CHAPTER 9

In the quarter of a century since DeBakey had come to Houston, the list of young doctors banished from his surgery was always growing. A few weeks before Geoff’s experience, DeBakey had been watching with obvious annoyance the performance of an Italian surgeon who was spending a year in Houston. During an operation, DeBakey instructed the man, whose name was Mario, to sew up the chest incision while he attended to a matter of the femoral artery. When DeBakey was done, he looked up, peered at Mario’s sutures, frowned, took his scalpel, and brusquely cut each of them out—replacing them himself, muttering all the while, “If you can’t learn, you can’t be taught.” Later he blew up at Mario and ordered the Italian to “stay out of my sight—I don’t even want to see you.” Mario interpreted this, with help, as meaning that he could not scrub in on DeBakey’s service. So he spent the remaining months in Houston assisting the other heart surgeons and slinking about the corridors, hoping he would not encounter DeBakey.

A general surgeon from St. Louis, a patrician-looking doctor with erect posture and gray sideburns to mark his 58 years, gave up his practice and convinced his wife and family that he should go to Houston and spend a year starting over again to learn heart surgery. He made it through the year, but not without frequent crises. During one operation he asked DeBakey a question and the response was several stormy minutes of criticism for having asked it. “You know, Doctor,” said DeBakey, witheringly, “by the very nature of your question I wonder if you understand the simple hemodynamics of this case.”

DeBakey seemed patient, even kind with the students who came to his table; normally only the man well along in his residency, or his career, felt the heat. “By the time you get to be seniors,” he once told a group of freshmen medical students, “we’ll be competitors. Don’t forget it.”

Geoff’s sentence was unusually severe. DeBakey had ordered him not only out of the operating room, but also out of the hospital, which meant that he could not finish his year on someone else’s service. For days he searched his past conduct and his soul for a reason; the one given by DeBakey hardly seemed to fit the crime, if indeed, in Geoff’s opinion, that had been a crime at all. “The final breakup had been coming for three days,” Geoff reflected. “Everybody had warned me to watch out. We had already sewed up the patient and we were suturing the wound where a catheter had been stuck into an artery. I was doing nothing but holding the sutures while he cut them, but he said I was cutting them off too long. Suddenly he began telling me to get out of the room.”

Geoff had come to Houston from New England in 1963 after making applications for residencies at several hospitals around the country. “I hadn’t really expected to be chosen for a DeBakey residency. But in typical DeBakey fashion he sent me a telegram saying I had been accepted and to please answer within 24 hours. In other words, I had to commit to four years in Houston within 24 hours. I called friends around the country inquiring about him, and I got all the terror stories about Big Mike. I figured they couldn’t be that bad.… I was wrong. They were worse.

“I chose Houston because it seemed ideal to be on the frontiers of heart surgery. At other hospitals there might have been one open-heart case a month and 30 residents would be scrubbed in trying to watch. Where else in the world was there a Denton Cooley doing three or four pumps a day? And a George Morris and a Stanley Crawford and all the other heart surgeons turned out by DeBakey?”

Geoff had spent his first year in the Baylor program without being introduced to DeBakey. “He didn’t even nod at me in the operating room. Every time a patient died in the Intensive Care Unit, he’d usually fire a guy and blame him for the death. But I also noticed it was usually premeditated. Word would get out that he was after somebody and he’d rag them and pick on them and finally erupt with an enormous harangue and fire them—always in front of everybody. Sometimes these were doctors who needed firing, and always the lesson soaked in. Each time he fired someone, the reason—the alleged reason, because it was not necessarily the real reason—was cemented into all of our brains.”

There were DeBakey “quirks” that every resident quickly learned to tolerate and obey. One Geoff learned was his insistence that suture needles be thrown onto the operating room floor after their use. “At other hospitals they don’t do that, because the wheels of the stretcher pick them up,” Geoff said. “But you damn well learned to throw them on the floor in Mike’s room.”

Another concerned the surgical drapes. “They must be taut; this is a fetish, little else.”

