The Heart Healers (18 page)
Authors: James Forrester
Let’s follow Walt Lillehei’s career. With his pioneering role in hypothermia, cross-circulation, methods of oxygenation, pacemakers, and later prosthetic heart valves, Lillehei stood as a modern Thomas More, a Man for All Seasons poised to challenge every assumption of a deeply entrenched establishment. In the late 1960s, passed over for the position of chief of surgery at the University of Minnesota, he was recruited with great fanfare to become the chief of surgery at the prestigious New York Hospital-Cornell Medical Center. That was when I first met Walt. His lymphosarcoma was now a distant memory, but as the years passed, scarring of the tissues in his neck caused his head to tilt to one side. With his bald head tilted precariously on his narrow neck and an enigmatic smile, he reminded me of Steven Spielberg’s E.T. By now, people who knew Lillehei fell into two camps. Those who liked him because he was true to himself whatever the cost, and those who disliked him for the same reason. The flip side of being a creative iconoclast is lack of respect for convention. I saw Lillehei as a maverick with compassion. So I liked him.
When Walt Lillehei came east, his wife, Kaye, elected to stay in Minneapolis so that their three younger children could remain in local schools. Before he left, Walt was returning home from dinner in his powerboat with Kaye. Roaring at high speed in low light along the Mississippi River, he was risk-taking Walt being Walt. In the evening darkness he failed to see a sandbar. He ran suddenly aground. Kaye was launched into the boat’s dashboard, sending a part of the rearview mirror into her skull and the ignition key into her nose. Beautiful Kaye survived but required hospitalization for facial reconstructive surgery.
After he arrived in New York, as Kaye observed, “Walt went a little crazy.” Single in Manhattan, he acquired a four-bedroom apartment with a split-level living room, recreation room, and spectacular city view on the swanky Upper East Side. He hired an interior decorator. He threw lavish parties and continued his pattern of assignations with local nurses that he had begun in Minnesota. He became a denizen of a nearby local bar, the Recovery Room, got in a barroom fight, and ended up with a black eye.
Lillehei’s antics shocked Cornell Medical Center’s conservative power elite. The aggressively self-confident entourage of Minnesota surgeons that trailed in his wake on hospital rounds seemed like the hospital’s own Macy’s Day Parade. His over-the-top expensive redecoration of his office, including a flamboyant fabric on the wall of his private bathroom, was seen as creating an aura of arrogant superiority. Within the medical center, he skipped executive committee meetings, implying that he was above the petty concerns of the local power structure. As a newcomer whose every action was scrutinized and judged, he seemed hell-bent on proving both entitlement and his disdain for the norms of his new Manhattan community.
Frustration boiled into outrage when Walt sent a letter on Cornell stationery to all New York state physicians urging them to donate in support of Minnesota’s Senator Hubert Humphrey’s candidacy for the Democratic presidential nomination. Cornell had had quite enough of Walt Lillehei. The Minnesota maverick was a misfit in Manhattan society. Cardiac surgery’s Caesar was surrounded, the long knives emerged, and Walter Lillehei, uncrowned Father of Open Heart Surgery, past president of the American College of Cardiology, Lasker Award recipient, and Nobel Prize nominee was summarily fired as chairman of the department of surgery. He would be allowed to continue operating and to retain his title as professor. At age fifty-one, just sixteen years since Annie Brown’s VSD repair during cross-circulation had brought him international fame, many were saying Walt Lillehei was a modern-day Icarus whose reckless lifestyle had carried him too close to the sun. What his critics could not possibly imagine was that Lillehei’s spiraling descent was about to become a pure vertical fall.
Less than two years after his demotion at Cornell, a St. Paul Minnesota grand jury indicted Walt Lillehei on the charge of tax evasion. The charge carried the possibility of twenty-five years in prison and loss of his medical license. As always Walt Lillehei emerged as the sole architect of his torment. He had first attracted the attention of the Internal Revenue Service in 1964 by completely failing to file income tax returns for two consecutive years. When challenged, he paid his taxes and penalties; then with stunning Lillehei chutzpah, did not pay taxes for the next three years. Such behavior irritates the IRS. When the IRS again contacted him, what did he do? He raised the stakes. He simply ignored them. Walter Lillehei’s lifelong contempt for entrenched authority, the fount of his brilliant innovations in surgery, had become his Achilles’ heel. The IRS relished destruction of high-profile tax cheaters. Walt Lillehei, the world-famous doctor with the tawdry personal history, had single-handedly, almost magically levitated himself to the status of their perfect foil. The IRS initiated a savage public attack. Recalling those days, the ferocity of the IRS take-no-prisoners attack seemed equal to those launched on mobsters like Al Capone years before, or John Gotti years later.
