by Jim Murphy
Thomas appeared in the gallery a few minutes later, but that wasn’t what Blalock wanted. “Vivien, you’d better come down here,” he said in his soft southern drawl. Blalock was so insecure about the operation that he wanted Thomas near him to observe and advise him if necessary.
Here, a World War II medic administers anesthetic to a wounded soldier. The “open anesthesia” method would be used during the first blue baby operation. The anesthetic would be dripped through a fine mesh so that the patient inhaled its fumes. This meant that the anesthesiologist had to guess when enough had been administered. Not enough would mean the patient might wake during surgery; too much could kill the patient.
As the rest of the surgical team assembled, Thomas positioned himself just behind Blalock on a small wooden step stool, which allowed him to see over Blalock’s shoulder. It is safe to say that no other surgeon in the United States, let alone a southern surgeon, had ever had an African American research assistant monitoring his every move so publicly.
When Eileen was wheeled in, Thomas recalled, “The patient [was so small] it was difficult to ascertain whether [she] was beneath the sterile drapes.” Dr. Harmel administered the anesthesia. When this was complete and everyone was certain Eileen would feel no pain, Blalock went to work.
Using a scalpel, Blalock made a curving four-inch incision in the left side of Eileen’s chest, cutting first through the skin, then a thin layer of fat. He paused to study the small amount of blood that oozed from the cut. It was dark and syrupy thick, a sign that there was little oxygen in it. Next, he used a metal device called a rib spreader to separate the patient’s ribs, and held them apart with a clamp. Finally, he cut through a tough membrane, called the pleura, that lines the chest cavity. This was done slowly and painstakingly. After each step Blalock paused to be sure Eileen was still breathing normally.
Inside the chest cavity Blalock encountered his first problem: light. Or rather, a lack of it. A four-inch opening doesn’t allow much light to enter the chest cavity, and the tight space and shadows made every cut of the scalpel potentially dangerous. When surgery took place on gloomy days, Blalock often dragged a common floor lamp with an ordinary incandescent bulb into the operating room to add a bit more light. The lamp that Thomas had brought in the day before was moved closer and focused on the incision, and Blalock was able to proceed.
An overhead view of a blue baby operation. Thomas is standing just behind Blalock, partially hidden by the lamp.
When he reached Eileen’s heart, he and Thomas saw their second problem. Eileen’s arteries were, in Thomas’s words, “less than half the size of vessels of the experimental animals that had been used to develop the procedure.” Thomas had done his experimental surgeries on dogs that were easily twice Eileen’s size, so their arteries and veins were proportionally bigger.
Because the arteries of very young children are so small, Blalock would refuse to operate on patients as young as Eileen in the future. But it was too late now to back out. Eileen’s physical strength was already compromised by the opening of her chest. To stop the operation would not lessen her weakness in any way and certainly wouldn’t help her oxygenate her blood.
While Blalock hesitated, Thomas leaned in for a closer look. Dr. Cooley remembered, “Dr. Blalock would ask Vivien questions over his shoulder. He would say, ‘Vivien, should I do it this way or that way?’ Vivien would know the answers as he was used to having those kinds of questions put to him.”
Moving very cautiously, Blalock began the most serious work of the operation. He clamped a branch of the aorta shut. After pausing to see if the patient was tolerating this, he cut the clamped section free of the surrounding tissue and was able to move it close to the pulmonary artery.
Next Blalock cut into the pulmonary artery and began the painstaking process of suturing the end of the aortic branch to it. “I watched closely as each suture was placed,” Thomas recalled. In order to hold the aorta and pulmonary artery securely together, the sutures had to be no more than one millimeter (approximately the thickness of a dime) apart. “If he began a suture in the wrong direction (which he did on several occasions), I would say, ‘the other direction.’”
Reading about the blue baby operation takes only a few minutes. Blalock’s postoperative account is a mere one and a half pages. But the actual operation took more than an hour and a half to complete. Blalock’s delicate work of cutting and suturing “was all done with some difficulty but with great skill,” Dr. Longmire noted. “Dr. Blalock’s surgical skill has been questioned, but if you could have seen him complete [this] difficult operation you would recognize that the skill was there.”
The joining of the two arteries was complete and seemed to be a success, but Blalock did not immediately close up Eileen’s chest. He used two fingers to feel the pulmonary artery and was “disturbed because I could not feel a thrill,” meaning he couldn’t feel the movement of blood through the artery.
Blalock, Thomas, Taussig, and the rest of the surgical team, as well as the gallery watchers, all paused, hushed and quite literally holding their breath. It was entirely possible to perform a perfect operation and yet have the patient die.
Then the anesthesiologist, Merel Harmel, looked at Eileen’s face and said in an excited whisper, “The color is improving.” A few seconds later he added even more urgently, “Take a look. Take a look.”
Blalock’s hand-typed notes about the first blue baby operation.
Dr. William Stoney recounted that Blalock, Taussig, and Longmire all “leaned over . . . and looked at the child’s face.” Instead of ashen skin and sickly blue lips, they now “saw the cherry-red color of her lips. It was astounding how quickly the child’s color improved. It was really quite dramatic.”