A third, and cardinal, rule related to the lights. DeBakey uses four overhead, movable, sterile spots. Most surgeons (Cooley, for example) use only two. “The unwritten, unspoken, but religiously observed law is that the light opposite the Professor does not shine onto the field, because it bounces off the retractors and annoys him. If anybody dares to touch those lights.…”

But Geoff had not touched the lights nor broken the other rules. He had stayed seven years learning his craft and was on the thresh-hold of his surgical majority when the blade fell. Perhaps one thing he had done to annoy DeBakey was to admire Denton Cooley’s skill—Cooley, after all, had been a member of the Baylor surgical faculty until a few months before—and he had gone to an occasional party with Cooley’s fellows. But if those were contributing factors, Geoff could no more understand it than he could understand DeBakey. And after seven years, he had found no Rosetta Stone to help him. “He has taught me virtually nothing, because we had hardly a relationship at all. But the years were valuable, nonetheless. The things Mike had taught the others, and the improvements they had added, these things seeped down to me. Everything emanates from Mike! Suture technique, for example, which is the basis for all vascular work, was developed by Mike. Invented? No, developed. But what is ‘invented’ anyway? Some dodo off in the North Woods might have done the first abdominal aneurysm, but unless he was shrewd enough to market it and run with it and publish it—who knew? Who cared?”

And that, certainly, was something he learned from Mike DeBakey.

DeBakey! Ask six doctors to describe him and they become six blind men telling of the elephant. Don Bricker says there is “the charming DeBakey, the tyrannical DeBakey, the gracious DeBakey, the political DeBakey, the despot DeBakey, and original healer DeBakey.”

In his ninth and last year in Houston, Don Bricker held one of the most important positions in the Baylor program—he ran the vast surgery service at Ben Taub General, the huge charity hospital that served America’s sixth largest city. DeBakey actually held the title of “Surgeon-in-Chief” at Ben Taub, but on his priority of participation, it was well down the line, so far down as to be practically nonexistent. Bricker relished the responsibility and wide pathology of the Taub job, but he gave notice in mid-1970 that he was quitting to go to Lubbock, a growing town in West Texas, where he would start up a private heart-surgery service from scratch.

Bricker’s reasoning pointed up both the nature and the dilemma of the modern surgeon. Surgery, until quite recently, was a specialty of medicine in itself. “Suddenly,” said Bricker, “we are in the era of the super-specialist, the super-surgeon, and the only way to get ahead in my racket is to do one thing better than anybody else. I have the widest repertoire of any surgeon in Houston—at the age of 35—but I’m a dinosaur. I don’t specialize. I’ve decided to go to a place where I can.”

In every aspect but one, Bricker’s appearance and dossier matched the classic image of the young Houston heart surgeon. He had a strong, open face; a compact, well-controlled body (DeBakey once snapped at an overweight resident, “I never knew a good fat doctor, Doctor!”), his clothes were quiet and from the rack of an Ivy League shop, his politics were conservative, his wife was a former nurse, his nonmedical passion was sports and the souping up of ordinary cars, and he swam in his pool with his three sons and a giant black dog, who was the most able water-polo player in the household. Only his attitude regarding his moral responsibility as surgeon toward the patient differed from what I had grown familiar with. Scattered among the gunshot wounds, the radical breasts, the crushed chests were but a few open-heart cases a month. But for each of these—charity bum, junkie, hooker, or forgotten old man—he not only repaired the heart, but went afterward into the Recovery Room and put a blanket on the floor and slept beside the bed. “I think it is necessary that I stay beside my patient until he has no further need of the surgeon,” he said, cutting off further conversation on the subject as men do when elaboration on a deeply held belief seems unnecessary.

Bricker had come to Houston in 1961 from New York Hospital, where he had become enamored of the then still infant area of open-heart surgery. “But there was nobody in New York to teach it, so I applied to DeBakey. He asked me but one question, was I a member of Alpha Omega Alpha, the medical honor fraternity. I said yes, and I was hired.”

