BY THE END OF JUNE 1950, Joe had finished his sixth-month rotation in plastic surgery that Franny had arranged for him at Memorial Hospital in New York. And he knew now—with no doubts—that he was going to pursue a career as a plastic surgeon. To become board certified, he needed another year of training, this time at New York Hospital across from Memorial.
Since the thought of being separated from his young family any longer was unbearable, he found an apartment ten minutes from the hospital. And Bobby, the girls, and the new baby on the way joined him there. By now he knew that family came first. Without Bobby and their children, he was adrift, unable to be at his best.
As 1951 arrived, Joe was winding up his last year in training and by the following July was back in Boston, ready to start private practice. Dr. Bradford Cannon took him on as a clinical associate and gave him space in his office on Dartmouth Street.
That first year, Joe had a total of three patients. He was also in debt for an examining table that he compared to a custom-made Ferrari. He kept busy as a plastic surgical consultant, accompanying Dr. Cannon on his hospital rounds to four hospitals. Each week, there were also tumor clinics at two veterans’ hospitals to attend. With his experience at Valley Forge and the New York hospitals, he felt ahead of the other surgeons. But he bit his tongue.
Sitting on his impatience, he waited. One day at a tumor conference, the surgeons at the conference table asked him how he would treat a man who had just come in with an extensive tongue cancer invading his jawbone. Joe had done just such a case while at New York Hospital. He laid out the procedures he had used to excise the cancer and perform immediate reconstruction. Usually reconstruction was performed in a later, separate operation, which, to Joe, made no sense. Do it all at once he thought; build back a face during the same surgery, as he had learned to do at Valley Forge.
When he finished laying out his plan for the patient, Dr. Cannon jumped in, saying, “Give the kid a chance.” Joe suspected Dr. Cannon must have briefed the chief of surgery on his frustration, for now the chief quickly echoed, “How about we give the young fellow a chance to show what he can do?”
Joe performed the surgery. He took out the tumor and used a bone graft to replace the excised part of the jawbone. A week later, when he returned to Veterans Hospital, the staff greeted him as a hero. No one expected the patient to recover from such extensive surgery without serious complications.
Joe’s specialized practice was now launched.
No plastic surgery service existed at the Brigham; a weekly visit from the plastic surgeon at Children’s Hospital was serving the Brigham’s needs. When Franny invited Joe to treat patients there, he jumped at the chance. In joining the staff, he would not only be doing plastic surgery as well as general surgery, he would also be allowed to explore his seemingly off-the-wall idea of kidney transplantation. Already in place at the Brigham was a program for the treatment of kidney disease, with hospital administrators, physicians, surgeons, pathologists, radiologists, nurses, and social workers ready to take on the unprecedented effort of treating end-stage renal disease with a groundbreaking approach.
There were warnings, though. Many called organ transplantation science fiction, a field for fools. Joe was told that he could harm his career. If organ transplantation was viewed as a risky field only for the foolhardy, Joe was more than happy to sign on as a member. Despite the seemingly miraculous invention of the dialysis machine, its limits were becoming heartbreakingly clear. Dialysis could keep a patient alive for only so long, and as those with chronic, ongoing kidney failure were kept alive for weeks, months, or even a year, without the hope of replacing their diseased kidneys there was no future to look forward to.
In March 1951, that exact situation led to the first desperate and remarkable attempt to transplant a kidney. A thirty-seven-year-old man came to the Springfield Hospital with his kidneys failing. His surgeon, James Scola, asked the Brigham to accept him for dialysis. As a child, the man had developed glomerulonephritis after a severe streptococcal sore throat. The dangerous bacterium that often causes strep throat can be cured with penicillin, but when the man contracted strep as a child, penicillin was not available to the general public. Now that early bout of strep had left damage to his kidneys, and that damage threatened his life.
At the Brigham, he received dialysis, which improved his condition. But his well-being was only temporary. Every day he moved closer to death. He went back to the Springfield Hospital with no future, no hope, and no options. When Dr. Scola told him that a nearby dying patient had offered his kidney on the chance it could be transplanted, the man jumped at the idea.
In groundbreaking surgery, Dr. Scola placed the donor kidney in his desperate patient, attaching its blood supply by the intricate suture anastomosis devised by Alexis Carrel decades before. The borrowed kidney was without a blood supply for seventy minutes.
The Brigham transplant team closely followed this historic first try. After surgery, the patient was sent back to the Brigham where the transplant team could care for him with the dialysis machine standing by. For a few days, he did well. But the output from the transplanted kidney was meager, certainly not enough to maintain a normal life. Dialysis could not relieve his progressing renal failure, and five weeks after the risk-taking surgery, he died.
During an autopsy, the borrowed kidney was found to be surrounded by infection, showing all the changes associated with rejection.
Three weeks later, refusing to give up, the Brigham transplant team decided to try a different tactic. Kidney transplantation now appeared the only option to relieve not only suffering, but an end to the added suffering of having no hope to live without it. In April 1951, the Brigham surgical team designed a new trial. They placed kidneys in the upper thighs of patients being kept alive only by dialysis.
Placing a kidney in the thigh required only local anesthesia. Furthermore, the transplanted kidney could easily be monitored and, if found to be harming the patient, easily removed. These kidneys came from within the hospital as by-products of surgery for hydrocephalus, also known also “water on the brain.” In children the condition is usually caused by a congenital abnormality, leading to an accumulation of too much fluid in the ventricles of the brain. A former classmate of Franny, Don Matson, had advanced a procedure to relieve the pressure by placing a small plastic tube, a shunt, to drain the fluid from the child’s brain into the ureter, out through the bladder. In that way, the excess fluid was flushed from the child’s body along with urine. In placing the shunt, the surgery required that one kidney had to be sacrificed.
Don’s support was critical. Franny had asked him to see if the children’s parents would donate the sacrificed kidneys to the transplant trials. After all, he and Don were bonded from their mischief-making days when Don put on a grass skirt to spoof the Harvard Medical School faculty in a skit. That Franny asked Don to supply kidneys for their new trial made a lot of sense. In the 1940s, Don had supplied spare kidneys for vaccine research, sending them across the street to Boston Children’s Hospital, where a team of residents led by Dr. John Enders was trying to grow viruses in tissue culture with the goal of producing vaccines to prevent them. One day Enders and his residents Weller and Robbins put various viruses, along with the poliovirus, in one of Don’s donated human kidney tissues and, astonished, watched it begin to grow. There was the answer that Jonas Salk had been searching for: kidney tissue could become the means to produce the virus to harvest for a vaccine. The discovery led to Enders and his residents being awarded the Nobel Prize in 1954.
During the war, Don had served close to the front lines, collecting information for new surgical treatments for brain injuries, which he then summarized for the surgeon general. Eventually he would become famous for publishing the first comprehensive text on the neurosurgery of infancy and childhood. His residents looked upon him with awe and trepidation, but with really no need. He had such a mild temperament that he would often nudge aside a resident in the midst of surgery, saying gently, “Let me take a look for a minute.” When Joe and Franny asked him to participate in the thigh-kidney trials, he was happy to oblige and passed along sacrificed kidneys to give hope to those dying of renal failure.
For a while, those kidneys worked well. They held good color. They made urine. But within days, things changed. The kidneys lost color. They shriveled and stopped putting out urine. The patient showed signs of battling rejection and soon died.
Dejected, the surgeon-scientists assessed what the trials had made clear. Rejection was more complicated than anyone had guessed. Joe and Franny took comfort in reminding themselves that “a start must be made if anything at all is to be achieved.”
Now they were back to square one.