JENS KRISTIAN LILLEHEI left Tysnes, a heart-shaped island in Norway, in 1885, when he was seventeen. He was from a family of poor fishermen and farmers and, like so many others, he sailed to America seeking a better life. He got barely a taste. After becoming a bricklayer, marrying, and having two sons, Jens died of tuberculosis in 1898 in Minnesota at the age of thirty. His sons were not yet in school.
Jens’s widow, Paluda, was determined that her children would make something of themselves. With two dollars a day cleaning houses, she put her sons through the University of Minnesota. The younger became a doctor. The older, Clarence, became a dentist and married Elizabeth Walton, a professional piano player. Clarence was in the army when the first of their three children, all sons, was born, on October 23, 1918.
Walt was a handsome boy, with Nordic features that one day would enchant women. He enjoyed the outdoors, especially the pond near his home in Edina, a suburb of Minneapolis. He played sports and he enjoyed winning, but off the field he was an easygoing boy—and a bit of a loner. Walt liked nice clothes. He liked the neighborhood library and the Edina Country Club, to which his parents belonged.
Despite their comfortable existence, the Lilleheis instilled in their children the value of hard work; Walt was not simply a Boy Scout, but an Eagle Scout—and as soon as he was old enough, he became a caddy. The Lilleheis also stressed independence. Accompanied by their dog Jiggs, a stray that showed up on the doorstep one day, Walt and his brothers would set off on Saturday mornings for the pond, not having to return until suppertime. And before they drove, the boys were free to take the trolley into the city by themselves.
The Lilleheis believed in measured discipline; the consequence for their children’s bad behavior was an examination of the issue, not the back of the hand. One day when Walt was coming home from school, a classmate jumped onto the running board of his Model T, which Walt had bought with his savings from caddying. Walt wanted the classmate to get off. When the classmate refused, Walt put the gas to the floor and tore off, fishtailing down the road—and flipped his car rounding a bend. No one was badly hurt, the car still ran—and Walt got away with a lecture from Dad.
“I didn’t necessarily believe in signs that said ‘don’t do this’ or ‘don’t do that,’” Lillehei said years later. “If I had a reason to do it, I usually did it.”
A better clue that Lillehei was destined for something other than middle-class anonymity was his skill with his hands. Lillehei instinctively understood how things worked—and how he might make them work. As an eighth grader, Walt successfully modified a BB gun to shoot .22-caliber bullets. As a young teen, he begged his parents for a motorcycle; they resisted. When Walt found some motorcycle parts for sale—a tangled mess in a couple of bushel baskets—his parents, thinking he’d never assemble them, let him buy them. Without benefit of a manual, Walt built the motorcycle and got it running. And when he bought his Model T, Walt slung a hoist over a tree limb, took the engine out, broke it down, and reassembled it with ease.
Although he skipped two grammar school grades, Lillehei became an average high school student who nearly flunked chemistry. He won’t last six weeks in college, the chemistry teacher said to Walt’s father on Walt’s graduation day, in 1935. That fall, at the age of sixteen, Lillehei entered the University of Minnesota. He thought he’d become a lawyer, an engineer, or possibly a dentist, like Dad, but when he learned the requirements for medical school were the same as for dentistry, he figured: Why not? With the exception of three C’s, including one for surgery, Lillehei’s grades at the University of Minnesota Medical School were outstanding. He graduated tenth in a class of 103.
But Lillehei was no bookworm; he had a wry sense of humor, he loved to carouse, and, after graduating from high school without having dated a girl, he developed an eye for the ladies. He coined his own motto, which he carried throughout his life: Work hard, play hard! Consciously or not, he already was a kindred spirit to John Hunter, the renowned eighteenth-century Scottish surgeon whose biography Lillehei had savored. Hunter was a tireless experimenter who was the first to demonstrate that surgery could be more than glorified butchery—that a surgeon could also be a scientist. But Hunter was no scholarly straight arrow; as a young man, he was drawn to London’s gin dens and bordellos, and his lifelong disregard for risk bordered on recklessness. In an effort to demonstrate that gonorrhea and syphilis were manifestations of the same disease, Hunter, while engaged to the woman he would marry, infected himself with a pus-laden lancet. “This was on a Friday,” observed Hunter. “On the Sunday following there was a teasing itching in those parts, which lasted until the Tuesday following.”
During Lillehei’s college years, he and his friends spent Saturday afternoons at University of Minnesota football games. On Saturday nights, they drove out to Mitch’s, an establishment on the edge of town run by a one-time bootlegger who booked Hoagy Carmichael, Jack Teagarden, and other Dixieland jazz greats. Mitch’s was a bottle club: you could drink all you wanted, provided you came with your own. Walt and the boys arrived with bottles of near-beer, which they brought up to strength with grain alcohol pilfered from a medical school lab.
