Hearts

by Thomas Thompson

  “Yeah.” Russell gazed at the heart.

  “I didn’t hear you go through.”

  “It’s very soft bone. You don’t hear the pop in kids.”

  A visiting doctor standing on a stool shook his head. “Jesus Christ, look at that greedy heart.”

  Wordlessly, Cooley entered the room. Three doctors stepped back from the table to permit him entry. Hurriedly he put the child on the pump. When her blood was flowing through the tube into the oxygenating machine and back again into her body, when the gross heart was still enough for him to enter, he cut it open, peeled back a flap and stitched it tightly to the thoracic cavity to keep it out of the way. His fingers found the atrial septal defect—one of the suspected holes in the heart—and he began trimming a piece of Dacron to cover it. “The hairy part,” Allmendinger whispered to me, giving me a play by play, as he could see better than I, “is the valves … whether he’ll be able to resuspend them … or replace them.”

  But when Cooley was finished sewing in the patch, his slender fingers moved again inside the heart. He stopped. He re-entered. He stopped again. It was not his custom to stop. His surgery was always a fluid motion. Fifty eyes raced from his face to his hidden hands and back again. What horror had he encountered? Suddenly he smiled. “We have an ostium primum, I believe, gentlemen,” he said. There was not the second suspected hole in the heart. Nor would the valves have to be replaced. There was only one complicated hole in the heart, an atrial septal defect known as ostium primum. As a sudden storm breaking the August heat, the tension in the room shattered. Some of the visiting doctors even left, as people walk out of a disappointing play. Cooley satisfied himself one more time that the valves were not damaged, then closed the pericardial sac. “This just goes to show that one peek is worth two finesses,” he said as he sewed. He was elated. He was, in fact, triumphant. “The cardiologists have been finessing this child all of her life, seeing shadows and pronouncing her doomed and predicting her death. All the surgeon had to do was go in and look. Now she should be fine!”

  By mid-afternoon, Tammi was groggily awake and asking for a hairbrush. She returned to her room the next day and 36 hours after the operation was walking about her room. Her recovery astonished her mother. “Mama came in and found me walking around the room and almost had a heart attack,” Tammi said, accepting my kiss. “Now let’s play cards.” Her doll was beside her on the bed; she had had an operation as well, her chest was covered with a large bandage, and tubes dangled from her arm.

  The jaundice had come back and Fisher had turned the color of an old coin. It was difficult to talk with him, but he wanted to talk. His voice was raspy. He spoke of the things cluttering his mind—his love of flying, his work at the university, his family, his ordeal. I complimented him on his courage. He closed his eyes tightly and when he opened them there were tears in the yellowness of them. “I’ve given up many a time,” he said. “Nobody knows it. I’ve laid back and said, ‘I quit.’ I feared the Intensive Care Unit. I’ve always had a fear of choking to death—it happened that I almost drowned once—and when they put me in that room full of sick people and stuck the tubes down my throat, I knew they were going to let me lie there and strangle to death. The roof of my mouth is still sore from where I pushed on the breathing tube.”

  He fell silent for a time. I took it as my signal to leave. “I’m ashamed of what I just told you,” he said. “A man shouldn’t give up that way.…”

  The women of his family had gathered. Over the weekend, the men had come, too—brothers, brothers-in-law, sons-in-law. But they had gone away. “Men can’t sit in the hospital and wait the way we can,” said one of the women. Mrs. Fisher refused to let them move her husband back to the Intensive Care Unit. “He’s had enough,” she said. She sat outside his room in a chair, leaning against the corridor wall. Before she would go in to relieve her daughter, she would go to the ladies’ room and put on fresh makeup and achieve a difficult, but workable smile.

  Fisher’s heart had slowed down and was betraying his body. Fluids were collecting everywhere. Diuretics were administered to speed up expulsion of the liquids, but they always came back. Tourniquets were tied on his arms and legs to stop the fluids from going to his heart and drowning him—that long hidden fear. But it was an exercise in palliation. Even he must have known.

  The last time I made rounds with Denton Cooley he began at the summit. He inspected Tammi’s rapidly healing incision and swooped her up for her mother’s camera. She challenged him to play cards with her sometime and he laughingly accepted. He seemed almost reluctant to leave her. Phil Allmendinger had already noticed, in the brief time he had been with the surgeon, how much Cooley favored the pediatric cases. “I think he only comes alive when he’s with the congenital heart kiddies,” Allmendinger said. “They trust him, they don’t ask questions, they have rapid healing powers, and they get well quickly. It’s usually permanent with them. They don’t give the surgeon that tiny, nagging doubt in the back of his head that so often haunts him with the grownups.”

