CHAPTER 14

There was a conspicuous silence at Methodist Hospital in the immediate months after Christiaan Barnard performed his first transplant and startled the world. Mike DeBakey had made an immediate statement of congratulation to the South African surgeon. “He has broken the ice,” said DeBakey, when asked by a reporter for his reaction. “It is a real breakthrough in the whole field of heart replacement. It is a great achievement.” There were, DeBakey said, at least twenty medical centers in the world where there was skill and knowledge enough to perform transplants. “What we’ve all been waiting for,” he went on, “is the right circumstances—the right donor and the right recipient. Dr. Barnard had the right circumstances and he did it. They took the first step. We will do it, too.”

But the months began to pass and across the way at neighboring St. Luke’s, Cooley began his program in May. And by mid-summer, 1968, when Cooley had become the man who had done more heart transplants than any surgeon in the world, DeBakey, somewhat uncharacteristically, had not yet moved. He seemed almost reluctant to enter the transplant business. He commented more and more about transplants being but a “way station” on the road to an artificial heart, the road he had been traveling for almost a decade. He called for more federal funds to support the artificial-heart research. “If we mobilized our resources like we do to launch artificial satellites,” he said, in the city where science had reached the moon, “say 4 or 5 billion dollars, then we would get the artificial heart much faster.” And in speeches and papers, DeBakey urged the need for exceptional caution and judgment from surgical teams before deciding to do heart-transplant surgery.

DeBakey, in the March, 1968, issue of the Journal of Thoracic and Cardiovascular Surgery, wrote, “Since the physician can never afford to delay medical treatment until knowledge is complete and risk is entirely removed, he must apply current knowledge cautiously and judiciously, weighing the benefits against the hazards, in his efforts to relieve suffering and cure disease. Continued clinical trials [of transplants] are therefore necessary, but only after the most sober deliberation and most prudent consideration of all present evidence of their potential usefulness and limited scope. The indications for transplantation of the human heart at present must therefore be carefully delineated.

“The competing risks must be thoroughly assessed: application of a procedure, results of which are not completely known, against withholding of a clinical trial that may save the patient’s life. Such assessment requires the sagest, most deliberate judgment, based on extensive clinical experience in the cardiovascular field and on the knowledge and skills acquired in the specialized cardiovascular research and transplantation centers of the world.”

Despite DeBakey’s sensible and cool attitude toward transplants, his staff nonetheless chafed to get into the business. The vast medical and scientific resources of Baylor had begun making their own ALG—the immunosuppressive drug; they had arranged a liaison with Terasaki in Los Angeles for rapid tissue-typing. Moreover, the Fondren-Brown Cardiovascular Center, though not yet fully opened in 1968, had an elaborate area for transplant recovery and postoperative intensive care. Ted Diethrich, George Noon, and several of the residents began practicing transplants on dogs. By August, 1968, the DeBakey team was better prepared than Cooley and his staff were when they had begun transplantations three months earlier.

“We were ready to go,” said Ted Diethrich. “In fact, we were raring to go.” But it went without saying that it would take a spectacular achievement to catch up to what Cooley was doing with such apparent success across the way. Unknown to DeBakey, Diethrich and his friend John Liddicoat, a surgical resident from Michigan, drew up in their spare time a complicated outline of organizational structure, a plan for an incredible operation or series of operations. It was their audacious idea that a multiple transplant could take place using various organs from the same donor. If conditions were suitable, a donor’s heart, lung, and both kidneys could be transplanted into four different people in four different operating rooms at the same time. It would entail breathtaking precision, teamwork, and the talents of almost one hundred medical personnel. But if it could be brought off, it would be an amazing feat.

When the charts had been meticulously prepared, listing in minute detail everything from how many movie photographers were required for each of the four operating rooms down to weekend telephone numbers for standby nurses, Diethrich sent word quietly out through the hospitals of Houston and surrounding areas that he would like to be notified if a promising donor heart turned up.

On the last day of August, 1968, Diethrich was driving down a Houston freeway when he received a squawk on his beeper, the radio paging system used by doctors. He answered the call and was told to get in touch with a nurse at St. Joseph’s Hospital. Diethrich was puzzled because St. Joseph’s was a hospital in downtown Houston not connected with the Texas Medical Center and a hospital at which he neither operated nor had connections. He turned off the freeway quickly and found a telephone. The nurse at St. Joseph’s spoke in a whisper. “We have a girl who has shot herself in the head,” she said sotto voce. “That’s all I know, but if you want to come down you can talk to her doctor.”

