Hearts

by Thomas Thompson

  “DeBakey operated on December 27, 1965, he went in and scraped the heart raw and implanted an artery. The next day my house burned to the ground in Indiana! My family didn’t tell me about it for six weeks. They didn’t want to excite me any more than I was. DeBakey’s operation did some good, but by late 1966 the pain was back and so bad that DeBakey did another artery implant. I went home to Indiana and sat around and made a big mistake by reading about a new gas-jet operation they were doing in New York City. I asked around about it, and a doctor friend said if I went there and had it, I’d come home in a pine box.

  “I had learned you shouldn’t always believe doctors, so I went to New York City. And that was the biggest mistake I ever made. It was June, ’68, and they did this new operation on me—they shoot little jets of carbon dioxide gas into the blocked-up heart arteries and pull out cores of blockage—and while I was still in Intensive Care, I got up goofy and walked out of the hospital and actually made it several blocks before somebody missed me and went out to look for me. When they found me, I was dragging bottles, IV tubes and squirting blood out of my femoral artery every time my heart beat. To top that, the new operation worked for about two weeks before the arteries clotted up again, and when I got home I was bedridden two months with infection.”

  Stapler took a long sip of ice water, but ignored the food tray that a dietician had brought in during his monologue. Could he eat the night of his transplant?

  “From 1968 on,” he continued, “I’ve had almost constant pain from angina; if you took a hammer and hit each one of my fingers, it wouldn’t hurt more than it does now. DeBakey tried two months ago to do something else, but my heart stopped cold during the operation. Dr. Dennis, he’s my cardiologist, he came out and told my wife he was extremely sorry but this time I was definitely dead. About 30 minutes later out comes DeBakey grinning and shouting, ‘We did it! We did it!’ But what he meant was that he had started up the heart.”

  But what were his thoughts about borrowing someone else’s heart? The dice seemed to have only twos and twelves in them.

  “I’ve already died four times,” he said softly. “Once in an ambulance on the way to some hospital, somewhere, my heart stopped and the attendant beat on me with his fist so hard and so long that my chest was black and blue for months. I’ve got 75 inches of scars on my chest and there’s nothing left but to try another heart.… I never thought I would die. I still have a little optimism left. My kids are too precious for me to leave. I’ve got a nice little wood-working shop to go home to and I’ll make somebody some nice cabinets and tables.”

  He fell silent and I thanked him and started out. He stopped me. “Some day I’m going to be lying here in the middle of a Zane Grey and the nurse is going to come in and say, ‘Okay, Howard, up and at ’em. There’s a heart downstairs with your name on it.’”

  As Stapler talked, Diethrich was at that very moment learning that Elizabeth Dagley had suffered severe pneumonia during the five days she lay comatose. Her heart was too contaminated by pneumonia to consider using it for transplantation. All Howard Stapler would receive this night would be a shot to kill his pain and a shot to put him to sleep. No sooner had the surgeon called off the cardiac preservation chamber than did the telephone ring again. This time it was Dr. Suki, a renal specialist at Baylor, asking if Diethrich could do a kidney transplant later that night. Diethrich agreed. He did not ask who the donor was, nor who the recipient would be. Not until a few moments before the operation began would he learn that the kidney had come from Elizabeth Dagley. Her heart was not suitable for a transplant, but neither of her kidneys had been affected by the pneumonia.

  Two months before this, an eleven-year-old boy named Wesley Connor from Fort Polk, Louisiana, had been worked up by Dr. Suki, found to be a suitable candidate for a kidney transplant, and was told to stand by at his home. Wesley had been born with a chronic bladder condition, which had destroyed his kidneys; he had been urinating through two holes created near his navel, the urine flowing into pouches strapped around his waist. His mother and stepfather had bought a new car in anticipation of a sudden emergency summons. On the afternoon it arrived, they scooped up Wesley from a playground and were racing toward Houston.

  The body of Elizabeth Dagley was transferred by ambulance the 1,500 yards across the Medical Center and she was wheeled into Room 3. The respirator was forcing her lungs to inhale and exhale; the illusion of life still clung to her. But her face was shut by death.