His residency was more tempestuous than most. “When it was done, if I had to choose between going back to DeBakey’s service for three months or going to Vietnam to do battlefield surgery for three months, I’d choose Vietnam. Now that it is over, I have tremendous respect and affection for the man, but there were days when I wanted to kill him. I’d stand there and let him punch me on the chest with his stabbing fingers and listen to his tirades and I’d have my fists clenched behind my back.”

On other days DeBakey would be harassing someone and Bricker noticed that the deeply browed eyes were sparkling during the tirade. “I think he’s actually having fun doing this,” thought Bricker at the time.

During the decade of the 1960s, the widely held opinion in the surgical world was that DeBakey, although an excellent surgeon, was not as technically gifted as Cooley. Bricker had stood across the table from both men during hundreds of operations and had come to conclusions on both men’s abilities:

“Cooley had and has a particular genius for taking the bits and pieces of another doctor’s work, then putting it together again in a new whole to suit himself—and doing it better than anybody in the world. He has advanced heart surgery more than any other man. I’m not as good as Denton in the operating room; nobody could be until he’s done 6,000 hearts—and then you still wouldn’t be Denton Cooley.

“But DeBakey’s surgery was also a thing of astonishing beauty. He, too, was an incredible technician, but it was, for those assisting, a very traumatic episode.”

By 1965, Bricker’s fourth year of residency, DeBakey was enjoying the fallout from two public relation coups—his appearance on the cover of Time magazine and his operation on the Duke of Windsor for an abdominal aneurysm—which increased his patient census to as many as 200 at one time, enough to fill an entire respectable-sized hospital. “And the Professor expected his resident to know literally everything about every patient. He’d chew you out for something you had absolutely no control over. He never quits, he persists beyond reason.

“Once he ripped into me for the hundredth time over something and I was ready to tell him off and get out. At that moment somebody came up and told me I was wanted down at Admitting because there was some hassle over a Spanish-speaking family. I speak Spanish and I went down and encountered a ragtag-looking couple from Bolivia and their sick kid. All they had was a cardboard suitcase and a crumpled yellow telegram. I read it, and it said ‘If you will come to Houston on such and such a date, I will operate for no fee on your child. Signed, Michael DeBakey, M.D.’ I melted. DeBakey in all his power had reached out to a Bolivian village and touched this poor, pathetic family.”

During his DeBakey years, Bricker watched several of his colleagues thrown off the service. “I finally came to believe that nobody got fired who didn’t need firing. DeBakey is celebrated for axing people on a whim, but it was usually a whim he had invented as an excuse, a last straw, because he had watched them and had been ready to fire them for weeks. Some teachers give you questions to answer, DeBakey puts you under this enormous stress, he pushes you as far as you will go, sometimes beyond human reason, and if you can’t take it, you’re out.”

The strain on the younger doctors was not wholly mental; often their bodies would collapse and they would fall ill, but because DeBakey did not tolerate personal illness, he did not expect his residents to get sick either. (For a man of 62, DeBakey takes dismal care of himself. I once asked him when was the last time he had had an EKG, since he spends every day reading those of others. “I can’t remember,” he said, almost sheepishly. “Have you ever had one?” I pressed. He shook his head negatively. His personal nutrition would distress the mother of any adolescent. All day long he snacks on chocolate candy and peanuts and caramel-covered popcorn. Once when we dined at a fashionable New York steak house he ordered a strip sirloin and when it came, impeccably cooked, he asked for a bottle of Tabasco sauce, the fiery concoction two drops of which can ignite a Bloody Mary. Taking the bottle he slathered his steak with Tabasco, spreading it from end to end as one would spread tomato sauce over a veal cutlet. His fondness for Tabasco, a product of his native Louisiana, caused one associate to say, “Mike DeBakey puts Tabasco on everything he eats—and everything he says.”)

