Hearts

by Thomas Thompson

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  Hearts

  Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier

  Thomas Thompson

  To my parents and my sons

  Prologue

  I once knew an unimportant man who lived in a village near Kilimanjaro, where he sewed uniforms for the officers. He was a splendid tailor but he did not want to settle for that, so he spent his other hours pushing back the brush and the wait-a-minute thorns—so called because when one snared your jacket you had to stop and pull it out—searching for precious stones. When he finally found some stones one day, he fell to his knees and wept, because for the remainder of his life he would be rich and celebrated. But quickly the lions came and attacked his camp, thieves came and stole his gems, and enemies came to dispute his claims. Before a very short time had passed, his heart, as people say, broke. He died and was buried in the coffin of a tailor. I have no moral, only an observation: in the country of the unexplored, diligence can find the treasure, but only power can keep it.

  I drove west, then south and down from New York. Winter gray hung stubbornly to Pennsylvania, Virginia was softening with a haze of green not quite there but in the crisp air, Georgia and Mississippi, already ripe, pink and white with first cotton. Finally Texas and its Gulf Coast, flaming with azaleas; alfalfa to the ankle, corn to the knee, new life arrogantly ahead of that not yet born in the American East.

  I was driving home rather than flying because I needed to shake New York out of my head and ease into Texas. In three days on the road, one can read the signs, hear the music, see the shirt collars, accept the advice of the gas-station attendants, eat the food, drink the beer, sleep on the motel mattresses, realize once more the land of Monkey Ward and Dr. Pepper. It takes so little time to cross back to the defensive paranoia of the American South. We put it aside when we leave, but it is inbred, chronic, and almost welcome when it returns.

  It is, for example, pleasant to drive in Texas not because the scenery is interesting—mostly it is not—but because the expressways, highways, roads, farm-to-market lanes are probably the best in the world (fifteen years away and one day back, and the native speaks as if he had never left). Texas has sent men to Washington—Sam Rayburn, John Nance Garner, Tom Connally, Martin Dies, and, of course, Lyndon Johnson—who patiently learned the secrets of power and patronage and, once claiming it, well served the constituents at home with surveyors, tar, and concrete.

  On the spectacular straight highway to Houston, a boulevard through the forests and pine thickets of East Texas, cars shot past on this early April morning, 1970, with their windows rolled shut, drops of moisture identifying the mechanical cold within. Everything is refrigerated here because otherwise it could not exist. There is so little reason for Houston.

  Because Houston had no link to the sea as most great cities do have, a canal was carved out 60 miles to the Gulf of Mexico and shippers were persuaded by charming Houston leaders to bypass the more convenient, much cheaper port of Galveston. Because the savanna land was so flat and marshy and streaked with creeks (called bayous, from neighboring Louisiana Cajun influence) that foundations seemingly could not support major skyscrapers, architects and engineers designed floating concrete slabs to anchor the tallest buildings west of Chicago. Because the air settled so heavy and humid for half the year that to be outdoors was to bathe in liquid glue, everything was air-conditioned: homes, offices, shopping centers, even the domed stadium where baseball was played: “WELCOME TO THE ASTRODOME—TEMPERATURE INSIDE, 72—TEMPERATURE OUTSIDE, 96” reads the score-board, and people applaud. One drive-in restaurant even offered tubes of rushing cold air, which could be stuck inside the window of that rare automobile without built-in comfort.

  Because great cities must have culture, and because Houston had none to merit national attention, it was bought and paid for: first Leopold Stokowski, then Sir John Barbirolli, finally André Previn were engaged to lead the ever-improving Houston Symphony. (Previn, it is said, was fired not because of his heavy programming of avant-garde music, nor because of his fertile alliance with Mia Farrow, but because of his guest appearance on a national television program during which he trumpeted con brio about his conductorship of the London Symphony, but said nothing at all—nothing!—about his simultaneous job with the Houstonians, who paid him more money.)

