Hearts

by Thomas Thompson

  The lawyer had a stack of medical books and scientific papers on his desk. He had been reading up on heart transplants. He had, in case the self-defense theory failed, a sensational backstop.

  “I will also ask the question, ‘What is death?’” he said, “and, perhaps more relevant, ‘When is death?’ Clarence Nicks was pronounced dead twice, perhaps three times the morning of May 8, 1968.

  “I wonder if Clarence Nicks might still be alive today if his heart had not been cut from his chest. I have seen movies of a heart-transplant operation. The way the surgeons tell it, the donor heart is barely palpitating. But the way I saw it, and the way a jury will see it, the heart is beating like a bass drum! Whomp! Whomp! WHOMP! You gonna tell me that sum bitch is dead when his heart is a-whompin’ away like that? You show that whompin’ heart to a jury and you think for one minute they’ll consider this to be a murder victim?”

  Attorney Hudson paused and smiled. Then he frowned. He leaned forward and addressed an imaginary jury:

  “I don’t think we’ve gotten to the point where doctors can declare somebody a vegetable and then drop the executioner’s ax on him!”

  CHAPTER 12

  Two of Cooley’s first three transplants died quickly—yearbook salesman Cobb of infection within three days; hospital administrator Stuckwish from a variety of complications ranging from blood clots to liver malfunction within six days. The controversial heart of Sonny Nicks had functioned normally, but in vain.

  Cooley’s first transplant, the remarkable Everett Thomas, overcame a brief period of rejection, a touch of jaundice, and moved almost hurriedly to what seemed would be total recovery and acceptance by his system of the new heart. There was one early distasteful moment when the nineteen-year-old widower of the girl whose heart had been donated decided that he should receive money for his generosity. “He sort of demanded that Thomas pay him regular rent on the heart!” exclaimed one of the nurses. The news was leaked to the newspapers and radio, and despite the nurses’ attempts to keep the ghoulish report from Everett Thomas, he announced one morning that he knew a price had been put on his new heart. “It doesn’t bother me,” he assured the nurses. “I have no attachment to this heart at all. It’s just a pump, after all. I came to St. Luke’s Hospital just like it was a store and they could have had this heart on a shelf for all I care. I bought it like any other piece of merchandise.”

  The fourth day after his operation, Thomas was walking and taking solid food. He said he felt like a man getting over nothing more serious than the flu. “I’m a little weak in the legs,” he said, “but I haven’t felt this good in years.” Suddenly he broke into tears. “Dr. Cooley has been named Man of the Year by a lot of organizations.… All I can say is that he is … he is … he’s the man of my life.”

  Everyone noticed that a change had come over Denton Cooley. He never had been comfortable in the spotlight, but suddenly he was giving interviews, appearing on television, posing with Christiaan Barnard at transplant seminars and seemingly enjoying every moment of it. He remarked in conversation to a visiting psychiatrist from Los Angeles, “The most stimulating experience in my professional life was the completion of our first transplant … to see that organ begin to function again in a new body. As a consequence, unfortunately I guess, but in some ways fortunately, I as a personality was vaulted into some sort of orbit where they thought I was some kind of super-surgeon.… It was fantastic! The reaction that the public and the news media had was fantastic. We were dealing with the heart! We were taking one man’s heart and putting it into another. Every day we put in three or four mechanical valves into peoples’ hearts and nobody got excited about it, but do a heart transplant, and overnight the surgeon becomes some sort of diety!”

  Don Rochelle, the boyish-looking cardiologist who was asked by Cooley to serve with Jim Nora as immunologist for the transplants, remembered the first three months of the transplant year—May, June, July—as being a time of “tremendous euphoria.”

  “Denton was willing to transplant everybody,” said Rochelle. “Of our first nine, three were almost dead when they went into surgery, they never really stood a chance. Denton took ’em on anyway—to hell with the statistics! To the surgeon, it was almost akin to really being God. It was a feeling of rare ecstasy that enveloped Denton. He was given the power to grant life!” That the surgeon had jumped completely ahead of the rest of medicine was something that would not become obvious for a few months to come.

