Hearts

by Thomas Thompson

  DeBakey asked a few questions that Johnson answered well—patient histories, how they appeared when they entered the hospital, whether an arteriogram—in which dye is inserted into a vessel and x-ray pictures taken—had been done. He frowned but said nothing when Johnson slapped an x-ray onto the viewing screen backward, and then stood up and quickly rushed from the room. The delegation fell in after him by rank, first Sylvia, then Johnson, then eleven other staff doctors and two visiting physicians.

  DeBakey always walks tilted slightly forward with his head bent as if encountering a north wind. One would never expect him to run into anyone because his approach is made known by the circles of power which dance visibly about him. He is a slight, short man with a body of steel, a face dominated by a hawk nose that presumably marks his Lebanese ancestry but that fits more the Indian-head nickel. The photographer Karsh likened the profile to an Assyrian frieze from Nimrud in the British Museum, but eyes cannot be carved in stone and DeBakey’s eyes are commanding, magnified out of proportion behind thick trifocals. I have always worried about men with eyes larger than mine because I assume they can see more.

  On this spring day, DeBakey was wearing his scrub suit with his white lab coat thrown over it, the initials M.E.D. embroidered in black at the pocket. M.E.D. was everywhere—on strips of tape at the foot of patients’ beds, on charts, on doors—initials dominating this empire as SPQR did ancient Rome.

  Refusing to wait for an elevator, DeBakey threw open a stairwell door and bolted up, two or three steps at a time. There are those not impressed by DeBakey who suggest he bolts faster when the press or a VIP is around, but I disagree. He always bolts, he cries, he seizes, he whirls; verbs of passivity rarely describe him or his movements.

  In the Intensive Care Unit on the surgical floor, he checked a dozen patients recuperating from surgery. At one bed he asked a man wearing an oxygen mask to squeeze his hand, and the man did so firmly. DeBakey’s face softened into a smile. At the next bed he bent down and shouted the patient’s name and the man responded in a fuzzy voice. Heart-surgery patients normally stay in the Intensive Care Unit about 48 hours, until they are completely awake from anesthesia and extubated, able to breathe without the respirator, which has worked for them since the commencement of the operation.

  Everyone seemed to be progressing well except Signor Montini, a youthful Italian who had arrived in Houston in massive heart failure from two deteriorating valves in his heart. Impassively DeBakey listened to the heart into which he had replaced the mitral and the aortic valves that morning, then he knelt down and with a hint of annoyance saw that the urine bottle beside the bed was almost empty with scant fluid in the drainage tube. Passage of urine is a vital sign after heart surgery, indicating that the kidney is functioning well and receiving a good supply of blood from the reconstructed heart. It was obvious that this heart had not yet adjusted to its new hemo-dynamic system.

  Montini was in his early thirties with a thick shock of dark curly hair. He was semiconscious, and now and then he would, with great effort, raise his right hand and look with wonder at the fingernails. “They’ve been blue so long that he can’t get over the fact that they’re pink now. They’re getting blood after the operation,” said Dr. Reed, the resident spending an unbroken 30-day-and-night tour of duty in Intensive Care Unit as part of his three months on the DeBakey service.

  Now word was spreading through Fondren-Brown, into adjoining Methodist, and through the Methodist Annex a mile away, that DeBakey was making rounds. Nurses hurried down corridors shutting the doors of patients who were not on DeBakey’s service so they would not come into the halls and stop him for autographs. In the annex, a loudspeaker intoned, “Will all of Dr. DeBakey’s patients quickly and quietly—and immediately—go to their rooms.”

  When he was done in the Intensive Care Unit, DeBakey stopped briefly in a nearby room to talk to his wife, a handsome and gentle Southern lady who had that day checked into the hospital with a minor complaint. “Perhaps she wanted a chance to see her husband,” a nurse suggested quietly, mindful of the normal eighteen hours a day, seven days a week DeBakey lives in his hospital. Mrs. DeBakey had been known to attend teas and draw wives of young doctors into corners and tell them, in effect, “There’s still time; don’t let your husband become so committed to his job that you never see him.” There are four DeBakey sons and they have not been able to claim a proportionate amount of their father’s time. None has chosen a career in medicine.

