CHAPTER 3

After a quarrel with her estranged husband, followed by a yelling argument with her mother for an entire afternoon, a 23-year-old pregnant Houston cocktail waitress named Elizabeth Dagley locked herself in the bathroom in mid-April, 1970, shook out 50 Valium tranquilizer tablets into her hand, took every one of them, swallowed something else from another bottle she found in the medicine cabinet, and lay down to die. Her mother discovered her and phoned for an ambulance, which rushed the girl to Ben Taub General, the charity hospital for Houston and Harris County, named after DeBakey’s friend and benefactor. Ben Taub is located in the Texas Medical Center, connected by tunnel with the Baylor College of Medicine, and but a few hundred yards away from Methodist and St. Luke’s Episcopal hospitals.

At first glance, Taub’s Emergency Room seems a carnival of suffering, violence, and delay. At the admitting desk, mothers stand with feverish children slung whimpering over their hips, alcoholics tremble with DTS, children who have fallen out of trees or stepped on nails or pulled pans of boiling grease onto their heads, wait to be treated by an exhausted but usually efficient team of residents and interns from adjoining Baylor. Some women have learned to wait until after 10 P.M. to bring their sick children in, knowing that the pediatric clinic closes at that hour and that in the turbulence of the Emergency Room, they can often get by without paying, and can almost always get faster service. One of the duties of the poor is to wait.

Several times each night and double that on weekends, people whose lives have been very nearly destroyed by bullet or knife or cars or their own hand are brought dying to Taub’s Emergency Room and hurried into one of two Shock Rooms. A team of fifteen doctors and nurses swarm over the victim and within seconds have intravenous fluids started in both arms, an airway, if needed, jammed down the throat, bleeding stopped, vital signs measured, and on the most desperate occasion have cracked the chest for emergency surgery. Every city should have Shock Rooms like these, manned by round-the-clock teams, but they are an enormous expense to equip and operate; most hospitals settle for those Emergency Rooms that are all too often staffed by a nurse who is somewhere else in the building when a case comes in and who has to telephone the doctor “on call.” Translated, that often means he is at home. Sick people die every day while the nice woman from Admitting is asking questions about Blue Cross and putting a plastic identification bracelet on their arms.

When Elizabeth Dagley was wheeled into the Taub Emergency Room, no questions were asked. The ambulance driver shouted “OD” as he pushed the stretcher through the doors and a resident directed the stretcher to the room in Emergency where overdoses are treated. Two or three suicide attempts come in each night, but unless there is great loss of blood, they do not have to go to the Shock Room. Elizabeth, woozy but still conscious, confessed that she had taken 50 Valiums. “Anything else?” asked the tired young doctor. Elizabeth shook her head negatively. She was given a drug to make her vomit and her stomach was washed out, a messy, smelly process. A tube was rammed down her throat into her stomach and water was pumped down, 50 cc’s at a time, then drawn back up with a suction machine, repeated over and over until the water came up clear. An intravenous was put in her arm to flood the body with fluids and step up urination, to pass out tranquilizers that might have reached her kidney.

But within a few hours, Elizabeth fell into a coma and started turning blue—symptomatic of barbiturate poisoning. She had also taken, it turned out, a hefty dose of phenobarbital but had not told the doctor about this. It was attacking her liver and brain. “There are two kinds of suicides,” observed one of the residents. “Those who mean it, and those who don’t. This old gal obviously meant it, or else she would have told us about the phenobarb.” Elizabeth stayed in a coma for four days and on the afternoon of the fifth, her brain waves went flat. After a few hours, she was pronounced “brain dead” by a staff neurologist.

When a young, previously healthy, and—that curious medical term—“well-nourished” person dies, the nearest relative is routinely asked to consider donating organs to potential recipients who might be waiting. Elizabeth’s distraught mother agreed and telephone calls quickly poured out to hospitals and medical centers in the area.

Did Galveston need an eye? A cornea? No.

