The Open Heart Club

by Gabriel Brownstein

  The operation was scheduled, but then delayed when Pamela suffered yet another attack of pneumonia. There were other difficulties. Pamela’s mother’s blood type did not match the girl’s. And Pamela’s father, a factory worker, had too low a hemoglobin count. He was anemic. The hospital’s hematologists recommended against his being used as a blood donor. The Schmidts were anxious; they knew about Gregory Gliddens’s death. But Lillehei promised them that his was the only way that their daughter would survive.

  Walt drove a big, shiny Buick convertible. He wore gold jewelry. He cruised the pretty nurses. He had seen martial slaughter in Italy. He had been eviscerated on the operating table and had come back to life. He was on a mission. He was not going to be put off by a hospital administrator, a case of pneumonia, or a previous failure. When Pamela Schmidt recovered from her lung infection, the operation was scheduled to proceed, and Pamela’s father, Ronald Schmidt, was to act as donor. He was five times the size of his little girl.

  Again, two beds were set up in Room II. Again, the patient’s chest was sectioned, and the father was anesthetized. The doctors used the same dairy pump and fresh beer-keg tubing. Lillehei wore no surgical magnification glasses (those hadn’t been invented yet), and he borrowed a headlamp from an otolaryngologist.

  With a stiletto-bladed knife, he punctured the patients’ arteries. Soon two sets of tubing ran between the beds. Little Pamela’s blood ran from her vena cava into the Sigmamotor T-6S and then through a transparent tube into her father’s leg. Blood from her father’s lungs ran through the pump and right into Pamela’s aorta, into her brain.

  Examining the trabeculated wall of little Pamela’s septum, Lillehei found the VSD. He sutured and knotted and sewed the hole shut. There were no other leaks. All was going well, but when he began to close the incision he’d made into the ventricles, Pamela’s heart slowed. The ventricles and atria beat out of time. The coordination of her heartbeat collapsed. Pamela’s heart spasmed out of control, bloodless and sputtering. Then—ninety seconds after it had gone wrong—the heart righted itself and beat normally. The arrhythmia passed as mysteriously as it had appeared. Lillehei made the call.

  “Release the tourniquets!”

  Blood filled the little girl’s heart. Pamela’s heart kept a healthy rhythm. The father and daughter were disconnected from the tubes and the dairy pump. Everything was stable.

  In 1954, professional ethics forbade physicians from advertising themselves to the public. Charles Bailey, when he took his patient on a long train ride to a medical conference in Chicago, had been showboating. John Gibbon, after his quiet victory, had been perhaps overly modest, but he was scrupulously correct.

  Quiet and modest wasn’t Walt Lillehei’s style. The University of Minnesota’s publicity team put together a four-page news release, complete with photos purporting to show Lillehei operating on Pamela. (In fact, the photos were staged, the doctors posing in an autopsy room.) Lillehei called a press conference in the theater of the Variety Club Heart Hospital. He took the stage, commanding and glamorous. He told the sad and difficult story of Pamela’s life before surgery. He showed slides of the pictures from the press release. He showed diagrams of a heart with a VSD.

  He discussed his dog-heart experiments. “We have long felt that there must be some simple way of working inside the heart. When elaborate machines designed as a substitute for the heart and lungs proved unsatisfactory we tried using the animal’s own lungs and substituted the simple mechanical pump for the heart.” He reviewed the failures of his peers and compared his technique to theirs. “Our method,” he said, “is widely applicable by surgeons experienced in heart surgery.”

  The press release was distributed. Little Pamela Schmidt was pushed into the room by her beaming, crying parents. She had ribbons in her dress, big brown eyes, and freshly combed curls. The family posed for pictures with Lillehei. “She’s a little fighter,” Schmidt said of his daughter. “She’ll never give up.”

  The news made the front page in Minneapolis and echoed all over the world. “Impossible Surgery Now Done” was the headline in the New York Times. London’s Daily Mirror called it “an operation as extravagant and fantastic as any ever written in a shilling science ‘thriller.’” The Minnesota chapter of the American Heart Association (AHA) named Pamela Schmidt “the Queen of Hearts” and in its publicity materials showed pictures of her riding on a tricycle. Senator Hubert Humphrey sent Pamela a birthday card.