  The rounds stretched on. DeBakey made an unexpected stop at the room of Howard Stapler, whom he introduced as “a brave soldier, a very brave soldier.”

  “How is that, Dr. DeBakey?” I asked.

  “This brave soldier is waiting for a heart transplant.”

  Stapler nodded his head and reached out to take DeBakey’s hand. He was a man old beyond his years; he looked 65, he was not yet 50. He had sagging wrinkled skin that made his face seem to be melting wax and there were uneven tufts of stone-gray hair. Much of it had fallen out in adverse reaction to drugs. He was from a small town in Indiana, and he had been in and out of hospitals with his deteriorating heart for almost a decade. He had read so much literature on his condition that he had become efficient with cardiac terminology, almost like a prisoner who becomes a jailhouse lawyer writing habeas corpus petitions to the court.

  Stapler was searching for a piece of paper on which he had written something he had read about a new operation. But before he could find it, DeBakey was out of the room, rushing across the second-story passageway that connected Fondren-Brown and Methodist. “When will the transplant take place?” I wanted to know.

  “I don’t know,” DeBakey said. “Stapler’s been worked up as well as anybody we have ever done, but there’s no abundance of donor hearts anymore.”

  There was no shortage of violent death in Houston. Almost every morning the newspaper reported another murder in the city (Murdertown, U.S.A., as the local press casually refers to it), where guns could be purchased as easily as flashlights. One drive-in grocery owner that week had slain a bandit who had attempted to rob him. A few nights later, another bandit came to the same store and killed the owner.

  “Yes,” said DeBakey, “but they have to be killed just right before we can use their hearts.”

  The sixth floor of Methodist is practically DeBakey’s private ward. Most patients begin their hospital stay by checking into the Methodist Annex for preliminary tests. They are then transferred to Fondren-Brown for surgery and a stay in Intensive Care. Finally they are moved to Methodist’s sixth floor for Intermediate Care, followed by routine nursing in preparation for going home. The extent of DeBakey’s practice could best be seen on the sixth floor. In room after room, the initials on the door were M.E.D., and in the majority of them, the atmosphere was pain tempered with exultation.

  There was a battered-looking man named Templeton from a small town in mid-state New York whose leg had been saved from amputation. DeBakey had removed a portion of an artery occluded by atherosclerosis and replaced it with a Dacron graft, which restored circulation. The leg was still hideous-looking, with dead flesh flaking off and black patches of sores, and the toenails were those of a jungle animal, but he would walk on it again and the doctor in New York had wanted to chop it off. “If I could put the world on a silver platter and give it to you, Dr. DeBakey, I would,” said Templeton, eyes glistening with tears.

  The news was not that hopeful for Diane Perlman down the hall. There was extensive occlusion of several small blood vessels in her left leg, which made arterial reconstruction difficult. DeBakey had tried once before to build a new circulatory system in the leg, but the occlusion had returned. Once Mrs. Perlman had been a pert, slender, vivacious New Yorker who had modeled in the garment district before she married a shipper and bore two children. Now in her mid-thirties she was pale, frightened, and in pain from the red streaks which ran up and down the affected leg.

  One of the horrors of atherosclerosis—the disease w
hich affects countless millions of Americans and kills at least one million a year—is that it not only causes heart attacks, it can treacherously shut off a blood vessel anywhere in the body and turn a leg or an arm purple-black with gangrene.

  DeBakey made a gesture with his hands and the entourage backed quickly from Mrs. Perlman’s room. As he shut the door and returned to sit beside her, she began to weep bitterly. DeBakey had nothing to offer but amputation. Twice this night the surgeon would return to her room and talk to her again, telling of what can be done with artificial legs, winning permission for the amputation, and cheering her to the point where she would say, “Thank God for pants suits.” Her husband, a weary man in an iridescent silk suit and tinted glasses, told a nurse, “After God comes DeBakey; Diane is completely hypnotized by this man.”

