I was surprised to hear what had become of my boyhood friend Robert Holmes à Court. After Trevor was killed by bees, Holmes à Court emigrated to Australia, where he became a lawyer and then built a vast corporate empire that included wool production, transport, mining, and media. A feared corporate raider, he was the first Australian businessman to be worth more than a billion dollars and was now among the richest men in the world. A year after my visit to Chobe, Holmes à Court would die in his bed of a heart attack at the age of fifty-three. His mother had joined him in Perth, where he had a horse-breeding operation, after she sold the Chobe River Hotel. Against all odds, I met up with her a few years after my visit to Africa when I went to Perth to operate on a visiting English earl—he was the horse trainer to the queen of England—who was too sick to be transferred to America. This big world is, as the saying goes, sometimes a small place.
After tea, I set off for the game reserve. The road was rough enough to make it slow going. The bend that had been made to go around the carcass of the elephant shot by the district commissioner guarding Katharine Hepburn was still there, though after thirty years, no one knew why. The elephant population had soared after the game reserve was established, and the evidence of their presence was everywhere when I reached Chobe. Most of the big trees were gone, especially those that used to line the river, pushed over by the elephants to get to the juicy bark and branches on their upper limbs. There were elephant droppings everywhere, and plenty of signs of buffalo. But there were no elephants and buffalo around, as it was noon and getting hot.
I drove to Serondella, or rather, to the place where our cottage by that name used to be. Now there was a campsite named Serondella in its place. It was empty. A baboon was sitting on an overturned garbage can. I found Pop Lamont’s grave near the riverbank, under the shade of one of the remaining trees. He’d been ordered out when the game reserve was established but had refused to leave. In the end they let him stay, perhaps because he had African children. Few in Kasane remembered or cared who he was. The early days of Chobe were mostly forgotten.
I had come to see elephants—some of which would surely be old acquaintances I’d known as a child. I drove along until I came across fresh tracks. I left the road and drove toward the river. Sure enough, there was an elephant herd moving through the scrub, headed to the water for a drink. One mother had a little baby. I backed the Land Rover into a clump of bushes to keep out of their way. Then several others I hadn’t seen at first showed from where I’d come and started toward the Land Rover. I was downwind, so they had no idea I was there. Though they were not more than a few yards away, they didn’t see me. The first group also turned in my direction then—and they had my scent. They halted twenty-five yards away, flapping their ears and raising their trunks to sniff the air. An elephant herd is ruled by the matriarch, and breeding herds with babies can be dangerous. I was concerned about some mothers in this herd who seemed agitated, but they eventually ambled away in front of me and into the water. One elderly female, who seemed to be in charge, stood her ground. She looked at me, waving her trunk and shuffling about, not knowing whether to come on or back off. I was now surrounded by elephants—one of which was nervous and blocking my way out. I started the engine and inched out toward her. She shuffled aside, allowing me to get back on the road.
I drove on to the lavish new Chobe Game Lodge, which was not far away. It was on the river just below Crocodile Island, perhaps two miles from where I had caught the black mamba. Cool and luxurious, the hotel had air-conditioning, several swimming pools, and splendid views of the river and the savanna stretching to the horizon beyond. It was full of rich Americans and Germans. Everyone was fitted out in tailored safari gear. This wasn’t the Chobe I knew, which had been remote and wild. A few tame warthogs rooted around in the garden. Each morning and evening, the hotel took guests out to watch the animals.
After lunch I drove back into the bush again. There was no shortage of game, and by dark I’d seen my fill of animals—including two large herds of buffalo that must have numbered in the hundreds. After dark, trying to get out of the park before the gates closed, I ran into more elephants. One, frightened by the headlights, trumpeted menacingly. I switched off the lights, and after a few moments the elephant turned away. I was up at dawn and back into the reserve the next day. Some giraffes crossed the road in front of me. Later there were more buffalo, flanking me on either side of the road, chewing the grass and watching me with little interest.
