The Heart Healers (7 page)

Mitral stenosis is severe narrowing of the opening between the sheets of the mitral valve. A tragic sequel of rheumatic fever, mitral stenosis is like a subway train door at Manhattan rush hour or a closed tunnel exit in a soccer stadium. Blood cells behind the narrowed opening in the valve back up into the lungs “congesting’’ them. When the blood vessels can swell no more, they burst. If the vessel is large, the patient literally drowns in her own blood.

To relieve the valve narrowing, the purse-string suture Harken had used to encircle shrapnel was the key. Instead of tightening the purse string as he pulled out the shrapnel, he would tighten the sutures as he inserted his index finger into the heart just above the mitral valve. He then blindly would push his finger into the narrowed mitral valve orifice, and by forcefully wiggling his finger back and forth, tear apart the scar tissue that fused sheets (called “leaflets”) of the valve. Today I marvel anyone would attempt such an incredibly crude procedure. Even in an era before heart surgery, reasoning that you could treat valve disease by sticking your index finger through a hole in the heart was wildly outside the box. But still, there was also the strange logic that if the surgeon was lucky, the tearing force of his finger could separate the two fused sheets along their original natural lines of separation without shredding them, allowing a marked increase of blood flow across the valve.

In November 1945 Bailey made his move. He operated on a man dying the slow inevitable death of severe mitral stenosis. The details of his surgical strategy were simple in concept. Open the chest to expose the heart. Place a circle of sutures in the left atrium just above the mitral valve. Make a small incision in the atrium within the circle and quickly insert the index finger into the hole. Advance the finger to the mitral valve. Use the finger to blindly tear apart the scar tissue that had fused the leaflets of the valve together. Withdraw the finger while simultaneously tightening the sutures. Voilà, a cure of mitral stenosis. Bailey could visualize it so clearly. No more blood backed up behind the valve, no more bursting vessels in the lung, no more nightmares of his father coughing blood into a basin.

Bailey’s first patient was eerily reminiscent of his father. Walter Stockton was thirty-seven years old, with a sixteen-year history of shortness of breath and weakness from mitral stenosis. In the past year he had had severe episodes of coughing up blood. He was quite clearly approaching the catastrophic denouement of his life. On a crisp November 1945 Philadelphia morning in the Hahnemann operating room Bailey made a long incision between the third and fourth ribs. He inserted a rib spreader to create a wider surgical field. As he had practiced in the animal laboratory, he made a small incision in the pericardium, which allowed him to expose the surface of the left atrium. Next, he stitched a circle of sutures (threads) into the surface of the atrium, in the form of a purse string.

His stitches in place, Bailey paused to absorb the full physical and emotional panorama of what was to be a transcendent moment in medical history. Satisfied, he made a small incision in the atrium. He was met instantly by a torrent, a gushing fury of bright red blood, a fierce insistent reply to the audacity of his incision, as if he had released years of the heart’s pent-up rage. Bailey immediately inserted his gloved index finger into the incision, as if to stem the sudden surge from a broken dike, while simultaneously tightening his purse-string sutures, just as Harken had described. But the blood kept coming, his patient’s life now spilling through his fingers into the open chest cavity, obscuring vision, as sutures meant to close the gap instead shredded the tissue, culminating in chaos as clamps tore even larger rents in the atrium.

Bailey described the carnage: “The purse-string suture was pulled upon and tore out … Severe bleeding occurred and a large clamp was hastily applied … The clamp cut through the appendage wall … It was impossible to get sutures to hold.” In the space of a minute or so Bailey witnessed a violent burbling of blood, then gentle spurts, then sporadic pulsations, then nothing but horrifying stillness. In Bailey’s terse later description: “Massive uncontrollable hemorrhage resulted in immediate fatality.” In a space of a few hundred horrifying seconds, Charles Bailey had utterly failed his thirty-seven-year-old patient. He had failed the memory of his father. He had gained nothing but a new nightmare.