  As Cooley strode toward the adult floor, he gestured with his head back toward Tammi’s room. “That case shows how necessary it is for the surgeon to go ahead sometimes when everybody else is predicting disaster. Tammi is fine, there’s no more murmur, she’s looking good, she’s alive!”

  He walked on and spoke to John Russell. “It makes all the weeping and wailing of relatives worthwhile,” he said. “When we first started doing this work, kids died on the table every week. We practically had to wade through hysterical relatives.”

  He was in fine fettle for half an hour, a pleasant half-hour with a series of bright, sunny rooms and, within, patients and families whose faces were cheered when the surgeon entered. But finally there was the woman sitting in the chair outside a room, and the entourage stopped. Russell looked at the name on the door and said, unnecessarily, “It’s Mr. Fisher.”

  There was nothing to do. There was nothing left for the surgeon except to wrestle with his soul for that last moment. He had already seen his failure, and nothing—neither his hands nor his sorrow—could alter the destination. Mrs. Fisher did not look up. His face sagged and he shook his beautiful head. “Poor bastard,” he said softly as he moved on. There was nothing to do but move on to the next patient.

  Fisher died the next day.

  Tammi went home and five months later, at Christmas, wrote me a letter in New York. “Dear Tom,” it read, “I am a Brownie. I marched in the Christmas parade. I did not get tired. I love you. Happy Christmas! Love! Tammi.”

  CHAPTER 18

  Duson Vlaco left Belgrade in the late summer of 1970 and flew a third of the way around the world to Houston for a routine examination of his physical condition and of the heart that two years before had been taken from a 36-year-old man and implanted within him. The heart was no longer a foreign object. Duson’s system had manufactured billions of new cells and they had lived and died and had been reborn on the surface of the heart until the organ belonged solely to him. After a fortnight of tests—EKGS, x-rays, blood counts, bicycle pedaling, cardiograms—Duson stopped Ted Diethrich in the hospital corridor and said shyly: “I’d like to get out of the hospital for a day and go swimming at your house.”

  On the following Sunday, Diethrich held a regular sports day at his home and from noon on, a dozen young surgeons and medical students spent the early hours of the afternoon bashing each other in frontenis, football, water basketball, water volleyball, and bouncing on the trampoline. Shortly after 3 P.M., Duson appeared, accompanied by his Yugoslavian cardiologist, Dr. Anicic. My first reaction to the strange child with the new heart was to recoil and shudder with pity. He walked happily across the patio on match-stick legs supporting a barrel-like torso. The skinny arms and hands seemed not so much a part of him but instead hastily attached, like branches slapped onto a snowman by a child. His head was huge, swollen to a pumpkin shape by the daily tablet of cortisone still taken to guard against rejection. There was a
buffalo-like hump at the back of his neck, a thin, fine layer of hair across his shoulders, and purple stretch marks on his abdomen. Another purple blotch covered one side of his face and neck. But he shook hands firmly with everyone on the patio and sat down in a deck chair and smiled with a warmth that washed away much of the grotesqueness. “I like the Texas sun,” he said, tilting the pumpkin head toward the heat and opening his shirt. Ted brought him a soft drink and Duson drank it hurriedly. He saw the bicycle of one of Diethrich’s children and asked if he could ride it. Diethrich did not hesitate. “Have a go at it,” he said, and the boy with the borrowed heart ran to it and climbed on it and rode out the driveway onto a quiet lane with huge oaks. There were oil-company executives mowing their yards on sit-down machines and women pruning roses and children shrieking at their Sunday games, but none looked up as Duson rode somewhat unsteadily by.

  “We didn’t do that to him,” said Diethrich, who had seen the unconcealed look on my face, that of a man standing in the carnival midway and eyeing the poster promises of the freak show. “The cortisone makes his face swell a little, but everything else he was born with.”

  “What have the tests shown?”

  “No rejection. None whatsoever.”

  Anicic, the Yugoslavian doctor, said, “The boy is incredible. He is leading a completely normal life. I see him about once a week, but when I went on holiday for a month, I didn’t see him at all. The only noticeable complication has been an elevated white blood cell count after the tiring five-day trip back home to Yugoslavia from Texas.” Duson lives with his widowed mother and receives a special allotment from Tito’s government to help pay his medical expenses. He is a national hero there.