Lillehei’s case went to trial with broad media coverage. His billing records consisted of a messy assortment of file cards stored in shoe boxes. The IRS matched every shoe box card he submitted to the hospital’s records of his actual operations. His file cards failed to show $250,000 of income from 318 operated-on patients. That was a lot of tax evasion. But the IRS then rolled out tax deductions, which were so ridiculous that they were hilarious. Under the category drugs and pharmaceuticals, the IRS research revealed that Lillehei had deducted veterinary expenses for his family cat. Under business expenses he had deducted the cost of his parents’ fiftieth wedding anniversary. The IRS completed their dissection of Lillehei by publicizing lubricious tidbits that made Lillehei a subject of ridicule: as a married man, he had deducted gifts to three girlfriends as professional expenses. One of the three testified that they had an intimate relationship. The prosecutors then presented the jury with their salacious slam dunk, perfect for jaded New York tabloids even today. The good doctor had deducted a payment to a Las Vegas call girl as “typing expenses.” The call girl was brought to court to testify that she had no particular talent for typing. She did not do shorthand. In fact, she testified with a coy smile, that typing was not really the service she provided.
In response to the missing bills on 318 patients, Lillehei then found a water-damaged shoe box in his basement. He had not evaded taxes, really … he had just misplaced the box of file cards. These just-discovered records, however, quickly mired Lillehei deeper in legal quicksand. The IRS prosecutorial team subjected the ink on the index cards to infrared forensic examination. Their expert testified that some of the original billing amounts on the cards had been later altered with different ink. Now in addition to tax evasion, the cloud of criminal fraud hung over Walter Lillehei. By the end of the four-week trial, prosecutors had overwhelmed his defense with 164 witnesses. In exposing the darker side of “work hard, play hard,” the IRS lawyers had decimated both the career and the personal life of the best that cardiovascular medicine had to offer.
Lillehei’s lawyers rose to his defense. They argued that his failure to file returns was the understandable mistake of a dedicated surgeon too busy to attend to life’s details. His errors in tax deductions came not from an intent to deceive, but from poor memory combined with sloppy record bookkeeping. As for back taxes, the defense had its own bombshell. The defense claimed that the IRS actually owed the good doctor Lillehei $53,000, because he had donated the proceeds from a prosthetic valve he had invented to the University of Minnesota without claiming a charitable donation. Independent of guilt or innocence, however, the defense was pilloried with the evidence that Walt Lillehei was incredibly cavalier with his personal finances, and the impression his sins emanated from a philosophy of life that few jurors endorsed.
The Day of Judgment arrived. After two days of deliberation, the jury delivered its verdict: Dr. C. Walton Lillehei, the pride of the University of Minnesota, was guilty, resoundingly guilty on all five counts.
At sentencing, Lillehei’s lead lawyer Jerry Simon begged for leniency, based on his service to his country in war, his generosity to patients who could not afford his services, and his remarkable contributions to the advancement of medicine. “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,” Simon pleaded.
Judge Phillip Neville confronted a personally wrenching decision. Should Lillehei go to jail? He seemed flagrantly guilty. Yet Lillehei’s unique strength had been his willingness to challenge conventional wisdom, combined with the intense focus he brought to a single problem. Gazing down on his frail, guilty defendant he could see a modern Greek hero whose strength became the source of his demise. Lillehei’s flaw did not seem to be greed; his failure lay in his deliberate disregard of the rules that governed other men’s behavior. In the final analysis, Lillehei generated not contempt, but astonished disbelief in his reckless conviction that he could ignore society’s rules and pay no price. Judge Neville could not bring himself to send this flawed genius to jail. He fined Lillehei $50,000, the maximum amount allowed, and added six months of community service.
Perhaps Neville also knew that Lillehei’s greatest punishment for hubris and recklessness would lie outside the courtroom. His professional career was finished. The state of Minnesota revoked his license to practice medicine. The American College of Surgery suspended him indefinitely. In cardiology’s inner circles I am sorry to say I sensed schadenfreude far more often than sympathy. To add to his misery, his mother and his father both died before the end of the year.
