“On January 23, 1964—how well I remember the day—a man named Boyd Rush from Laurel, Mississippi, a man who had had heart trouble for years, was brought into our hospital in shock. We examined him and told his family that there was nothing that could be done for him surgically—but that there was the possibility of a cardiac transplant. We explained that there was a neurological case in the hospital, with the patient near death, and that if death did occur, then we could perhaps use the heart. (I’ve often since thought that if the situation arose today, the neurosurgeon would simply pull the plug.) But if death did not occur, then would they agree to the heart of a suitable primate? They were less enthusiastic about a ‘suitable primate,’ but they finally agreed. We told them that if we could improve Mr. Rush’s condition to the point where we could explain everything to him, then we would ask him for his consent. But he never reached that state.
“Actually we knew that the chimp heart was vigorous and sound with cardiac output much stronger than either patient Rush or his potential donor, since the donor was drugged and ill.
“When we finally decided to go ahead, the opposition within the hospital began clamoring all over again. Even the cardiologist, who had earlier agreed, stood outside the surgery doors wringing his hands and saying, ‘I don’t know, I just don’t know.’ I said, ‘Look, when you’re going to jump, you’re going to jump.’ I realized that once this enormous psychological hurdle was cleared, then the others would be easier. We put in the chimp’s heart and it started up right away. It beat regularly for a while, but it lasted only two hours because the patient was in terminal shock. He was too sick to accept anything.
“The commotion afterwards was enormous, from the hospital to the pulpits, so we stopped doing them until the immunosuppressive field improved and until we could get better recipients.”
Hardy had finished his story. He looked at his watch and excused himself. One more question.
“Had you ever heard of Christiaan Barnard?”
“No. Didn’t know the man. Perhaps I had seen his name quite vaguely on some paper about valves. Otherwise, no.”
Vincenza, the tiny Italian woman with the reddened, sunken cheeks, developed pneumonia, which dragged on for three weeks, and then she died. It turned out that Leachman had predicted just that; he had, in fact, strongly recommended against her surgery for Ebstein’s Disease. An associate, Greek cardiologist Dennis Cokkinos, had argued against him. “When the surgeon is not very good,” Cokkinos had said, “then I would vote to wait. But with Cooley and his hands, the cardiologist can afford to be liberal. The girl weighed 78 pounds, she has no life. If we send her back to Italy, do you think she could ever make the trip to Houston again?”
Maria Celestina, the “Please help me” patient, soon thereafter developed a hemothorax—bleeding within the chest cavity—where Cooley had excised the huge aneurysm and replaced it with Dacron. She was rushed back in one night for emergency surgery but Zaorski said there was little hope. “The surgeons in Italy screwed her up royally. Cooley tried to sew stitches into tissue that was like an egg shell.”
So many hopeful, hopeless foreigners! The publicity that first DeBakey, and later Cooley, so adroitly courted, coupled with the referrals wooed by hundreds of scholarly papers and lectures and warm welcomes for visiting doctors, had produced a never-ending pilgrimage. Houston was the new Lourdes and the new saints were the old maestro and his banished protégé. “But their families can honestly say to themselves,” observed Leachman when he learned of Vincenza’s death, “that if the great Doctor Cooley—or DeBakey—could not save their loved one’s life, then nobody could. They would much rather think that than have the patient die at home. Then they would cry for the rest of their lives, ‘If only we had gone to Houston.’”
Cooley had a run on desperately sick Greeks all spring and summer. So many flew to Houston on stretchers, so many were carried into the hospital frothing at the mouth with pulmonary edema, so many died in the hall or on the table or in Recovery, so many should never have left Athens, that Cooley remarked with near melancholy—a remark picked up by several others who started using the line more wryly—“We get so many dying Greeks that they should bring an urn with them when they come to Houston.”
On a Friday morning, a fresh death certificate was on the catch-all shelf outside Cooley’s surgery office. A youngish Greek fellow in his thirties had died in Intensive Care the night before. Shafi was on duty and when the patient went into left ventricular failure, he could not be resuscitated. The blame for the deaths, Shafi was saying to Bruno Messmer, should be placed with cardiologists who treat patients with operable defects for twenty years. “They wait until the fellow turns blue before they pack him off to Houston.”