Longmire would add that the entire team were beside themselves with joy that the operation—one that many thought would fail—had indeed worked. Yet Blalock and his team still had plenty to do. They dosed the newly connected arteries and surrounding area with sulfanilamide, a common antibacterial used to fight off infection, then began the painstaking work of sewing their tiny patient back together. Eventually, the incision was closed and Blalock and his colleagues could lean back and take a deep, relaxing breath. The operation was not just complete; it was a success.
CHAPTER EIGHT
Then What Happened?
ONCE the operation was over, Eileen Saxon was whisked to her crib in a fourth-floor hospital room, where she would be constantly monitored by a doctor and a team of nurses. Every so often, Blalock or Taussig came by to check on their young patient.
There wouldn’t have been much any of the doctors could do if something did go wrong. At the time, aside from the sulfanilamide splashed on the wound after the procedure, and orally administered penicillin, very few drugs existed to treat infections. There were no defibrillators to shock a failed heart back into action, and no drugs to slow a rapidly beating heart. In 1957 the British surgeon Dr. Geoffrey Wooler lamented that so many patients were dying in the days following heart operations “because of the lack of modern postoperative care. [Doctors] did not have an intensive care unit, no ventilator, and no [blood circulation] monitoring.” And conditions were far more primitive back in the 1940s.
There were some rough moments for Eileen in the days after surgery. She would suddenly begin gasping for air, and the attending doctor had to give her oxygen until her breathing returned to normal. “Eileen’s recovery was not as smooth or as rapid as we had hoped,” Thomas noted, “but after two weeks of intensive care, her condition improved. Improvement continued, and after almost two months she was released. . . . Her complexion, no longer ashen blue, was an almost normal pink.”
With Thomas standing right behind him and Taussig watching carefully, Blalock performed two additional blue baby operations in early February 1945. Both the twelve-year-old girl and the six-year-old boy showed immediate and dramatic improvement.
After this, Blalock and Taussig wrote a detailed, scholarly article
about the operations that appeared in a major medical journal. The brief article had an amazing impact on Blalock, Taussig, Johns Hopkins, and the world of medicine. Within days of its May 1945 publication, surgeons from all over the United States were calling, asking to observe the new procedure. A few weeks later, as news spread, doctors from around the world began contacting Johns Hopkins.
Magazine and newspaper reporters wrote about the remarkable operation in which a child who was literally blue one moment suddenly began to take on a pink, healthy glow—and the information was seized by the public. Soon parents with blue babies began appearing at the doors of Johns Hopkins. “Some of the parents did not bother to [consult] their doctors,” Thomas said. “They came by automobile, train, and plane. Many had not communicated with the hospital, had no appointment in the clinic, and had no hotel reservations; the cardiac clinic was overrun with patients.” But every child brought to the hospital was taken in and given a bed.
A newspaper article about the blue baby operation and two children who were saved by it.
Both Blalock and Taussig were astonished by the dramatic reaction. They had hoped the procedure would be successful and be duplicated again and again—and that it would save lives. But the national and international response was overwhelming. Thomas knew why. “To these parents, this operation was their great hope; this was what they had been praying for.”
At first, the attention embarrassed Blalock. He had a strong enough ego, but he never clamored for personal attention. Besides, at the time it was considered unseemly for a surgeon, even the head of a surgical department, to appear in too many newspaper or magazine articles. But the demand for more and more information about the operation continued. Soon Blalock was traveling to Europe to demonstrate the procedure. On a 1945 visit to Great Britain, Blalock and Taussig gave a series of speeches to various medical groups. Dr. Russell Brock was astonished when he tried to attend one lecture and found it “literally impossible to enter the building by the time the lecture was about to start” because of the overflowing crowd.
Dr. Brock did manage to get into the lecture Blalock and Taussig gave to the British Medical Association a few days later. The Great Hall was packed, he wrote in a letter afterward, and Dr. Taussig delivered a precise description of congenital heart abnormalities and of the work she had done with Dr. Blalock. Blalock spoke next, delivering “a forceful and impressive presentation” about the technical aspects of the operation and the results.
Blalock with his surgical house staff, 1945.
Blalock delivered his remarks in a subdued voice, and the audience listened in absolute silence to his every word. Dr. Brock recalled that the hall was quite dark because Blalock presented a series of slides with his talk. When Blalock finished, “A long searchlight beam traversed the whole length of the hall and unerringly picked out on the platform a [nurse] sitting on a chair holding a small cherub-like girl of 2 1/2 years with a halo of blonde curly hair and looking pink and well; she had been operated on by Blalock a week earlier.”
Blalock and Taussig, 1946.
The audience sat in silence looking at the child for a moment or two. Another physician who was there, Dr. Alex Haller, remembered, “There was a sort of awe, then a quiet, and then there was this emotional upheaval and outstanding applause. A lot of people realized that this was a very significant breakthrough.”
