Hearts

by Thomas Thompson

  But any confidence misplaced or temporarily lost during the transplant year had long since come back. Cooley seems to feel that if he cannot help a patient in the operating room, if his hands cannot find and hold the spark of life, then it simply cannot be done. “Denton knows when he has done a good operation,” observed a senior member of his team. “But he doesn’t go to all extremes to keep them alive in Recovery or ICU. If they don’t get better due to their new hemodynamic situation, then …”—the doctor made a hopeless gesture with his upturned hands. “Mike DeBakey, conversely, will go to hell and back to keep the patient alive. If he dies a month later at home—well, the operation was a success.…”

  At the Saturday morning pathology conference, Cooley talked briefly and dispassionately of the ten-month-old baby Kimberly’s death. One case a week is selected for extensive discussion. “It was a most confusing heart,” he said. “She had such complete heart block afterward that even a pacemaker wouldn’t drive it, and we ended up with a fiasco on our hands.” Dr. Rosenberg, the pathologist, took the infant’s heart out of a plastic container and put it on a sheet of wrapping paper to give his theories. “The septum was closed, there was a grotesque left ventricle. And note this unusually deep cleft in the mitral valve, which is rapidly becoming our most frequent rarity.”

  CHAPTER 8

  Something struck me again and again, and though I witnessed it, and heard and thought about it a hundred times, I never understood why—why the passive acceptance, why the offering up of the human heart to this man with fewer words than one would deliver to a splendid mechanic on the subject of a malfunctioning limousine? Twenty times a week, when Cooley entered their rooms on the eve of their surgery, they turned down their television sets and scrooched up on their pillows and the conversations—invariably—went like this:

  Cooley: (Ambling near) “Well, we think we ought to fix you up tomorrow.”

  Patient: “Okay.”

  Cooley: “I’ll be out to see your wife [or husband] after the operation.”

  Patient: “That’s what I came here for.”

  Cooley: “You’ll be fine.” (Smiling, exiting.)

  I have never had a tooth filled without worrying the dentist with questions from the cost of his drill to the identity of the artist who composed the water color above his mixing pots. On the two occasions I underwent minor surgery—a hernia and an appendectomy—I put everyone, scrub maids not excepted, through my inquisition. How can it be otherwise? Is the eve of heart surgery so staggering that one falls mute? Or is it that one becomes timid in the presence of celebrity, as a child would do if suddenly face to face with a baseball player?

  I asked Cooley why everyone acquiesced so readily. Fear? Ignorance? Shock? “Blind faith, mainly,” he replied. “They’ve read that it’s good and they want to keep that feeling.” He was walking down a corridor at the moment with John Russell and they were talking of a child who had been admitted to the hospital for probable surgery, but about whom a decision had not been reached by the pediatric cardiologists. “Most pediatricians I’ve known are thoughtful and deliberate,” Cooley said, “and to the surgeon that means slow.”

  Leachman catheterized a patient that afternoon who would have seemed to have been the last man alive in need of heart surgery. The very antithesis of Arthur Bingham, he followed all the rules. At 44, Vic Coleman had a strong, finely proportioned physique, still hardened by the football he had played in the Marine Corps V12 program during World War II, later at the University of Southern California, where he starred in the Rose Bowl and got whipped by Alabama—he remembers every play—still later with a professional team at Buffalo in the old All-American Conference, finally with the Rams. He had been a sculptured 215 pounds then, 40 more than his present weight, and he had never suffered a major injury. Since 1951 he had been an oilman in Midland, Texas.

  Questioned by Leachman, Coleman said his job was a low-pressure one, that he went to work at eight or nine or whenever he felt like it, and he rarely stayed past four. He did little traveling other than going to the site of a well and sitting around waiting for it to come in. Moreover, he did not smoke, drink, eat butter, eggs, milk, or high cholesterol foods. He took superb care of himself, watched his weight, had a complete medical checkup including an EKG each year, and had never stopped participating in sports. He played tennis in the summer, skied in the winter, even rounded up a group of twenty businessmen and persuaded them to skip the cocktail hour in favor of jogging every afternoon at five. “We did twenty laps—five miles—on the high school track and I was to the point where I could do it in 38 minutes—about seven minutes for one mile.” Coleman’s father had died of a heart attack at the age of 63, which was the only blemish on an otherwise extraordinary prognosis for the good long life.

