Hearts

by Thomas Thompson

  Q. “What was their relationship in the beginning?”

  A. “Professional. No warmth. Mike, after all, had come from a Lebanese immigrant family in Lake Charles, Louisiana, and his mother taught him how to sew his own underwear and he worked in his father’s drugstore and when he finally got to Tulane, he was not popular. In fact, he was very much an outsider, the owl, the foreigner, the guy who didn’t get invited to join a top fraternity. It wasn’t that he was not well liked, I just don’t think people paid much attention to him at all. Cooley, on the other hand, was the son of a rich society dentist in Houston and they owned a lot of the north side of town. Denton was always the most popular kid in the crowd, the leader, the one with charisma, the star athlete, the one all the fraternities at the University of Texas fought to rush. And the handsomest son of a bitch to ever pick up a scalpel. How’d you like to shave Mike DeBakey’s face every morning and then have to look across the table at Denton Cooley?”

  Q. “Was there trouble between them from the beginning?”

  A. “No. For a few years, Mike was the maestro, Denton played the protégé, although he was equally as skilled and knew far more about heart surgery—such as it was—than Mike. DeBakey, in fact, didn’t start poking around hearts until about 1961. He had concentrated on his aneurysms and vessel work, Denton did the hearts, and the arrangement seemed ideal. I was around during the first big aneurysm DeBakey did, but not having the overview that he has, I didn’t even know history was taking place. Judging from the coolness with which they went at it, you’d have thought it was a routine operation. Denton ‘first-assisted,’ but I heard, had you stood at the table, you might have wondered who was leading whom.”

  Q. “Why is there antagonism toward the two men within the Houston medical community?”

  A. “Some are jealous. Hell, Mike and Denton shouldn’t be doing hernias and gall bladders, but they do, and it is irritating to the rest of us. The patient is usually some prominent fellow who has asked for them and who might make a big donation to their causes. Others of us feel that medicine should be conducted quietly, privately, not in headlines or on the Johnny Carson Show. And with Mike, it’s just because he is so impossible to deal with.”

  Q. “Meaning?”

  A. “Meaning he is consumed with his work and himself. The human factor is missing. If you looked back over the careers of the great surgeons—and Mike is certainly in that category, it’s tragic that his personality clouds his magnificent contributions to the art—you will find that all of them, Cushing, Halstead, whoever, had a peak period of perhaps ten productive years. These were years of impact. Of history. And then they de-accelerated, usually by more and more teaching, by developing rapport with their younger men, by helping them get good jobs and by taking pride in their achievements. There is none of this warmth, this fatherly feeling with Mike, Out of 25 years of heading Baylor’s surgical department, Mike does not have one—not even one—chairman of a surgery department somewhere. Dr. Alfred Blalock, who was Denton’s mentor at Johns Hopkins, has them scattered all over academic medicine. This is Mike’s shortcoming—he becomes a rival to his own doctors. If he doesn’t fire them or run them off, he becomes jealous and envious of them.”

  Q. “But what does the medical world as a whole think of DeBakey and Cooley?”

  A. “No matter what excesses they have committed, they have made Houston the finest cardiovascular institution in the world. We have doctors coming here from the seven continents to see in one week what they wouldn’t see in years of observation somewhere else.”

  Q. “Is heart work done in Houston that is not done anywhere else?”

  A. “No. Mike and Denton just do ten times more of it.”

  Q. “May I ask a rude question.”

  A. “Sure.”

  Q. “Are you ever jealous of those two across the street?”

  A. “Truthfully? Of course. I sit here in a little office and Mike and Denton are over there in surgical palaces. But I content myself with knowing that I am a good surgeon, that I stay with my patient before, during, and after the operation, that I have a good relationship with my family, that I have a good relationship with my peers.”

  Q. “What is that peer relationship?”

  A. “In Houston it is clean-cut. We are not a city brushed with sophistication. In New York, I know of internists who make sweetheart deals with surgeons. No one has ever spoken to me this way in Houston. If one did, the conversation wouldn’t last fifteen seconds.”

