CHAPTER 16

My sons flew from New York to Houston as summer began in 1970 and I met them at the airport. Both were pale from the long Eastern winter and shaggy in the land of short haircuts. We drove to my apartment near the Medical Center; chattering, proud father and progeny, of baseball statistics and unpleasant instructors who had assigned summer homework and all things important to boys nine and twelve. Both had received physical examinations by an eminent woman pediatrician in New York to fulfill requirements for admission to summer camp in Texas and once again a doctor had heard the unknown in Scott’s heart. Their mother had told the pediatrician that Scott’s murmur would be heard by the sophisticated ears of the Houston heart world and the doctor seemed elated. “Be sure and have them send me a report, and an x-ray, or if.…” She left the rest unspoken. Not even she would speak of surgery.

At my apartment, the boys stripped off their flannels and blazers and striped ties in seconds and leaped yelling into the pool. Their happiness, plus the fact that Houston’s largest park and zoo lay unexplored directly across the street, seemed reasons enough to delay talk of the stethoscope for a few days at least.

Cooley and Liotta were to be decorated by the Spanish government and Monday surgery was concluded by 2 P.M. so they could change into formal dark suits and somber ties for the ceremony in the auditorium of Texas Children’s Hospital. Cooley had arranged a liaison with the Spanish medical community in which he would receive around $3 million for his Texas Heart Institute and in return would train Spanish cardiologists and surgeons in Houston. It was said that research money was so scarce in the United States that Cooley had to go to a foreign source to find some. There was further talk in Houston that some of Cooley’s contributors had grown disenchanted after the artificial heart controversy. Cooley discounted this and blamed the slowness of his fund-raising to the general business recession of 1969–70.

Cooley would also perform guest surgeries in Madrid and Liotta would spend considerable time there developing a new artificial heart and testing it on Spanish calves, which were a great deal cheaper than those in Texas. Cooley and Liotta were to be awarded the Grand Cross of Alfonso X, who had ruled Spain from 1221 to 1284. The decorations were in honor of “meritorious service to medicine,” for their use of the artificial heart in Haskell Karp fourteen months before. If the prophet was without honor in certain parts of his own city, then at least a foreign government recognized the achievement.

On the afternoon of the award ceremony, the Texas Children’s Hospital auditorium was filled with nurses, doctors, patrons of the hospital, and the many children of the two honorees. There was a decided “hooray for our side” feeling in the room. From Madrid had come a dashing representative, Dr. Cristobal Martinez-Bordieu, who was also the Marquis de Villaverde, in addition to being the son-in-law of Francisco Franco. Struggling in English, the Marquis made a brief speech explaining that Alphonso X was known as “a monarch of the highest intellect” and that the award named after him had originated in 1903, given at first to those who achieved excellence in the literary field and later changed to science. Only four Grand Crosses of Alphonso had been awarded since 1944 and the new members of the order, Cooley and Liotta, were honorary knights and entitled to be called “Excellency.” Franco himself had authorized the decoration of the two Houston doctors, the Marquis said with flourish.

“The implantation of the artificial heart was a moment in history,” said the Marquis, and with that pronouncement he draped a crimson sash from the neck of each man, embraced him, and pinned on a striking red and white medal. The next day, the nurses called Cooley “Sir Denton” and “Your Excellency” in the operating rooms.

The great annual kiddie rush had begun. Open-heart surgery is, in the majority of cases, an elective procedure. Many parents traditionally waited until the summer and school vacations to bring their children to Cooley’s table. On one Monday in early June, Cooley scheduled correction of three Tetralogy of Fallots, the classic “blue babies.” Each had received a preoperative “briefing” from a nurse named Diane whose job was to explain to the child facing open-heart surgery what would happen to him and what he would look like afterward in the Recovery Room.

“On Monday, Dr. Cooley is going to fix your heart up,” said Diane to a solemn-looking boy of eight named Kenny from Mississippi. She sat on his bed and talked to him directly. “On Sunday night they’ll give you a Phisohex bath to make you very clean, and then before you go to sleep you’ll have shots—one to kill germs, one to make you sleepy. You won’t remember anything until you wake up after the operation, and then you’ll look like this.”

Diane pulled from her shopping bag a Raggedy Ann doll with carrot-colored hair and tubes and wires sticking from her, a doll that seemed to have broken apart many times and, out of love, been wired back together again.

