by Jim Murphy
Contents
* * *
Title Page
Contents
Copyright
Dedication
Epigraph
Preface
In the “Dog House”
The Professor and His Assistant
Surrounded by Failure
Answered and Unanswered Questions
The Search
“All the World Is Against It”
“Vivien, You’d Better Come Down Here”
Then What Happened?
Acknowledgments
Source Notes
Bibliography
Picture Credits
Index
About the Author
Clarion Books
3 Park Avenue
New York, New York 10016
Copyright © 2015 by Jim Murphy
All rights reserved. For information about permission to reproduce selections from this book, write to [email protected] or to Permissions, Houghton Mifflin Harcourt Publishing Company, 3 Park Avenue, 19th Floor, New York, New York 10016.
Clarion Books is an imprint of Houghton Mifflin Harcourt Publishing Company.
www.hmhco.com
The Library of Congress has cataloged the print edition as follows:
Murphy, Jim, 1947–
Breakthrough! : how three people saved “blue babies” and changed medicine forever / Jim Murphy.
pages cm
Audience: Age 9–12.
Summary: “The story of the landmark 1944 surgical procedure that repaired the heart of a child with blue baby syndrome—lack of blood oxygen caused by a congenital defect. The team that developed the procedure included a cardiologist and a surgeon, but most of the actual work was done by Vivien Thomas, an African American lab assistant who was frequently mistaken for a janitor”—Provided by publisher.
ISBN 978-0-547-82183-2 (hardback)
1. Thomas, Vivien T., 1910-1985—Juvenile literature. 2. Blalock, Alfred, 1899–1964—Juvenile literature. 3. Taussig, Helen B. (Helen Brooke), 1898-1986—Juvenile literature. 4. Surgeons—Maryland—Biography—Juvenile literature. 5. Cardiovascular system—Surgery—Juvenile literature. 6. Heart—Surgery—Juvenile literature. I. Title.
RD27.35.T46M87 2015
617'.0232—dc23
2015013601
eISBN 978-0-547-82188-7
v1.1215
To my childhood physician, Dr. George F. Simms, who traveled to his first patients via horse and buggy and was still practicing medicine seven decades later,
and
To my present GP, Dr. Michael A. Parziale, who is highly knowledgeable and informative and does his work with easy grace and humor
There are men and women, but not a great number, created for the service of Medicine: who were called to be doctors when they were not yet called to be babies.
Dr. Stephen Paget, 1908
Preface
THE cast-iron radiator in Johns Hopkins Hospital operating room 706 rattled and hissed but didn’t give off much heat on the morning of November 29, 1944. Outside, a miserable, cold rain was falling, allowing only a feeble bit of gray light to seep through the room’s large windows.
The somber atmosphere was matched by the mood of the surgeon, Dr. Alfred Blalock, and the seven other people who made up his surgical team. And for good reason. The patient they were about to operate on, Eileen Saxon, was eighteen months old and weighed only 8.8 pounds. Eileen had a severe congenital heart defect that made it difficult for her to breathe and turned the skin on parts of her body an unhealthy-looking dark color. Dr. William Longmire, assisting Blalock that morning, was absolutely horrified by what he saw. “I took one look at the little patient and thought, ‘My God, this man isn’t going to operate on her!’ I thought that after [the initial] incision . . . this child would surely die.”
Others had worried that simply administering the anesthetic might kill Eileen. Dr. Austin Lamont, the chief of anesthesia at Johns Hopkins, felt the girl’s health was so fragile that he refused to assist Blalock.
No doctor who examined the girl would have disagreed with Lamont’s assessment. Eileen was gravely ill and about to die. But Blalock and the head of the Children’s Cardiac Clinic, Dr. Helen Taussig, had argued that it was precisely because she was so close to death that the surgery was necessary. Eileen’s condition was rapidly deteriorating, they explained. She might live for a few hours, possibly even a day, but probably not much longer. The operation, if successful, was the only way to prolong her life.
The procedure was allowed to go forward, but the words “if successful” haunted Blalock. Responsibility for the operation and for Eileen’s life rested squarely on his shoulders. Self-doubt had been nagging at him since he’d first scheduled the surgery a few days before. At one point, he grew so upset over some research experiments that hadn’t gone well that he blurted out to Longmire, “Bill, I am discouraged. Nothing I do seems to work these days.” His lack of confidence had been following him everywhere and at all times. The night before the procedure Blalock had a difficult time sleeping; the next morning he was so distracted and nervous that he decided he couldn’t drive safely and asked his wife to drive him to the hospital.
It wasn’t only that the operation was very complex and risky. The surgery he was about to perform on Eileen’s struggling heart had never been done on a human before, let alone one so tiny or frail. This was why the balcony-type observation stand along the west side of room 706 was packed with curious Johns Hopkins staff and why a movie camera had been set up pointing at the operating table. If the operation worked—if the patient survived—history would be made.
Moreover, Blalock had never performed this procedure, not even on an experimental animal. In fact, the only person to have done it successfully, start to finish, wasn’t an official member of the surgical team. According to hospital rules, he wasn’t even supposed to be in the room. But he was there now, at Blalock’s request, standing just behind the surgeon on a wooden step stool. His name was Vivien Thomas, and most people at the hospital thought he was a janitor.
