Spoken in a resounding basso, Dr. Farelli’s phrases seemed to be slung at his cowed listeners as if thrown by a catapult. His damp, black locks hung over his forehead, shaking as his head moved. His dark eyes sparked, his hook nose quivered, his white teeth gleamed, and his protruding jaw dared all disbelief. Beside him, as unremarkable as a slight blemish, sliding lower and lower into the sofa as if sinking into a quicksand patch of inadequacy, was Dr. John Garrett, brown hair and rimless spectacles and lack-lustre countenance slowly fading into the wan beige of the sofa, until both were one, and Farelli seemed quite alone.
Yet Jacobsson tried to judge the phenomenon fairly. This dominance was not of Farelli’s doing. It was invited, nay, desired, by the dozen journalists. In the Italian they sensed excitement, and they wanted to draw upon it and inject it into their routine accounts, so that their stories would be as alive as their subject.
Jacobsson pondered the possible results of this group interview. Did Dr. Garrett realize that he was being made as extinct as the dodo bird? Did he realize what was happening to him?
On the sofa, melted into the fabric, nearly vanished, Dr. John Garrett felt no pain. From the second that he had been introduced to Farelli, his immediate surface anger and antagonism had been blotted up and absorbed by the Italian’s overpowering charm. Thus drained of righteous indignation, he was less man than automaton.
When the interviewing had begun, Garrett had been offered his fair share of questions, and had answered them simply, but then there had been fewer questions, and finally none, as if the audience had made a choice as to the player they preferred. Now all questions were being directed at Farelli, and all replies were being given by him. Oddly, Garrett experienced apathy, not rebellion. To join Farelli, to participate, would seem to be intruding on an enchanting Pirandello play. Gradually, Garrett had become so mesmerized by the Italian’s words and histrionics that he felt he no longer shared the laureate sofa with him, but rather belonged apart, to the press audience, logically listening with them.
Even now he listened, still bound helplessly in the same hypnotic trance of inferiority, as if his contribution to their great work had been a minor accident, and now he wished to make amends through apologetic silence.
‘One asks oneself, after all, what is this organ, the heart, that it is so difficult to replace?’ Farelli was saying. ‘It is a simplified pump, a hollow muscular bag somewhat larger than a tennis ball or my fist, weighing no more than ten ounces. Seventy-two times a minute it beats, perpetually beats, and through it, each minute, pass six quarts of blood. One sees that in its design the heart is simple to duplicate, yes? Though, do not be fooled by its simplicity. For sixty or seventy or eighty years, it pumps with no rest. Where can one buy a machine guaranteed to pump for sixty—seventy—eighty years without failing once?
‘Both Dr. Garrett and I fell into the error of trying to find such a man-made machine to use as a model, a machine that would equal or surpass the living heart. There were many models, of course. For several decades, scientists have been constructing artificial hearts to perform outside the body. One remembers the year 1935, when Dr. Alexis Carrel admitted that he and Colonel Charles Lindbergh had kept alive an animal organ with the first artificial heart made of a pump and coiled glass tube. One remembers Dr. John H. Gibbon, of Jefferson Medical College in Philadelphia, who was among the first, possibly the first, to employ an artificial heart-and-lung machine on a living patient, to keep the patient alive forty-five minutes, while surgery was being done. One remembers Dr. Leland C. Clarke, in Yellow Springs, Ohio, who kept a fireman alive seventy-five minutes with a heart-and-lung machine, while chest surgery was completed.
‘In the world, there have been thirty or forty such artificial heart devices. And other remarkable cardiac devices, too, such as the recent electronic pacemaker. One saw the brilliance of these efforts, and the progress made, but still one—who was a perfectionist—despaired. For all of these machines were temporary devices outside the human body. They could not, in any form, be trusted inside the body—and will not be trusted, until we have discovered perpetual motion. Dr. Garrett and I saw that the practical heart, the one that might prolong or even double longevity, must be alive and mammalian and in the image of the human heart. Here was a goal for a Dr. Frankenstein—but where, my friends, where in the medical profession, was there a Mary Shelley?’
Farelli had spread his broad palms in a gesture of helplessness, and the audience, almost collectively, sighed in distressed understanding of his problem, as a theatre audience might sigh at the dilemma of the beset hero. Farelli cast a friendly glance at Garrett, who sat agape, like a boy child waiting for Father to turn the page.
