May 1988
Dying for a Heart
Ted Segal was racing against the clock. If he didn’t get a transplant in six months, he’d be dead. Any number of surgeons and organ banks in Texas were available to help him, but a wrong turn could kill him as sure as anything.
Dr. Scotty Hermann was running late. Though he was usually rushing to deliver a baby, today he had promised his father-in-law, Ted Segal, that he would meet him at Providence Hospital in Waco to check the results of Ted’s catheterization, a test in which dye is pumped into the heart. Scotty arrived, breathless, just as the nurse was wheeling Ted to his room. They waved at one another, and Scotty promised that he and his wife, Tracie, would be back later to visit. Then he sat down with the cardiologist to watch a videotape of Ted’s test.
Scotty saw what he had expected but what he had hoped he would not see. He turned to the other doctor and said, “God Almighty, he ought to be dead.”
The film showed that Ted’s heart was pumping out only about 10 percent of the blood going through it. A normal heart should pump out at least 40 percent. What should have looked like a pumping fist looked more like a stiff new baseball glove with the fingers barely wiggling. And now, in April 1987, Ted had begun to develop the signs of heart failure—fluid retention, weight gain, shortness of breath, fatigue.
Scotty was amazed at how much self-control Ted had. “He didn’t let on how sick he was. He didn’t complain, but he knew as well as I did that he was a dying man,” Scotty recalls.
That night Scotty and Tracie went to the hospital room, where Pat, Ted’s wife, was with him. “What the hell are you waiting for Ted?” Scotty asked. “Either you get a heart transplant or you die.”
“Well, then, I guess I don’t have any choice,” Ted replied. “Let’s go get a transplant.”
Under a Lucky Star
Getting a transplanT—it sounded so simple. The classic front-page photo showed a Learjet, a handsome doctor, and an Igloo ice chest with a human heart inside. In 1986 surgeons transplanted 1,368 hearts; a year later four out of five recipients were still alive. Ted Segal liked his chances. But little did he know as he steeled himself to face the calculable risks of the operating room that he would soon be wrestling with the ethical and procedural vagaries of a whole new branch of medicine: organ banks. At 53, Ted was full of hope. It was only after months of frustration that he began to think of his search for a new heart as his “odyssey.”
Ted had known for years that the only way he would live to see his fifty-fifth birthday was to have a heart transplant. His first heart attack had come in 1977. He was watching his younger daughter, Dena, play softball when he started to feel bad. He drove himself to the hospital, walked into the emergency room, and announced that he was having a heart attack. Sure enough, his diagnosis was correct; he was having a myocardial infarction—the official term for “heart attack.”
At one time, Ted had aspired to be a doctor. Born and raised in Dallas, he left home after high school to attend the University of Texas at Austin. Overcome by restlessness, he joined the Navy in 1951 and trained as a hospital assistant. In 1955 he headed to Southern Methodist University on the GI bill to major in pre-med.
Two years later, though, Ted caved in to parental pressure and joined the family cotton-products manufacturing business with the promise of eventual partnership. Soon after, he met Pat Gordon of Houston on a San Jacinto Day blind date, and it was love at first sight. Four months later Pat and Ted were married, and Pat was soon pregnant. She lost two babies and underwent eight hospitalizations before their first daughter, Tracie, was born in 1961. Unable to have more children, Pat and Ted adopted Dena, then Bradley, and their family was complete.
In 1966 the Segals moved to Waco to take over Pat’s parents’ maternity-wardrobe business. Money was tight, but Ted remained optimistic. “I was born under a lucky star,” he often told Pat. “Things are going to get better—as long as we have our health and our children.” Pat remembers that when Ted first saw her at the hospital after his heart attack, he asked, “Did Dena get a hit?”
The myocardial infarction left 20 to 30 percent of his heart muscle dead; even a man as athletic as Ted was lucky to survive. But he rebounded, and after rehabilitation he was running 25 to 30 miles a week. He had never felt better.
Then one day in 1982 he couldn’t run his usual five miles; he could run only two. It was only a small symptom, and he didn’t complain. He tried not to worry, but he felt worse and worse and finally ended up back in the hospital with another heart attack. Once in the coronary-care unit, Ted had a second coronary. The damage was so extensive that doctors decided bypass surgery wouldn’t help, and they told Ted that without a heart transplant, he would be sedentary for the rest of his life.