CHAPTER ONE
In the “Dog House”
VIVIEN Thomas took one look at the old Hunterian Laboratory on the Johns Hopkins campus and his heart sank. The building was squat and dour looking, an unruly growth of vines barely covering an undistinguished brick exterior. The interior was no better. The walls were painted a “drab hospital-green,” Thomas remembered, and “[Dr. Blalock and I] were greeted by the odor from the [experimental] animal quarters in the basement. No wonder people referred to the building as the ‘dog house.’”
Thomas had mixed emotions about following Blalock to Johns Hopkins University as his research assistant in 1941. The city of Baltimore was teeming with activity because the United States would very soon be at war with Germany and Japan. In addition to being a major seaport, Baltimore was a center of shipbuilding and steel production, both important industries during wartime. “Baltimore was one of the busiest cities in the country,” Thomas noted. “Jobs were plentiful and people were coming from all over the country to fill them.” The arrival of thousands of workers and their families had resulted in a severe housing shortage.
Vivien Thomas with his wife, Clara, and their daughters, 1941.
Thomas and his wife, Clara, had grown up in “individual dwellings with lawns and trees that allowed for some outdoor living—what I called a little elbow room.” The Thomases were unable to find such a place in Baltimore. Rental houses of this type were unavailable, not just because the recent influx of workers had made housing scarce, but because Thomas and his wife were African American. Real estate agents simply refused to show them houses in all-white suburbs.
Racial prejudice and segregation weren’t ne
w experiences for Thomas and his wife. They had always lived in the South, first in a moderate-sized Louisiana town near the Gulf of Mexico, then in the larger city of Nashville, Tennessee. Both states had oppressive Jim Crow laws on the books, statutes that kept African American citizens separate from their white counterparts. Public bathrooms, restaurants, trolley cars, schools, hospitals, cemeteries, swimming pools, drinking fountains, prisons, and even churches existed for whites and blacks, but never for both together. Even with these unfair restrictions in place, Thomas had always been able to rent a real house with a yard. Until, that is, he got to Baltimore.
Thomas had been hoping that Baltimore, being farther north than any other city he’d lived in, would be somewhat more tolerant. Sadly, as the historian C. Fraser Smith points out, “There was little difference from the deep south. There were just as many exclusions for black people in Baltimore as anyplace else.” A glance around Johns Hopkins would have told Thomas this: every bathroom was clearly marked either WHITE or COLORED.
When Thomas moved to Baltimore, the city was strictly segregated. Most amenities and facilities were clearly marked for who was allowed to use them. Even buying a soda from the wrong machine could lead to arrest or violence.
Frustrated and annoyed, Thomas was forced to search for an apartment in the “congested, treeless, grassless” inner city. “Many of the apartments that bore ‘for rent’ signs could hardly be classified as fit for human habitation,” Thomas complained. “I finally found an apartment which was really marginal as living quarters, but I decided to take it with the hope of finding something more suitable [at a later time].” It would take Thomas and his wife more than a year to find a larger, nicer apartment.
Now he and Blalock went up the stairs at the foul-smelling Hunterian Laboratory where they would work. Thomas found their spaces a dirty wreck, with peeling paint, old, rusty pipes, a thick layer of dust on countertops, broken glass and wadded pieces of paper on the floor.
The Hunterian Laboratory at Johns Hopkins, referred to as the “dog house” because it smelled so awful.
Thomas nimbly slid his tall, thin body around the dirty tables, benches, and chairs. He ran his long index finger along the surface of a table, looked at the sooty dirt gathered on his fingertip, and shook his head in disgust. There was no excuse for such neglect and filth, especially in a medical research laboratory.
After they discussed the dilapidated condition of the laboratory and office, Blalock asked Thomas to clean up the space and paint the large classroom-laboratory and two smaller adjacent rooms a lively color. Having already worked for Blalock at Vanderbilt Medical School in Nashville for more than eleven years, the thirty-one-year-old Thomas had long ago outgrown this sort of menial job. But, he recalled, “I would have agreed to almost anything to change what, to me, was a depressing and almost revolting atmosphere. If he had suggested tearing the building down and erecting a new one, I would have gladly accepted the challenge.”
There was nothing modern, sleek, or hygienic about most research laboratories when Blalock and Thomas started at Johns Hopkins.
Thomas set to work during the steamy hot months of July and August, painting the walls, cleaning and waxing the grimy floors, washing windows, piling trash in the garbage can—doing anything he could to spruce up the lab. He was also trying to assemble up-to-date equipment so that he and Blalock could resume their research.
While he was ordering two vital items for experimental surgery, Thomas encountered the same prejudice he had met while house hunting. To get new equipment, Thomas had to submit requests to the director of the laboratory, Dr. Edgar Poth. Poth was extremely civil to Thomas, but he refused to order the items requested. When Thomas tried to explain why he and Dr. Blalock needed the equipment, Poth cut him off sharply and pointedly told him that he would have to make do with what was already available. Poth added that he did not want to discuss the matter with Thomas again.
