CHAPTER 5

Toward the end of April, 1970, a green, tropical month in Houston, Dr. Denton Cooley, then 49 years old, flew to a medical meeting in West Virginia where he concluded his speech by talking of his dormant transplant program. He defended his implanation of 21 human hearts and one artificial heart, illustrating his words with slides that showed groups of his transplanted patients, seemingly radiant with health, photographs taken before they began falling, one by one. The audience applauded not only the speech’s content, but its delivery—low-keyed, boyish, earnest, Texan. It was a speech he would give several times in the months to come and invariably it would be successful. Cooley is not only a surgeon, not only a speaker, but a presence, frankly sexual. He accepts center stage as Olivier does, a possession earned. He rises slowly, unfolding the lanky, muscled body, walking with athletic grace to the lectern, pausing for a calculated second to meet the audience with his gray-blue eyes, and leads audiences into the awesome valley of open-heart surgery.

It may be facetious to talk of a surgeon by commencing with his looks but everyone does. One Houston matron, explaining her hypothetical choice of Cooley over DeBakey, said, “When I wake up from anesthesia, honey, I want Denton Cooley leaning over my bed.” A Houston medical writer feels the physical characteristics are a major factor in aligning support within her city. “DeBakey, whom I feel is a deeper man, a more introspective man, nonetheless looks as if he could play Shylock,” she says. “Cooley is the golden boy.”

When Methodist Hospital and St. Luke’s Episcopal Hospital were first planned in the early 1950s, the governing boards decided to specialize in different fields. After all, they were neighborly institutions only one hundred or so yards apart, and religiously endowed neighbors at that. In addition to general hospital services, Methodist would feature a psychiatric floor, orthopedics, a renal service, and neurological specialists. St. Luke’s would handle urology and premature infants. Neither hospital made room for heart-surgery patients, because in the early 1950s there were none. Nor could the planners have foreseen the tidal waves of patients that would wash in from all over the world. Each hospital soon had to make urgent accommodations to stay up with the burgeoning heart business. Methodist, DeBakey’s hospital, made four major additions, growing from an original size of 301 beds to its current 1,021, and added its spectacular Fondren-Brown wing. Cooley’s St. Luke’s moved more slowly but with a Texas-sized goal in sight. By mid-1970, a 27-story tower addition had been topped off, dominating the Texas Medical Center as the Colossus dominated Rhodes. There would be seven full floors for Cooley’s Texas Heart Institute. Cooley had hoped to have the Institute in its new quarters by 1969, but labor strikes and a shortage of borrowable money had delayed it two years.

Houston is a rich city and its millionaries have become accustomed to answering the knock at their door and encountering DeBakey or Cooley or the head of another medical institution standing there with hat in hand. Dr. R. Lee Clark, who heads the massive M. D. Anderson cancer hospital across the street from Methodist and St. Luke’s and who has plans to double its size, never loses his optimism. “I spent quite some time in Florence trying to see what brought about the Renaissance,” he said one day as he showed me the table-top model of the additions. “I came to the conclusion that it was due to the people of the city and the scientists of the city working together. We’re going through a Renaissance of Health in Houston. We’ve got people who aren’t afraid of raising $100 million. Houston is a place where you can go and present an idea at dinner time and raise $3 million by 10 P.M.”

Physically joined to St. Luke’s Hospital with common corridors is the Texas Children’s Hospital. When Cooley had grown disenchanted with DeBakey in the mid-1950s he had moved, without a formal break, to Texas Children’s, where he began a series of heart operations on children. The hospital, one of the most remarkable in the world, had been funded in a manner unique, if not to Florence, then to Houston. Leopold Meyer, a wealthy Jewish merchant and developer, was enlisted to scout the city for money. He went to visit his Episcopalian friend, J. S. Abercrombie, who on the occasion of the visit was in a downtown Baptist hospital with a back problem.

“Say, Jim, you got any money?” asked Meyer after the social amenities.

“Little.”

“Well, I want to spend some.”

“What for?”

