Hearts

by Thomas Thompson

  If Duson and his mother wanted, Diethrich told the Yugoslavian doctor, he would attempt a transplant as “an emergency, a desperate act.” No tissue typing had been done on the boy, nor would there be time. His condition was so grave and his body so massively deteriorated by the malfunctioning heart that the odds were overwhelmingly against success. The proposition was put to the mother. She shook her head almost immediately. “No,” she said in her native language, “we heard about transplants before we came to Houston but neither Duson nor I want it.” “I understand your point of view,” the surgeon said, “but we don’t have another thing to offer him. We’ll do the very best we can with medicines, but it’s a mechanical problem within his heart and we just can’t fix it.” Diethrich turned and walked from the room. No sooner was he in the corridor when the broken voice of the mother stopped him.

  “Doctor! Doctor! Please!” she cried in English. Her hands were outstretched. The Yugoslavian cardiologist spoke for her. “She wants the transplant. She wants her son saved.”

  The transplant began within an hour. The anesthesiologist, who had to put the boy to sleep in a sitting-up position because of the pulmonary edema said, “Ted, you’ve lost your mind.” Diethrich resisted a shudder himself as he sliced into the taut chest and encountered the huge, flaccid heart. This is what the operation is all about, he said to himself. This is a dying patient. There is nothing else for him. If there is a justification for heart transplantation, it is lying before me on this table.

  Within two weeks, Duson was greedily taking food. Within four weeks he was chattering in English. Quickly he was up and about the hospital. He learned to play the guitar and serenaded the nurses. He laughed for the first time in years. He got a part-time job helping feed the dogs and experimental animals in the Baylor laboratories. He shook Diethrich’s hand hard when he flew back to Yugoslavia. There he formed a rock-and-roll band and began making records. He wrote Diethrich several months later that his song, written in honor of the Houston-based astronauts, was rapidly climbing up the Yugoslavian pop charts.

  The DeBakey team did all in all twelve transplants, and by the beginning of summer, 1971, both Bill Carroll and Duson Vlaco were still very much alive. Diethrich felt the results were, in fact, better than the statistics. “We had two patients die from infection, from colon problems not related to the heart,” he said. “The transplanted hearts were working fine. We had one patient in whom the donor heart failed. We had another who died of a cerebral embolus, a clot to the brain. It could have happened to anybody. The statistics are not really as bad as they sound on the surface. I truly believe this can be a useful operation. There are two witnesses, one in Phoenix, one in Belgrade, who will testify to it.”

  The legitimacy of the surgeon in the world of medicine—the supreme academic moment of his long ascent from barber to eminence—was ensured when Michael E. DeBakey was installed as president and chief executive officer of the Baylor College of Medicine in May, 1968, about the time that Denton Cooley was beginning his transplant program. No one could remember if a surgeon had ever become president of a major medical school. Nor could anyone understand why DeBakey would want the job; his curriculum vitae was already eighteen closely printed pages long.

  There had been two immediate presidents of Baylor who had feuded with the board of trustees. They had left with the school in financial distress. One Houston doctor remarked, “Baylor was broke, there was practically no fiscal program. It was heading downhill fast. DeBakey volunteered to take over as a kind of interim chief executive to get the school back on its feet. Nobody in Houston medicine had the glamorous image he did, he could raise money, he could attract great teachers. But there was a fight from those who did not want him to take over as president. They knew how much work he already had, and they wanted a full-time president. Mike beat them down, he always wins. He wanted to be president and he became president.” Leachman had once remarked as to what drove the Cooleys and the DeBakeys of the world: “They seek to leave bigger footprints than anybody else.” DeBakey’s were now gigantic. He had operated on royalty, he had dazzled the scientific world with his surgery, his name was a household word, and now he was president of one of America’s leading medical schools. Someday he would crown his career with the perfection of an artificial heart.

  One of his first steps as president of Baylor was to sever the school from its parent institution, Baylor University in Waco, Texas, a conservative Baptist school whose leaders once fired the noted theatrical director Paul Baker from its faculty because he refused to delete the profanity from a Eugene O’Neill play.

  Much of 1968 was spent by DeBakey in establishing a fiscal policy for the now independent medical school. He sought out private and public money. Those who previously had difficulty in obtaining the DeBakey ear now complained that it took weeks instead of days before he would return a telephone call, much less grant an appointment—if at all. One who was exceptionally frustrated was Dr. Domingo Liotta, the surgeon researcher who had been laboring for five long years in the secluded laboratories of Baylor, building and testing and discarding and starting again with hundreds of intricate plastic and metal parts, hoping to be the first man in history to develop, under DeBakey’s sponsorship, an artificial heart. His work had received dramatic impetus with the wave of human heart transplantations dominating the press. And because the human hearts were not being tolerated as well as had been expected, the mechanical one loomed all the more paramount. DeBakey had many times predicted the coming of the artificial heart in speeches before medical meetings and congressional committees. He told of the great promise that it held. In 1964, DeBakey had made a flat prediction that the artificial heart would be ready for implantation in a human within three to five years. But in mid-1968 he upped that another five. Liotta was more optimistic. By September, 1968, he and his associates had developed a prototype, which seemed to hold great promise. But when Liotta sought to convince DeBakey of this, he was turned away. Impatience is a disease that strikes every man at least one moment of his life, and it found fertile ground in Houston. Liotta felt he stood on the threshhold of greatness, but that his way was being blocked by the most famous—and often exasperating—surgeon in America. “Every time Domingo finally got through to Mike to urge that more attention be paid to the artificial heart,” said one Houston doctor, “he would be told to get back down to the laboratory and continue his work. Mike keeps his eye on people and their work in his own way. But there were weeks, sometimes months, when Liotta couldn’t get through to Mike at all. He began to feel DeBakey was simply not interested in the artificial heart.”

