Breakthrough!

by Jim Murphy

  Over the next week, Thomas and Blalock realized that their newly painted and cleaned laboratory was beginning to look cluttered and dirty again. “Trash cans hadn’t been emptied, the floor under the sink was piled high with used paper towels, the sink hadn’t been cleaned, the floor hadn’t been swept, the counter tops hadn’t been wiped off or dusted.”

  Thomas investigated and discovered that the laboratory’s white housekeeper “was taking care of the rest of the building, right up to our door. Why not our laboratory too?” Thomas, of course, had his suspicions: “Knowing Dr. Poth’s attitude toward me, I believed he was orchestrating the entire situation.”

  Thomas had done the initial cleanup and painting to get the research projects moving forward again. But he had “no intention of cleaning here” on a regular basis. Once again, he went to Blalock, who sputtered and said, “Good Lord, I hope we aren’t getting into trouble already!” Thomas’s response was characteristically straightforward and practical: “I answered that we were going to have to face it now or later.” There was a short period of complete silence; then Blalock jumped up, stood a moment next to his desk thinking, and left the laboratory at a brisk pace.

  Blalock was not an imposing man physically, and his manner was that of a quiet, thoughtful person who didn’t rock the boat; if anything, he came across as agreeable and passive. His privileged upbringing had given him a sense of his place in the world and an understanding of how to deal with people who dismissed his reasonable requests. But when Blalock went to confront another white man over the treatment of his black assistant, he was taking a risk, as Thomas had. He could find himself ostracized by colleagues at Johns Hopkins even before he had a chance to establish himself as a leader. As Blalock disappeared down the hall, Thomas “had a feeling that something was going to happen.”

  Something did happen between Blalock and Poth, though exactly what is unclear. Blalock never told Thomas what he did or said, and he never wrote about it. Clearly he viewed the racial prejudice his assistant was being subjected to as disruptive and hurtful; he probably also worried that if other members of the lab followed Poth’s lead, Thomas might become fed up enough to quit.

  Whatever was said seems to have worked. In the days to follow, the lab was always clean and tidy, though the housekeeper refused to enter Thomas’s work area when he was there. Instead, she did her work well before Thomas arrived in the morning. She left Johns Hopkins a few months later. A year after the incident, Poth took another position deeper in the South, where Jim Crow laws were still strictly enforced.

  No one would consider Blalock a civil rights advocate. He was too much a part of the established South to completely escape its conventions and prejudices. He and Thomas often had a glass of whiskey in the lab after work when they sat down to talk over projects, but they never had a drink together in public. Nevertheless, the way he had interceded on Thomas’s behalf put others at Johns Hopkins on notice: anything that stood in the way of Dr. Blalock’s research would not be tolerated, even if that meant his white colleagues had to treat Thomas as an equal. And so the Blalock-Thomas laboratory opened, and research experiments began again with uncompromising energy.

  CHAPTER TWO

  The Professor and His Assistant

  WHEN Alfred Blalock came to Johns Hopkins, he had already achieved international fame. While at Vanderbilt he had conducted groundbreaking experiments on the cause and cure of shock, and he planned to carry on that research at Johns Hopkins.

  The shock he researched is different from the shock someone might feel at receiving bad news or being surprised at night by someone leaping out and shouting Boo! Shock is also the name for a medical condition that can occur after a severe physical injury, such as being in a car crash, being cut or burned or wounded in battle, or falling hard to the ground. When Blalock began his research on shock at Vanderbilt in 1925, its symptoms were well known: they included a thin, rapid heartbeat; a sudden drop in blood pressure; intense thirst; fatigue; and cool, clammy skin. Once shock set in, the symptoms almost always became worse, and frequently resulted in a heart attack or kidney failure, either of which could cause death.

  Blalock was very happy when he arrived at Vanderbilt University in 1925.

  Despite a great deal of medical knowledge about the symptoms and effects of shock, no one knew what caused it or how to reverse it. At the time, the generally accepted notion was that shock made the body produce a poisonous substance, though no one could verify this.

  The thirty-one-year-old Blalock was five years into his study of shock when nineteen-year-old Thomas applied for a job at Vanderbilt in 1930. Blalock was trying to establish a scientific understanding of shock. To accomplish this, he had to produce shock in experimental animals and then analyze the data he gathered, such as changes in blood pressure or in the level of oxygen in the blood. In addition to pursuing this research, Blalock’s responsibilities included instructing medical students, taking care of patients, and numerous administrative duties. All these tasks were very time-consuming, which meant his research lagged.

  Because of his many obligations, Blalock decided he needed someone to help him out. But he wanted more than just a skilled technician to assist him; he needed a partner. He explained this to Thomas during his initial job interview at Vanderbilt and told him exactly what sort of person he was looking to hire: “I want to carry on my research and laboratory work and I want someone [here] I can teach to do anything I can do and maybe do things I can’t do.” To be certain he was clear, Blalock added, “I want someone who can get to the point that he can do things on his own even though I may not be around.”