“We want to build a children’s hospital.” Meyer explained the idea and the potential.

“I’m not sure your idea is a practical one, but if you’re that sold on it, how much money you talking about?”

“Couple of million dollars.”

“Go ahead.”

“I’m going to commit you, Jim.”

“I know it. Now get out of my room. My back hurts.”

Abercrombie later announced that he was tired of being solicited every year thereafter to make up the deficit of operating the hospital, so he pledged his dividends and stock holdings in the Cameron Iron Works for the next 40 years. “Our hospital,” said Meyer, “will never be in want.”

On the first Monday morning in May, 1970, Dr. Robert Leachman was holding forth in the Cardiology Section of St. Luke’s, where he was the chief, trying with no success to get out and see the new batch of patients who had checked in the night before. In the two Houston hospitals, it is the problem of the cardiologist to dwell in the shadow of the surgeon—Leachman describes his role as that of “surgical pimp”—but he, in fact, seemed a good counterpart to the dash and élan down the hall. He had hair he had forgotten to cut, a suit he had forgotten to press, shoes he had forgotten to shine. A cigar seemed permanently growing on his hand or face, except on those reluctant occasions when he had to put it down on a window sill to enter a patient’s room. His teeth were uneven, with a prominent gold one sparkling in front, but he was a man of gentle nature who, after being around for a while, became highly attractive. He was the country doctor in the city, but he was comfortable in the role. He spent as much time in the patient’s room as the patient wanted; he never seemed in a hurry. He would lean against a staircase wall for half an hour to go over a puzzling EKG with a group of foreign cardiology fellows who trailed him. He was a philosophical, self-searching physician who fretted now and then that a surgeon got $1,500 for the operation that took only a half hour of his time, while a cardiologist billed a patient only $300 for managing him before, during, and the ten days to two weeks after the procedure.

Leachman spoke fluent if atrociously accented Spanish, which was valuable to Cooley because of the volume of patients streaming in from Mexico and South America. When the earthquake of 1970 devastated Peru, Leachman spent almost a week on the telephone trying to arrange to go there to care for the injured; the trip was never made because Peruvian authorities said they had enough doctors.

It took Leachman more than an hour to leave his office: three patients were waiting for catheterizations of their hearts, one woman from Long Island repeating over and over again, “I dread this more than I do surgery. For God’s sake, knock me out.” Leachman picked up her wrist and held it as if checking her pulse; doctors frequently do this and do not even bother to count. Pulse-taking can be a gesture of friendship and interest. “It isn’t exactly painless dentistry,” he told the woman, explaining that general anesthesia was not necessary, “but we try.” A problem had arisen with a Spanish patient and three doctors—one from Venezuela, two from Mexico—were loudly debating it. Phones were ringing, the radio was turned up loudly to a rock and roll revival, the coffee pot was breaking down, a new secretary was breaking in, the air-conditioning system was out, a drug detail man was following the doctors about with a new pain-relief pill, and a two-year-old child, back for a postoperative checkup, was screaming, spitting out his pacifier, growing increasingly angry, finally throwing up on his mother, himself, a nurse, and the floor. Leachman looked slowly around and said quietly, “I think it’s a good time to make rounds.”

Cooley normally has from 80 to 100 patients in St. Luke’s and Texas Children’s, and he arbitrarily assigns each of them to a staff cardiologist. Leachman carries about 30 on his census. By the time a heart patient gets to Houston, he has been through the medical mill. If he is from a small town, he probably started with the local general practitioner, who, upon suspecting something wrong with his heart, referred him to the nearest big-city internist, who, if the diagnosis indicated surgery, dispatched him to Houston and Cooley.

“I’ve noticed there are two groups of patients,” said Leachman as he ambled easily down a hallway. He had thrown his brown suit jacket over his hospital greens. I cannot recall ever seeing him with the crisp white glamorous coat that marks his profession. “There are the ones who identify instantly with the surgeon, and a second group which identifies with me. These are usually people who have been kicked around so long by their sickness that they know the surgeon is not the only answer.”