“The first thing you’ll notice is this mouthpiece. There’ll be a funny machine beside your bed and it’s to help you breathe. This machine breathes for you while you’re getting your heart fixed up and they’ll keep it going until you get all waked up in the Recovery Room. You probably won’t like the mouthpiece and you’ll bite down on it. But it’s important that you not be afraid of it and not fight it. The best thing to do is take a few big deep breaths through the tube and go back to sleep. Okay?”

“Okay,” echoed Kenny, his eyes as large as half-dollars. He glanced anxiously at his mother, who nodded reassuringly.

“The nurse will come by your bed and ask you to squeeze her hand. When you can do that big and strong, then she’ll take the tube out of your mouth.… Now, have you seen an oxygen tent before?”

“Yes, ma’am.”

“They’ll probably put you inside one. It’ll be like a glass playhouse, it’ll be cool. There may be some mist inside to help you clear your chest so you can cough good. This is important. If they ask you to cough, you’ll promise to do your best and cough for the nurse?”

“Yes, ma’am.”

“Your stitches,” said the nurse, pointing to the doll’s sewn-up chest, “will look like a zipper, or a railroad track. And you’ll be hooked up to a little TV set so we can watch your heart rate. Maybe you can lean your head around and see it, too. There’ll be another tube here”—she pointed to the doll’s arm—“or maybe here”—pointing to the foot—“to feed you and give you medicine.”

The nurse gave Kenny the doll to hold and ponder over for a few moments. He gave it quickly back to her; it was an offending object. “Do you have any questions, Kenny?”

“Will I have shots?” Children fear shots more than the surgery itself.

“Only those on Sunday night. After that they’ll give you all your medicine through an iv tube like this.”

Kenny smiled for the first time.

“One more thing. The first day after your operation, you’ll be real sleepy. You’ll get to see Mommy and Daddy that same night. Then you’ll be moved over to another Recovery Room on the same floor with only children around you. Maybe you can talk to them and there’s a window you can look out. Probably in a day or two you can come back to this room. The most important thing, remember, is not to fight the breathing tube and to cough when they ask you, and turn when the nurses tell you to. And when you come back to this room, promise me you’ll exercise your body. It’s like when you get hurt playing ball or something, it doesn’t do much good to stay home in bed. You’ve got to make your heart work again.”

Diane shook Kenny’s hand and hurried from the room. She had another appointment down the hall and she was worried because a Korean child had flown in from Seoul for surgery and there was no Korean interpreter immediately available to translate the briefing with the doll.

On Sunday night before the three Tetralogy of Fallot cases were scheduled, an emergency case appeared at St. Luke’s and John Zaorski squeezed him into the crowded schedule. The patient was an Italian clerk from Rome, a thin, once handsome man in his forties who worked for the police department. His name was Nino Bergoni, and his wife, Maria, half-carried him into the hospital, her handkerchief wet and dirty from his vomit, her own face weary from tears and hysteria. Neither spoke a word of English but somehow it was learned that the trip had been arranged through the office of Pope Paul, that they had gotten lost during a seven-hour layover at Kennedy Airport in New York, and that Nino almost had died on the flight to Houston. Zaorski slapped him instantly into Recovery, where nurses could keep an around-the-clock vigil and try to keep him alive long enough for Cooley to operate in the morning.

The three Tetralogy of Fallots, including Kenny, were done by noon without complications and each was sent to Recovery with a newly plumbed heart by the surgeon who had refined the hellish operation to where it was routine. Nino would be done after lunch and I went down to pediatric cardiology, where the technicians were already complaining, mildly, about the flood of youngsters pouring into the hospital.

There Jim Nora was catheterizing a poignant case, a four-and-a-half-year-old boy, son of a Midwestern psychologist and his wife, who, in addition to having the gravest congenital heart defect—the AV commune—was suspected of an equally rare genetic disorder, which caused mental retardation. The only sound the child could make was a high-pitched wail, the cry of a frightened kitten. The medical name for it is crie de chat, “cry of a cat,” named by a Frenchman who first encountered it.

It took Nora more than an hour just to get the catheter into a vein. “This is the end of the line for so many kids,” he said. “They’ve been worked up and studied and cathed elsewhere so many times that they just have no veins left when they get down here. All I’m finding is scar tissue.”

