Hearts
Page 32
He withdrew more and more to the locked office, preferring more and more the sureness of the telephone over the permanence of the letter. The only man whom he could fully trust was Michael E. DeBakey. The only man to fully understand what he would do, his wrath, his wisdom, his loneliness, was Michael E. DeBakey.
Geoff, the expelled surgical resident, was reinstated as abruptly as he had been thrown out. He never learned the exact reason for his dramatic censure and expulsion from the hospital, nor did he know why DeBakey casually invited him back into the program, with credit for the academic year, with an even better job in the Ben Taub charity program. Only DeBakey knew.
Though he was increasingly engaged on matters academic and national, the senior surgeon did not short his responsibilities in the operating room. There his manner and disposition had not changed. Toward the end of August, 1970, there were two vivid examples.
The first case was a Tetralogy of Fallot, a boy who had flown from Europe with money raised by his village. “Mike is always interested in these mercy-flight cases,” said a junior surgeon as he recounted the story. “Anyway, the kid had the usual VSD, which we sewed up, but we couldn’t get the boy off the pump. We tried for 30 minutes and DeBakey was distraught. He was, in fact, going out of his mind. He yelled for another anesthesiologist to come into the room, and when he did, and when that didn’t help, Mike cried, ‘It must be metabolic,’ and he called for a new cardiologist. All the time he was crying, ‘Do something! Do something!’ When nothing worked, when every new idea had been exhausted, Mike and the assisting surgeon discovered what had really happened. The kid’s aorta was coming out of the right side of the heart, a freaky thing. We had fixed one defect but overlooked the other more complex problem, which was uncorrectable from the beginning. The kid died and Mike looked up with his eyes glistening and said, ‘Who’s going to go out there and tell that mother her child is dead?’”
The one DeBakey practice that most annoyed his young surgeons was his custom of making out the surgical schedule himself, not permitting it to be done by anyone else. “Consequently,” griped a junior surgeon, “you don’t know who you’re going to operate on tomorrow until nine or ten the night before. The blood bank has to spend all night rushing around and calling to locate blood, and anesthesia has to wait until 10 P.M. to talk to the patients, and nobody gets much sleep. But that’s the way Mike does things.”
On a Sunday night, after having been out of town for a few days, DeBakey made rounds and scheduled a staggering array of operations for Monday morning—eleven in all, including four coronary bypasses and one gasendarterectomy, those new, meticulous procedures that gossip held DeBakey had not learned. Or perhaps could not do. On the Monday morning, as he scrubbed in at seven, DeBakey frowned upon hearing that George Noon was on vacation. There were some who later claimed that DeBakey knew it all along. For what was about to happen would be talked about in Houston medicine for years to come.
His face grew more stormy when Ted Diethrich did but one case, a carotid—reaming out of the carotid artery is always done first because such cases are normally easy and gotten out of the way quickly—and then flew off to New York to deliver a paper to a medical meeting. There were some who later claimed that DeBakey knew of Diethrich’s trip as well.
“Nobody wants to work any more,” griped DeBakey as he began a coronary artery bypass operation at eleven, the procedure that Denton Cooley was now committed to and proclaiming its beauty at medical meetings. The operation took two grueling hours with the tenseness on DeBakey’s face apparent to everyone in the room. When he was done, it was early afternoon, and the staff assumed he would do perhaps one more case and cancel the schedule until his assisting surgeons returned. But instead he moved wordlessly to the adjoining operating room and began a valve replacement. By 4 P.M. it became obvious something was up. At six, the nurses and junior men began eyeing the operating room clock because it was known that DeBakey had a 10 P.M. flight to Washington and he would have to quit by eight to make it. His temper had flashed so often during the day that no one dared ask if he was going to the airport. Once during the long afternoon he had exclaimed that he was in the company of incompetents and that he would do all the work himself. He tried to hold the retractor, the sucking machine, and the sewing needle all at once. “If I only had three hands,” he cried out, “I could operate all by myself.…”
Between early-evening cases, he slipped out and made rounds with a nurse. He also sent out for hamburgers to feed the entire team, an act of kindness that startled the newer members. He moved back and forth from operating rooms 2 to 3 to 4 as the cases were brought in. He would let one of the assistants make the opening skin incision, but that was all. “God help us,” murmured one of the residents as the evening began, “he’s going to do the whole schedule.” DeBakey’s work, that of three surgeons, was breathtaking. Eight o’clock came and went, nine flew by, and at ten one of the strong young doctors who starred each Sunday at Ted Deithrich’s sports marathons felt the pain in his spine and the heaviness in his eyes, but he remained spellbound by the power and beauty of DeBakey’s surgery.
