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Hearts

Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier

OPEN ROAD INTEGRATED MEDIA

On Easter afternoon, 1970, in the paneled chapel of St. Luke's Episcopal Hospital in Houston, a brief and moving memorial service was held for Leo Boyd, a once strapping Canadian railroad man who had lived for sixteen mostly anguished months with the heart of an illiterate Mexican peasant woman within his chest. In his last moments, Boyd was comatose and he began to twist and turn. His wife, Ilene, reached as she had so many times before for the Panic Button beside his bed, but her sister's arms held her back and this time Boyd opened his eyes, shut them, and died. He had been Dr. Denton Cooley's longest surviving transplant and he was the last of twenty-one men, women, and children to die.

The next morning, in neighboring Methodist Hospital — more particularly in its adjoining wing called the Fondren-Brown Cardiovascular Center, a $20 million house of science and surgery created by Dr. Michael DeBakey — there came a telephone call that caused grave concern to his transplant team. They had transplanted only twelve hearts, but two of their patients were still alive some eighteen months postoperatively and both had long since returned to their homes and were leading fairly normal lives. Dr. Ted Diethrich, one of DeBakey's aggressive junior surgeons, took the call, which was from Phoenix, and when he hung up, his tanned, boyish face was twisted into annoyance and exasperation. He walked into the bullpen, an outer office where x-rays are studied and where young doctors and students sit for gossip and coffee.

"I just heard that Bill Carroll read about Leo Boyd's death and got despondent," said Diethrich. "Apparently he went out bar-hopping and in about the fourth place passed out. They thought he was just another drunk and God knows how long it took them to learn he was a transplant and get him to the right hospital."

"You going up there, Dr. Diethrich?" asked Jerry Naifeh, a second-year medical student who had been infatuated with surgery even before he entered medical school. He had spent one summer in Cooley's operating suites holding the sucking machine, a hose that withdraws excess blood from the chest cavity to keep the field clean for the surgeon.

"I can't," said Diethrich. "I've got too many operations here. I'll have to stay in touch on the phone." Diethrich had been a principal planner of DeBakey's transplant program and had actually put the new heart into Carroll's body and nursed him through the rejection periods. "Damn," he said morosely as he left the bullpen. "Damn. Damn. Damn!"

There were eight or ten people in the bullpen and they were waiting now for DeBakey to come out of his office for the precise ritual known as afternoon patient rounds. There was a new resident from Arkansas and today was his first chance at guiding the Professor, as DeBakey is known, up, down, and around the stairways, corridors and mazes of the three buildings over which his patients were scattered. DeBakey uses the giant Methodist Hospital, its adjoining Fondren-Brown wing, which is a self-contained hospital, and the Methodist Annex one mile south, a former nursing home taken over and refurbished to house patients during the diagnostic, preoperative period.

One of the things DeBakey pioneered is volume surgery. In the mid-1950s, the Mayo Clinic became renowned for large numbers of operations, but only those procedures — gall bladders, lung removals, and so on — that other surgeons were doing. DeBakey's volume, which stunned the medical world, was aneurysms and vessel work, then the most sophisticated and daring of operations. DeBakey did as many cases in one month as some surgeons did in a year.

The new resident, Dr. Jerry Johnson, a strong, severely barbered, raw-boned looking fellow newly back from Vietnam, was silently going over his list of patients and praying that he knew any detail DeBakey might ask about one of them. There was a rumor among the staff that DeBakey might be leaving this week on a long European tour. The staff looked forward to long absences because it cut down the patient load. Unfortunately for them, however, DeBakey did not announce his frequent departures for guest lectures, honors acceptances, and fund-raising appearances. A few years ago there had been large three-months-at-a- glance desk calendars on which DeBakey's commitments were entered. Two were on desks outside his office and they were among the most heavily read documents in the hospital. But one afternoon he came out and gathered them up and since then has kept his schedule to himself.

Sylvia Farrell came into the bullpen looking cheerful with a new bouffant hairdo. She poured herself a cup of black coffee, put her hands on her hips and quickly appraised the preparations for the Professor. Once she had been a floor nursing supervisor but now she had responsibilities for everything from driving DeBakey to the airport to booking hotel rooms for patients' families to acting as mother hen to the younger doctors. She was a plump, effusive woman who could read, sometimes even predict, her boss's moods better than anyone else. To Dr. Johnson she said, "He'll probably only want to see the post-ops tonight, but you'd better have the other x-rays ready just in case."

Johnson nodded and hurriedly began arranging a large stack of x-rays in their manila folders. By the time they got to DeBakey, many patients had been in and out of hospitals for years and their accumulated x-rays were as thick as a family album. Sometimes DeBakey would only want to see that very morning's x-rays, sometimes he would want to observe the course of a disease by looking at x-rays for the past decade. The resident had to have them available — and available instantly — whatever.

