CHAPTER 18

Duson Vlaco left Belgrade in the late summer of 1970 and flew a third of the way around the world to Houston for a routine examination of his physical condition and of the heart that two years before had been taken from a 36-year-old man and implanted within him. The heart was no longer a foreign object. Duson’s system had manufactured billions of new cells and they had lived and died and had been reborn on the surface of the heart until the organ belonged solely to him. After a fortnight of tests—EKGS, x-rays, blood counts, bicycle pedaling, cardiograms—Duson stopped Ted Diethrich in the hospital corridor and said shyly: “I’d like to get out of the hospital for a day and go swimming at your house.”

On the following Sunday, Diethrich held a regular sports day at his home and from noon on, a dozen young surgeons and medical students spent the early hours of the afternoon bashing each other in frontenis, football, water basketball, water volleyball, and bouncing on the trampoline. Shortly after 3 P.M., Duson appeared, accompanied by his Yugoslavian cardiologist, Dr. Anicic. My first reaction to the strange child with the new heart was to recoil and shudder with pity. He walked happily across the patio on match-stick legs supporting a barrel-like torso. The skinny arms and hands seemed not so much a part of him but instead hastily attached, like branches slapped onto a snowman by a child. His head was huge, swollen to a pumpkin shape by the daily tablet of cortisone still taken to guard against rejection. There was a buffalo-like hump at the back of his neck, a thin, fine layer of hair across his shoulders, and purple stretch marks on his abdomen. Another purple blotch covered one side of his face and neck. But he shook hands firmly with everyone on the patio and sat down in a deck chair and smiled with a warmth that washed away much of the grotesqueness. “I like the Texas sun,” he said, tilting the pumpkin head toward the heat and opening his shirt. Ted brought him a soft drink and Duson drank it hurriedly. He saw the bicycle of one of Diethrich’s children and asked if he could ride it. Diethrich did not hesitate. “Have a go at it,” he said, and the boy with the borrowed heart ran to it and climbed on it and rode out the driveway onto a quiet lane with huge oaks. There were oil-company executives mowing their yards on sit-down machines and women pruning roses and children shrieking at their Sunday games, but none looked up as Duson rode somewhat unsteadily by.

“We didn’t do that to him,” said Diethrich, who had seen the unconcealed look on my face, that of a man standing in the carnival midway and eyeing the poster promises of the freak show. “The cortisone makes his face swell a little, but everything else he was born with.”

“What have the tests shown?”

“No rejection. None whatsoever.”

Anicic, the Yugoslavian doctor, said, “The boy is incredible. He is leading a completely normal life. I see him about once a week, but when I went on holiday for a month, I didn’t see him at all. The only noticeable complication has been an elevated white blood cell count after the tiring five-day trip back home to Yugoslavia from Texas.” Duson lives with his widowed mother and receives a special allotment from Tito’s government to help pay his medical expenses. He is a national hero there.

“I think we’ll be able to cut down the cortisone,” said Diethrich. “Maybe shrink his face a little.”

We returned to the frontenis court and in the middle of a stormy doubles match with the ball hurtling at the forward wall, Duson entered the court and picked up a racket to join in. Speedy Zweibeck, a new DeBakey fellow just down from New York, stopped and asked Duson politely to move to a grassy area for spectators and watch. The child obeyed, but in a few minutes he was back, still wanting to join the surgeons at their game. “Look, kid,” said Speedy, half-exasperated, “if you don’t get off the court, we’re going to take your heart back.”

Duson wandered to the nearby trampoline and climbed onto it, bouncing tentatively at first, then shouting with glee as he sprang up and down, his swollen face dripping with honest, joyful perspiration. “I hope you sewed that heart in good, Diethrich,” said Speedy.

Later, when my team was beaten at the frontenis game, I plunged into the pool and swam underwater as long as my breath would allow me, rejoicing in the coolness and languor of the depths. When I surfaced, someone jumped in beside me and laughed loudly. It was Duson. “We can swim together,” he said, and the boy with the faded scar on his pigeon chest was suddenly nothing more than another youth reveling in the summer afternoon, wanting to be accepted as a human being, not a medical oddity. We took eight laps together, talking, shouting, splashing, using the palms of our hands to slap the water and shower those watching, with amazement, our exhibition.

