Hearts

by Thomas Thompson

  When Nino was taken off the pump, his heart began to fibrillate. “We’ve got a circus movement,” Cooley said, his voice becoming serious. Gwen, the supervising nurse, was at his side instantly with the electric paddles and with one jolt, the heart regained its normal rhythm. Another nurse came into the operating room and said that Nino’s wife, Maria, was giving everybody a hard time. All afternoon the hospital staff had been chasing her out of the surgical area, but at that moment she was standing outside the “Do Not Enter” doors with her nose pressed against one glass, and holding up to the adjoining pane her wallet, which contained photographs of Dr. Cooley and Pope Paul, side by side.

  “I met the Pope once,” said Cooley. He was satisfied now that the heart was beating naturally and as he began sewing up the pericardial sac, he recounted his conversation in the Vatican study.

  “The Pope said he had followed our work and had kept track with all the transplants and he endorsed our work with but one exception. ‘What was that?’ I wanted to know. He said he was concerned about the definition of the donor’s death.

  “Do I infer, your Holiness, that you do not accept brain death? ‘I would prefer,’ he said, ‘that the heart also be stopped.’

  “That would be putting the rights of the dead over the rights of the living, your Holiness.”

  At 7 P.M., the parents of the three Tetralogy of Fallots were permitted in to see their children and despite the shock of the tubes and wires and monitors, none fainted. Maria, however, came into Recovery just as Nino was starting to awaken from the anesthesia, his body quivering and in spasms. She assumed her husband was in terminal throes, that she was witnessing his death rattles, and she began to moan and tear at her rosary. Just then a well-meaning priest ambled by on his nightly rounds, glaced at Nino’s chart, saw that he was Catholic, and idly made the sign of the cross. Screaming, Maria collapsed and had to be helped from the room, with two nurses and a frustrated resident trying to find the Italian word for “normal.”

  Within 48 hours, Nino was recovered sufficiently and had gained enough strength to be transferred to the sixth-floor Intensive Care Unit. In celebration, Maria positively blossomed. From the haggard, sobbing woman in a dowdy, farm-wife’s dress, she appeared in a stylish green and white jersey ensemble with a gold belt and gold shoes. Her face was beaming as she waited outside the Intensive Care Unit for the six daily visits she was permitted to make to her husband’s bedside.

  Late one afternoon that mid-June week, I was leaving the hospital to collect my children from a friend’s pool when Grady Hallman stopped me. Hallman was a perfect partner and alter ego for Cooley. Quiet, confident, slim, youthful, the surgeon took the spotlight only when he conducted and played trombone solos for the Heartbeats. On those occasions, Cooley was in the back row playing string bass. In the hospital, Hallman worked almost privately in Operating Room 3, doing the aneurysms and vessel work and less glamorous operations, while Cooley drew the acclaim down the hall. I had sought several times to speak with Hallman at length, but he had always seemed too busy.

  “There’s a patient of mine you might want to see,” he said. “It’s a case of a man with a lethal lesion who got here in time.” Hallman introduced me to an elderly, strong-looking man from Arkansas named Allgood, who had thick white hair and whose room was filled with flowers, candy, and get-well cards from back home. Allgood sat up in bed and shook hands all around. “I’d get up and do a little dance, but I just got back from walking around the halls,” he said. A few days earlier he had been in bed in his Arkansas home when he felt a “terrific pulsating in my lower abdomen.” The local doctor suspected an aneurysm but advised that he could wait for surgical attention until after a grandson’s high-school graduation. “But the back pain got so bad that they told me to get to Houston as fast as possible.”

  Allgood had arrived on a stretcher in the back of a chartered Lear jet and Hallman operated immediately. It was, he saw, the kind of rupturing aneurysm that had killed Albert Einstein. Death would have come within hours, or minutes. “The Lord just wasn’t ready for me to get gone from here,” he said. “I am a strong believer in Jesus Christ and the Baptist church. A real Christian goes to the limits of his ability and then the Lord takes over. With help from Dr. Hallman.”