  Blalock lecturing medical students about surgery.

  Blalock decided to hire Thomas, finding him intelligent, well-spoken, and curious. Thomas had asked a great many smart questions during the interview. Most important, he did not seem overwhelmed by the idea of doing complex research experiments.

  For Thomas, if there was a downside to the position, it was the salary. He made twenty dollars a week as a carpenter, while Vanderbilt was willing to pay him only twelve dollars a week, the rate for a newly hired janitor. Even so, he accepted the job, planning to stay a very short while. “To me the job was a stop-gap measure to get me through the cold winter months,” he recalled.

  Thomas was born in August 1910 to Mary and William Thomas. They were hard-working and loving parents who encouraged their five children to pay attention in school and discouraged idleness and foolish behavior. “Our parents,” Thomas said with pride, “took time to let us know, in no uncertain terms, what was expected of us, and we made every effort to live up to their expectations.”

  Both parents were highly skilled in their professions. His mother was an “excellent seamstress” and made all of the clothes her family wore, from dresses and blouses to pants, shirts, and jackets. Decades later, her precise, intricate needlework was something Thomas recalled vividly and imitated while performing surgery. His father was a master carpenter and successful contractor who worked mainly in the northwest section of Nashville, where the majority of the African American community lived. His hard work and frugal nature enabled him to purchase a half acre of land and build his own home there before Thomas was five years old.

  Thomas’s parents knew that the way to a secure life was through a solid education and the acquisition of real, marketable skills. Thomas and his two older brothers got an early start working for their father: “My father took advantage of the propensity of boys to hammer on things and brought us up in his own trade of carpentry.” Beginning when he was thirteen, Thomas would report immediately after school to whatever job his father had in progress. “So we [worked] from 3:00 to 5:30. . . . We also worked from 7 a.m. until noon on Saturdays.”

  Thomas could do more than hammer a nail into wood. Over the course of several years, he learned how to hang doors, install flooring, and do very complicated finishing woodwork, all to his father’s exacting standards. “I . . . learned the lesson which I
still remember and try to adhere to [in my medical research]: whatever you do, always do your best; otherwise it might show up to haunt and embarrass you.” Thomas was so adept at carpentry work that “my father had me working almost independently by the time I was sixteen years old.”

  Policemen shout out to the crowd that the bank behind them has just closed its doors and gone out of business.

  Thomas was paid for his work, and he carefully saved his money in hopes of attending college and eventually going on to medical school. Being a doctor had long been his goal. He had grown up admiring a local African American doctor, not just for his intelligence and important skills, but also for the respect he was shown by everyone in the community. Thomas’s desire to earn a medical degree drove him to study hard, and he was accepted by Tennessee State College in 1929. But before he set foot inside a classroom, the stock market collapsed and sent the United States into the Great Depression. Thomas watched helplessly as the bank that held his tuition money closed its doors for good and his savings disappeared—along with his hopes of going to college. At the same time, the need for carpenters dried up as well.

  It was this terrible personal loss that sent Thomas to apply for the job at Vanderbilt University in 1930. He needed work desperately and asked a friend if he knew of any job leads. The friend said he’d heard that the research laboratory there was looking for an assistant. Thomas clearly impressed Blalock, because he was offered the job on the spot and began work the very next day. Blalock had no way of knowing during the interview that Vivien Thomas was the answer to his prayers.

  The Professor, as most people in the lab referred to the thirty-one-year-old doctor, plunged his new assistant into important research projects immediately. That first morning, Blalock arrived early to personally teach Thomas the technique of weighing a research animal to determine how much anesthesia it would need, how to prepare it for surgery, and how to administer the painkiller. Then he explained what he intended to do, demonstrated how the procedure was done, and showed Thomas how to record the findings. “Dr. Blalock believed in statistics,” Thomas observed, “and insisted on large numbers of experiments . . . in order to have meaningful statistics from which he could judge and draw conclusions.”

  Thomas in the Vanderbilt University laboratory, 1931.

  Over the following weeks and months, Blalock trained his new assistant in a wide variety of challenging procedures. Blalock also had other doctors in the lab teach Thomas valuable skills—how to perform various surgical procedures, do complicated chemical analysis, and operate and repair equipment. Thomas was being given what amounted to crash versions of postgraduate courses with material he might have encountered in many advanced medical programs.

  Blalock discovered that administering whole blood or plasma to a shock victim could avert long-term and sometimes fatal reactions. Here a medic is giving blood to a soldier wounded in combat during World War II.

  “The volume of work each day was tremendous,” Thomas recalled. “Besides having an experiment in progress, the chemical analyses from the previous day’s experiment were being done.” But something else—something surprising and amazing—was happening. Despite the low pay and Dr. Blalock’s occasional grumpiness, Thomas found himself caught up in the Professor’s obvious passion for his research. “I did not realize that enthusiasm was contagious until I found that I didn’t mind if I had to cancel some social activity” to complete the day’s work, he recalled.