But in 1982 the “miracle” anti-rejection drug, cyclosporine-A, was not yet on the market, and there were only three places in the United States where heart transplant continued experimentally: The University of Pittsburgh School of Medicine, the Stanford University School of Medicine, and the Medical College of Virginia at Richmond. Ted was betting that technology would someday catch up with his problem; he purchased a $1 million catastrophic health insurance policy and hunkered down.
In 1984 the job he had taken as a traveling carpet salesman became too difficult. The foods that fit his low-cholesterol, salt-free diet were hard to find in hotels and restaurants, and Pat worried about him constantly. Eventually, Ted couldn’t lift the carpet samples out of his car for demonstrations. By the following year, his condition had made it impossible for him to work full time. He opened a carpet showroom in his home and worked whenever he could.
By March 1987, Ted could not even walk to the end of the driveway to take out the garbage without having to sit down to rest. Just talking exhausted him. His heart became so weak that it couldn’t pump the blood and fluid out—a condition known as congestive heart failure. When the fluid and blood backed into his lungs, Ted felt a choking sensation, a new and ominous development. He had enough knowledge of human anatomy to realize that it wouldn’t be long before his kidneys, liver, and other internal organs began to fail too.
Before his son-in-law walked into his hospital room that April night in 1987, Ted knew what his choices were. Transplantation and its aftermath were fearsome and mysterious, but they sure beat the hell out of the here and now.
The Cyclosporine Era
By April 1987, heart transplantation had become more common, and Ted had several Texas programs from which to choose—three in Dallas, two in Houston, two in San Antonio, and one in Austin. With the exception of the two in Houston, none of the programs was older than a year and a half.
American doctors had begun experimenting with heart transplants in the early sixties at Stanford and the Medical College of Virginia. Doctors learned early on that the real problem was not the surgery itself but rejection by the host’s immune system. Then in 1967 an unknown surgeon, Christiaan Barnard of Cape Town, South Africa, captured the world’s imagination with the first human-heart transplant. Within the next eighteen months, more than one hundred patients received heart transplants worldwide.
Many of the early operations took place in Houston. Dr. Michael DeBakey of Methodist Hospital and his student-turned-rival Denton Cooley of St. Luke’s Episcopal Hospital became the new superstars of medicine. One third of all transplants during the eighteen months after Barnard’s first operation occurred at Methodist or St. Luke’s.
The transplant surgery itself was simple enough. Once a donor heart was found, it was preserved in a saline solution, then packed on ice. Meanwhile, surgeons made an incision near the breastbone of the recipient, attached him to a machine that pumped oxygen and blood, and removed the old heart, except for the atria, or upper chambers. They next attached the old atria to the donor atria, pulmonary artery, and aorta. After the new heart was in place, they forced out the air, removed the clamps from the aorta so blood could flow, and waited for the heart to beat on its own.
The surgery worked, but most of the early patients were dead within two years. Some died from rejection. Others inadvertently succumbed to steroids and other drugs used to keep the immune system from attacking the new heart. Those powerful drugs also suppressed the body’s overall ability to fight infections, turning even the common cold into a killer. In 1970 most institutions, including the two in Houston, declared a moratorium on heart transplants.
Coincidentally, the year the moratorium began was also the year cyclosporine was discovered. When Jean Borel, a researcher at the Swiss drug company Sandoz Limited, was vacationing in Norway, his company asked him, as it does all of its traveling employees, to bring back soil samples. There was always the hope that some anti-cancer agent could be found in the soil organisms. The soil that Borel brought back had not one but two new forms of fungus, and one extract killed “clinically irrelevant organisms.”
His company was not impressed, but Borel persisted in his research and by 1972 discovered the remarkable immunosuppressive effect of cyclosporine. American scientists at Johns Hopkins University School of Medicine in Baltimore began experimenting with cyclosporine and over several years determined that whereas the previously used immunosuppressive drugs had decimated the immune system, leaving it vulnerable to infection, cyclosporine destroyed only the part that rejected foreign tissue. The Food and Drug Administration approved cyclosporine in 1983, and a new era of heart transplantation began.
