THE HEADLINES on April 13, 1972, stunned people who knew Dr. C. Walton Lillehei only as a world-renowned surgeon. A grand jury in St. Paul, Minnesota, had indicted Lillehei on charges of evading $125, 100 in U.S. income taxes. He faced up to twenty-five years in prison—and the loss of his license to practice medicine.
Lillehei had tried to stave this off, but the Internal Revenue Service had no interest in accommodating the doctor whom some were beginning to call the Father of Open Heart Surgery. The agency wanted to make an example; it wanted coast-to-coast headlines on the eve of Tax Day, and it got them.
Had you visited Lillehei’s office back in the hectic 1950s, you might well have predicted tax trouble.
The University of Minnesota frowned on doctors using the medical school’s secretaries for billing, so Lillehei did his own—or didn’t do his own. Bills to patients and insurers were late going out, and when the checks finally came in, Lillehei tossed them in a drawer. When he needed money he’d fish around and pull out a check that was about the amount he needed and take it to the bank—if the check hadn’t expired. When he got around to bookkeeping, Lillehei used index cards filed in shoe boxes.
And what were taxes, really, but even more paperwork? Walt, legendary procrastinator, was always late filing his returns—by a few months at first, but soon he’d gotten a year or more behind. Initially, the IRS failed to notice. Then, on April 27, 1966, Lillehei filed returns: not for the preceding year, however, but for 1963 and 1964. His income had increased, and this time, the IRS looked into his delays.
An inspector concluded that while Lillehei was a procrastinator, he wasn’t a crook.
“This guy is clean,” said the inspector.
But now the IRS was watching closely. When almost two years passed without further word from him, the agency sent a letter, in December of 1967, the month Christiaan Barnard transplanted the first human heart.
“Dear Dr. Lillehei,” said the agency. “The files of the district director of Internal Revenue, St. Paul, show no record of federal income returns in your name for the years 1965 and 1966. We are assigning this matter to a special agent.”
Lillehei responded immediately, promising returns and payment by January 15. But once again, he procrastinated. It was now early in his tenure at the New York Hospital-Cornell Medical Center; his time was scarce, and he didn’t file his 1965 return until November of 1968—two and a half years late. By then, Lillehei should also have filed his returns for 1966 and 1967, but he hadn’t. Nor did he offer an excuse; he simply ignored the government, again.
The special agent was Ray W. Jackson, a career bureaucrat whose education consisted of high school and correspondence courses. He called Lillehei in late December 1968, but the surgeon was not available. He was busy transplanting a heart and two lungs—busy with the Christmas present operation that made headlines around the world.
Jackson persisted, and Lillehei finally began to get the picture. He hired a tax lawyer and, in May of 1969, filed returns for all three delinquent years, along with payment of taxes, interest, and penalties. But Jackson was only getting started. The special agent burrowed into shoe-boxed index cards, microfilmed bank records, travel and expense reports, all manner of receipts. He tracked down former patients, professors who’d paid Lillehei to lecture, people who’d tended bar at Lillehei’s parties.
Special agent Jackson found more than evidence of tax fraud. He discovered that Lillehei had been leading something of a secret life—a life that included mistresses and even a Las Vegas call girl.
The day in 1972 that his indictment hit the news, Lillehei sent a letter to Wangensteen, who was still saddened by Walt’s fall from grace at New York-Cornell.
“I know you must be disturbed by the recent tax publicity,” wrote Lillehei, “but all I can tell you at this time in this communication is that it is not at all what it appears on the surface. I am quite confident that I am going to be acquitted.”
Wangensteen wasn’t so sure; he knew that juries could be unpredictable, and he urged Walt to settle out of court. “Washing linen in public is never a very rewarding experience, as many who have tried it have learned to their sorrow,” said Wangensteen. But the IRS wasn’t dealing. The agency had already given Lillehei this choice: plead guilty and put yourself at the mercy of a judge, or go to jury trial.
