His continuing study since 1962 was called “Ion Transport in Cardiac Muscle,” in which Schwartz had concerned himself with the chemical process that makes the heart contract and expand and push blood throughout the body. With fresh heart tissue, he was able to process all the membrane systems in cells which have anything to do with ion transport. Ions are electrolytes—calcium, sodium, potassium—and when a heart beats, it is the reflection of these ions moving in and out of millions of heart cells. After studying 25 recipient hearts that were diseased, Schwartz made a surprising discovery.
“Every heart has a calcium binding system that must contract and relax over and over again for 70 or 80 years,” he explained. “In the 25 defective recipient hearts we studied, in every single one of them, this system was defective. This was learned only since heart transplants began.
“Now we are studying the hearts of dogs and rabbits and we are discovering the same defective system, which you could call a chemical imbalance. This is a breakthrough—this could be the cause of heart attacks. Diet and stress and all the rest could aggravate a condition, but the main cause of a man dropping dead from a defective heart might be a chemical imbalance within his electrolytes.”
If Schwartz becomes convinced that his discovery is of the magnitude he is beginning to suspect it is, then he and the Baylor pharmacologists can explore possible drugs or hormones to prevent the calcium binding system from becoming defective. His work would seem to be the most hopeful thing salvaged from the transplant year.
Between Methodist and St. Luke’s hospitals in Houston there is a cluttered, cut-up area of little more than a hundred yards across, which some of the younger doctors refer to as “No-Man’s Land.” In the summer of 1970, bulldozers and heavy machinery needed for construction work going on at St. Luke’s roamed the small area. Trucks with girders, cement mixers backed in and out, sometimes throwing a shower of gravel against a small tin shack called Animal House, so named because experiments with animals are sometimes conducted there. Often workers in hardhats leaned against the shack to smoke or look at blueprints. It was a place of such ordinary anonymity that I passed it, parked my car within a few feet of it a hundred times and never noted its sand-colored presence.
But within Animal House is a narrow closet, two feet or so wide, and if one had a key to the closet, one could open it and find seven ordinary shelves, crowded with white plastic containers, the kind women use to store food in large freezers. Within these containers are the 22 transplanted hearts that were given to 21 people (Everett Thomas got two) who came to St. Luke’s Hospital for the operation that ignited men’s dreams that December night in Cape Town. The hearts are a grayish yellow now, rubbery from the alcohols and formaldehydes preserving them. Someday there will be a Museum of the Heart in Cooley’s fine Texas Heart Institute and perhaps these will be displayed for the student and historian.
Each of the hearts showed in autopsy the same signs of rejection, signs unique to transplantation: hemorrhage along the lining of the heart, thickening of the heart walls, mottled appearance of the myocardium. Each of the hearts was studied, probed, analyzed, pushed under microscopes, wondered over, despaired of, and finally put into the white plastic containers and taken to a locked closet in Animal House, where they were stored, and where, for weeks at a time, no one even thought of them.
If you stood very long in front of the closet and looked at the shelves, you would gaze first with curiosity and then with wonder and then with sadness, and after a while your eyes would sting from the fumes of the acids. I saw the hearts and I felt a strange unsettling and I walked hurriedly away from the ghosts and into the blazing Texas sun, feeling my own heart pounding in me.
* In April, 1971, Mrs. Shirley Karp, widow of Haskell Karp, sued Cooley, Liotta and St. Luke’s Hospital for damages totalling more than $4 million. Although Mrs. Karp signed a release for her husband’s surgery and afterwards publicly praised Cooley, she claimed in her suit that she did not understand what she was signing and that her husband was “the unfortunate victim of human experimentation.” She further claimed that neither she nor her husband knew that the artificial heart had never been used in a human being.