Nora paused and looked at the child, struggling beneath him. “He’s a nice little boy, but the parents refuse to accept any diagnosis of retardation,” he said. His face was enveloped by sadness. “He makes a sound which the mother insists sounds like ‘mama.’ She says he is only slow to develop.” Now there was the weary edge of frustration to Nora’s voice, which, as he went on, became understandable. Nora would have to spend several hours of his and his staff’s time, as would Cooley, attempting to repair an almost impossibly damaged heart—and even if the procedure was successful, the child would live but a short, fitful life, bringing pain and cruelty to all concerned. And he would probably never speak, other than to make that chilling noise of a cat crying. “Other places wouldn’t touch this kid,” said Nora. “They’d consider it a waste of hospital resources. At the University of Wisconsin, where I used to be, they could do only four open-heart operations a week. But here Denton does forty, and he’s good enough to try anything. And if the parents want it, he’ll attempt it.” (Ironically, this child survived surgery, a procedure that has an 80 percent mortality rate. But another child with the same AV commune disease who was completely normal otherwise died a few weeks later on the operating table.) The pediatric cardiologists frequently study mentally retarded children with heart defects, in particular, Mongoloids. Nora willingly recommends heart surgery for these, even though their anticipated life span is also short and discouraging. “A Mongoloid child often becomes a sweet, loving member of a family. Operating on a congenitally damaged Mongoloid heart seems somehow worth the effort,” he said.

I had missed earlier that day one of the most unnerving and delicate procedures in the heart world, one that Nora and the other pediatric cardiologists do in the catheterization lab, not the operating room. When a baby is born with transposition of the great vessels of the heart—the same defect that Cooley had repaired in Pamela Kroger in April—it may be necessary to operate immediately and create a hole between the chambers of the heart. The surgeon is creating a new, and less serious defect to enable the blood to circulate better. Theoretically, the child will live until he reaches the age of four or five and is better able to withstand open-heart surgery and having his blood circulated through the pump-oxygenator. “The trouble was,” explained Nora, “a lot of kids didn’t even survive that first operation and died within a few weeks.” A cardiologist named Rashkind at the University of Pennsylvania developed a technique in which a catheter is stuck into a baby’s arm and threaded gently up the arm and down into the heart. At the end of the catheter is a tough plastic balloon, which, when in exactly the right position, is blown up. The cardiologist then takes a deep breath and yanks on it forcibly, ripping a hole in the heart. Though fraught with tension, the procedure seems to work surprisingly well; better, in fact, than surgery. “But it still scares the hell out of us when we yank,” said Nora.

Nino Bergoni’s operation began at mid-afternoon and Cooley was in an expansive mood, perhaps because the three Fallots had gone so perfectly that morning, perhaps because he had raised at long last enough money to award the contracts on the eight new operating rooms for the Texas Heart Institute.

As he put two valves into Nino’s heart, deciding against a third because triple-valve replacements have had discouraging results, Cooley talked of the news that Dr. Walton Lillehei, pioneer of American open-heart surgery and chairman of Cornell’s department of surgery at the New York Hospital, was resigning. Lillehei also had been criticized for his heart-transplant program. “I remember one Christmas Eve a year or two ago when the phone rang,” said Cooley, pausing a moment to peer at the new mitral valve he had sewn into Nino, “It was old Walt calling. He says to me, ‘Denton, I’m fixing to do a heart-lung transplant. You did one. You got any advice?’ ‘Yeah,’ I say. ‘What is it?’ ‘Don’t.’”

When Nino was taken off the pump, his heart began to fibrillate. “We’ve got a circus movement,” Cooley said, his voice becoming serious. Gwen, the supervising nurse, was at his side instantly with the electric paddles and with one jolt, the heart regained its normal rhythm. Another nurse came into the operating room and said that Nino’s wife, Maria, was giving everybody a hard time. All afternoon the hospital staff had been chasing her out of the surgical area, but at that moment she was standing outside the “Do Not Enter” doors with her nose pressed against one glass, and holding up to the adjoining pane her wallet, which contained photographs of Dr. Cooley and Pope Paul, side by side.

“I met the Pope once,” said Cooley. He was satisfied now that the heart was beating naturally and as he began sewing up the pericardial sac, he recounted his conversation in the Vatican study.

“The Pope said he had followed our work and had kept track with all the transplants and he endorsed our work with but one exception. ‘What was that?’ I wanted to know. He said he was concerned about the definition of the donor’s death.