The prosecution began its case on January 15, 1973, with a thunderous attack on the open heart surgeon. It seemed to Lillehei that the prosecution intended to do more than prove that he’d underpaid his taxes. It seemed that the government of Richard Nixon wanted to destroy him—in retaliation, Lillehei suspected (but never did prove), for his support of Nixon’s opponent in the 1968 presidential election.
In his opening statement, U.S. District Attorney Robert Renner accused Lillehei of double billing. He maintained that income from at least 318 patients, several visiting lectureships, and savings accounts had never been reported. He said that Lillehei had claimed the cost of his parents’ fiftieth wedding anniversary party as a business expense, and gifts to three girlfriends and the Las Vegas call girl as tax-deductible “typing” expenses. As the trial progressed, Renner planned to have these four women testify about the definition of typing.
But first, he began to call former patients—people who’d paid Lillehei fees that the government claimed he had not reported. Dutifully, these upstanding citizens paraded to the stand, their stories punishing the man who’d literally held their lives in his hands. Lillehei sat quietly, sometimes looking puzzled or pained. The days of the Queen of Hearts seemed a very long time ago.
Then, on the second day, unexpected sympathy.
Carl Schuler, of Waterloo, Iowa, was testifying. Renner coaxed from him the story of how, for three hundred dollars, Lillehei had cured his wife, Shirley Schuler, who was also in the courtroom.
Renner finished and handed the witness over to the defense.
“Mr. Schuler,” said one of Lillehei’s lawyers, “what is your occupation?”
“Brick mason,” said Schuler.
“How did Mrs. Schuler happen to go to Dr. Lillehei for services?”
“Our family physician wanted her to have the best and he is the one that contacted him.”
“Were you subpoenaed to be here today?” said the lawyer.
Schuler said yes.
“Was your wife also subpoenaed?”
“Yes.”
“Did she respond to the subpoena?”
“She told them she would just as soon not,” said Schuler. “It was very hard for her.”
As Shirley Schuler left the courtroom, the reporters asked her about Dr. Lillehei. “If it wasn’t for him,” she said, “I wouldn’t be here today.”
The trial entered a second week, then a third.
Through a string of witnesses, Renner exposed the most intimate details of Lillehei’s life. Under “drugs and pharmaceutical charges,” Lillehei had deducted veterinary bills for the family cats, Tinkerbell and Peter Pan. He had written off piano lessons for his children; dance lessons for him and his wife, Kaye; and tuition for Kaye’s university courses, including one on existentialism.
But what really got Minnesotans talking was the doctor’s other women, each of whom Judge Philip Neville permitted on the stand over Lillehei’s lawyers’ objections. One was the Variety Club Heart Hospital nurse: she testified that she’d had an “intimate” relationship with Lillehei, during which he’d given her five hundred dollars, an amount he claimed on his returns under “additional professional, secretarial and maid help.” The most devastating of the four paramours was the Las Vegas call girl, who said the hundred-dollar check Lillehei had given her was not for typing. The call girl left quite an impression. Judge Neville interrupted her testimony early on to ask her to please stop chewing her gum.
The question that no one could seem to answer was: Assuming that all of these allegations were true, how could such a brilliant man have been so foolish? The best answer anyone could provide was that Lillehei, in a rush to reconstruct so many years of such atrocious record keeping, had monumentally blundered.
Lillehei’s billing system was the core of the government’s case. Even if the jury accepted Lillehei’s unorthodox accounting, argued the U.S. attorney, why was so much patient income unrecorded—and thus unreported? According to Lillehei’s system, every payment from every patient was supposedly entered on one of those shoe-boxed index cards. But there were no cards for at least 318 patients.
The trial was under way when Lillehei, digging around in his untidy cellar, found more boxes. The cards therein were a mildewy mess—firefighters extinguishing the 1967 fire had caused water damage—but there they were, the missing records for the 318 patients. This couldn’t be fraud, the defense maintained; this was only classic paper chaos.