  Hallman had slipped out of the room during the story and when I found him he was at the nursing station writing medication. It was past 9 P.M. and he was still making rounds. “That’s a rewarding case,” I said, gesturing toward Allgood’s room. “He’s a nice old fellow,” Hallman said without looking up from a chart, “I’m glad he got here when he did.” Since Hallman had himself broken the ice, so to speak, I asked if we could have a lengthy conversation one evening soon. The young surgeon thought about it and finally nodded. He gave me a tentative date a few nights hence.

  It was my hope that I would learn not only something about Hallman and his work, but that he would illuminate the mystery of Cooley for me. After months of false intimacy about and around the man, of standing in his surgery and witnessing every detail of his art, his speech, his silences, his rounds, his almost reluctant entrances and exits from patients’ rooms, I knew little more of him than did those who entrusted their hearts to him.

  When Hallman and I finally sat down and had that evening’s talk—not a few nights but a few weeks later, just before Hallman went away on vacation—I knew little more of Denton Cooley. But the conversation itself cast a light on the craft and business of surgery. It was the most candid, and in some ways most frightening, five hours I had spent in Houston.

  We had drinks and dinner in a new private club, one of the hundreds scattered throughout Houston, a city where the state law said that mixed alcoholic drinks could not be served in public places. When I had gone to college and worked as a newspaperman in Texas, it was a brown-paper-bag society. One dined in the finest restaurants with a wrinkled bag on the table concealing a bottle of whisky. It was within the law to bring the bottle to the restaurant and use it as a centerpiece. The restaurant would even furnish a glass, ice, and mix. But in more recent years, private clubs with instantly acquired memberships had prospered under the archaic, Baptist-enforced law. Houston wanted so desperately to become a big-time city—and in so many ways it is—that authorities tolerated the illegal imbibing.

  I had become accustomed to Houston’s heart doctors giving me courteous thirty-minute interviews during office hours and beyond that the impression that I was stealing highly valuable time. Now I had one after hours.

  “How long do you have?” I began with Hallman. It was 7 P.M.

  “As long as you need.”

  Hallman had gone to the University of Texas and then to Baylor, where, in the early 1950s, he became enchanted by internal medicine. The surgeon had not yet come into his prime in Houston. “The men I met doing internal work were intelligent, they spoke well, they seemed to be investigators. I was convinced my career would be among them. But when I was a senior I was assigned to the charity clinics and there I sat all afternoon … interviewing women with boring chronic illnesses … problems that needed weeks or months of tests to learn the answer, if there was an answer. Problems that could perhaps never be solved. When I rotated onto the surgical service, I was instantly struck by the positive action, by the possibility of spotting a problem and doing something immediately!”

  One of the top five graduates in his class, Hallman chose an internship at Wesley Memorial Hospital, in Chicago, and for a time switched his interest to anesthesiology. “I saw myself as both an administrator of drugs and a great teacher and writer.” But once again surgery lured him back. It was not his participation in surgical cases. For an intern, there is scant stimulation in working up patients, writing histories, finding x-rays, holding retractors, or maybe cutting a stitch now and then in the operating room. It was the invitation from a great chest surgeon for Hallman to spend an afternoon seeing patients and making diagnoses in the surgeon’s Chicago office. “I didn’t even have anything to wear,�
�� remembered Hallman. “I asked the surgeon what I’d need, and he said, ‘Just wear what you’ve got.’ So I put on a zip jacket and spent a fantastic afternoon. When it was over that night the surgeon and I compared notes; our diagnoses generally matched. He was seriously interested in me. He was everything I had wanted to be in medicine. That one afternoon turned me onto surgery for good.”

  Hallman thereupon wrote DeBakey “a flowery letter, telling him how much I admired the accomplishments of the Baylor Department of Surgery.” DeBakey was now a prominent surgeon, world-known among doctors, but without the glamour that would soon come. Hallman was promptly accepted and spent seven years in residency: four in general surgery, three in chest.