Diethrich remembers he tried “not to sound excited” as he thanked the nurse and hung up. He telephoned Liddicoat and said, “This is it, I think we’re on countdown. Change clothes and meet me at Methodist right away.” The two young doctors slipped out of business clothes and into surgical greens with white lab coats—the uniform of office is far more eloquent and persuasive than a blazer and flannel slacks. Arriving at St. Joseph’s at 9 P.M., Diethrich found the doctor attending the gunshot victim. “She’s a kid about nineteen or twenty, Latin American I think,” said the doctor. “She shot herself in the brain. If we shut the respirator off, she’s gone.”

“What about a heart transplant?” asked Diethrich.

The doctor shook his head. “We’ve never had a donor here. I simply don’t know the procedure.”

“First of all,” said Diethrich hurriedly. “She has to be pronounced neurologically dead.”

“Well, we can do that right now. Just hook up the EEG.”

“Second of all,” said Diethrich, “we need permission from the next of kin. Who is that?”

“There’s a husband, I believe. She’d only been married a few months.”

“Where is the husband?”

“I have no idea.”

A nurse hovering nearby interrupted cautiously. “The police came by and locked him up. He’s in jail.”

“Why?” asked Diethrich.

“Perhaps they don’t believe it was suicide.”

“How much time do you have before the heart would be useless to you?” asked the doctor.

“I don’t know for sure,” said Diethrich. “There’s already a slight decrease in blood pressure.” At that moment, Diethrich remembers, he almost cancelled the entire plan. There seemed to be a police-legal snarl—it might take wasted hours to unravel it. “But just as a chance that it might go,” said Diethrich, “I called the kidney and lung transplant team leaders at Methodist and told them to stand by.”

That night in Methodist Hospital, four patients were waiting for organ transplants. One man with severe emphysema needed a lung, two others—one 50, one 22—wanted new kidneys. Bill Carroll, a factory worker from Scottsdale, Arizona, had come to Methodist for open-heart surgery, but tests had revealed that nothing could be done. Diethrich had suggested a transplant, offering him the services of neighboring St. Luke’s and Cooley, or, if he was willing to wait a few days or weeks, the untried capacities of the DeBakey team. Carroll agreed quickly to the transplant and said, “I’ll try my luck with you, Ted.”

Diethrich drew a vial of blood from the girl who had shot herself—whom we will call Mrs. Gonzalez—and rushed it by messenger to the Baylor laboratories. There the typing and testing could begin while Diethrich sought to see if legally the heart could be used.

Diethrich raced out of St. Joseph’s and drove at high speeds the two miles across downtown Houston to the central police station. In the homicide division, an officer was familiar with the case but said, “Doc, I just don’t know—or can’t tell what happened. We brought the kid in because he was hysterical. He saw his wife at St. Joe’s and collapsed. He hasn’t quieted down long enough for us to question him.”

“Where is he?” asked Diethrich. “May I talk to him?”

The policeman nodded. He took the young surgeon to a small questioning room, a barren place with cold walls, a table, two hard chairs, a coffee can for cigarette butts. The young husband, Raul Gonzalez, confused, sobbing, was brought in and left alone with Diethrich. “I’m Dr. Diethrich,” he said, “I’ve just come from the hospital and your wife is doing very poorly. I don’t think she can possibly make it.” The youth began screaming; Diethrich cut through bluntly.

“I want to know how it happened. It is very important to know exactly how it happened.”

Suddenly Raul Gonzalez quieted. He cupped his head in his hands and began to talk. His marriage, he said, had been a stormy one and his wife had become despondent over financial problems. She had threatened suicide four months earlier. On this second night they had been driving down a road when she suddenly produced a gun, put it to her head, and shot herself.

“Right there in the car, sitting beside you?” asked Diethrich, picturing the grisly scene.

The youth nodded and began to cry again.

Diethrich cut through once again. He asked his most important question. “Was it an accident? Or suicide? Or did you do it?” If it had been either of the first two, Diethrich felt he could use the girl’s heart. But if he suspected that a homicide had taken place, he could not. Already there had been the unpleasant incident over Cooley using the heart of Clarence (Sonny) Nicks. DeBakey and his staff had agreed with the medical examiner’s plea not to transplant hearts that might be involved in a murder trial.

“It was suicide, Doctor,” said Gonzalez. “She shot herself.” His face, his words seemed so convincing that Diethrich believed him. A homicide lieutenant came in and talked privately with the youth. When he was done he spoke with Diethrich in an outer office. “I’ll go with suicide,” he said. “I’ll accept your medical judgment. I’m releasing him in your custody, but we’ll still want to talk to him a little more.”

