by Rob Dunn
11. This is much simpler than the movement of oxygenated blood in the body. In the body, two large pulmonary veins leave each lung and travel to the left atrium, where the blood is pumped to the left ventricle and then out to the body.
12. According to D. K. C. Cooper, and as a measure of how much medicine has changed, the room to which Cecelia was sent to recover was a forty-bed ward, twenty beds to a side in a long room like that in which Florence Nightingale did her work. A nurse sat at a desk nearest to the sickest patient, in this case, Cecelia, who lay, recovering, beside the nurse’s desk and beneath the nurse’s ever-watchful gaze.
13. See a more complete description of the public response to the device in James Le Fanu, The Rise and Fall of Modern Medicine (New York: Carroll and Graf, 1999).
14. “Historic Operation,” Time 61 (1953).
15. The lungs need almost as much oxygen, and hence blood, as the heart and brain, and they suffer a similar problem as the heart because the blood that arrives at the lungs is depleted of oxygen. The lungs are able to deal with this problem by having their own set of arteries, the bronchial arteries, which, like the coronary arteries of the heart, supply a high dose of oxygen-enriched blood. Like much about the cardiovascular system, these arteries were first described by da Vinci, in beautiful drawings in which they cascade over the lungs like tangled hair.
16. Others followed in the next decades with their own heart-lung machines, each a derivation of Gibbon’s design. By the 1960s, heart-lung machines were standard enough that several companies had begun to produce them.
17. For the general story of the body’s amazing electricity, see F. Ashcroft, The Spark of Life: Electricity in the Human Body (New York: W. W. Norton, 2012).
18. The link with coffee is actually still subject to debate; generally, both doctors and patients perceive a link between coffee consumption and minor heart arrhythmias. Yet the biggest studies to date on such a link have found nothing.
19. The possibility of clots is why patients with atrial fibrillation are given blood thinners such as warfarin.
20. This is what was first tried, unsuccessfully, on my mom.
21. It is because of ventricular fibrillation that paddles are most often used on the heart. The paddles are used not to restart the heart but instead to briefly stop it, in the hopes that when it restarts naturally, it will do so with a more normal rhythm.
22. Heart block is another problem of the heart’s electricity, but one that historically was very rare. Heart block occurs when the signal between the atria and ventricles is impaired (the ventricular node does not get the signals it is supposed to). Heart block became more common as a result of open-heart surgeries, which can cause interference with electrical signals. Heart block is not, in and of itself, necessarily fatal. Enough blood falls from the atria to the ventricles to allow the heart and its function to continue, but the heart and the patient’s life slow down.
23. H. G. Mond and A. Proclemer, “The Eleventh World Survey of Cardiac Pacing and Implantable Cardioverter-Defibrillators: Calendar Year 2009—a World Society of Arrhythmia’s Project,” Pacing and Clinical Electrophysiology 34 (2011): 1013–27.
24. The Chimera has even become a kind of unofficial symbol of organ transplantation, the ugly amalgamated beast of the past a symbol of the hoped-for future; see R. Kuss and P. Bourget, An Illustrated History of Organ Transplantation (Rueil-Malmaison, France: Laboratoires Sandoz, 1992).
25. J. Dewhurst, “Cosmas and Damian, Patron Saints of Doctors,” Lancet 2 (1988): 1479.
26. A. Carrel and C. Lindbergh (yes, the flying one), “Culture of Whole Organs,” Science 31 (1935): 621.
27. A Kansas surgeon, J. R. Brinkley, single-handedly performed more than 16,000 such transplants, mostly with gonads from goats. Brinkley was eventually barred from practicing medicine, after which he lost a close race for governor; see D. Hamilton, The Monkey Gland Affair (London: Chatto and Windus, 1986). See also F. Lydston, “Sex Gland Implantation: Additional Cases and Conclusions to Date,” Journal of the American Medical Association 94 (1930): 1912.
7. Frankenstein’s Monsters
1. Interestingly, it remains unclear why a dog’s heart is less supple than a human’s. This is not the only difference between dogs and humans in terms of cardiovascular systems either; for example, dog lungs are much more prone to collapse during surgery.