Many nights, the jamming continued until dawn. Lillehei’s stamina was unsurpassed. With only an hour or two of sleep, he was ready to take on the day, no matter what he’d had to drink.
When he was a boy, Owen H. Wangensteen did not intend to become a doctor. He wanted to be a farmer, like his father, a Norwegian immigrant who also ran a prosperous general store in the prairie town of Lake Park, Minnesota. Owen would likely have excelled: when he was a high school junior, he devised an ingenious new way to deliver some three hundred piglets from sows that, unable to farrow their young, had been destined for the slaughterhouse. Owen intended to study veterinary science at the University of Minnesota, but his father, a stern man who punished his young children by paddling them out in the woodshed, insisted on medicine. The son finally acceded to the father’s wish during the unbearably hot summer of 1917, when Mr. Wangensteen made Owen haul manure until his university classes resumed. “I said, ‘Well, anything would be better than this,’” Owen later recalled.
Gifted with a photographic memory, Wangensteen was first in his class at Lake Park High School and the University of Minnesota Medical School. After completing his surgical residency and earning a doctoral degree (for study of the undescended testis), he declined an offer to go into private practice at an annual salary of $15,000, a princely sum. He wanted to teach as well as to operate, and he wanted a lab. So he became an instructor in surgery at the university—for less than seventy dollars a week. Owen’s father was disappointed, as was Owen’s new wife, a woman who’d majored in home economics and believed a doctor husband was a ticket to the good life. But Wangensteen stood firm.
It was 1926, and the University of Minnesota Medical School was a pale imitation of the famous medical schools back east. European professors rarely stopped by on their lecture tours of America, nor did famous researchers covet a university appointment. The school did not even have a full-time chief of surgery. No one wanted the job.
“Well, there isn’t anything here, nor will there ever be,” said a Harvard surgeon who declined the position after visiting Minneapolis.
Owen Wangensteen thought this was balderdash. He sensed a rare opportunity, and, after a year of study in Bern with one of Europe’s preeminent surgeons, he accepted the position of associate professor at Minnesota. The next year, he was named chief of surgery. Wangensteen was thirty-one years old—perhaps the youngest chief of surgery ever at any university, but already a formidable clinician and researcher, with nearly three dozen published papers on such disorders as bowel obstruction and ulcers, two of his favorite subjects.
Wangensteen had barely taken office when grumbling opponents accused him of losing too many cancer patients. What his opponents really wanted was less an improved survival rate than for the chief to resign—they were jealous, and Wangensteen knew it. “This is a bunch of trivial drivel,” Wangensteen told the dean, who kept him as chief.
Politically nimbler now, the new chief began to build his department.
Lillehei was a sophomore in medical school when he first saw Wangensteen. It was the fall of 1938, and Lillehei was just twenty. Wangensteen was lecturing.
Short and slight, Wangensteen nonetheless was impressive: with his white lab coat, wire-rimmed glasses, and slicked-back hair, he resembled one of the great European professors. And he was young—not yet forty, yet he had been chief for nearly a decade.
Listening to him, Lillehei understood why. Wangensteen expounded for two hours without notes. He brought in patients and presented the case history of each entirely from memory.
The subject was acute appendicitis—the bursting of the appendix—which can kill without surgical intervention. Wangensteen told his students that only a short while ago, the cause was mysterious. Was it infection, as many believed? Skeptical, Wangensteen set out to find the answer.
He initially studied animals. With his research assistant, surgeon Clarence Dennis, Wangensteen observed, measured, and monitored internal pressures after tying animal appendices off. Wangensteen knew nature sometimes hides her secrets in unlikely places, and so he became familiar with the innards of rabbits, dogs, cats, and skunks. Then he moved on to monkeys and apes.
Still, he wasn’t satisfied. The young Lillehei listened spellbound as Wangensteen described experimenting on a tiger and a bear, which had been subdued with raw meat laced with barbiturates.
“When they became groggy,” Wangensteen recalled, “we rushed up with an ether can and put it over the animal’s nose and carried him, with the help of four hands, to the operating table—and then went ahead with surgery after tying the animal down.”
Having exhausted the available animals, Wangensteen studied humans. During surgery on colon cancer patients, he performed a second operation that left the patient’s appendix sticking out of his abdomen like a misplaced finger; then he tied off the tip and connected it to a bedside meter. And what Wangensteen found was that obstruction, creating internal pressure, caused an appendix to burst, and not infection. It was no earth-shattering discovery and it had limited clinical value, but it proved the merit of Wangensteen’s philosophy. It proved what determination and original thinking could do.