“I did not feel it was incumbent upon me to try to force the issue,” Thomas recalled, so “I had no alternative but to tell Dr. Blalock what I had been told.”
Blalock had been champing at the bit for weeks to get his research projects up and running and was in no mood to hear about further delays. He usually spoke in a soft, gentlemanly manner, with a slight southern accent. But when Thomas told him what had happened, Blalock exploded. “Who the hell does he think he is?” he demanded. “I run this department. Tell him.” He reached for a piece of paper and wrote in very bold longhand: “Dr. Poth—Get everything Vivien asks for for my work,” and signed it. He turned to Thomas and said, “Here, give it to him.”
For Blalock, this situation represented a simple if annoying turf battle. Poth was a part of the old guard at Johns Hopkins, people who wanted to continue to follow the easy and established ways and avoid any unnecessary and annoying change in their work routines. Blalock had been made head of the laboratory as well as head of surgery specifically to change such attitudes; his goal was not to maintain the status quo but to make the research facility one of the best in the country, if not the world.
Blalock’s note put Thomas in an awkward, even dangerous, position. Thomas was new to the hospital, and was officially listed as a laboratory assistant. Because every other African American working at Johns Hopkins was a janitor, waiter, or cook, most people at the hospital thought Thomas was merely a janitor. Now he was in effect going to insist that a white doctor do something he had categorically refused to do.
Thomas had good reason to be concerned. At the time, a seemingly innocent interaction between a black person and a white person could go from civil to tense to violent very easily. Throughout the South, an African American had been hanged, burned alive, or beaten to death by a white mob every four days from 1889 through 1929. The alleged crimes of these victims included “frightening school children,” “seeking employment in a restaurant,” and “trying to act like a white man.” At least sixty-six were murdered for “insult to a white person.” And the violence continued into the 1930s and 1950s. In historian Isabel Wilkerson’s words, “In everyday interactions, a black person could not contradict a white person or speak unless spoken to first. . . . The consequences for the slightest misstep were swift and brutal.”
After an African American mother and her son were lynched for alleged crimes, the lynch mob lined up on the bridge to be photographed. Photos such as this were often printed as postcards and sent to friends as souvenirs.
Thomas was a tall, physically fit man and not at all afraid of confronting people he felt were wrong. At Johns Hopkins, for instance, Thomas ignored the WHITE signs on the bathrooms and used whichever one was nearby. And he had stood his ground with Blalock himself years before, when they were still at Vanderbilt University. Thomas had made an error while carrying out an experiment, and “Dr. Blalock sounded off like a child throwing a temper tantrum. The profanity he used would have made the proverbial sailor proud of him.”
Thomas’s response to this tongue-lashing spoke volumes about his character. After Blalock stormed from the room, Thomas calmly changed into his street clothes and went to Blalock’s office, where he asked to be paid off. “I told him . . . if it was going to be like this every time I made a mistake, my staying around would only cause trouble. I said I had not been brought up to take or use the kind of language he had used across the hall.”
Blalock’s family were southern aristocracy and had been the owners of several plantations. His mother’s people were directly related to Jefferson Davis, the president of the Confederacy during the Civil War. No one working for them, black or white, talked back.
Blalock was a proud product of that segregated past when both established laws and unspoken social rules created an invisible wall between whites and blacks. He grew up expecting to be listened to, not lectured. But Thomas’s quiet dignity and his calm but determined manner impressed Blalock immensely. Besides, in the short period they had been working together, Blalock had come to respect and value Thomas’s g
reat skill and keen mind. Thomas recalled that after a brief pause, Blalock “apologized, saying that he had lost his temper, that he would watch his language, and asked me to go back to work.”
When Thomas told a fellow employee what Blalock had said, the man laughed and predicted Blalock would probably yell at Thomas again, and soon. A half-century later, Thomas was able to say, “We had occasional disagreements and sometimes almost heated discussions. But Dr. Blalock kept his word for the next thirty-four years, even though I made mistakes.”
Thomas was well aware that Poth might react in anger and that handing him the surgeon’s note in person might cause serious trouble. Conflict with Poth might turn a great many people at the hospital against him and Dr. Blalock, which would undoubtedly slow down their research. Thomas wanted to avoid delays at all costs. So instead of delivering the note himself, he put it in an envelope and had Blalock’s secretary leave it on Poth’s desk.
As Thomas had anticipated, there were repercussions. “The day after the note was left on his desk, I greeted [Dr. Poth] in the corridor, but my greeting was not acknowledged or returned. . . . He never spoke to me [again], even though our [work spaces] were next door to each other.”
A thoughtful Dr. Blalock studies a patient’s medical chart.
Not only did Thomas receive the silent treatment from Poth, but he became aware that word about the Poth letter had spread—or rather had been spread by prejudiced colleagues. This probably surprised both Blalock and Thomas, but to many others it was business as usual. As C. Fraser Smith recalled, “[Johns] Hopkins was regarded as prejudiced at the time. That was the word that was used. That they were an implacable fortress.”