  Because Houston wished to play a prominent role in the nation’s burgeoning exploration of outer space, the leaders approached Lyndon Johnson, who, ever accommodating to all things Texan and particularly mindful of the suddenly undependable Democratic vote of the nation’s sixth largest city, generously helped put the Manned Spacecraft Center there—ideally located some 1200 miles from Cape Kennedy—showering hundreds of millions of dollars and datelines from the cosmos, making it, of all things, Space City.

  The comparison is made between Houston and Los Angeles because of the urban sprawl—Houston has 486 square miles within its city limits—and a rocketing population; Greater Houston, as the Chamber of Commerce likes to put it, is approaching two million people. But the comparison should not include the people themselves, because having known both cities well, I can state that there is a marked difference. The citizens of Los Angeles are hardly members of a city but participants in a condition unified by (1) the sun, when it can be seen, and (2) disasters—fires, floods, earthquakes, the terror of freeways that loop and whirl like insanely tied Christmas ribbons.

  Houstonians, conversely, have a pride bordering on conceit. They are doers—and once something is done, they want to tell about it. When the city accumulated funds for a striking new concert hall, the mayor and a delegation hurried up to New York and held a breakfast press conference. I have been to cocktail parties in New York and found myself face to face with a stranger and have asked what he does and if the answer is, as it often is, “nothing,” then I assume he is thinking, or is preparing to write a poem, or is extremely clever. In Houston the answer “nothing” would be greeted by a certain coldness because this restless, driving city welcomes only those who find the most oil, or construct the world’s only air-conditioned dome, or manage the acquittal of more clients on trial for murder.

  But none of this can explain the most extraordinary phenomenon of all: in a city where 25 years ago there was practiced medicine of the most mediocre sort—where there was but one infant medical school newly transferred from Dallas and a third-rate medical school at that; where there was no heritage of scholarly thinking, no foundation for orderly investigation; where extinguishing life by violence was far more common than investigating methods to prolong it—there sprang up in a swampy area six miles south of the heart of downtown, in fields where raccoons and water moccasins lived, a collection of medical facilities which, by 1970, had become one of the handful of distinguished medical centers in the world. At a cost of almost one quarter of a billion dollars, there had risen the Texas Medical Center—five large, all-purpose, general hospitals; a huge pink granite center for care of patients and research against cancer; hospitals for the eye, teeth, mind, crippled children; centers for public health, speech and hearing, rehabilitation, nursing, occupational therapy, physical therapy, the biomedical sciences and, dominating all—the heart.

  In less time than it takes to age a good bottle of wine, Houston found itself with not only the most celebrated, but the two most celebrated heart institutes extant, standing side by side, headed by two master surgeons, Dr. Michael Ellis DeBakey and Dr. Denton Arthur Cooley, who for years had worked across the same operating table, who had become estranged,
who had become pitted against each other in a passionate and poignant encounter, and who now loathed each other so that they did not even speak.

  In the medical history of the city, DeBakey had come first, lured to exploding Houston in the boom years of post-World War II, brought from his native Louisiana by a consortium of doctors and civic leaders who required a force to weld a department of surgery for the infant Baylor College of Medicine. A quarter of a century ago, surgery was not the glamorous specialty it is today. Surgery was performed chiefly by general practitioners and the notion of training medical students to do nothing but cut and sew was not widely accepted.

  DeBakey immediately stumbled into hostile walls, partly because of his passion for the surgeon’s art and the position he felt destined to secure for it—and himself—in the course of medicine, partly because of the manner in which he sought it. At one hospital where he began operating, DeBakey observed some of the other surgeons at work and told them bluntly that they were butchers who operated when it was not necessary. At another, the staff doctors soon grew so angry with the slight, dark, hard little man that they sought to oust him. He was, they said, a tyrant: he had too many patients, he dominated the schedule, the nurses disliked him, he was disrupting the silent sanctuary that medicine was supposed to be. Moreover, they did not say it, but they considered him, the son of a Lebanese immigrant merchant, to be an outsider. He was not a regular Texan. He was intruding on them. The chief of surgery at the hospital listened quietly to their complaints and finally rose. “Mike DeBakey,” he said, “may well be everything you say he is. But he may also be possessed of greatness. He may contribute something historic to medicine. Let’s pull in our horns and tolerate him.”

