The Open Heart Club

by Gabriel Brownstein

  Plate XIX is tetralogy of Fallot. Eleven images are squeezed onto a single plate: two schematic line drawings, two diagrams demonstrating the results of medical tests, a couple of EKG readings, an X-ray, and four delicate illustrations of cross sections of the deformed heart. The facing plate includes a short introduction, two or three inches of knotty prose, and then annotations of all eleven images. Between the introduction and the annotations runs a band of smaller text, a list of sixteen references for further study. Tetralogy of Fallot, she says, “is also the most important [defect] from the clinical stand point” because of its frequency and also because patients suffering with it can survive into their teenage years.

  “The whole appearance,” she writes in her dense, rapid-fire prose, “is highly suggestive of the relationships that would result from the uncovering of the right reptilian aorta and obliteration of the left in the delayed torsion of Spitzer’s theory (his types I and II of transposition) and is of great interest in this connection.” There’s little room for elaboration. This book wants to be a museum, a museum that wants to be an encyclopedia, and it seems to carry its own delayed torsion, its own power, and a sense of embattled growth of intellectual life, an intelligence overflowing the arbitrary boundaries that try vainly to restrain it.

  These knotty sentences are the beginnings of pediatric cardiology. With her atlas, Maude Abbott brought congenital heart disease out of obscurity and into serious study—carrying kids like me out of darkness and into the light. Her book (no exaggeration) saved my life.

  20.

  SO, AFTER I got the letter from Dr. Freed and canceled my catheter exam, I stepped out of my morning shower and heard that message on my answering machine: “It’s Dr. Rosenbaum, calling about your heart.” I went to work without calling him back.

  Barnard College had been nice to me, and while I taught there on an adjunct basis, I was given use of the office of a distinguished professor currently on leave. So on the first day of school, I had the key to a beautiful book-lined room, and a big desk with framed black-and-white photographs of the distinguished professor’s children, and a leather swivel chair and windows overlooking the quad. I sat in the well-appointed office and picked up the phone. I told Dr. Rosenbaum’s secretary that I was returning the doctor’s call. Then I went to the photocopier. I looked like an academic. I wore a blazer, and I carried a notebook and a copy of Emily Dickinson’s poems. Photocopies made, I went back to my borrowed office and stared hard at the telephone, waiting for it to ring. I drank an entire sixteen-ounce bottle of seltzer, and then I was late to class.

  In the hall, I ran into the novelist Mary Gordon, someone whose books I’d read and admired but whom I’d never before spoken to. She stopped to chat and introduce herself. She wondered what books I’d assigned for my class. She ooh-ed and aah-ed at my choices. She asked after my writing, and I asked after hers, and then I was so distracted and insecure that I didn’t stop at the bathroom to urinate.

  Around the big seminar table sat sixteen bright young women, all ready for their first day of college. I went through the syllabus with them and asked them to introduce themselves.

  “Say your name and something you’d want the class to know about you,” I said. “Something interesting or funny or just something you feel okay telling us all. Let’s go around the room.”

  I heard the sighs. Everyone hates to go around the room. The nervous ones announced their hometowns. The cute ones talked about their pets. The pretentious ones mentioned Fyodor Dostoevsky. Then it was my turn.

  “I’m Gabe,” I blurted, “and I’m not a real professor.”

  Before the words came out, they seemed reasonable—or at least honest: their families were paying tens of thousands of dollars for the privilege of their sitting in that room with me. But once spoken, the words hung in the air like a fart.

  “What do we call you then?” one student asked.

  “Gabe?” I suggested. “Gabriel? Mr. Brownstein?”

  “How about Comrade Brownstein,” said my new favorite. Let’s call her Olivia. Olivia had tiny features, freckles, a wide face, and a gigantic smile.

  “Comrade Brownstein,” I agreed. She had rescued me. We got to the Dickinson poem “I like to see it lap the Miles.” We read it aloud, a student for each stanza. I asked for vocabulary questions.