On the unsettling drive to St. Joseph’s, with Gonzalez sniffling in the back seat, Diethrich brought up the idea of a heart transplant. The youth seemed unable to comprehend what the young doctor was saying; Diethrich dropped it for the time being. In the hour he had been away, all of the girl’s relatives had flocked to the hospital and were crowded outside the emergency room where she was being attended. Diethrich tried to find the voice of authority in the family but none rose above the hysteria. The rosary beads were out in the purging rite of grief. Gonzalez demanded to see his wife, and Diethrich unwisely agreed. The moment the youth saw his wife on her medical bier, the breathing machine forcing her chest to rise and fall, the intravenous tubes sending the fluids of false-hope through her useless body, the monitoring machines clicking and chanting about her, he cried, in exultation, “But she’s alive! She breathes! Her chest is moving!” Diethrich took him by the arm and led him outside and for more than an hour tried to explain what “neurologically dead” meant, with the family flocked about answering in Spanish and English. The girl’s sister and sister-in-law emerged as the most intelligent, rational voices in the family unit and they seemed resigned to the difficult fact that the girl was alive only by the grace of the machines and once their force was shut off, then nothing would be left. They seemed flattered at Diethrich’s suggestion that their relative could perhaps give life to a stranger. They persuaded Raul Gonzalez to agree to transfer his wife to Methodist for “further evaluation.” Diethrich promised to have another EEG taken there. Gonzalez nodded; in one hour he had learned what brain waves are and how they govern the destiny of the earthly soul.

Convinced that he could win permission from Gonzalez to take not only his wife’s heart but a lung and both kidneys as well, Diethrich once again telephoned Methodist and set the plan in action. Calls went out quickly for the four teams—more than 75 people—to report to the hospital in secrecy. In the hour and a half that it took to arrange for the girl’s transfer by ambulance from St. Joseph’s across town to Methodist, all four of the recipient patients had been prepped, photographed, given antibiotics and ALG, their blood typed. The hospital was swept up in the urgent exhilaration of the event when Ted arrived. A second EEG was taken of the girl’s brain by a neurologist not connected with the transplant team and the waves were flat. Diethrich showed the monitor to Gonzalez, who looked at it only briefly before he nodded. He agreed to the doctors using whatever part of his wife they felt necessary. “Her soul is with God,” one of the sisters had said earlier, and Gonzalez repeated it now over and over again.

At 11:30 P.M. Diethrich called DeBakey at home and for the first time informed him of what was being prepared at Methodist. DeBakey asked the bare particulars of the case, then wanted to know what any surgeon would: Where would the blood come from in the middle of the night for four sudden major surgeries? “Everything is under control,” said Diethrich. “I’m going to the blood bank right now.” Between sixteen and twenty pints would have to be found. DeBakey was skeptical as to whether four surgeries could be done. He felt only the heart transplant should be attempted. He had not known of the elaborate battle plan that his junior man had drawn up in the study of his own home.

There were last-minute problems; the hospital’s administration wanted a legal officer to check that the permission forms had been properly signed and that a neutral physician had pronounced the donor dead. The medical photography department had difficulty finding enough photographers to staff four operating chambers and the donor’s room. DeBakey arrived at 1 A.M. and was impressed enough by the fervor of his staff that he endorsed what was to be attempted.

“We held our breath because DeBakey could have cancelled the whole thing at that point,” said one of the junior men. “He walked around to all of the rooms and saw how everybody was working together, how beautifully Ted and John’s battle plan was coming off, and he realized a series of four transplants would not only be history, but Something Else!” Moreover, six months had passed since DeBakey had written his plea for caution in heart transplantation, and much had been learned.

At 1:45 A.M. the historic procedures began.

The dead girl was placed in Room 5, Bill Carroll, who would receive the heart was in 4, the lung recipient in 2, the kidney recipients in 6 and 7. Diethrich opened Carroll and removed his diseased heart. He went across to Room 5 and performed a median sternotomy on the donor, removing her heart and saving a piece of pulmonary vein for the atrium and anastomosis (suturing) to Carroll’s lung. While Diethrich with DeBakey sewed in the girl’s heart, other surgeons went, in turn, to the cadaver in Room 5 and took what they needed—first the lung, then the kidneys. “It could not have gone more smoothly,” said Diethrich later. “If we had rehearsed the thing a thousand times, it could not have come off better.” One by one the patients were transferred across the elevated corridor that connects Methodist with Fondren-Brown and all were installed in the sterile transplant-recovery suite.

One of the kidney recipients, the 50-year-old man, died of a heart attack one month later. The lung recipient died about the same time. But the young man who received the girl’s other kidney not only recovered but married the nurse who cared for him in Intensive Care. Bill Carroll defied what was known of the then infant art of heart transplantation.

