A FEW DAYS BEFORE DECEMBER 20, Ronald Herrick received a phone call. It was the Brigham asking him to come in. The surgery was set for the morning of December 23. The date was the tenth anniversary of Charles Woods’s plane crashing on the runway in India. Thinking of that irony, as well as the effect of the scientific phenomenon of Charles’s skin grafts lasting beyond the usual, Joe wrote a note on his surgical schedule. December 23, 1954: kidney transplant.
Later, he would say, “I was aware of its historical significance. In truth, I treated it as just part of the week’s work. Two days prior to the transplant…I repaired a double cleft lip, resected a recurrent cancer of the mouth, corrected ‘lop’ ears in a child, and closed a burn.”
While planning the surgery, Joe and Dr. Merrill, the nephrologist on the team, disagreed on whether Richard’s diseased native kidneys should be removed. Joe wanted to take both kidneys out immediately, believing that leaving them in could pose a risk of infection that would transmit disease to the new kidney. Dr. Merrill, however, believed that Richard should keep at least one of his native kidneys to act as a sponge, absorbing any harmful substances that might remain. He also felt that if the transplanted kidney failed later on, the native kidney might recover well enough to resume functioning. Joe strongly disagreed.
Franny, after considering both sides, advised Joe to acquiesce. He felt the decision was more in the domain of the medical specialty of urology than of surgery.
With that disagreement solved, the next few days became a countdown. The city of Boston was on edge. The Brigham was primed.
Now Franny, despite his excitement, became cautious. A test run of the surgery on a cadaver might be a wise move. He wanted to make sure the transplanted kidney would fit comfortably in its new site. He and Joe discussed it and agreed to practice the surgery one more time.
Joe had studied and performed the surgery on animal models for years, searching for the right position to place the kidney, the right techniques for securing it and threading the ureter to the bladder in a natural course, or rerouting it. But, still, the idea of a rehearsal on a human body seemed wise.
Joe called pathology departments all across the city asking them to alert him the minute a patient died so he could use the cadaver for a trial run of the transplant. He then concentrated on making his schedule seem normal. He also kept reminding himself that in his lab, he had done the transplant surgery many times, discovering the best techniques by operating on dogs, with their veins and arteries a good match for those of a human. He had been exploring this exact surgery for nearly ten years. In Richard’s case, though, he would have no second chance. He added to his notes, “The kidney I was transplanting was the only compatible kidney in the entire universe! I did not want it to fail for any reason—especially for a reason I had neglected to anticipate.”
December 20, Ronald reported to the Brigham. Richard was already there, holding onto his life by a disappearing thread. They were put on different floors: Ronald on the first, Richard on the second. During Ronald’s discussions with the transplant team, Richard had been too ill to participate. Now that Ronald had been admitted to the hospital and the surgery was scheduled, Richard was distressed to learn of the sacrifice Ronald was about to make. He asked their Uncle Lee what he should do about it.
“Let things stand,” his uncle reassured him. “Ronald wants to do it. You’ll have the most skillful surgeons; the outcome will then be in God’s hands.”
At the Murray house that night, Joe and Bobby were throwing a neighborhood holiday party. It was cold and snowy. Seventy-five friends and neighbors were due to arrive at any minute. Joe was making the eggnog. He told his eight-year-old daughter Ginny to stay off the phone. He didn’t want to miss the critical phone call that a cadaver was available for the test run. He also worried that Richard would be lost if the surgery were not performed as planned. The dialysis was upsetting the balance of chemicals in Richard’s blood, which could cause serious cardiac irregularities. Coordinating the timing of the dialysis with the operation itself could avoid this risk.
When the phone rang, Joe was stirring the eggnog. Yes, a cadaver was available. It was at the Brigham’s pathology department.
Joe handed Bobby the eggnog. He kissed her goodbye and rushed to his car.
Anxiously he drove the icy roads into the city. And with his left-handed surgical instruments met Franny in the postmortem room. Together, they went through the entire operation, thinking of every possible surgical mishap. The test run took a couple of hours.
By the time Joe made it back home, the last of the guests were leaving. He drank some eggnog with them. And soon after he went to bed, feeling prepared to do the historic surgery three days later.
THE NIGHT OF DECEMBER 22, Richard sent Ronald a message: “You get out of here and go home!”
Ronald sent back: “I am here and I’m going to stay here. And that’s it.”