Farelli met the attention of his audience again. He would not let slack the communicative bond between them. ‘The goal was clear, but so, also, were the steep hurdles. What kept us from grafting lower mammalian hearts into human bodies? Preliminary attempts had been made on dogs, in England, in America, and the animals had survived three weeks. Why not men and women? The hurdles were these—to find an animal heart of similar structural design to the human heart, to find a means of storing this organ, to find a workable operative technique, to find a way of preventing irreversible ischemic damage to the transplanted heart—yes, I could go on and on. These were hurdles, but they were not the largest. The largest was the one I speak of last—to find means of preventing the rejection mechanism of the cells from marching out to attack and crush all invading material trying to enter the body.
‘Those of us who dreamed of an eternal body spent our long nights of lonely strategy devising means to overcome these hurdles. In the Istituto Superiore di Sanita, in Rome, I did my research and experiments. In the Rosenthal Medical Centre, in Pasadena, my admirable colleague, Dr. Garrett, did his research and experiments. We met our difficulties, one by one through the years, and we overcame them. Blood for the brain during surgery? We used a plastic booster heart, a pump oxygenator, outside the body. Clotting? Anticoagulants, of course. The replacement heart? One grafted from a mammal near the weight of the patient. Storage of the replacement heart? Perfusion and cooling, now useful for several hours, but already progress is being made on a special drug which will arrest metabolism. Suturing of blood vessels? Prosthetic materials like Teflon or dacron, or sometimes spare blood vessels from human cadavers. Technique of suturing? Our adaptation of a vessel-suturing instrument, resembling a miniature sewing machine, first used by the Russians at the Sklifosovskii Institute. And the rejecting mechanism? Ah, here the fight was the longest. We employed massive radiation, various radiomimetic drugs, steroids—and discarded them—and went on—and in the end we found the combination, Dr. Garrett in Pasadena, and I in Rome, to neutralize the enemies of our transplanted hearts. We found what my colleague has so aptly named Anti-reactive Substance S.’ He paused. ‘I have been too verbose for your purposes—and too brief for mine—but that is the answer to what was asked, that was our long road to Stockholm.’
Farelli settled back and enjoyed the intermission of journalists recording his story.
Garrett, bewildered and muted by the Italian’s glib locution, watched Farelli find a lozenge and place it on his tongue. Spread before him, Garrett observed the reporters writing. What were they writing? Farelli said, Farelli said, Farelli said, the renowned Farelli, the incredible Farelli, the genius Farelli. In the centre row, a lady’s hand waved, her bracelet jangling.
Garrett stirred himself from the long sleep. ‘Yes?’ he called out weakly.
‘Dr. Farelli—’ replied the lady’s masculine voice. Her demand buried Garrett deeper into the obscure corner of the sofa.
‘Dr. Farelli, I am Stockholms-Tidningen,’ she said. ‘I would like from your own lips the story of your first successful case.’
‘You have all read about it,’ said Farelli with a self-depreciating gesture. ‘It has been made romantic enough.’
‘Yes, but in your words, no matter how briefly—’
‘Very
well. I was at the Istituto, early one afternoon, preparing to transplant a mammalian heart into a St. Bernard dog, for the benefit of foreign physicians en route to Milan for a medical convention. In the midst of my preparations, I was informed of an important emergency case. The patient, in his seventies, was a great international figure. He was an English expatriate, a playwright, who had known James McNeill Whistler and Oscar Wilde and Lily Langtry, and for some years had been living in Ravenna. He was on a business visit to Rome, and he had suffered a coronary thrombosis only a few blocks from the Istituto. I rushed to save him, but there seemed little hope. His common-law wife, an Italian lady from a titled family, a lady I had met socially and who had attended my lectures, knew of my dreams and begged me to replace her playwright’s dying heart with the mammalian one I had ready for my exhibition experiment. Even as she signed the release, and my equipment was being set up in surgery, the playwright expired on the table. I had no more than five minutes to open his chest and begin a cardiac massage, while my anesthesiologist established an airway. When the patient had first been wheeled in, expiring, I had been frightened. But now that he was dead, all hesitancy left me. I worked like ten demons. Massage immediately reactivated his heart, his breathing, so no brain damage was incurred. Next, I put into use the cardiopulmonary bypass machine. After ninety minutes, I was able to effect the transplantation of the new mammalian heart into his chest. I then connected his circulatory system to the new heart, closed his chest, and resumed treatment with my anti-reactive drug. In three months, he was on his feet—and just before coming to your gracious city I received, by air post, an advance copy of his latest play—his best yet!’