  Two rooms at the end of Three South in St. Luke’s were converted into a special transplant suite. The hospital carpenters built an anteroom, which shut off the suite from the rest of the floor. Cooley wanted a special nurse to run the transplant suite and supervise the care of his star patients, a strawboss of super efficiency who would not fear these extraordinary people. The transplants were becoming such celebrated residents of the hospital that some nurses were frankly loath to work with them, fearing a nursing error might bring down the wrath of all the doctors involved. One of the supervisors thought of Alice Nye.

  Alice was a splendid choice. Steel-backed, with a rich booming contralto, she was the kind of nurse anyone really sick would want to have—feminine enough to mother you, tough enough to know when to sympathize and when to bark. During World War II, she was a first lieutenant who had won a battlefield decoration for bravery in the Normandy campaign. She had come to Houston in the late 1940s and vividly remembers being scrub nurse for one of Mike DeBakey’s very first operations. DeBakey had come up with a new theory that if lap packs were hot enough, they would cauterize blood vessels. He wanted them dipped in boiling hot saline solution just before they were handed to him. Alice stood next to the surgeon, expected to pass him his surgical instruments and at the same time dip the lap packs into pans of steaming water borne in by a procession of orderlies. Her hands turned lobster red inside her gloves, followed by her temper, and she finally announced, in battlefield terminology, that she could not do both efficiently. Even Mike DeBakey accepted what Alice said.

  Alice had trained at a sprawling hospital in Shreveport, Louisiana, and had set high personal standards for herself. But modern medicine had changed in the three decades since she had learned her art. “When I started out as a nurse, I was perfectly capable of handling 26 patients on a floor at one time,” she said, “but medicine grew so fast that I found I just couldn’t do it my way any more. I didn’t want some nurse’s aid to take the blood pressure of a critically ill patient because I was busy with something else, or some licensed vocational nurse to give medicine and write up charts. Rather than do less than what I forced myself to do, I quit hospital work and went into private-duty nursing.”

  But she was intrigued by the offer to boss the transplant suite. Quickly she confessed that she knew little of how to handle them. “Who does?” was the answer.

  In the year that followed, Alice would become more than a nurse: she was mistress of the moon landing and sometimes head of a nursery. She became emotionally involved with her brood—arbiter of heated jealousies among the transplanted hearts—and in some cases their families. She spent the last few desperate months tending to dying people and telling lies as well and as fast as she could. Her philosophy always had been: “I want everybody to get well, I want to win them all.” But she lost them all, and not until the last was gone did she have the time to break. And cry.

  On the first day Alice discovered that transplants were terrified if there was the slightest deviation in care and routine. Her initial hours on the job were spent in listening to Everett Thomas announce and lecture to her how things should be done for him, how the other nurses had taken his temperature and read his monitoring devices, and when he had received his shots and pills. Alice assured him that she had the ability to nurse him well. Patients began squealing on doctors who walked into their rooms without wearing sterile gowns, caps, and masks. There was a running battle with Leachman over his cigar that Alice never did win. “Dr. So and So just came in without a mask,”
one would complain to Alice. “That’s all right,” she would answer wryly, “They’re all sterile doctors around here, anyway.”

  It was a year of doctor pitted against doctor, nurse against nurse, a year of resurrection, a year of grotesque horror. At one point in deepest autumn, more than twenty people were camped in motels scattered about Cooley’s hospital, all waiting for new hearts, all waiting for Cooley’s hands to open their chests and install them there, waiting on fretful motel beds, eyes to the telephone, ears to the open windows—better to hear the ambulance when it sped out South Main to the Medical Center. The cry of an ambulance meant that somewhere in the city someone had been shot or run over or crushed in a fall, and if that someone was dead or dying, perhaps the heart would still be usable. When the ambulance broke the quiet autumn nights, the waiters—as they were called—sat up in their motel beds and switched on bedside lights and stared hard at the telephone … and waited to be summoned across the street to the hospital for tests. “For a hundred nights I prayed,” said the wife of a man now long dead, “let tonight be the night that Sonny will get his new heart.”