  Once all the words were nailed down, we read the poem a second time. I kept spacing out, thinking of the big, black Bakelite telephone on the distinguished professor’s desk, imagining the ring and, on the other end, Marlon Rosenbaum. Also, I had to pee.

  The students got to work on the poem’s famous riddle. They wanted to know what the “it” was that lapped the miles and licked the valleys up. Some kind of monster? God? Jesus? Sex? I urged them to go slowly. What would “neigh”? What would have a “stable door”?

  “A horse!” someone cried.

  “Why is she writing about a giant, angry, valley-destroying horse?”

  I threw out a question in return: “What’s a ‘horrid, hooting stanza’?”

  “It’s a train!”

  Bingo! Elation!

  And then for an awful moment I felt there was nothing left to say. All sixteen ounces of soda bubbled in my bladder. I reminded my students that in the mid-nineteenth century, the train was a new, anomalous thing. I asked about the words “I like” at the start of the poem.

  “It’s not a train,” said Olivia, intently, big smile gone from her freckled face. “Or it’s a train but it’s not a train. If it was a train, she would just say it was a train, but the whole point of the poem is that she can’t speak it. It’s the thing you just can’t say, and when she says she likes it, she doesn’t mean she likes it at all. She likes to watch it. Or that’s what she says.”

  I stood. Sixteen pretty expectant faces looked up at me, as if I could extend or explain Olivia’s point.

  “I gotta go,” I said.

  I handed out the assignment sheet and dashed out of the room, down the hall for a toilet. When I closed my borrowed office door, I was sweating. I sat down in the big chair. I stared at the phone. When it rang, it startled me.

  “You can’t cancel today,” said Dr. Rosenbaum. “We’ve got the cath lab set up. Everything’s scheduled. You can’t call up the day before and say no.”

  I just got Freed’s letter, I explained. How could I have called earlier when I just got that letter Sunday?

  “Dr. Freed wrote a long letter.” He sighed.

  “He said I should wait. I don’t want to take the risk.”

  Dr. Rosenbaum assured me the procedure was safe. “We do this on people who are moribund, Gabriel. Moribund.”

  I was getting frustrated. “I can’t do it if he said no.”

  “What do you want?”

  “I want time to think about it. To talk about it.”

  His patience snapped. “We have talked about it a lot.”

  I hung up. As a patient and doctor, we seemed done.

  That night, I went to a party for a colleague who taught with me at my other adjunct job, at Parsons School of Design. The chair of my department at Parsons was there, along with the rest of the liberal arts faculty. There was a stack of handsome volumes of poetry and an open bar, and I started on gin and moved to whiskey. I flirted recklessly with a redheaded actress/model and got so drunk I vomited in the toilet. The redheaded actress/model took pity on me and helped me into a cab, and when I got home, I knew that I would never see her again.

  I woke up with a dry mouth and a head like an egg whose yolk had been replaced with mercury, an egg that had to be held very carefully because at any moment it might split, and the goop within would go spilling all over the place. I drank water and coffee and took Tylenol and ate eggs, and my head swelled and shrank. There was a message on my answering machine, the same one I had heard the morning before.

  “It’s Dr. Rosenbaum,” it said, “calling about your heart.”

  21.

  HELEN TAUSSIG ENTERED the lab carrying
a small cage with a cat in it. She turned on the lights, put on a smock, and tied up her hair. There was no one in the room but her. It was 1923. In US medical schools and hospitals, congenital heart diseases were not being studied or diagnosed, let alone cured. Taussig was twenty-six years old.

  She had been loaned this laboratory at Boston University. She was not a student there, or a doctor, or a technician. She had no assistants. She had no salary. She was working in a purely amateur capacity.

  She set out her instruments: her scalpel, scissors, flasks, lever, saline solution, digitalis, adrenaline, and oxygen tanks. She prepared a syringe, filled it with the necessary dose of chloretone, and opened the cage, gripping the mewling cat by the nape of its neck and murmuring to it sweetly. She jabbed her needle into the animal’s belly, careful not to hit the liver or any other major organ. The cat convulsed. It kicked and flashed its claws. Twenty minutes later, it was deeply anesthetized. Thirty minutes later, it was dead. Taussig jotted down the time of death in her notebook: 2:40 p.m.

