Hearts

by Thomas Thompson

  Adult patients were also in Texas Children’s, stashed there temporarily until the additions to St. Luke’s were finished. Leachman’s first stop was to see a cheerful, thirtyish fellow who had sailed through his surgery, but whose teeth had all fallen out afterward in adverse reaction to a drug. It was one of those weird side effects that could not be anticipated and that plague doctors.

  “Did you eat your breakfast this morning?” asked Leachman.

  “All except a hard piece of toast I couldn’t gum to death.”

  “Well, at least you can honestly say, ‘Look, Ma, no cavities.’”

  “Dr. Leachman, do you know if Blue Cross pays to put a fellow’s teeth back in?”

  “Sure don’t. I’ll look into it, though.”

  It was almost noon, but Leachman was not half done with rounds. Cooley and DeBakey would have seen ten times this number of patients within the two hours that Leachman had prowled the wards. But patients sit in their beds all day long waiting for the big moment of the doctor’s appearance, and when one like Leachman strolls in—one who does not seem in a rush to get out—the patient takes advantage of it.

  “You’ve got heart palpitations, all right,” said Leachman to an elderly, heavy woman. “But we don’t think you need surgery just now. We’ll treat it medically for a while and watch it.”

  The woman cut in hurriedly. “But I’m not too old for surgery, am I?”

  “How many years you owning up to?”

  “Sixty-nine.”

  “You may be too young for surgery.”

  “Oh God, oh merciful sweet Jesus, I’m so glad. Doctors used to discriminate against older people.… Well, if surgery is ever indicated, I certainly want it. I want to live as long as I can.… That’s not being selfish, is it?”

  Leachman shook his head in agreement. “I think every patient should have the medical facts and apply them to himself and then make his own decision about surgery. But you can go on home now and stay in touch.”

  The woman lifted her arm. There was a Band-Aid at the crook of the elbow where the catheterization probe had been injected. Two stitches were there to close the small incision. “I’ll take these out myself at home,” she said.

  “Can’t do that,” said Leachman. “Against union rules. Somebody’ll be around later today to take them out.” He patted her arm and made to leave.

  Leachman went off to search for his cigar; he had momentarily forgotten where he laid it down. “Is it true what she said?” I asked, “that they used to discriminate against older people?”

  He nodded. “Still do, as a matter of fact. A lot of surgeons wouldn’t touch a woman that old. We didn’t used to do many, but we’re a little more confident and knowledgeable now. Some of our confreres, however, are continually concerned about their batting averages.”

  The last patient of the morning was Harold Carstairs of Illinois. He had checked in the night before and this was Leachman’s first visit. Carstairs already had been worked up by the cardiology and surgical divisions. They had confirmed with their stethoscopes what the hometown doctor had suspected—grave heart disease, a whopping hole in the heart called a ventricular septal defect. The hole had been there for years, possibly since Carstairs’ birth 49 years ago, and the heart had been forced to beat harder than it should have, enlarging it as surely as the muscle on a man’s arm enlarges when he picks up heavy crates every day.

  “Does your heart bother you,” asked Leachman as an introduction, “or does it just bother your doctors?”

  “I read the obituaries every night to make sure I’m still alive,” answered Carstairs in a quiet little voice. He was a short, average-looking man with thinning hair well oiled and combed back behind his ears. There was the same sadness about him that had enveloped Pamela Kroger in Children’s two hours earlier.

  “Did you get any breakfast?”

  “Not much.”

  “Well, we try to make you suffer as much as possible and at the same time cut down on hospital expense.”

  “You think Dr. Cooley’s going to operate on me?”

  “We’re not at that plateau just yet.” Leachman spoke carefully. The man’s heart was as gross and flabby as an overripe pumpkin. It could stop and give out during surgery or after surgery or—for that matter—while Leachman was talking to him. “We’re going to do this catheterization on you this afternoon, and if it shows what your doctor back home thinks it will show, then we’ll come back and talk to you some more.”