As we dried ourselves with thick beach towels, Duson talked of his rock group. “It is called The Beatniks,” he said, “and I am the leader. I wrote a song called ‘The First Step on the Moon’ and last week it was number one on all the charts in Yugoslavia.” He grinned broadly, waiting for my nod of compliment.

“You could get the same noise,” said Anicic, “by putting two cats, two dogs, and a screech owl in the recording studio.” Duson stuck his thumb in his soda bottle and shook it and sprayed his doctor.

“He doesn’t like my music,” said Duson, “but everybody else does. I make money to go to musical school.” He was in his first year of a four-year musical education. He could look ahead that far!

Diethrich grilled hamburgers and hot dogs in the twilight and his star guest heaped a plate full with beans, potato salad, tomatoes, and pickles. He ate ravenously and stretched out on a horizontal deck chair. He belched and patted his stomach. When Diethrich walked by to get some more meat patties, Duson stopped him shyly and touched his arm. “Thank you,” the boy said.

As the boy and his doctor took their leave, I shook their hands. “I’m glad to see you don’t favor your new heart,” I said to my swimming partner.

“Days, sometimes weeks go by and I don’t even think about it,” he said. “I don’t think about it today at all.…”

Despite the extraordinary witness born by Duson Vlaco, the heart-transplant program, completely moribund at St. Luke’s Hospital, was scarcely more alive at Methodist. Howard Stapler’s heart failure was treated by the cardiologists on DeBakey’s staff and he recovered sufficiently to return to his Western novels, his home in Indiana, and yearnings for another heart. Twice again in the summer and autumn of 1970 he would fly back to Houston seemingly in the throes of death, only to be revived by medication and observation. He asked both Diethrich and DeBakey regularly when they were going to transplant him, but the answers he got were guarded and noncommital. Diethrich said the transplant program was blocked by lack of money, which was, in a large sense, true. Transplants had cost an average of $75,000 and a considerable portion had come from Baylor’s research funds. In the inflation of Nixon’s administration, money for medical research had grown increasingly scarce and there was no willingness on DeBakey’s part to spend what there was on heart transplants.

Privately, the junior surgeons believed DeBakey to be totally disenchanted by the transplant experience. Cooley’s record of 100 percent mortality, the unpleasantness of the artificial-heart trial, the enormous drain on the talents and capacities of the hospital staff in caring for transplant patients, and the public’s disinterest in donating hearts had brewed a bitter potion. “The Professor’s career has been built on winning,” said one of the younger men. “Why risk failure this late in his game?”

In late August, Ted Diethrich summoned his courage, rehearsed mentally for the twelfth time what he would say, and asked DeBakey for a private audience. He spoke quickly and enthusiastically, looking directly into the magnified eyes behind the thick glasses. He would be resigning, Diethrich said. He had been privately working on a dream to build his own heart institute, and now it was far enough along to be assured. “I’m going to Phoenix, Arizona,” Diethrich said. He had found backers to build a $3 million addition to an existing Catholic hospital. He would form his own team of cardiologists, nurses, and pump technicians and there would be affiliations with the University of Arizona Medical School.

“Where is that?” asked DeBakey.

“In Tucson, about 150 miles away.”

“That’s about close enough,” said DeBakey wearily, caught up at that moment in a struggle across the street with the Baylor faculty over his plan to slice one year from the four-year medical education and, hopefully, turn out doctors faster.

DeBakey did not attempt to dissuade his junior man, even though Diethrich was an invaluable member of his team, even though the Arizona Heart Institute, if successful, would service a portion of the country, the American Southwest, which had sent hundreds of patients to Houston. “Keep me informed,” was all he said.

With the long-kept-quiet cat finally out of the bag, Diethrich spoke with excitement as he began recruiting. “It’s going to be FAN-TAS-TIC,” he fairly cried. “Suppose a doctor calls up and says, ‘I’ve got a 45-year-old man who’s just had an acute coronary, what can we do for him?’ Well, the Arizona Heart Institute will have on hand a 24-hour-a-day ambulance with a doctor inside. They go out, bring this man in, not to the emergency room of a hospital, but to an area in our Institute that is equipped for everything from minor IV support to coronary catheterization to immediate bypass surgery. Nobody has this concept yet. This is the Outer Space Medicine of the ’70s, of the ’80s. We can pick up patients by helicopter from 200 miles around. We’ll have our own jet, too. When somebody calls in sick from Chicago, what can we do for him? We can do many things for him, we can send our jet out to get him and perhaps save his life.… The philosophy of so many doctors is twenty years back—a hundred years back. They give a heart-attack victim an EKG, put him to bed, start him on exercise. I’m not at all sure that you shouldn’t start exploring his vessels right away, do cardiac catheterization immediately upon his arrival at the hospital. We have surgical methods now to immediately revascularize the heart, to immediately restore a new blood supply. If you look at statistics on coronary death rate of people admitted to hospitals who have low blood pressure on arrival, 75 percent of them never leave the hospital. This doesn’t even take into consideration the 50 percent who never even arrive.