  At 10:35 P.M. Diethrich scrubbed to go into surgery. Jerry Naifeh, the medical student, asked him what the case was going to be. “Kidney transplant.”

  “Who’s the recipient?” asked Jerry.

  “Some kid. I don’t know him,” said Diethrich.

  “Who’s the donor?”

  “Cadaver. I’m just going to sew it in. This is the odd thing about transplant surgery; you don’t meet the patients sometimes until you see them on the table.”

  Wesley was being prepared for surgery. A round-faced blond youngster with freckles, he had wide blue eyes stretched with apprehension over what was going to happen. Patients normally are sedated in their rooms before surgery so that they enter the operating room tranquil and sleepy. But Wesley had gone directly from his stepfather’s new car into the operating room. A nurse was bent over him, gently talking nonstop, diverting his attention from the hot lights and the dozen people busied about him with needles, bottles, and tubes.

  “Do you have a dog? Do you help your mama? Do you like to cook? Hamburgers? You seem like a 100 percent boy to me.…”

  Wesley looked up and saw the off-duty nurses and students watching from the glass dome. A transplant always draws an audience. The nurse threw her hand over his eyes to block the sight but it was not necessary; the anesthesiologist had gone to work and the child’s eyes closed quickly on their own.

  It was almost midnight when Diethrich opened Wesley’s abdomen and removed his kidney, a shriveled, useless organ. It was sent to pathology for examination and study. In the adjoining operating room, a resident had sliced open Elizabeth’s stomach not quite so carefully and removed both of the kidneys. Mrs. Dietrich (no relation to Ted Diethrich) the head operating room nurse, put one kidney into a steel mixing bowl filled with saline solution and bore it cautiously to Wesley’s room. It had been carefully flushed with a solution to remove any blood clots and the tranquilizers and barbiturates that Elizabeth had used to destroy herself.

  Several doctors were around the table watching the transplant. “I don’t know how in hell Ted’s going to fit that big kidney in that little boy’s pelvis,” one of them said. The girl’s kidney was approximately twice the size of the one from the child that had been removed. The doctor beside him drawled loudly, “I hope y’all washed the barbiturates out of that gal’s kidney; you don’t wanna put this little boy to sleep forever.”

  Mrs. Dietrich bustled next door again to supervise the packing of Elizabeth’s other kidney for shipment to Dallas. The respirator had been turned off and Elizabeth Dagley was forever dead. A resident was stitching up her incision; someone had tied a tag with her name on it around her toe. The color of death is blue if the breathing stops first; if the heart stops first, it is gray.

  Though she had been technically dead for nine hours now, Elizabeth was still building up a sizable hospital bill: the ambulance ride across the Medical Center, the operating room fees, the surgeon’s charges. But Wesley’s mother had agreed to pay for all of the donor’s expenses; it has become established hospital policy for the recipient to bear the donor’s charges.

  Mrs. Dietrich had found a white styrofoam case about a foot high. The kidney was put into a steel canister, floating in a solution of cold saline and then into the styrofoam case. There was a slight argument between the efficient, veteran nurse and one of the young doctors about whether to use dry ice or real ice packed around the canister. Mrs. Dietrich, who wanted a small amount of dry ice, pointed out that it would not be proper to send Dallas a fr
ozen-solid kidney. “Hmmm. I guess you’re right,” said the young doctor.

  “Who’s going to take it up?” someone asked.

  “Probably some Braniff stewardess in her flight bag,” said someone else.

  Somebody stuck their head in the operating room door and said, “No hurry. Dallas found a pilot who’s coming down to get it.”

  Mrs. Dietrich dropped dry ice into the box, sealed it up, wrapped it well with tape, and slapped a FRAGILE, HANDLE WITH CARE sticker on top. Dr. Suki had prepared a letter with the tissue typing results, which was Scotch-taped on the side. The box was carefully carried out to the operating room administration desk, where an assistant hospital administrator would watch it until the messenger came to take it to the airport.

  Wesley’s right colon had to be moved up a bit to accommodate the new kidney: the child gained exactly one pound during surgery. Seven hours later, a transplant team in Dallas sewed Elizabeth’s other kidney into a young man.

