Hearts

by Thomas Thompson

  The disenchantment set in with Cooley’s ninth transplant in the blazing August of 1968. He had by then done more transplants than any other surgeon in the world; the hospital had to install security guards to contain the press and keep them from forbidden areas. Jerry Strong had leaned over the operating table one day and said to Cooley during a valve case, “Tell me, Denton, who was the second man to fly the Atlantic solo?”

  There appeared at St. Luke’s that August a beautiful dark-haired five-year-old girl whose heart muscle was so diseased that Cooley’s surgery could not repair it. Both she and her parents agreed to a transplant. Their wait was not long; an eight-year-old boy fell from a tree in a Midwestern state, hit his head, and destroyed his brain. He was the son of a college professor. Nora recalled what happened:

  “The two sets of parents met in the lobby outside surgery and both were crying. The parents of the girl made plans to share her with the parents of the boy who was giving up his heart. We were readying the child for a transplant and I can remember saying to myself, ‘I must do something different, I must not affect her growth’—how naive this sounds now—‘I must be careful with the steroids so I will not affect her psyche.’ I wanted her to lead a normal life.”

  Cooley performed a splendid operation and within 24 hours the child was sitting up in bed coloring. But the next day she rejected, and on the eighth day she was dead.

  “The euphoria for me was gone,” said Nora. “Our first transplants had seemed so hopeful that we thought we had somehow overcome that basic biological rule: the body rejects to protect itself against foreign matter. But we had not overcome the rule. Not at all.”

  Nora began urging both in his own hospital and in national medical meetings that only transplants of the very best tissue matches be attempted, but he was not heard. Tissue matches between donor and recipient were graded on a scale from A down to D. An A match would be possible only when an identical twin donated his heart to his twin. Of Cooley’s transplants, only one tissue match was graded a C-plus. Seven were graded C, four were C-minus, and eight were D. “Perhaps we should do only one or two transplants a year, but we could make sure that they had a better chance to work,” Nora said. Bob Leachman was a powerful senior voice against him. “If we’re going to be in this game,” said the older cardiologist, “then we’re going to need to do enough transplants to make the experiment valid, to determine if it is valid clinical therapy. If we only do five or six, we could get bombed either way. You could have six bad ones or six lucky ones and you’d never really know.”

  When the pattern of rejection had become a familiar one, Nora, distraught, went to Cooley and in a dramatic confrontation begged him to stop. “At least wait until the matches become better,” he pleaded. The surgeon was preparing a new transplant. “This is not a good candidate,” said Nora.

  “But I’ve promised the family,” Nora remembered Cooley saying. It seemed almost an evangelical laying-on-of-hands. It seemed almost God guiding a scalpel. If a borrowed heart could be kept in place by the surgeon’s skill—and by his faith in that skill—then none of Cooley’s people would have died.

  Disenchantment spread. Don Rochelle was attending a medical meeting in New York when he received a telephone call from the hospital in Houston. After a long and moving struggle for life, one of the transplants had died. Rochelle put down the phone and was near tears. He told his wife, who, on hearing the news, became ill. Both had been especially close to the patient. Rochelle located Cooley at the meeting playing string bass with the Heartbeats, a band composed largely of Houston heart doctors, which is well known in the medical world. When the music was over, Rochelle whispered the saddening report. Cooley shook his head and excused himself to attend a reception. Rochelle had been invited to the same party but he was too overcome to attend.

  “Denton was disturbed by the deaths, sure,” said one member of his team, “but he didn’t lose much sleep over them. He gave them the most beautiful surgery in the world. It was not the surgeon’s fault that the patient died.”

  Nora tried to point out that two of America’s most distinguished heart surgeons, John Kirklin of Alabama and Dwight McGoon of the Mayo Clinic did not attempt a single transplant. Jim Hardy of Mississippi did but one. Only two were attempted in Russia. Cooley remained convinced of the procedure’s validity.

  For a time, Cooley even felt that variations on the theme were perhaps possible. One such departure from the norm—if indeed there was a norm to heart transplantation—turned into a bizarre and dark comedy.