  “What kind of cases does a first-year resident do?” I asked. I had been spending my days in Houston among those at the top of the profession and had no idea what the beginning man went through.

  “Well, you fix hernias, take out appendixes, remove hemorrhoids. You do procedures commensurate with your level of talent, with a senior man supervising you all the time. You do work that the patient thinks the senior man is doing.

  “In the second year, you graduate to gall bladders, you explore gunshot wounds, do amputations, thyroidectomies. Third year you should be up to gastrectomies, radical breasts, colon resection. And by the fourth year, if you make it that far, you’re administratively the head of the service. You get the pick of the operations. You can take out entire stomachs, do all the vascular surgery, pneumectomies, etc.”

  During his three-year chest residency under DeBakey, Hallman went through the traumas indigenous to the work. “My third child was born in another hospital during this time and had it not occurred on a Sunday morning, I wouldn’t have been able to slip away from DeBakey long enough to see him. I didn’t see the kid again for another three months. My car was stolen when I was on the unbroken 90-day shift and I couldn’t even get out to see about it. I lived on sandwiches, fried pies, and Fritos. I got a vitamin deficiency and my tongue turned fire red. I figured that what I went through was the supreme test of human endurance. But there came the day that it was all over. I made it through.”

  “Did DeBakey shake hands and show his appreciation?”

  Hallman looked startled. “He’s not that type. He never tells anybody thank you, or good job. He’s never done that in his life.”

  Toward the end of his chest residency, in July, 1962, Hallman analyzed carefully the problem of where he would go to work.

  “I never even considered trying it on my own because I knew if I hung out a shingle, the only cases I’d get would be from relatives. So I said to myself, ‘Of everything you’ve done and seen in medicine, what is the most interesting, most challenging, and potentially the most financially rewarding?’ I answered myself, ‘Denton Cooley.’ I got up my courage and went over and cornered him and blurted out, ‘You don’t have any help. I want to go with you. DeBakey’s always had a right-hand man, or several.’” Everyone knew that Cooley had always been a loner.

  Cooley’s reaction, Hallman remembered, was looking as if he were in an enormous hurry to get on with what he had been doing before the young surgeon had trapped him. But Hallman pressed. “You say to yourself, ‘What can this unknown doctor offer me?’ Well, he can do surgery that’s sent to him by people who know him, he can do the clinic cases, and he can co-write a textbook on pediatric heart surgery and make you first author.…’” With that, Hallman remembered, “Denton’s eyes lit up.” A book was needed in the field, Hallman said hurriedly, and where could a better one emerge than from Cooley’s case histories and data?

  Thinking he had interested the great heart surgeon, Hallman went away to await an offer. Days, weeks, months passed and not a word was sent from Cooley. One afternoon, in despair, Hallman saw Cooley backing out of the hospital parking lot and flagged him down. “I made the pitch again, but he didn’t seem too interested. He was running only one operating room then and doing about three or four cases a day. Maybe, I see now, he didn’t want the competition.”

  As a distinctively second choice, Hallman applied to DeBakey and it seemed he would be hired as a junior man when “a strange thing happened.” The Houston Chronicle wanted to interview a surgical resident for a feature story on medicine. Someone recommended Hallman as the subject and a woman reporter interviewed him. “She wrote mainly about the financial problems—she wanted to know how many suits I had, and I said one, a $25 number I picked up in a bargain basement. She wrote that my shoes were resoled, that we fed a family of five on $5 a week, that we had a $25 car, that we had a hand-me-down television set sitting on a packing crate.… A surgeon I knew told me, after reading the article, ‘You couldn’t buy that kind of article for $1 million. It makes you out to be the all-time champion underpaid, starving, dedicated young doctor.’”

  Not two days later, Cooley telephoned and asked if Hallman still wanted to join him.

  “What did you do for him at first surgically?” I asked.