Did Dallas have anybody worked up and waiting? Parkland Hospital there could use a kidney. Could Houston do tissue typing and fly it up?

Someone remembered that Howard Stapler was across the street at Methodist waiting for a heart; Ted Diethrich was notified. He felt Elizabeth’s heart was worth studying for a possible match. He hung up the phone and hurriedly instructed his research nurse, Kem, to prepare the cardiac preservation chamber.

In 1967, when transplantation of hearts was still confined to dogs, Diethrich had found some research money and persuaded the Grumman Aerospace Corporation to put engineers to work constructing a machine about the size of a kitchen dishwasher. The idea was to remove both heart and lungs from a donor, put them into the chamber, bathe them with a cooling mist, keep them under constant monitoring, and preserve them alive and healthy until they could be transplanted into a recipient. The chamber had to be small and portable so it could be flown anywhere in the world. Several dog hearts had been kept alive for more than 30 hours, and on one occasion, in late 1969, a human heart had lived within the chamber for almost two days. As a test, Diethrich even chartered a Lear jet and flew the chamber successfully to a hospital in San Antonio. To see the suspended organs pulsating within the chamber—the heart beating from its natural pacemaker—seemingly floating in the mist, was to think of the lab in a horror film. Diethrich took a lot of kidding as Dr. Frankenstein. He saw his project in a different light. “This is outer-space medicine,” he said.

Stapler was not notified this stormy April late afternoon that the heart of a “technically dead” cocktail waitress was being considered for him. Twice before his hopes had been aroused, twice before the match had been deemed too poor to attempt. The results of heart transplantation during the years 1968 to 1969 had been so disappointing that only the best matches of donor and recipient were even being considered now. One of the other facts that nagged at Stapler’s doctors was his morale: his decade of pain and sickness had left him addicted to morphine, had made him listless, had gravely depressed him.

The room was almost dark, and outside, rain swept against the windows in sheets. Stapler was dozing in his chair, a Western paperback open in his lap. When the door opened and the crack of light fell across his face, he opened his eyes. I started to leave, apologizing, but he called out. “No, no, come in. I’m not asleep. I was just reading.…” He held up the book. “I like the kind of stuff Ike used to read,” he said. “And he fooled a few heart doctors in his time, too.”

He got up slowly and eased his thin, unused body into the bed, gesturing for me to take his chair. He found a cigarette and lit it with a I-know-I’m-not-supposed-to shrug. “I was thinking of my home,” he said. He did not turn on the light for a while and there were only the voices of two strangers and the glow of his cigarette in the room.

“It’s a small town in Indiana, sort of an artists’ colony, real rustic, the new buildings aren’t very popular there. Even the new bank looks a hundred years old. We’re old fashioned there. My kids read about juvenile delinquency and student protest and they say, ‘Daddy, what’s that?’”

There was an accordion-file folder of family pictures beside his bed and next to it, a stack of Polaroid color photographs. He dealt them out on the bed in front of him, a man playing solitaire with the images of his children. I wanted to tell him that two floors below men and women were preparing to study a dead woman’s heart to see if it could fit into this ghostly white body. Instead I asked if he would tell me the history of his illness. His eyes almost brightened; for a few moments, as he spun his tale, they lost the film that had grayed them. He knew his story well, he had exact dates, hours, minutes of his multiplying catastrophes. It became apparent that his heart was the dominant factor of his life. It was his occupation. It was his obsession.

“On January 16, 1961,” he began, “I was driving down the highway. I was in sales and promotion for heavy industrial equipment. Nice day. No ice on the road. I had both hands on the wheel and suddenly pain shot down both of them. I stopped the car and got nauseated and opened the door and vomited. I drove on after a while and I must have stopped a dozen more times. I finally got to a hospital in Franklin, Indiana, and four days later—a Sunday morning—I had a second heart attack. I spent four months there. They let me go back to work on July 1, and exactly thirteen days later I had a third heart attack in an Indianapolis hotel. This time I knew what was happening, so I drove myself to the Methodist Hospital. By April, 1965, I had had seven heart attacks.