A half dozen conversations, including some pleasant kidding of Diethrich's stunning Peruvian secretary Marguerita, because she had landed a medical student and would shortly marry him, expired in mid- sentence. DeBakey's door, 30 feet away, had opened. DeBakey came out, turned around and locked his door with a set of keys attached to his belt — he enters and leaves his office 30 times a day and never fails to lock it after him — and came wordlessly into the bullpen. He sat down and his staff gathered formally behind him. Johnson placed a neatly typed list of patients before him. These made up the patient census — everybody DeBakey has in the hospital — with a few lines after each name detailing disease, progress, treatment. There were also one or two names with nothing but a cryptic "HELLO" typed in capital letters following them, indicating to DeBakey that these are prominent patients, not necessarily his patients, but ones he might wish to stop in on for a goodwill appearance.

DeBakey asked a few questions that Johnson answered well — patient histories, how they appeared when they entered the hospital, whether an arteriogram — in which dye is inserted into a vessel and x-ray pictures taken — had been done. He frowned but said nothing when Johnson slapped an x-ray onto the viewing screen backward, and then stood up and quickly rushed from the room. The delegation fell in after him by rank, first Sylvia, then Johnson, then eleven other staff doctors and two visiting physicians.

DeBakey always walks tilted slightly forward with his head bent as if encountering a north wind. One would never expect him to run into anyone because his approach is made known by the circles of power which dance visibly about him. He is a slight, short man with a body of steel, a face dominated by a hawk nose that presumably marks his Lebanese ancestry but that fits more the Indian-head nickel. The photographer Karsh likened the profile to an Assyrian frieze from Nimrud in the British Museum, but eyes cannot be carved in stone and DeBakey's eyes are commanding, magnified out of proportion behind thick trifocals. I have always worried about men with eyes larger than mine because I assume they can see more.

On this spring day, DeBakey was wearing his scrub suit with his white lab coat thrown over it, the initials M.E.D. embroidered in black at the pocket. M.E.D. was everywhere — on strips of tape at the foot of patients' beds, on charts, on doors — initials dominating this empire as SPQR did ancient Rome.

Refusing to wait for an elevator, DeBakey threw open a stairwell door and bolted up, two or three steps at a time. There are those not impressed by DeBakey who suggest he bolts faster when the press or a VIP is around, but I disagree. He always bolts, he cries, he seizes, he whirls; verbs of passivity rarely describe him or his movements.

In the Intensive Care Unit on the surgical floor, he checked a dozen patients recuperating from surgery. At one bed he asked a man wearing an oxygen mask to squeeze his hand, and the man did so firmly. DeBakey's face softened into a smile. At the next bed he bent down and shouted the patient's name and the man responded in a fuzzy voice. Heart-surgery patients normally stay in the Intensive Care Unit about 48 hours, until they are completely awake from anesthesia and extubated, able to breathe without the respirator, which has worked for them since the commencement of the operation.

Everyone seemed to be progressing well except Signor Montini, a youthful Italian who had arrived in Houston in massive heart failure from two deteriorating valves in his heart. Impassively DeBakey listened to the heart into which he had replaced the mitral and the aortic valves that morning, then he knelt down and with a hint of annoyance saw that the urine bottle beside the bed was almost empty with scant fluid in the drainage tube. Passage of urine is a vital sign after heart surgery, indicating that the kidney is functioning well and receiving a good supply of blood from the reconstructed heart. It was obvious that this heart had not yet adjusted to its new hemo-dynamic system.

Montini was in his early thirties with a thick shock of dark curly hair. He was semiconscious, and now and then he would, with great effort, raise his right hand and look with wonder at the fingernails. "They've been blue so long that he can't get over the fact that they're pink now. They're getting blood after the operation," said Dr. Reed, the resident spending an unbroken 30-day-and-night tour of duty in Intensive Care Unit as part of his three months on the DeBakey service.

Now word was spreading through Fondren-Brown, into adjoining Methodist, and through the Methodist Annex a mile away, that DeBakey was making rounds. Nurses hurried down corridors shutting the doors of patients who were not on DeBakey's service so they would not come into the halls and stop him for autographs. In the annex, a loudspeaker intoned, "Will all of Dr. DeBakey's patients quickly and quietly — and immediately — go to their rooms."

When he was done in the Intensive Care Unit, DeBakey stopped briefly in a nearby room to talk to his wife, a handsome and gentle Southern lady who had that day checked into the hospital with a minor complaint. "Perhaps she wanted a chance to see her husband," a nurse suggested quietly, mindful of the normal eighteen hours a day, seven days a week DeBakey lives in his hospital. Mrs. DeBakey had been known to attend teas and draw wives of young doctors into corners and tell them, in effect, "There's still time; don't let your husband become so committed to his job that you never see him." There are four DeBakey sons and they have not been able to claim a proportionate amount of their father's time. None has chosen a career in medicine.