  She took out her scissors and snipped open the cat’s belly, cutting through the blood-matted fur. She excised the heart. With her scalpel, she cut it free from the great arteries. Then it was in her hands, a cat’s heart, the size of a plum. She placed it in a warm bath of 75 ccs Tyrode’s saline solution and marked the time: 3:40 p.m. As the heart lay in its bath, the dead ventricle began slow, definite contractions.

  Carefully, Taussig segmented off a strip of muscle fiber. She held it with a clip specially covered with paraffin and attached the clip to a glass hook. She attached the hook by fine threads to her lever and then gently lowered her strip of muscle fiber into a new flask of saline solution, this one mixed with cat blood. The muscle strip began to contract in strong, alternating pulses. The beating continued for nearly fifty minutes. When the beating stopped, at 4:40 p.m., Taussig administered a solution of 1:1000 P&D adrenaline chloride to the flask. One tiny, calibrated squeeze from the glass dropper, and the muscle beat in short, jerky rhythms. Five minutes later, the effects of the adrenaline passed. Now, Taussig administered five drops of digitalis and watched the muscle fiber work for a full half hour more. Then she looked at the clock. It was 5 p.m. She bundled and disposed of the cat corpse and soaped and sponged down the tables. At 5:15 p.m., when she had to leave the lab, the little strip of ventricle muscle was still beating.

  Taussig had tried to gain admission to Harvard Medical School, but because she was a woman, she had been refused. She’d tried to attend the School of Public Health and was told a woman could attend classes but could not receive a diploma.

  “Who is going to be such a fool as to spend four years studying and not get a degree?” she asked the dean.

  “No one, I hope,” he replied.

  “I’ll not be the first to disappoint you,” said Taussig. “Good afternoon.”

  At lectures at Harvard, she was forced to sit in the back row of the auditorium. When the medical students examined slides, Taussig and her microscope were put in a separate room.

  “So I wouldn’t contaminate the other—male!—students,” she remembered.

  She set out on her independent research through the help of a friendly professor at Boston University and began investigating the beat of the heart muscle. She prowled the morgue and the hospital for subjects. A patient died at 2:30 p.m. one afternoon, and by 5:30 p.m., Taussig had the man’s heart in her lab. By 5:50 p.m., a strip of his ventricle was on a glass hook, tied by a linen thread to a lever. In 1924, Helen Taussig’s first academic article was published, “Rhythmic Contraction in Isolated Strips of Mammalian Ventricle,” in the American Journal of Physiology.

  Taussig, unaffiliated with any medical institution, was the first to discover that “isolated strips of mammalian muscle” could “give spontaneous rhythmic contractions after simple immersion in oxygenated solution.” This was the level of achievement required, in 1924, for a woman to get into medical school. Johns Hopkins, at the time of its founding, had accepted a large donation from a group of wealthy women and in return accepted ten female applicants each year. (“In effect,” as historian Paul Starr puts it, “American women were forced to buy their way into elite medical education.”) Taussig went off to Baltimore and began her career.

  In 1924, there were no organized descriptions of congenital heart defects. It was a decade and a half before Maude Abbott published her atlas. In 1924, no one was interested in diagnosing children with defective hearts because no one believed those children could be cured—least of all Helen Taussig. But she was a remarkable woman, born to a remarkable family.

  Her paternal grandfather, William Taussig, a Jewish immigrant from Prague, had been a chemist who became a doctor, and a mayor, and a judge. He was a friend of Ulysses S. Grant, and during the Civil War, Judge Taussig served in the Union Army. When a band of Confederate terrorists led by Bloody Bill Anderson overthrew an insane asylum in Fulton, Missouri, Judge Taussig got on his horse, guns and medical supplies in his saddlebags, and rode a hundred miles. Arriving in town, he organized a volunteer posse, and he gathered the lost patients together and loaded them into farm wagons. Without military escort, he led the wagon train through a territory wild with guerrilla warriors—Quantrill’s raiders were out there and men like Frank and Jesse James, murderers and rapists and sadists whose most grotesque exploits were celebrated in the rebel press. Taussig guided his patients to Mexico, Missouri, and loaded them on a train for St. Louis.