  Carstairs’ eyes had been clear during Leachman’s earlier remarks, but suddenly they began to cloud. He cleared his throat and spoke hesitantly in a voice that was difficult to hear. “I wanted to say … it’s just that I’m ready.…”

  Leachman smiled. He slapped him gently on the leg. He walked outside and hurried back to cardiology. “That’s one sick boy,” he murmured. “I wonder how they live long enough to get here.”

  In Leachman’s absence, little had improved in the cardiology lab. There were patients still waiting for catheterizations, phones were still ringing, the Spanish voices were still caught up in urgent debate over another EKG. I would learn in the months to come that chaos often defeated order in the burdened chambers of Cooley’s heart institute. The surgeon had thrown enormous pressure onto the hospitals: cases flowed out of his operating rooms and jammed the Recovery Room and Intensive Care and the wards and the waiting rooms. Everything from x-ray to the snack bar felt the weight of the numbers and not until the seven new floors of the Texas Heart Institute were open would there be abatement. Everyone complained, everyone said they were overworked, but somehow people got operated on and most of them got well. An anesthesiologist would tell me, “In Houston, success means numbers. First and Most. If a patient wants tender, loving care, he’s not going to get it from Denton Cooley or Mike DeBakey.”

  Dr. Leachman slipped into his cubbyhole office and sat down gratefully. “Surgery, you see,” he began immediately, starting a new topic but launching into it as if he had been lecturing on it all morning, “is a tremendous injury, a major insult. Surgery is like … like getting hit by a car! The critical period is not only when the patient is on the operating table, it is the 24 hours, the 48 hours afterward. Will the heart stand the new circulation process? Will the lungs take the new pressure? Sometimes the surgeon eliminates the mechanical defect that he is hired to do, but if the heart is so sick that it cannot accommodate the repair, if it cannot assume the new work, then the patient will die. But he will die in the recovery room or in his own room or at home, and the surgeon has long since washed his hands of it.”

  One of the South American cardiology fellows appeared abruptly with a catheterization report and an EKG trailing on the floor. He said it strongly suggested the patient in question would be a good candidate for the coronary artery bypass—the operation Ted Diethrich had done on Arthur Bingham, the procedure which was the number one topic in the heart surgery business. One of the few it had not excited—yet—was Denton Cooley who, hospital gossip had it, thoroughly disliked the meticulous, lengthy procedure. Gossip in a hospital is no more reliable than gossip anywhere else, only there is more of it. One reason is the insularity of medicine; the nature of medical work is that it tends to shut out the world beyond, locking both patients and personnel within. (A few months later, St. Luke’s would be boarded up for a threatened hurricane. With doors and windows covered, the hospital seemed physically what it had always been spiritually—a womb.) One of the gossips, a general surgeon, had commented that Cooley simply could not afford the time required for the new operation. “Denton’s got himself in a bind; he’s got to operate eight, ten times a day to bring in the revenue for his various projects. If he does the coronary properly, it’d mean cutting his list in half.”

  Leachman shot that notion down.

  “It takes a lot of time, true,” he said, “but there are other reasons. I’m not yet sold on whether the operation does anything but cut down anginal pain. It’s too early to tell if it
does anything for longevity, because the surgeons have only been doing them in big numbers for a year or so.”

  He stopped and picked up the reports the younger doctor had left on his desk. “Take this fellow.… He’s, let me see, he’s 47 years old, one previous heart attack, he’s probably building up to another. He’s got bad anginal pain. So what we’re dealing with here are two main problems: one, suffering from pain, and two, suffering from the threat of death. This patient has coronary artery disease, a disease that you and me and every single one of us is going to get sooner or later if we don’t die from car wrecks or gun shot or air pollution. We might even say that aging is nothing more than the process which occurs in our arteries. But there are other facts that can bring on this condition besides age—diabetes, hypertension, the hereditary factor, civilization as a whole. You can almost measure a country’s progress when its statistics on heart deaths start to go up. I went to Venezuela years ago and there were very few heart cases; their babies were dying of diarrhea and the adults of tuberculosis. Now Venezuela is either an emerging or a developing nation and its people are dropping dead from heart attacks. And they’re almost proud of it! Like the Russians were when they started reporting their coronary statistics at world meetings.