“I went to one of the specialists in Cleveland and he examined me and condemned me to die. He gave me six months, a year at best. He said if I ever ran a dozen steps, I would meet my Maker. Well, you can imagine how many different doctors I must have talked to from 1961 to 1965, and I kept noticing that all of them would tell me different things. I started reading the medical journals and asked pretty good questions, and some of the damn doctors—pardon my French—didn’t even know what I was talking about, much less know how to answer my questions.

“One afternoon in November, ’65, I’d been to a cardiologist in Indianapolis and I’d picked up my heart catheterization report and I was driving down the I-65 and got a little tired so I stopped off at a roadside park. I was reading the cath, trying to figure out what it meant, and somehow—I’ll never know the reason—the name DeBakey flashed into my head. I had a $10 roll of quarters in my pocket. I decided to go for broke and call him. I found a pay phone and dialed Houston. He answered the phone himself. I gave him my case history while all the while dropping quarters in the phone. When I was down to fifty cents, he told me to come right on down to Houston.

“DeBakey operated on December 27, 1965, he went in and scraped the heart raw and implanted an artery. The next day my house burned to the ground in Indiana! My family didn’t tell me about it for six weeks. They didn’t want to excite me any more than I was. DeBakey’s operation did some good, but by late 1966 the pain was back and so bad that DeBakey did another artery implant. I went home to Indiana and sat around and made a big mistake by reading about a new gas-jet operation they were doing in New York City. I asked around about it, and a doctor friend said if I went there and had it, I’d come home in a pine box.

“I had learned you shouldn’t always believe doctors, so I went to New York City. And that was the biggest mistake I ever made. It was June, ’68, and they did this new operation on me—they shoot little jets of carbon dioxide gas into the blocked-up heart arteries and pull out cores of blockage—and while I was still in Intensive Care, I got up goofy and walked out of the hospital and actually made it several blocks before somebody missed me and went out to look for me. When they found me, I was dragging bottles, IV tubes and squirting blood out of my femoral artery every time my heart beat. To top that, the new operation worked for about two weeks before the arteries clotted up again, and when I got home I was bedridden two months with infection.”

Stapler took a long sip of ice water, but ignored the food tray that a dietician had brought in during his monologue. Could he eat the night of his transplant?

“From 1968 on,” he continued, “I’ve had almost constant pain from angina; if you took a hammer and hit each one of my fingers, it wouldn’t hurt more than it does now. DeBakey tried two months ago to do something else, but my heart stopped cold during the operation. Dr. Dennis, he’s my cardiologist, he came out and told my wife he was extremely sorry but this time I was definitely dead. About 30 minutes later out comes DeBakey grinning and shouting, ‘We did it! We did it!’ But what he meant was that he had started up the heart.”

But what were his thoughts about borrowing someone else’s heart? The dice seemed to have only twos and twelves in them.

“I’ve already died four times,” he said softly. “Once in an ambulance on the way to some hospital, somewhere, my heart stopped and the attendant beat on me with his fist so hard and so long that my chest was black and blue for months. I’ve got 75 inches of scars on my chest and there’s nothing left but to try another heart.… I never thought I would die. I still have a little optimism left. My kids are too precious for me to leave. I’ve got a nice little wood-working shop to go home to and I’ll make somebody some nice cabinets and tables.”

He fell silent and I thanked him and started out. He stopped me. “Some day I’m going to be lying here in the middle of a Zane Grey and the nurse is going to come in and say, ‘Okay, Howard, up and at ’em. There’s a heart downstairs with your name on it.’”