When the report came back from Terasaki in Los Angeles the day after Carroll received his heart, it revealed that he and the girl were a D-match, the poorest type on the scale. But he not only tolerated the heart, he regained almost robust health, returned to Phoenix and found an active job as a worker in a sheet-metal factory, resumed his passion for golf and told Diethrich proudly that his marriage was better than it ever had been. He was alive, spectacularly alive more than two and a half years postoperatively when this book was completed. He personified everything the operation should be and do, but so rarely was and did.

The transplanters received one tantalizing clue from studying Carroll’s case. All people are either hyper-reactors, meaning their bodies react strongly to something, or, conversely, they are hypo-reactors. Carroll was a hypo-reactor. When foreign protein is injected into a hypo-reactor, his body pays less attention to it. In a highly sophisticated test, white cells are taken from the blood, grown in a culture dish, and challenged with foreign protein. Either they react or do not react. “Perhaps we should transplant only the hypo-reactors,” mused Ted as he elatedly studied Carroll’s progress.

Five days after the multiple transplant procedures, the “DeBakey team,” as it would become known in the press, performed their second heart transplant. Their success was considerably less; the patient died on the eighth day.

Their third was the most remarkable of all. Duson Vlaco, a sixteen-year-old Yugoslavian boy, had been in Methodist for two weeks while the cardiologists studied him. Shockingly thin, the boy had a grotesque collection of congenital heart defects. He was born with an AV commune, meaning that he had a common atrium and ventricle; only one chamber in effect, rather than the four of the normal heart. Blood sloshed back and forth within the deformed pump fighting to get in and out. The tricuspid and mitral valves were malformed. He had arms and legs like toothpicks and he weighed, upon arrival, less than sixty pounds. It was an act of enormous pain merely to gaze upon the boy, much less probe his pitiful body for the possibility of surgical relief. “He was the sickest human being I had ever laid eyes on,” said Diethrich.

On the evening of September 15, 1968, Duson lay in his hospital bed half-propped up because his lungs were so filled with edema that fluid bubbled up and spilled from his lips. Had he been flat on his back he would have drowned in his own juices. The decision already had been made that there was nothing to be done surgically. The heart doctors were trying to deplete the fluid so Duson could fly back to Yugoslavia and die on his native soil. At 11 P.M. Diethrich was called to the boy’s room because he seemed to be in terminal failure. The look of death was in his eyes, his mother sat helplessly beside her only child. Neither she nor the boy spoke English and they depended upon a Yugoslavian cardiologist who had accompanied them to translate. Mrs. Vlaco stood up in despair when Diethrich entered the room. He made a brief examination of the boy and took her to a corner where he talked quietly. “I don’t think he will last until morning,” he said. The translator hesitated, then repeated. Mrs. Vlaco threw her hand to her face at the condemning sentence. There was, Diethrich said, a patient who had been brought a few hours earlier to neurological intensive care. He had suffered pancreatis and cardiac arrest but had been resuscitated. His brain was dead. His family had agreed to donating his heart to anyone who needed one.

If Duson and his mother wanted, Diethrich told the Yugoslavian doctor, he would attempt a transplant as “an emergency, a desperate act.” No tissue typing had been done on the boy, nor would there be time. His condition was so grave and his body so massively deteriorated by the malfunctioning heart that the odds were overwhelmingly against success. The proposition was put to the mother. She shook her head almost immediately. “No,” she said in her native language, “we heard about transplants before we came to Houston but neither Duson nor I want it.” “I understand your point of view,” the surgeon said, “but we don’t have another thing to offer him. We’ll do the very best we can with medicines, but it’s a mechanical problem within his heart and we just can’t fix it.” Diethrich turned and walked from the room. No sooner was he in the corridor when the broken voice of the mother stopped him.

“Doctor! Doctor! Please!” she cried in English. Her hands were outstretched. The Yugoslavian cardiologist spoke for her. “She wants the transplant. She wants her son saved.”

The transplant began within an hour. The anesthesiologist, who had to put the boy to sleep in a sitting-up position because of the pulmonary edema said, “Ted, you’ve lost your mind.” Diethrich resisted a shudder himself as he sliced into the taut chest and encountered the huge, flaccid heart. This is what the operation is all about, he said to himself. This is a dying patient. There is nothing else for him. If there is a justification for heart transplantation, it is lying before me on this table.

Within two weeks, Duson was greedily taking food. Within four weeks he was chattering in English. Quickly he was up and about the hospital. He learned to play the guitar and serenaded the nurses. He laughed for the first time in years. He got a part-time job helping feed the dogs and experimental animals in the Baylor laboratories. He shook Diethrich’s hand hard when he flew back to Yugoslavia. There he formed a rock-and-roll band and began making records. He wrote Diethrich several months later that his song, written in honor of the Houston-based astronauts, was rapidly climbing up the Yugoslavian pop charts.