  For more than fifteen years, at Vanderbilt and then at Johns Hopkins, Blalock and Thomas carried out experiments on shock. The work took on real urgency when Blalock and Thomas moved into Johns Hopkins in 1941, with the United States on the verge of entering World War II; soldiers wounded on the battlefield were often shock victims. With Thomas’s assistance, Blalock was able to show that shock wasn’t caused by some unrecognized toxic agent produced by the body but resulted from a rapid loss of blood. He also suggested that the infusion of whole blood or plasma could minimize shock or even prevent it from occurring.

  As often happens with new theories, some scientists questioned Blalock’s results, mainly because his conclusions about the cause and treatment of shock seemed too simple. But during the course of the war, his ideas were proven to be correct and probably saved hundreds of thousands, if not millions, of military and civilian lives.

  Blalock’s study of shock did not end with the publication of his scientific papers on the subject during the late 1930s and 1940s. And at Vanderbilt and Johns Hopkins, Thomas continued to absorb information and to perfect his research and surgical skills.

  It seemed as if the Blalock/Thomas work routine would continue on the same path forever. Then they met Dr. Helen B. Taussig.

  CHAPTER THREE

  Surrounded by Failure

  IF you look at a cutaway illustration of an adult human heart, you will see that it is made up of four distinct chambers. Two of them (the right atrium and right ventricle) pump blood that has been depleted of oxygen to the lungs, where new oxygen is added. The other two (the left atrium and left ventricle) pump the now-oxygenated blood throughout the body. But the heart of a developing human fetus is an even more stunningly amazing and strange thing.

  In fact, a few-days-old fetus has no heart at all. It has two primitive heart tubes. As the fetus grows, the tubes are pushed together, and by the twenty-first day they actually fuse to form what looks like an X. This primitive heart begins beating at day twenty-two, and starts to twist and bend into what we might recognize as the familiar heart shape.

  Meanwhile, the interior of the heart is slowly changing as well. Over the following months it will grow from a single chamber into a two-, then three-, and finally a four-chambered heart. An unborn fetus doesn’t need a fully functioning heart because its mother is supplying it with oxygen and nutrients through the placenta. To ensure that it is pumping blood to the lungs and then throughout the body as efficiently as possible, the heart continues to develop even after the baby is born.

  Unless, of course, it doesn’t.

  This sequence shows the development of the primitive heart tubes.

  Sometimes the heart of an unborn baby doesn’t develop properly. “Congenital disease can warp the heart with great variety,” says medical writer G. Wayne Miller. “Valves can be sealed tight, missing parts. . . . Major vessels can be misplaced, narrowed, or blocked completely. A chamber can be too small or missing, a wall too thick or thin. The muscle may be weak. Holes may occur almost anywhere, in almost any size.”

  Dr. Helen Taussig, the head of the Children’s Cardiac Clinic at Johns Hopkins from 1930 to 1963, knew as much about heart defects in children as anyone in the world. She had more than two hundred malformed hearts floating in formaldehyde-filled glass jars at Johns Hopkins’s pathology museum. They were there to be studied by Taussig and anyone else interested in abnormal hearts. They also represented something much more personal to Taussig. Each one had once beat in the chest of one of her patients; each one told her that aside from providing comfort and support and some basic medical assistance, such as oxygen, neither she nor anyone else had been able to help these patients and save their lives. She was, in fact, surrounded by failure: her own. But Helen Taussig was not the sort of person who gave up without a fight.

  Taussig was born in Cambridge, Massachusetts, in 1898. She grew up tall and physically fit and was always either playing tennis, swimming, canoeing, or sailing. And she was extremely bright; before her mother became ill with tuberculosis, she taught Helen botany, while her father helped her learn German. Even with all of this positive experience, her childhood was plagued with adversity.

  In elementary school, she barely passed arithmetic, and repeatedly failed in both reading and spelling. No matter how hard Taussig tried, she was unable to piece letters into words and read them. She had a learning disability known today as dyslexia. The situation worsened when at age thirteen she contracted a mild case of tuberculosis and could attend school only in the morning for ov
er a year.

  Taussig’s mother had died when Helen was just eleven, so it was her father who sat with her day after day and patiently helped her with her studies, encouraging her to never give up on the task at hand or on herself. She would always have some difficulty reading, but with her father’s guidance and her own strong will to learn, Taussig’s grades gradually improved to the point where she wanted to attend medical school. “My father helped me to express myself clearly,” Taussig would recall years later. She, like Thomas, was struggling to achieve her dreams against what must have seemed like insurmountable odds. And, like Thomas, her upbringing helped her in this battle. “[My father] also helped me to realize the importance of carrying through to completion any project I undertook.”

  Persevering despite obstacles would help Taussig obtain her medical degree and choose a specialty. Medicine was a white male–dominated profession when Taussig sought entrance to medical school in 1921. At that time, only 5 percent of practicing physicians in the United States were women. Most medical schools either barred women entirely or refused to grant them degrees even if they fulfilled all of the school’s requirements. In other words, women were permitted to study medicine but not to practice medicine.