The Heart Healers (6 page)
Authors: James Forrester
Harken informed the world of his stunning success in the
American Heart Journal
in July 1946. The first sentence of his twenty-page manuscript speaks to the future by recalling the past. Harvard academician to the core, he quotes the Greeks: “Aristotle wrote, ‘The heart alone of all viscera cannot withstand serious injury.’” Harken added quotes from Billroth and Paget before proceeding to demolish them with compelling photographs and graphs. On that muggy July day, an idea that stood sacrosanct for two millennia, “Do not touch the heart,” vanished from medicine. Of the Nazi shrapnel lodged in the hearts of young soldiers, the trigger of cardiology’s first great turning point in the battle with heart disease, it could be said, “although man meant it for evil, God meant it for good.”
* * *
WHY HAD HARKEN
succeeded where other surgeons, including his contemporaries, failed? What was the source of Harken’s intuition, his genius, his sixth sense? In his contemporary bestseller
Outliers
Malcolm Gladwell proposes that the person the world sees as an innovative genius is instead often the product of vast experience. Gladwell points to the Beatles’ thousands of hours performing in Hamburg, Germany beer halls before they exploded on the world of music, and to Bill Gates’s years of writing computer programs in high school at the dawn of the digital era. Could Harken’s innovative genius be one more example? Every textbook that relates the history of cardiac surgery describes Dwight Harken’s brilliant burst of innovative genius but in none have I found the tale that Harken told his friends.
Prior to the United States’s entry into World War II, Harken had been trying to develop a method for removing bacterial infections from the surface of heart valves in the Harvard animal research laboratory. Pathologists, with their penchant for conflating the grisly with the edible, call these infections vegetations. They appear as soft mounds of clotted blood and bacteria attached to the heart valves. Cardiac pathologists have bequeathed us a feast of culinary delights, like the nutmeg liver of heart failure and the bread and butter heart of pericarditis. To develop a surgical approach to vegetations on valves Harken spent countless hours in the animal laboratory trying to develop a model that mimicked the human condition. After many failures he finally hit upon an answer: he speared a dog’s mitral valve with a dirty safety pin. A clot and infection quickly formed on the pin. With his model, Harken then spent countless hours trying to surgically extract the pin from the valve without killing the dog in the process. When he was called to the battlefield in World War II, he had just succeeded in extracting a safety pin from within a dog’s heart in his Boston laboratory. How difficult was it to make the mental leap from a safety pin to a sliver of shrapnel? And what was the essence of the method for extracting the safety pin? What else but sutures encircling his finger? Dwight Harken’s genius in the battlefield operating room, like Bill Gates’s genius at the genesis of Microsoft, was real, but the hunch was an educated guess based on years of unheralded prior experience.
And why did Harken tread a path to success whereas Ludwig Rehn with the same result entered a blind alley a half a century earlier in Frankfurt? After all, both had arrived at the same precedent-shattering answer: the heart is a legitimate surgical target.
As we will see, in science the best answers always lead to new questions. The unanswered “yes-but” question that followed Harken’s success came from Britain’s great thoracic surgeon Lord Brock, who pointedly needled Harken after he demonstrated his technique in the London operating room theater: “Dwight, what useful purpose can this be turned to? After all, no shell fragments presumably are going to appear in people’s hearts in a peacetime situation.” Brock was of course correct. Harken’s achievement seemed little more than a parlor trick. It saved lives, but there were not many men with metal stuck in their hearts back in Boston or London. Ludwig Rehn had not had an answer, but Dwight Harken would.
The tallest trees are most in the power of the winds, and ambitious men of the blasts of fortune.
