Super Medicine
At the Texas Medical Center doctors can rebuild your heart, give you new limbs, treat your cancer, save your children from affliction, and maybe even bring you back from the dead.
(Page 11 of 12)
Still, the time on the machine was an hour and fifteen minutes, and after Cooley had finished his sewing it became clear that something was amiss. The final ritual of most open-heart operations is taking the patient off the machine, restoring the flow of blood, and touching the heart with two electric-shock disks. At that point the heart should start to beat regularly. The blood pressure should be normal and stable. The blood should be able to clot. But in this case the heart would beat regularly for a while, then irregularly; the blood pressure wouldn’t stay up; and the chest cavity kept springing little leaks. The anesthesiologist injected protamine, a coagulating agent, into the man’s bloodstream, and Cooley kept sewing up the leaks, but every time one was closed there seemed to be a little pool of blood forming somewhere else. Cooley ordered the heart-lung machine turned back on. All that could be seen of the patient besides his chest cavity was a pinkish, well-manicured hand that poked out from under the drape.
A little after seven, having stood at the table for three hours, Cooley ducked out of the operating room and into his office—a room just a few feet away that is cluttered with medical journals, pictures, plaques, 8-track country-music tapes, and television sets—and left his associates to watch over the patient. He drank a Coke, put on a white coat, and took off on his rounds, a resident in tow.
Generally Cooley would walk hesitantly into a patient’s room, smile, and mumble, “Hello, I’m Doctor Cooley. How’re you feeling? We’re going to get you fixed up tomorrow morning, all right? Fine.” In the room would be the patient, lying in bed, his wife at his side (heart disease in adults is primarily a male affliction, because estrogen somehow retards cholesterol buildup and because only in recent years have women smoked cigarettes as heavily as men), invariably watching television. Patients usually seemed surprised to see Cooley, as if they hadn’t known that personal contact with the man who was going to save their lives was part of the deal, and they seldom reacted to his little speech except by nodding and smiling. Thirty per cent of the Heart Institute’s patients are foreign—a planeload flies over from the Netherlands every two weeks—and in those cases Cooley would smile a lot and make some rueful stab at communication. One little girl with congenital heart disease said to him accusatorily when he came into her room, “I know who you are. You’re famous. My mommy showed me a book about you.”
In the hallway between rooms, the resident would fill Cooley in on the next patient. “This next patient is Mr. al-Diab, doctor,” he said in front of one room. “He’s from Iran.”
“Iran, Texas? I don’t believe I’ve ever been to that town.”
“I think it’s up in the Panhandle,” the resident said.
While Cooley was making rounds, Dr. John C. Norman was in the operating room down below, sewing up leaks in the aneurysm patient’s chest, watching the heartbeat and blood pressure and brain waves on electric screens, muttering to himself. He kept sewing and watching and muttering for another two hours. But the patient kept bleeding, and finally his brain waves went flat. Norman told the technician to shut off the heart-lung machine and pronounced him dead.
Weary and depressed, he went up to his office to write the necessary reports. To cheer himself up, he thought for a moment about Mr. Clancy, another of his patients. “Mr. Clancy is going to make it,” he said. “He should be dead. He was dead about fifty times, but we saved him. One we win, one we lose. Of course, you remember most the ones you lose. They leave a little scar. But Mr. Clancy should have been in the morgue by now, and he’s going to go home.”
John Norman is the director of research at the Texas Heart Institute and, aside from being a heart surgeon and a work addict, is different from Cooley in just about every respect. Cooley is a product of San Jacinto High School, the University of Texas, and the Medical Branch at Galveston; Norman went to Harvard, then to Harvard Medical School. Cooley is a passionate believer in free enterprise, a real-estate speculator, a man who can think of no prospect as horrible as working for the federal government; Norman is a liberal who edited a book called Medicine in the Ghetto, a lifelong academic, an enthusiastic procurer of government grants. Cooley is a tall man of relaxed bearing and a deeply chauvinistic Texan; Norman is slight, wiry, constantly in motion, and a loyal Bostonian. Cooley is white, Norman is black. It’s hard not to think that what attracts the two men to each other is the unlikeliness of the partnership, and indeed they milk their differences for all they’re worth, bantering endlessly across the operating table about Boston versus Houston, Harvard versus UT, liberalism versus conservatism.