  The next afternoon in DeBakey’s bullpen, Hans, the German doctor, was talking with some of the students and residents about transplants. In his country, Hans said, a flat brain wave is required for 24 hours before the patient is legally dead. “Here,” said Hans, “as soon as the wave goes flat, they start transplanting.”

  DeBakey was back. He returned to a house full of patients. Polly Tovar, his admissions secretary, does not need his authorization to tell patients to come to Houston. She takes most of his long-distance telephone calls, notes the particulars of the case and the referring doctor’s opinion, and makes a generally immediate appointment for the patient to enter Methodist on a given date. Surprisingly, it is not difficult to gain admission to DeBakey’s service, nor is there a waiting period of seldom more than a few days.

  On afternoon rounds DeBakey was in a good mood; most everyone he had operated on before his European trip was now ready to go home, stitches out, bags packed, hopes up. “I’m sorry to ask this, Dr. DeBakey,” said one elderly woman, almost timidly, “but I sure would like to get out of here.”

  “Don’t be sorry about that,” answered DeBakey, beaming. “That’s what we doctors like to hear.”

  He dismissed Stapler, telling him he could just as easily wait for a heart at home in Indiana. “It doesn’t take long to fly here, does it?”

  “Couple of hours,” said Stapler.

  “You go on home then, and we’ll let you know just as soon as we might be able to do something for you.”

  Stapler nodded glumly. His disappointment was clear. A year earlier there would have been more enthusiasm to transplant him.

  Diane Perlman was not tolerating the pain from her amputation. Jerry Johnson had become concerned over pus at the site of her wound and had mentioned casually that DeBakey would take a look at it upon his return from Europe. Mrs. Perlman referred to this while DeBakey was examining her. His face visibly tensed. Outside, he stood Johnson against the wall. “You don’t know anything,” he said. “You don’t know enough yet to tell anybody when I should see them.”

  Johnson had unknowingly committed a blunder that others had learned in similar hard ways: be extremely cautious in communicating postoperative complications. Years ago, one resident even wrote down three rules and passed them on to his successor. They were:

  “1. If the complication is minor, treat it yourself, keep it to yourself, and pray that it works.

  “2. If it is major, wait for the best opportune moment—it may never come—to tell the Professor that the patient is infected or that the graft is bleeding.

  “3. If the patient dies, pray that the Professor is out of town.”

  DeBakey’s attitude toward death was puzzling; no physician likes to lose patients. DeBakey, however, took death as an intolerable almost personal affront to his skill, to his very being. On the rare occasion that patients died on his table, he would cancel the rest of the day’s schedule, stalk to his office, shut the door, lock it, and stay inside for hours.

  One prominent Houston surgeon remembers an incident that occurred a few years ago. The story sounds suspiciously apocryphal, but the surgeon swears he witnessed it. “The quickest way to get fired off the Professor’s service was to have someone die on you in ICU. He’d come in with storm clouds over his head and look at the patient and after a long while he’d look at you and he’d say, ‘I don’t understand this, Doctor. I gave this patient a perfect operation and now he’s dead. How could this happen?’ Well, sometimes he was right. Often complications were the fault of the younger guys, but when a surgeon does as many operations as DeBakey does, you cannot expect 100 percent recovery. One afternoon a resident was on duty in ICU and it was a day when DeBakey was leaving on a long trip. Suddenly one of the patients upped and died. The resident was petrified. He had already done a few wrong things; this was a major crime. He knew DeBakey would be coming through on rounds just before he left for the airport. So he took the monitoring wires off the dead man and transferred them to the patient in the next bed. He dumped a lot of medication down the dead man’s IV tube, made sure the respirator was working, and swore the nurse to secrecy. DeBakey came through on rounds, stopped at the dead man’s bed, looked at the monitor. The resident murmured, ‘He’s doing about the same, Dr. DeBakey,’ and DeBakey flew off. The moment he left the hospital, the kid disconnected everything and pronounced the guy.”