  There was to be an alternative. Liotta had long admired Denton Cooley. When he had first come to Houston in 1961 and was still not comfortable in English, Liotta had found Cooley to be kind to him. The Texan had sponsored the Latin’s candidacy for a national scientific association. They had remained friends over the years, Cooley appreciating Liotta’s skill in the research labs, Liotta frankly spellbound by Cooley’s dash in the surgical suites. In early December of 1968, the two doctors met in private. Liotta expressed his anguish over what he felt was difficulty in getting DeBakey to move toward a clinical test of the artificial heart. Cooley nodded in sympathy. He knew DeBakey well. When their conversation was done, they made a secret pact that would bring the transplant year in Houston to an explosive climax, one that would wrench the world of medicine, and strip bare the ambition and jealousies and furies of those who work in the human heart.

  In the first days of April, 1969, there emerged these facts:

  1. On April 4, Denton Cooley, with Domingo Liotta at his side, became the first surgeon in history to implant an artificial heart into a patient, Haskell Karp, a 47-year-old printing estimator from Illinois.

  2. Cooley, with Mrs. Karp beside him, went on television and radio the next day to announce the historic operation, to explain that it was a desperate, stop-gap measure because no human donor heart had been available, and to appeal nationally fo
r such a human heart, which could be substituted for the plastic and metal one—powered by a huge, freezer-sized console standing beside Karp’s bed.

  3. Karp lived for 63 hours with the artificial device before it was removed in favor of a donor heart taken from a 40-year-old woman, whose body had been flown by chartered jet from Massachusetts in answer to the Cooley appeal.

  4. Karp died about twenty hours later.

  The Karp affair became the Chinese box of medicine, a complex puzzle of ethics and science wrapped deep within the passions of men, not to be fully unraveled by committees and testimony. DeBakey first heard of the operation the morning after, when he walked into a Washington, D.C. meeting of the National Heart Institute, from whom he had received grants to develop the artificial heart. Never a man with time to read the newspapers or listen to the radio, he had neither seen nor heard Mrs. Karp’s appeal for a human heart. The men at the Washington meeting crowded around DeBakey and pressed him for particulars of the breakthrough, if there had been a breakthrough.

  Cooley was, after all, a member of the Baylor faculty and DeBakey was its president. Cooley had been linked with DeBakey in the medical world’s mind for almost two decades. Surely DeBakey would know what had happened the night before at the hospital next door to him. But DeBakey knew nothing. He was more surprised than any man in the room. How ironic, in fact, how cruel, that the rug should be pulled in the presence of his peers. One doctor said that DeBakey’s face went white with rage.

  As soon as he got back to Houston, DeBakey immediately launched a private investigation. The first thing he learned was that Domingo Liotta had been serving two masters—working for some four months not only for Mike DeBakey, but in secret for Denton Cooley as well. He was serving both surgeons on the same Herculean task—developing the artificial heart.

  The second thing DeBakey discovered was that the device implanted in Haskell Karp looked amazingly like the very one Mike DeBakey knew was being developed in his own laboratories. “They used the exact same heart,” he said when he looked at the drawing St. Luke’s had released to the press. Months later, in conversation with a friend, DeBakey brandished the drawing and said, “Look! They weren’t even clever enough to make it look different!”

  Cooley’s immediate answer was that Liotta had worked for him privately, on nights and during weekends, and that the heart they developed, with some $20,000 of Cooley’s money, was independent from the one that DeBakey was producing. Moreover, Cooley pointed out, he was a member of the Baylor faculty, a full professor of surgery, and was entitled to use the research knowledge that flowed from the school’s laboratories. What was research for in medicine, if not to serve the clinician?

  Liotta was asked by a reporter how he could conscientiously work for two men on the same project. “It’s a sticky thing and I don’t think it would be right to put it in the press.” As to the heart, he hewed to Cooley’s statement that the apparatus was indeed different, and that he felt DeBakey had not given its development his attention. “If you don’t have a man who will go ahead and take the risk,” Liotta said, “then my work is valueless.”

  Reporters also sought out Dr. Charles W. Hall, who had been Liotta’s co-director on the DeBakey artificial heart program, but who had left to take a position in San Antonio before the Karp operation. “About one year ago, we started designing on paper a sac type, pneumatically energized pump to be used for total heart replacement,” Hall said a few days after the scandal erupted. “Dr. Cooley never worked with us on this project. But DeBakey called us in periodically to make changes or to try to get the research speeded up. Until I left in January, several hundred lab operations had been performed to test various parts of the pump for blood interface and electronic problems.