At midnight, the senior surgeon called for the gasendarterectomy patient who was fetched somewhat bewildered from his room and wheeled to the operating room. There DeBakey, with no sign of weariness, began his eleventh operation of the day, a day which had begun at 7 A.M. He made the tiny incision within the artery of the heart and injected the whiffs of carbon dioxide to loosen the layers of occlusion, those layers which threatened to close the artery and possibly bring on a heart attack. With grace and sureness he loosened the core and pulled it out, holding the offending mass for a moment in the strong lights from the four spots that bathed him and the patient’s heart. “He was the tallest man I ever saw,” said Speedy Zweibeck when it was over, “and the proudest, and certainly the youngest.”
When he was done sewing up the eleventh and last patient of a day that had stretched eighteen and a half unbroken hours, DeBakey glanced up at the operating room clock and saw that it was 1:25 A.M. Around him stood men and women, who, had they not been masked and gowned and gloved, would have applauded and shook his hand. Someone else could play the concerto well in Houston. DeBakey was exhilarated as he walked to the heavy swinging doors. He opened one as if to leave. Instead he stuck his head out and he cried in a voice of triumph that burst through his mask and broke the quietness of the empty corridor: “Anybody else out there want an operation?”
Summary of Heart Transplants as of March 1, 1971
Total No. of Transplants: 170
U.S.: 108
Foreign: 62
Total No. of Recipients: 167
Total No. of Deaths: 143
Number of Survivors: 24
U.S.: 18
Foreign: 6
Total Number of Countries: 20
Total Number of Surgical Teams: 65
U.S.: 29
Foreign: 36
Survivors as of Mar. 1, 1971
Date of Surgery
Days Surviving
Russell
8-24-68
919
Carroll
8-31-68
912
Vlaco
9-18-68
894
Sanchez
10-01-68
881
Anick
10-21-68
861
Sheaffer
10-26-68
856
Parkinson
11-03-68
848
Johnston
11-17-68
834
Vitira
11-27-68
824
Kaminski
12-01-68
820
Gilian
2-08-69
751
Pounds
4-14-69
686
Fisher
4-17-69
683
Trout
5-22-69
&nb
sp; 648
Paul
8-13-69
565
Johnson
9-03-69
544
Bartholomew
9-29-69
518
Van Buren
1-04-70
421
Marshall
1-16-70
409
Madigan
4-28-70
307
Townswick
7-04-70
240
Cope
10-15-70
137
Kinsley
1-11-71
48
Knudson
2-24-71
5
HUMAN HEART TRANSPLANTS *
DATE OF TRANSPLANT
STATUS †
RECIPIENT/DONOR
AGE
SEX
REPORTED CAUSE OF
DEATH
SURGEON/INSTITUTION CITY, STATE, COUNTRY
01-23-64
Dead 2 hrs.
01-23-64
Unidentified
Donor-Chimp
68
—
M
—
heart too small
Hardy, University of Mississippi
12-3-67
Dead 18 ds.‡
12-21-67
Washkansky
Donor-Human
53
25
M
M
infection/rejection
Barnard, Groote Schuur Hosp., Capetown, South Africa
12-6-67
Dead 6 ½
hrs. 12-6-67
Baby
Donor-Human
17 ds.
2 ds.
M
M
metabolic and respiratory acidosis
Kantrowitz, Maimonides Hosp., Brooklyn, New York
01-2-68
Dead 593 ds.
8-17-69
Blaiberg
Donor-Human
58
24
M
M
chronic rejection
Barnard, Groote Schuur Hosp., Capetown, South Africa
01-6-68
Dead 15 ds.
1-21-68
Kasperak
Donor-Human
57
43
M
M
internal hemorrhage
Shumway, Stanford Med. Ctr., Palo Alto, California
01-10-68
Dead 8 ½ hr.