Jerry Simon, Lillehei’s lead lawyer, managed to get the cards entered into evidence without having to put his client on the stand. Simon now thought acquittal was likely. If Lillehei was guilty of anything, Simon believed the jurors would decide it was bad judgment, carelessness, and of course procrastination—but not fraud.
The trial had entered its fourth week when the prosecution dropped a bomb.
Unbeknownst to Lillehei’s lawyers, prosecutor Renner had sent some of the newfound cards to a documents examiner; with an infrared viewer, the examiner had discovered that many had been altered. Someone using different ink had changed numbers, making it appear as if several accounts still had outstanding balances; under his unique accounting system, Lillehei wouldn’t have considered payments to such accounts as reportable income (not until they’d been paid in full). The alterations seemed damning evidence of criminal intent.
Simon was floored. He offered no explanation.
The trial ended its fourth week. Renner rested the government’s case, and Simon began the defense.
Treading carefully through the issue of altered cards, which he knew the jury found deeply disturbing, Simon played for sympathy. He sought to create in jurors’ minds the image of Walt as a great humanitarian whose contributions had come at great personal cost; if he’d cheated anything, it had been death. The legendary Professor Wangensteen, seventy-four, could speak most eloquently to that point, so Simon called him.
The retired chief of surgery testified about diagnosing Lillehei’s lymphosarcoma—about how eminent pathologists had predicted that the young surgeon would probably not survive five years and how Lillehei had thus first cheated death, his own. Wangensteen then went on to discuss something even more miraculous: the untold thousands of children and adults whom Lillehei had saved with his open heart advances. But miracles do not come free, Wangensteen testified, and in Lillehei’s instance one cost was an astounding inattention to paperwork. But there were only so many hours in the day, said Wangensteen, and Lillehei had spent most of his on surgery, research, and teaching; in the balance, wasn’t that what counted?
Lillehei’s former partner Richard Varco also testified for the defense, along with Maria Ramsay, a wealthy benefactor who’d brought some 140 impoverished children to Lillehei, who fixed their hearts without fee. An aerospace engineer testified that Lillehei was the only surgeon who had the “guts” to perform a coronary-bypass operation on him when he was dying; thus snatched from death, the engineer had survived until Norman Shumway gave him a healthy new heart in an operation at Stanford.
“The doctor saved my life,” said the engineer. “I want to save his.”
There was a final twist, mere hours before the case went to the jury.
Lillehei hadn’t underpaid his taxes, Simon argued—the government owed him, $53,000, to be exact. That was the net result of charitable deductions that Lillehei could have claimed, but did not, for royalties on a commercially successful heart valve he’d codeveloped in the 1960s. Lillehei had not profited from the valve; he had directed the proceeds to the University of Minnesota.
On February 14, 1973—Valentine’s Day—the case of the United States of America versus C. Walton Lillehei went to the jury. The trial had consumed twenty-one days and cost hundreds of thousands of dollars. One hundred and sixty-four witnesses had been called by the prosecution, sixteen by the defense. More than six thousand exhibits had been entered into evidence.
“I have the definite impression that the jury is with you,” said Wangensteen in a note to Lillehei. Lillehei himself was optimistic that the bad times, which had really begun long before his indictment, were about to end. Lillehei retreated to his St. Paul home to await the verdict.
His wife accompanied him.
Kaye had left town for the trial: she did not need to see Walt’s embarrassing transgressions splashed in lurid detail across the hometown papers. Nor would she have learned much, sitting in court. Quite some time before 1973—during Walt’s tenure at Cornell, in fact—Kaye had discovered his secret life.
Early in their marriage, Kaye gave up a future in nursing for a young family and a husband who worked six and often seven days a week. “R.N. earns MRS. Degree,” declared a Minneapolis Star headline on an article about the celebrated surgeon’s wife in 1955, when the Lilleheis’ four children were all younger than seven. “What he’s doing is as important as anything can be,” Kaye told the writer of the story.