  CHAPTER 5

  Toward the end of April, 1970, a green, tropical month in Houston, Dr. Denton Cooley, then 49 years old, flew to a medical meeting in West Virginia where he concluded his speech by talking of his dormant transplant program. He defended his implanation of 21 human hearts and one artificial heart, illustrating his words with slides that showed groups of his transplanted patients, seemingly radiant with health, photographs taken before they began falling, one by one. The audience applauded not only the speech’s content, but its delivery—low-keyed, boyish, earnest, Texan. It was a speech he would give several times in the months to come and invariably it would be successful. Cooley is not only a surgeon, not only a speaker, but a presence, frankly sexual. He accepts center stage as Olivier does, a possession earned. He rises slowly, unfolding the lanky, muscled body, walking with athletic grace to the lectern, pausing for a calculated second to meet the audience with his gray-blue eyes, and leads audiences into the awesome valley of open-heart surgery.

  It may be facetious to talk of a surgeon by commencing with his looks but everyone does. One Houston matron, explaining her hypothetical choice of Cooley over DeBakey, said, “When I wake up from anesthesia, honey, I want Denton Cooley leaning over my bed.” A Houston medical writer feels the physical characteristics are a major factor in aligning support within her city. “DeBakey, whom I feel is a deeper man, a more introspective man, nonetheless looks as if he could play Shylock,” she says. “Cooley is the golden boy.”

  When Methodist Hospital and St. Luke’s Episcopal Hospital were first planned in the early 1950s, the governing boards decided to specialize in different fields. After all, they were neighborly institutions only one hundred or so yards apart, and religiously endowed neighbors at that. In addition to general hospital services, Methodist would feature a psychiatric floor, orthopedics, a renal service, and neurological specialists. St. Luke’s would handle urology and premature infants. Neither hospital made room for heart-surgery patients, because in the early 1950s there were none. Nor could the planners have foreseen the tidal waves of patients that would wash in from all over the world. Each hospital soon had to make urgent accommodations to stay up with the burgeoning heart business. Methodist, DeBakey’s hospital, made four major additions, growing from an original size of 301 beds to its current 1,021, and added its spectacular Fondren-Brown wing. Cooley’s St. Luke’s moved more slowly but with a Texas-sized goal in sight. By mid-1970, a 27-story tower addition had been topped off, dominating the Texas Medical Center as the Colossus dominated Rhodes. There would be seven full floors for Cooley’s Texas Heart Institute. Cooley had hoped to have the Institute in its new quarters by 1969, but labor strikes and a shortage of borrowable money had delayed it two years.

  Houston is a rich city and its millionaries have become accustomed to answering the knock at their door and encountering DeBakey or Cooley or the head of another medical institution standing there with hat in hand. Dr. R. Lee Clark, who heads the massive M. D. Anderson cancer hospital across the street from Methodist and St. Luke’s and who has plans to double its size, never loses his optimism. “I spent quite some time in Florence trying to see what brought about the Renaissance,” he said one day as he showed me the table-top model of the additions. “I came to the conclusion that it was due to the people of the city and the scientists of the city working together. We’re going through a Renaissance of Health in Houston. We’ve got people who aren’t afraid of raising $100 million. Houston is a place where you can g
o and present an idea at dinner time and raise $3 million by 10 P.M.”

  Physically joined to St. Luke’s Hospital with common corridors is the Texas Children’s Hospital. When Cooley had grown disenchanted with DeBakey in the mid-1950s he had moved, without a formal break, to Texas Children’s, where he began a series of heart operations on children. The hospital, one of the most remarkable in the world, had been funded in a manner unique, if not to Florence, then to Houston. Leopold Meyer, a wealthy Jewish merchant and developer, was enlisted to scout the city for money. He went to visit his Episcopalian friend, J. S. Abercrombie, who on the occasion of the visit was in a downtown Baptist hospital with a back problem.

  “Say, Jim, you got any money?” asked Meyer after the social amenities.

  “Little.”

  “Well, I want to spend some.”

  “What for?”

  “We want to build a children’s hospital.” Meyer explained the idea and the potential.