“Do I infer, your Holiness, that you do not accept brain death? ‘I would prefer,’ he said, ‘that the heart also be stopped.’

“That would be putting the rights of the dead over the rights of the living, your Holiness.”

At 7 P.M., the parents of the three Tetralogy of Fallots were permitted in to see their children and despite the shock of the tubes and wires and monitors, none fainted. Maria, however, came into Recovery just as Nino was starting to awaken from the anesthesia, his body quivering and in spasms. She assumed her husband was in terminal throes, that she was witnessing his death rattles, and she began to moan and tear at her rosary. Just then a well-meaning priest ambled by on his nightly rounds, glaced at Nino’s chart, saw that he was Catholic, and idly made the sign of the cross. Screaming, Maria collapsed and had to be helped from the room, with two nurses and a frustrated resident trying to find the Italian word for “normal.”

Within 48 hours, Nino was recovered sufficiently and had gained enough strength to be transferred to the sixth-floor Intensive Care Unit. In celebration, Maria positively blossomed. From the haggard, sobbing woman in a dowdy, farm-wife’s dress, she appeared in a stylish green and white jersey ensemble with a gold belt and gold shoes. Her face was beaming as she waited outside the Intensive Care Unit for the six daily visits she was permitted to make to her husband’s bedside.

Late one afternoon that mid-June week, I was leaving the hospital to collect my children from a friend’s pool when Grady Hallman stopped me. Hallman was a perfect partner and alter ego for Cooley. Quiet, confident, slim, youthful, the surgeon took the spotlight only when he conducted and played trombone solos for the Heartbeats. On those occasions, Cooley was in the back row playing string bass. In the hospital, Hallman worked almost privately in Operating Room 3, doing the aneurysms and vessel work and less glamorous operations, while Cooley drew the acclaim down the hall. I had sought several times to speak with Hallman at length, but he had always seemed too busy.

“There’s a patient of mine you might want to see,” he said. “It’s a case of a man with a lethal lesion who got here in time.” Hallman introduced me to an elderly, strong-looking man from Arkansas named Allgood, who had thick white hair and whose room was filled with flowers, candy, and get-well cards from back home. Allgood sat up in bed and shook hands all around. “I’d get up and do a little dance, but I just got back from walking around the halls,” he said. A few days earlier he had been in bed in his Arkansas home when he felt a “terrific pulsating in my lower abdomen.” The local doctor suspected an aneurysm but advised that he could wait for surgical attention until after a grandson’s high-school graduation. “But the back pain got so bad that they told me to get to Houston as fast as possible.”

Allgood had arrived on a stretcher in the back of a chartered Lear jet and Hallman operated immediately. It was, he saw, the kind of rupturing aneurysm that had killed Albert Einstein. Death would have come within hours, or minutes. “The Lord just wasn’t ready for me to get gone from here,” he said. “I am a strong believer in Jesus Christ and the Baptist church. A real Christian goes to the limits of his ability and then the Lord takes over. With help from Dr. Hallman.”

Hallman had slipped out of the room during the story and when I found him he was at the nursing station writing medication. It was past 9 P.M. and he was still making rounds. “That’s a rewarding case,” I said, gesturing toward Allgood’s room. “He’s a nice old fellow,” Hallman said without looking up from a chart, “I’m glad he got here when he did.” Since Hallman had himself broken the ice, so to speak, I asked if we could have a lengthy conversation one evening soon. The young surgeon thought about it and finally nodded. He gave me a tentative date a few nights hence.

It was my hope that I would learn not only something about Hallman and his work, but that he would illuminate the mystery of Cooley for me. After months of false intimacy about and around the man, of standing in his surgery and witnessing every detail of his art, his speech, his silences, his rounds, his almost reluctant entrances and exits from patients’ rooms, I knew little more of him than did those who entrusted their hearts to him.

When Hallman and I finally sat down and had that evening’s talk—not a few nights but a few weeks later, just before Hallman went away on vacation—I knew little more of Denton Cooley. But the conversation itself cast a light on the craft and business of surgery. It was the most candid, and in some ways most frightening, five hours I had spent in Houston.

