it was hopeless. I told him to call 911, and in a few minutes the paramedics arrived and after assessing the situation sent for someone to take the body away. The husband moved out a few days later. I think he was angry with me. I never took in a patient again.
From the beginning, things were different to what I was used to. Most of the good heart surgeons were gone, having either left the state or joined Nicoloff’s group. There was practically no heart surgery being done at the university—something I already knew. When I checked on my promised lab space, I learned it still belonged to a member of Najarian’s group—who refused to get out. Nothing happened in his lab, but the guy wouldn’t move. I didn’t want to make waves so soon, but I wanted what I had been promised. When I spoke to the dean about it, he told me to talk to Najarian. Najarian said there was nothing he could do. I strongly suspected that Najarian could do anything he wanted to. But I decided to let it go and leave my research for later while I worked on building up the clinical practice.
Going into the OR at Minnesota was like going back in time. Surgery was being done the same way it had been twenty years earlier. It was like exploring a canyon in the desert and coming upon dinosaurs. Times had changed, but not here. One thing that especially troubled me was that the scrub nurses were not assigned exclusively to the cardiac unit. One day they’d be assisting on a heart surgery, the next they were in the OR for a brain operation. This was not the accepted standard of care. In heart surgery you need the same people there all the time, so they learn the procedures, which are complicated and have to be executed precisely. Every day I’d explain what we were going to do, and in what order, and with what instruments, and what was expected of everyone involved. The next day I’d have to go through it all again. It was like building an elaborate sand castle at the water’s edge on the beach. When you come back the next day, it’s gone.
It was the same with the anesthesiologists, which was even worse. The chairman of anesthesia had been there since the times when Lillehei and Lewis were in the OR, when cardiac surgery had grown out of general surgery. He didn’t see the need to change. Time had passed him by. I began to get a sense of what kind of struggle I faced. I had always worked in hospitals that were on the cutting edge and were striving for excellence. Minnesota was fossilized.
My main hope was that a new university hospital that was scheduled to open in a few weeks would change the environment. Or at least allow me to change it. The new hospital included two cardiac operating rooms. I soon discovered the new setup was less than ideal. It takes a lot of bulky equipment—including a heart-lung machine—to do open-heart surgery. In most hospitals, the biggest ORs are usually reserved for cardiac surgery. Najarian had designed the operating suite in the new hospital. The biggest operating room had been reserved for him. I looked over the rooms I was being given and decided I could make do.
The Phillips-Wangensteen center was the largest building in the university hospital complex. Thirteen stories high, with two additional floors below, the building housed the Department of Surgery and Najarian’s lavish office. Jay Phillips was a philanthropist friend of Wangensteen. The son of Russian Jewish immigrants, he had started a liquor business in Wisconsin that became the Phillips Distilling Company. Phillips moved the company to Minneapolis in 1935, and by the end of World War II, the company was the largest spirits distributor in the United States. Phillips’s close friend and administrator of his empire was a man named Stanley. I had been in Minneapolis only a few weeks when Stanley was admitted to another hospital in town with chest pain.
In his eighties, Stan had severe coronary artery disease. I was asked to operate on him. I didn’t want to operate in a hospital where I’d never worked and didn’t know anybody. I persuaded Stan to be moved to the university over the weekend and scheduled surgery for Monday. Stan would be to be our first cardiac case in the new hospital.
On Saturday night, Stan developed sudden chest pain and then suffered a cardiac arrest. Fortunately, I was in the hospital at the time. He was resuscitated, and I put in a balloon pump through his leg to augment his cardiac output. I decided to do the surgery right away. I called in the operating room staff, and we started in the early hours of Sunday morning. By three a.m. we had Stan on the heart-lung machine with his heart stopped. Suddenly, the power went out. Emergency lights came on in the OR right away, but the heart-lung machine did not restart. Unless we could do something, Stan would be brain-dead in minutes.
My chief resident started to crank the heart-lung machine pump by hand. This wouldn’t work for long. A technician went off to search for the fuse box and found it in a passageway. A circuit breaker had tripped. When he reset it, the power returned, and I finished the operation with no further interruption.
Stan recovered and became a friend and supporter. It was a start.
I had not been in Minnesota long when I got a surprise. Demetre Nicoloff called, inviting me to lunch. How odd, I thought. The devil himself! I met him at the University Club, a quiet, elegant place on storied Summit Avenue, a street where F. Scott Fitzgerald once lived and which curved along the bluff high above St. Paul. We had a pleasant talk. Contrary to what I had been told, Nicoloff did not have horns or a forked tail. He was extraordinarily decent. At one point he asked me what I thought of Najarian. I told him I felt that we got along well, and that I trusted him.
“I hope you never find out anything different,” he said and changed the subject. I should have seen this as a warning.
Nicoloff o
ffered to help me any way he could and wished me luck in rejuvenating the cardiac program at the university. I was delighted to have a new friend.
After only six weeks in Minnesota, I did my first heart-and-lung transplant. It was on a Thursday, the first of May. At that time heart-and-lung transplants in the United States had only been done at four cardiac centers: Stanford, where most of them had been done by me; the Texas Heart Institute, by Denton Cooley; Johns Hopkins, by Bruce Reitz; and in Pittsburgh, by Bartley Griffith. This was going to be the first heart-and-lung transplant in the Midwest. The surgery created a stir. There were television crews outside the hospital that I was fortunately able to avoid. I had not yet trained anyone to do the donor operation, but by chance my friend Bruno Reichart, from Cape Town, was visiting at the time. Bruno agreed to supervise the donor team.
The patient was Kenneth Jones, a thirty-seven-year-old Minnesotan—about the same age as me and the father of a six-year-old son. Jones had originally been referred to me at Stanford by the Mayo Clinic. He’d been on the list for six months and had come home to Minnesota when I moved there. Ken suffered from pulmonary hypertension. The donor was a young man who had shot himself.
During the operation the telephone in the operating room rang repeatedly—an interruption I always hated. I told a nurse to turn the phone off. Somehow it kept ringing anyway. Finally, the nurse picked it up. She said a man on the other end insisted on talking to me. I walked over to the phone and the nurse held it up to my ear. The person on the line identified himself as the hospital’s chairman of the human subjects committee. He said that the operation I was doing was experimental and that I did not have permission to proceed. I told him that I didn’t consider it experimental, but that in any case we had already started and the patient’s useless heart and lungs had been taken out and were lying in a bucket. He told me to put them back. I nodded at the nurse to hang up the phone. I went back to work wondering if I’d made a powerful enemy. This absurd demand should have been a warning.
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