Dennis Cokkinos, listening to the conversation, said there were several capable cardiovascular surgeons in Athens but that little heart work was being done.
“Why not?” said Jerry Strong. “You’ve got a pump, don’t you?”
“Yes. But they don’t operate.”
“If you’ve got balls, use them.” Strong was on his way to Room 1, where still another sick Greek, a woman named Anna Zaranikos, was to have two valves replaced.
“They’ve tried and had some bad results,” answered Cokkinos. “Two or three patients died and now nobody will go near the surgeons.”
“You’ve got to educate the people. Hire a press agent, for Christ’s sake, and get him to teach people what can be done, not what can’t.”
Nine days after surgery, Vic Coleman, thinner, but cheerful despite his pain and pallor, walked happily out of the hospital. When he returned a week later for a checkup with a new haircut, a new blazer and some beach tan, he hardly looked like a man whose heart had been stopped and altered two weeks before. The incision on his leg, where the vein had been removed, was slightly inflamed with a pus pocket, but Leachman said the skin would flake off shortly and stop the infection.
“Ten days after the operation I walked four-tenths of a mile,” Coleman said. “And I’m just about ready to start jogging.”
Leachman normally lets patients set their own pace of living, but this seemed to be a man who needed a word of caution. “I’d take it a little bit easy for a couple of months,” he said. “It normally takes that long for any major injury to the body to heal, and surgery is a big injury.”
“Why did Cooley only do one bypass graft when two had been suggested?”
Leachman, being from Amarillo in the Texas Panhandle and the proud proprietor of a ranch outside Houston where he bred cattle, often used farmer talk for his medical analogies. “Circulation of the heart is rather like irrigation ditches in a corn patch. You might get two or three of them blocked off, but a third would be strong enough to take over and wet the field.”
Coleman nodded. What about diet? he wanted to know.
“Well, I wouldn’t eat eggs twice a day or meat twice a day, and not too much greasy foods, but aside from that, anything you want.”
Coleman looked for Cooley to say thanks and good-bye, but he was in surgery and unavailable.
A patient at Fondren-Brown required emergency surgery a few nights later and George Noon looked for someone to first-assist him. DeBakey was out of town apparently, although his associates rarely knew for sure unless it was an extended overseas trip, a national medical meeting, or an appearance on a network talk show where he could be seen. Ted Diethrich was in Phoenix looking in on Bill Carroll, now completely recovered from his bar crawl. In urgent need of a pair of hands, George called Geoff, the expelled resident, and asked him to scrub. Geoff readily agreed and the operation had been underway but a few moments when the doors to the operating room swung open and there stood DeBakey.
His face a mask of fury, he ordered Geoff to clear out and stay out.
* The Vineburg is a coronary operation pioneered by a Canadian doctor and now totally out of favor at the Houston hospitals. It consisted of tunneling the mammary artery to the heart and hoping for a new blood supply.
The trouble was that it took three months to become functional—time enough for someone with heart disease to have another heart attack—and the flow of blood was less than 10 cc’s per minute, about one-tenth that of normal coronary arterial flow.
CHAPTER 9
In the quarter of a century since DeBakey had come to Houston, the list of young doctors banished from his surgery was always growing. A few weeks before Geoff’s experience, DeBakey had been watching with obvious annoyance the performance of an Italian surgeon who was spending a year in Houston. During an operation, DeBakey instructed the man, whose name was Mario, to sew up the chest incision while he attended to a matter of the femoral artery. When DeBakey was done, he looked up, peered at Mario’s sutures, frowned, took his scalpel, and brusquely cut each of them out—replacing them himself, muttering all the while, “If you can’t learn, you can’t be taught.” Later he blew up at Mario and ordered the Italian to “stay out of my sight—I don’t even want to see you.” Mario interpreted this, with help, as meaning that he could not scrub in on DeBakey’s service. So he spent the remaining months in Houston assisting the other heart surgeons and slinking about the corridors, hoping he would not encounter DeBakey.