PART THREE
CHAPTER 16
My sons flew from New York to Houston as summer began in 1970 and I met them at the airport. Both were pale from the long Eastern winter and shaggy in the land of short haircuts. We drove to my apartment near the Medical Center; chattering, proud father and progeny, of baseball statistics and unpleasant instructors who had assigned summer homework and all things important to boys nine and twelve. Both had received physical examinations by an eminent woman pediatrician in New York to fulfill requirements for admission to summer camp in Texas and once again a doctor had heard the unknown in Scott’s heart. Their mother had told the pediatrician that Scott’s murmur would be heard by the sophisticated ears of the Houston heart world and the doctor seemed elated. “Be sure and have them send me a report, and an x-ray, or if.…” She left the rest unspoken. Not even she would speak of surgery.
At my apartment, the boys stripped off their flannels and blazers and striped ties in seconds and leaped yelling into the pool. Their happiness, plus the fact that Houston’s largest park and zoo lay unexplored directly across the street, seemed reasons enough to delay talk of the stethoscope for a few days at least.
Cooley and Liotta were to be decorated by the Spanish government and Monday surgery was concluded by 2 P.M. so they could change into formal dark suits and somber ties for the ceremony in the auditorium of Texas Children’s Hospital. Cooley had arranged a liaison with the Spanish medical community in which he would receive around $3 million for his Texas Heart Institute and in return would train Spanish cardiologists and surgeons in Houston. It was said that research money was so scarce in the United States that Cooley had to go to a foreign source to find some. There was further talk in Houston that some of Cooley’s contributors had grown disenchanted after the artificial heart controversy. Cooley discounted this and blamed the slowness of his fund-raising to the general business recession of 1969–70.
Cooley would also perform guest surgeries in Madrid and Liotta would spend considerable time there developing a new artificial heart and testing it on Spanish calves, which were a great deal cheaper than those in Texas. Cooley and Liotta were to be awarded the Grand Cross of Alfonso X, who had ruled Spain from 1221 to 1284. The decorations were in honor of “meritorious service to medicine,” for their use of the artificial heart in Haskell Karp fourteen months before. If the prophet was without honor in certain parts of his own city, then at least a foreign government recognized the achievement.
On the afternoon of the award ceremony, the Texas Children’s Hospital auditorium was filled with nurses, doctors, patrons of the hospital, and the many children of the two honorees. There was a decided “hooray for our side” feeling in the room. From Madrid had come a dashing representative, Dr. Cristobal Martinez-Bordieu, who was also the Marquis de Villaverde, in addition to being the son-in-law of Francisco Franco. Struggling in English, the Marquis made a brief speech explaining that Alphonso X was known as “a monarch of the highest intellect” and that the award named after him had originated in 1903, given at first to those who achieved excellence in the literary field and later changed to science. Only four Grand Crosses of Alphonso had been awarded since 1944 and the new members of the order, Cooley and Liotta, were honorary knights and entitled to be called “Excellency.” Franco himself had authorized the decoration of the two Houston doctors, the Marquis said with flourish.
“The implantation of the artificial heart was a moment in history,” said the Marquis, and with that pronouncement he draped a crimson sash from the neck of each man, embraced him, and pinned on a striking red and white medal. The next day, the nurses called Cooley “Sir Denton” and “Your Excellency” in the operating rooms.
The great annual kiddie rush had begun. Open-heart surgery is, in the majority of cases, an elective pro
cedure. Many parents traditionally waited until the summer and school vacations to bring their children to Cooley’s table. On one Monday in early June, Cooley scheduled correction of three Tetralogy of Fallots, the classic “blue babies.” Each had received a preoperative “briefing” from a nurse named Diane whose job was to explain to the child facing open-heart surgery what would happen to him and what he would look like afterward in the Recovery Room.
“On Monday, Dr. Cooley is going to fix your heart up,” said Diane to a solemn-looking boy of eight named Kenny from Mississippi. She sat on his bed and talked to him directly. “On Sunday night they’ll give you a Phisohex bath to make you very clean, and then before you go to sleep you’ll have shots—one to kill germs, one to make you sleepy. You won’t remember anything until you wake up after the operation, and then you’ll look like this.”