We had drinks and dinner in a new private club, one of the hundreds scattered throughout Houston, a city where the state law said that mixed alcoholic drinks could not be served in public places. When I had gone to college and worked as a newspaperman in Texas, it was a brown-paper-bag society. One dined in the finest restaurants with a wrinkled bag on the table concealing a bottle of whisky. It was within the law to bring the bottle to the restaurant and use it as a centerpiece. The restaurant would even furnish a glass, ice, and mix. But in more recent years, private clubs with instantly acquired memberships had prospered under the archaic, Baptist-enforced law. Houston wanted so desperately to become a big-time city—and in so many ways it is—that authorities tolerated the illegal imbibing.

I had become accustomed to Houston’s heart doctors giving me courteous thirty-minute interviews during office hours and beyond that the impression that I was stealing highly valuable time. Now I had one after hours.

“How long do you have?” I began with Hallman. It was 7 P.M.

“As long as you need.”

Hallman had gone to the University of Texas and then to Baylor, where, in the early 1950s, he became enchanted by internal medicine. The surgeon had not yet come into his prime in Houston. “The men I met doing internal work were intelligent, they spoke well, they seemed to be investigators. I was convinced my career would be among them. But when I was a senior I was assigned to the charity clinics and there I sat all afternoon … interviewing women with boring chronic illnesses … problems that needed weeks or months of tests to learn the answer, if there was an answer. Problems that could perhaps never be solved. When I rotated onto the surgical service, I was instantly struck by the positive action, by the possibility of spotting a problem and doing something immediately!”

One of the top five graduates in his class, Hallman chose an internship at Wesley Memorial Hospital, in Chicago, and for a time switched his interest to anesthesiology. “I saw myself as both an administrator of drugs and a great teacher and writer.” But once again surgery lured him back. It was not his participation in surgical cases. For an intern, there is scant stimulation in working up patients, writing histories, finding x-rays, holding retractors, or maybe cutting a stitch now and then in the operating room. It was the invitation from a great chest surgeon for Hallman to spend an afternoon seeing patients and making diagnoses in the surgeon’s Chicago office. “I didn’t even have anything to wear,” remembered Hallman. “I asked the surgeon what I’d need, and he said, ‘Just wear what you’ve got.’ So I put on a zip jacket and spent a fantastic afternoon. When it was over that night the surgeon and I compared notes; our diagnoses generally matched. He was seriously interested in me. He was everything I had wanted to be in medicine. That one afternoon turned me onto surgery for good.”

Hallman thereupon wrote DeBakey “a flowery letter, telling him how much I admired the accomplishments of the Baylor Department of Surgery.” DeBakey was now a prominent surgeon, world-known among doctors, but without the glamour that would soon come. Hallman was promptly accepted and spent seven years in residency: four in general surgery, three in chest.

“What kind of cases does a first-year resident do?” I asked. I had been spending my days in Houston among those at the top of the profession and had no idea what the beginning man went through.

“Well, you fix hernias, take out appendixes, remove hemorrhoids. You do procedures commensurate with your level of talent, with a senior man supervising you all the time. You do work that the patient thinks the senior man is doing.

“In the second year, you graduate to gall bladders, you explore gunshot wounds, do amputations, thyroidectomies. Third year you should be up to gastrectomies, radical breasts, colon resection. And by the fourth year, if you make it that far, you’re administratively the head of the service. You get the pick of the operations. You can take out entire stomachs, do all the vascular surgery, pneumectomies, etc.”

During his three-year chest residency under DeBakey, Hallman went through the traumas indigenous to the work. “My third child was born in another hospital during this time and had it not occurred on a Sunday morning, I wouldn’t have been able to slip away from DeBakey long enough to see him. I didn’t see the kid again for another three months. My car was stolen when I was on the unbroken 90-day shift and I couldn’t even get out to see about it. I lived on sandwiches, fried pies, and Fritos. I got a vitamin deficiency and my tongue turned fire red. I figured that what I went through was the supreme test of human endurance. But there came the day that it was all over. I made it through.”

“Did DeBakey shake hands and show his appreciation?”

Hallman looked startled. “He’s not that type. He never tells anybody thank you, or good job. He’s never done that in his life.”

Toward the end of his chest residency, in July, 1962, Hallman analyzed carefully the problem of where he would go to work.

“I never even considered trying it on my own because I knew if I hung out a shingle, the only cases I’d get would be from relatives. So I said to myself, ‘Of everything you’ve done and seen in medicine, what is the most interesting, most challenging, and potentially the most financially rewarding?’ I answered myself, ‘Denton Cooley.’ I got up my courage and went over and cornered him and blurted out, ‘You don’t have any help. I want to go with you. DeBakey’s always had a right-hand man, or several.’” Everyone knew that Cooley had always been a loner.