A general surgeon from St. Louis, a patrician-looking doctor with erect posture and gray sideburns to mark his 58 years, gave up his practice and convinced his wife and family that he should go to Houston and spend a year starting over again to learn heart surgery. He made it through the year, but not without frequent crises. During one operation he asked DeBakey a question and the response was several stormy minutes of criticism for having asked it. “You know, Doctor,” said DeBakey, witheringly, “by the very nature of your question I wonder if you understand the simple hemodynamics of this case.”
DeBakey seemed patient, even kind with the students who came to his table; normally only the man well along in his residency, or his career, felt the heat. “By the time you get to be seniors,” he once told a group of freshmen medical students, “we’ll be competitors. Don’t forget it.”
Geoff’s sentence was unusually severe. DeBakey had ordered him not only out of the operating room, but also out of the hospital, which meant that he could not finish his year on someone else’s service. For days he searched his past conduct and his soul for a reason; the one given by DeBakey hardly seemed to fit the crime, if indeed, in Geoff’s opinion, that had been a crime at all. “The final breakup had been coming for three days,” Geoff reflected. “Everybody had warned me to watch out. We had already sewed up the patient and we were suturing the wound where a catheter had been stuck into an artery. I was doing nothing but holding the sutures while he cut them, but he said I was cutting them off too long. Suddenly he began telling me to get out of the room.”
Geoff had come to Houston from New England in 1963 after making applications for residencies at several hospitals around the country. “I hadn’t really expected to be chosen for a DeBakey residency. But in typical DeBakey fashion he sent me a telegram saying I had been accepted and to please answer within 24 hours. In other words, I had to commit to four years in Houston within 24 hours. I called friends around the country inquiring about him, and I got all the terror stories about Big Mike. I figured they couldn’t be that bad.… I was wrong. They were worse.
“I chose Houston because it seemed ideal to be on the frontiers of heart surgery. At other hospitals there might have been one open-heart case a month and 30 residents would be scrubbed in trying to watch. Where else in the world was there a Denton Cooley doing three or four pumps a day? And a George Morris and a Stanley Crawford and all the other heart surgeons turned out by DeBakey?”
Geoff had spent his first year in the Baylor program without being introduced to DeBakey. “He didn’t even nod at me in the operating room. Every time a patient died in the Intensive Care Unit, he’d usually fire a guy and blame him for the death. But I also noticed it was usually premeditated. Word would get out that he was after somebody and he’d rag them and pick on them and finally erupt with an enormous harangue and fire them—always in front of everybody. Sometimes these were doctors who needed firing, and always the lesson soaked in. Each time he fired someone, the reason—the alleged reason, because it was not necessarily the real reason—was cemented into all of our brains.”
There were DeBakey “quirks” that every resident quickly learned to tolerate and obey. One Geoff learned was his insistence that suture needles be thrown onto the operating room floor after their use. “At other hospitals they don’t do that, because the wheels of the stretcher pick them up,” Geoff said. “But you damn well learned to throw them on the floor in Mike’s room.”
Another concerned the surgical drapes. “They must be taut; this is a fetish, little else.”
A third, and cardinal, rule related to the lights. DeBakey uses four overhead, movable, sterile spots. Most surgeons (Cooley, for example) use only two. “The unwritten, unspoken, but religiously observed law is that the light opposite the Professor does not shine onto the field, because it bounces off the retractors and annoys him. If anybody dares to touch those lights.…”
But Geoff had not touched the lights nor broken the other rules. He had stayed seven years learning his craft and was on the thresh-hold of his surgical majority when the blade fell. Perhaps one thing he had done to annoy DeBakey was to admire Denton Cooley’s skill—Cooley, after all, had been a member of the Baylor surgical faculty until a few months before—and he had gone to an occasional party with Cooley’s fellows. But if those were contributing factors, Geoff could no more understand it than he could understand DeBakey. And after seven years, he had found no Rosetta Stone to help him. “He has taught me virtually nothing, because we had hardly a relationship at all. But the years were valuable, nonetheless. The things Mike had taught the others, and the improvements they had added, these things seeped down to me. Everything emanates from Mike! Suture technique, for example, which is the basis for all vascular work, was developed by Mike. Invented? No, developed. But what is ‘invented’ anyway? Some dodo off in the North Woods might have done the first abdominal aneurysm, but unless he was shrewd enough to market it and run with it and publish it—who knew? Who cared?”