  By July 30, 1968, Cooley had transplanted nine hearts, and six of the owners—five men and one woman—appeared beside him triumphant. They posed for photographs with Cooley, who stood proud as a schoolmaster. Cooley’s sudden penchant for publicity surprised many Houston doctors. One, a veteran cardiologist, analyzed it carefully. “The odd thing,” he told a visitor months after the hysteria had passed, “is that in the early years, Cooley was a white hat, a supporter of the medical society and its ethics regarding publicity. He disapproved of DeBakey’s pursuit of print. I feel Denton sat down with himself one night and decided that the only way to get funds for his Texas Heart Institute was through publicity—and to ride it out through hell and high water. I think he made this decision carefully, consciously. To become a star in medicine, you needed a gimmick. And he had been taught by a master.”

  Everett Thomas was well enough to leave the hospital, but not the city, so he found work in the trust department of a bank directly across from St. Luke’s. Louie Fierro, Cooley’s fourth transplant, found the same work he had done in Yonkers, New York—selling used cars. After his operation Cooley had said to him, “You are the only used-car salesman in the world who ever had a change of heart.” Garrulous and friendly, Fierro had become a great favorite of the hospital staff. He spoke in the rapid style of Eastern America and he usually had a blue joke for any nurse he met.

  Though released from the hospital, Thomas and Fierro were bound to it—medically and emotionally. They were instructed to return officially at least three days a week for shots, EKGS, x-rays, and blood tests by Nora or Rochelle. But almost every morning they began their day by looking in on Alice and the exclusive sterile club she ran. They came to make “rounds.” They put on cap, gown, masks, and paper boots over their shoes and they questioned Alice in the manner of doctors. “How’s the new guy doing?” they would demand. “How’s his pulse? How’s his respiration? Is he taking his Kickapoo Joy Juice?”—Alice’s term for the daily solu-curtef (a cortisone derivative) injections.

  Those with new hearts became the new celebrities. Lives of pain and dullness and fear, of being confined to a back bedroom with drawn shades and a night stand crowded with bottles and solutions, were transformed by Cooley’s knife into lives of dazzle and acclaim. Each kept scrapbooks and autograph albums beside his bed. Their mail was enormous; one had stamps from 37 countries. Kings and leaders of government visited them, congratulated them, offered prayers for them.

  Don Rochelle noted that they became “evangelists, almost as the Twelve Apostles went out to tell of the wondrous thing that had happened to them.” Everett Thomas had been a quiet, retiring, shy man, but with his new heart he was transformed into a social lion, comfortable on the dais, accustomed to the microphone, familiar to the Rotarians and Kiwanians of South Texas. Television cameras captured Louie Fierro patting fenders at his used car lot. Carl Van Bates, shoe salesman from Amarillo, became so passionate over his new heart that he wrote fellow golfer Dwight David Eisenhower a letter as the stricken President lay in Walter Reed Hospital in Washington, D.C. Ike should come to Houston, Van Bates wrote, and let the hands of Denton Cooley give him a new heart, a new life. Alice obtained a putter and a golf ball and rigged up a styrofoam cup for Van Bates to practice putting in his hospital room. They became exhibits A, B, C, D, E, and F for the most astonishing operation—in the public eye—since medicine began.

  Philip Blaiberg was one faraway hero. Every time he was photographed riding a bicycle on a Cape Town lane or plunging into the surf, that clipping became, to the Houston transplants, almost as sacred as a religious icon. Denton Cooley was the other. Even though the surgeon had little to do with managing the transplants in the critical postoperative weeks, each owner of a new heart identified strongly with him. Though fifteen physicians—from dermatologist to inhalation specialist to radiologist—were often intimately involved with the care of a transplant, Dr. Kraft, the Baylor psychiatrist said, “The patients always conceptualized themselves as being the surgeon’s patients. Thus, at each step of the stairway to transplantation and the subsequent war with rejection, the patients felt constantly the highly charged impact of the personality and charisma of the surgeon.”