Once, Bricker recalled, DeBakey turned up in the operating room with a terrible cold, made even more insufferable by the mask over his mouth and nose. “He sniffled around and growled like a lion with a sore paw. I slipped out and went down to the pharmacy and got him a bag full of antibiotics and antihistamines and rather boldly thrust it on him and told him to take it. He poked around the bag and said, ‘This stuff’s no good; the only thing that works is aspirin.’ I insisted that he go home early—like 8 P.M. instead of midnight—and take some. The next morning he was obviously better. He sidled up to me and said, ‘Do you think you could get me some more of that stuff?’”

On another day, DeBakey was felled with a severe virus but he insisted on going to surgery. He was, said Bricker, “so pale, so sick, that the team almost forcibly made him lie down on the OR table. He was vomiting and feverish and furious. Someone notified the chairman of the department of medicine, who came down and took one look at Mike and ordered him to take the day off and rest. Mike refused to leave the hospital. ‘Very well,’ said the chairman, ‘you can have a room in the hospital, but if we have to tie you up and take you there, we will.’ Complaining bitterly, Mike got off the table, bolted out of the OR, ran up four flights of stairs to prove that—even sick—he was a better man than anybody else, lay down on a hospital bed and slept eight hours straight through. As much as we hated him, we were sad that the lion was sick. He was back the next day yelling at us. So we knew he felt better.”

There came the day when Bricker almost threw away his medical career. He had advanced to chief resident, an exalted position in other surgical training programs but under DeBakey still very much a junior man. A 25-year-old patient in the Intensive Care Unit who had been operated on for repair of a ventricular septal defect suddenly developed a hemothorax in his left chest and was bleeding to death. Bricker almost tore open his chest and sucked blood out and got it under control, then ran into surgery and told DeBakey the patient would have to come back in for emergency repair.

“DeBakey was furious,” remembered Bricker. “He always was when the schedule was interrupted, but he agreed to let me bring the boy in. For two hours he stood over me and yelled that the mistake should have been caught the night before and repaired then. He gave me unmerciful hell. The boy had had his VSD operation that very morning, not the day before, and DeBakey had done it, not me. Finally I had all I could take. I stripped off my gloves, I broke scrub, I lunged across the table for the Professor and tried to get my hands around his throat. Ed Garrett and Jimmy Howell grabbed me and physically dragged me out of the OR. I went back to ICU and kicked the wall.”

Bricker hung low for three days, assuming that he would be kicked far out of not only Methodist, but out of medicine as well. On the fourth dark day, word was sent that DeBakey wanted Bricker present at a staff conference. “I went in scared to death, but ready to take whatever he was going to dish out. I was surprised to find that it was an ordinary patient conference. DeBakey was looking at some x-rays and he turned to me and said, ‘Don, I just don’t know what to do for this patient. What do you suggest?’”

It was DeBakey’s business-as-usual way of acknowledging a mistake and inviting Bricker back into the program.

In August of 1970, Bricker went to the Cooley camp and filled in for Grady Hallman while he was on holiday. Although now a grown-up surgeon, very much his own man, so to speak, and on his way to Lubbock and private practice, he worked the entire two weeks almost furtively, worried that DeBakey would hear of his favor and pronounce him disloyal.

During the period, Bricker overheard a coffee-room conversation between two fellows who were complaining that they were not allowed to do any actual heart surgery under Cooley. In the entire year, they would do nothing but assist and tend to the patients before and after. They had come expecting to actually get their hands into hearts—with Cooley standing beside them giving advice and counsel.

“I know how they feel,” Bricker said later, on a Sunday afternoon beside his pool, watching the big black dog chase his sons in the churning water. “What can you learn watching Cooley do a thousand patients? There is nothing so frightening, nothing so gut-wrenching as the moment when someone finally hands you a knife and says—‘Here, cut this heart.’”