Cooley’s reaction, Hallman remembered, was looking as if he were in an enormous hurry to get on with what he had been doing before the young surgeon had trapped him. But Hallman pressed. “You say to yourself, ‘What can this unknown doctor offer me?’ Well, he can do surgery that’s sent to him by people who know him, he can do the clinic cases, and he can co-write a textbook on pediatric heart surgery and make you first author.…’” With that, Hallman remembered, “Denton’s eyes lit up.” A book was needed in the field, Hallman said hurriedly, and where could a better one emerge than from Cooley’s case histories and data?

Thinking he had interested the great heart surgeon, Hallman went away to await an offer. Days, weeks, months passed and not a word was sent from Cooley. One afternoon, in despair, Hallman saw Cooley backing out of the hospital parking lot and flagged him down. “I made the pitch again, but he didn’t seem too interested. He was running only one operating room then and doing about three or four cases a day. Maybe, I see now, he didn’t want the competition.”

As a distinctively second choice, Hallman applied to DeBakey and it seemed he would be hired as a junior man when “a strange thing happened.” The Houston Chronicle wanted to interview a surgical resident for a feature story on medicine. Someone recommended Hallman as the subject and a woman reporter interviewed him. “She wrote mainly about the financial problems—she wanted to know how many suits I had, and I said one, a $25 number I picked up in a bargain basement. She wrote that my shoes were resoled, that we fed a family of five on $5 a week, that we had a $25 car, that we had a hand-me-down television set sitting on a packing crate.… A surgeon I knew told me, after reading the article, ‘You couldn’t buy that kind of article for $1 million. It makes you out to be the all-time champion underpaid, starving, dedicated young doctor.’”

Not two days later, Cooley telephoned and asked if Hallman still wanted to join him.

“What did you do for him at first surgically?” I asked.

Hallman made a circle with his index finger and his thumb. “Zilch,” he said. “He gave me nothing. Surgeons always feel they can do everything best and that they have no need for anybody else. Sort of by accident I started doing arteriograms when Denton didn’t have time to do them. I did three or four a day, at $50 each, and for the first time in my life, I started making money at medicine. And I did my very rare private surgical case. Mainly I spent the next five or six years researching that book and when it was finished—and successful—I suddenly had offers from Mayo to New York. There was a lot of fertile ground in 1967. I was all set to take one of them when Denton announced he wanted me to become his partner. He had got a second operating room by then and his case load was exploding. Now I think I made the best decision. Financially, it has become the most attractive place in medicine. And it’s gratifying that people come from all over the world to be operated on by us.… I’m able, in fact, to operate as much as I want, which very few surgeons can say. And our band, the Heartbeats, is a tremendous emotional outlet for me.”

Hallman fell silent for a minute and when he next spoke, he revealed himself. “The only thing I’m not is the complete boss … my own man.…” DeBakey had looked over his shoulder once and had seen Cooley and if Cooley were to look over his, there would be Hallman. My attention was caught and held by what Hallman said in the late hours of the evening. It began with my observation that patients agreed so quickly, almost mutely, to surgery, that Cooley was in and out of their rooms and in and out of their hearts.

Hallman smiled. “Denton believes in the blitzkrieg approach. He storms into a patient’s room, tells the guy he needs the operation, and he thinks the problem can be fixed, and the patient is so overwhelmed by this that he agrees.”

I had once seen a patient decline surgery and Cooley had seemed disappointed; yet he had made no attempt to change the decision. He only nodded and walked brusquely from the room. “There’s no hard sell,” Hallman said. “First of all, we don’t need the business. We’re not going to miss the case and the schedule will be filled anyway. Secondly, most of the selling has already been done. By the time a patient sees us, he’s already been to at least two or three other doctors. Thus the phrase which I’m sure you’ve heard over and over again, ‘That’s what I came for … the sooner, the better.’ If a guy doesn’t want surgery, then it’s his decision. Denton doesn’t try to change anybody’s mind.”

But why the volume? Why the relentless pursuit of first place? Was there not a peril in the sophisticated, impersonal, medical assembly line?

