Hearts

by Thomas Thompson

  “Cooley had and has a particular genius for taking the bits and pieces of another doctor’s work, then putting it together again in a new whole to suit himself—and doing it better than anybody in the world. He has advanced heart surgery more than any other man. I’m not as good as Denton in the operating room; nobody could be until he’s done 6,000 hearts—and then you still wouldn’t be Denton Cooley.

  “But DeBakey’s surgery was also a thing of astonishing beauty. He, too, was an incredible technician, but it was, for those assisting, a very traumatic episode.”

  By 1965, Bricker’s fourth year of residency, DeBakey was enjoying the fallout from two public relation coups—his appearance on the cover of Time magazine and his operation on the Duke of Windsor for an abdominal aneurysm—which increased his patient census to as many as 200 at one time, enough to fill an entire respectable-sized hospital. “And the Professor expected his resident to know literally everything about every patient. He’d chew you out for something you had absolutely no control over. He never quits, he persists beyond reason.

  “Once he ripped into me for the hundredth time over something and I was ready to tell him off and get out. At that moment somebody came up and told me I was wanted down at Admitting because there was some hassle over a Spanish-speaking family. I speak Spanish and I went down and encountered a ragtag-looking couple from Bolivia and their sick kid. All they had was a cardboard suitcase and a crumpled yellow telegram. I read it, and it said ‘If you will come to Houston on such and such a date, I will operate for no fee on your child. Signed, Michael DeBakey, M.D.’ I melted. DeBakey in all his power had reached out to a Bolivian village and touched this poor, pathetic family.”

  During his DeBakey years, Bricker watched several of his colleagues thrown off the service. “I finally came to believe that nobody got fired who didn’t need firing. DeBakey is celebrated for axing people on a whim, but it was usually a whim he had invented as an excuse, a last straw, because he had watched them and had been ready to fire them for weeks. Some teachers give you questions to answer, DeBakey puts you under this enormous stress, he pushes you as far as you will go, sometimes beyond human reason, and if you can’t take it, you’re out.”

  The strain on the younger doctors was not wholly mental; often their bodies would collapse and they would fall ill, but because DeBakey did not tolerate personal illness, he did not expect his residents to get sick either. (For a man of 62, DeBakey takes dismal care of himself. I once asked him when was the last time he had had an EKG, since he spends every day reading those of others. “I can’t remember,” he said, almost sheepishly. “Have you ever had one?” I pressed. He shook his head negatively. His personal nutrition would distress the mother of any adolescent. All day long he snacks on chocolate candy and peanuts and caramel-covered popcorn. Once when we dined at a fashionable New York steak house he ordered a strip sirloin and when it came, impeccably cooked, he asked for a bottle of Tabasco sauce, the fiery concoction two drops of which can ignite a Bloody Mary. Taking the bottle he slathered his steak with Tabasco, spreading it from end to end as one would spread tomato sauce over a veal cutlet. His fondness for Tabasco, a product of his native Louisiana, caused one associate to say, “Mike DeBakey puts Tabasco on everything he eats—and everything he says.”)

  Once, Bricker recalled, DeBakey turned up in the operating room with a terrible cold, made even more insufferable by the mask over his mouth and nose. “He sniffled around and growled like a lion with a sore paw. I slipped out and went down to the pharmacy and got him a bag full of antibiotics and antihistamines and rather boldly thrust it on him and told him to take it. He poked around the bag and said, ‘This stuff’s no good; the only thing that works is aspirin.’ I insisted that he go home early—like 8 P.M. instead of midnight—and take some. The next morning he was obviously better. He sidled up to me and said, ‘Do you think you could get me some more of that stuff?’”

  On another day, DeBakey was felled with a severe virus but he insisted on going to surgery. He was, said Bricker, “so pale, so sick, that the team almost forcibly made him lie down on the OR table. He was vomiting and feverish and furious. Someone notified the chairman of the department of medicine, who came down and took one look at Mike and ordered him to take the day off and rest. Mike refused to leave the hospital. ‘Very well,’ said the chairman, ‘you can have a room in the hospital, but if we have to tie you up and take you there, we will.’ Complaining bitterly, Mike got off the table, bolted out of the OR, ran up four flights of stairs to prove that—even sick—he was a better man than anybody else, lay down on a hospital bed and slept eight hours straight through. As much as we hated him, we were sad that the lion was sick. He was back the next day yelling at us. So we knew he felt better.”