  “So, how do we go about dealing with massive disease? We can try to prevent it in the first place by proper diet, activities, drugs, but prevent is a strong word. What we are really doing is stalling if off longer. If we ever got to the point where we could prevent atherosclerosis, we’d have people living to be 150, 200 years old. That would almost be an immoral act on the doctors’ part. We could be guilty of the ultimate population explosion. And if the medical profession ever achieves that goal, then the politicians are going to move in fast and restrict the kind of people we will be allowed to keep alive. Here we have the Mudd Family, for example, five documented generations of incest, murder, rape, and thieving. How much of our food and living space shall we allow them to use? I can see the catchy headline now, ‘We’ve Got Too Many People: Who’s Going to Go?’”

  “But,” I asked, “wouldn’t birth control at the start avoid this?”

  “Nope. The desirable people of our society are already restricting their families; the undesirables won’t and never will. But we’re digressing. Maybe what we should do to get at heart disease is to study the population—take the families with no diabetes or coronary artery disease, the families with ‘good genes,’ and breed them with the ones who are most liable to die of heart attacks. This would be one way to attack coronary disease—breeding control.”

  Leachman was out of cigars so he bummed a cigarette. Next to a minister who drinks, there is nothing more comforting to a sinner than a doctor who smokes. “Now, this super-duper new operation, this venous bypass. Granted, it is the first operation that seems relatively logical. But it is nothing more, so far, than a palliative procedure at best—and there are many other ways to reduce the pain from angina. We can always cut the nerves leading to a guy’s heart and he won’t feel a thing. Not even the heart attack that finally kills him.”

  Denton Cooley finished his eighth case of the day at 5:35 and lightly placed a gauze sponge into the incision of the heart, his unspoken signal that the first assistant was to take over and close. Neither Cooley nor DeBakey has the time to make the initial incision or the final sewing up. This is fairly common practice among important surgeons; were they to do the case from “skin to skin” it would take an average of three to four hours. (At a cocktail party in New York several months after my return from Houston, I met a businessman from Long Island who told me of his surgery by DeBakey. He was so overwhelmed by his good health that he stripped off his coat, unbuttoned his shirt, and displayed a well-healed scar, stretching from Adam’s apple to navel. “Professor DeBakey did this,” he said, as if showing off a first folio Shakespeare. I congratulated him on his recovery and decided against spoiling his notion of authorship.)

  Rounds would commence as soon as Cooley went out and told the families what had happened to their loved ones in surgery that day, a job he executed with as much speed and dispatch as the operations themselves. He strode quickly down the hall to a crowded waiting room outside Leachman’s lab where he pulled out a small filing card with names written on it. Fifty people stopped talking and someone shut off the television set.

  “Mrs. Brown?” Mrs. Brown hurried up, pale, haggard. “Your husband’s fine; we put in a new aortic valve in his heart. He’s just going to recovery now and you can go in and see him at seven.…”

  “Mrs. Green?” Mrs. Green was lurking nearby, waiting, fearing her turn. She had an autograph book in her hand but first she would learn of Mr. Green. “He’s fine, just fine. We put in a Dacron graft right where we told him we would.… You can see him in the recovery room at seven.”

  “Mr. Jones?” Mr. Jones was helped to his feet by two grown daughters, he being an aged, wrinkled man who had been mentally standing beside his wife’s grave all day. “Your wife is fine. She took the surgery very well. You can see her in the recovery room at seven.”

  They all had questions, but Cooley was gone, vanishing around the corner and on his way back to surgery. Silent, elegant, giant steps on rubber-cushioned soles. How could the relatives know that he rarely spoke, even to the patients? He was in and out of rooms at times without uttering a syllable, sometimes a nod, other times only a touch at the foot of the bed where the strip of tape bears the name of the patient and the disease and his name. The only time he was at total ease was in his operating rooms, where he was among his friends, where the only strangers were those on his table and by the time he saw them they had become abstract figures in the medical landscape, openings in green drapes. “He’s done 69 pumps in the last nine days!” exclaimed a surgical fellow named John Zaorski as he waited for Cooley to change from greens to street dress. “Pumps” are open-heart cases in which the oxygenating machine is used. “I spent a year at the leading hospital in New Jersey and we did 35 pumps the whole twelve months. The man is incredible. The man is absolutely a magician.”