  Merely by walking into their room for a few moments, Cooley elated his people. He was the producer of the film dropping into the dressing room of the starring actor, and, indeed, each case had been filmed before, during, and after his transplant. Each cherished Cooley’s public comments as insurance for his transformation.

  “There is no question in my mind that heart transplants can be done with very low risk—say 5 percent mortality,” he said during the period of euphoria. “It will become a routine operation during the next decade. The clinical feasibility has already been established. It’s only a question now of resolving such details as body rejection and getting people to accept the idea of walking around with someone else’s heart.”

  On another occasion Cooley remarked, “People might wonder what life with another person’s heart would be like after the initial risk of the operation is past. After all, the heart has long been considered the seat of the soul and the objects of poets and songs. I believe the best way to think of life is that every organ in the body is a servant to the brain. Once the brain is gone the servant is unemployable. Then we must find these organs other employment.”

  When he was criticized at one medical meeting for transplanting hospital administrator Stuckwish, who had suffered one cardiac arrest in the hours before his surgery and a second attack even as the doctors cut into his chest on the table, Cooley answered sharply, “There are few surgeons in the world who would try what we did on Stuckwish. We don’t refuse to operate on patients if they are too sick, only if they’re not sick enough. The real issue here is not are we going to offer a transplant to a man, but are we going to deny it to someone who is in the last hour of his life!” The fact that Stuckwish died within a few days of the transplant was less relevant, Cooley said, than the fact that the transplant resuscitated him and gave him those few more days of life. “Stuckwish’s case illustrates dramatically that a transplant has real therapeutic clinical value,” he said. “We have demonstrated that resuscitation of a patient by transplant is possible.”

  There were even words from the surgeon to gladden those camped out in the motels waiting for hearts. Rumbling was heard in the medical world that transplants were becoming a carnival of false hope. Many doctors were pleading for a moratorium to examine and contemplate what was happening. “Nonsense,” said Cooley. “We don’t have enough patients done yet to assess the results. Every case that is attempted proves the validity of the concept.”

  But the new moon turned and by autumn its dark side came into view.

  Within every human body dwells a defense mechanism to protect the body against foreign intrusion. Let the thumb pick up a splinter and instantly the mechanism goe
s into action, examining the sliver of wood, deciding it is not “self” but “non-self” and taking steps to expel it.

  When the surgeon puts a foreign heart into a body, the defense mechanism is outraged. The transplanted heart leaks antigens, those indicators of genetic difference, into the new system. They begin to explore the strange new environment. Antigens hurry to the lymph nodes, which in turn promptly manufacture antibodies and immune competent lymphocytes to wage war against these unknown invaders. The body is sending out “self” to repel “non-self.” The antibodies and immune competent lymphocytes rush to the new heart—the source of these antigens—and chew it up, immobilize it, reject it.

  The defense mechanism not only works against transplanted hearts; it is there to guard against infection, viruses, any foreign threat to the body. After the surgeon had done his quick work, the cardiologists faced the maddening problem of how to slow down and stall off the rejection process against the new heart, but at the same time not cripple the mechanism so drastically that the body had no strength to battle pneumonia or infection. It loomed eminently possible that a transplant patient could be treated with enough drugs to permit his system to accept the new heart, but he might die of a common cold.

  To Jim Nora and Don Rochelle, with help from the entire St. Luke’s cardiology staff, Leachman, Dennis Cokkinos, and Louis Leatherman among others, fell the complex task of managing rejection. There was no principle that cut across the body of their work, because each system was different, each patient reacted differently to the drugs. “After a while, it got to the point where we would say, ‘Well, let’s try this or that and see what happens,’” said one of the heart doctors. “Every day was a new ball game.”

  The names of the cardiologists were rarely if ever in newspapers, but their lives were far more deeply entwined with the bearers of the new hearts than the surgeon himself. Rochelle estimated he saw the transplants up to twenty-five times every day.