I felt crosscurrents of emotion when it was time to leave. Chobe had changed, and I could never wholly revisit the world I’d known there. But many of the things that I remembered most fondly were as they always had been. The broad sweep of the river and the animals that roamed along it took me back to a childhood filled with such scenes. How remarkable it was that I’d grown up in an untamed place and had never once been harmed by animals—only to learn many years later that the most dangerous animal of all is my own species.
The bus picked me up on the road outside the car rental hut. There was a new driver, and this time I had company—a young English couple headed to Victoria Falls on their honeymoon, and a husband and wife in their seventies. The older man was organized. He had a tidy file with their passports and entry forms, which he filled out on the bus to speed their way through the border at Kasungula. But there was a problem clearing the checkpoint into Zimbabwe. On his way out, the man had declared all the currency he was carrying and had been required to leave a portion of his Zimbabwean notes at the checkpoint to retrieve on his return. Unfortunately, this money had been locked away in a safe, the key to which now could not be located. We were told the man who might have the key was probably coming on duty later that day—or possibly not, a classically African abundance of variables. The dilemma was resolved when the customs officials took up a collection to pay the man his money, which turned out to be a trivial sum. They would reimburse themselves when the key to the safe turned up, and everyone was congratulated on an ingenious solution to the problem. We climbed back into the bus and rattled down the road toward the falls.
I flew on to Lake Kariba, a reservoir on the Zambezi River that is the world’s biggest man-made body of water. The dam was built when I was at Whitestone, flooding the Kariba Gorge. From the air, it was a breathtaking expanse of water that looked like it had always been there. When the dam was completed, thousands of animals were trapped on islands that continued to shrink as the waters rose. A rescue effort, called Operation Noah, was undertaken, during which everything from elephants and rhinos to snakes and lions were hauled off and relocated to dry land. I still remembered when that stretch of the Zambezi was a hot and humid valley buzzing with tsetse flies that carried sleeping sickness. Now it was water for as far as the eye could see.
I checked into the Caribbea Bay Hotel on the shore of Lake Kariba. Elegant and vaguely Spanish-looking, the hotel seemed out of place. I was surprised to discover that one of the other guests was the actor and director Clint Eastwood, who was staying there while making a movie, White Hunter Black Heart, a film based on the making of that earlier picture The African Queen. I was amused to see that among its amenities, the hotel rented windsurfers. You could pick them up right next to a sign warning, “Swim at Own Risk, Beware of Crocodiles.” There are some huge crocs in Kariba, where the locals call them flat dogs. I heard stories about crocodiles climbing onto houseboats and pulling careless vacationers into the water. Supposedly, there was a six-foot-long croc along every hundred yards of the river. I was told that at least one person was eaten every week, which was not surprising, as I saw people washing themselves and their clothes in the river, standing in the water to their knees.
That night, in the bar, I ran into the son of someone who’d gone to Whitestone with me. His father was a farmer in the northern part of Rhodesia who was shot and killed on his farm during the war. Of the seventy white farmers in the area, only two survived the conflict.
The next morning I got a ride i
n the open back of a Land Rover to a small river town named Chirundu. We passed an elephant shortly after setting out, and then disturbed a huge male lion who had been lying by the side of the road. The lion grumpily trotted off into the bush. There were more elephants at the river. They were hunted here, and as a result were skittish and more ill-tempered than the elephants at Chobe. I got to Chirundu around noon. There were monkeys playing on the corrugated iron roofs of the village and climbing in the bougainvilleas. I bought food and supplies, rented a canoe, and loaded up for a four-day trip downriver to the Mana Pools, some sixty miles through the heart of one of the wildest parts of Africa.