  “I’m not sure your idea is a practical one, but if you’re that sold on it, how much money you talking about?”

  “Couple of million dollars.”

  “Go ahead.”

  “I’m going to commit you, Jim.”

  “I know it. Now get out of my room. My back hurts.”

  Abercrombie later announced that he was tired of being solicited every year thereafter to make up the deficit of operating the hospital, so he pledged his dividends and stock holdings in the Cameron Iron Works for the next 40 years. “Our hospital,” said Meyer, “will never be in want.”

  On the first Monday morning in May, 1970, Dr. Robert Leachman was holding forth in the Cardiology Section of St. Luke’s, where he was the chief, trying with no success to get out and see the new batch of patients who had checked in the night before. In the two Houston hospitals, it is the problem of the cardiologist to dwell in the shadow of the surgeon—Leachman describes his role as that of “surgical pimp”—but he, in fact, seemed a good counterpart to the dash and élan down the hall. He had hair he had forgotten to cut, a suit he had forgotten to press, shoes he had forgotten to shine. A cigar seemed permanently growing on his hand or face, except on those reluctant occasions when he had to put it down on a window sill to enter a patient’s room. His teeth were uneven, with a prominent gold one sparkling in front, but he was a man of gentle nature who, after being around for a while, became highly attractive. He was the country doctor in the city, but he was comfortable in the role. He spent as much time in the patient’s room as the patient wanted; he never seemed in a hurry. He would lean against a staircase wall for half an hour to go over a puzzling EKG with a group of foreign cardiology fellows who trailed him. He was a philosophical, self-searching physician who fretted now and then that a surgeon got $1,500 for the operation that took only a half hour of his time, while a cardiologist billed a patient only $300 for managing him before, during, and the ten days to two weeks after the procedure.

  Leachman spoke fluent if atrociously accented Spanish, which was valuable to Cooley because of the volume of patients streaming in from Mexico and South America. When the earthquake of 1970 devastated Peru, Leachman spent almost a week on the telephone trying to arrange to go there to care for the injured; the trip was never made because Peruvian authorities said they had enough doctors.

  It took Leachman more than an hour to leave his office: three patients were waiting for catheterizations of their hearts, one woman from Long Island repeating over and over again, “I dread this more than I do surgery. For God’s sake, knock me out.” Leachman picked up her wrist and held it as if checking her pulse; doctors frequently do this and do not even bother to count. Pulse-taking can be a gesture of friendship and interest. “It isn’t exactly painless dentistry,” he told the woman, explaining that general anesthesia was not necessary, “but we try.” A problem had arisen with a Spanish patient and three doctors—one from Venezuela, two from Mexico—were loudly debating it. Phones were ringing, the radio was turned up loudly to a rock and roll revival, the coffee pot was breaking down, a new secretary was breaking in, the air-conditioning system was out, a drug detail man was following the doctors about with a new pain-relief pill, and a two-year-old child, back for a postoperative checkup, was screaming, spitting out his pacifier, growing increasingly angry, finally throwing up on his mother, himself, a nurse, and the floor. Leachman looked slowly around and said quietly, “I think it’s a good time to make rounds.”

  Cooley normally has from 80 to 100 patients in St. Luke’s and Texas Children’s, and he arbitrarily assigns each of them to a staff cardiologist. Leachman carries about 30 on his census. By the time a heart patient gets to Houston, he has been through the medical mill. If he is from a small town, he probably started with the local general practitioner, who, upon suspecting something wrong with his heart, referred him to the nearest big-city internist, who, if the diagnosis indicated surgery, dispatched him to Houston and Cooley.

  “I’ve noticed there are two groups of patients,” said Leachman as he ambled easily down a hallway. He had thrown his brown suit jacket over his hospital greens. I cannot recall ever seeing him with the crisp white glamorous coat that marks his profession. “There are the ones who identify instantly with the surgeon, and a second group which identifies with me. These are usually people who have been kicked around so long by their sickness that they know the surgeon is not the only answer.”