The somewhat shy and reclusive Blalock was already internationally famous for his life-saving work on the causes and treatment of shock. The blue baby operation had made him as well known as any star of stage or screen, the most famous cardiac surgeon of his generation.
The impact of the blue baby operation on Johns Hopkins was “more than a flood of patients with congenital heart disease,” Dr. William Stoney observed. “It also brought a succession of talented and creative young surgical residents, most of whom went on to distinguished careers in other medical schools. The blue baby operation and all that came with it reestablished the Hopkins program as the premier surgical training program of the era.”
Other research hospitals in the United States and around the world noticed this sudden intense interest in cardiac problems. Those that already had budding heart research programs began to increase their budgets. Other hospitals opened research programs of their own, many headed by doctors who had worked with Blalock and Thomas at Johns Hopkins. These facilities not only conducted research in new surgical procedures, but in time they also pioneered such innovative medical devices as artificial hearts, defibrillators, and the heart-lung machine.
By the time they had performed the third blue baby operation, Blalock and Thomas realized they wouldn’t be able to repeat the procedure often if Thomas had to make all the special surgical equipment needed every time. Thomas thought the problem over and, as always, devised an efficient and simple plan. He went to various local manufacturers and paid them to produce the required needles, silk thread, clamps, and other items.
After the operation, Blalock became a superstar of heart surgery, and newspapers and magazines asked for photographs. Here he poses with a photograph of one of his patients.
The decision was a wise one. Once word about the operation went public and patients began arriving in droves, Blalock and the surgeons under him began doing blue baby operations regularly. By 1950, one thousand such operations had been performed at Johns Hopkins alone.
Over the following years, medical suppliers noticed the sea change in cardiac surgery and research and began producing a wide variety of surgical devices. From a handful of manufacturers offering a limited number of items in 1945, the industry grew steadily as more and more innovative surgical procedures were introduced. Today, more than 1,300 companies produce surgical devices in the United States alone, with combined annual sales of over $42 billion.
Johnson & Johnson was an important manufacturer in 1947, when this advertisement for baby powder and baby oil appeared. Once medical research teams were established in universities and hospitals around the country during the 1950s, the company would grow into an international giant.
Helen Taussig had her fair share of fame as well. As they had in England, she and Blalock often paired up to give lectures on congenital heart abnormalities and the blue baby operation. She also lectured widely on other pediatric heart problems and went on to write two definitive books on congenital heart defects that are still in use today, as well as 129 scientific articles. She would head the pediatric cardiology unit at Johns Hopkins for more than thirty years and was one of the first doctors in the United States to recognize and lobby against the use of the drug thalidomide by pregnant women because it could cause severe birth defects.
When Taussig retired in 1963, the doctors who had trained with her commissioned the young artist Jamie Wyeth to paint her portrait. The result startled and disappointed everyone because she looked severe, almost witchlike, in the painting. Taussig appreciated the gesture but never hung up the picture.
For her many accomplishments, Taussig received an astonishing number of awards and honors for a woman in a male-dominated occupation—twenty honorary degrees from medical schools, more than thirty major medical awards, and the Medal of Freedom, the highest honor that can be given to an American citizen. In presenting this award in 1964, President Lyndon B. Johnson said of Taussig, “Physician, physiologist and embryologist, her fundamental concepts have made possible the modern surgery of the heart.”
Taussig (back row, center) with members of her staff as President Lyndon B. Johnson awarded her the Medal of Freedom, the highest honor that can be bestowed upon an American civilian, in 1964.
Oddly enough, in the aftermath, a number of doctors and medical historians minimized her contribution to the research and the operation. Some suggested that Taussig merely asked Blalock if there might be a surgical way to provide more oxygen; others implied that she added nothing to the research. This wasn’t true, of course, and Alfred Blalock was the first to praise her expertise and contributions. It was Taussig, B
lalock noted in their report, who figured out that oxygen depletion needed to be reversed, an understanding that “led to the clinical work recorded in this paper.” Blalock, it seemed, was willing to share the credit, even if some other colleagues were not as generous.
Meanwhile, Vivien Thomas went back to the laboratory. There was work to be done on shock and other projects that Blalock had put in motion, and the blue baby operation needed refinement. After the first procedure, Blalock and Thomas conferred on how to avoid the problems they had encountered and how to improve the results. They wanted to take a good operation and make it better. The next two operations were both a little different from the first, which meant Thomas had to work out the details in the lab beforehand.
What did Thomas think about the frantic media attention and worldwide fame Blalock, Taussig, and Johns Hopkins received during the months and years after the blue baby operation? No one will ever know. Thomas left behind no written record about this and never said anything to colleagues or friends about his feelings. He was a reserved and quiet man, not used to drawing attention to himself or to complaining.
But it would be entirely understandable if he felt some level of resentment. After all, he had spent thousands of hours working on the procedure, almost all of the time by himself. Blalock and Taussig clearly made vital contributions to the research, but Thomas was as much the creator of the blue baby operation as they were. And yet he wasn’t mentioned in the Blalock-Taussig journal article or in any of their lectures or magazine articles on the operation.