I paddled mainly to steer, letting the current carry me. I reflected on my life, which in so many ways seemed to have come apart. I’d lost my childhood home to war and a warped sense of progress, while my career had paused ominously. The river reminded me of the journey we all take, starting out and moving with the flow, traveling into the unknown and staying alert to the dangers that might be anywhere along the way. Loss is in most ways unquantifiable, as is the sadness that accompanies it. I couldn’t measure how I felt, and as I floated onward, I gave up trying.
Birds and animals were everywhere. There weren’t many mosquitoes, but I took antimalaria medication. The weather was perfect, which would not have been the case in many other months of the year. In summer the heat would make the trip intolerable. Now in June the midwinter days were warm and pleasant, the nights cool. To my right was Zimbabwe, and on the left Zambia. I followed the border, drifting on an imaginary line. The Zimbabwe side was a game park. Rangers there fought an ongoing war with poachers, who crossed over from Zambia and shot rhinos with fully automatic AK-47s, taking the horns and leaving the carcasses. On average, one rhino was taken every day, and back then horns fetched $50,000, a fraction of what they’re worth today. Poachers were shot on sight.
I stayed mainly to the Zimbabwean side, hoping to avoid trigger-happy Zambians, though there were more immediate threats. Hippos were everywhere. They like to wallow in shallow water. When alarmed, they head for the deep water. The secret is not to get between them and their refuge. When I came upon hippos out on a sandbar or standing in the shallows, I would head straight for them, banging on the side of the canoe to make them move. They’d careen off into deeper water and I’d continue on. This wasn’t necessarily safe, as hippos are not always predictable. At several places I could not find an easy route through the pods of hippo. My only choice then was to paddle hard and trust that if I passed over a hippo, it would not take an interest in me. When I was growing up, the father of one of my friends had gone on a canoe trip and been killed by a hippo.
Crocodiles have good hearing. They would slide off the sandbanks a hundred yards before I came to them, leaving big skid marks on the sand. Occasionally I surprised one, and with a splash and swirl, it would be gone.
At the end of each day, I looked for a sandbar in the middle of the river to make camp. The riverbank would be too dangerous on account of lions, as I didn’t want to make a fire and invite the attention of either poachers or rangers. The odds of being shot without warning in such an encounter at night would not have been in my favor. I stayed close to my camp and tried to leave few tracks for the same reason. I was much less concerned about the animals. I knew lions would not swim the river to eat, and crocs don’t generally feed at night. Still, I stayed alert to everything around me. I hadn’t brought a gun, and it was good to feel the hairs on my neck prickle now and again.
I didn’t have a tent, just a sleeping bag that I crawled into during the brief interlude between sundown and darkness. A brilliant spray of stars filled the night sky. I slept soundly, waking before dawn to a loud chorus of birds. After a cup of coffee, I was away again as the sun rose, lighting the mist that hung over the river. I let the current pull me on through the murk, listening to the sounds of hippos grunting contentedly somewhere ahead. Africa is nature’s cathedral, and I found its wild congregation restorative. I was in the middle of nowhere—and at the center of everything.
After four idyllic days, I arrived at the Mana Pools Game Reserve camp and found it largely deserted. There was a canoe onshore with two large holes in it, the result of a hippo attack that had thrown the occupants into the river. They’d managed to escape. But the more disturbing news was that one of the park’s rangers had been eaten by a lion the previous day. He had been tracking poachers and was sleeping under a tree that night. He didn’t light a fire to avoid alerting the poachers, preferring to take his chances with the lions—a fatal decision, as it turned out. My life back in the United States seemed a long way away. But I knew it was there. A Land Rover was waiting to take me back to civilization. I climbed in and started thinking about how I would build a cardiac program in San Diego. I was ready to start again.
CHAPTER TWENTY-ONE
THE LONG VIEW
My team had got to UCSD ahead of me. When I arrived in July of 1989, Michael Kaye had already set up the offices of the Journal of Heart and Lung Transplantation and the International Registry for Heart and Lung Transplants. He was also working on our experimental laboratories. Jolene Kriett and Riyad Tarazi were there, as were the transplant coordinators, Ann Hayden and Becky Robert. Apart from Tarazi, the whole crew were from the Midwest. I was happy they were willing to pack up and come to California with me.