Diane pulled from her shopping bag a Raggedy Ann doll with carrot-colored hair and tubes and wires sticking from her, a doll that seemed to have broken apart many times and, out of love, been wired back together again.
“The first thing you’ll notice is this mouthpiece. There’ll be a funny machine beside your bed and it’s to help you breathe. This machine breathes for you while you’re getting your heart fixed up and they’ll keep it going until you get all waked up in the Recovery Room. You probably won’t like the mouthpiece and you’ll bite down on it. But it’s important that you not be afraid of it and not fight it. The best thing to do is take a few big deep breaths through the tube and go back to sleep. Okay?”
“Okay,” echoed Kenny, his eyes as large as half-dollars. He glanced anxiously at his mother, who nodded reassuringly.
“The nurse will come by your bed and ask you to squeeze her hand. When you can do that big and strong, then she’ll take the tube out of your mouth.… Now, have you seen an oxygen tent before?”
“Yes, ma’am.”
“They’ll probably put you inside one. It’ll be like a glass playhouse, it’ll be cool. There may be some mist inside to help you clear your chest so you can cough good. This is important. If they ask you to cough, you’ll promise to do your best and cough for the nurse?”
“Yes, ma’am.”
“Your stitches,” said the nurse, pointing to the doll’s sewn-up chest, “will look like a zipper, or a railroad track. And you’ll be hooked up to a little TV set so we can watch your heart rate. Maybe you can lean your head around and see it, too. There’ll be another tube here”—she pointed to the doll’s arm—“or maybe here”—pointing to the foot—“to feed you and give you medicine.”
The nurse gave Kenny the doll to hold and ponder over for a few moments. He gave it quickly back to her; it was an offending object. “Do you have any questions, Kenny?”
“Will I have shots?” Children fear shots more than the surgery itself.
“Only those on Sunday night. After that they’ll give you all your medicine through an iv tube like this.”
Kenny smiled for the first time.
“One more thing. The first day after your operation, you’ll be real sleepy. You’ll get to see Mommy and Daddy that same night. Then you’ll be moved over to another Recovery Room on the same floor with only children around you. Maybe you can talk to them and there’s a window you can look out. Probably in a day or two you can come back to this room. The most important thing, remember, is not to fight the breathing tube and to cough when they ask you, and turn when the nurses tell you to. And when you come back to this room, promise me you’ll exercise your body. It’s like when you get hurt playing ball or something, it doesn’t do much good to stay home in bed. You’ve got to make your heart work again.”
Diane shook Kenny’s hand and hurried from the room. She had another appointment down the hall and she was worried because a Korean child had flown in from Seoul for surgery and there was no Korean interpreter immediately available to translate the briefing with the doll.
On Sunday night before the three Tetralogy of Fallot cases were scheduled, an emergency case appeared at St. Luke’s and John Zaorski squeezed him into the crowded schedule. The patient was an Italian clerk from Rome, a thin, once handsome man in his forties who worked for the police department. His name was Nino Bergoni, and his wife, Maria, half-carried him into the hospital, her handkerchief wet and dirty from his vomit, her own face weary from tears and hysteria. Neither spoke a word of English but somehow it was learned that the trip had been arranged through the office of Pope Paul, that they had gotten lost during a seven-hour layover at Kennedy Airport in New York, and that Nino almost had died on the flight to Houston. Zaorski slapped him instantly into Recovery, where nurses could keep an around-the-clock vigil and try to keep him alive long enough for Cooley to operate in the morning.
The three Tetralogy of Fallots, including Kenny, were done by noon without complications and each was sent to Recovery with a newly plumbed heart by the surgeon who had refined the hellish operation to where it was routine. Nino would be done after lunch and I went down to pediatric cardiology, where the technicians were already complaining, mildly, about the flood of youngsters pouring into the hospital.