  The man is also obsessed. He operates beyond fatigue, beyond endurance. He once broke two ribs water skiing, had them bound, and attended surgery the next day. A horse kicked him at his ranch and broke his leg; he ordered a cylinder cast put on it and hobbled to the table where he did a full schedule. In pain from a hernia, he operated an entire day, then lay down on his own table and permitted his associate, Grady Hallman, to repair it. Within two days he was operating again, and in his haste, he had torn his stitches. His back went out on a golf course and he could not straighten up; an ambulance picked him up like a jack knife. But he did not miss a day. In recent weeks he had suffered from a kidney stone and thrombosed hemorrhoids, two conditions that can make a strong man cry out, but he would not stop working.

  “Denton would rather operate than fuck,” said a longtime friend and associate. “And I’ve never seen him give less than his best, even when we’ve been called back to the hospital from a party at midnight and we both had to chew gum before we could go into the operating room.”

  Another friend from medical-school years has long since stopped trying to fathom the man. “I can understand why someone would drive himself that way when he is young and trying to make his name, his reputation,” said the friend. “But Denton was honored for his one-thousandth open heart at least seven years ago. Who can approach that? Life is a competition for him; in our generation, the people who were looked up to were the competitors.”

  He is not an approachable man. He would seem to feel that the public needs to know but two marks of his heroism: he is handsome, he is skilled. Perhaps a third. He has done the most. He does not even permit himself the changes of mood of other surgeons. Changes can betray an image, and Cooley has carefully constructed his. DeBakey shouts; another Houston surgeon has been known to fall to his knees and beat his gloved fists against the operating-room floor in despair; still another throws up his hands and cries, “Won�
�t somebody please help me?” Cooley grows impatient, and impatience breeds anger, but his anger is masked behind a muttered sarcasm or, worse, half an hour of complete silence. The friend from medical school remarked: “Even at sixteen he was an enigma to all of us. He had an aura about him. He was one of those golden boys—now a man—whom you don’t feel quite at ease around. It is almost as if you are afraid you will make a mistake. I feel insecure; I feel uncomfortable in his presence and I am supposed to be his oldest friend.”

  Cooley had a tiny office, perhaps four feet wide by six feet long, on an elevated platform with windows overlooking Operating Room 1 but two feet below, and here he had gone to change. He drew on dark trousers, a lemon shirt with a monogram on the pocket, a widely knotted tie. DeBakey charges about his hospital in surgical scrub with occasional flecks of blood on his uniform. Cooley glides through his, tailored, immaculate, his lab coat pristine white.

  Trailed by his dozen surgical fellows, all from foreign countries except for John Zaorski, Cooley stopped in the jammed, turbulent Recovery Room and touched the foot of the bed of a young Ceylonese girl. “This is a gratuitous operation,” he said, and moved on. A surgeon in Ceylon had attempted to correct her Tetralogy of Fallot, had botched it, and had sent her to Houston. She would fly home, radiant, in two weeks.

  “Gratuitous,” as I use the word, has more than one meaning; I asked Cooley which he was using. “Free. Gratis,” Cooley said. “And so is he.” He pointed to a painfully thin, elongated Asian-looking patient thrashing about in his bed, just coming around from anesthesia. One of the fellows murmured that he was Pakistani. He had an atrial septal defect, which Cooley had just repaired.

  The Pakistani had flown to Houston without an appointment and had talked a cab driver into taking him to Cooley’s home in the exclusive River Oaks section of Houston. There he had presented himself for treatment; the maid sent him to the hospital, where Cooley performed the surgery. Ten days later he was complaining loudly that the hospital bill was outrageous and he should receive a “student discount.”