  William’s son Frank was a large, handsome boy who played basketball and rowed crew at Harvard, graduated a year early at the top of his class, completed a PhD in economics, and married Edith Guild, a wealthy New England girl with two degrees in botany from Radcliffe. They bought a big Victorian house in Cambridge, a few blocks from the university. You can still see it, painted white and gray with high hedges that surround its generous lawn. Except for the satellite dish, it probably looks like it did in 1898, when Helen Taussig was born, their fourth child and third daughter. Frank Taussig was the chair of the economics department at Harvard, one of the most influential economists in the country—he helped settle the terms of surrender in the Treaty of Versailles.

  Helen’s first scientific interest was botany. She examined the pistils and stamens of the gladioli in her mother’s flower garden and used a magnifying glass to look into the parts of the geraniums. With her father, she planted seeds and tended a vegetable garden. Frank Taussig taught all his children German and music. They took picnics in the countryside and had a summer home in Cotuit in Cape Cod. When Helen was three, her father suffered a nervous collapse. Frank Taussig left his wife and children and spent two years in Europe recovering. Not long after his return, Edith Taussig came down with tuberculosis.

  For two years, she coughed up blood. Frank Taussig had an elevator installed in the house, with big rope pulleys so servants, nurses, and doctors could heft his wife up and down between the second and first floors. Young Helen found herself struggling at school. Letters played tricks on her. They reversed themselves, p’s turned into q’s, b’s into d’s, d’s into q’s and back again. The orders of letters dissolved and reorganized. She saw no difference between the words dread and bread and beard. Dyslexia was not a common diagnosis then. To her teachers, Helen seemed slow and stubborn. They forced her to stand and read in front of the class, and she suffered panic attacks, sweats, stomach cramps, and trembling. She’d get it wrong, and they’d ask her to do it again, and she would burst into tears and go running home, where her bed-bound mother was coughing up blood. Her father would tend to Helen.

  The chairman of the Harvard economics department sat with his youngest daughter night after night, going through her homework, helping her with her French verbs, reading with her slowly and carefully, while his wife lay dying upstairs. When Helen was eleven, she became tubercular too. She had to sleep on the porch of the house—the fresh air was thought to be good for her lungs. From the upstairs open windows came her mother’s coughing, and from all around, t
he sound of Cambridge at night. Edith Taussig died. Helen, after two and half years of sickness, recovered.

  As an adult, she liked to sleep on porches. She liked to say that childhood sickness had taught her “a sound lesson in how to economize one’s strength and an understanding of those who did not have it.” At Radcliffe, she played basketball and volleyball. When her father remarried, Helen moved across the country to California. She finished school at Berkeley. She liked to hike in the hills and look down at the harbor.

  Although Johns Hopkins admitted ten women each year, it only awarded one graduate internship per graduating class. In 1927, a competing female student had a GPA two-tenths of a point higher than Taussig, and that was it: no internship for Helen Taussig. Her career had hardly started, and on a second important occasion she had been knocked to the side on account of her sex. After graduation, she left Baltimore for a period of wandering, part-time positions. She went to New York and to Boston.

  Dr. Edwards Park, one of her professors at Hopkins, wanted to hire her for a position that interested no one else: running the dispensary at the Harriet Lane Home, a new clinic for the study of children with heart disease, mostly kids with scarred valves due to rheumatic fever. Taussig seemed to prefer no job at all to a job looking after those heart-sick babies.

  “The field does interest me,” she wrote Park, politely declining his offer, but “my experience in dealing with acute cardiac conditions in children is virtually nil.” And “I do appreciate the opportunity that it offers to me, but my feeling is that I do not offer it enough to make it the success I want to see.”