In the Murray home, Bobby told her children, “Daddy’s doing an important operation tomorrow. Let’s pray and hope it goes well.” They knelt, and Bobby led them in prayer. Even though they often did so, that night the prayer felt very different.
At dawn the next morning, Joe drove Route 9 to the Brigham, waving to commuters as he usually did. Suddenly, the car radio carried a news report of the historic surgery to be performed that day. Joe was still not prepared for the media attention. He also realized “it was both an education and a shock to discover how sustained and widespread public interest in organ transplantation was.” He knew that while some hoped for a success, others had taken the time to warn him that he could be jeopardizing his career by performing the risky surgery. In any case, if not all the radios in the world were tuned in to hearing what he and the Brigham were about to do, certainly most in the cars of his fellow commuters were.
As the stress built up, he took comfort in knowing that he had done all he could to be prepared for this moment. He also concentrated on the advice of a favorite theologian, Thomas Merton, who said that one’s work should be a “wordless prayer.”
Two days before Christmas, a Thursday, both Richard and Ronald were under anesthetic—Richard with a spinal, but sedated and unable to urge Ronald to go home. Joe walked into one operating room. Another surgical team with Franny and Dr. Harrison were in an adjacent room.
The surgery was set to begin on Richard at 8:45 a.m. By 9:50, the blood vessels to Ronald’s kidney were isolated and exposed, but still attached. Joe took a deep breath and gave Dr. Harrison the go-ahead to sever the blood supply from Ronald’s left normal kidney.
From that moment, the timing was critical. In a moment of near catastrophe, the clamp that Dr. Harrison had put on Ronald’s aorta suddenly slipped. A whoosh of blood flooded the operative field. Jumping into emergency mode, the surgical team offered hands to help control the bleeding. As soon as Dr. Harrison repaired the artery, he lifted out the donated kidney.
Wrapping it in a cold, wet towel, a member of the team then set it in a sterile stainless-steel basin and handed it to Franny. Quickly, but gently, Franny walked the gifted kidney to the adjacent room where Joe picked it up and placed it into the “bed” he had prepared for it in Richard’s abdomen. Now he worked rapidly to reestablish blood flow. He began suturing artery to artery, vein to vein, much as Carrel had taught fifty years before.
Clamps on two of Richard’s arteries, one supplying blood to his kidney, another to his leg, held back the means to keep the borrowed tissue alive. At 10:10, Joe finished joining arteries to the gifted kidney. The veins were taking longer. All the while, Joe was aware of the time ticking away—everyone was—but he could only continue to work carefully and systematically. At 11:15, he pulled through the last stitch.
Soon now, they would all know if he had succeeded.
A collective hush hung over the room as he gently removed the clamps from the vessels attached to Ronald’s transplanted kidney. For a total of an hour and twenty-two minutes, it had been without blood flow. Everyone on the team was breathing shallowly, barely pulling in air, as they watched Richard’s new kidney suddenly turn pink. Smiles broke out behind their masks, the creases at their eyes the outward signs of joy and relief.
Ten minutes later, Joe removed the last clamp from Richard’s iliac artery, and immediately the pulse in Richard’s right foot began visibly thumping.
The transplanted kidney lay comfortably in its new site, pulsing with life-giving fresh blood. Next, urine visibly began flowing from the catheter inserted in it. Joe soon began rerouting it into the bladder in its natural way. But until then, urine flowed so vigorously, it had to be mopped up from the floor. Comically, gloriously, the essential fluid spurted, making puddles, no longer stymied by disease.
NEWS OF THE SUCCESSFUL transplant sped around the world. Within days, those who were studying renal failure knew of it. Franny pointed out that the discovery of ether 108 years before had taken months to be known. And now, even science, with its age-old methods bound to facts and truth, was being affected by modern communication.
The next step was to duplicate the success of the transplant to prove that the procedure would indeed be lasting.
To many in the world of traditional medicine, the transplant’s success seemed a fluke. Doubters pointed out that many coincidences had to be in place to match its success. The gem at the center of the sparkling achievement was that the transplant had been performed on identical twins. And those twins had been young. One had been in the end stage of renal failure and also in the hands of a physician who referred the case to a transplant surgeon and team. Not everyone could be so lucky.
Joe and Franny and the Brigham team did not yet feel justified in publishing their results. Their scientific achievement had to be duplicated by others. Besides, to really make the surgery a success, Richard had to live. And Ronald had to show that giving away an organ did not compromise his future.