2. “Surgeons Repair Hearts of Four Dogs,” New York Times, April 19, 1962.
3. Mary writes of this influence: “Many and long were the conversations between Lord Byron and Shelley, to which I was a devout but nearly silent listener. During one of these, various philosophical doctrines were discussed, and among others the nature of the principle of life, and whether there was any probability of its ever being discovered and communicated. They talked of the experiments of Dr. Darwin [Erasmus] who reserved a piece of vermicelli in a glass case, till by some extraordinary means it began to move with voluntary motion. Not thus, after all, would life be given. Perhaps a corpse would be reanimated; galvanism had given token of such things: perhaps the component parts of a creature might be manufactured, brought together, and endured with vital warmth.” Yes, you read that correctly: Mary Shelley was inspired by Erasmus Darwin, who was inspired by a rotting noodle.
4. Here, the linguistic story of the emotional heart is as rich as the biological one. One can be, if contented, lighthearted, bright-hearted, happy-hearted. One can take heart or be heartened. One can have a peaceful, quiet, or restful heart. One’s heart can be at ease. It can be at rest. It can be healthy. Something can be heart-cheering, it can do the heart good or make it leap or dance for joy. The heart can swell or even burst; it can also rejoice. In passion, one can be a sweetheart or a heartthrob. Meanwhile, if things go wrong, one can be heavyhearted, downhearted, disheartened, have a heart of darkness, a stricken heart, a struck heart, a broken heart, an achy heart, or a wrenched heart. Something can eat at the heart, and, if it does, rend it, cause it to sink, even to fall into one’s boots.
5. M. C. Truss, C. G. Stief, and U. Jonas, “Werner Forssmann: Surgeon, Urologist, and Nobel Prize Winner,” World Journal of Urology 17 (1999): 184–86.
6. At this time in the United States, most hospitals still required that donors were dead, even with regard to their hearts, before their organs could be transplanted. This meant that Shumway, Lower, and other surgeons had to wait for hearts to stop before transplanting them. This both lowered the odds of getting a heart and made it less likely that the heart transplant would succeed.
7. Initially, the care of living heart cadavers was very simple, but with time it would become clear that these “patients” required all of the care given to normal patients and more. Because their brains could not control their blood pressure, it had to be attended to, as did their hormone levels.
8. Although Shumway did not, at the time, publicly express his disappointment about what had happened, others did so on his behalf. James Hardy, the man who transplanted the heart of a chimpanzee into the body of a man, an odd voice of moderation, wrote, “My disappointment is enormous, though not so much for myself personally. I know that Norman Shumway’s group at Stanford have done the most extensive and the best work in this field. We have long been waiting for them to transplant a heart from one man to another, following which, after more considered research, my team hoped to emulate them. We were technically ready long before Barnard, but we were burdened by the need to protect our public from the possible failure of such a great experiment. Shumway did everything by the book—only to have history stolen from him.”
9. Kantrowitz was, during this period, asked to leave the small Jewish hospital, Maimonides, where he worked. This was clearly a difficult time for the man, but years later, in reflecting on his role in the story of heart transplants, he was less humble. “Galileo,” Kantrowitz said, “was fired; they really gave him hell when he said that maybe the Earth is not the center of the university.” Kantrowitz went on to compare heart transplants to
Galileo’s heliocentrism, suggesting that transplants too would, although initially seen as radical, eventually succeed.
10. After his retirement, Shumway, in reflecting upon Barnard, indicated to Donald McRae in his book Every Second Counts that Barnard was haunted by what he had done in turning heart transplants into a spectacle and stealing from Shumway and Lower what all seemed to agree they had earned. Shumway, however, in that same interview said he had come to believe that “maybe it was a blessing that we weren’t first… we had enough trouble anyway dealing with the press and all that hoohah. Boy, we had plenty of trouble. So maybe, in the end, it all worked out for the best.”
11. The longest lived of these twenty-three living recipients in 1970 was one of Lower’s patients, Louis B. Russell Jr., a teacher who would go on to have six additional good years of, to paraphrase Russell, living hard, eating well, and making love.