And that, certainly, was something he learned from Mike DeBakey.
DeBakey! Ask six doctors to describe him and they become six blind men telling of the elephant. Don Bricker says there is “the charming DeBakey, the tyrannical DeBakey, the gracious DeBakey, the political DeBakey, the despot DeBakey, and original healer DeBakey.”
In his ninth and last year in Houston, Don Bricker held one of the most important positions in the Baylor program—he ran the vast surgery service at Ben Taub General, the huge charity hospital that served America’s sixth largest city. DeBakey actually held the title of “Surgeon-in-Chief” at Ben Taub, but on his priority of participation, it was well down the line, so far down as to be practically nonexistent. Bricker relished the responsibility and wide pathology of the Taub job, but he gave notice in mid-1970 that he was quitting to go to Lubbock, a growing town in West Texas, where he would start up a private heart-surgery service from scratch.
Bricker’s reasoning pointed up both the nature and the dilemma of the modern surgeon. Surgery, until quite recently, was a specialty of medicine in itself. “Suddenly,” said Bricker, “we are in the era of the super-specialist, the super-surgeon, and the only way to get ahead in my racket is to do one thing better than anybody else. I have the widest repertoire of any surgeon in Houston—at the age of 35—but I’m a dinosaur. I don’t specialize. I’ve decided to go to a place where I can.”
In every aspect but one, Bricker’s appearance and dossier matched the classic image of the young Houston heart surgeon. He had a strong, open face; a compact, well-controlled body (DeBakey once snapped at an overweight resident, “I never knew a good fat doctor, Doctor!”), his clothes were quiet and from the rack of an Ivy League shop, his politics were conservative, his wife was a former nurse, his nonmedical passion wa
s sports and the souping up of ordinary cars, and he swam in his pool with his three sons and a giant black dog, who was the most able water-polo player in the household. Only his attitude regarding his moral responsibility as surgeon toward the patient differed from what I had grown familiar with. Scattered among the gunshot wounds, the radical breasts, the crushed chests were but a few open-heart cases a month. But for each of these—charity bum, junkie, hooker, or forgotten old man—he not only repaired the heart, but went afterward into the Recovery Room and put a blanket on the floor and slept beside the bed. “I think it is necessary that I stay beside my patient until he has no further need of the surgeon,” he said, cutting off further conversation on the subject as men do when elaboration on a deeply held belief seems unnecessary.
Bricker had come to Houston in 1961 from New York Hospital, where he had become enamored of the then still infant area of open-heart surgery. “But there was nobody in New York to teach it, so I applied to DeBakey. He asked me but one question, was I a member of Alpha Omega Alpha, the medical honor fraternity. I said yes, and I was hired.”
His residency was more tempestuous than most. “When it was done, if I had to choose between going back to DeBakey’s service for three months or going to Vietnam to do battlefield surgery for three months, I’d choose Vietnam. Now that it is over, I have tremendous respect and affection for the man, but there were days when I wanted to kill him. I’d stand there and let him punch me on the chest with his stabbing fingers and listen to his tirades and I’d have my fists clenched behind my back.”
On other days DeBakey would be harassing someone and Bricker noticed that the deeply browed eyes were sparkling during the tirade. “I think he’s actually having fun doing this,” thought Bricker at the time.
During the decade of the 1960s, the widely held opinion in the surgical world was that DeBakey, although an excellent surgeon, was not as technically gifted as Cooley. Bricker had stood across the table from both men during hundreds of operations and had come to conclusions on both men’s abilities:
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