“These may seem like wild, far-out ideas, but these are things I could never develop here in Houston. There’s no way for me to do this in Houston. I’ve got to put myself in a position where I have my own team. And I can’t sit around another five or ten years until DeBakey retires. When he leaves, there’s going to be the maddest scramble for power you ever saw.… We’re going to start clean in Arizona. I’m going to have only people who can get excited. People that you can’t excite, I’m through with. I’ve got to have people beside me whom you can light a bomb under and they’re in orbit—seven days a week. I want a handful of people with me who can change the world of heart care.”

Don Bricker had said there were a half-dozen DeBakeys. A year after L’affaire Cooley, there seemed to be a hundred more, all possessed, consumed, driven to plant footprints so large that no new wave could wash them away. There was the DeBakey boldly seeking $30 million for Baylor in a recession year, the DeBakey overhauling the medical school’s curriculum and doubling the freshman class enrollment from 84 to 168 and doing it on a few weeks’ notice over the anguished objection of more than one veteran faculty member. There was the DeBakey flying as commuter to Washington and meeting with Senator Edward Kennedy to write a universal health-plan bill that would, as one Houston doctor complained, “push American medicine totally over the brink into the swamp of socialism.” DeBakey snapped back to all such attacks that medical care in his country was a right, not a privilege, that it belonged to all Americans, not only those over 65. There was the DeBakey wooing in person and on telephone some of the great names in science, attempting to persuade them to come to Houston to fill five long-vacant academic chairs at Baylor—vacant, some said, because the great names did not relish working within the volcano of Mike DeBakey. There was the DeBakey pushing his artificial heart program with a new man down to head it, wrapping it in security measures comparable to a NASA installation. There was even the DeBakey appearing on midnight television talk shows, giving awards of merit to Jerry Lewis. But these were only the public DeBakeys. The private one was buried even deeper in a body of secrecy. He had placed himself within a labyrinth to which all access seemed blocked. Suspicion appeared to emanate from him toward all. “I can understand how Mike is hurt over the artificial heart,” said one who had known him for years, “but I cannot understand why he has to distrust practically everybody in the Medical Center.”

He withdrew more and more to the locked office, preferring more and more the sureness of the telephone over the permanence of the letter. The only man whom he could fully trust was Michael E. DeBakey. The only man to fully understand what he would do, his wrath, his wisdom, his loneliness, was Michael E. DeBakey.

Geoff, the expelled surgical resident, was reinstated as abruptly as he had been thrown out. He never learned the exact reason for his dramatic censure and expulsion from the hospital, nor did he know why DeBakey casually invited him back into the program, with credit for the academic year, with an even better job in the Ben Taub charity program. Only DeBakey knew.

Though he was increasingly engaged on matters academic and national, the senior surgeon did not short his responsibilities in the operating room. There his manner and disposition had not changed. Toward the end of August, 1970, there were two vivid examples.

The first case was a Tetralogy of Fallot, a boy who had flown from Europe with money raised by his village. “Mike is always interested in these mercy-flight cases,” said a junior surgeon as he recounted the story. “Anyway, the kid had the usual VSD, which we sewed up, but we couldn’t get the boy off the pump. We tried for 30 minutes and DeBakey was distraught. He was, in fact, going out of his mind. He yelled for another anesthesiologist to come into the room, and when he did, and when that didn’t help, Mike cried, ‘It must be metabolic,’ and he called for a new cardiologist. All the time he was crying, ‘Do something! Do something!’ When nothing worked, when every new idea had been exhausted, Mike and the assisting surgeon discovered what had really happened. The kid’s aorta was coming out of the right side of the heart, a freaky thing. We had fixed one defect but overlooked the other more complex problem, which was uncorrectable from the beginning. The kid died and Mike looked up with his eyes glistening and said, ‘Who’s going to go out there and tell that mother her child is dead?’”