12. Wilder’s story is fascinating. He was the grandson of slaves and would go on to many forms of greatness, including a term as Virginia’s governor, but also most recently two terms as the mayor of Richmond, Virginia. He also founded the U.S. National Slavery Museum. Today he is an adjunct professor of public policy at Virginia Commonwealth University.
13. Of course, this was the Western definition of life. Life and death are defined in many ways in many places. To his horror, the anthropologist Colin Turnbull was famously declared dead by the Pygmies with whom he was living. The good news was that the Pygmies believed there were seven different kinds of death, and since Turnbull was in one of those stages from which it was possible to recover, they did not bury him.
14. Wada was eventually found to have “lied to the media” and “tampered with the valves in the recipient’s original heart to exaggerate their defectiveness.” No new heart transplants would be permitted in Japan until 1999.
15. R. Converse, “But When Did He Die: Tucker v. Lower and the Brain-Death Concept,” San Diego Law Review 424 (1974–1975): 424–35. Because this case was in trial court, it does not serve as a formal legal precedent, but culturally, it set a precedent, one that has been revisited each time the issue of defining death has reemerged, as one suspects it will continue to do forever.
16. At the time, many doctors still viewed either the death of the brain or the death of the heart as a sufficient marker of the death of an individual. In this light, Lower, Barnard, and others were literally bringing their patients back to life, at least for a few days.
17. The State of Virginia voted in legislation to formalize brain death as a medical and legal concept, as, ultimately, did many other states. Another major moment in the debate about brain death came in California: Andrew Lyons shot Samuel Mitchell Allen in the head. Allen was taken to the hospital where, upon his being pronounced brain-dead, his heart was harvested for transplant into Blain Wixom by Shumway. The murderer then contended that he had not murdered the other man because his heart was still alive. The jury convicted Lyons, which led to a California law defining death specifically as brain death.
18. “Heart Transplant Decision Questioned,” Lakeland Ledger, June 5, 1972.
19. In his book Invasion of the Body, the surgeon Nicholas L. Tilney mounts a defense of the actions of those who raced to transplant hearts. I’ll let you choose how to weigh it. “A central theme,” said Tilney, “of these often troubling events is of surgeons desperately trying all means possible to salvage a handful of dying patients using concepts and techniques still in their infancy. At such climactic moments, the individual responsible must be totally convinced of himself and his talents to make instantaneous and sometimes irrevocable decisions, cast aside philosophical, religious, or societal considerations, and leave debate about correctness, appropriateness, and even the ethics of the decision to the future.”
20. They dominated the field until Lower bought a cattle ranch in Montana, where he spent his retired years taking care of three hundred cattle, by himself. The animals’ big hearts needed no help. He fed them, moved them, and cured them of their parasites, but he never again did surgery.
21. We think of rejection as bad, but it is really just the immune system doing part of what it has evolved to do: recognizing foreign cells. The problem with rejection is that heart transplants, however ingenious, are at odds with the evolutionary history of the body, one in which a foreign cell was always seen as dangerous. The presence of a transplanted organ triggers what is, in essence, an attack against foreign cells, the severity of which depends in part on how different (in each of many ways) the cells of the donor are from the cells of the recipient. The first step in reducing rejection was to choose a donor whose cells were as similar as possible to those of the potential recipient.
22. H. Schwartz, “A Long Shot, and Still Running: Heart Transplants,” Lakeland Ledger, August 26, 1973.
23. J. F. Borel, “The History of Cyclosporin A and Its Significance,” in D. J. G. White et al., eds., Proceedings of an International Symposium on Cyclosporin A (Amsterdam: Elsevier, 1972).
24. See, for example, “European Multicentre Trial, Cyclosporin in Cadaveric Renal Transplantation: One Year Follow-Up of a Multicentre Trial,” Lancet 2 (1983): 986.
25. For Hodge’s version of the story, see K. T. Hodge, S. B. Krasnoff, and R. A. Humber, “Tolypocladium inflatum Is the Anamorph of Cordyceps subsessilis,” Mycologia 88 (1996): 715–19.