“For more than a year now, I’ve been all pent up,” said Ted Diethrich on another steamy new summer Sunday afternoon. “I haven’t made a contribution in twelve months, except banging out these hearts day after day.” He was sitting on the patio of his splendid, low-slung brick home in suburban Houston, an old house rebuilt to his specifications for embracing the outdoors. Walls of glass slide open for instant access to the large pool. There is a curious-looking athletic court—the only one in the United States—with three cathedral-like brick walls for the playing of a passionate and violent form of Mexican sport called frontenis. There is an adjoining vacant lot for football. Every Sunday, after morning hospital rounds, Diethrich would lead a pack of young heart surgeons and medical students through an orgy of athletic endeavor which, well-fueled by vodka and tonic, would stretch deep into the night. It became a pursuit of the fine edge of complete exhaustion, a search for physical pain, the cleansing purge that would send the surgeon back to the hospital and its world of imperfect minds and bodies.

On occasional Sundays, Diethrich asked an important, recuperating patient out to his home, and the man, still feeble from surgery, would sit in a chair with his shirt unbuttoned. He would watch the handsome, strong, young men pummeling each other at water polo, hear their shouting on the tennis court, feel the spray as they tossed themselves into the pool. No doubt the man was happy to leave the hospital for an hour or two, even with the nurse and her blood pressure cuff beside him, but as he watched the spectacle, there came a sadness, which only I saw, in his eyes.

Sundays tore at me. I recognized the need to push out the traumas of the week, but I would have preferred to accomplish it on a 30–15 ratio—30 minutes of sport, 15 minutes of chair. The surgeon syndrome had different rules, more like 58 and 2. Frontenis was undeniably exhilarating, entwining elements of handball, jai alai, and tennis, but with the hard rubber ball hurtling past at speeds up to 80 miles per hour, it was alarming as well. By the end of the summer, my torso, as were those of the other players, was dotted with bruises. My elbow was blue-green and swollen. “If you’re going to have a heart attack,” one of the doctors said cheerfully, “this is not a bad place to have one.”

Earlier in the year I had skied with Diethrich and a group of Michigan surgeons in Aspen. The other men were all ten years our senior but they seemed to have taken the same oath as Diethrich. I am a skier and I love the sport but my notion is to tear off a thousand-yard descent or so, stop, find a chalet with hot wine, and look at the trees. Not the surgeons. Their idea of skiing was to rise at dawn and be first in the lift line—very important, being first—be first to the top of the mountain, be first to the bottom of the mountain, over and over again, until threatening shadows threw fingers across the runs. No stopping. No reflecting. No wasted moment.

Among surgeons who fly their own airplanes—and there are many—the rate of crash and death is four times that of the businessman pilot. One reason is the surgeon’s rush to return to the hospital on Monday morning. Another, I suspect, is the surgeon’s desperate bear hug on life, paired with the feeling—as some Las Vegas gamblers have—that God sits on their shoulder and will not allow His blessed ones to lose.

At the age of 35, Diethrich had reached a level of professional reputation and personal reward that other surgeons would not reach until their fifth or sixth decade. But as it had with so many before him, a restlessness was setting in. The pattern was well established. If the young doctor survived the residency program and if he was exceptionally skilled in the operating room, DeBakey would ask him to stay on in the Baylor program. He would receive an academic appointment to the surgical faculty and he would assist DeBakey on his cases. He would also be permitted to establish his own private practice, keeping a small percentage of his fees. The balance went to the medical college; DeBakey turned over between 50 and 75 percent of his to the department.

But how many men have sat close to the throne without wondering if the chair is comfortable? The doctor who relaxed in the St. Luke’s coffee room one midnight and figured on his scrub suit leg the potential income of Denton Cooley had not been the first man to multiply the staggering figures. And the 27-story tower of St. Luke’s hospital, of which Cooley’s Texas Heart Institute would occupy a considerable section, dominated the Texas Medical Center as the Shell Building did downtown Houston. Cooley’s hands had built one hospital; DeBakey’s hands—and power—had built another. It had not escaped Diethrich’s attention, and he was even then nursing a plan.