There Jim Nora was catheterizing a poignant case, a four-and-a-half-year-old boy, son of a Midwestern psychologist and his wife, who, in addition to having the gravest congenital heart defect—the AV commune—was suspected of an equally rare genetic disorder, which caused mental retardation. The only sound the child could make was a high-pitched wail, the cry of a frightened kitten. The medical name for it is crie de chat, “cry of a cat,” named by a Frenchman who first encountered it.
It took Nora more than an hour just to get the catheter into a vein. “This is the end of the line for so many kids,” he said. “They’ve been worked up and studied and cathed elsewhere so many times that they just have no veins left when they get down here. All I’m finding is scar tissue.”
Nora paused and looked at the child, struggling beneath him. “He’s a nice little boy, but the parents refuse to accept any diagnosis of retardation,” he said. His face was enveloped by sadness. “He makes a sound which the mother insists sounds like ‘mama.’ She says he is only slow to develop.” Now there was the weary edge of frustration to Nora’s voice, which, as he went on, became understandable. Nora would have to spend several hours of his and his staff’s time, as would Cooley, attempting to repair an almost impossibly damaged heart—and even if the procedure was successful, the child would live but a short, fitful life, bringing pain and cruelty to all concerned. And he would probably never speak, other than to make that chilling noise of a cat crying. “Other places wouldn’t touch this kid,” said Nora. “They’d consider it a waste of hospital resources. At the University of Wisconsin, where I used to be, they could do only four open-heart operations a week. But here Denton does forty, and he’s good enough to try anything. And if the parents want it, he’ll attempt it.” (Ironically, this child survived surgery, a procedure that has an 80 percent mortality rate. But another child with the same AV commune disease who was completely normal otherwise died a few weeks later on the operating table.) The pediatric cardiologists frequently study mentally retarded children with heart defects, in particular, Mongoloids. Nora willingly recommends heart surgery for these, even though their anticipated life span is also short and discouraging. “A Mongoloid child often becomes a sweet, loving member of a family. Operating on a congenitally damaged Mongoloid heart seems somehow worth the effort,” he said.
I had missed earlier that day one of the most unnerving and delicate procedures in the heart world, one that Nora and the other pediatric cardiologists do in the catheterization lab, not the operating room. When a baby is born with transposition of the great vessels of the heart—the same defect that Cooley had repaired in Pamela Kroger in April—it may be necessary to operate immediately and create a hole between the chambers of the heart. The surgeon is creating a new, and less serious defect to enable the blood to circulate better. Theoretically, the child will live until he reaches the age
of four or five and is better able to withstand open-heart surgery and having his blood circulated through the pump-oxygenator. “The trouble was,” explained Nora, “a lot of kids didn’t even survive that first operation and died within a few weeks.” A cardiologist named Rashkind at the University of Pennsylvania developed a technique in which a catheter is stuck into a baby’s arm and threaded gently up the arm and down into the heart. At the end of the catheter is a tough plastic balloon, which, when in exactly the right position, is blown up. The cardiologist then takes a deep breath and yanks on it forcibly, ripping a hole in the heart. Though fraught with tension, the procedure seems to work surprisingly well; better, in fact, than surgery. “But it still scares the hell out of us when we yank,” said Nora.
Nino Bergoni’s operation began at mid-afternoon and Cooley was in an expansive mood, perhaps because the three Fallots had gone so perfectly that morning, perhaps because he had raised at long last enough money to award the contracts on the eight new operating rooms for the Texas Heart Institute.
As he put two valves into Nino’s heart, deciding against a third because triple-valve replacements have had discouraging results, Cooley talked of the news that Dr. Walton Lillehei, pioneer of American open-heart surgery and chairman of Cornell’s department of surgery at the New York Hospital, was resigning. Lillehei also had been criticized for his heart-transplant program. “I remember one Christmas Eve a year or two ago when the phone rang,” said Cooley, pausing a moment to peer at the new mitral valve he had sewn into Nino, “It was old Walt calling. He says to me, ‘Denton, I’m fixing to do a heart-lung transplant. You did one. You got any advice?’ ‘Yeah,’ I say. ‘What is it?’ ‘Don’t.’”
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