  During the spring and summer of 1954, Walt Lillehei was the only person in the world performing cardiac bypass surgery. Through the summer, his success rate was strong. Six out of eight patients survived the surgery and thrived. He was the most famous heart surgeon in America at the time, and desperate parents drove their children to Minneapolis, hoping he would save their kids. Money rolled in from private sources like the Variety Club, from public charities like the AHA, from the Minnesota state government through the university, and from the federal government, where Walt’s new buddy Hubert Humphrey worked. Lillehei became more and more ambitious. In late August, he moved beyond ASDs and VSDs and attempted a full correction of a tetralogy of Fallot—the first attempt ever at a complex congenital heart defect.

  The patient was Mike Shaw, a ten-year-old whose divorced mother worked in a Minnesota poultry-processing plant, cutting the wings and legs off chickens. Mike was so cyanotic that he could barely walk. His mother couldn’t afford a car, and so she pulled her boy around in a red wagon. Doctors had scheduled Mike for a blue baby operation at University Hospital; they could safely put in a Blalock shunt and potentially give the boy new energy and years of life. But Lillehei intervened. He offered to cure the boy entirely, but he said it had to be one or the other: if they chose the blue baby operation, then, Lillehei said, he would not be able to justify signing the boy up for a cross-circulation.

  Mrs. Shaw decided to go for the promised total cure.

  Unfortunately, her blood type didn’t match Mike’s, and neither did Mike’s father’s. Mike was AB negative—only one in a hundred people would match him—but with the help of the hospital, the AHA, and the Blue Cross, Lillehei found a potential donor, Howard Holtz, a twenty-nine-year-old highway worker and father of three boys.

  Lillehei told Holtz that the surgery was the only chance to save the boy’s life. Holtz agreed to participate. “I just wanted to do what I hope someone would do if my child were a blue baby.” And he lay down on the bed in the hospital room next to little Mike Shaw—Mike with his chest sawed open and Holtz drugged and stripped and shaved. The tubes were attached. The dairy pump started churning. “The following day,” wrote Mrs. Shaw in her journal, “we noticed the color returning to [Mike’s] lips and fingernails and ears. He was turning a nice rosy pink.”

  Lillehei scheduled a report of his success for December at the next gathering of the American College of Surgeons in Atlantic City. He was going to show that cross-circulation was a solution for even complex deformities. But then, Lillehei’s luck turned. On September 7, just a week after the tetralogy of Fallot operation, he lost a patient. A seven-month-old girl died of heart block on his operating table. The following week, he lost another. Then another. Over a period of nine weeks, Lillehei performed eight operations, with six fatalities.

  On October 5, he lost his first blood donor. Geraldine Thompson had taken her daughter to see heart specialists in Boston and Colorado and Texas before she settled on Lillehei. She’d met with Denton Cooley and Robert Gross. Her eight-year-old daughter Leslie had a VSD and had undergone any number of X-rays, catheterizations, and examinations. On October 5, 1954, Geraldine and Leslie were lying side by side in the operating room, connected to the Sigmamotor T-6S. Something went wrong. The anesthetist hadn’t connected the pump and tube correctly. A technician noticed air bubbles heading into Geraldine Thompson’s thigh. At the sight of the air bubbles, Lillehei cancelled the surgery, closed the patient’s chest, and detached the mother from the device. But it was too late. Geraldine Thompson
’s heart was beating, but the air bubbles had met her brain, and she would never wake up again. Her mind was wiped clean and empty.

  That December, Lillehei took the stage at Atlantic City to report his tetralogy of Fallot triumph. On stage, he was his usual charismatic, assured, and enthusiastic self. But the audience knew. Lillehei was heckled.

  “Admit that you have a vegetable in the hospital!” someone screamed.

  Helen Taussig, told that Lillehei had succeeded with a tetralogy patient, said, “Too bad, now, he’ll continue.”

