We might never completely unlock the secrets of the human heart.
Not metaphorically — literally.
After reading Mimi Swartz’s terrific “Ticker: The Quest to Create an Artificial Heart,” one realizes that, over and over, the more surgeons thought they understood the heart, the more complex it showed itself to be. The quest in the title becomes one long asymptote — doctors get closer and closer and closer, not quite reaching the ultimate goal: a completely internal artificial heart with its own contained power source.
Once regarded both as just a pump and perhaps the seat of the human soul, the heart revealed itself to be a spectacularly complex organ that foiled artificial replication. The missions of getting to the moon and creating a permanent artificial heart both took shape in the early 1960s; it didn’t occur to anyone involved in the latter than the former would be the easier achievement.
“Quest” is the right word — no wonder the thing became a medical Holy Grail.
“I also think they always felt like they were right on the edge of success,” Swartz, a longtime Texas Monthly writer and editor, said in an interview. We were discussing why so many of these doctors stayed on the job until they were well into their 70s. “So if you just stay (working for) one more year, if you did one more thing, you’d get there.”
“They” refers to the remarkable cast of character, almost all Texans, who were at the bleeding edge of heart surgery, transplants and the aforementioned quest.
There’s the “impatient and high-handed” visionary Michael DeBakey, who ruled the Baylor College of Medicine with an iron, brilliant and often disdainful fist, and Denton Cooley, DeBakey’s handsome, privileged, impossibly cool rival, determined to be “the best surgeon who ever lived, period.” For a while there in the 1950s, ’60s and part of the ’70s, these two were the Beatles and Stones of heart surgery.
There’s surgeon and inventor Billy Cohn and Australian inventor Daniel Timms, whose Bivacor model is the current hope for the artificial heart.
There’s Robert Jarvik, the medical scientist (read: not a doctor) whose Jarvik-7 heart made headlines around the world in 1982. That one did not go so well: The recipient, Barney Clark, lived for a little less than four horrible months.
And then there’s Oscar “Bud” Frazier, a Vietnam vet who studied in Houston under both DeBakey and Cooley and a brilliant surgeon in his own right who became a living legend at the Texas Heart Institute. Over the decades Frazier contributed breakthrough after obsessive breakthrough, though not without controversy. A May 24 ProPublica/Houston Chronicle piece covered accusations of Frazier “violating federal research rules and skirting ethical guidelines, putting his quest to make medical history ahead of the needs of some patients.”
“Ticker” is a frequently hypnotic story, one about five years in the making for Swartz, who with Sherron Watkins co-authored “Power Failure: The Inside Story of the Collapse of Enron” (2003) and has picked up multiple National Magazine Awards.
Swartz says she was casting around for a book topic when she had lunch with an artist and new Houstonian named Dario Robleto, who had become interested in Frazier and the story of the artificial heart.
“I’ve lived here since 1976,” Swartz said. “Dario was seeing Houston with fresh eyes. I was like, ‘Yeah, I know Dr. Frazier, I thought about writing about him, but I couldn’t make it all into a book, it wasn’t enough.’ And then he started talking to me about, ‘Well, do you know this doctor named Denton Cooley?’ and I was like, ‘Yeah, yeah, I know all about them.’”
And then it hit her: This story, one of the great medical stories of our time, had been going on (mostly) in Houston for 50 years. “It was kind of weird to me to walk away from one lunch and know, ‘Oh, this is so obvious, how could I have missed this?’” Swartz said.
“Ticker” chronicles about 70 years of medical history, most of it taking place at the near-city-state that is Texas Medical Center and later the Texas Heart Institute. First, the DeBakey and Cooley rivalry, then Frazier’s maverick style. A lot of artificial hearts were sewn into a lot of young cattle over the years.
After the first human-to-human heart transplant in 1967, the race is on not just to perfect the science, but also to explore the ways that technology can help people live longer while waiting for a human heart. One time Cooley, completely out of options and with a near-death patient on the table, cut out a sheep’s heart and sewed it into the fellow in a bid to get him some more time before a human heart could be located. (It did not work.) Eventually, the goal becomes: Can we make an entirely artificial one of these things?
This, in turn, then becomes a story of the nexus between talent, institutional support, experimentation and money. Vast lakes of money, Texas-size money, be it the money that Cooley made (he was worth almost $40 million in 1980, which is more than $100 million in today’s moolah) or the money necessary to fund development of a technology that some folks regarded with extreme skepticism. Remember poor Barney Clark and the Jarvik-7? Swartz noted that the whole thing was a “PR disaster … a story of dashed hope” that likely set back the book’s titular quest by years.
It is a story that has been told in pieces here and there. Swartz counts herself lucky: There was already a wealth of secondary material. Cooley had written an autobiography, while Tommy Thompson’s 1972 book “Hearts” laid out the rivalry between Cooley and DeBakey. Both Frazier and Cooley sat for extensive interviews with Swartz (Cooley died in 2016), as did patients, families of patients and younger innovators such as Cohn and Timms.
But Swartz admits a special fondness for Frazier.
“Frazier is a really amazing combination of old and new,” Swartz said. “That guy lived at the hospital. He did not go home. He didn’t see his kids. He performed more than 1,300 heart transplants and ran the lab.
“But at the same time, he loves literature and music,” Swartz said. “People who have devoted their life to one thing can be very single-minded, and he’s not like that.”
Being a heart surgeon (and incredibly rich) is good for the lifespan — DeBakey lived to be 99, Cooley to 96. Both lived long enough to see the work they all but invented grow by leaps and bounds.
Once, when Swartz was observing a surgery, she saw Cooley get to examine the Bivacor.
“By then, Cooley was in a wheelchair, and they brought him in and showed him the Bivacor,” Swartz said. “They could actually put it in his hands, and it was a little smaller than a tennis ball. And the thing that Cooley had worked with was three times that size at least, and I watched him turn it over in his hand and just look at it, and you could tell he was in awe, that he had lived long enough to even get close to seeing this.”
Swartz said she wishes she could have gotten a little bit more about the surgeons’ private (or, at least, non-heart-related) lives into the book.
“There’s a bar in Houston called Anderson Fair where Lyle Lovett, Nanci Griffith, got their start,” Swartz said. “At one point they were going to go under, and Dr. Frazier came up with the cash to save the place. Billy Cohn, who is himself a musician, got (the late Houston blues musician) Little Joe Washington a place to live. All these guys had lives outside of the hospital.”
And if there is one thing you learn from “Ticker,” it’s that this is one hella-Texas story.
“I think the Cooley-DeBakey feud and the whole seat-of-your-pants surgery and experimentation aspect of this story was really Texan,” Swartz said. “Cooley was big on asking for forgiveness, not permission. The idea of ‘let’s just try it,’ ‘let’s just see if this works.’ I still think there’s an openness to innovation here that’s still part of Texas culture, though it’s not quite as much as it used to be.
“Which may be OK,” Swartz added. “Thank God nobody’s going to put a sheep’s heart in somebody.”
STATESMAN SELECTS AT BOOKPEOPLE
Mimi Swartz will speak and sign copies of her new book, “Ticker: The Quest to Create an Artificial Heart” (Crown, $27), at 7 p.m. Aug. 8 at BookPeople, 603 N. Lamar Blvd. Only books purchased at BookPeople will be signed. Find out more at bookpeople.com.