  In the decade that followed, DeBakey built a department of surgery at Baylor and at the Methodist Hospital, which was to become one of the most celebrated in the world, a galaxy of young stars that revolved around the blazing sun of the brooding, exasperating man from Louisiana. DeBakey chose as his specialty occlusive disease, the building up of deposits in the bloodstream that lead to strokes or heart attacks or gangrene and amputation. He propounded his philosophy, which was to change the course of medicine: “Occlusive disease is segmental; it does not occur all over the body at the same time. You don’t have to know the cause or the prevention. You bypass it, literally.”

  In the 1950s, Houston became the world capital for bypass surgery. DeBakey and his men devised grafts, first from the flesh of dead men, later from plastics, to sew into a threatened body and send blood detouring around an obstacle. In the mid-1950s, a remarkable device called a heart-lung oxygenating machine—known in the heart world as simply “the pump”—was developed elsewhere but so perfected in Houston that for the first time in the history of man, the surgeon was able to stop the heart and enter its quiet depths to repair the holes or deteriorating valves or redirect the flow of blood.

  The doctor who became the world leader of surgery within the open heart was not Mike DeBakey, but a young disciple, Denton Cooley, who had been born in Houston to a family of wealth and social prestige. While DeBakey continued his pioneering work on the vessels of the body, Cooley plunged into hearts. Hundreds of cases became thousands, and in a city where to be first was cherished, nothing could compare with the inventory of human hearts that Cooley had repaired.

  The older man, it was said, first encouraged, then was proud of, but finally became jealous of the work of his protégé—and of the man himself. Cooley was very much a Texan, very much of the regular order, very much favored by society and by nature which had blessed him with tall, powerful beauty.

  The younger man broke with DeBakey in the early 1960s and moved his practice to neighboring St. Luke’s Episcopal Hospital of Houston, only a hundred yards or so away. DeBakey rapidly turned his attention to heart surgery and quickly became as acclaimed as the youth who had left him. The years would bring them their own individual great houses of surgery, conceived and dedicated to healing the human heart and diseases of the vessels that serve it, but the years would bring as well a feud unprecedented in science, a feud more angry, more poignant, more useless than Freud’s sorrowful estrangement from his disciple Jung.

  In the words of one Houston physician who had observed DeBakey and Cooley for years, “You see, Denton not only stole Mike’s heart, he broke it.”

  PART ONE

  CHAPTER 1

  On Easter afternoon, 1970, in the paneled chapel of St. Luke’s Episcopal Hospital in Houston, a brief and moving memorial service was held for Leo Boyd, a once strapping Canadian railroad man who had lived for sixteen mostly anguished months with the heart of an illiterate Mexican peasant woman within his chest. In his last moments, Boyd was comatose and he began to twist and turn. His wife, Ilene, reached as she had so many times before for the Panic Button beside his bed, but her sister’s arms held her back and this time Boyd opened his eyes, shut them, and died. He had been Dr. Denton Cooley’s longest surviving transplant and he was the last of twenty-one men, women, and children to die.

  The next morning, in neighboring Methodist Hospital—more particularly in its adjoining wing called the Fondren-Brown Cardiovascular Center, a $20 million house of science and surgery created by Dr. Michael DeBakey—there came a telephone call that caused grave concern to his transplant team. They had transplanted only twelve hearts, but two of their patients were still alive some eighteen months postoperatively and both had long since returned to their homes and were leading fairly normal lives. Dr. Ted Diethrich, one of DeBakey’s aggressive junior surgeons, took the call, which was from Phoenix, and when he hung up, his tanned, boyish face was twisted into annoyance and exasperation. He walked into the bullpen, an outer office where x-rays are studied and where young doctors and students sit for gossip and coffee.

  “I just heard that Bill Carroll read about Leo Boyd’s death and got despondent,” said Diethrich. “Apparently he went out bar-hopping and in about the fourth place passed out. They thought he was just another drunk and God knows how long it took them to learn he was a transplant and get him to the right hospital.”