“He who rides a tiger can never get off,” answered the young surgeon. “It’s intimately tied in with pride and arrogance, as well. When a referring doctor sends us a patient and we’re too busy or too exhausted, what are we going to do? Send him over to DeBakey? Refer him to Mayo? To Ochsner? If we don’t do the surgery, who is? A patient pays us an enormous compliment by wanting to partake of what we offer—and we do it better than anybody else. We play the violin concerto better than anybody else down here because we’ve played it more times. We do so many cases that our patients get well! The same case might go to Boston or New York or Mayo and get sick, have clots, lose legs, or die. We have perfected heart surgery.”

But, I wondered, how then does the artist avoid destroying himself physically if not emotionally by playing so many concertos?

“Denton has a need, a compulsion to work. Nobody in the world works harder than he does. There are few people on earth who have unlimited capacities for work. He’s one.… I’m another. Besides, surgery is like show business. We’re performing in there. No matter how exhausted one becomes, you get up the moment you enter the operating room. It’s like a second cup of coffee, a pep pill, a dexedrine, an amphetamine.… You see the patient lying there before you and a second wind comes to you. When we were doing transplants, we often worked all day and all night and all the next day. The sheer drama of the situation was a stimulant.”

What of the shield between Cooley and his world?

“Anybody who has the exigencies of Denton doesn’t have the minutes left to get close to anybody. Nor do I. I used to love to read … it was my supreme joy, and now I have no time to read.” Hallman’s voice was, for a moment, sad. He seemed to be speaking not to me but to himself. “A person who has no time to read has no time to come close to anybody or thing. When you commit yourself to becoming a heart surgeon, you must divorce all human relationships—wife, family, patients.…”

My face must have reacted and asked a silent question. Hallman must have anticipated it, because he was ready with an answer.

“Any physician who lets himself become emotionally involved with the patients disables himself. This applies more particularly to the surgeon. In OB-GYN there are rarely deaths … in dermatology, no deaths.… The GP has an occasional death but they’re usually old, worn-out people who are ready to die anyway. The only weapon we have against death is the ability to convince ourselves that we’ve done the best possible surgery.

“People must die! It’s no good to speculate that somebody else might have done a better job, that somebody else might have cut this or that differently.… But unless you do the surgery, how then are you going to become good?”

I interrupted. “Then what you’re saying is that patients must be.…”

Now Hallman cut in. “Sacrificed.”

He said the word softly.

I fumbled. I was, in truth, stunned. “I was going to suggest an easier word,” I said, “like ‘pioneers.’”

“Sacrificed is a better word. Some patients must be sacrificed to the God of Experience. Excellence comes out of experience and nothing else. A doctor can reach the supreme pinnacle of technique, but only after he has done many, many cases and perhaps participated in many, many deaths. If every patient in the world got the best possible surgery, then there would be no resident program and, consequently, no new surgeons. Some surgery simply must be done by those who are less than perfectly qualified.”

I looked down, away, not for a waiter, not to watch the people in the club going about the business of drinking and talking and living, but to hide. I wanted no more truth. Hallman pulled me back. He was not done. He needed to get it all out. “It’s true!” he said. He waited until I nodded. Of course it was true. But truth is not necessarily a defense.

“A surgeon who is the best,” he went on, “is a surgeon who has gained the most experience.” He reached into his memory and found a part he had long since shut away. “And some of the first few people that surgeon operated on are dead. This is blunt talk, but every surgeon would say the same thing.… I know a lot of people who are dead today because I operated on them early in my career. If I could do them tomorrow, they’d be alive.…”

We talked for another restless hour. I don’t remember what we talked about.

I was a father with a son whose heart made an alarming sound and I was a man with access to the great heart surgeons of the world. There were so many judges to stand the boy in front of. I weighed them all in my mind—the exasperating, ruthless genius of DeBakey, the cold beauty of Cooley, the energy, the strength of tested youth that was Diethrich, the chilling honesty of Hallman. Bricker slept beside his patients. But only Nora had wept. I had seen him try to understand why children are defective and die, I had seen him unable to control the pain of having to deliver the ultimate message. I had heard his sorrow of the transplant year. I was not a liberal seeking comfort in another liberal, nor did I equate tears with ability. But tears as I knew them in Houston were strength, tears could mean compassion. I wanted a doctor to lean on. Nora, the pediatric cardiologist, was not even a surgeon—but in the land of kings, I asked a commoner for his favor.