The DeBakey team did all in all twelve transplants, and by the beginning of summer, 1971, both Bill Carroll and Duson Vlaco were still very much alive. Diethrich felt the results were, in fact, better than the statistics. “We had two patients die from infection, from colon problems not related to the heart,” he said. “The transplanted hearts were working fine. We had one patient in whom the donor heart failed. We had another who died of a cerebral embolus, a clot to the brain. It could have happened to anybody. The statistics are not really as bad as they sound on the surface. I truly believe this can be a useful operation. There are two witnesses, one in Phoenix, one in Belgrade, who will testify to it.”

The legitimacy of the surgeon in the world of medicine—the supreme academic moment of his long ascent from barber to eminence—was ensured when Michael E. DeBakey was installed as president and chief executive officer of the Baylor College of Medicine in May, 1968, about the time that Denton Cooley was beginning his transplant program. No one could remember if a surgeon had ever become president of a major medical school. Nor could anyone understand why DeBakey would want the job; his curriculum vitae was already eighteen closely printed pages long.

There had been two immediate presidents of Baylor who had feuded with the board of trustees. They had left with the school in financial distress. One Houston doctor remarked, “Baylor was broke, there was practically no fiscal program. It was heading downhill fast. DeBakey volunteered to take over as a kind of interim chief executive to get the school back on its feet. Nobody in Houston medicine had the glamorous image he did, he could raise money, he could attract great teachers. But there was a fight from those who did not want him to take over as president. They knew how much work he already had, and they wanted a full-time president. Mike beat them down, he always wins. He wanted to be president and he became president.” Leachman had once remarked as to what drove the Cooleys and the DeBakeys of the world: “They seek to leave bigger footprints than anybody else.” DeBakey’s were now gigantic. He had operated on royalty, he had dazzled the scientific world with his surgery, his name was a household word, and now he was president of one of America’s leading medical schools. Someday he would crown his career with the perfection of an artificial heart.

One of his first steps as president of Baylor was to sever the school from its parent institution, Baylor University in Waco, Texas, a conservative Baptist school whose leaders once fired the noted theatrical director Paul Baker from its faculty because he refused to delete the profanity from a Eugene O’Neill play.

Much of 1968 was spent by DeBakey in establishing a fiscal policy for the now independent medical school. He sought out private and public money. Those who previously had difficulty in obtaining the DeBakey ear now complained that it took weeks instead of days before he would return a telephone call, much less grant an appointment—if at all. One who was exceptionally frustrated was Dr. Domingo Liotta, the surgeon researcher who had been laboring for five long years in the secluded laboratories of Baylor, building and testing and discarding and starting again with hundreds of intricate plastic and metal parts, hoping to be the first man in history to develop, under DeBakey’s sponsorship, an artificial heart. His work had received dramatic impetus with the wave of human heart transplantations dominating the press. And because the human hearts were not being tolerated as well as had been expected, the mechanical one loomed all the more paramount. DeBakey had many times predicted the coming of the artificial heart in speeches before medical meetings and congressional committees. He told of the great promise that it held. In 1964, DeBakey had made a flat prediction that the artificial heart would be ready for implantation in a human within three to five years. But in mid-1968 he upped that another five. Liotta was more optimistic. By September, 1968, he and his associates had developed a prototype, which seemed to hold great promise. But when Liotta sought to convince DeBakey of this, he was turned away. Impatience is a disease that strikes every man at least one moment of his life, and it found fertile ground in Houston. Liotta felt he stood on the threshhold of greatness, but that his way was being blocked by the most famous—and often exasperating—surgeon in America. “Every time Domingo finally got through to Mike to urge that more attention be paid to the artificial heart,” said one Houston doctor, “he would be told to get back down to the laboratory and continue his work. Mike keeps his eye on people and their work in his own way. But there were weeks, sometimes months, when Liotta couldn’t get through to Mike at all. He began to feel DeBakey was simply not interested in the artificial heart.”

There was to be an alternative. Liotta had long admired Denton Cooley. When he had first come to Houston in 1961 and was still not comfortable in English, Liotta had found Cooley to be kind to him. The Texan had sponsored the Latin’s candidacy for a national scientific association. They had remained friends over the years, Cooley appreciating Liotta’s skill in the research labs, Liotta frankly spellbound by Cooley’s dash in the surgical suites. In early December of 1968, the two doctors met in private. Liotta expressed his anguish over what he felt was difficulty in getting DeBakey to move toward a clinical test of the artificial heart. Cooley nodded in sympathy. He knew DeBakey well. When their conversation was done, they made a secret pact that would bring the transplant year in Houston to an explosive climax, one that would wrench the world of medicine, and strip bare the ambition and jealousies and furies of those who work in the human heart.