  “I think we’ll be able to cut down the cortisone,” said Diethrich. “Maybe shrink his face a little.”

  We returned to the frontenis court and in the middle of a stormy doubles match with the ball hurtling at the forward wall, Duson entered the court and picked up a racket to join in. Speedy Zweibeck, a new DeBakey fellow just down from New York, stopped and asked Duson politely to move to a grassy area for spectators and watch. The child obeyed, but in a few minutes he was back, still wanting to join the surgeons at their game. “Look, kid,” said Speedy, half-exasperated, “if you don’t get off the court, we’re going to take your heart back.”

  Duson wandered to the nearby trampoline and climbed onto it, bouncing tentatively at first, then shouting with glee as he sprang up and down, his swollen face dripping with honest, joyful perspiration. “I hope you sewed that heart in good, Diethrich,” said Speedy.

  Later, when my team was beaten at the frontenis game, I plunged into the pool and swam underwater as long as my breath would allow me, rejoicing in the coolness and languor of the depths. When I surfaced, someone jumped in beside me and laughed loudly. It was Duson. “We can swim together,” he said, and the boy with the faded scar on his pigeon chest was suddenly nothing more than another youth reveling in the summer afternoon, wanting to be accepted as a human being, not a medical oddity. We took eight laps together, talking, shouting, splashing, using the palms of our hands to slap the water and shower those watching, with amazement, our exhibition.

  As we dried ourselves with thick beach towels, Duson talked of his rock group. “It is called The Beatniks,” he said, “and I am the leader. I wrote a song called ‘The First Step on the Moon’ and last week it was number one on all the charts in Yugoslavia.” He grinned broadly, waiting for my nod of compliment.

  “You could get the same noise,” said Anicic, “by putting two cats, two dogs, and a screech owl in the recording studio.” Duson stuck his thumb in his soda bottle and shook it and sprayed his doctor.

  “He doesn’t like my music,” said Duson, “but everybody else does. I make money to go to musical school.” He was in his first year of a four-year musical education. He could look ahead that far!

  Diethrich grilled hamburgers and hot dogs in the twilight and his star guest heaped a plate full with beans, potato salad, tomatoes, and pickles. He ate ravenously and stretched out on a horizontal deck chair. He belched and patted his stomach. When Diethrich walked by to get some more meat patties, Duson stopped him shyly and touched his arm. “Thank you,” the boy said.

  As the boy and his doctor took their leave, I shook their hands. “I’m glad to see you don’t favor your new heart,” I said to my swimming partner.

  “Days, sometimes weeks go by and I don’t even think about it,” he said. “I don’t think about it today at all.…”

  Despite the extraordinary witness born by Duson Vlaco, the heart-transplant program, completely moribund at St. Luke’s Hospital, was scarcely more alive at Methodist. Howard Stapler’s heart failure was treated by the cardiologists on DeBakey’s staff and he recovered sufficiently to return to his Western novels, his home in Indiana, and yearnings for another heart. Twice again in the summer and autumn of 1970 he would fly back to Houston seemingly in the throes of death, only to be revived by medication and observation. He asked both Diethrich and DeBakey regularly when they were going to transplant him, but the answers he got were guarded and noncommital. Diethrich said the transplant program was blocked by lack of money, which was, in a large sense, true. Transplants had cost an average of $75,000 and a considerable portion had come from Baylor’s research funds. In the inflation of Nixon’s administration, money for medical research had grown increasingly scarce and there was no willingness on DeBakey’s part to spend what there was on heart transplants.

  Privately, the junior surgeons believed DeBakey to be totally disenchanted by the transplant experience. Cooley’s record of 100 percent mortality, the unpleasantness of the artificial-heart trial, the enormous drain on the talents and capacities of the hospital staff in caring for transplant patients, and the public’s disinterest in donating hearts had brewed a bitter potion. “The Professor’s career has been built on winning,” said one of the younger men. “Why risk failure this late in his game?”