  There came the day when Bricker almost threw away his medical career. He had advanced to chief resident, an exalted position in other surgical training programs but under DeBakey still very much a junior man. A 25-year-old patient in the Intensive Care Unit who had been operated on for repair of a ventricular septal defect suddenly developed a hemothorax in his left chest and was bleeding to death. Bricker almost tore open his chest and sucked blood out and got it under control, then ran into surgery and told DeBakey the patient would have to come back in for emergency repair.

  “DeBakey was furious,” remembered Bricker. “He always was when the schedule was interrupted, but he agreed to let me bring the boy in. For two hours he stood over me and yelled that the mistake should have been caught the night before and repaired then. He gave me unmerciful hell. The boy had had his VSD operation that very morning, not the day before, and DeBakey had done it, not me. Finally I had all I could take. I stripped off my gloves, I broke scrub, I lunged across the table for the Professor and tried to get my hands around his throat. Ed Garrett and Jimmy Howell grabbed me and physically dragged me out of the OR. I went back to ICU and kicked the wall.”

  Bricker hung low for three days, assuming that he would be kicked far out of not only Methodist, but out of medicine as well. On the fourth dark day, word was sent that DeBakey wanted Bricker present at a staff conference. “I went in scared to death, but ready to take whatever he was going to dish out. I was surprised to find that it was an ordinary patient conference. DeBakey was looking at some x-rays and he turned to me and said, ‘Don, I just don’t know what to do for this patient. What do you suggest?’”

  It was DeBakey’s business-as-usual way of acknowledging a mistake and inviting Bricker back into the program.

  In August of 1970, Bricker went to the Cooley camp and filled in for Grady Hallman while he was on holiday. Although now a grown-up surgeon, very much his own man, so to speak, and on his way to Lubbock and private practice, he worked the entire two weeks almost furtively, worried that DeBakey would hear of his favor and pronounce him disloyal.

  During the period, Bricker overheard a coffee-room conversation between two fellows who were complaining that they were not allowed to do any actual heart surgery under Cooley. In the entire year, they would do nothing but assist and tend to the patients before and after. They had come expecting to actually get their hands into hearts—with Cooley standing beside them giving advice and counsel.

  “I know how they feel,” Bricker said later, on a Sunday afternoon beside his pool, watching the big black dog chase his sons in the churning water. “What can you learn watching Cooley do a thousand patients? There is nothing so frightening, nothing so gut-wrenching as the moment when someone finally hands you a knife and says—‘Here, cut this heart.’”

  “For more than a year now, I’ve been all pent up,” said Ted Diethrich on another steamy new summer Sunday afternoon. “I haven’t made a contribution in twelve months, except banging out these hearts day after day.” He was sitting on the patio of his splendid, low-slung brick home in suburban Houston, an old house rebuilt to his specifications for embracing the outdoors. Walls of glass slide open for instant access to the large pool. There is a curious-looking at
hletic court—the only one in the United States—with three cathedral-like brick walls for the playing of a passionate and violent form of Mexican sport called frontenis. There is an adjoining vacant lot for football. Every Sunday, after morning hospital rounds, Diethrich would lead a pack of young heart surgeons and medical students through an orgy of athletic endeavor which, well-fueled by vodka and tonic, would stretch deep into the night. It became a pursuit of the fine edge of complete exhaustion, a search for physical pain, the cleansing purge that would send the surgeon back to the hospital and its world of imperfect minds and bodies.

  On occasional Sundays, Diethrich asked an important, recuperating patient out to his home, and the man, still feeble from surgery, would sit in a chair with his shirt unbuttoned. He would watch the handsome, strong, young men pummeling each other at water polo, hear their shouting on the tennis court, feel the spray as they tossed themselves into the pool. No doubt the man was happy to leave the hospital for an hour or two, even with the nurse and her blood pressure cuff beside him, but as he watched the spectacle, there came a sadness, which only I saw, in his eyes.