But the long hours hurt; even on Saturday nights, on their way to the Parker House for an evening out, Walt would insist on stopping by University Hospital or Millard Hall to check on a patient or the progress of an experiment. Walt missed his daughter’s high school graduation, and he was no Little League dad to his three sons. Kaye raised the children; as they grew, she golfed, bowled, skied, and volunteered for the Red Cross, pursuits that did not involve Walt. “I created my own life,” said Kaye years later. “Like they always say: the doctor’s wife will either drink herself to death, or she’ll commit suicide—unless she does something else.”
When she discovered what her husband was up to in New York, Kaye considered divorcing him. But she did not. Lillehei lost his job as chief of surgery, and his tax troubles soon began; the party ended, and Walt begged for one more chance.
“If you can forgive me,” he said in a letter to Kaye, “I’ll do anything to make up for it.”
Two days after the jury got the case, the Lilleheis’ phone rang. The eight men and four women jurors had decided.
Accompanied by their daughter and Walt’s aging parents, the Lilleheis went into the courthouse. Several of Walt’s friends were there, including Wangensteen and Varco.
Everyone took a seat, and count one was read.
How say you? asked Judge Neville.
Guilty, said the foreman.
Count two?
Guilty.
Guilty on all five counts.
Lillehei faced twenty-five years of hard time and a $50,000 fine. The Father of Open Heart Surgery was a felon.
Walt embraced his wife and daughter. On his way out of the courtroom, he said nothing to the reporters.
Kaye said only, “I don’t believe it.”
On the morning of May 4, Lillehei, his family, and some friends returned to court. Lillehei was to be sentenced.
Jerry Simon pleaded for leniency. He spoke of Lillehei’s service to his country in war—the Bronze Star he’d earned for valor. He spoke of Lillehei’s generosity to patients who could not afford his services, and of his priceless advances in open heart surgery. “Humanity has benefitted immensely from the work of this man, work which was not done without great sacrifice on his part,” said Simon. “Society is indebted for what he has done, and perhaps this is the time for society to recognize and perhaps in some measure repay him for the contributions he has made.”
“Dr. Lillehei,” said the judge, “do you wish to make any statement to the court?”
Lillehei did.
“First, of course, I stand before you labeled as a criminal,” he said. “I must say I don’t feel like one. I hope I don’t look like one. I don’t believe I am one. My conscience is quite clear on that score. I certainly have been guilty of poor judgment, a good deal of carelessness, some good honest mistakes. But those are hardly criminal acts. And I find it hard to accept the fact that I stand before you in this position.”
Lillehei spoke briefly of his extensive charity, and of his many gifts to medicine—all the machines, techniques, and instruments he developed or codeveloped but which had never enriched him, since he never sought patents in his name.
“I find it difficult, if not impossible, to comprehend the charge and conviction of me being a money-hungry, conniving individual,” said Lillehei.
The surgeon closed with an allusion to Ecclesiastes.
“Your Honor,” he said, “I think I have cast a little bread upon the waters, and I can only hope—perhaps pray is the better word—that the time has come. Thank you.”
Philip Neville was no hanging judge. He had a strong record on civil rights, and lawyers considered him a fair jurist who took his power as a sacred charge. He had also, unknown to anyone but his family, recently been diagnosed with leukemia. At the age of sixty-three, he was dying.
Few if any cases had so confounded Neville as Lillehei’s. After the guilty verdict, letters poured into his chambers; they ran about fifty-fifty, with half asserting that Lillehei’s contributions should spare him prison, and the other half maintaining that no man, Nobel contender or not, was above the law. Neville was similarly torn; for nearly three months, he had agonized over what to do.
In the end, Neville decided to fine Lillehei the maximum, $50,000, and order him to serve six months of community service. Neville could not bring himself to imprison Lillehei.