  “Jesus H. Christ,” said one of the fellows after checking him over. “If he has heart trouble, we should all be dead from infarcts about six years ago.”

  But by no means did all the heart doctors subscribe to the recognized guidelines to forestall heart trouble. DeBakey, for one, feels stress is not only acceptable, but “quite good for you.” A Houston cardiologist named Dr. Charles Armbrust had one patient who suffered a heart attack and died in the middle of his morning pushups. “And every morning when I’m driving to the hospital,” said Dr. Armbrust, “I see an elderly man and his elderly dog jogging beside the road. I keep wondering who is going to infarct first—the dog or his master.”

  The matter of cholesterol had long divided those involved in heart work. No doctor would deny the value of a low cholesterol diet—for one thing, it lowers calories and would tend to keep the patient slim and reduce the amount of work the heart must do. But no one has ever proved that reducing cholesterol intake in an adult’s diet has anything to do with reducing the danger of a heart attack!

  Coleman’s trouble had come suddenly, less than three months earlier, when he had been jogging and felt sharp chest pains just under his rib cage. “The pain kept boiling up for days after,” he told Leachman, “but I passed it off. Then I went skiing and fell on my pole, which made the pain worse. I thought I’d cracked a rib. I went back to Midland and played three sets of tennis and I could hardly get through them. In the days after that, for the first time in my life, any exertion at all would bring on pain. I couldn’t walk a block and a half without it coming on.”

  “How would you describe the pain?” asked Leachman.

  “Like somebody was standing on my chest and wouldn’t get off. And I knew my heart was skipping a beat because I checked it regularly with a stethoscope. I always had. It was crazy, it ran like an old John Deere tractor. It’d go one-two-three-skip, or sometimes it would go up to fourteen and then skip three times.”

  A hometown doctor diagnosed angina pectoris and informed Coleman that he could live for years by popping nitro tablets—but that it would mean a drastic if not total curtailing of his passion for sport. “I’d just as soon be dead,” he said. “I charged down to the University of Texas Medical Center in Galveston, where this specialist wanted to do a Vineburg* on me. Then I heard that Cooley was doing this bypass operation up in Houston and five minutes after I heard about it, I knew I had to get up here and have it done. It’s a shame I had to get heart trouble, but if I’ve got it, let’s get the game on and get it over with.”

  The cardiograms showed that Coleman was the classic candidate for the bypass: a man in his mid-forties with obstruction high up in the right coronary artery. He had not progressed to the point of advanced arterial disease which would have made it difficult for the surgeon to sew in the leg vein. And, ideally, he had extreme pain, the one thing that can usually be improved by the procedure.

  I asked cardiologist Don Rochelle why Coleman had been stricken. With not a visible misdemeanor on his medical records, what hope was there for those of us who commit compound felonies?

  “I guess he just has an inability to handle fat within his body,” said Rochelle. “We all try to avoid cholesterol, but w
hat the lay public doesn’t realize is that two-thirds to three-fourths of it is manufactured within the body and not brought in by diet. The pure form of this is definitely inherited.”

  Cooley scheduled Coleman for a coronary bypass the next day, and when informed of his patient’s extraordinary health regime, said dryly, “The trouble is, his grandfather wasn’t castrated.”

  Late that afternoon one of the residents from DeBakey’s program trudged into the St. Luke’s coffee room looking one-third sheepish, one-third frightened, and one-third hysterical. He sat down and, explaining his presence in the alien camp, said, “I just got thrown out of DeBakey’s operating room.”

  “What’d you do?” asked John Zaorski.