The Stockholms-Tidningen lady clapped her hands, and several other reporters joined in applause.
Farelli cast his eyes downward, modestly, and then he looked up. ‘That was my first case. Since then, I have made twenty additional human heart transplantations, on qualified patients, and I am proud to say that there has not been one failure. So much for my work. Now, I am certain, you would like to hear my fellow Nobel laureate tell you about his.’ He opened his hand towards his companion on the sofa. ‘Please, Dr. Garrett—’
The sudden invitation to share honours and newspaper space had caught Garrett completely off guard. He had been dazzled by Farelli’s account, and felt shrunken and wizened after the applause. Now, to follow Farelli was as impossible as to conclude a story that had been half told by Scheherazade.
‘I—I don’t know if—’ He found himself speaking to Farelli, and he realized that this was all wrong. He faced the reporters, and imagined that he saw impatience, even hostility, in their faces. Desperately, he sought a thread of coherent narrative. ‘I was in the hospital in Pasadena—it’s in California—I had my calf’s heart and had been working on a canine specimen—it was late, after dinner—this truck driver—sixty-seven—Henry M., I called him in my paper—I made the heterograft of the organ—and he’s alive today. It was—there were obstacles, still—’
Garrett became aware that one reporter, not listening to him, had completely turned his back to consult with another reporter behind him. He heard the rustling of paper. There was an excessive amount of coughing. A chair scraped the floor. They wanted Scheherazade, Garrett knew. The inattention flustered him. He was defeated.
‘—anyway, it was a gratifying experience, and the reception was gratifying, and I was gratified.’ The record needle was stuck and Garrett wanted to quit. He quit. ‘That was my first case,’ he concluded lamely.
The waiter appeared with his tray of drinks, to which cigarettes had been added. Farelli accepted a sherry, and, dazed, Garrett took one, too, though he detested the drink. The waiter circulated among the press, and Farelli sipped his sherry, and Garrett did the same.
Garrett tried to think. Had Farelli deferred to him, offered him the chance to state his own case, out of geniune respect? Or had the Italian been sensitive to the fact that he had been putting on a one-man show and felt a pang of guilt? Or had the Italian elected to display his superiority by deigning, on his terms, at his command, to allow a lesser royalty to speak?
Considering Farelli’s motive, Garrett emerged from his hypnotic trance, reminding himself that beside him sat the usurper, the rival, the enemy, a crafty Machiavelli of medicine who must be battled word for word, to the death. He had been given an opportunity, moments before, and he had fumbled it badly, out of surprise, out of self-imposed inferiority. This must not happen again, and it would not. Farelli was a braggart, a highwayman, an alchemist. He, Garrett, had been first in the field, first acknowledged and first recognized, and now, because he was humble and kind, he had allowed the Italian to take the lead through dubious forensics. He must sharpen his wits, become a recognized member of the press meeting, and hold his own. He gulped the distasteful sherry, pushed himself to the very tip of the sofa, like an anchor man on a relay team awaiting the baton, and poised himself for the next questions.
A distant hand went up. It belonged to the Il Messaggero man from Rome. ‘Dr. Farelli, did you and Dr. Garrett work together, and if so, to what extent?’
‘I will answer that!’ Garrett shouted, and then, horrified at the loudness of his voice and at the suddenness with which he had attracted the attention of the whole room, he modulated his next utterance to a whisper. ‘We did not work together at all.’
Farelli waited until he was sure that Garrett had nothing more to say, and when he was sure, he added his own comment, addressing the reporters. ‘Dr. Garrett and I, unfortunately, never set eyes upon each other until one hour ago. We never corresponded. We knew nothing of the progress or details of each other’s work—except, of course, what we read in the scientific journals.’
‘Is that not unusual?’ asked the Il Messaggero man.