On the last day of December 1973, C. Walton Lillehei performed his very last surgery at the young age of fifty-five. His vision now impaired by cataracts, a side effect of his radiation therapy two decades earlier, Walt Lillehei was an academic pariah. There were no invitations to lecture, no prestigious visiting professorships, no colleagues calling him forward to rhapsodize about his accomplishments or to drape a beribboned medal around his neck. He was ostracized in Minneapolis society. His long-standing friend Dr. Daniel Goor recalls in his Lillehei biography being seated with Walt and Kaye at a Minneapolis country club dinner. Among about twenty people who stopped to chat with Kaye, not a single one spoke to Walt. The Minnesota Silent Treatment must have withered his soul. To his critics, Lillehei’s life stood as a parable of a man supremely gifted yet unable to recognize his own fallibility, prone to flawed judgment, shattered by the very hubris that had originally carried him to the pinnacle.
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WALT LILLEHEI, AS
in the days and months surrounding his diagnosis of cancer, remained outwardly strong, the living embodiment of Ernest Hemingway’s phrase for courage: “grace under pressure.” Loyal Kaye stayed with him. And then years later, Walt Lillehei was granted a heart-wrenching epilogue. John Kirklin, his former intellectual foe from the Mayo Clinic, had succeeded Lillehei as one of the world’s most respected cardiac surgeons. In 1979 Kirklin was elected president of the American Association for Thoracic Surgeons. We may recall that his biographer nicknamed him The Iceman, reflecting both his scintillating intellect and aloof persona. Speaking at his presidential inauguration ceremony, Mayo Clinic’s Kirklin spotted his old University of Minnesota surgical rival in the audience. The Iceman gestured toward Lillehei, and then spoke from his heart: “He was and still is a great hero of mine; because of his enormous ability … he was one of cardiac surgery’s greatest innovators. Dear colleagues, may I depart from my text to ask this great and pioneering surgeon to stand to your applause. Walt Lillehei may we see you?” Walt Lillehei—brilliant innovator, savior of hundreds of children, iconoclast, consummate risk taker, showman, press charmer, reckless carouser, and finally Dead Man Walking—was himself resurrected in that glorious moment, as he stood glassy-eyed to a standing ovation of a thousand hands.
Viewed through my own retro scope of history, I like to imagine that Walt Lillehei rose from the ashes, and was reborn on that day. Buoyed by a thunderous wave of heartfelt applause, his deeply painful ignominious isolation was over. The last years were good to Walt and Kaye. He served as medical director of St. Jude Medical, the Minnesota manufacturer of pacemakers and one of the world’s most successful artificial heart valves, which we used for many years at our medical center. Walt again became a respected sought-after lecturer.
And the Rest of the Story? At his eightieth birthday party the former Minnesota Queen of Hearts, Annie Brown now Janakowski, once a four-year-old dying with a VSD and now a healthy forty-seven-year-old, joined him in celebration of his life and hers.
Six months later Walt Lillehei encountered his old surgical nemesis, pneumonia, but this time it was personal. He passed away quietly in his home. In his obituary Denton Cooley, one of his students, who had become one of the greatest surgeons of the next generation, wrote that the unique innovative genius of the American heartland had outlived his humiliation. He had regained the respect and affection of his surgical brethren, and been levitated to the pinnacle … he had earned a legitimate claim to the title of Father of Open Heart Surgery.
You see things; and you say, “Why?” But I dream things that never were; and I say, “Why not?”
—THE SERPENT IN GEORGE BERNARD SHAW’S PLAY,
BACK TO METHUSELAH
AS SUDDEN AND
shocking as can be imagined, neither ventricular fibrillation nor heart block was the most psychologically devastating complication of early heart surgery. It was death on the table due to preoperative misdiagnosis. Because early surgeons and cardiologists had to base their preoperative cardiac diagnoses on their stethoscope, the heart’s X-ray silhouette, and the ECG, their diagnoses were imprecise. Surgeons, thinking they were operating on a simple hole in the heart, opened it to find additional complex abnormalities of valves for which they had no surgical solution. Desperate children died on the operating table or soon thereafter as surgeons tried to explain the mistaken diagnosis to grieving parents. Cardiac surgeons needed preoperative images of the chambers, valves, and the inflow and outflow vessels. And so it was that another tragedy of cardiac surgery stimulated the development of X-ray suites called catheterization laboratories, devoted solely to analysis of the heart.