  In late August, Ted Diethrich summoned his courage, rehearsed mentally for the twelfth time what he would say, and asked DeBakey for a private audience. He spoke quickly and enthusiastically, looking directly into the magnified eyes behind the thick glasses. He would be resigning, Diethrich said. He had been privately working on a dream to build his own heart institute, and now it was far enough along to be assured. “I’m going to Phoenix, Arizona,” Diethrich said. He had found backers to build a $3 million addition to an existing Catholic hospital. He would form his own team of cardiologists, nurses, and pump technicians and there would be affiliations with the University of Arizona Medical School.

  “Where is that?” asked DeBakey.

  “In Tucson, about 150 miles away.”

  “That’s about close enough,” said DeBakey wearily, caught up at that moment in a struggle across the street with the Baylor faculty over his plan to slice one year from the four-year medical education and, hopefully, turn out doctors faster.

  DeBakey did not attempt to dissuade his junior man, even though Diethrich was an invaluable member of his team, even though the Arizona Heart Institute, if successful, would service a portion of the country, the American Southwest, which had sent hundreds of patients to Houston. “Keep me informed,” was all he said.

  With the long-kept-quiet cat finally out of the bag, Diethrich spoke with excitement as he began recruiting. “It’s going to be FAN-TAS-TIC,” he fairly cried. “Suppose a doctor calls up and says, ‘I’ve got a 45-year-old man who’s just had an acute coronary, what can we do for him?’ Well, the Arizona Heart Institute will have on hand a 24-hour-a-day ambulance with a doctor inside. They go out, bring this man in, not to the emergency room of a hospital, but to an area in our Institute that is equipped for everything from minor IV support to coronary catheterization to immediate bypass surgery. Nobody has this concept yet. This is the Outer Space Medicine of the ’70s, of the ’80s. We can pick up patients by helicopter from 200 miles around. We’ll have our own jet, too. When some
body calls in sick from Chicago, what can we do for him? We can do many things for him, we can send our jet out to get him and perhaps save his life.… The philosophy of so many doctors is twenty years back—a hundred years back. They give a heart-attack victim an EKG, put him to bed, start him on exercise. I’m not at all sure that you shouldn’t start exploring his vessels right away, do cardiac catheterization immediately upon his arrival at the hospital. We have surgical methods now to immediately revascularize the heart, to immediately restore a new blood supply. If you look at statistics on coronary death rate of people admitted to hospitals who have low blood pressure on arrival, 75 percent of them never leave the hospital. This doesn’t even take into consideration the 50 percent who never even arrive.

  “These may seem like wild, far-out ideas, but these are things I could never develop here in Houston. There’s no way for me to do this in Houston. I’ve got to put myself in a position where I have my own team. And I can’t sit around another five or ten years until DeBakey retires. When he leaves, there’s going to be the maddest scramble for power you ever saw.… We’re going to start clean in Arizona. I’m going to have only people who can get excited. People that you can’t excite, I’m through with. I’ve got to have people beside me whom you can light a bomb under and they’re in orbit—seven days a week. I want a handful of people with me who can change the world of heart care.”

  Don Bricker had said there were a half-dozen DeBakeys. A year after L’affaire Cooley, there seemed to be a hundred more, all possessed, consumed, driven to plant footprints so large that no new wave could wash them away. There was the DeBakey boldly seeking $30 million for Baylor in a recession year, the DeBakey overhauling the medical school’s curriculum and doubling the freshman class enrollment from 84 to 168 and doing it on a few weeks’ notice over the anguished objection of more than one veteran faculty member. There was the DeBakey flying as commuter to Washington and meeting with Senator Edward Kennedy to write a universal health-plan bill that would, as one Houston doctor complained, “push American medicine totally over the brink into the swamp of socialism.” DeBakey snapped back to all such attacks that medical care in his country was a right, not a privilege, that it belonged to all Americans, not only those over 65. There was the DeBakey wooing in person and on telephone some of the great names in science, attempting to persuade them to come to Houston to fill five long-vacant academic chairs at Baylor—vacant, some said, because the great names did not relish working within the volcano of Mike DeBakey. There was the DeBakey pushing his artificial heart program with a new man down to head it, wrapping it in security measures comparable to a NASA installation. There was even the DeBakey appearing on midnight television talk shows, giving awards of merit to Jerry Lewis. But these were only the public DeBakeys. The private one was buried even deeper in a body of secrecy. He had placed himself within a labyrinth to which all access seemed blocked. Suspicion appeared to emanate from him toward all. “I can understand how Mike is hurt over the artificial heart,” said one who had known him for years, “but I cannot understand why he has to distrust practically everybody in the Medical Center.”