The rounds stretched on. DeBakey made an unexpected stop at the room of Howard Stapler, whom he introduced as "a brave soldier, a very brave soldier."

"How is that, Dr. DeBakey?" I asked.

"This brave soldier is waiting for a heart transplant."

Stapler nodded his head and reached out to take DeBakey's hand. He was a man old beyond his years; he looked 65, he was not yet 50. He had sagging wrinkled skin that made his face seem to be melting wax and there were uneven tufts of stone-gray hair. Much of it had fallen out in adverse reaction to drugs. He was from a small town in Indiana, and he had been in and out of hospitals with his deteriorating heart for almost a decade. He had read so much literature on his condition that he had become efficient with cardiac terminology, almost like a prisoner who becomes a jailhouse lawyer writing habeas corpus petitions to the court.

Stapler was searching for a piece of paper on which he had written something he had read about a new operation. But before he could find it, DeBakey was out of the room, rushing across the second-story passageway that connected Fondren-Brown and Methodist. "When will the transplant take place?" I wanted to know.

"I don't know," DeBakey said. "Stapler's been worked up as well as anybody we have ever done, but there's no abundance of donor hearts anymore."

There was no shortage of violent death in Houston. Almost every morning the newspaper reported another murder in the city (Murdertown, U.S.A., as the local press casually refers to it), where guns could be purchased as easily as flashlights. One drive-in grocery owner that week had slain a bandit who had attempted to rob him. A few nights later, another bandit came to the same store and killed the owner.

"Yes," said DeBakey, "but they have to be killed just right before we can use their hearts."

The sixth floor of Methodist is practically DeBakey's private ward. Most patients begin their hospital stay by checking into the Methodist Annex for preliminary tests. They are then transferred to Fondren-Brown for surgery and a stay in Intensive Care. Finally they are moved to Methodist's sixth floor for Intermediate Care, followed by routine nursing in preparation for going home. The extent of DeBakey's practice could best be seen on the sixth floor. In room after room, the initials on the door were M.E.D., and in the majority of them, the atmosphere was pain tempered with exultation.

There was a battered-looking man named Templeton from a small town in mid-state New York whose leg had been saved from amputation. DeBakey had removed a portion of an artery occluded by atherosclerosis and replaced it with a Dacron graft, which restored circulation. The leg was still hideous-looking, with dead flesh flaking off and black patches of sores, and the toenails were those of a jungle animal, but he would walk on it again and the doctor in New York had wanted to chop it off. "If I could put the world on a silver platter and give it to you, Dr. DeBakey, I would," said Templeton, eyes glistening with tears.

The news was not that hopeful for Diane Perlman down the hall. There was extensive occlusion of several small blood vessels in her left leg, which made arterial reconstruction difficult. DeBakey had tried once before to build a new circulatory system in the leg, but the occlusion had returned. Once Mrs. Perlman had been a pert, slender, vivacious New Yorker who had modeled in the garment district before she married a shipper and bore two children. Now in her mid-thirties she was pale, frightened, and in pain from the red streaks which ran up and down the affected leg.

One of the horrors of atherosclerosis — the disease which affects countless millions of Americans and kills at least one million a year — is that it not only causes heart attacks, it can treacherously shut off a blood vessel anywhere in the body and turn a leg or an arm purple-black with gangrene.

DeBakey made a gesture with his hands and the entourage backed quickly from Mrs. Perlman's room. As he shut the door and returned to sit beside her, she began to weep bitterly. DeBakey had nothing to offer but amputation. Twice this night the surgeon would return to her room and talk to her again, telling of what can be done with artificial legs, winning permission for the amputation, and cheering her to the point where she would say, "Thank God for pants suits." Her husband, a weary man in an iridescent silk suit and tinted glasses, told a nurse, "After God comes DeBakey; Diane is completely hypnotized by this man."

Jerry Johnson led the procession around a corner, paused momentarily, then pushed open a door. "This is Mrs. So and So," he said softly, giving a name uncertainly. DeBakey walked in with the name fresh on his lips and greeted a confused-looking woman who was not Mrs. So and So, but Mrs. Such and Such, and she was not even a DeBakey patient. DeBakey strode outside in anger. "You're supposed to be leading me, Doctor," he said to Jerry Johnson in a loud, withering voice that drew the attention of the nursing station, "and it looks as if I'll have to lead you instead! Now let's see if you can't do this very simple thing right!"

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Excerpted from Hearts by Thomas Thompson. Copyright © 1971 Thomas Thompson. Excerpted by permission of OPEN ROAD INTEGRATED MEDIA.
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