As Stapler talked, Diethrich was at that very moment learning that Elizabeth Dagley had suffered severe pneumonia during the five days she lay comatose. Her heart was too contaminated by pneumonia to consider using it for transplantation. All Howard Stapler would receive this night would be a shot to kill his pain and a shot to put him to sleep. No sooner had the surgeon called off the cardiac preservation chamber than did the telephone ring again. This time it was Dr. Suki, a renal specialist at Baylor, asking if Diethrich could do a kidney transplant later that night. Diethrich agreed. He did not ask who the donor was, nor who the recipient would be. Not until a few moments before the operation began would he learn that the kidney had come from Elizabeth Dagley. Her heart was not suitable for a transplant, but neither of her kidneys had been affected by the pneumonia.

Two months before this, an eleven-year-old boy named Wesley Connor from Fort Polk, Louisiana, had been worked up by Dr. Suki, found to be a suitable candidate for a kidney transplant, and was told to stand by at his home. Wesley had been born with a chronic bladder condition, which had destroyed his kidneys; he had been urinating through two holes created near his navel, the urine flowing into pouches strapped around his waist. His mother and stepfather had bought a new car in anticipation of a sudden emergency summons. On the afternoon it arrived, they scooped up Wesley from a playground and were racing toward Houston.

The body of Elizabeth Dagley was transferred by ambulance the 1,500 yards across the Medical Center and she was wheeled into Room 3. The respirator was forcing her lungs to inhale and exhale; the illusion of life still clung to her. But her face was shut by death.

At 10:35 P.M. Diethrich scrubbed to go into surgery. Jerry Naifeh, the medical student, asked him what the case was going to be. “Kidney transplant.”

“Who’s the recipient?” asked Jerry.

“Some kid. I don’t know him,” said Diethrich.

“Who’s the donor?”

“Cadaver. I’m just going to sew it in. This is the odd thing about transplant surgery; you don’t meet the patients sometimes until you see them on the table.”

Wesley was being prepared for surgery. A round-faced blond youngster with freckles, he had wide blue eyes stretched with apprehension over what was going to happen. Patients normally are sedated in their rooms before surgery so that they enter the operating room tranquil and sleepy. But Wesley had gone directly from his stepfather’s new car into the operating room. A nurse was bent over him, gently talking nonstop, diverting his attention from the hot lights and the dozen people busied about him with needles, bottles, and tubes.

“Do you have a dog? Do you help your mama? Do you like to cook? Hamburgers? You seem like a 100 percent boy to me.…”

Wesley looked up and saw the off-duty nurses and students watching from the glass dome. A transplant always draws an audience. The nurse threw her hand over his eyes to block the sight but it was not necessary; the anesthesiologist had gone to work and the child’s eyes closed quickly on their own.

It was almost midnight when Diethrich opened Wesley’s abdomen and removed his kidney, a shriveled, useless organ. It was sent to pathology for examination and study. In the adjoining operating room, a resident had sliced open Elizabeth’s stomach not quite so carefully and removed both of the kidneys. Mrs. Dietrich (no relation to Ted Diethrich) the head operating room nurse, put one kidney into a steel mixing bowl filled with saline solution and bore it cautiously to Wesley’s room. It had been carefully flushed with a solution to remove any blood clots and the tranquilizers and barbiturates that Elizabeth had used to destroy herself.

Several doctors were around the table watching the transplant. “I don’t know how in hell Ted’s going to fit that big kidney in that little boy’s pelvis,” one of them said. The girl’s kidney was approximately twice the size of the one from the child that had been removed. The doctor beside him drawled loudly, “I hope y’all washed the barbiturates out of that gal’s kidney; you don’t wanna put this little boy to sleep forever.”

Mrs. Dietrich bustled next door again to supervise the packing of Elizabeth’s other kidney for shipment to Dallas. The respirator had been turned off and Elizabeth Dagley was forever dead. A resident was stitching up her incision; someone had tied a tag with her name on it around her toe. The color of death is blue if the breathing stops first; if the heart stops first, it is gray.