Leachman was on the seventh floor of Texas Children’s and he stopped at a nursing station to pick up a new patient’s chart. Putting his smoldering cigar down on the edge of a new white formicatopped desk, he received a frown from the head nurse.

Leachman flipped through the chart. It told the medical history of a four-year-old child from Austin, Pamela Kroger, who had been born with the great vessels of her heart transposed. Until half a dozen years ago, such transposition meant early death, usually within a few weeks after birth. Now surgical correction is possible, done in two stages. In the first few weeks or months after birth, the infant receives a palliative operation to improve oxygenation. The surgeon, in effect, creates another defect to replace the primary one. When the child is four or five years old and better able to tolerate major surgery, total correction can be attempted. A Canadian surgeon, Dr. Mustard, was the first to carry out this procedure, but Cooley has since done more “Mustards” than all the other heart surgeons in the world put together. After a few months in Houston, the superlatives—the “more than’s” and the “most of’s” become familiar, even wearisome to the ear.

Leachman had said surgery was not the only answer to heart disease. How, then, had two surgeons built two heart centers in the same city, casting the cardiologist in a supporting role?

“Like it or not,” Leachman said, “structural power, economic power, and political power rests in the surgeons’ hands. They are not the intellectuals of medicine, but they have the clout.”

He stopped and looked back at the nursing station. He was going to talk a while and he missed his cigar. “I’m not so sure I disagree with this, either. There needs to be a God-image. The patient has to have it all built up in his mind that this one guy and his two hands—that after all the other doctors who have pawed him and pulled him, after all the pills, all the pain, that this pair of hands is going to make him well. I would be uncomfortable thrust in the role of Super-Jesus, but somebody must play it. There is a well-known heart clinic in Mexico which decided to have a lot of important apostles and no Super-Jesus, and I believe it is about to collapse.”

The transposition case, Pamela Kroger, began to shriek the moment Leachman entered her room. She was a thin, pale child with a bluish cast to her body. There was enormous pain and sadness in her presence, despite the dolls and laughing clowns scattered on her bed covers. The room itself was gaily decorated with one red wall and stylish lithographs of children and animals.

“Hello, Pammy,” Leachman said, trying to take an unwilling pulse. He surrendered and pressed his stethoscope against her nightgown. Doctors who deal with children learn to listen patiently and catch the heart sounds in between sobs. Mrs. Kroger attempted to calm her child, but Leachman shook his head that it was not necessary. He motioned for her to follow him into the hallway.

“The catheterization tells us it’s worth trying,” he began. Mrs. Kroger nodded, biting her lip. “But there is, you should know, a definite risk involved.” Mrs. Kroger nodded again; she was clutching her elbows tightly. “I suppose,” Leachman said, “everything gets down to a calculated risk.”

“But we don’t really have a choice, do we,” she said as statement, not as question.

Leachman shook his head from side to side. “Dr. Cooley’ll be by tonight to talk with you. You make your decision and tell him.”

A few doors down was a teen-age Italian boy, who seemingly had been making a textbook recovery from his heart surgery but whose prosperous-looking father was now distraught over a peculiar-looking patch of something that had appeared on the back of his son’s head. Almost weeping, he implored Leachman with gesture, in a mixture of Italian and English, to inspect the suspicious growth. Leachman seemed puzzled and took the boy’s head in his hands. He had to bite his lips to keep from laughing. “How do you say, ‘Head and Shoulders’ in Italian?” he said to the nurse. “The kid’s got a big patch of dandruff. All he needs is a shampoo.”

A Venezuelan baby, chubby, with huge dark solemn eyes, toddled down the hall, waving at the older children riding up and about the corridor in wheelchairs. Kids bounce back fast and they are encouraged to get out of their beds and play, even if it means hide-and-go-seek in the nursing station or bumper cars in the foyer. Leachman picked up the baby and laughed with him. “Cooley did a low-risk palliative procedure last week. Mario here is the classic blue baby, he has Tetralogy of Fallot, which is four major heart defects. He’ll have to come back for more surgery in a few years.”