  “He said I made the sutures too long.” The resident’s name was Geoff and he was a red-haired father of four. Zaorski shook his head in sympathy and disbelief. A third-year medical student learns how to put in sutures; by the time a doctor reaches his third year of surgical residency—with eleven years of medical training behind him—there could be little question as to his ability in sewing up wounds. Geoff was considered one of the more promising heart surgeons in Houston; the very real peril he faced was that with little more than one month remaining on the academic year, he would not get credit for the year unless he somehow found his way back into DeBakey’s good will. A senior member of DeBakey’s staff had advised Geoff to stay low for a few days and then drift back in. “Usually he’ll miss you in the middle of an operation and growl for you to get scrubbed—quick,” said the older man, who had seen the trauma before and knew what to prescribe.

  Leachman heard of Geoff’s trouble and grimaced. “Well, he isn’t the first resident, nor will he be the last, to get chucked out by Mike. And Mike’s too powerful to argue with. He may well be the most powerful physician in America, and that does not exclude the Surgeon-General or the Secretary of Health, Education and Welfare.”

  Surgery in both hospitals was especially well attended the next several days because the World Cancer Congress was meeting in downtown Houston and scores of surgical delegates slipped away to the Texas Medical Center to watch Cooley and DeBakey. The protocol of such visits has long since been established. It is not unlike travel in the Middle East, in that the traveler can go without trouble from Cairo to Tel Aviv. The Israelis do not care. But it is impossible to go the other way without having two passports. The touring doctor does well to call on Methodist and DeBakey first, and then go the hundred yards to St. Luke’s and Cooley, who, in truth, does not mind being the second stop, because he knows that his surgery is dazzling enough for anybody.

  Cooley was at the peak of his form for Coleman’s coronary artery bypass. Twenty-five doctors jammed the room, including a doctor from India with a floppy nurse’s hat covering his pink turban. “This may be the record,” said a nurse with some annoyance as she kept pushing visitors out of her view so she could see when Cooley needed, say, the defibrillator paddles. When the anastamosis was finished and Cooley ordered the patient off the pump and Coleman’s heart leaped up and began to beat like the finest, truest watch, Zaorski shrewdly asked the head pump technician how long he had been on bypass. She checked the digital timer on the pump and said, “28 minutes.” The visitors made looks of approving envy or frank astonishment.

  Some surgeons outside Houston who attempt the operation take up to eight hours to accomplish it. Coleman’s was only one of eight procedures that Cooley had routinely scheduled for the day, including another coronary bypass immediately afterward. (Christiaan Barnard and other well-known cardiovascular surgeons do only one open-heart case a day, so intense is the emotional and physical strain.)

  Zaorski knew that Cooley is proudest of his speed and relished hearing the pump time—the most crucial moments of heart surgery—publicly announced. Had Zaorski, or one of the other fellows failed to pick up the cue, then Cooley himself would probably have asked, and, upon receiving the figure from the head pump technician, would most likely have said, “That long, huh?”

  I do not know the boundaries between pride and hubris. But Cooley was later complimented by a delegation of important doctors, including the Surgeon-General of Pakistan, who said, with fervor, “I have never seen surgery like this—anywhere.” Cooley, knowing that the man was on a tour of American medical centers, asked, “Where have you been so far?” The Pakistani mentioned several leading hospitals including neighboring Methodist, the Mayo Clinic, and Cornell. “Well,” said Cooley, as if that explained everything, “you’ve been in the backyard.”

  Once he was showing me around the unfinished surgical floor of the Texas Heart Institute—there would be eight operating rooms, as many as DeBakey had—and he began telling of how difficult it was to raise enormous sums of money and some of the strings people attached. One foundation wanted to name the hospital after Denton Cooley. “I declined,” he said. “It won’t happen in my lifetime. But a fellow can’t control what might come about when he is gone.”

  Cooley’s college friend, the one who still felt uncomfortable in his presence, remarked: “He is a very chauvinistic Texan in which two things merged: Texas pride and his own reputation. These created the edifice we will work in. He sought something permanent by which to be remembered—a bridge, a statue, a hospital.”