Though she had been technically dead for nine hours now, Elizabeth was still building up a sizable hospital bill: the ambulance ride across the Medical Center, the operating room fees, the surgeon’s charges. But Wesley’s mother had agreed to pay for all of the donor’s expenses; it has become established hospital policy for the recipient to bear the donor’s charges.

Mrs. Dietrich had found a white styrofoam case about a foot high. The kidney was put into a steel canister, floating in a solution of cold saline and then into the styrofoam case. There was a slight argument between the efficient, veteran nurse and one of the young doctors about whether to use dry ice or real ice packed around the canister. Mrs. Dietrich, who wanted a small amount of dry ice, pointed out that it would not be proper to send Dallas a frozen-solid kidney. “Hmmm. I guess you’re right,” said the young doctor.

“Who’s going to take it up?” someone asked.

“Probably some Braniff stewardess in her flight bag,” said someone else.

Somebody stuck their head in the operating room door and said, “No hurry. Dallas found a pilot who’s coming down to get it.”

Mrs. Dietrich dropped dry ice into the box, sealed it up, wrapped it well with tape, and slapped a FRAGILE, HANDLE WITH CARE sticker on top. Dr. Suki had prepared a letter with the tissue typing results, which was Scotch-taped on the side. The box was carefully carried out to the operating room administration desk, where an assistant hospital administrator would watch it until the messenger came to take it to the airport.

Wesley’s right colon had to be moved up a bit to accommodate the new kidney: the child gained exactly one pound during surgery. Seven hours later, a transplant team in Dallas sewed Elizabeth’s other kidney into a young man.

The next afternoon in DeBakey’s bullpen, Hans, the German doctor, was talking with some of the students and residents about transplants. In his country, Hans said, a flat brain wave is required for 24 hours before the patient is legally dead. “Here,” said Hans, “as soon as the wave goes flat, they start transplanting.”

DeBakey was back. He returned to a house full of patients. Polly Tovar, his admissions secretary, does not need his authorization to tell patients to come to Houston. She takes most of his long-distance telephone calls, notes the particulars of the case and the referring doctor’s opinion, and makes a generally immediate appointment for the patient to enter Methodist on a given date. Surprisingly, it is not difficult to gain admission to DeBakey’s service, nor is there a waiting period of seldom more than a few days.

On afternoon rounds DeBakey was in a good mood; most everyone he had operated on before his European trip was now ready to go home, stitches out, bags packed, hopes up. “I’m sorry to ask this, Dr. DeBakey,” said one elderly woman, almost timidly, “but I sure would like to get out of here.”

“Don’t be sorry about that,” answered DeBakey, beaming. “That’s what we doctors like to hear.”

He dismissed Stapler, telling him he could just as easily wait for a heart at home in Indiana. “It doesn’t take long to fly here, does it?”

“Couple of hours,” said Stapler.

“You go on home then, and we’ll let you know just as soon as we might be able to do something for you.”

Stapler nodded glumly. His disappointment was clear. A year earlier there would have been more enthusiasm to transplant him.

Diane Perlman was not tolerating the pain from her amputation. Jerry Johnson had become concerned over pus at the site of her wound and had mentioned casually that DeBakey would take a look at it upon his return from Europe. Mrs. Perlman referred to this while DeBakey was examining her. His face visibly tensed. Outside, he stood Johnson against the wall. “You don’t know anything,” he said. “You don’t know enough yet to tell anybody when I should see them.”

Johnson had unknowingly committed a blunder that others had learned in similar hard ways: be extremely cautious in communicating postoperative complications. Years ago, one resident even wrote down three rules and passed them on to his successor. They were:

“1. If the complication is minor, treat it yourself, keep it to yourself, and pray that it works.

“2. If it is major, wait for the best opportune moment—it may never come—to tell the Professor that the patient is infected or that the graft is bleeding.

“3. If the patient dies, pray that the Professor is out of town.”

DeBakey’s attitude toward death was puzzling; no physician likes to lose patients. DeBakey, however, took death as an intolerable almost personal affront to his skill, to his very being. On the rare occasion that patients died on his table, he would cancel the rest of the day’s schedule, stalk to his office, shut the door, lock it, and stay inside for hours.