Bailey returned to the animal lab, tinkering with alternate ways to approach the problem. Perhaps the finger was not the best way to reopen the mitral valve orifice. Six months later he was ready to try again. Twenty-nine-year-old Wilma Stevens was a mother of two, already in desperate condition from her disease. She breathed heavily from fluid accumulation in her lungs. Her body was frail but her abdomen was swollen. Her liver was huge and tender. Wilma had the typical signs of end-stage heart failure. This time Bailey fit a tubular metal device over the tip of his finger, then attempted to disrupt the scar that stenosed the mitral valve. When he did so, Wilma turned blue. Bailey withdrew the device and resorted to tearing apart the scar tissue with his finger. Instead of tearing along the lines of fusion of the two leaflets of the valve, however, he shredded them. It was as if he had removed the mitral valve. Each heartbeat now sent torrents of blood flowing backward to the lungs. Wilma was not better, she was much worse. She survived the procedure, but died on the second postoperative day. Whispers depicting horrifying images of operating room chaos found ready ears in the halls of Hahnemann Hospital. Charles Bailey, never an endearing figure, now had acquired a universal new name among the nurses and medical staff. He was Butcher Bailey.

Bailey stood alone, a powerful grizzly surrounded by baying hounds. He pointed to Harken who was up in Boston, matching him patient for patient with similar failures. His colleagues countered that madness in Boston never justified similar behavior in Philadelphia, that his surgeries were unjustifiable, that Hahnemann Hospital had an ethical responsibility to terminate Bailey’s human experimentation, that failure to do so betrayed the trust that the city of Philadelphia had invested in the hospital and its physicians. Hahnemann Hospital’s headstrong misfit Charles Bailey had to be stopped before it was too late. Cooler heads suggested they reason with Bailey. Dr. George Goekler, Hahnemann’s chief of cardiology, asked that Bailey come to his office to discuss the shame he was bringing to his institution, his profession, and to himself.

Bailey recounted the meeting: “First, he allowed me the privilege of the floor, which took up practically the entire interview … Then he pulled out a previous typewritten sheet of paper on which he had methodically explained that as a physician it was his Hippocratic duty to do no harm when he could do no good. He ended up telling me it was his Christian duty to keep me from doing any more of these homicidal operations.” His response to Goekler’s reasoned rebuke was pure Bailey: “I responded with some heat. I told him I believed in this operation, that I was sure I was right … and that it was my Christian duty to continue. We shook hands and I departed.” No doubt Bailey felt that he had overwhelmed another opponent, that he had quite decisively won his argument with Goekler. If so, his was a Pyrrhic victory. Hours later Charles Bailey’s operating privileges at Hahnemann were suspended. He had become Hahnemann’s persona non grata.

No problem. Bailey drove down the Delaware River to unsuspecting Wilmington Memorial Hospital. His patient was thirty-eight-year-old William Wilson. Wilson also survived the operative procedure itself. But when Bailey opened Wilson’s valve obstruction with his device, he overdid it. His device cut through scar that he was unable to separate with his finger, but it was too crude for finer dissection. The torn valve again lost its capacity to prevent backflow. In medical terms, he had converted mitral stenosis into mitral insufficiency. Wilson died on postoperative day five. When the Wilmington Hospital authorities became cognizant of Bailey’s prior history at Hahnemann, Bailey’s operating privileges at Wilmington Hospital were suspended. Now with three deaths, at age thirty-eight Charles Bailey had become a pariah among Philadelphia physicians. Discussions began about the possibility of presenting his cases to the Pennsylvania State Board of Medical Licensure in a petition to suspend his license to practice medicine. It seemed clear that one more attempt at “this homicidal operation” would terminate his entire surgical career.

Bailey’s response arguably puts him in a class by himself for bullheadedness and hubris. He doubled down. There were two remaining local hospitals where he still retained surgical privileges. He might as well take his best shot: he scheduled two surgeries on the same day, one at each hospital. The 8 a.m. morning surgery was to be at Philadelphia General Hospital, to be followed by his second surgery in the afternoon at Episcopal Hospital on the other side of town. The strategy was as clear as it was cynical. As Bailey explained, “If the operations were done at different hospitals, the probability was great that news of a mortality during the first operation would not reach the second hospital in time to interrupt the performance of the later procedure.” He would hope that the car was faster than the telephone.