  Jerry Johnson led the procession around a corner, paused momentarily, then pushed open a door. “This is Mrs. So and So,” he said softly, giving a name uncertainly. DeBakey walked in with the name fresh on his lips and greeted a confused-looking woman who was not Mrs. So and So, but Mrs. Such and Such, and she was not even a DeBakey patient. DeBakey strode outside in anger. “You’re supposed to be leading me, Doctor,” he said to Jerry Johnson in a loud, withering voice that drew the attention of the nursing station, “and it looks as if I’ll have to lead you instead! Now let’s see if you can’t do this very simple thing right!”

  Sylvia Farrell interceded in a pacifying tone. “Dr. DeBakey, this is Dr. Johnson’s first time,” she said gently. Later she would take the new resident aside and suggest that he make a trial run every afternoon until he had the complicated routine down pat.

  Every young doctor who has rotated onto DeBakey’s service for the past quarter century in Houston has learned the potential traps that can be fallen into during the several miles of rounds. One new resident boldly led the procession into a new section of the hospital, became momentarily confused, then struck out confidently to what he thought was the door to a stairwell. DeBakey and half the group followed him, not into a stairwell but a broom closet, where in the half-second before DeBakey growled his displeasure, the doctor thought his heart would stop. Another now-prominent doctor remembers falling behind on rounds and trying to catch up while DeBakey flew down a staircase. The straggler lost his footing and fell, bowling over an intern and two medical students on his way, rolling down and down until he came to a merciful halt just at DeBakey’s feet. DeBakey stepped over him without comment and kept descending.

  In mid-rounds, DeBakey went into the room of a friend, Ben Taub, for a welcome interlude that the staff awaited. Every afternoon when he was in town, DeBakey would stop in to visit with Taub, a multimillionaire patriarch near 80 who lived in the hospital in a two-room suite with color TV, refrigerator, lounge chairs, and a courtly black valet to attend his wishes. He was a magnificent-looking old man with skin like rare parchment and the air of a wise rabbi about him. His fortune sprang from importing cigars although it soon swelled with real estate and banking, but he would prefer to poor mouth people into thinking he was a modest tobacconist and his plain downtown office an extension of the nearby Salvation Army. DeBakey was criticized by some doctors for permitting Taub and another millionaire or two to live in the hospital, since none was ill with anything in particular to require constant hospitalization. But Taub and the others had been long-time benefactors of DeBakey’s projects, indeed of all Houston medicine, and he ignored the carping.

  When DeBakey first came to Houston in 1948 from New Orleans to become chairman of Baylor’s surgery department, he was dismayed to find the school broke and without a hospital affiliation, something as basic to medical education as a stadium is to football. Ben Taub was a bachelor with a large personal fortune and was trustee for three other rich estates. Moreover, he was chairman of the board of managers of Jefferson Davis, at that time Houston’s only charity hospital.

  Within a year DeBakey had won affiliation with Jefferson Davis for his medical school, and in the years that followed had pried more than $2 million from Taub’s purse for his projects. Taub said he took to the brash Louisiana surgeon immediately. “He didn’t care about money,” said Taub. “I know very many men who don’t care about money—and I’m not one of them because I care very much about money.” The two men had spent a good many early Sunday mornings together at Taub’s home before he moved into the hospital. “Sometimes he would fly in at 2 A.M. and ring me up and I’d tell him to come on over and maybe we could find an egg,” said Taub. “And we’d sit and talk and he would tell me about his projects and his dreams. He’s always had more things going than you could believe. I knew there would be no stopping that fellow.”

  DeBakey automatically took the old man’s wrist to feel his pulse and with his free hand dipped into an open box of chocolates.