—WILLIAM PENN, FOUNDER OF PENNSYLVANIA
HISTORIANS HAVE LONG
noted that after victory in war, countries often experience an outburst of peacetime creativity. The chaos of war severs the shackles of conventional wisdom, infusing the victor with visions of new vitality. At war’s end, the United States was the world’s superpower, poised to initiate a phenomenal boom in international innovation and productivity. British Prime Minister Winston Churchill pronounced the verdict, “America at this moment stands at the summit of the world.” Optimism infused all walks of life. The economy boomed. The rate of new childbirths escalated to eight every minute. Economist John Galbraith christened “the affluent society” as young couples bought suburban homes, television sets, washing machines, Studebakers or finned Cadillacs, and danced to rock ’n’ roll. Belief in the power to create, in both science and medicine, was boundless. After all, the brilliant atomic physicists of the Manhattan Project had brought the war to an abrupt end. In medicine, penicillin, tetracycline, and new antibiotics had suddenly made infections manageable. Life expectancy had increased by twenty-five years in just fifty years. New hospitals were springing up across the country at the rate of two each day, ready to provide cures for every illness.
But the new illnesses were not the old ones. The new diseases were heart disease and cancer, and the old guard of medicine had no remedies for either. Worse, the gray-haired eminences of the medical establishment had no idea where to find them. So just as American’s youth was soon to reject the teaching and values of their parents, so did a tiny handful of medical revolutionaries, the young thoracic surgeons returning from World War II, reject the myths and beliefs of their surgical elders. They would be the ones to confront heart disease.
My own early memories of those early postwar years circle around the social life in my house when I was in grade school. Soon after my physician-father returned from the war, we moved into our new postwar home on a street nicknamed Pill Hill because four doctors lived on the same long sloping block. When my father’s doctor friends stopped by, I strategically positioned myself beneath a mahogany drop-leaf table my mother had placed against the back of our living room sofa. Unseen but still within earshot I listened as my father, whom I revered, the next-door cardiologist, and the doctors from up the street discussed their patients. When the mystery of a patient’s symptoms was solved by my pathologist father’s microscope, I beamed with secret delight. But most of all I was moved by the doctors’ humanity as they told their patients’ stories. Science with compassion. One day I wanted to be like them, beneficence and expert knowledge in a humble white coat.
As I eavesdropped beneath the table I could not imagine that the cardiologist’s diagnostic tool kit was limited to a blood pressure cuff, otoscope, stethoscope, an ECG, and a chest X-ray. Worse, his medicine bag had little more than aspirin, digitalis, nitroglycerin, a few topical antimicrobials, and some derivatives of roots. He knew his drugs’ safety and efficacy, but virtually nothing about their mechanism of action. The truth was that postwar cardiology could transiently relieve some symptoms of heart disease, but could not alter its course at all. The postwar cardiologist could offer only a modicum more than doctors in Voltaire’s time when “the art of medicine consists in amusing the patient while nature cures the disease.”
* * *
WHEN DWIGHT HARKEN
came home, he set out to change that world. It is said that a pile of rocks ceases to be a rock pile when a single man gazes on it bearing within him the image of a cathedral. Dwight Harken had imagined his cathedral in that battlefield hospital. He would attack mitral valve stenosis, the same disease that had confounded his mentor Elliot Cutler. If he was successful, he would have a permanent place in the history of his profession as the first to operate successfully on the human heart. Harken soon learned that another unknown young battlefield surgeon shared both his vision and his unbounded self-confidence about surgical repair of the mitral valve.
Dr. Charles Bailey of Philadelphia was the polar opposite of Harken. He had been raised by his mother in a dusty small New Jersey town mired in Depression-era poverty. His small-town banker father, destroyed financially in the Depression, died from mitral stenosis at age forty-two, “coughing blood into a basin as my mother tried to soothe him.” Bailey was forced to become self-sufficient just as he entered his teenage years when his father died. With only a widowed mother to care for him, both nature and experience stitched combativeness into hardscrabble Charles Bailey’s psyche. His mother, a real-life version of Tennessee Williams’s Blanche DuBois with ambition, hopes, dreams, and consuming desire to return to better days, focused on Charles becoming a doctor. The devoted son did not disappoint, and did not deviate from the course set for him by his mother. After two years at Rutgers University he entered Hahnemann Medical College, moved to New York to train in surgery, then returned to join the Hahnemann surgical staff at the academic entry level of lecturer, ready to cross scalpels with Harken.