  Sundays tore at me. I recognized the need to push out the traumas of the week, but I would have preferred to accomplish it on a 30–15 ratio—30 minutes of sport, 15 minutes of chair. The surgeon syndrome had different rules, more like 58 and 2. Frontenis was undeniably exhilarating, entwining elements of handball, jai alai, and tennis, but with the hard rubber ball hurtling past at speeds up to 80 miles per hour, it was alarming as well. By the end of the summer, my torso, as were those of the other players, was dotted with bruises. My elbow was blue-green and swollen. “If you’re going to have a heart attack,” one of the doctors said cheerfully, “this is not a bad place to have one.”

  Earlier in the year I had skied with Diethrich and a group of Michigan surgeons in Aspen. The other men were all ten years our senior but they seemed to have taken the same oath as Diethrich. I am a skier and I love the sport but my notion is to tear off a thousand-yard descent or so, stop, find a chalet with hot wine, and look at the trees. Not the surgeons. Their idea of skiing was to rise at dawn and be first in the lift line—very important, being first—be first to the top of the mountain, be first to the bottom of the mountain, over and over again, until threatening shadows threw fingers across the runs. No stopping. No reflecting. No wasted moment.

  Among surgeons who fly their own airplanes—and there are many—the rate of crash and death is four times that of the businessman pilot. One reason is the surgeon’s rush to return to the hospital on Monday morning. Another, I suspect, is the surgeon’s desperate bear hug on life, paired with the feeling—as some Las Vegas gamblers have—that God sits on their shoulder and will not allow His blessed ones to lose.

  At the age of 35, Diethrich had reached a level of professional reputation and personal reward that other surgeons would not reach until their fifth or sixth decade. But as it had with so many before him, a restlessness was setting in. The pattern was well established. If the young doctor survived the residency program and if he was exceptionally skilled in the operating room, DeBakey would ask him to stay on in the Baylor program. He would receive an academic appointment to the surgical faculty and he would assist DeBakey on his cases. He would also be permitted to establish his own private practice, keeping a small percentage of his fees. The balance went to the medical college; DeBakey turned over between 50 and 75 percent of his to the department.

  But how many men have sat close to the throne without wondering if the chair is comfortable? The doctor who relaxed in the St. Luke’s coffee room one midnight and figured on his scrub suit leg the potential income of Denton Cooley had not been the first man to multiply the staggering figures. And the 27-story tower of St. Luke’s hospital, of which Cooley’s Texas Heart Institute would occupy a considerable section, dominated the Texas Medical Center as the Shell Building did downtown Houston. Cooley’s hands had built one hospital; DeBakey’s hands—and power—had built another. It had not escaped Diethrich’s attention, and he was even then nursing a plan.

  Diethrich was born in Michigan. His mother was a nurse and he did his first operations on stuffed animals when he was five. He was in the hospital working as an orderly by the time he was fourteen. At fifteen he assisted and actually did the cutting on a vasectomy—male sterilization—and he could never remember a time when he was not consumed with ambition to be a surgeon. There had been a period when he pointed himself toward neurosurgery, that last glamour specialty, but by the time he had completed his surgical residency at the University of Michigan, he had been converted to a future in the heart. He applied to several hospitals for the necessary two-year thoracic-surgery residence but held little hope that he could be accepted by DeBakey. The University of Michigan had and has one of the most respected thoracic programs in the world of medicine but it required equal surgical time all over the chest cavity; Diethrich knew Houston concentrated on the heart.

  “Finally a letter came from Baylor saying I had been accepted and I went down to Houston to meet DeBakey. I waited hours, I sat outside his office, I watched him operate, I followed him up and down stairs. Finally at five in the afternoon, after he had finished doing a beautiful arch aneurysm on a captain in the Air Force, he walked up to me and spoke to me for perhaps 30 seconds. He said ‘Very glad to have you here; I hope we see you soon.’ I was struck stone dead. I was in the presence of God.”