“I can’t help but recognize that you have this great talent that should be of use to society,” the judge said. “And sitting in jail in a cell, if it doesn’t destroy that ability—if you are there for several years, at least it impedes it and renders it [useless] for that period of time.”
After getting away with Kaye for a few days to Hawaii, Lillehei returned to the New York Hospital-Cornell Medical Center, where he was allowed to keep his operating privileges through the end of the year. After that, the director and the dean wanted him out altogether. They would honor the financial terms of his contract, which ran through the end of 1974, but that final year, they decreed, would be a paid leave of absence. Come December 31, 1973, they wanted Lillehei off the premises.
They needn’t have bothered.
Lillehei was developing cataracts—the cruelest possible side effect of his radiation treatment for cancer was manifesting itself almost a quarter of a century later. There is no good time for a surgeon to suffer such a curse, but for Lillehei, the timing couldn’t have been worse.
On December 30, 1973, Lillehei performed open heart surgery. Then he left the New York Hospital without telling anyone of his suspicion that he’d done his last operation.
Lillehei was scheduled for cataract surgery in 1974, but he doubted any ophthalmologist could restore the sharp eyesight he needed for his work. He was right. Denton Cooley would still be operating well into his seventies, and Michael DeBakey would still be going at ninety, but C. Walton Lillehei, fifty-five years old, never scrubbed again.
Lillehei’s tribulations did not end with his trial. Heartbroken, some said, by their son’s humiliation, Lillehei’s mother and father both died before 1973 ended. The American College of Surgeons suspended Lillehei indefinitely, and the state of Minnesota revoked his license to practice medicine there until completion of his community service.
But Lillehei had trouble even finding a hospital that would let him fulfill his sentence: surgeons, including some Lillehei had trained—chiefs and department chairmen themselves now—shied from association with public scandal. So what if, for some, this was hypocrisy? Lillehei’s private affairs, not theirs, had been all over the front pages.
Lillehei could not bring himself to beg for a job, but Wangensteen could.
Wangensteen wrote letter after letter, pleading, calling in old favors, praising Walt’s brilliance. “As I said at the trial, he is truly one of the Surgical Immortals,” Wangensteen wrote to one prospective employer. “To the harsh impeachment of C. Walton Lillehei I would remind his critics of that ageless truth that to err is human, to forgive divine.”
But not even Wangensteen could change perception.
“Gossip is so rampant that Walt would have a very difficult time of it here,” wrote the chief of heart surgery at one prominent center. “As a matter of actual fact, I know I could never get him appointed. The only thing worse would be if I did. Then there would be nothing but gossip and innuendo.”
A veteran’s hospital in Brooklyn finally agreed to let Lillehei serve his community service there—but not without a fight. Wangensteen prevailed only through Senator Hubert Humphrey, who intervened on behalf of his surgeon friend.
On October 6, 1975, nearly five hundred heart surgeons and cardiologists gathered at the Henry Ford Hospital in Detroit. The invitation-only Second International Symposium on Cardiac Surgery was the most prestigious such affair in twenty years. Every living leader in heart surgery attended or sent an original paper: Cooley, DeBakey, Shumway, Lower, Dennis, Bigelow, Mustard, Harken, even the old renegade Charlie Bailey.
Yet two big names were absent.
Chris Barnard was one. The invitation committee believed that the South African surgeon had plagiarized the work of Shumway and Lower, even though Barnard had always acknowledged the debt he owed them.
Lillehei was the other.
Walt had attended the first Henry Ford Symposium, in 1955, when he electrified the audience with a masterly presentation of surgical correction of VSD, tetralogy of Fallot, and atrioventricular canal. His name had come up during selection for the second symposium, of course. But led by a longtime critic of Lillehei—a surgeon whose own meager contributions did not match his ego—the invitation committee had voted Lillehei down.
Another rebuke by his peers; by then, they were common. Lillehei bore his new status as pariah with humor and grace. He was sensible, not vindictive; sanguine, and only rarely angry. Lillehei had been places most never go, seen things most never do.