In the first days of April, 1969, there emerged these facts:

1. On April 4, Denton Cooley, with Domingo Liotta at his side, became the first surgeon in history to implant an artificial heart into a patient, Haskell Karp, a 47-year-old printing estimator from Illinois.

2. Cooley, with Mrs. Karp beside him, went on television and radio the next day to announce the historic operation, to explain that it was a desperate, stop-gap measure because no human donor heart had been available, and to appeal nationally for such a human heart, which could be substituted for the plastic and metal one—powered by a huge, freezer-sized console standing beside Karp’s bed.

3. Karp lived for 63 hours with the artificial device before it was removed in favor of a donor heart taken from a 40-year-old woman, whose body had been flown by chartered jet from Massachusetts in answer to the Cooley appeal.

4. Karp died about twenty hours later.

The Karp affair became the Chinese box of medicine, a complex puzzle of ethics and science wrapped deep within the passions of men, not to be fully unraveled by committees and testimony. DeBakey first heard of the operation the morning after, when he walked into a Washington, D.C. meeting of the National Heart Institute, from whom he had received grants to develop the artificial heart. Never a man with time to read the newspapers or listen to the radio, he had neither seen nor heard Mrs. Karp’s appeal for a human heart. The men at the Washington meeting crowded around DeBakey and pressed him for particulars of the breakthrough, if there had been a breakthrough.

Cooley was, after all, a member of the Baylor faculty and DeBakey was its president. Cooley had been linked with DeBakey in the medical world’s mind for almost two decades. Surely DeBakey would know what had happened the night before at the hospital next door to him. But DeBakey knew nothing. He was more surprised than any man in the room. How ironic, in fact, how cruel, that the rug should be pulled in the presence of his peers. One doctor said that DeBakey’s face went white with rage.

As soon as he got back to Houston, DeBakey immediately launched a private investigation. The first thing he learned was that Domingo Liotta had been serving two masters—working for some four months not only for Mike DeBakey, but in secret for Denton Cooley as well. He was serving both surgeons on the same Herculean task—developing the artificial heart.

The second thing DeBakey discovered was that the device implanted in Haskell Karp looked amazingly like the very one Mike DeBakey knew was being developed in his own laboratories. “They used the exact same heart,” he said when he looked at the drawing St. Luke’s had released to the press. Months later, in conversation with a friend, DeBakey brandished the drawing and said, “Look! They weren’t even clever enough to make it look different!”

Cooley’s immediate answer was that Liotta had worked for him privately, on nights and during weekends, and that the heart they developed, with some $20,000 of Cooley’s money, was independent from the one that DeBakey was producing. Moreover, Cooley pointed out, he was a member of the Baylor faculty, a full professor of surgery, and was entitled to use the research knowledge that flowed from the school’s laboratories. What was research for in medicine, if not to serve the clinician?

Liotta was asked by a reporter how he could conscientiously work for two men on the same project. “It’s a sticky thing and I don’t think it would be right to put it in the press.” As to the heart, he hewed to Cooley’s statement that the apparatus was indeed different, and that he felt DeBakey had not given its development his attention. “If you don’t have a man who will go ahead and take the risk,” Liotta said, “then my work is valueless.”

Reporters also sought out Dr. Charles W. Hall, who had been Liotta’s co-director on the DeBakey artificial heart program, but who had left to take a position in San Antonio before the Karp operation. “About one year ago, we started designing on paper a sac type, pneumatically energized pump to be used for total heart replacement,” Hall said a few days after the scandal erupted. “Dr. Cooley never worked with us on this project. But DeBakey called us in periodically to make changes or to try to get the research speeded up. Until I left in January, several hundred lab operations had been performed to test various parts of the pump for blood interface and electronic problems.

“During the period from July, 1968, to January, 1969, the artificial heart was used with some success, in four calf operations, the longest of which lived 40-odd hours. But we had never satisfied ourselves that it was ready to be used clinically.… Technical errors caused air embolisms. There was always a great destruction of blood cells and improper internal-flow configuration caused stagnation. The heart used in the Karp operation appears to be the same model we worked on.”

Was it possible, reporters asked, that Liotta could have designed and built an entirely new model for Cooley? Not likely, said Hall. How could Liotta have done work for Cooley in four months of nights and weekends that it had taken him five years of working for DeBakey full time?