  Hallman made a circle with his index finger and his thumb. “Zilch,” he said. “He gave me nothing. Surgeons always feel they can do everything best and that they have no need for anybody else. Sort of by accident I started doing arteriograms when Denton didn’t have time to do them. I did three or four a day, at $50 each, and for the first time in my life, I started making money at medicine. And I did my very rare private surgical case. Mainly I spent the next five or six years researching that book and when it was finished—and successful—I suddenly had offers from Mayo to New York. There was a lot of fertile ground in 1967. I was all set to take one of them when Denton announced he wanted me to become his partner. He had got a second operating room by then and his case load was exploding. Now I think I made the best decision. Financially, it has become the most attractive place in medicine. And it’s gratifying that people come from all over the world to be operated on by us.… I’m able, in fact, to operate as much as I want, which very few surgeons can say. And our band, the Heartbeats, is a tremendous emotional outlet for me.”

  Hallman fell silent for a minute and when he next spoke, he revealed himself. “The only thing I’m not is the complete boss … my own man.…” DeBakey had looked over his shoulder once and had seen Cooley and if Cooley were to look over his, there would be Hallman. My attention was caught and held by what Hallman said in the late hours of the evening. It began with my observation that patients agreed so quickly, almost mutely, to surgery, that Cooley was in and out of their rooms and in and out of their hearts.

  Hallman smiled. “Denton believes in the blitzkrieg approach. He storms into a patient’s room, tells the guy he needs the operation, and he thinks the problem can be fixed, and the patient is so overwhelmed by this that he agrees.”

  I had once seen a patient decline surgery and Cooley had seemed disappointed; yet he had made no attempt to change the decision. He only nodded and walked brusquely from the room. “There’s no hard sell,” Hallman said. “First of all, we don’t need the business. We’re not going to miss the case and the schedule will be filled anyway. Secondly, most of the selling has already been done. By the time a patient sees us, he’s already been to at least two or three other doctors. Thus the phrase which I’m sure you’ve heard over and over again, ‘That’s what I came for … the sooner, the better.’ If a guy doesn’t want surgery, then it’s his decision. Denton doesn’t try to change anybody’s mind.”

  But why the volume? Why the relentless pursuit of first place? Was there not a peril in the sophisticated, impersonal, medical assembly line?

  “He who rides a tiger can never get off,” answered the young surgeon. “It’s intimately tied in with pride and arrogance, as well. When a referring doctor sends us a patient and we’re too busy or too exhausted, what are we going to do? Send him over to DeBakey? Refer him to Mayo? To Ochsner? If we don’t do the surgery, who is? A patient pays us an enormous compliment by wanting to partake of what we offer—and we do it better than anybody else. We play the violin concer
to better than anybody else down here because we’ve played it more times. We do so many cases that our patients get well! The same case might go to Boston or New York or Mayo and get sick, have clots, lose legs, or die. We have perfected heart surgery.”

  But, I wondered, how then does the artist avoid destroying himself physically if not emotionally by playing so many concertos?

  “Denton has a need, a compulsion to work. Nobody in the world works harder than he does. There are few people on earth who have unlimited capacities for work. He’s one.… I’m another. Besides, surgery is like show business. We’re performing in there. No matter how exhausted one becomes, you get up the moment you enter the operating room. It’s like a second cup of coffee, a pep pill, a dexedrine, an amphetamine.… You see the patient lying there before you and a second wind comes to you. When we were doing transplants, we often worked all day and all night and all the next day. The sheer drama of the situation was a stimulant.”

  What of the shield between Cooley and his world?

  “Anybody who has the exigencies of Denton doesn’t have the minutes left to get close to anybody. Nor do I. I used to love to read … it was my supreme joy, and now I have no time to read.” Hallman’s voice was, for a moment, sad. He seemed to be speaking not to me but to himself. “A person who has no time to read has no time to come close to anybody or thing. When you commit yourself to becoming a heart surgeon, you must divorce all human relationships—wife, family, patients.…”

  My face must have reacted and asked a silent question. Hallman must have anticipated it, because he was ready with an answer.