Adult patients were also in Texas Children’s, stashed there temporarily until the additions to St. Luke’s were finished. Leachman’s first stop was to see a cheerful, thirtyish fellow who had sailed through his surgery, but whose teeth had all fallen out afterward in adverse reaction to a drug. It was one of those weird side effects that could not be anticipated and that plague doctors.

“Did you eat your breakfast this morning?” asked Leachman.

“All except a hard piece of toast I couldn’t gum to death.”

“Well, at least you can honestly say, ‘Look, Ma, no cavities.’”

“Dr. Leachman, do you know if Blue Cross pays to put a fellow’s teeth back in?”

“Sure don’t. I’ll look into it, though.”

It was almost noon, but Leachman was not half done with rounds. Cooley and DeBakey would have seen ten times this number of patients within the two hours that Leachman had prowled the wards. But patients sit in their beds all day long waiting for the big moment of the doctor’s appearance, and when one like Leachman strolls in—one who does not seem in a rush to get out—the patient takes advantage of it.

“You’ve got heart palpitations, all right,” said Leachman to an elderly, heavy woman. “But we don’t think you need surgery just now. We’ll treat it medically for a while and watch it.”

The woman cut in hurriedly. “But I’m not too old for surgery, am I?”

“How many years you owning up to?”

“Sixty-nine.”

“You may be too young for surgery.”

“Oh God, oh merciful sweet Jesus, I’m so glad. Doctors used to discriminate against older people.… Well, if surgery is ever indicated, I certainly want it. I want to live as long as I can.… That’s not being selfish, is it?”

Leachman shook his head in agreement. “I think every patient should have the medical facts and apply them to himself and then make his own decision about surgery. But you can go on home now and stay in touch.”

The woman lifted her arm. There was a Band-Aid at the crook of the elbow where the catheterization probe had been injected. Two stitches were there to close the small incision. “I’ll take these out myself at home,” she said.

“Can’t do that,” said Leachman. “Against union rules. Somebody’ll be around later today to take them out.” He patted her arm and made to leave.

Leachman went off to search for his cigar; he had momentarily forgotten where he laid it down. “Is it true what she said?” I asked, “that they used to discriminate against older people?”

He nodded. “Still do, as a matter of fact. A lot of surgeons wouldn’t touch a woman that old. We didn’t used to do many, but we’re a little more confident and knowledgeable now. Some of our confreres, however, are continually concerned about their batting averages.”

The last patient of the morning was Harold Carstairs of Illinois. He had checked in the night before and this was Leachman’s first visit. Carstairs already had been worked up by the cardiology and surgical divisions. They had confirmed with their stethoscopes what the hometown doctor had suspected—grave heart disease, a whopping hole in the heart called a ventricular septal defect. The hole had been there for years, possibly since Carstairs’ birth 49 years ago, and the heart had been forced to beat harder than it should have, enlarging it as surely as the muscle on a man’s arm enlarges when he picks up heavy crates every day.

“Does your heart bother you,” asked Leachman as an introduction, “or does it just bother your doctors?”

“I read the obituaries every night to make sure I’m still alive,” answered Carstairs in a quiet little voice. He was a short, average-looking man with thinning hair well oiled and combed back behind his ears. There was the same sadness about him that had enveloped Pamela Kroger in Children’s two hours earlier.

“Did you get any breakfast?”

“Not much.”

“Well, we try to make you suffer as much as possible and at the same time cut down on hospital expense.”

“You think Dr. Cooley’s going to operate on me?”

“We’re not at that plateau just yet.” Leachman spoke carefully. The man’s heart was as gross and flabby as an overripe pumpkin. It could stop and give out during surgery or after surgery or—for that matter—while Leachman was talking to him. “We’re going to do this catheterization on you this afternoon, and if it shows what your doctor back home thinks it will show, then we’ll come back and talk to you some more.”