One prominent Houston surgeon remembers an incident that occurred a few years ago. The story sounds suspiciously apocryphal, but the surgeon swears he witnessed it. “The quickest way to get fired off the Professor’s service was to have someone die on you in ICU. He’d come in with storm clouds over his head and look at the patient and after a long while he’d look at you and he’d say, ‘I don’t understand this, Doctor. I gave this patient a perfect operation and now he’s dead. How could this happen?’ Well, sometimes he was right. Often complications were the fault of the younger guys, but when a surgeon does as many operations as DeBakey does, you cannot expect 100 percent recovery. One afternoon a resident was on duty in ICU and it was a day when DeBakey was leaving on a long trip. Suddenly one of the patients upped and died. The resident was petrified. He had already done a few wrong things; this was a major crime. He knew DeBakey would be coming through on rounds just before he left for the airport. So he took the monitoring wires off the dead man and transferred them to the patient in the next bed. He dumped a lot of medication down the dead man’s IV tube, made sure the respirator was working, and swore the nurse to secrecy. DeBakey came through on rounds, stopped at the dead man’s bed, looked at the monitor. The resident murmured, ‘He’s doing about the same, Dr. DeBakey,’ and DeBakey flew off. The moment he left the hospital, the kid disconnected everything and pronounced the guy.”

DeBakey’s transplant team did four more kidney transplants the same week Wesley received his. Baylor hurried out a press release claiming a world’s record, five kidneys in five days. All were “doing satisfactorily.”

Seven days after his bypass operation, Arthur Bingham was preparing to go home to Phoenix. His color was good, his eyes were clear, he yearned for a cigarette, but he had not smoked one even though his fist clenched when others did around him. Diethrich had pronounced the new artery within his heart to be working beautifully, maintaining a good flow of blood. Bingham could have posed as a testimonial to the new procedure. “The only thing bothering me is The Roadrunner in the next bed,” he said, pointing to a middle-aged man asleep. “Last night he stood up in bed and started taking his clothes off and thrashing around and yelling, ‘Let’s get outta this cheap hotel.’ Then he urinated in the wastebasket. He’s an old bachelor, he told me, and he’s scared and lonely.”

The Roadrunner was Miles Vogler, a merchant from Denver, who had come to Houston complaining of severe pains in his legs. He could not walk very far without having to stop and rest. An arteriogram revealed occlusion in his lower abdominal aorta, and Diethrich recommended a Leriche operation—a bypass around the obstruction using a Y-shaped Dacron graft, where the aorta branched off to supply the legs with blood. Vogler listened attentively as it was explained where the graft would be implanted in the area above the groin, then beckoned for Diethrich to come close so they could talk confidentially.

“I’ve been a bachelor all my life,” he said in a gravelly voice. “I’m 55, and I never really fell in love. My doctor back home told me my sex life was about over, but Doc, I can tell you it isn’t. I went to St. Paul a while back and met this lady and we made love twice a day for five days. Now I ask you, does that sound like my sex life is over? What I’m getting at, Doc, I just don’t want you to cut anything you don’t have to.”

Diethrich nodded seriously. “This procedure will help the circulation in your legs only,” said Ted. “As to your sex life, I congratulate you. I promise not to hurt it, but on the other hand, I can’t guarantee it will be any better.”

Vogler bit his lower lip. A few moments passed. He began hesitantly. “Well … okay.… When do you wanna do it?”

“Tomorrow.”

“That soon?”

“Why not?”

“I guess so.”

Vogler was scheduled, but that very night he packed up his things, ran frightened out of the hospital and flew back to Denver. A nurse witnessed the flight and reported, “He looked just like The Road-runner.”