  “During the period from July, 1968, to January, 1969, the artificial heart was used with some success, in four calf operations, the longest of which lived 40-odd hours. But we had never satisfied ourselves that it was ready to be used clinically.… Technical errors caused air embolisms. There was always a great destruction of blood cells and improper internal-flow configuration caused stagnation. The heart used in the Karp operation appears to be the same model we worked on.”

  Was it possible, reporters asked, that Liotta could have designed and built an entirely new model for Cooley? Not likely, said Hall. How could Liotta have done work for Cooley in four months of nights and weekends that it had taken him five years of working for DeBakey full time?

  Houston’s medical community was sharply divided. One group held that Cooley’s use of the artificial heart was a brilliant scientific advancement. The patient in question was dying, and he lived for 65 precious hours with the mechanical pump doing the work of his heart. He regained consciousness, he spoke to his wife, he was alive! Science would not progress unless someone dared to put the mosquito on his arm, they said. A second point of view was that Cooley and Liotta were striking back at years of slights and harassment from DeBakey. A third group considered it an act of betrayal and a severe breach of ethics. There were carefully laid down guidelines to follow in surgery of an experimental nature. Cooley clearly had not followed them. He had made his plans in secret, he had not sought permission from DeBakey, the senior investigator of the artificial heart program, he had not asked for permission to perform the surgery from the Baylor Committee on Research Involving Human Beings, a group of doctors who can theoretically be called into session on 30 minutes’ notice to ponder a request, even as a patient is lying on an operating table. “It would not have done any good to call them,” said Cooley in private. “Mike dominates the committee and they would have automatically turned me down.”

  A letter promptly arrived addressed to DeBakey from the National Heart Institute. Written by Dr. Theodore Cooper, director of the Institute, it demanded in curt language a full explanation of the affair:

  “The reports in the news media indicate that the artificial heart implanted by Dr. Cooley was developed by Dr. Domingo Liotta. Our grant records indicate that Dr. Liotta’s salary and, to a substantial degree, his research, is supported by grant HEW 05435.

  “This being the case, I would like to request that the Institute be provided with summary data on the testing and evaluation of this particular device in animals prior to clinical application.

  “Also, as you know, current department guidelines require that projects involving human subjects be approved by local committees for human investigation. Was the protocol for the clinical application of this device reviewed by your local committee?”

  Investigating committees looking into the controversy proliferated rapidly in the Texas Medical Center. Hearings were held before the Baylor Committee on Research Involving Human Beings, before a hurriedly organized blue-ribbon panel of doctors and scientists who would report to the National Heart Institute, and before an extraordinary commission reporting to the medical school’s lay board of trustees. Even Congress rumbled of an investigation as to what was happening with taxpayer money in Houston. DeBakey leveled the indictment in blunt language:

  “Application of an unproved device … into a human being for primary experimentation before its safety and effectiveness have been proved scientifically in animal experiments is a breach of scientific ethics.” The ball was in Cooley’s court. Disprove it.

  Although the various committee hearings were all conducted in secret—the first time, someone remarked, that anything relating to heart transplants was not filmed with movie cameras—the essential positions of the two sides emerged.

  With what one committee member called an “almost patrician manner,” Cooley set forth his case. Another told a friend that Cooley seemed “polite at all times, mannered, responsive, in absolute control of himself, supremely confident, even proud of what he had done.… He seemed at a loss to understand why he was not being congratulated, rather than investigated.”

  Cooley said he had become concerned the previous autumn over the increasing scarcity of donor hearts. Leo Boyd had waited ele
ven weeks for his. Others had died while waiting, still more had gone home untransplanted when their money or patience had run out. Cooley admitted that he knew Liotta was fully committed and in the hire of DeBakey, and being paid a salary from the National Heart Institute. But Cooley had proposed at their private meeting that the Argentine surgeon develop something different for him. He wanted a sort of halfway house, an artificial heart to keep a dying patient alive long enough to find a human heart donor. Cooley in his testimony more often referred to a “resuscitative pump” than to an “artificial heart.”

  “I talked to Dr. Liotta about this idea,” said Cooley. “I felt he was as well versed as anyone. I talked to him about the possibility of helping me to develop such a device. Dr. Liotta expressed a willingness to do so.”

  But why had he not informed the senior investigator, DeBakey, of the arrangement? the committees asked. “Having met with nothing but negative replies to anything of this nature,” Cooley said, “and being determined to develop this device, we did not make a formal report.” Cooley made several veiled, somewhat sarcastic remarks about his relationship with DeBakey in the Baylor program. At one point he said, “Let me remind you that my position is rather awkward in the surgical research labs. Apparently my abilities more or less have been overlooked in the medical school.” After Christiaan Barnard’s first transplant, there was, Cooley said, “a great furor here to create a transplant committee at the medical school.… I was not invited to be on the committee—but I had no feelings about it one way or another. It gave me a certain independence which I relished.”