26. The asexual, soil-dwelling stage of this fungus goes by another name, Tolypocladium inflatum. Fungi are complex, and so, it seems, are the folks who make a living naming them.
8. Atomic Cows
1. For a nuanced depiction of the personalities of DeBakey and Cooley and their interactions, see D. K. C. Cooper, Open Heart: The Radical Surgeons Who Revolutionized Medicine (New York: Kaplan Publishing, 2010). Although the men would eventually reconcile, for most of their professional lives, they were the two “big men” competing in Texas medicine, each with an outsize personality befitting the outsize state.
2. The broader history of prostheses is fascinating and worth a read; see A. J. Thurston, “Paré and Prosthetics: The Early History of Artificial Limbs,” ANZ Journal of Surgery 77 (2007): 1114–19.
3. This is roughly the number of people on heart-transplant waiting lists in the United States in an ordinary year.
4. The National Heart Institute was created in 1948 during Truman’s administration to research the causes, prevention, diagnosis, and treatment of heart and other cardiovascular diseases (including strokes). Today, the NHI lives on as the National Heart, Lung, and Blood Institute (NHLBI).
5. When a nucleus of plutonium 239 is hit by a neutron, it undergoes fission (releasing an enormous quantity of energy). It also releases additional neutrons, which hit adjacent atoms and lead to a chain reaction that runs out of control.
6. The director of the Artificial Heart Program had asked for $2 million in the first year, $8 million in the second year, and $100 million in each subsequent year, all in 1965 dollars.
7. According to Shelley McKellar, a historian who has written about this episode, “The agencies could not agree on management jurisdiction or the approach for engine development, making a collaborative venture practically impossible.” Also, they seemed to hate each other.
8. The other use envisioned for plutonium 238 was in generating long-term electricity in space.
9. The first sixteen patients Kolff tried the machine on died. The seventeenth was a Nazi collaborator, Sophia Schafstadt; she lived, but in the weeks after the war, many of those who worked with Kolff wished she had not. Kolff himself had supported the Dutch resistance during the war.
10. Plutonium 238 had the advantage of a long half-life and relatively low cost. Interestingly, the cost of plutonium 238 was tied to the number of nuclear reactors in the U.S. The more nuclear the U.S. went in terms of energy, the cheaper atomic hearts would become.
11. On April 27, 1970, one human subject in Russia actually received a nuclear pacemaker inside which 165 milligrams of plutonium were enclosed and shi
elded. Nuclear pacemakers eventually came to the U.S. as well. Fifteen were implanted in just two days. By 1979, nearly three thousand had been implanted worldwide.
12. See discussion of this whole episode in N. L. Tilney, Invasion of the Body (Cambridge, MA: Harvard University Press, 2011).
13. Quoted in R. C. Fox and J. P. Swazey, The Courage to Fail (Chicago: University of Chicago Press, 1974).
14. The mechanical heart itself is now stored in a cabinet at the National Museum of American History, where, according to Alex Madrigal, one can still see, on the tubes leading out of the device’s twin pumps, a little of Karp’s blood. For the official report, see W. C. DeVries et al., “Clinical Use of the Total Artificial Heart,” New England Journal of Medicine 310 (1984): 273.
15. The National Heart Institute and Baylor both held inquiries into Cooley’s actions. Liotta was suspended. Cooley voluntarily left his university position, though he continued to be among the world’s most active heart surgeons and innovators. In fact, by losing his position, he was actually freed up to make even more money than he had while at Baylor.
16. W. J. Kolff and D. B. Olsen, “Testing of Radioisotope-Powered Mechanical Heart in Calves,” Biomedical Engineering Support Progress Report, August 15, 1976–May 15, 1977.
17. The plutonium in artificial hearts was dangerous for several reasons. There was the (very low) chance it would leak in the body. But there were also two more obvious problems. Once someone with an atomic heart died, what happened to the plutonium? Old plutonium is still radioactive; it is also toxic, one of the most poisonous substances on Earth.