The one DeBakey practice that most annoyed his young surgeons was his custom of making out the surgical schedule himself, not permitting it to be done by anyone else. “Consequently,” griped a junior surgeon, “you don’t know who you’re going to operate on tomorrow until nine or ten the night before. The blood bank has to spend all night rushing around and calling to locate blood, and anesthesia has to wait until 10 P.M. to talk to the patients, and nobody gets much sleep. But that’s the way Mike does things.”

On a Sunday night, after having been out of town for a few days, DeBakey made rounds and scheduled a staggering array of operations for Monday morning—eleven in all, including four coronary bypasses and one gasendarterectomy, those new, meticulous procedures that gossip held DeBakey had not learned. Or perhaps could not do. On the Monday morning, as he scrubbed in at seven, DeBakey frowned upon hearing that George Noon was on vacation. There were some who later claimed that DeBakey knew it all along. For what was about to happen would be talked about in Houston medicine for years to come.

His face grew more stormy when Ted Diethrich did but one case, a carotid—reaming out of the carotid artery is always done first because such cases are normally easy and gotten out of the way quickly—and then flew off to New York to deliver a paper to a medical meeting. There were some who later claimed that DeBakey knew of Diethrich’s trip as well.

“Nobody wants to work any more,” griped DeBakey as he began a coronary artery bypass operation at eleven, the procedure that Denton Cooley was now committed to and proclaiming its beauty at medical meetings. The operation took two grueling hours with the tenseness on DeBakey’s face apparent to everyone in the room. When he was done, it was early afternoon, and the staff assumed he would do perhaps one more case and cancel the schedule until his assisting surgeons returned. But instead he moved wordlessly to the adjoining operating room and began a valve replacement. By 4 P.M. it became obvious something was up. At six, the nurses and junior men began eyeing the operating room clock because it was known that DeBakey had a 10 P.M. flight to Washington and he would have to quit by eight to make it. His temper had flashed so often during the day that no one dared ask if he was going to the airport. Once during the long afternoon he had exclaimed that he was in the company of incompetents and that he would do all the work himself. He tried to hold the retractor, the sucking machine, and the sewing needle all at once. “If I only had three hands,” he cried out, “I could operate all by myself.…”

Between early-evening cases, he slipped out and made rounds with a nurse. He also sent out for hamburgers to feed the entire team, an act of kindness that startled the newer members. He moved back and forth from operating rooms 2 to 3 to 4 as the cases were brought in. He would let one of the assistants make the opening skin incision, but that was all. “God help us,” murmured one of the residents as the evening began, “he’s going to do the whole schedule.” DeBakey’s work, that of three surgeons, was breathtaking. Eight o’clock came and went, nine flew by, and at ten one of the strong young doctors who starred each Sunday at Ted Deithrich’s sports marathons felt the pain in his spine and the heaviness in his eyes, but he remained spellbound by the power and beauty of DeBakey’s surgery.

At midnight, the senior surgeon called for the gasendarterectomy patient who was fetched somewhat bewildered from his room and wheeled to the operating room. There DeBakey, with no sign of weariness, began his eleventh operation of the day, a day which had begun at 7 A.M. He made the tiny incision within the artery of the heart and injected the whiffs of carbon dioxide to loosen the layers of occlusion, those layers which threatened to close the artery and possibly bring on a heart attack. With grace and sureness he loosened the core and pulled it out, holding the offending mass for a moment in the strong lights from the four spots that bathed him and the patient’s heart. “He was the tallest man I ever saw,” said Speedy Zweibeck when it was over, “and the proudest, and certainly the youngest.”

When he was done sewing up the eleventh and last patient of a day that had stretched eighteen and a half unbroken hours, DeBakey glanced up at the operating room clock and saw that it was 1:25 A.M. Around him stood men and women, who, had they not been masked and gowned and gloved, would have applauded and shook his hand. Someone else could play the concerto well in Houston. DeBakey was exhilarated as he walked to the heavy swinging doors. He opened one as if to leave. Instead he stuck his head out and he cried in a voice of triumph that burst through his mask and broke the quietness of the empty corridor: “Anybody else out there want an operation?”