There were two hospitals associated with the university: the main university hospital in San Diego, called Hillcrest, and the Veterans Administration hospital. We operated at both. The work consisted of adult and congenital cardiac surgery and lung surgery. My chief operating room nurse from Minnesota, Carol Hamlin, used her vacation time to come to UCSD to get things organized and to help train our new operating room staff. When she left, she gave me a note that said, “Tough times never last, but tough people do.”
The team on arrival in San Diego (left to right) Front row: Jolene Kriett, me, and Ann Hayden. Back Row: Riyad Tarazi, Becky Robert, and Michael Kaye.
One day early on, when I returned to my office after operating, I found Moossa waiting to see me. He gave me a UCSD tie. In my three years in Minnesota, Najarian had never once come to my office. In fact, I don’t think he ever visited the Heart and Lung Institute that I created.
The warm welcome at UCSD was nice, but I was eager to move the program forward. And I felt that because of what happened in Minnesota, I had no margin for error—there would be no second chance if I failed here. Although I trusted Kriett and Tarazi, at first I insisted on doing all of the difficult cases myself. This was a heavy workload, and it was challenging to navigate the resistance to my appointment. I still had to win over the people who’d threatened to leave if I came to San Diego.
The first was Ken Moser, whom I met when I was interviewing for the job. Moser was in charge of a strong pulmonary program that he’d founded in the early days of UCSD. He was an institution. His reputation rested largely on his work on thromboembolic disease, a condition in which high blood pressure in the lungs, or pulmonary hypertension, is caused by blood clots. I was also interested in this disease, because we were performing lung transplants for pulmonary hypertension. In fact, all of my first heart-and-lung transplants, which were among the first in the world, had been for this condition—which is a fairly common problem.
There are two types of pulmonary hypertension: one is caused by disease of the small pulmonary vessels, the cause of which is often unknown; the other is a disease of the larger vessels, usually the result of blood clots that travel from large veins in the body, pass through the heart, and become incorporated in a layer of scar tissue on the inner walls of the pulmonary arteries—where they obstruct the blood flow to the lungs. This “back pressure” eventually leads to heart failure. It also impedes the supply of oxygen to the body and causes shortness of breath.
Moser was an intimidating figure. He had trained one of my first mentors, Felix Eastcott. At Georgetown, Moser had persuaded Charles Hufnagel to remove clots from the lungs of a pa
tient with chronic pulmonary hypertension way back in 1961. The operation, called a pulmonary thromboendarterectomy, or PTE for short, was a primitive and risky procedure then. The clots were removed while the heart was still beating. Heavy bleeding obscured the operating field so that it was hard for Hufnagel to see what he was doing.
When Moser moved to San Diego in 1968 as one of the founding members of the UCSD faculty, he convinced Nina Braunwald, a cardiac surgeon, to try the procedure. She did and it worked. In the intervening years, a handful of PTEs had been done by surgeons at UCSD, but without good success. When I arrived Pat Daily was the primary surgeon doing them at UCSD. Although a heart-and-lung transplant was one way to cure pulmonary hypertension, I was intrigued by the idea of coring out the pulmonary arteries with the PTE procedure. The fact that UCSD did this operation was one of the attractions of the job. I also thought I could do it better than they did—when I arrived, mortality in PTE surgeries was 20 percent.
After I replaced Daily as chief of cardiac surgery, he was still working at UCSD and at Sharp. I wanted to end this dual enterprise, which was one of the main reasons Moossa had hired me. Daily lobbied hard to stay, doing his best to convince his colleagues at UCSD that he was indispensable. Ken Moser was a strong Daily ally, which was why he had been so opposed to my appointment. Moser didn’t think that anyone but Daily could do the PTE operation. Moser’s threat to resign was still on the table.
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