1-10-68
Block
Donor-Human
58
29
M
F
left ventricular failure
Kantrowitz, Maimonides Hospital
02-16-68
Dead 3 hr.
2-17-68
Chithan
Donor-Human
27
20
M
F
pulmonary
hypertension
P. K. Sen, King Edward Hosp., Bombay, India
04-27-68
Dead 2 ds.
4-29-68
Roblain
Donor-Human
66
23
M
M
embolism/brain damage
Cabrol, La Petie, Paris, France
05-2-68
Dead 3 ½ ds.
5-6-68
Rizor
Donor-Human
40
43
M
M
deprivation of oxygen/pulmonary embolism
Shumway, Stanford Med. Ctr.
05-3-68
Dead 204 ds.
11-23-68
Thomas
Donor-Human
47
15
M
F
rejection
D. Cooley, St. Lute’s Hosp., Houston, Texas
(Note: this patient received a second trans plant 11/18/68)
05-3-68
Dead 45 ds.
6-17-68
West
Donor-Human
45
26
M
M
multiple pulmonary emboli
Longmore, National Heart Hosp., London, England
05-5-68
Dead 3 ds.
5-8-68
Cobb
Donor-Human
48
15
M
M
leukopenia, pneumonia, and sepsis
Cooley, St. Luke’s
05-7-68
Dead 7 ds.
5-14-68
Stuckwish
Donor-Human
62
36
M
M
renal and hepatic failure
Cooley, St. Luke’s
05-8-68
Dead 2 ds.
5-10-68
Reynes
Donor-Human
65
35
M
M
pulmonary injury, cerebral air embolism
Negre, St. Eloi Hosp., Mt. Pelier, France
05-12-68
Dead 523 ds.
10-17-69
Boulogne
Donor-Human
56
39
M
M
rejection
Charles DuBost, Broussais Hosp., Paris, France
05-21-68
Dead 146 ds.
10-14-68
Fierro
Donor-Human
54
17
M
M
cardiac arrest/rejection
Cooley, St. Luke’s
05-25-68
Dead 7 ds.
6-1-68
Klett
Donor-Human
53
48
M
M
total rejection
Richard Lower, Med. College of Virginia, Richmond, Va.
05-26-68
Dead 28 ds.
6-23-68
F. da Cunha
Donor-Human
24
40
M
M
rejection
E. Zerbini, Hosp. das Clinicas, Brazil
05-31-68
Dead 5 ds.
6-5-68
A. Serrano
Donor-Human
54
47
M
M
cerebral embolism
Miguel Bellizzi, Clinic Lanus, Buenos Aires, Argentina
05-31-68
Dead 1 day
6-1-68
A. Murphy
Donor-Human
59
38
M
F
low-output heart failure
Pierre Grondin, Montreal Heart Institute, Canada
05-31-68
Dead 0 hrs.
5-31-68
R. Smith
Donor-Human
39
29
M
M
malfunction of right ventricle
C. W. Lillehei, Cornell Medical Center, NYC
06-7-68
Dead 1½ hrs.
6-7-68
E. Matthews
Donor-Human
41
26
F
M
acute rejection
Webb, U. of Texas Southwestern Med. School, Dallas, Texas
06-12-68
Dead 0 hrs.
06-12-68
Willoughby
Sheep (125 lbs.)
48
—
M
—
heart did not start
Cooley, St. Luke’s
06-28-68
Dead 156 ds.
12-1-68
Paris
Donor-Human
>
49
23
M
M
asphyxiation following indigestion
Grondin, Montreal Heart Institute
06-28-68
Dead 133 ds.
11-8-68
Penaloza
Donor-Human
24
32
F
M
cerebral embolus
J. Kaplan, Admiral Neff Naval Hosp., Valparaiso, Chile
07-2-68
Dead 0 hrs.
7-2-68
Z.M.
Calf heart
14
—
F
—
?
Poznan City Hosp., Warsaw, Poland
07-2-68
Dead 149 ds.
11-28-68
DeBord
Donor-Human
48
50
M
M
chronic rejection
Cooley, St. Luke’s
07-9-68
Dead 5 hrs.
7-9-68
Horvathona
Donor-Human