  DeBakey’s transplant team did four more kidney transplants the same week Wesley received his. Baylor hurried out a press release claiming a world’s record, five kidneys in five days. All were “doing satisfactorily.”

  Seven days after his bypass operation, Arthur Bingham was preparing to go home to Phoenix. His color was good, his eyes were clear, he yearned for a cigarette, but he had not smoked one even though his fist clenched when others did around him. Diethrich had pronounced the new artery within his heart to be working beautifully, maintaining a good flow of blood. Bingham could have posed as a testimonial to the new procedure. “The only thing bothering me is The Roadrunner in the next bed,” he said, pointing to a middle-aged man asleep. “Last night he stood up in bed and started taking his clothes off and thrashing around and yelling, ‘Let’s get outta this cheap hotel.’ Then he urinated in the wastebasket. He’s an old bachelor, he told me, and he’s scared and lonely.”

  The Roadrunner was Miles Vogler, a merchant from Denver, who had come to Houston complaining of severe pains in his legs. He could not walk very far without having to stop and rest. An arteriogram revealed occlusion in his lower abdominal aorta, and Diethrich recommended a Leriche operation—a bypass around the obstruction using a Y-shaped Dacron graft, where the aorta branched off to supply the legs with blood. Vogler listened attentively as it was explained where the graft would be implanted in the area above the groin, then beckoned for Diethrich to come close so they could talk confidentially.

  “I’ve been a bachelor all my life,” he said in a gravelly voice. “I’m 55, and I never really fell in love. My doctor back home told me my sex life was about over, but Doc, I can tell you it isn’t. I went to St. Paul a while back and met this lady and we made love twice a day for five days. Now I ask you, does that sound like my sex life is over? What I’m getting at, Doc, I just don’t want you to cut anything you don’t have to.”

  Diethrich nodded seriously. “This procedure will help the circulation in your legs only,” said Ted. “As to your sex life, I congratulate you. I promise not to hurt it, but on the other hand, I can’t guarantee it will be any better.”

  Vogler bit his lower lip. A few moments passed. He began hesitantly. “Well … okay.… When do you wanna do it?”

  “Tomorrow.”

  “That soon?”

  “Why not?”

  “I guess so.”

  Vogler was scheduled, but that very night he packed up his things, ran frightened out of the hospital and flew back to Denver. A nurse witnessed the flight and reported, “He looked just like The Road-runner.”

  About a fortnight later, the Roadrunner
came beep-beeping back into the hospital, almost knocked down the same nurse, scurried up to Diethrich and once more agreed to surgery. The surgeon scheduled him the first thing the next morning, “before he gets scared and runs out again.” The operation was entirely successful, but Vogler was still mentally fuzzy from the anesthesia and his stay in Intensive Care Unit. “Sometimes it takes a few days for the older patients to get their marbles lined up again,” explained an anesthesiologist.

  Later that week, DeBakey did six beautiful operations, including an aortic arch aneurysm, impeccably excised and replaced with a Dacron graft. This is DeBakey’s specialty; had he never touched a human heart, his place in the history books would have been secure from this work alone. Before 1952, these insidious weaknesses anywhere along the aorta would swell and eventually rupture—the classic lay description is that of a bubble in an inner tube—and, as one surgeon recalls, “There was nothing for us to do but sit around in the coffee room and make bets as to when the aneurysm in Room 306 would burst and die.” There is confusion as to who actually did the first excision and repair of aneurysms—some claim DeBakey in the 1951–52 period, others claim Dr. DuBost of France slightly earlier, but there is no doubt that DeBakey became the foremost practitioner and preacher of the gospel. In the mid-1950s at national medical meetings, some surgeons would get up and say it was dangerous, reckless, and foolish to even attempt such surgery; others would stand and report a series of six or ten. DeBakey would rise and report a series of two hundred and fifty, with such spectacularly low mortality rates that those present would either draw in their breaths in surprise or express disbelief.

  One Houston physician who has worked with both DeBakey and Cooley recalled those early years:

  “Both men always reported such excellent results that their peers thought they were liars. They weren’t out-and-out liars, but what you call an improved patient is a value judgment. You may cure a patient’s headache but have to cut his leg off.