  When Coleman’s operation was done, Cooley, trailed by the delegation, went across the hall to perform a coronary bypass on a laundry route foreman from Chicago, who had suffered heart failure a decade previously and a massive coronary two years ago—the reverse of how things usually happen. Doctors in Chicago had told him his heart was so bad that they considered it a 70 percent risk of death to attempt the operation, an 80 percent risk of death if nothing was done at all. “I was between a rock and a hard place,” said the foreman. Cooley knocked two minutes off his pump time on this operation, a piece of surgery so exquisite that one of the cancer doctors stood in the room long after Cooley had left and shook his head in amazement.

  One of the visitors to the Cancer Congress was obviously well known and respected at St. Luke’s because he called Cooley “Denton” and he called Hallman “Grady” and both men made sure he got a favored position at their table. I had glanced at his name tag but it meant nothing to me until John Zaorski tipped me off. He was Dr. James Hardy of the University of Mississippi, a man who three years prior to Christiaan Barnard had performed a surgical feat of stunning magnitude, but which was all but overlooked by the laity. His peers, however, applauded him for it, and he was recognized as one of the world leaders in heart surgery. Hardy was a youngish-looking middle-aged man with a soft Southern accent and that highly charged field of vitality that seems to envelop the surgeon. He was scheduled to deliver a major paper at the Congress the next day but we made a rendezvous for breakfast at 6:30 A.M.

  Hardy renewed his amazement at what regularly occurred in Houston. He understood how Cooley could operate on such a schedule because he had no teaching or administrative responsibilities with Baylor. But DeBakey’s pace and the breadth of his private practice Hardy could not accept. “I’m chairman of a department of surgery and there are simply not enough hours in a day to do what is expected of me. A chairman’s time becomes dissipated. When you become fairly well known, there is a certain amount of national tithing that one must do. And we use the Hopkins system, which is simply that a medical school is there to educate people, not to glorify a surgeon’s private practice. There is no way that Mike could function in his manner at our institution. But I suppose we all knew he would become somebody when he dropped in on Dr. Ravdin in Philadelphia about 25 years ago. Ravdin was then the ranking figure of American surgery and one would have expected him to give Mike about ten minutes if he saw him at all. But Mike walked in and spent the whole day. You’ve got to hand it to Mike and Denton,” he said. “Denton is the technician and Mike knew how to spread the news. They’ve made Houston the heart capital of the world.”

  From 1956, shortly after the heart-lung bypass pump became available, until
1963, Hardy and his staff did several hundred organ transplants in dogs, swapping kidneys, hearts, and lungs, pointing to the day when a human heart transplant would be possible.

  “I realized it would be fraught with enormous emotional overtones. So many people felt the soul dwelt within the heart. I used to ask lay audiences, if they were dying, how many would agree to a kidney transplant to save their life, and a large number would raise their hands. I then asked how many would accept a liver transplant, and a smaller number went up. When I moved to the heart, nobody raised their hand. Nobody.

  “The mere fact that we were considering it—working toward it—drew enormous criticism from members of our own institution. The internists thought it was not only immoral but amoral, another surgical prank. If we had waited until the internists were absolutely ready, we wouldn’t have gone ahead with kidneys, and thousands of people are alive today due to kidney transplants.

  “In late ’63 or early ’64, we began actively looking for a human recipient in which to implant the heart of a chimpanzee. We were offered numerous potential recipients but they all seemed to be wrong. At that time a human donor had to be, in effect, dead, and the recipient as well. It would have had to have been an extraordinary circumstance, almost an uncanny coincidence, for us to find both donor and recipient at the same moment.

  “We felt a chimp’s heart was about right physiologically and was as close as we could get to the human organ. Incidentally we paid only $600 for two chimps at that time, and as soon as word got out, doctors all over the country started buying them and overnight the price went up to $1,000 each, and they’re $1,500 now, if you can find one.