The bond between them is, generally, a desire to be involved in the biggest and best cardiovascular surgery in the world; both are competitive overachievers. More specifically, the bond is a titanium cylinder about the size of a soup can, with a tube sticking out of each end—the ALVAD, or artificial left ventricular assist device, a replacement part for the most important chamber of the heart. Norman and Cooley are doing the pioneering experiments on the ALVAD in humans.
Norman decided he wanted to be a doctor during his freshman year at Harvard. He looked around for the toughest, most competitive, most challenging thing to do, and hit upon becoming a pre-med. Of his entering class of 1000, 500 were pre-meds, and he knew that only 25 of them would get into Harvard Medical School, so that became his goal.
As he came to the end of medical school he decided he wanted to do his internship at the Peter Bent Brigham Hospital in Boston, for much the same reason he had wanted to be a doctor—it was the toughest and the best. But the professor he was closest to kept telling him he should go back home to Charleston, West Virginia, and set up a quiet family practice. An internship at the Brigham, the professor said, wasn’t for him. To Norman it was obvious what his professor was really saying: it was all well and good for blacks to become doctors, but they were not meant to play the really big medical game. The Brigham turned him down.
Norman didn’t tell the professor, or anyone else, what he thought about that; he only became more determined to rise to the very top. He picked the toughest specialty, surgery, and the toughest subspecialty, cardiovascular. He became a chief resident. He returned to Harvard, still wounded about the Brigham but still quiet about it, and rose steadily up the academic ladder.
Ten years ago, when Cooley put the artificial heart into Haskell Karp, John Norman had at last achieved it all. He was a tenured associate professor of surgery at Harvard Medical School, married to a professor at Boston University, father of a teenage daughter, owner of a beautiful house in the suburbs. He was 39 years old and just coming into the best years of a career at the peak of academic medicine. He was engaged in an important series of experiments with artificial parts of the heart, implanting mechanical left ventricles into hundreds of calves. The fine old world of Boston medicine was horrified by what Cooley, the cowboy, the egomaniac, the outlaw, had done that spring with DeBakey’s heart. He had set back artificial heart research twenty years, given it a bad name. Norman himself disapproved.
But there was something else. Norman was tired of implanting left ventricles in calves. He wanted to try them in human patients. He thought it could work, and he knew that in Boston it could be years and years before he would get his chance. In 1971 he went to Russia to deliver a lecture. On the plane back, Denton Cooley happened to sit down next to him. “By the time we were over Warsaw,” says Norman, “we were talking business. By Paris, we were coming to terms.” In 1972 Norman moved to the Texas Heart Institute.
The first clue a visitor picks up that Norman does not live a normal life is the bathroom in his office. The office itself is large and comfortable; the desk is littered with paperwork, the walls with diplomas and citations. But in the bathroom there is a bowl full of tiny bars of hotel soap next to the shower; a full range of toiletries on the ledge of the sink; and a small but complete business wardrobe hanging on hooks on the door. The fact is, Norman has no residence in Houston. His house and his wife are still in Concord, Massachusetts, to which he returns for a brief visit every month or two. In Houston he sleeps on a bed tucked away in some little-known room of the hospital. But he saves someone’s life almost every day, and he is on the crest of the wave of medical research. He is playing the biggest game.
On December 23, 1975, Norman and Cooley implanted their first ALVAD in a human patient. In 1978, appropriately enough on Valentine’s Day, but with relatively little fanfare, they followed an ALVAD implant with the first heart transplant done in Houston in almost nine years. The ALVAD is still being perfected, but eventually it is supposed to be able to take over most of the functions of a worn-out heart, allowing it to recover, at which point the ALVAD will be removed and the heart will take over again. At this writing, Norman and Cooley have implanted 21 ALVADS in humans whose hearts have stopped working. All the recipients have died.
At 8 a.m. one day in early January Norman appeared in Operating Room 3 of the Texas Heart Institute for his first case of the day. He had been up since 5 a.m. writing up reports and putting to bed the new issue of Cardiovascular Diseases, the Heart Institute’s journal. In the preceding week he had implanted the latest ALVAD, worked through the holidays, entertained his daughter in Houston, mailed off 165 pounds of application material for renewal of one of his federal grants, talked to Joseph Califano, and been asked by the Encyclopaedia Britannica to write its article on surgery. There was no particular reason for him to be in the operating room that morning, or ever, for that matter—his job is to do research, not cut. But he loves it so much that he does both and scrimps on sleep.
My Library