Diethrich was born in Michigan. His mother was a nurse and he did his first operations on stuffed animals when he was five. He was in the hospital working as an orderly by the time he was fourteen. At fifteen he assisted and actually did the cutting on a vasectomy—male sterilization—and he could never remember a time when he was not consumed with ambition to be a surgeon. There had been a period when he pointed himself toward neurosurgery, that last glamour specialty, but by the time he had completed his surgical residency at the University of Michigan, he had been converted to a future in the heart. He applied to several hospitals for the necessary two-year thoracic-surgery residence but held little hope that he could be accepted by DeBakey. The University of Michigan had and has one of the most respected thoracic programs in the world of medicine but it required equal surgical time all over the chest cavity; Diethrich knew Houston concentrated on the heart.

“Finally a letter came from Baylor saying I had been accepted and I went down to Houston to meet DeBakey. I waited hours, I sat outside his office, I watched him operate, I followed him up and down stairs. Finally at five in the afternoon, after he had finished doing a beautiful arch aneurysm on a captain in the Air Force, he walked up to me and spoke to me for perhaps 30 seconds. He said ‘Very glad to have you here; I hope we see you soon.’ I was struck stone dead. I was in the presence of God.”

On July 1, the traditional end and beginning of the medical year, 1964, Diethrich presented himself to DeBakey’s office and much to his surprise was assigned to Denton Cooley. Cooley already had become estranged from Mike DeBakey and had shifted his surgery to neighboring St. Luke’s. But Cooley at that time was still very much a member of the Baylor surgical faculty—indeed he contributed half of his enormous surgical fees to the department of surgery—and he was entitled to a resident. Diethrich became disenchanted very quickly. Accustomed to the academic, ordered scheme at Michigan, he was confused by the breakneck atmosphere of Houston medicine. “I was used to a program where someone said, ‘This is who you are, Doctor, this is what you do, this is where you can progress to.’ Instead, it seemed to be a jumble. There were about 40,000 people jammed into the operating room, you couldn’t even get near Cooley. I was totally lost the first month.”

When he rotated several months later onto DeBakey’s service, Diethrich found himself even further from the operating room. For two and one half months he was not even invited into surgery, this young doctor who had just completed four years at Michigan operating almost every day. One afternoon, DeBakey abruptly said, “Ted, you’ve got to develop yourself technically in the operating room—starting tomorrow, I want you to scrub in with me on every single case.” Diethrich bit his tongue to keep from saying that judgment on his need for technical development seemed premature, since DeBakey had never seen him tie a single knot.

“Well, we started that,” recalls Diethrich. “The first three or four days went perfectly. He didn’t say anything to me, all was quiet, it was going to be everything I had hoped it would be. I was in the presence of the master. Then came the months of hell. It was to be the worst experience of my whole life. It got so bad he wouldn’t even let me drape the patient, something I had been doing for years, as routinely as reading a thermometer. I hold the all-time record for draping a patient! It was a carotid operation (reaming out the artery in the neck to prevent strokes) and I got the patient ready and DeBakey came in and took one look and said it was not properly done. So he went out and I took the drapes off and opened another sterile package and draped the patient again. DeBakey came the second time and again it was wrong. So I took the drapes off and broke open a new package and did it again. And again! And again! Four drapings! It got so bad I couldn’t tie a knot in the operating room without doing it wrong. It got so bad the anesthesiologist said to me one day, ‘Ted, I just dread to see you come into this operation room.’

“I never made it through a case with him. I’d make the incision wrong. I couldn’t hold a retractor. I was standing in the light. Everything was wrong. He’d say, ‘Why can’t you do this for me, Doctor, why, why, WHY? Don’t you want to help me, Doctor? This doctor doesn’t want to help me!’

“We’d start a case, we’d get about ten minutes into it, he’d stop and throw up his hands and say, ‘Ted, would you get Dr. Garrett?’ Somebody would go and get Dr. Garrett and DeBakey would banish me to a corner and say, ‘You just stand over there, Doctor.’

“It got to a point where I lost all my confidence. He can shatter you, absolutely shatter you. He would say to the whole operating room, ‘It must be intentional—nobody could operate like this unless it was intentional.’ I never answered back to him. I never raised my voice, because this was what provoked him the most. It went on day after day after day until one afternoon he laid down the instruments and he said, ‘All right, Doctor, all right. This is it. This is it! You obviously do not want to assist me. You want to be number one. Doctor, I’m going to assist you. Here, you take this forceps, and you take this needle, and you take this suture, and you sew up the artery.’ I started in and it lasted about 30 seconds before he grabbed everything back from me.”