Amazing, thought Lillehei. Wangensteen had embarked on a quest. Here was science in two dramatic environments: the operating room and the lab. Here was Hunterian medicine.
Geez, Lillehei said to F. John Lewis, his closest medical school friend. We ought to go into surgery!
Lillehei finished his internship in the spring of 1942, and war summoned him. He went enthusiastically. He believed in serving his country, and he wanted to see the world.
He first saw London, then northern Africa, where, with the 1st Infantry Division, he commanded a mobile army surgical hospital (MASH) unit in the campaign against German field marshal Erwin Rommel’s infamous Afrika Korps. Lillehei was introduced to the brutal realities of war even before the enemy was engaged: on the eve of combat, Lillehei and his staff were up all night treating American soldiers who’d shot themselves in the foot, a ploy to escape combat. Lillehei was dumbfounded that anyone could be so scared. He himself was fascinated by war, as John Hunter had been two centuries before. He was heeding the advice of Hippocrates, who declared: “He who wishes to be a surgeon should go to war.”
From Africa, the Allies crossed the Mediterranean to Italy, where Lillehei participated in the landing at Anzio, thirty miles south of Rome. It was early in 1944. Anzio was crucial to the Germans, and they defended it fiercely, using punishing air and ground attacks to create what an American general called a “flat and barren little strip of hell.” Red crosses on tent tops failed to protect, and U.S. casualties mounted; for days on end, Lillehei did not sleep.
But this was the very heart of war, and the twenty-five-year-old captain found lessons in the carnage—lessons beyond the more obvious ones of management and medicine.
In one letter home, Lillehei wrote: “I’ve certainly seen more of the horrors of modern warfare than I had ever anticipated … you have to see it to believe it. After being around here, it certainly is going to seem funny to go to a football game or something for excitement.” In another letter, the young captain observed: “As commander of a hospital, one of my duties is to pick those who have been severely wounded due to direct enemy action and award them the Purple Heart. It is a beautiful medal, but not much to give a man in return for his arm, leg or face.” Years later, Lillehei would hope to reward sacrifice with something far greater.
As German resistance weakened and the Allies advanced to Rome, Lillehei found opportunity for other pursuits. Having kept detailed records of all of the operations that his surgeons performed, Lillehei began an analysis of the treatment of war wounds—which he hoped someday to publish. He frequented Rome’s cafes with fellow officers and pretty nurses—and he sent love letters home to his girlfriend, the beautiful Kaye Lindberg, a student nurse whom he’d met while he was an intern in Minneapolis and whom he would marry a year after returning from war. Lillehei savored a hearty meal and a night of good drinking, but he mailed most of his officer’s pay home to his father, who invested it for him in a savings account. Years later, this would turn out to be fortuitous for Walt, for a reason he could never have imagined.
Lillehei was a lieutenant colonel when he returned to Minnesota, and he wore a Bronze Star, a Bronze Arrow Head, and a European Theater Ribbon with five battle stars. If he’d been even-mannered going to war, he was unflappable coming home. He was a twenty-seven-year-old without discernible temper or fear—a man who was now strangely driven.
“The one change that has occurred in myself since leaving home is that I’ve become intensely restless,” Lillehe wrote before leaving Italy. “If I’ve stayed longer than 4–5 days in any one place, I long to get on the move again.”
Lillehei sailed home late in 1945. Primarily an administrator during the war, he still intended to become a practicing surgeon. It was time for his residency.
He applied to only one program. You do not forget a man who operates on tigers and bears.
When can you start? Wangensteen said at the end of a brief interview.
Today, Lillehei said.
You’ll need a white coat, the chief said.
Although it owed a debt to John Hunter, Owen Wangensteen’s surgical training program was unusual, if not unique. Unlike physicians at some of the European and eastern American centers and even the world-famous Mayo Clinic, ninety miles south in Rochester, Minnesota, Wangensteen was obsessed with research. Many of the great surgical centers emphasized the operating room, where blade met living tissue, but Wangensteen thought that was the easier half. What a surgeon did in the lab—whether he proved to be an original thinker—was more precious, in his view.
“Tradition is good for the French Foreign Legion or the Cold Stream Guards,” Wangensteen liked to say, “but it’s a disaster in science.” (Residents had a saying of their own. “Nothing is too strange as far as Wangensteen is concerned,” they said, though never to his face.)
Despite the intellectual freedom he allowed his residents, Wangensteen tightly structured his training program. He demanded regular publication and membership in professional associations. He insisted on master’s degrees for all of his surgeons and he encouraged the brightest to earn a doctoral, as he himself had. C. Walton Lillehei was unquestionably one of the brightest.