Carstairs’ eyes had been clear during Leachman’s earlier remarks, but suddenly they began to cloud. He cleared his throat and spoke hesitantly in a voice that was difficult to hear. “I wanted to say … it’s just that I’m ready.…”

Leachman smiled. He slapped him gently on the leg. He walked outside and hurried back to cardiology. “That’s one sick boy,” he murmured. “I wonder how they live long enough to get here.”

In Leachman’s absence, little had improved in the cardiology lab. There were patients still waiting for catheterizations, phones were still ringing, the Spanish voices were still caught up in urgent debate over another EKG. I would learn in the months to come that chaos often defeated order in the burdened chambers of Cooley’s heart institute. The surgeon had thrown enormous pressure onto the hospitals: cases flowed out of his operating rooms and jammed the Recovery Room and Intensive Care and the wards and the waiting rooms. Everything from x-ray to the snack bar felt the weight of the numbers and not until the seven new floors of the Texas Heart Institute were open would there be abatement. Everyone complained, everyone said they were overworked, but somehow people got operated on and most of them got well. An anesthesiologist would tell me, “In Houston, success means numbers. First and Most. If a patient wants tender, loving care, he’s not going to get it from Denton Cooley or Mike DeBakey.”

Dr. Leachman slipped into his cubbyhole office and sat down gratefully. “Surgery, you see,” he began immediately, starting a new topic but launching into it as if he had been lecturing on it all morning, “is a tremendous injury, a major insult. Surgery is like … like getting hit by a car! The critical period is not only when the patient is on the operating table, it is the 24 hours, the 48 hours afterward. Will the heart stand the new circulation process? Will the lungs take the new pressure? Sometimes the surgeon eliminates the mechanical defect that he is hired to do, but if the heart is so sick that it cannot accommodate the repair, if it cannot assume the new work, then the patient will die. But he will die in the recovery room or in his own room or at home, and the surgeon has long since washed his hands of it.”

One of the South American cardiology fellows appeared abruptly with a catheterization report and an EKG trailing on the floor. He said it strongly suggested the patient in question would be a good candidate for the coronary artery bypass—the operation Ted Diethrich had done on Arthur Bingham, the procedure which was the number one topic in the heart surgery business. One of the few it had not excited—yet—was Denton Cooley who, hospital gossip had it, thoroughly disliked the meticulous, lengthy procedure. Gossip in a hospital is no more reliable than gossip anywhere else, only there is more of it. One reason is the insularity of medicine; the nature of medical work is that it tends to shut out the world beyond, locking both patients and personnel within. (A few months later, St. Luke’s would be boarded up for a threatened hurricane. With doors and windows covered, the hospital seemed physically what it had always been spiritually—a womb.) One of the gossips, a general surgeon, had commented that Cooley simply could not afford the time required for the new operation. “Denton’s got himself in a bind; he’s got to operate eight, ten times a day to bring in the revenue for his various projects. If he does the coronary properly, it’d mean cutting his list in half.”

Leachman shot that notion down.

“It takes a lot of time, true,” he said, “but there are other reasons. I’m not yet sold on whether the operation does anything but cut down anginal pain. It’s too early to tell if it does anything for longevity, because the surgeons have only been doing them in big numbers for a year or so.”

He stopped and picked up the reports the younger doctor had left on his desk. “Take this fellow.… He’s, let me see, he’s 47 years old, one previous heart attack, he’s probably building up to another. He’s got bad anginal pain. So what we’re dealing with here are two main problems: one, suffering from pain, and two, suffering from the threat of death. This patient has coronary artery disease, a disease that you and me and every single one of us is going to get sooner or later if we don’t die from car wrecks or gun shot or air pollution. We might even say that aging is nothing more than the process which occurs in our arteries. But there are other facts that can bring on this condition besides age—diabetes, hypertension, the hereditary factor, civilization as a whole. You can almost measure a country’s progress when its statistics on heart deaths start to go up. I went to Venezuela years ago and there were very few heart cases; their babies were dying of diarrhea and the adults of tuberculosis. Now Venezuela is either an emerging or a developing nation and its people are dropping dead from heart attacks. And they’re almost proud of it! Like the Russians were when they started reporting their coronary statistics at world meetings.