About a fortnight later, the Roadrunner came beep-beeping back into the hospital, almost knocked down the same nurse, scurried up to Diethrich and once more agreed to surgery. The surgeon scheduled him the first thing the next morning, “before he gets scared and runs out again.” The operation was entirely successful, but Vogler was still mentally fuzzy from the anesthesia and his stay in Intensive Care Unit. “Sometimes it takes a few days for the older patients to get their marbles lined up again,” explained an anesthesiologist.

Later that week, DeBakey did six beautiful operations, including an aortic arch aneurysm, impeccably excised and replaced with a Dacron graft. This is DeBakey’s specialty; had he never touched a human heart, his place in the history books would have been secure from this work alone. Before 1952, these insidious weaknesses anywhere along the aorta would swell and eventually rupture—the classic lay description is that of a bubble in an inner tube—and, as one surgeon recalls, “There was nothing for us to do but sit around in the coffee room and make bets as to when the aneurysm in Room 306 would burst and die.” There is confusion as to who actually did the first excision and repair of aneurysms—some claim DeBakey in the 1951–52 period, others claim Dr. DuBost of France slightly earlier, but there is no doubt that DeBakey became the foremost practitioner and preacher of the gospel. In the mid-1950s at national medical meetings, some surgeons would get up and say it was dangerous, reckless, and foolish to even attempt such surgery; others would stand and report a series of six or ten. DeBakey would rise and report a series of two hundred and fifty, with such spectacularly low mortality rates that those present would either draw in their breaths in surprise or express disbelief.

One Houston physician who has worked with both DeBakey and Cooley recalled those early years:

“Both men always reported such excellent results that their peers thought they were liars. They weren’t out-and-out liars, but what you call an improved patient is a value judgment. You may cure a patient’s headache but have to cut his leg off.

“Mike and Denton accepted every speaking invitation from every county medical society. Mike became known as fearless for tackling desperate situations, ruptured abdominal aneurysms. They rapidly had their referrals and they rapidly had the largest series of operations ever reported. Pretty soon the guy with the aneurysm in New York would ask his doctor, ‘Who’s the best surgeon in this field?’ and the doctor would answer, ‘I don’t know who’s the best but the guy who’s done the most is Mike DeBakey.’ And the parent with a child with a hole in his heart would ask his doctor in Seattle, ‘Who’s the best for this?’ and his doctor would say, ‘I don’t know who’s the best but the guy who’s done the most is Cooley in Houston.’ And they very rapidly outstripped the more experienced and better known. Neither man oddly has ever relied on local referrals. Cooley gets a few; DeBakey gets hardly any at all.” Neither world-famous surgeon is greatly popular in Houston’s medical community.

When Albert Einstein suffered a ruptured aneurysm in 1955, his doctor telephoned DeBakey, described the case, and asked if surgery was possible. “By all means,” said DeBakey over long distance. “In fact, I will dictate what needs to be done.” But Einstein, perhaps feeling his work was done, refused surgery and died.

A young surgeon named Don Bricker came to Houston in 1961 from Cornell and was astonished to discover how rapidly and efficiently aneurysms were done, and the scope of the cases. “I had been in New York City and there was only one surgeon there even attempting them, and he took five or six hours on a case, and the patient often died. I walked into DeBakey’s OR and he’s doing five or six cases a day, and he took an hour on each one at best, and most of them lived!”

As he neared 62, everyone said DeBakey was making a few concessions to age. Rarely did he operate alone, calling upon Ted Diethrich or George Noon more and more to first-assist, and because they were full-fledged surgeons, often they did more. He no longer scheduled surgery on Christmas Day. (On a Christmas not too many years back, DeBakey was making rounds when he suddenly stopped to complain, “Where are all the residents? Where are all the interns and students? Nobody wants to help me; nobody cares anything about medicine any more.” The resident accompanying him said, “Sir, they’re all at home celebrating the birth of another great man.” And DeBakey laughed.) Sundays were usually free now, but not always. Last year a DeBakey patient had been scheduled for an aneurysm operation on a Tuesday when suddenly one Sunday morning while sitting up in his bed he ruptured. DeBakey rushed him to the operating room, lost him, and then told his resident John Russell that he was going to operate on every aneurysm in the house. By late Sunday night he had done three or four, and none was in further danger of rupturing.