  Leachman was on the seventh floor of Texas Children’s and he stopped at a nursing station to pick up a new patient’s chart. Putting his smoldering cigar down on the edge of a new white formicatopped desk, he received a frown from the head nurse.

  Leachman flipped through the chart. It told the medical history of a four-year-old child from Austin, Pamela Kroger, who had been born with the great vessels of her heart transposed. Until half a dozen years ago, such transposition meant early death, usually within a few weeks after birth. Now surgical correction is possible, done in two stages. In the first few weeks or months after birth, the infant receives a palliative operation to improve oxygenation. The surgeon, in effect, creates another defect to replace the primary one. When the child is four or five years old and better able to tolerate major surgery, total correction can be attempted. A Canadian surgeon, Dr. Mustard, was the first to carry out this procedure, but Cooley has since done more “Mustards” than all the other heart surgeons in the world put together. After a few months in Houston, the superlatives—the “more than’s” and the “most of’s” become familiar, even wearisome to the ear.

  Leachman had said surgery was not the only answer to heart disease. How, then, had two surgeons built two heart centers in the same city, casting the cardiologist in a supporting role?

  “Like it or not,” Leachman said, “structural power, economic power, and political power rests in the surgeons’ hands. They are not the intellectuals of medicine, but they have the clout.”

  He stopped and looked back at the nursing station. He was going to talk a while and he missed his cigar. “I’m not so sure I disagree with this, either. There needs to be a God-image. The patient has to have it all built up in his mind that this one guy and his two hands—that after all the other doctors who have pawed him and pulled him, after all the pills, all the pain, that this pair of hands is going to make him well. I would be uncomfortable thrust in the role of Super-Jesus, but somebody must play it. There is a well-known heart clinic in Mexico which decided to have a lot of important apostles and no Super-Jesus, and I believe it is about to collapse.”

  The transposition case, Pamela Kroger, began to shriek the moment Leachman entered her room. She was a thin, pale child with a bluish cast to her body. There was enormous pain and sadness in her presence, despite the dolls and laughing clowns scattered on her bed covers. The room itself was gaily decorated with one red wall and stylish lithographs of children and animals.

  “Hello, Pammy,” Leachman said, trying to take an unwilling pulse. He surrendered and pressed his stethoscope against her nig
htgown. Doctors who deal with children learn to listen patiently and catch the heart sounds in between sobs. Mrs. Kroger attempted to calm her child, but Leachman shook his head that it was not necessary. He motioned for her to follow him into the hallway.

  “The catheterization tells us it’s worth trying,” he began. Mrs. Kroger nodded, biting her lip. “But there is, you should know, a definite risk involved.” Mrs. Kroger nodded again; she was clutching her elbows tightly. “I suppose,” Leachman said, “everything gets down to a calculated risk.”

  “But we don’t really have a choice, do we,” she said as statement, not as question.

  Leachman shook his head from side to side. “Dr. Cooley’ll be by tonight to talk with you. You make your decision and tell him.”

  A few doors down was a teen-age Italian boy, who seemingly had been making a textbook recovery from his heart surgery but whose prosperous-looking father was now distraught over a peculiar-looking patch of something that had appeared on the back of his son’s head. Almost weeping, he implored Leachman with gesture, in a mixture of Italian and English, to inspect the suspicious growth. Leachman seemed puzzled and took the boy’s head in his hands. He had to bite his lips to keep from laughing. “How do you say, ‘Head and Shoulders’ in Italian?” he said to the nurse. “The kid’s got a big patch of dandruff. All he needs is a shampoo.”

  A Venezuelan baby, chubby, with huge dark solemn eyes, toddled down the hall, waving at the older children riding up and about the corridor in wheelchairs. Kids bounce back fast and they are encouraged to get out of their beds and play, even if it means hide-and-go-seek in the nursing station or bumper cars in the foyer. Leachman picked up the baby and laughed with him. “Cooley did a low-risk palliative procedure last week. Mario here is the classic blue baby, he has Tetralogy of Fallot, which is four major heart defects. He’ll have to come back for more surgery in a few years.”