As day dawned at Philadelphia General Hospital, Bailey opened the chest of thirty-year-old Jerome Randall. Disaster struck immediately. Each time he touched the heart, it responded with a volley of arrhythmia. Despite all available arrhythmia suppressing medications then available, his patient had a cardiac arrest. Bailey managed to revive the heart with manual cardiac massage. Seeing no hope for his patient if Bailey closed the chest and terminated the procedure, Jerome Randall’s primary physician, who had accompanied his patient, urged Bailey to continue. Bailey refused, using the feeble reasoning that he would somehow calm his detractors by arguing that this death was not attributable to him, since it had preceded the actual cardiac surgery. Wanting to at least try the surgery yet escape criticism, Bailey then proposed what must be the most bizarre compromise in the history of cardiac surgery. He would agree to operate, but only after Randall’s physician declared his patient dead. With the patient declared legally dead, Bailey opened the heart and separated the stenosed mitral valve with his finger. But it was indeed hopeless. Minutes later Jerome Randall’s heart stopped forever.

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NOW WITH FOUR
deaths on his hands, Bailey returned to the dressing room, cleaned up, and headed for Episcopal Hospital to perform the procedure at which he had failed just hours before. Fail this time, and it was all over. At Episcopal Hospital, twenty-four-year-old housewife Constance Warner awaited him. Let’s pause for a moment to salute the courage of this young woman, who epitomizes the bravery that we will so often behold in the patients in our narrative. Her chance of survival was remote. But even if she were the first to survive, who could say if she would feel more or less fatigued, more or less short of breath? When Constance Warner underwent anesthesia at age twenty-four, she had to imagine she would never wake up.

Bailey opened her atrium. Perhaps the solution to the dilemma of opening a scarred mitral valve lay in the combination of the device and the finger. He would use the device for crude separation, the finger for finer dissection. He slipped a curved blade over the end of his index finger, and inserted it into her atrium. He moved his finger over the scarred valve. There it was … the point at which the two leaflets had fused. The scar was too tough to separate with his finger, but if he could use the blade … Bailey used his curved blade to cut through the toughest scar on valve leaflets. Now he had a small groove that separated the fused leaflets. He withdrew his finger and slipped the blade off the tip of his finger. He reinserted his index finger. There was his groove. Now he could use his sense of touch to pry apart the remaining scar. By touch, at least, it seemed like an excellent separation. He withdrew his gloved finger. He closed the hole in her atrium. As he closed the incision in her chest, Bailey looked down at his sleeping patient and allowed himself just a ray of hope. This time, surely his last chance, every part of his surgery had gone well. When he finished, Charles Bailey harbored the hope, however forlorn, that he was discarding far more than his operating gown and mask.

Constance Warner’s recovery was different from the very start. She returned to her bed with stable vital signs. By the third post-op day Constance got out of bed. She walked to the bathroom, then the halls. Her breathing, her energy, her sense of well-being already was vastly improved.

As Constance walked the ward, Bailey plotted his vindication. It lay a half continent and a week away, and it was pure Charles Bailey. At the end of the week, he convinced Constance to take a 1,000-mile train trip with him to Chicago. Before a packed auditorium at the annual meeting of the American College of Chest Physicians, the most prestigious professional organization of his peers, Charles Bailey rose to introduce Constance Warner. His presentation electrified the attendees. Sensational world headlines followed. Back in Philadelphia, daggers were sheathed as Bailey’s critics fell silent. What had begun two weeks earlier as an outrageous duplicity had become an interesting footnote to a moment in history. Charles Bailey, the dirt-poor kid with the domineering mother, the commoner with unquenchable ambition, the avenging son, the curmudgeon battling pigheaded fools, the Chosen One, had seized the prize. Charles Bailey was cardiac surgery’s Neil Armstrong: vaulted forward by the work of others, yet venturing where no person had gone before, he stepped out onto the lunar landscape of cardiac surgery and planted his flag.

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AND WHAT ABOUT
Constance Warner? When reporters contacted her nine years later in her second-floor walk-up apartment, Constance had a second child and was taking full care of her children. A walk-up apartment had been beyond her imagination a decade earlier. Bailey never failed to stay in touch with Constance as she had two more children, became a grandmother, and lived a full life over the next thirty-eight years. She died at age sixty-two of severe respiratory complications following an episode of herpes simplex.