* * *
TWENTY-FOUR-YEAR-OLD
Housewife Constance Warner had lived a normal childhood until that day she got a fever and a severe sore throat. When she developed joint pain and ring-shaped eruptions on her arms and legs, her mother took her to the doctor. He performed an ECG; it was abnormal. He diagnosed rheumatic fever, the predominant cause of heart valve damage before the discovery of penicillin. In her teens, when Constance seemed to fatigue more easily than others, her doctor said that Constance had a heart murmur. Then soon after the birth of her first child, her health had begun a rapid descent into invalidism. Now she was unable to care for her baby, profoundly weak, and short of breath with the most minimal exertion. Her cardiologist said that rheumatic fever had scarred the valve between her left atrium and left ventricle, leaving it severely narrowed. Her doctors called her condition mitral valve stenosis, and said there was no treatment. Constance rejected her summary verdict: no surgical treatment. Just a condemnation to slow deterioration and a gruesome death drowning in one’s own blood.
There
were
two surgeons, one in Boston and the other in Philadelphia, who were willing to tackle the problem, but all they did was make death come quickly … in the operating room. Against her family doctor’s advice and aware of the risk of almost certain death that she faced, Constance and her husband, Morton, went to Philadelphia to meet Dr. Charles Bailey.
* * *
PREMATURELY BALDING WITH
closely cropped hair and pursed lips, Bailey could have passed for an easily irritated marine drill sergeant except for the huge professorial wire-rimmed glasses perched on his straight nose. His personality reflected this dichotomy. Bailey was part irascible sergeant and part academic intellectual. Hahnemann lacked the academic cachet of Harken’s Harvard. Bailey had none of Harken’s panache and people skills. He disdained pretension and seemed intent on making it abundantly clear that he cared not a whit for others’ opinions. When he formed a theory he saw each new fact as confirming his ideas. When challenged he was typically aggressive and confrontational. Although he lacked Harken’s academic record and Harvard patois, he was Harken’s equal in vaulting ambition, self-confidence, and drive to innovate. Bailey’s passion, however, was intense and personal, steeped in righteous messianic contempt for the disease that killed his father.
Typically, doctors who become professors earn far less income than those in private practice. The currency of academic medicine, then and now, is recognition. For the academician the sometimes irresistible siren song is acclaim and power, an attraction every bit as seductive and compelling as money. In medicine, there is no greater accomplishment than being the first to successfully implement a treatment that changes the history of medicine. Charles Bailey was tied to no mast. He and Harken both recognized the limitless future of cardiac surgery for congenital heart disease, valve disease, and ultimately the final prize, coronary artery disease. Both wanted surgery’s greatest prize, the mythical title, the public recognition, the worldwide acclaim accorded to the mythical Father of Cardiac Surgery.
Bailey challenged Harken across an academic and cultural gulf that echoed the centuries-old competition between Boston and Philadelphia, The Cradle of Liberty vs. The Birthplace of a Nation, John Adams vs. Ben Franklin, Harvard vs. Hahnemann, Russell vs. Chamberlain. Harken was the charming silk-stocking Bostonian, Bailey the cantankerous Philadelphia proletarian. Although both were iconoclasts, Harken was an academic who reveled in challenging ideas; Bailey reveled in challenging people. He cared little for others’ opinions when they conflicted with his own. Convinced of his righteousness Charles Bailey hewed to his own, not society’s, behests and standards. Society be damned.
For the two adversaries, the battle was winner take all. If Harken had any thoughts about sharing the pinnacle, Bailey was blunt: “In India, you never find two male tigers on the same hill.” By the time a victor was crowned two and a half years later, the psychological endurance of both tigers would be tested almost beyond endurance.
The left atrium collects blood coming from the lungs, and delivers it to the left ventricle, which pumps blood to the body. The mitral valve separates the two chambers. When I look at a normal mitral valve, it reminds me of two white sheets pressed against each other, and each tethered to one side of the inner wall of the ventricle. When the heart is relaxed, its sheets go slack, falling away from each other, allowing blood to flow into the left ventricle. When the ventricle contracts, the force of blood against the sheets causes them to billow backward, just like sails in the wind. The two sheets slam against each other closing the opening between the atrium and the ventricle.