  Outside, Jerry Johnson was waiting slumped against a wall, his face almost white, beads of perspiration dotting his forehead despite the chill of the air-conditioning. One of the doctors who had been through the ordeal tried to cheer him up. “You’re doing fine,” he said. “Sometimes the old man takes a wrong turn deliberately just to see if you’re paying attention and to screw you up if you’re not.” Another doctor nodded. “Just be sure not to volunteer any extra information,” he said. “I told him one night that I was concerned about a patient’s potassium level and he said, ‘That’s very interesting, Doctor, now I’d like to know the potassium levels of everybody we have in the hospital.’ I ran my ass bloody all night long getting them and the next day he never even asked to see them.”

  At the dead end of one corridor was a door with no name on the outside, a giveaway that a celebrated patient dwelt inside. In this instance it was a princess royal, the sister of the king of an obscure Asian country—a regal woman of indefinite age whose left arm from fingertip to shoulder was that purplish black of occlusive tragedy. It had been treated in New York, DeBakey thought, quite poorly. He was now prescribing drugs and waiting for the line of demarcation to settle in, indicating the place where he would, or hopefully would not, have to amputate. Often his cases were those that had been botched up or ignored elsewhere and about twice an afternoon he came out of a patient’s room muttering, “Butchery, sheer butchery.”

  Methodist Hospital attempts to cloak famous patients—the Duke of Windsor, Jeanette MacDonald, Curt Jurgens—with anonymity, but DeBakey has never become exceptionally upset when their names, coupled with his, get into the newspapers. “He is a master of publicity,” says one DeBakey watcher. “He was the first doctor to realize what a valuable tool it could be.” The two Houston papers cover both heart hospitals as a major beat and DeBakey and Cooley’s activities produce several local stories a month. Such exposure has traditionally outraged the Harris County Medical Society’s ethics committee, which feels the only paper a doctor’s name should appear in is a medical journal. Both men have been before the committee on publicity charges but neither pays much attention to such hearings. DeBakey usually turns the matter over to his lawyer.

  A Biafran chief had been waiting all afternoon for DeBakey to enter his room and when DeBakey arrived, the splendidly muscled black man presented a new complaint. He had originally come to Houston for open-heart surgery, which was successfully over with; then he complained of a gall bladder, which was repaired; now he thought he had a hernia. It seemed he was fully prepared to stay in Methodist for years, undergoing procedure after procedure and delaying the day he would have to return to his fallen country.

  The last stop was to see a woman whose mitral valve, one of four valves in the heart that control the flow of blood, needed to be replaced. The mitral, located in the heart’s left ventricle, is the one most often damaged by childhood rheumatic fever. The patient was a country woman and so frightened that her huge butter-and-milk body was jerking as she listened fearfully to DeBakey’s terse remarks. “We’re going to fix that up for you tomorrow, deah,” he said in his soft Louisiana drawl. The staff turned to one another and spoke with
their eyes. This apparently meant DeBakey would not be leaving for Europe. DeBakey took her hand and patted it; she glanced down at his abnormally long, slender, almost feminine fingers, the tops heavily covered with black bristly hair. She put her other chubby hand on top of his and pressed it tightly. “Well,” she said, “if that’s what you have to do.…” DeBakey nodded. “Then,” she was summoning courage and picking up speed, “you go right ahead and do it. Just make sure you do it. That’s what I came for.”

  “You’ll be fine, just fine,” he said, almost automatically. “I’ll see you tomorrow in the recovery room after the operation.” The last remark was subtly important; it gave the patient a projection into the future, beyond the operation, beyond the terrible unknown of this small, tense, abrupt man who was going to cut into her heart.

  On the way back to his office DeBakey suddenly said, “I’ll be leaving in a few days for Europe. I’ll be gone about a week. I’ve got to deliver a speech in Rome and then stop by Belgium to see King Leopold and Princess Lilliane. The king has not been feeling well lately.” I could not tell from his routine delivery of this interesting itinerary if it was information or a boast—but he certainly looked like a court physician, scurrying off, entourage at his heels. He had seen 47 patients in 32 minutes.