“So, how do we go about dealing with massive disease? We can try to prevent it in the first place by proper diet, activities, drugs, but prevent is a strong word. What we are really doing is stalling if off longer. If we ever got to the point where we could prevent atherosclerosis, we’d have people living to be 150, 200 years old. That would almost be an immoral act on the doctors’ part. We could be guilty of the ultimate population explosion. And if the medical profession ever achieves that goal, then the politicians are going to move in fast and restrict the kind of people we will be allowed to keep alive. Here we have the Mudd Family, for example, five documented generations of incest, murder, rape, and thieving. How much of our food and living space shall we allow them to use? I can see the catchy headline now, ‘We’ve Got Too Many People: Who’s Going to Go?’”

“But,” I asked, “wouldn’t birth control at the start avoid this?”

“Nope. The desirable people of our society are already restricting their families; the undesirables won’t and never will. But we’re digressing. Maybe what we should do to get at heart disease is to study the population—take the families with no diabetes or coronary artery disease, the families with ‘good genes,’ and breed them with the ones who are most liable to die of heart attacks. This would be one way to attack coronary disease—breeding control.”

Leachman was out of cigars so he bummed a cigarette. Next to a minister who drinks, there is nothing more comforting to a sinner than a doctor who smokes. “Now, this super-duper new operation, this venous bypass. Granted, it is the first operation that seems relatively logical. But it is nothing more, so far, than a palliative procedure at best—and there are many other ways to reduce the pain from angina. We can always cut the nerves leading to a guy’s heart and he won’t feel a thing. Not even the heart attack that finally kills him.”

Denton Cooley finished his eighth case of the day at 5:35 and lightly placed a gauze sponge into the incision of the heart, his unspoken signal that the first assistant was to take over and close. Neither Cooley nor DeBakey has the time to make the initial incision or the final sewing up. This is fairly common practice among important surgeons; were they to do the case from “skin to skin” it would take an average of three to four hours. (At a cocktail party in New York several months after my return from Houston, I met a businessman from Long Island who told me of his surgery by DeBakey. He was so overwhelmed by his good health that he stripped off his coat, unbuttoned his shirt, and displayed a well-healed scar, stretching from Adam’s apple to navel. “Professor DeBakey did this,” he said, as if showing off a first folio Shakespeare. I congratulated him on his recovery and decided against spoiling his notion of authorship.)

Rounds would commence as soon as Cooley went out and told the families what had happened to their loved ones in surgery that day, a job he executed with as much speed and dispatch as the operations themselves. He strode quickly down the hall to a crowded waiting room outside Leachman’s lab where he pulled out a small filing card with names written on it. Fifty people stopped talking and someone shut off the television set.

“Mrs. Brown?” Mrs. Brown hurried up, pale, haggard. “Your husband’s fine; we put in a new aortic valve in his heart. He’s just going to recovery now and you can go in and see him at seven.…”

“Mrs. Green?” Mrs. Green was lurking nearby, waiting, fearing her turn. She had an autograph book in her hand but first she would learn of Mr. Green. “He’s fine, just fine. We put in a Dacron graft right where we told him we would.… You can see him in the recovery room at seven.”

“Mr. Jones?” Mr. Jones was helped to his feet by two grown daughters, he being an aged, wrinkled man who had been mentally standing beside his wife’s grave all day. “Your wife is fine. She took the surgery very well. You can see her in the recovery room at seven.”