  When a donor heart could not be found for a dying patient who needed one, Cooley elected to take a ram’s heart and implant it. The animal heart shriveled and rejected immediately as the human lay on the operating table. In anticipation of possible trouble, a large pig had been brought to Animal House, a small metal-walled laboratory next door to the main hospital. A pig’s heart is similar in physiology to a human heart. Word was quickly telephoned to a surgical team standing by there to prepare the pig—the ram’s heart had failed. The unwilling animal was chased about the room, caught, and strapped to the table. He was given anesthesia. He went out, then woke up squealing, fighting to break the straps that contained him. An anesthesiologist was called to bring a more powerful drug. Meanwhile, on the third floor operating room of St. Luke’s, the Cooley team was trying to keep the human patient alive. Finally too much time passed and Cooley cancelled the procedure. He pronounced his human patient dead before the pig’s heart could be tried.

  “A certain amount of naïveté can be forgiven,” said Nora, “because, after all, the transplantation business was so new, so unknown. But what destroyed it in my opinion was our continuing to do them after so many failures. It was an example of dehumanization by technology.”

  Nora remembers thinking as he drove to the hospital in the middle of some night to cope with yet another new crisis, “This is symbolic of everything wrong in our world. Fill in the blank, fill in any abuse you want—pollution, Vietnam, bureaucracy—the mechanics of that abuse are comparable with what we are doing.”

  “There should be a ‘Ballad of Leo Boyd,’” said one of the nurses who watched over him during the sixteen months of pain and crisis. “Few men have ever gone through what he did.” I saw Boyd only once. It was toward the end of his ordeal and he must have known it, or wished for it. He was sitting up in bed and his skin was the color of old ivory. He was a museum-piece man, his cheeks artificially puffed from the drugs. I did not speak to him except to nod encouragingly, and he returned my hope for him with an almost papal movement of his right hand, a benediction from a transplant.

  Jim Nora could no longer bear to even enter his room and had asked Don Rochelle and the others to care for Boyd. “He came to us a magnificent-looking man with great arm muscles,” said Nora. “I could not bear to look at his face and see what we had done to this strong, proud man.…”

  Boyd was born in the tiny Canadian village of Stratfordville in Ontario province. It had 500 people or so when Boyd was a child and most were involved in the harvesting and curing of bright leaf tobacco. Boyd’s parents and people were masons who built saw mills, silos, and factories for tobacco processing. Once in a baseball game with a rival village, Boyd’s father offered him a dollar for each home run. He hit four in four times at bat and collected four dollars from his proud but astonished father. Boyd had two brothers, both of whom were boisterous outdoor kids. One threw Boyd into a creek, where he hit his head on a stone and almost drowned. The other boxed with him and knocked him down so often that he became angry and learned the way of the gloves and began winning trophies by-the-time he was fourteen. Boyd became a strapping youth of six feet plus, with dark hair, hazel eyes, powerful arms and legs with muscles that rippled and veins that stood out like rope on a package. In the Canadian army during World War II, he took judo and after but a few lessons was taunted to climb into the ring with a burly teacher. Boyd slammed him to the mat and almost broke the man’s back.

 
Rather than the masonry trade of his family, Boyd chose railroading and in 26 years on the New York Central, advanced from brakeman to conductor to yardmaster. He was not a man to be kept indoors, for he had a quick temper that flared and died; it rarely flashed when he was hunting birds on the plains near his home or moose at North Bay or casting in the pools below Niagara Falls for perch, or bass, or—his lifelong hope—a muskie. At the age of 42 he took up bowling, became an expert, and scored over 200 in every match. He smoked a pack of Camels every day, and took but an occasional drink after bowling or at weddings. He had two daughters and seven granddaughters and a slender, pretty, hard-working wife named Ilene, who adored him.