  On July 1, the traditional end and beginning of the medical year, 1964, Diethrich presented himself to DeBakey’s office and much to his surprise was assigned to Denton Cooley. Cooley already had become estranged from Mike DeBakey and had shifted his surgery to neighboring St. Luke’s. But Cooley at that time was still very much a member of the Baylor surgical faculty—indeed he contributed half of his enormous surgical fees to the department of surgery—and he was entitled to a resident. Diethrich became disenchanted very quickly. Accustomed to the academic, ordered scheme at Michigan, he was confused by the breakneck atmosphere of Houston medicine. “I was used to a program where someone said, ‘This is who you are, Doctor, this is what you do, this is where you can progress to.’ Instead, it seemed to be a jumble. There were about 40,000 people jammed into the operating room, you couldn’t even get near Cooley. I was totally lost the first month.”

  When he rotated several months later onto DeBakey’s service, Diethrich found himself even further from the operating room. For two and one half months he was not even invited into surgery, this young doctor who had just completed four years at Michigan operating almost every day. One afternoon, DeBakey abruptly said, “Ted, you’ve got to develop yourself technically in the operating room—starting tomorrow, I want you to scrub in with me on every single case.” Diethrich bit his tongue to keep from saying that judgment on his need for technical development seemed premature, since DeBakey had never seen him tie a single knot.

  “Well, we started that,” recalls Diethrich. “The first three or four days went perfectly. He didn’t say anything to me, all was quiet, it was going to be everything I had hoped it would be. I was in the presence of the master. Then came the months of hell. It was to be the worst experience of my whole life. It got so bad he wouldn’t even let me drape the patient, something I had been doing for years, as routinely as reading a thermometer. I hold the all-time record for draping a patient! It was a carotid operation (reaming out the artery in the neck to prevent strokes) and I got the patient ready and DeBakey came in and took one look and said it was not properly done. So he went out and I took the drapes off and opened another sterile package and draped the patient again. DeBakey came the second time and again it was wrong. So I took the drapes off and broke open a new package and did it again. And again! And again! Four drapings! It got so bad I couldn’t tie a knot in the operating room without doing it wrong. It got so bad the anesthesiologist said to me one day, ‘Ted, I just dread to see you come into this operation room.’

  “I never made it through a case with him. I’d
make the incision wrong. I couldn’t hold a retractor. I was standing in the light. Everything was wrong. He’d say, ‘Why can’t you do this for me, Doctor, why, why, WHY? Don’t you want to help me, Doctor? This doctor doesn’t want to help me!’

  “We’d start a case, we’d get about ten minutes into it, he’d stop and throw up his hands and say, ‘Ted, would you get Dr. Garrett?’ Somebody would go and get Dr. Garrett and DeBakey would banish me to a corner and say, ‘You just stand over there, Doctor.’

  “It got to a point where I lost all my confidence. He can shatter you, absolutely shatter you. He would say to the whole operating room, ‘It must be intentional—nobody could operate like this unless it was intentional.’ I never answered back to him. I never raised my voice, because this was what provoked him the most. It went on day after day after day until one afternoon he laid down the instruments and he said, ‘All right, Doctor, all right. This is it. This is it! You obviously do not want to assist me. You want to be number one. Doctor, I’m going to assist you. Here, you take this forceps, and you take this needle, and you take this suture, and you sew up the artery.’ I started in and it lasted about 30 seconds before he grabbed everything back from me.”

  The harangue dragged on until Diethrich fell into depression. He would return home late at night and tell his wife, Gloria, “This man is intentionally trying to break me. It’s become a battle.” There were days when Diethrich would put on his scrubs and then fight down nausea at the thought of going into surgery. He would go to Ed Garrett, a surgeon who had been through the ordeal and who was now a member of the Baylor faculty and ask for help. “Ed, I don’t know how much more of this I can take. I’m losing my confidence, I dread to walk into the operating room, and I’ve loved the operating room since I was fifteen.” He went to Jimmy Howell, another surgeon, and begged him to scrub in and take his place and Howell would say, “I don’t even want to be near it.”