Houston’s medical community was sharply divided. One group held that Cooley’s use of the artificial heart was a brilliant scientific advancement. The patient in question was dying, and he lived for 65 precious hours with the mechanical pump doing the work of his heart. He regained consciousness, he spoke to his wife, he was alive! Science would not progress unless someone dared to put the mosquito on his arm, they said. A second point of view was that Cooley and Liotta were striking back at years of slights and harassment from DeBakey. A third group considered it an act of betrayal and a severe breach of ethics. There were carefully laid down guidelines to follow in surgery of an experimental nature. Cooley clearly had not followed them. He had made his plans in secret, he had not sought permission from DeBakey, the senior investigator of the artificial heart program, he had not asked for permission to perform the surgery from the Baylor Committee on Research Involving Human Beings, a group of doctors who can theoretically be called into session on 30 minutes’ notice to ponder a request, even as a patient is lying on an operating table. “It would not have done any good to call them,” said Cooley in private. “Mike dominates the committee and they would have automatically turned me down.”

A letter promptly arrived addressed to DeBakey from the National Heart Institute. Written by Dr. Theodore Cooper, director of the Institute, it demanded in curt language a full explanation of the affair:

“The reports in the news media indicate that the artificial heart implanted by Dr. Cooley was developed by Dr. Domingo Liotta. Our grant records indicate that Dr. Liotta’s salary and, to a substantial degree, his research, is supported by grant HEW 05435.

“This being the case, I would like to request that the Institute be provided with summary data on the testing and evaluation of this particular device in animals prior to clinical application.

“Also, as you know, current department guidelines require that projects involving human subjects be approved by local committees for human investigation. Was the protocol for the clinical application of this device reviewed by your local committee?”

Investigating committees looking into the controversy proliferated rapidly in the Texas Medical Center. Hearings were held before the Baylor Committee on Research Involving Human Beings, before a hurriedly organized blue-ribbon panel of doctors and scientists who would report to the National Heart Institute, and before an extraordinary commission reporting to the medical school’s lay board of trustees. Even Congress rumbled of an investigation as to what was happening with taxpayer money in Houston. DeBakey leveled the indictment in blunt language:

“Application of an unproved device … into a human being for primary experimentation before its safety and effectiveness have been proved scientifically in animal experiments is a breach of scientific ethics.” The ball was in Cooley’s court. Disprove it.

Although the various committee hearings were all conducted in secret—the first time, someone remarked, that anything relating to heart transplants was not filmed with movie cameras—the essential positions of the two sides emerged.

With what one committee member called an “almost patrician manner,” Cooley set forth his case. Another told a friend that Cooley seemed “polite at all times, mannered, responsive, in absolute control of himself, supremely confident, even proud of what he had done.… He seemed at a loss to understand why he was not being congratulated, rather than investigated.”

Cooley said he had become concerned the previous autumn over the increasing scarcity of donor hearts. Leo Boyd had waited eleven weeks for his. Others had died while waiting, still more had gone home untransplanted when their money or patience had run out. Cooley admitted that he knew Liotta was fully committed and in the hire of DeBakey, and being paid a salary from the National Heart Institute. But Cooley had proposed at their private meeting that the Argentine surgeon develop something different for him. He wanted a sort of halfway house, an artificial heart to keep a dying patient alive long enough to find a human heart donor. Cooley in his testimony more often referred to a “resuscitative pump” than to an “artificial heart.”

“I talked to Dr. Liotta about this idea,” said Cooley. “I felt he was as well versed as anyone. I talked to him about the possibility of helping me to develop such a device. Dr. Liotta expressed a willingness to do so.”

But why had he not informed the senior investigator, DeBakey, of the arrangement? the committees asked. “Having met with nothing but negative replies to anything of this nature,” Cooley said, “and being determined to develop this device, we did not make a formal report.” Cooley made several veiled, somewhat sarcastic remarks about his relationship with DeBakey in the Baylor program. At one point he said, “Let me remind you that my position is rather awkward in the surgical research labs. Apparently my abilities more or less have been overlooked in the medical school.” After Christiaan Barnard’s first transplant, there was, Cooley said, “a great furor here to create a transplant committee at the medical school.… I was not invited to be on the committee—but I had no feelings about it one way or another. It gave me a certain independence which I relished.”

The artificial heart was tested, Cooley said, by implanting it into seven calves. Though all died, one lived 44 hours. This seemed enough experimentation, he said, “to get this thing on.” The use of the apparatus in a human came about only because the man lay dying on the operating table and there was no donor heart available. The artificial heart was there, its large console was there, the patient was there. “Everything came together at once,” said Cooley, “everything.” And, in something of a side-bar remark, Cooley said he had heard that the Russians were planning to use an artificial heart, and he wanted American medicine to be first.

In his most impassioned remarks, Cooley reminded the investigators of his long experience within the human heart, of the thousands upon thousands of judgments he had made. “I have done more heart surgery than anyone else in the world,” he told a reporter in a statement that seemed to sum up his case. “Based on this experience, I believe I am qualified to judge what is right and proper for my patients. The permission I receive to do what I do, I receive from my patients. It is not received from a government agency or from one of my seniors.”

