Discovery Denton Cooley
Two Hearts
In this exclusive excerpt from his memoir, 100,000 Hearts, the Houston surgeon gives his version of the stories behind a pair of operations that turned him into a world-famous figure—and sparked his decades-long estrangement from his colleague Michael DeBakey.
Courtesy of Texas Heart Institute
On December 3, 1967, shocking news arrived from South Africa: a Cape Town surgeon, Dr. Christiaan Barnard, had performed the first human heart transplant. Probably no operation in history had ever generated so much publicity. In my professional circles, the excitement was particularly intense. At the time, I was a professor of surgery at Houston’s Baylor University College of Medicine and a cardiovascular surgeon at Texas Children’s Hospital and St. Luke’s Episcopal Hospital, which were the bases for my newly created Texas Heart Institute. Like many of my colleagues, I had long regarded heart transplantation as the next necessary development in our field, and I was envious of Chris’s success. The day after the story broke, I sent him a telegram: “Congratulations on your first transplant, Chris. I will be reporting my first hundred soon.”
Chris’s patient, Louis Washkansky, died after eighteen days, but Chris was not discouraged and soon performed another transplant, with similar results. Within a short time, a couple of other surgeons in the United States followed suit, and their patients, too, died within days. Dr. Michael DeBakey, the chairman of the Department of Surgery at Baylor, appointed a committee to explore establishing a heart transplant program at Baylor-affiliated Methodist Hospital. He did not include me, even though I was by then the most experienced heart surgeon in the world. This slight wasn’t unintentional, nor was it altogether unexpected. Mike was a difficult man, and though we had had many professional successes in the sixteen years we had worked together, by the late sixties our relationship had, for a variety of reasons, deteriorated significantly.
Under these circumstances, I didn’t feel that I had to get Mike’s approval to proceed independently. I asked my surgical associates Grady Hallman and Robert Bloodwell, who worked with me at St. Luke’s and Texas Children’s, to be part of my team. I let them know that I was planning to do a transplant at the first opportunity.
On May 2, 1968, I was in Shreveport, Louisiana, giving a talk to the medical society there. Just before my presentation, reporters asked whether I was planning to do a heart transplant. I answered, truthfully, that I had no “immediate plans.” A couple of hours later, I got a call from Robert. “Boss, I think we’ve got a donor,” he told me. “A fifteen-year-old girl who shot herself in the head with a .22 pistol after arguing with her nineteen-year-old husband. Her brain waves have been flat for several hours, and I have permission to take her heart.” I immediately chartered a plane and returned to Houston.
As I was flying home, I thought of Everett Thomas, a 47-year-old accountant whose heart had been severely damaged by rheumatic fever. He’d had two heart attacks and two strokes. Three of his heart valves needed to be replaced. Mr. Thomas had come to Houston from Phoenix after hearing of my successful record with valve replacement. He had been bedridden for six weeks, and his prognosis was bleak. We had already planned to do a triple valve replacement, but the odds were greatly against his surviving the procedure. Nonetheless, he and his wife had decided to go ahead with the surgery, so we had scheduled it for the morning of May 3. When I got back to the hospital, I asked the Thomases an important question. If, during his valve replacement operation, it became clear that Mr. Thomas could not survive, would they consent to my placing our donor’s heart in his body? They agreed.
Shortly before midnight, members of my team transferred the donor from the municipal Ben Taub Hospital emergency room to an operating room at St. Luke’s. (There was a peculiar and fortuitous coincidence at work here: six years earlier, I had operated on the donor for a coarctation, or narrowing, of the aorta. That condition had left her with a permanently enlarged heart, which would be better able to handle the circulation of a large man.) Mr. Thomas was in an adjacent operating room. Once I saw the inside of his heart, I knew that it could not be repaired. The valves were more heavily calcified than I’d expected, and the septum was also involved. A transplant was the only recourse.
The procedure went smoothly; it took me only 35 minutes of pump time to do the transplant. But I wasn’t certain the new heart would regain function. When we removed the vascular clamps, the heart went into ventricular fibrillation, and I asked for the defibrillator paddles. After a single electrical jolt, the heart began a regular beat. I felt as if I had witnessed a miracle. (Mr. Thomas survived with his new heart for nearly seven months.)
Soon after, the wire services spread the story around the world. Mike DeBakey received the news when he arrived at Methodist that morning. He was so upset that he canceled his scheduled surgery and spent the morning sequestered in his office. Not surprisingly, our rift, which was already painful for me, widened even more.
In 1948, when Michael DeBakey joined Baylor, he was known not only for his talent as a surgeon but also for his connections with federal agencies that were granting large sums of money for medical research. He was an extremely hard worker; he slept little and basically spent his life at the medical school and Methodist Hospital. After I arrived at Baylor, in 1951, I soon learned that he was much feared by his trainees. When a surgical assistant did not meet Mike’s standards, he would denounce that assistant loudly and send him from the operating room like a schoolboy to the principal’s office.
During the first few years that Mike and I worked together, we got along well, and Mike’s tireless promotion of our work established Baylor as a leading center for vascular surgery. But soon, though Baylor’s golden age was just beginning, my relationship with Mike started to wane. Over the next few years, he began to treat me as a rival rather than a colleague. He excluded me from projects I was well qualified to engage in; he tried to claim Baylor’s ownership of innovations I had created on my own time; and he made sure that his patients always took priority over mine. There didn’t seem to be room for me at Methodist anymore.
So in 1954 and 1955 I moved my surgical practice to Texas Children’s and St. Luke’s. (Though I maintained my faculty position at Baylor.) It was at St. Luke’s that I performed the heart transplant on Everett Thomas in May 1968, and over the next few months I performed nine more such procedures. Each operation was a success on its own terms, but by the end of the year only one of my first ten patients was still alive. Most had died of infections they were unable to fight off because of the immunosuppressant drugs we had to give them to prevent their bodies from rejecting their new hearts.
One possible solution to this problem was a total artificial heart, also known as a TAH, which would not be subject to tissue rejection. Some of the initial work on the TAH was done in the fifties by Dr. Domingo Liotta, an Argentinean surgeon. In 1961 Mike offered Domingo a surgical fellowship at Baylor, a position that Domingo thought would allow him to develop his TAH. In fact, Mike was more interested in developing a workable partial artificial heart, or left ventricular assist device, a more modest pump that could provide temporary support for patients who developed potentially reversible cardiac failure after heart surgery.
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