Lillehei began his residency on January 1, 1946, but before sending the young man to the lab, Wangensteen assigned him to the operating room, for an education in basic surgery. Lillehei started like everyone, by holding retractors and tying knots. He worked the University Hospital wards, ordering X rays, removing stitches, and changing dressings. Ward duty was essential to his training but dull—scut work, they called it. Yet here on the wards was where Lillehei learned to relate to patients, many of whom were terrified of the knife. For a surgeon, even a young one, Dr. Lillehei was unusually compassionate. And that was another lesson he brought home from war: the importance of comforting the sick and dying—a doctor’s moral obligation, Lillehei later called it.
Lillehei spent twenty-one months on this beginner’s rotation, and it was then—as he was gaining confidence in operating on the intestines, the stomach, the liver, and the lungs—that he had his first flirtations with the heart.
For that, Lillehei owed Richard Varco—like Clarence Dennis, a senior member of Wangensteen’s staff. Following groundbreaking work in Boston, Baltimore, and Stockholm, in the 1940s Varco was operating on peripheral structures of the heart. The interior remained beyond reach, but surgery on the outside anatomy was nonetheless a remarkable accomplishment. How amazed the world had been in 1938, when Harvard’s Robert E. Gross had ushered in the era of closed heart surgery—surgery that did not require cutting the organ open—with his daring operation on a girl born with a defect of the pulmonary artery and the aorta, the main vessel coming off the heart. How electrifying was the news six years later, when Alfred Blalock of Johns Hopkins University performed the first blue-baby operation, the lifesaving remedy (but not cure) of another deadly congenital heart defect!
Although Wangensteen had performed the first closed heart operation at the University of Minnesota, in 1939, he found cancer and ulcers more to his liking. And so the chief had handed the closed heart surgery to Varco, a gifted teacher who in turn had initiated Dennis.
Observing Varco operate on the heart’s exterior, Walt Lillehei began to get ideas.
By the autumn of 1947, Lillehei was itching for the lab. Wangensteen assigned the young resident to his.
Wangensteen’s laboratory percolated with new ideas: since becoming chief, Wangensteen, assisted by a succession of young doctors, had created many surgical innovations. Perhaps none benefited medicine as much as the gastric suction tube, used to treat bowel obstruction, a naturally occurring ailment that often killed the patient. Experimenting in his lab, Wangensteen had found that a simple flexible tube passed down the nose and through the stomach to the intestines relieved the pressure of backed-up gas and fluids—the actual cause of death. Used also to help treat abdominal wounds, the Wangensteen Tube had made its inventor something of a hero during World War Two, when so many soldiers took lead in the belly—and later prompted humorist Ogden Nash to pen an ode to the chief:
May I find my final rest in
Owen Wangensteen’s intestine,
knowing that his masterly suction
will assure my resurrection.
Wangensteen’s obsession in the autumn of 1947 was the peptic ulcer, in which gastric juices eat through the stomach wall. Ulcer was not the most glamorous disease around which a scientist could build a crusade, but a hole in the stomach could kill; even when it did not, an ulcer could make life painful and bloody. Surgeons and nonsurgeons—the internists— often disagreed over treatment. Ulcer was a modern field in the centuries-old contest between the men with knives and the lettered men of medicine, who hated bloodying their hands.
Led by such doctors as the University of Minnesota’s Chief of Medicine Cecil J. Watson, the internists preferred to treat ulcers with baking soda or a diet rich in milk and cream; surgeons such as Wangensteen, of course, wanted to cut. The truth was no one had found a universal cure, for no one understood what caused an ulcer.
Wangensteen and his young researchers sought answers in the usual subjects, laboratory dogs; they sought to determine precisely which part of the stomach offended, and exactly how big a piece a surgeon should then take. Lillehei plunged right in. Such adventure—right up there with tigers and bears.
Lillehei spent a year in Wangensteen’s lab, and then the chief handed him over to Maurice B. Visscher, chairman of the medical school’s physiology department. Like John Hunter, Wangensteen believed no surgeon could excel without knowledge of physiology, the study of function in living organisms.
Lillehei spent a year in Visscher’s lab and then, in October of 1949, Wangensteen appointed him the chief resident. Lillehei returned to the operating room, where he would finish his long training—and then join the faculty.
By now, surgeons in Boston and Philadelphia had taken another step toward true open heart surgery: they had devised a way to repair mitral stenosis, a comparatively simple defect inside the heart that involves a narrowing of the mitral valve. Like Alfred Blalock’s blue-baby procedure, the mitral valve operation had sent excitement through the surgical world.
Senior surgeon Varco had learned this latest cardiac surgery, and now he taught it and all of the other closed heart operations to Lillehei. Walt had yet to decide his life’s work, but the pull of the heart was strengthening.
KAYE LINDBERG LILLEHEI