DeBakey built a careful case against Cooley. Amassing an array of witnesses, documents, invoices, medical sketches, illustrations, diagrams, even careless, forgotten remarks by Cooley that he had made in past speeches—remarks such as his once calling the artificial heart “impractical wishful thinking,” and “science fiction”—DeBakey charged:

—That Cooley deliberately lured Domingo Liotta away with visions of a promised land, which must have seemed overwhelming to a man who had spent more than half a decade inside a surgical laboratory.

—That the Karp operation was well planned in advance and not a life-or-death one-minute-to-midnight decision made in the operating room. Indeed, the large console power source is not standard equipment in an operating room, nor are the movie cameras and equipment necessary to photograph an operation from start to finish. One Baylor surgeon said he was asked by Cooley days prior to the operation to participate in it.

—That the seven calves used in the artificial heart experiments all died of severe kidney failure brought on by the device, which should have been a warning that the machine held potential peril for a human. The calf that lived 44 hours was, according to DeBakey, “essentially a cadaver from the time of implantation.”

—That Cooley did little but change the valves in the artificial heart to make it different from the one that DeBakey thought was being developed exclusively in his own laboratories.

—That no appeal for a donor heart was made until the day after the artificial heart operation, when Karp’s wife went on television. What DeBakey left unsaid here was that if Cooley was truly using the mechanical apparatus only as a resuscitative device, he should have made an instant appeal.

—That by using the human heart flown in from Massachusetts to replace the artificial one was the waste of a “scarce organ.”

—That DeBakey was shocked and grieved that such an event had taken place within the confines of Baylor.

An observer of the days in which the hearings were held recalled DeBakey as “a man possessed … possessed with the need to punish Cooley for what he had done.” His eyes, the man said, were “on fire.”

Vengeance for DeBakey was quick, and it would have appeared, thorough. Liotta was fired from Baylor, though immediately hired by Cooley for his Texas Heart Institute and empowered to begin a new artificial heart development program. Cooley himself resigned, with sadness, from Baylor, the school he had served for eighteen years. His reason, he said, was that he would not sign the newly imposed restrictions of both the school and the National Institute of Health on experimental human surgery. It was not that he disagreed so much with these guidelines, he said privately, but that he felt if he signed them, he would be bowing to DeBakey. Baylor itself, and its president, were cleared of any inattention and misuse of federal grant money. All the official blame—the guilt—was placed at the neighboring doorstep of Denton Cooley. He was even found guilty by his local medical society on eight counts of “publicity,” to which he pleaded speedily, and wearily, “guilty.” None of the decisions against him kept him from his surgical practice, and he returned to the operating rooms with renewed vigor, still puzzled about the uproar. There were no outward marks of his flogging, nor had anyone challenged his surgical ability.

But DeBakey would not let the matter drop. Scores of angry letters went out to physicians and hospitals not only in America but in foreign countries, spelling out what Cooley had done and what the investigations had proved. More than one major scientific society felt the wrath of DeBakey when it scheduled an appearance by Cooley (much in demand) to speak on the Karp operation. One such meeting gave Cooley a fervent, standing ovation. DeBakey withdrew many of the classic motion pictures from Baylor’s film library of Cooley’s famous open-heart surgery in children, some of the definitive work in the field. Suddenly no more reprints were available of papers coauthored by the two men. When The Harvard Lampoon published a satire on transplant mania, writing maliciously of a surgeon in Texas named Desmond Coma, who transplanted everything, DeBakey’s office photostated copies and mailed them out, thoughtfully underlining the “D” in Desmond and the “C” in Coma, in case anyone missed the point.

His name was not to be spoken, printed, or, it would seem, remembered. Five times Cooley telephoned DeBakey. Five times he left his name with the secretary. “I felt we should at least declare a truce to discuss the future of our respective institutions,” said Cooley. “Even the Vietnamese declare a Christmas truce.” But DeBakey never called back. “Even when people have a particularly nasty divorce,” observed Grady Hallman, “they sit down and divide things up and arrange what’s best for the children. But Mike refused to even speak to Denton.”

Once, months later, the two men found themselves in the same room at a medical meeting in San Francisco. Everyone present felt the tension might suddenly shatter, that the two men would break from the clusters of admirers who surrounded them, that they might stride toward the center of the room and clasp hands and return to Houston as one, a uniting of their strengths, their skills, their destinies. Cooley, it was said, looked twice across his shoulder at DeBakey. But the older man, it was further said, no longer acknowledged that Denton Cooley was either present, or even alive.