The harangue dragged on until Diethrich fell into depression. He would return home late at night and tell his wife, Gloria, “This man is intentionally trying to break me. It’s become a battle.” There were days when Diethrich would put on his scrubs and then fight down nausea at the thought of going into surgery. He would go to Ed Garrett, a surgeon who had been through the ordeal and who was now a member of the Baylor faculty and ask for help. “Ed, I don’t know how much more of this I can take. I’m losing my confidence, I dread to walk into the operating room, and I’ve loved the operating room since I was fifteen.” He went to Jimmy Howell, another surgeon, and begged him to scrub in and take his place and Howell would say, “I don’t even want to be near it.”

“I was a person who had devoted so many years to becoming technically proficient, to achieving a certain skill, and to be ground down under his heel was frightening,” Diethrich said.

After three months, DeBakey approached Diethrich in the hallway early one morning and said, hurriedly, “You take Room 4 today.” Diethrich’s knees almost buckled. This meant he would be operating alone, with a junior man assisting him. “From that moment on, it was night suddenly day. He respected my judgment. He’d come in and assist me, or I’d go in and assist him and nothing more was said.”

Diethrich never knew what he had done to pass the test because he never understood the rules of the test. Or even if there was a test. Or why DeBakey chose and chose again to seize the Roman candle of youth and shake it and press his hands down on it and snuff out the fires of desire and ambition until the sparks—sodden with tears and sweat—were all but gone. Reporters sometimes asked DeBakey how he dealt with death and he usually replied with a reference to Irving Stone’s novel of Michelangelo, but he invariably mixed up the title. “It is the Ecstasy and the Agony for we heart surgeons,” he said. “To win is ecstasy, to lose is agony.” But was his vision of the business so painful that he chose to sort out those he would permit to enter?

Diethrich had come to believe that only those doctors from outside the Baylor program fell victim to DeBakey’s ire. One night as DeBakey and Diethrich drove to the Methodist Annex and were talking of a resident to whom the senior surgeon had been giving holy hell, DeBakey suddenly stopped and was silent for a while. His hands were on the steering wheel and he clutched it tightly. He began to speak again in a flat, cold voice. “Ted,” he said, “you know, I test people. I see what people can do under fire and under pressure. I must know what these people are made of.”

I dined at the home of a college friend who was now a successful surgeon and who had been through the DeBakey program. How alike the memoirs were becoming! I could almost recite along with him. “He put me through hell’s fire,” said my friend, whose face grew tight as he remembered it. “He used to say, ‘You are so stupid, you must be mentally retarded. Mentally retarded: Anyone who acts like you do must have brain damage. We’re going to take you right into surgery and fix your carotid artery. I don’t think we even need an arteriogram.’ He used to stand me up against the corner and jab those fingers of his into my chest and it was like being stabbed.”

His hand went to his shirt and he searched for an imaginary cavity.

“But now it’s over,” I said. “What do you think of the man?”

“Oh,” he began quickly, “I.…” He stopped. He had formed the syllable “L” with his lips but the word, that automatic word, that easiest word, would not come. “I … like him, I respect him,” my friend said. “He gave me opportunities that nobody else would have. He also built up Baylor in twenty years to where it ranked with Harvard and Johns Hopkins and it took those schools 200 years to get there.”

My friend stopped. He measured what he would say. “But he cannot run Baylor and be a full-time practicing surgeon … and fight the world.… How lonely he must be.”

On the next Sunday afternoon the green phone on the table beside Diethrich’s pool rang and he stopped playing tennis to take the call. It was from the hospital.

“Who was it?” one of the surgeons asked.

“Howard Stapler just checked back in in heart failure.”

“What can you do for him?” I asked.

“Transplant him, I guess,” said Diethrich, and he picked up the ball to serve.