  Lillehei did continue. All his patients were not treated equally. Calvin Richmond was a black sharecropper’s son in Little Rock, Arkansas, whose parents could not afford to send him to Minneapolis. A local charity drive run by newspaper and TV raised $3,000 and sent him to Lillehei. The Arkansas Air Guard flew the thirteen-year-old boy to Minnesota. “I wonder if he recognizes what preparations have already been made for him ahead,” wrote a reporter.

  Unfortunately, Calvin’s blood type didn’t match his mother’s, and no one else would act as a donor for the boy. The team at Minnesota looked to the local prison for volunteers, but no white person would allow their blood to mix with a black child’s. No black donor seems to have been approached. As a result, Lillehei’s team used a dog lung for Calvin—something closely resembling the apparatus William Mustard had set up with monkey lungs in Canada. The Washington Post trumpeted the news: “Heart Mended as Lung of Dog Aerates Blood.” The boy survived. It was one of the last cross-circulation operations to get national attention.

  John Kirklin wore his hair in an odd Caesar-style cut, with abrupt bangs high on his forehead. A tall, thin, pale man with a narrow face, large glasses, and a small, flat mouth, he was decorous and precise. At the Mayo Clinic, an hour-and-a-half drive from Minneapolis, he viewed what was happening at Variety Club Heart Hospital with some skepticism. Later he said, “I think the medical world… intuitively knew that the cross-circulation technique was not going to be widely accepted and/or used. Against that background there was no other alternative but to go with the heart-lung machine.” Kirklin visited Philadelphia to see what Gibbon was doing. He went to Toronto to see Mustard. He visited Dewey Dodrill in Detroit. “Dewey Dodrill’s machine was built for him by General Motors, and it looked like it—it looked like a car engine,” Kirklin said. “Dr. Gibbon’s machine had been built by IBM, and it looked like it—it looked like a computer.” Kirklin built a machine of his own.

  In March 1955, he began lining up patients. His first bypass surgery was successful. His second was not. Kirklin performed eight open-heart surgeries on patients with holes in their septa. He had a 50 percent mortality rate and published the results in the Mayo Clinic Proceedings. Almost simultaneously, Lillehei’s assistant, Richard DeWall, developed a simpler oxygenator.

  The story, probably apocryphal, is that DeWall and Lillehei came up with the idea of a bubble oxygenator in a bar, looking down at a glass of beer. Why not just fill the blood with oxygen, DeWall asked, just aerate the blood with bubbles and then let the bubbles filter out? He built the device with the same Sigmamotor T-6S dairy pump plus some stuff he’d found in the lab and $15 of odds and ends: a cork, a coil of beer-keg tubing, some narrower tubing he scavenged from a mayonnaise factory, a reservoir, two needles, and two filters. The blood was filled with bubbles of oxygen, then sent through an antifoaming agent and down a long, helix-shaped coil of hose. The extraneous oxygen floated to the top, and the bubbles burst. The oxygenated blood then ran into a reservoir and then into a tube that went into the patient’s aorta. The device, the DeWall Oxygenator, was a success, and by August 1955 Lillehei had stopped using cross-circulation entirely.

  More and better machines came to market. In 1957, Denton Cooley finished his own prototype, a three-chambered device that looked like a percolator and was dubbed “Cooley’s Coffee Pot.” In the first four months after its completion, Cooley in Texas did thirty-nine bypass operations. By the end of the year, he and his Texas colleagues had performed 137 open-heart operations, the most anywhere in the country. That same year, Kirklin published his textbook, Cardiac Surgery. The age of heart surgery had begun.

  35.

  IT WAS SEPTEMBER 2000. George W. Bush had not yet been elected president. I was out in front of the library on the paved concrete campus of the State University of New York at Stony Brook. I was eating an ice cream sandwich. My friend Astrid sat with me, drinking a cup of tea. We were enjoying the sun.

  I was a man returned from the dead. I was jogging a few times each week. I was practicing yoga. I told a joke that no one else thought was funny: I’m in training for my next open-heart surgery. (Rim shot. Silence.) Eliza had grown curly hair and chubby cheeks and walked around on little, spindly legs. My stories appeared in little magazines. Literary agents wrote me. I was putting together a manuscript. The value of our Brooklyn apartment tripled, and we were looking to sell. We were browsing houses a dozen blocks away, where the neighborhood got a little less ritzy. We decided to have a second child. I said to my friend Jeff on the phone, “If this is it, if there is no more success at all, I’m okay with it.”