There was open gossip that the eyes looming so large behind the trifocals were not as strong as once they were; for that reason, people said, he did not attempt the spectacular but optically grueling coronary artery bypass. But on this April day, as he sliced and sewed in an aortic valve into the heart, as he beckoned for a visiting surgeon to come closer and look, it would have been difficult to fault any part of the man or his work. He operated as surely as any master craftsman. He grumped twice about his assistants, saying “Can’t we do this right? For God’s sake, haven’t we done it enough?” And later, “If I only had a third sterile hand.… With a third hand I could do it all myself!” But these were outbursts, only minor rumblings, and they had been heard a thousand times before.

DeBakey had come to lean heavily on those who had been with him for many years, in particular two women. One was Mary Martin, the chief pump technician who had turned down an offer to go across the way and work with Cooley. In the beginning Mary had been the only pump technician; there were several now, but DeBakey called them all “Mary.” During the operation he said, without looking behind him, “How are we doing, Mary?” and Euford, bearded, replied, “Just fine, Dr. DeBakey.” The other woman was Ellen Morris, his personal scrub technician, the only one who ever scrubs for DeBakey. Each morning she rose early to pile her dyed blond hair up into an elaborate, towering coiffure, which she displayed beneath a see-through surgical turban of her own design. Other nurses had followed suit, and while most operating room women in hospitals elsewhere squashed their hair under flat, floppy caps, the women who worked on DeBakey’s service looked as if they had just left the beauty parlor as they passed the needle holders and sutures.

Both Mary and Ellen were not only capable and dependable, but intensely loyal—defensive of DeBakey against a hint of criticism. When a reporter asked Ellen if it were true that he sometimes yelled at inefficient nurses, she replied: “Dr. DeBakey would never do that. He is, after all, a Southern gentleman.”

On rounds that afternoon, Diethrich saw Mrs. Matthews, a tiny, wispy Florida woman on whom he had done two bypass arterial grafts, stretching practically from her armpits to her knees. She was a nice, uncomplaining lady, but one of those patients to whom complications swarm; every doctor has one disaster area like her on his service. She was in a special isolation room in the Intensive Care Unit for patients with infections. She reached up and took the surgeon’s arm and pulled him down and whispered, crying, into his ear. He put on a false bright face and whispered back, patting her gently.

He went out and motioned for Dr. Reed, the resident in charge of Intensive Care, to follow him down the hall out of earshot. At about fifteen feet Diethrich whirled and anger erupted. “Have you ever been sick, Doctor?” he almost shouted, and, not waiting for an answer, “Would you like to be told you’re bleeding internally?”

“But she was, she is,” said Reed quietly, not used to seeing Diethrich this way.

“Good God, Doctor, you’ve got to reassure the patient. This is a nut house anyway! Don’t make things worse. All you have to tell the patient is that she’s getting the best care she can get. That’s all! Understand? You’re playing God! You can scare a patient to death, because they will die of fright. It can happen, I assure you, it can happen.”

Bingham and The Roadrunner were both well enough to leave the hospital; Diethrich gave them a pass to spend a night on the town. They dined together at a seafood restaurant near the Medical Center and vowed—as people do on long ship crossings—to stay in touch.

Howard Stapler flew back alone to Indiana. But he had been there only a few days when a call came from Diethrich to prepare for a quick return to Houston. A hospital in Detroit had telephoned with a promising donor heart. A Lear jet was to fly there with the preservation chamber and pick it up. But within a few minutes, Detroit called back and the plan collapsed. The heart was a homicide case, and the legal complications were too tangled to unravel in the required speed.

Diethrich called the elated Stapler and told him to forget it for the time being. There was silence for a moment, and then both men hung up the phone.