  On an early autumn morning in 1965 Boyd slept late because he was on the 11 A.M. to 7 P.M. shift. He rose, washed his hair, had coffee, and dressed for work. He went to the garage of their home in Niagara Falls, Canada, and Ilene remembers hearing some muffled noises. The ensuing silence worried her. She walked down the long hall of the house and saw her husband sitting on their bed, his face a purple color.

  “I’ve got the worst pains in my chest,” he said. “Must be indigestion.”

  “But you didn’t eat any breakfast and nothing special last night. Leo, lay down.”

  He obeyed and fell backward, rubbing his left arm.

  “Leo, honey, have you got pains in your arm?”

  “Yes. All up and down.”

  Ilene started to back hurriedly out of the room. “I’m calling the doctor,” she said.

  “Oh, don’t do that, hon. It’ll pass. I’m due at work.”

  “Leo, I’m scared.” A neighbor had suffered similar pains in his arms while sitting in a lawn chair. He had died before he reached the hospital.

  Ilene called for an ambulance, which delivered Boyd to Niagara Falls General Hospital. He had suffered a whopping infarct and was hospitalized for seven weeks. “It was a frightening experience for him,” remembered Ilene. “He didn’t understand why it had happened to him. But he was a good patient.… He would always be a good patient.”

  Boyd asked his doctor why he had suffered a heart attack. The doctor drew a picture of a pipe rusting inside with little particles flaking off and building up until the pipe occludes and when the fluids can no longer pass through the pipe, it ruptures.

  For the first time in his active life, Boyd had to stay indoors and grouch for six months of semi-invalidity. He was a prisoner of blood thinners and digitalis and nitro tablets. He won permission to return to work and seemed restored to a normal life except for rare flashes of anginal pain. In September, 1966, Boyd and Ilene drove to Kentucky for the funeral of a relative and upon arriving back in Niagara Falls, Boyd crumpled to the floor with a second heart attack. Another seven weeks in the hospital, followed by months of terrible pains in his back, neck and head. “I’m going out of my mind with this pain,” he told Ilene. He would stuff himself with tranquilizers and pain pills and prowl the house at night. Once he fell asleep in a certain chair and became fond of it. The family dachshund, Gretel, was not allowed near that chair. When Boyd discovered her in it one day he picked up the squealing animal and yelled that he was going to kill her. Ilene smuggled the dog out of the house, gave it away, and interested Boyd in tending to tropical fish, more obedient pets.

  On an evening in 1966, Boyd went to sleep after Ilene had given him a shot of Demerol, as she had learned to do. “When they first told me I would have to learn to give the shots,” remembered Ilene, “I said I couldn’t possibly do that … but one learns.”

  Ilene herself was stricken with pneumonia and on this night she lay beside her drugged husband. When the Demerol wore off, Boyd roused himself and begged for another shot. Ilene refused. He began to rage for more pain killer. Ilene insisted she had to follow the regimen laid down by the doctors. Boyd got up and said he was going to walk about the house and try to make the pain go away.

  He was gone such a long time that Ilene got up and began to search for him. She discovered him on the couch in the living room, rolling on it, tossing his body from one end to another, crying out, his face contorted in agony. Then he rolled off the couch and onto the floor. “I had never seen a man in such pain before,” said Ilene. She called a doctor, who came and, after a rapid examination, said it might be a gall stone. “I don’t think it is another heart attack,” he said. But at the hospital, the EKG showed a third infarction had destroyed part of Boyd’s heart. It was, in fact, his most severe heart attack to date, and during the night his heart arrested. A team resuscitated him, and Ilene was called at home and told to be at the hospital by eight the next morning and to make up some excuse so as not to worry her husband. He was, they said, desperately ill.

  Boyd was in an oxygen tent and frowned at seeing his wife so early. “What are you doing here at this hour?”

  “I was going downtown shopping,” Ilene lied. “They have sales on and I wanted to be there when they opened the doors.… So I thought I’d come here first.”

  “I see.…” He was suspicious.

  “How are things?” she asked.

  “Something bad is wrong.…” Boyd was so gray and weakened from the attack that Ilene had to rush from the room. Outside, the doctor said, “Leo cannot possibly live until night. I think you should gather your family to the hospital.”