I made the boys dress up and sent them back to comb their hair. Permission had been obtained from Mrs. Sylvester, the operating room supervisor, for them to stand in the gallery and watch Cooley operate. That was the lure. I had expected them to watch with interest for a few moments and then be repelled by the wound. But they stood entranced for half an hour asking questions about anatomy and mechanics and movement, which, after my months in the chambers, I could answer. “Is that his heart?” Scott asked, pointing to the throbbing object encircled by the hands of Cooley and his men. I nodded. “How much will he hurt?” the child asked. Not a great deal, I hoped. I looked at my watch. It was time.

“Come on, Scott, as long as we’re here, I’d like for this doctor to listen to your heart.” I was pulling him from the gallery. He didn’t want to leave.

“Not again,” the little boy said fretfully. His heart had been heard in Paris and an EKG had been taken. The machine with its wires and attachments had frightened him, but there had been no pain. “Très curieux,” the cardiologist had murmured.

“He’s just going to listen. I promise.”

“Can I come back and watch Dr. Cooley some more?”

“Yes. If the nurses will let us. It depends on the case.”

“Can’t we do it another time?” He was stalling.

“No.” Firmly. Parental. “We’re here. Let’s get it over with. It’s all arranged. It’ll only take a minute. He’s a very nice doctor.”

We walked down the stairs. Scott was squeezing my hand. It was a game we had always played. He would grip me as hard as he could and I would feign at last that he was hurting me. “If I’m going to be a surgeon,” he said, relaxing his pressure, “I’ll have to start taking care of my hands.”

“I thought you were going to be a baseball player for the Mets.”

“But I’ve changed my mind. I want to operate on people.”

Nora was holding clinic. There were parents and their children stacked up outside his office. A baby was yelling in her mother’s arms. There was a strangeness, a cast to the infant’s face that alarmed her parents. Nora would run a genetics test to see if the baby had mongolism. They had learned of the possibility and their expressions showed that their jeopardy was perhaps graver than mine.

He worked us in ahead of the others. He accepted the tough handshake from my son and winced as if he knew how to play the game. He was good with children. He knelt down and looked the boy directly in the eye. It impressed me that he did not bend over. “Can you take your shirt and tie off for me, Scott?” My son looked at me with suspicion. It was going to take more than a minute.

Nora placed the stethoscope on the smooth, unblemished young chest and listened. “Okay,” he said, with no commitment. Neither yes nor no. What was he hearing? My thoughts flew to the boy’s mother. Her sister had been born with a heart defect, which Cooley had repaired in his first years of open-heart surgery. Surely her side of the family had passed down the abnormal seed, if there was to be one. I needed someone to blame.

Nora moved the stethoscope up and down and instructed Scott to hold his breath. I heard the baby crying outside. I was annoyed. There must be silence for the doctor to hear. Slowly he took the instrument away and let it drop to his chest; it hung there against his white coat and a thousand years crept by before he raised his head and spoke.

“It’s Still’s murmur. A false murmur. It is a vibration of the pulmonary valve. Here, listen for yourself.”

Nora handed me the stethoscope and placed its disk against Scott’s heart. The beat was firm, but in its aftermath, a quick hiss, a spurt of steam from a radiator.

“Put your shirt on, Scott. It’s all finished.” Nora seemed happy to gently slap the naked back of a whole child. I gave Scott a quarter and he went with his brother Kirk to find the Coke machine.

“There’s nothing to worry about. The vibration will be gone away by the time he’s thirteen or fourteen.”

“Then there’s no need to even think about surgery … ever?”

Nora shook his head.

“But what about those other doctors? He’s been listened to in New York and Paris.…”

“Don’t blame them. We get a lot of business out of Still’s murmur. The state of the art is such that they just don’t recognize some of the things we’ve heard a thousand times.”

Nora walked me out. “I assure you it’s nothing.”

“Nothing?”

Nora was smiling. His face lit up the room and all of my world.

Scott watched surgery for the rest of the morning. He was fascinated, entranced as I had never seen him, by the grace and strangeness of Cooley’s operating room. “Dr. Cooley works very hard,” he said.

“He works all the time. Being a surgeon is more than you think.”

“What did my heart sound like, Dad?”

“Like a bass drum.” I put my hand to my chest. “Boom! Boom! Boom!”

My son laughed; we left the hospital and went swimming. Scott stood on my shoulders and dived into the water, he prowled the bottom and attacked my legs, he pestered his brother, he squandered every moment of the day because he was rich, blessedly rich with time, newly endowed by the heart doctors.