He thought, Isn’t this life, too? Isn’t the guy on top of the mountain always a target?
Since before his breakthrough with Gregory Glidden, even, hadn’t the critics sniped? Not those, like the Mayo Clinic’s John Kirklin, who disagreed with this or that surgical approach because they believed they had something better. Not those critics, but the ones who resented the publicity, the parties, the Jaguar XKE, the architecturally acclaimed house—and mostly, the shimmering genius behind the piercing blue eyes.
Lillehei had cast bread upon the waters, all right. In 1975, nothing was coming back.
So Lillehei went home to Minnesota. He watched two sons become surgeons, and the third a businessman, and his daughter a good mother and wife. He did not become a recluse—he still dined with Kaye at the Parker House, still socialized with friends at the Pool and Yacht Club. He paid his fine, but he was hardly left impoverished. He was a millionaire; his investments beginning in the wake of his lymphosarcoma had paid off.
He wrote, although editors stopped clamoring for his work: author or coauthor of an extraordinary fifty-four published pieces in 1969, his most prolific year, Lillehei saw only nine articles in print from 1974 through 1978. Lectureships dried up almost completely in the United States, although other countries, where sensibilities were different, invited Walt as often as ever. Through the end of the decade, he was visiting professor in Paris, London, Rome, Baghdad, Rio de Janeiro, Istanbul, and many other places. Lillehei accepted these invitations gratefully. They gave him a forum in which to begin the slow work of reclaiming his place in history.
Wangensteen believed Lillehei’s reputation could be fully restored only if the University of Minnesota reappointed him to the faculty—in essence, pardoned him. But the university wouldn’t even accept Lillehei’s offer to lecture occasionally, for free; John Najarian, Wangensteen’s successor, could never forget a red rose on an empty floor.
Still, near the end of his life now, Owen set off on one last crusade for his dear Walt.
He died, of a heart attack, before succeeding.
John W. Kirklin was president of the American Association for Thoracic Surgery when it met in the spring of 1979, in Boston. Twenty-five years exactly had passed since Lillehei, in Montreal at the association’s annual convention, had astonished the audience with his report on Pamela Schmidt. Kirklin had been a relative unknown then, still struggling in a Mayo Clinic basement to perfect a heart-lung machine.
Now Kirklin was arguably the best practicing open heart surgeon anywhere. He was one of cardiac surgery’s most accomplished researchers, a scientist whose mind was sometimes compared, flatteringly, to a computer. It was no wonder Kirklin was president of the American Thoracic.
Kirklin was still straight-laced—still the bookworm holed up in the library while Walt and the boys were getting juiced at Mitch’s. Kirklin did not show slides of young patients in cowboy suits when he gave a presentation; he showed only graphs and tables, confirming the results.
And yet, Kirklin was one of the very few doctors who’d publicly supported Lillehei during the dark days (Cooley and Shumway were two others). Kirklin could not be silent. It offended his sense of justice that Lillehei, always willing to share the secrets of his success with even his most formidable competitors, had been blackballed.
On that spring day in 1979, Kirklin began his presidential address with a tribute to Lillehei.
“He always was and still is a great hero of mine, because of his enormous ability and warm friendship,” said Kirklin. “It’s some cruel trick of fate that there is no operation called the Lillehei operation, yet he was one of cardiac surgery’s greatest innovators and did scores of ‘first-time’ operations.” Lillehei, said Kirklin, was a genius.
Kirklin then spotted Lillehei in the audience. Walt was sitting with Kaye and Craig, one of his surgeon sons.
“Dear colleagues,” said Kirklin, “may I depart from my text to ask this great and pioneering cardiac surgeon to stand to your applause. Walt Lillehei, may we see you?”
Lillehei got to his feet—to a standing ovation.
THE LILLEHEIS, SHORTLY BEFORE WALT’S DEATH