  An hour later his heart went into fibrillation but the electric paddles jolted it with current enough to send it back to a fairly normal rhythm. When Ilene saw him later that afternoon, there were burn marks on his chest. But he was alive.

  Boyd’s life became a grotesque carousel spinning from hospitals to home to doctors’ offices, from new drugs to old ones, to increased dosages, to EKG machines, to sentences of doom, to scenes of horror in the living room when he would shriek his fury at Ilene because she would not quiet him with the medication she kept hidden. One doctor suggested that he go to Toronto General, where a bold surgeon might attempt an open-heart procedure. Boyd was elated at the possibility. But the EKGS and cardiograms were far too pessimistic for surgery. “From your studies, we feel you would not have one chance in a million,” they said. “A man with a weaker body than yours would already be dead. There is nothing we can do surgically. We’re going to put you on medication and, hopefully, strengthen your heart. Come back in six months and we will examine it again.”

  Boyd’s hopes crumpled. He felt he was beyond hope. He went home in despair with thirteen new drugs to take every day. Ilene chattered gaily beside him, but in her mind was ringing the surgeon’s report: one branch of Boyd’s left coronary artery was 90 percent blocked, a second branch, 30 percent, and the right, 70 percent.

  He would yell at Ilene for more Demerol. “What’s the difference in giving it to me now or in an hour and a half from now?… Woman, I’m dying from pain!” The scenes became such that Ilene felt her sanity was leaving her. She tried to work at a drugstore and slip away in the afternoon to nurse Boyd and he would be, more likely than not, half-conscious and delirious. “It was in and out of the hospital, in and out of the hospital.… One Saturday morning we brought him home, and took him back the same night.… I called Toronto and said that even though the six months were not up, couldn’t we come back and see if anything could be done? The surgeon there agreed. Leo went in for six weeks of tests. I was trying to save money so I was staying with my sister 85 miles from the hospital and commuting to Toronto with Leo’s railroad pass.… One night he called me and fairly shouted with happiness, ‘Come early tomorrow morning! Come extra early! They’re going to operate!’”

  Ilene rushed to the hospital by dawn and into her husband’s room. She found him curled into a tight ball, facing the wall, his face streaked with tears. “They’re not going to do it,” he said. “They’re sending me home to die.”

  They waited for death. Boyd took his medicine. Ilene drugged him to erase the pain and bring the sleep. Sometimes she would drive him to Niagara Falls and park and they would look at the happy, beautiful youngsters in yellow slickers, promenadin
g about the mist. Leo Boyd was only 48, but he was an old man. And tired. And deathly sick.

  When Boyd picked up the paper in early December, 1967, and read the headline from Capetown, South Africa, he cried for Ilene to come to his bed. “There may be hope for me,” he said, thrusting the paper at her. He followed the case hourly, by radio, by newspaper. Ilene was glad for something to occupy his interest. When Blaiberg was transplanted and seemed to be recovering, Boyd asked his doctor in Niagara Falls to explain the transplant procedure. “We may have to send you to South Africa, Leo,” said the doctor.

  “I’m just about ready to go,” he replied.

  A few weeks later, Ilene took Boyd to a larger hospital in London, Ontario. They sat in the waiting room for hours, Boyd’s breathing echoing through the room like an iron lung. A doctor finally examined him and said his heart would not last the night. “We have heard that so many times,” snapped Ilene. “He will not die if you can just find the time to take care of him.”

  A general practitioner, a Dr. Lamont, came into Boyd’s room and said, “I think you should consider a transplant. What would you think of that?”

  “There’s not much to think about,” said Boyd. “Where could I go?”

  “Cooley is doing them in Houston, and Grondin in Montreal.”

  “I’d rather go to Houston. Neither my wife nor me care much for French Canadians.”

  “Then I take it you want to go for broke in Texas?”

  “Is there another choice?”

  “Cooley has done five or six. He appears to be the world leader.”