They all had questions, but Cooley was gone, vanishing around the corner and on his way back to surgery. Silent, elegant, giant steps on rubber-cushioned soles. How could the relatives know that he rarely spoke, even to the patients? He was in and out of rooms at times without uttering a syllable, sometimes a nod, other times only a touch at the foot of the bed where the strip of tape bears the name of the patient and the disease and his name. The only time he was at total ease was in his operating rooms, where he was among his friends, where the only strangers were those on his table and by the time he saw them they had become abstract figures in the medical landscape, openings in green drapes. “He’s done 69 pumps in the last nine days!” exclaimed a surgical fellow named John Zaorski as he waited for Cooley to change from greens to street dress. “Pumps” are open-heart cases in which the oxygenating machine is used. “I spent a year at the leading hospital in New Jersey and we did 35 pumps the whole twelve months. The man is incredible. The man is absolutely a magician.”

The man is also obsessed. He operates beyond fatigue, beyond endurance. He once broke two ribs water skiing, had them bound, and attended surgery the next day. A horse kicked him at his ranch and broke his leg; he ordered a cylinder cast put on it and hobbled to the table where he did a full schedule. In pain from a hernia, he operated an entire day, then lay down on his own table and permitted his associate, Grady Hallman, to repair it. Within two days he was operating again, and in his haste, he had torn his stitches. His back went out on a golf course and he could not straighten up; an ambulance picked him up like a jack knife. But he did not miss a day. In recent weeks he had suffered from a kidney stone and thrombosed hemorrhoids, two conditions that can make a strong man cry out, but he would not stop working.

“Denton would rather operate than fuck,” said a longtime friend and associate. “And I’ve never seen him give less than his best, even when we’ve been called back to the hospital from a party at midnight and we both had to chew gum before we could go into the operating room.”

Another friend from medical-school years has long since stopped trying to fathom the man. “I can understand why someone would drive himself that way when he is young and trying to make his name, his reputation,” said the friend. “But Denton was honored for his one-thousandth open heart at least seven years ago. Who can approach that? Life is a competition for him; in our generation, the people who were looked up to were the competitors.”

He is not an approachable man. He would seem to feel that the public needs to know but two marks of his heroism: he is handsome, he is skilled. Perhaps a third. He has done the most. He does not even permit himself the changes of mood of other surgeons. Changes can betray an image, and Cooley has carefully constructed his. DeBakey shouts; another Houston surgeon has been known to fall to his knees and beat his gloved fists against the operating-room floor in despair; still another throws up his hands and cries, “Won’t somebody please help me?” Cooley grows impatient, and impatience breeds anger, but his anger is masked behind a muttered sarcasm or, worse, half an hour of complete silence. The friend from medical school remarked: “Even at sixteen he was an enigma to all of us. He had an aura about him. He was one of those golden boys—now a man—whom you don’t feel quite at ease around. It is almost as if you are afraid you will make a mistake. I feel insecure; I feel uncomfortable in his presence and I am supposed to be his oldest friend.”

Cooley had a tiny office, perhaps four feet wide by six feet long, on an elevated platform with windows overlooking Operating Room 1 but two feet below, and here he had gone to change. He drew on dark trousers, a lemon shirt with a monogram on the pocket, a widely knotted tie. DeBakey charges about his hospital in surgical scrub with occasional flecks of blood on his uniform. Cooley glides through his, tailored, immaculate, his lab coat pristine white.

Trailed by his dozen surgical fellows, all from foreign countries except for John Zaorski, Cooley stopped in the jammed, turbulent Recovery Room and touched the foot of the bed of a young Ceylonese girl. “This is a gratuitous operation,” he said, and moved on. A surgeon in Ceylon had attempted to correct her Tetralogy of Fallot, had botched it, and had sent her to Houston. She would fly home, radiant, in two weeks.

“Gratuitous,” as I use the word, has more than one meaning; I asked Cooley which he was using. “Free. Gratis,” Cooley said. “And so is he.” He pointed to a painfully thin, elongated Asian-looking patient thrashing about in his bed, just coming around from anesthesia. One of the fellows murmured that he was Pakistani. He had an atrial septal defect, which Cooley had just repaired.

The Pakistani had flown to Houston without an appointment and had talked a cab driver into taking him to Cooley’s home in the exclusive River Oaks section of Houston. There he had presented himself for treatment; the maid sent him to the hospital, where Cooley performed the surgery. Ten days later he was complaining loudly that the hospital bill was outrageous and he should receive a “student discount.”