To Ronald and Richard the Socratic discussions were of little consequence. Their lives were what mattered. They were more than relieved. They were in shock with joy.
And so was Franny. He noted that since the Brigham team had overcome the immune barrier by transplanting a kidney between identical twins, it had proven that tissue transplantation was here to stay. More than likely, too, adding to his and the hospital staff’s euphoria were the rumors being whispered in the halls: Richard was falling in love.
ON JANUARY 29, 1955, Joe wrote: Since operation five weeks ago, Richard has done very well. The wounds healed rapidly, his transplant has functioned immediately and continuously. The course of the future is unknown and the best method of future treatment is a matter of conjecture only. In my opinion, his future longevity depends entirely on his transplant as an “all or none” phenomenon. Either the transplant will take or it will not. Therefore every possible and theoretical mode of protecting this transplant should be taken as soon as possible.
During those five weeks, Richard not only awoke to a second life, he began to luxuriate in it. Almost from the moment he shook off the sedation of surgery, his eyes took in the sight of Clare Burta, a nurse from Glace Bay, Nova Scotia, who was too far away to go home for that Christmas holiday. And since she couldn’t go home, she was on duty in the recovery room, where she first saw Richard. And he, her—each looking at the other with the same infatuated wonder.
Slim, with a light complexion, dark brown eyes, a reluctance to ever stop moving, and a dry sense of humor, Clare seemed to have a witty remark for every other moment. On that first day in the recovery room, she noted, “Most of the patients I see are unconscious, but Richard wasn’t because he had a spinal. It was just four days later on December 27 that I was sent up on private duty in the room where Richard was, and I spent the whole day with him. That did it.”
She not only attended to Richard’s every need, she also kept him aware of reconnecting with life. When Richard wondered if he shouldn’t laugh so often for fear of breaking open his stitches, she quipped, “Of course you should. It’s good for you.”
Not until April would they have their first date. After all, other matters had to be attended to first, such as getting Richard home as well as seeing about his two diseased kidneys still in place. For a while, Richard was the only person on earth walking around with three kidneys.
As for Joe, he felt that the Herrick operation was “no different from any of the other procedures that surrounded it.” Or at least he pretended that. On Christmas Day, he was at the Newton-Wellesley Hospital emergency room suturing a cut on a child’s forehead.
Ronald went home the first week in January and picked up where he left off in his college classes. Richard, in the Brigham, began eating all the foods he’d been denied before and spent the days flirting with Clare. On January 19, only twenty-seven days after the historic operation, he was discharged, and Ronald went to the hospital to accompany him back to a full life.
They were now household names. Almost everyone in America knew of the Herrick twins. As they reached the hospital door, the press was waiting. Flashbulbs popped. Writers gathered around for interviews. Ron, always ready to hide his feelings, said he hadn’t been anxious before the surgery at all. He deferred credit to the doctors, “We felt very strongly that it would work. Of course, it hadn’t been done before. But they knew their research.”
Back home in Northborough, Richard took up what he had been unable to do for nearly a year, eating everything in sight, taking walks outside, even thinking about going to college. Before the surgery, his heart had been enlarged and there had been fluid in his lungs. All that disappeared. Being alive was a shock, a welcome one; he realized he now had a future. He began thinking mostly of Clare.
After a few weeks, when his blood pressure began to rise and signs of infection surfaced, Joe scheduled surgeries to remove Richard’s diseased kidneys. Joe and Dr. Merrill now agreed that the transplanted kidney was working so well, it was reasonable to remove the nonfunctioning ones.
On March 29, Joe took out the first one; the other surgery was scheduled for June. In April, Richard took Clare out in his new car to, as he said, see how it ran. They drove around. Clare would soon say, “I knew then I wanted to marry Richard, and I kind of guessed he felt the same about me, but he hadn’t said anything.” Richard would later admit that he’d already decided the whole thing by that time. But he was still getting used to a retrieved life and didn’t want to jinx it.
To make sure that her feelings were what she thought they were, Clare took a job in a hospital in Texas. She stayed there for three months in the midst of oil-well country until a proposal from Richard arrived in the mail. It was “on Friday the thirteenth of all things,” Clare said, laughing, and “we decided to get married in Texas…. We knew there’d be a lot of to-do in Massachusetts where everyone knew about Richard…and marriage to me is a serious thing.” She had the quiet, simple ceremony she’d always wanted.