‘Not at all, not at all,’ said Farelli. ‘There are many examples, in science, of similar parallel researches. I will submit two examples. Years ago, in Rochester, Minnesota, a biochemist, Dr. Edward Kendall, worked on secretions of the adrenal glands. At the same time, in Basle, Switzerland, another biochemist, Dr. Tadeus Reichstein, also worked on adrenal glands. By 1936, both biochemists, independent of one another, had discovered a new hormone, the same one, which later led to cortisone injections for arthritis. In 1950, these two men, and a third, Dr. Philip Hench, made a three-way share of the Nobel Prize in medicine for “discoveries relating to the hormones of the adrenal cortex”. Similarly, in 1956, Dr. Nikolai Semenov, of Soviet Russia, and Sir Cyril Hinshelwood, of Great Britain, won your chemistry prize, shared it, for work in the field of reaction rates—the mechanism of chemical reactions—although they experimented separately, far apart, but going along on the same researches.’ He paused. ‘You see, it happens. Dr. Garrett and I are not so unusual.’
‘Gentlemen, we are all wondering about the future,’ said the Associated Press man. ‘What will your heart transplant eventually mean to all of us and our children?’
Garrett was not certain if Farelli had deferred to him once more, and politely held back, or if he, himself, had merely leaped to the reply more rapidly. In either event, he had not given himself time to consider the question before answering it. His only objective now was to have the floor on his own. ‘That—that is a difficult question,’ Garrett began, ‘because it requires a prediction.’ He would make a joke. That would even him up with the Italian. He made the joke. ‘After all, Nostradamus never won the Nobel Prize.’
He waited for the loving burst of laughter that would greet his sally. There was none. He felt humiliated and undignified, and he tried to recover. ‘It is too early to guess at the future of our discovery. At present, the transplant can only succeed in limited blood types. The two of us have attempted the heterograft thirty-eight times, each time successfully, but still, in science, thirty-eight times is a conservative number. We are too deeply engaged in the present to give our thoughts to the future.’
He liked the roll of his last sentence, and examined the audience covertly
to see if it was being preserved. It was not. The pencils of the press remained stilled. Disheartened, he withdrew, and was not surprised to hear the Italian speak.
‘I should like to extend my American friend’s remarks a little further, if I may,’ said Farelli. ‘Dr. Garrett is a scientist, as am I, and naturally reticent. Everything he has said is correct, of course. Our work is in its pioneer phase. Yet I think this much can be added—both of us have our private, and similar, visions of the future. We are working towards the same end—and the end, with the Lord’s approval, is really the beginning—it is the immortality of man. A dream? Sì, sì, a dream, but now more, now a scientific possibility. As our work is improved, spread, the longevity of human beings will be doubled and trebled, and—who can say?—one day man, bolstered by artificial organs, may live forever.’
Farelli paused, and the pencils moved steadily, and Garrett was dismayed. Garrett was not dismayed at his personal failure alone—his reply had been dry and colourless, and the Italian’s had been a fairy tale that made copy—but also at his rival’s instinctive perception of what laymen wanted to hear. Farelli’s tactics, Garrett told himself, were not worthy of the medical profession. Was it right to feed them pap, optimistic tabloid pap that could not be supported, in order to make headlines? What would Dr. Keller and the therapy group in Los Angles think of all this? Perhaps the psychiatrist might disagree with him, and state that great scientists must have great dreams to justify the minute drudgery of the laboratory and thus give themselves lofty goals far beyond the immediate scalpel and surgery room. He prepared to argue with his psychiatrist, but was interrupted by Farelli’s basso, as it boomed again.
‘If we cannot be satisfied with our way of life and our society,’ Farelli was continuing, ‘we cannot afford to be satisfied with ourselves, with man himself. It is not cynical or irreligious—the Lord forgive me, if it is—to observe that man is an imperfect mammal. In the age of the machine, compared to the machine, man is poorly and frivolously designed and built. Think of a heavy machine standing precariously upright on two thin legs. Think of a machine, that must have vision, limited to two small eyes on one half of its head, instead of three, four or five all around. Think of a machine with wasted, useless parts, parts of the brain, an appendix, extra toes. Worst of all, think of a machine whose manufacturer gives no guarantee on moving parts, and who sells his apparatus at enormous cost without the promise of replacement parts. We want to improve on this machine. Man is a marvel, but he must be made more durable. Too many years, too much love, and too much money, are expended on each man to have him degenerate, part by part, and waste away so quickly. Schopenhauer once said, “It is clear that as our walking is admittedly nothing but a constantly prevented falling, so the life of our bodies is nothing but a constantly prevented dying, an ever-postponed death.” It is true, but it is wrong, and we—those of us in physiology and medicine—defy it. Our goal is immortal man, and it will never be less!’
(1961) The Prize Page 28