Little Pamela Kroger had been yelling at doctors and nurses all day, but when Cooley walked into her room smiling, she hushed. Even at four, she had respect for his celebrity. “Hello, honey,” he said, able to press his stethoscope against her heart and listen to the hissing irregularities without interruptions. He beckoned for Mrs. Kroger to follow him outside. She had talked to several doctors during the day and she well understood her option: take the child home and wait for her heart to stop, or agree to the nightmare of a man plunging his hands into the child’s heart, in a room where she, the mother, could not go.

“I think we can fix her up,” Cooley began. “But.…”

“I know,” she said. She had been wrestling over what she would say at this moment, and now it was time, and she was nearly mute.

Cooley helped her. “If she was my little girl, I’d have it done. I wouldn’t like it, but I’d agree to it. I just want you to know there is a risk, though.”

Mrs. Kroger stood silent for several moments, not aware that Cooley was anxious to be about his rounds. Finally she nodded her consent, began to cry, ashamed at breaking down in front of this man. She rushed back into her daughter’s room, a hand thrown across her face to conceal the tears from the child.

Outside another room, Cooley told Harold Carstairs’ wife, “This is high-risk surgery. The hole in his heart has been there for a long time, possibly since birth. We can repair that—that’s not the problem. It’s the three or four days later that we worry about.”

“What are the odds?” she asked. Patients and relatives always like to know the odds, as if there was a tote board for all lesions.

Cooley pursed his lips and pulled a figure at random. “About eight to five,” he said and walked away. He muttered to John Russell, his resident, “I hate to make book in front of the patients’ wives.”

One of the Iranian fellows caught Zaorski’s sleeve. “What did he say?” Zaorski explained what odds were and what a bookie was. “He talks so fast and so quiet I can’t understand him,” said the Iranian.

A voluptuous Eurasian mother wearing a mini skirt hesitantly walked up to Cooley, and in struggling English, said, “For you,” shoving a carefully wrapped package into his hands. Cooley thanked her and opened it, discovering a heavy, quite hideous statue of an ancient anonymous doctor or professor. Later, on the floor below, he looked at it again, grimaced, and said, as he handed it to an intern, “I guess I could always put trifocals on it and call it St. Michael.”

“What did he say?” asked one of the foreign doctors.

Zaorski gestured with his head toward Methodist.

On the eve of open-heart surgery, a man lies unfed in his bed and waits for the Nembutal to darken the strange walls. Harold Carstairs was bewildered. A simple man who had worked hard all of his life, he could not understand why he had been chosen to joust with death at the age of 49. He had pitched hay on a farm until he was 21 and thought himself to be a robust youth until the Army rejected him in 1946 because of a heart murmur. A heart murmur! Perhaps he had been born with it, perhaps it had come from an unknown attack of rheumatic fever. It so frightened him that he buried all thoughts of it, and when it threatened him he ran away from it, as a man runs from a criminal past. “A person has to work,” he said. “I got a job on a towboat picking up 85-pound rachets and carrying them around. I worked on the Illinois Central Railroad for ten years and I never once took the physical. I always figured out a way to avoid it. I thought if they heard my heart they would fire me.”

Six years before, a doctor told him to have his heart examined by a specialist. “But he didn’t press me about it, so I didn’t do it.” Not until six months before this Houston night had enough apprehension set in for him to find a heart doctor. He had begun to cough and could not drink enough syrup to make it stop. He felt generally run down and had begun, as he discreetly put it, “to lose my desire.”

Now his apprehension had turned to fright. He clutched his wife’s hand. “I’ve got so much back home,” he said. “I’ve got this wonderful family, the best a man ever had.…” “I never did anything bad to anybody.…” His tears were splashing down his face and, as men do when there is nothing else, he turned to his faith. “I had a vision last night. I saw Dr. Cooley walk in with his young doctors and I swore it was Jesus Christ and his Disciples.”

Super-Jesus!