  “You going up there, Dr. Diethrich?” asked Jerry Naifeh, a second-year medical student who had been infatuated with surgery even before he entered medical school. He had spent one summer in Cooley’s operating suites holding the sucking machine, a hose that withdraws excess blood from the chest cavity to keep the field clean for the surgeon.

  “I can’t,” said Diethrich. “I’ve got too many operations here. I’ll have to stay in touch on the phone.” Diethrich had been a principal planner of DeBakey’s transplant program and had actually put the new heart into Carroll’s body and nursed him through the rejection periods. “Damn,” he said morosely as he left the bullpen. “Damn. Damn. Damn!”

  There were eight or ten people in the bullpen and they were waiting now for DeBakey to come out of his office for the precise ritual known as afternoon patient rounds. There was a new resident from Arkansas and today was his first chance at guiding the Professor, as DeBakey is known, up, down, and around the stairways, corridors and mazes of the three buildings over which his patients were scattered. DeBakey uses the giant Methodist Hospital, its adjoining Fondren-Brown wing, which is a self-contained hospital, and the Methodist Annex one mile south, a former nursing home taken over and refurbished to house patients during the diagnostic, preoperative period.

  One of the things DeBakey pioneered is volume surgery. In the mid-1950s, the Mayo Clinic became renowned for large numbers of operations, but only those procedures—gall bladders, lung removals, and so on—that other surgeons were doing. DeBakey’s volume, which stunned the medical world, was aneurysms and vessel work, then the most sophisticated and daring of operations. DeBakey did as many cases in one month as some surgeons did in a year.

  The new resident, Dr. Jerry Johnson, a strong, severely barbered, raw-boned looking fellow newly back from Vietnam, was silently going over his list of patients and praying that he knew any detail DeBakey might
ask about one of them. There was a rumor among the staff that DeBakey might be leaving this week on a long European tour. The staff looked forward to long absences because it cut down the patient load. Unfortunately for them, however, DeBakey did not announce his frequent departures for guest lectures, honors acceptances, and fund-raising appearances. A few years ago there had been large three-months-at-a-glance desk calendars on which DeBakey’s commitments were entered. Two were on desks outside his office and they were among the most heavily read documents in the hospital. But one afternoon he came out and gathered them up and since then has kept his schedule to himself.

  Sylvia Farrell came into the bullpen looking cheerful with a new bouffant hairdo. She poured herself a cup of black coffee, put her hands on her hips and quickly appraised the preparations for the Professor. Once she had been a floor nursing supervisor but now she had responsibilities for everything from driving DeBakey to the airport to booking hotel rooms for patients’ families to acting as mother hen to the younger doctors. She was a plump, effusive woman who could read, sometimes even predict, her boss’s moods better than anyone else. To Dr. Johnson she said, “He’ll probably only want to see the post-ops tonight, but you’d better have the other x-rays ready just in case.”

  Johnson nodded and hurriedly began arranging a large stack of x-rays in their manila folders. By the time they got to DeBakey, many patients had been in and out of hospitals for years and their accumulated x-rays were as thick as a family album. Sometimes DeBakey would only want to see that very morning’s x-rays, sometimes he would want to observe the course of a disease by looking at x-rays for the past decade. The resident had to have them available—and available instantly—whatever.

  A half dozen conversations, including some pleasant kidding of Diethrich’s stunning Peruvian secretary Marguerita, because she had landed a medical student and would shortly marry him, expired in mid-sentence. DeBakey’s door, 30 feet away, had opened. DeBakey came out, turned around and locked his door with a set of keys attached to his belt—he enters and leaves his office 30 times a day and never fails to lock it after him—and came wordlessly into the bullpen. He sat down and his staff gathered formally behind him. Johnson placed a neatly typed list of patients before him. These made up the patient census—everybody DeBakey has in the hospital—with a few lines after each name detailing disease, progress, treatment. There were also one or two names with nothing but a cryptic “HELLO” typed in capital letters following them, indicating to DeBakey that these are prominent patients, not necessarily his patients, but ones he might wish to stop in on for a goodwill appearance.