  Astrid laughed. I checked my watch. The trains back to Brooklyn left every few hours. If I missed the 4:40, I wouldn’t get home until nearly midnight. But we still had a few minutes. Astrid, a stylish and fit older woman with trim gray hair, started telling me about her daughter’s life. Her family all seemed to me charmed and successful and brilliant and gorgeous, but she explained that her daughter’s boyfriend had a grave health problem. She was describing this illness to me, and I was leaning in to listen, when all of a sudden I found that I couldn’t follow her words at all.

  Something in my body had shifted, like a reversal in the poles of my electricity. My skin buzzed. I was lightheaded. There was a strange ferrous taste in my mouth, like the charge of a small battery.

  “What is it?” Astrid said.

  “Nothing,” I told her, but the change must have registered on my face.

  I said, “Don’t worry.”

  My heart was slamming against my ribs. I stood up, experimentally, to check my balance. Standing felt okay. I told Astrid what was happening. She told me to sit back down.

  Astrid is a poet and a translator and a potter and a physical therapist, the wife of a prominent biologist, a mother of two young adults. She is a woman twenty years older than me, a woman to trust in a moment of crisis, but I dismissed her concerns. I checked the time. It was a long way from the library to the station. I had to catch my train. I said good-bye. I started on my way. She insisted on accompanying me.

  We went down the stairs of the library, across one of the narrow roads that bisected the campus, and down a second narrow set of stairs toward the path that led to the playing fields and baseball diamonds. The kicker on the football team was practicing. Footballs spun end over end against the polarized sky, then down through the uprights. My heart was trying to break out of my chest.

  I felt no pain, and I tried to deny my panic, but the symptoms of my arrhythmia were the same as the symptoms of panic: the heart racing, the lightheadedness, and the stupidity. As my heart went wild, my brain went white. Mind and body ran in opposite directions, leaving the rest of me in the existential lurch. It was like a twinge in the knee, I told myself. It would pass.

  But it didn’t pass. We got to the train platform, a piece of raised concrete by a two-lane blacktop in the part of Long Island where the air smells like the salty bay. There was a convenience store across the street and a pay phone by the little steps of the platform. Astrid urged me to sit, to rest, and not to board the train.

  “Call Marcia,” she said.

  “Okay, okay,” I said, as though she were the one acting hysterical.

  With Astrid by my elbow and nervously watching, I picked up the pay phone, dialed home, and admitted to Marcia that my heart was pounding. Astrid thought I shouldn’t get on the train, I said, but really everything was fine. It had happened before, I admitted. N
o big deal. It had always gone away. Everything would be okay. I didn’t want to miss my train. There it was, headlight in the distance, horn sounding as it got closer.

  I told Marcia that I felt fine.

  “You’re probably right,” she said. “It’s probably nothing. But if it keeps going, get the conductor.”

  The train whistled and braked, metal wheels screeching. I hung up the phone. Astrid said I shouldn’t get on, no matter what Marcia had told me.

  “Don’t be reckless,” she said. “Be safe.”

  But apart from the panic in my head and the pounding in my chest—both of which I was doing my best to ignore—I felt perfectly fine. The train doors opened. I got on board, leaving Astrid disconsolate on the platform.

  I found a bench of three unoccupied seats. Stony Brook is the second-to-last stop on the ride the whole length of Long Island to New York City. I carried a portable CD player, headphones, and a wallet of music. The conductor punched my ticket. I lay across the length of the bench, put on some string quartets, laid the CD player on my savage breast, and watched it bounce to the crazy rhythm of my tachycardia.

  The stations went past. St. James. Smithtown. In those days all the posters were for new internet businesses. Wines.com. Pets.com. The whole world was floating in imaginary money. Kings Park. Northport. The landscape shifted from rural to industrial. The conductor walked by my seat. I promised myself that if the attack didn’t stop soon, if my heart didn’t slow by the next time he passed, I’d stop him and tell him I wasn’t feeling well.