‘We Are Here to Save Lives’ : Dr. Michael DeBakey: Tailor Who Mends Ailing Hearts

The surgeon’s steady hands clamp off a throbbing artery below the jaw of a 78-year-old stroke patient. The vessel flexes gently but perceptibly, like a high-tension wire in the crosswinds of a storm.

The target is a red artery pocketed in ribbons of muscle. The surgeon guides a razor’s edge along its length. The vessel is one of the carotids, through which blood reaches the brain. When these become clogged by atherosclerosis, people die.

The incision exposes the blockage. The tissue is removed. The surgeon closes the wound, weaving strands of silk-like gut into a thin black line of sutures, his hands plunging and rising with the rhythmic intensity of a symphony conductor. This music takes less than an hour to perform, and there is no sound, save the muffle of pumps and the chanting of life-support machines.

The chairman of surgery at Baylor College of Medicine, Michael Ellis DeBakey, knows what he is doing. Decades ago, he pioneered the technique known as carotid endarterectomy--the surgical removal of arterial blockage. Before this, stroke cases were considered nearly hopeless.

“My reward?” says DeBakey, 78, pulling elastic gloves from his large hands as he hurries to another operation. “My reward is that the patient is going to do well, and is going to have a lot more life in front of him.”

DeBakey knows about life. He has touched thousands of hearts, figuratively and literally, and mended most of them by grafting or replacing nonfunctional pieces of what only 30 years ago was an untouchable netherworld of human anatomy.

He has also transplanted scores of whole hearts, and has written more than 1,300 articles and essays as well as several books. He has trained more than 500 surgeons, an accomplishment that he considers his most lasting.

His inventions and techniques, including Dacron grafts and a heart-lung pump, both revolutionized and standardized the art of cardiovascular surgery.

He also knows death, the unremitting constant that eventually mocks his finest labors. Death swept off the patient he most wanted to save--his first wife, mother of four sons. She died of a massive heart attack.

DeBakey was in the operating room when he heard she had been stricken. He was helpless to save her, and cried at the foot of her hospital bed. That was in February, 1972. His brown eyes still mirror the pain of that day--and the pain of all the other souls lost in his war against heart disease.

“You fight (death) all the time, and you never really can accept it,” he said. His velvet-edged voice rises now and then for emphasis. “You know in reality that everybody is going to die, but you try to fight it, to push it away, hold it away, with your hands.”

This morning DeBakey rushes from the carotid operation to Baylor’s animal lab, where he is to put an experimental valve in the heart of a calf.

He arrives as the animal is being prepared, its chest clamped open, the acrid smell of smoke from the cauterizing knives hangs heavy in the air. There under the blue-white glare of surgical lights is a beating heart.

DeBakey pauses. He is enraptured. After 54 years, he still finds the heart, any heart, an item of inexpressible beauty.

DeBakey first saw a living heart in 1933, when he was a young intern-resident at New Orleans Charity Hospital. The victim of a knifing had been brought into the emergency ward. The organ lay palpitating, exposed.

“I could see it there even though we didn’t open the chest. I saw it beating and it was beautiful, a work of art, an awe-inspiring sight. I still have an almost religious sense when I work on the heart. It is something God makes, and we have yet to duplicate.”

Many Attempts

There have been many attempts, of course. DeBakey himself is credited with paving the way to the first artificial heart with the implantation of an assistance device 20 years ago. The patient was a 37-year-old Mexican woman. The device was a left ventricular bypass pump. It supplemented the function of the ventricular, or lower, chambers of the heart.

She lived with the pump for 10 days, and was weaned from it after her own diseased valves had been surgically repaired. She survived for six more years of normal life, until her heart was stilled in a car accident.

A number of years later, in 1971, DeBakey consulted with the designers of the famous Jarvik-7 mechanical heart. After long thought, he opposed its permanent use.

“They spent hours with me--(William) DeVries and (Robert) Jarvik--and I told them right from the start I could never, never use (the heart) as a permanent implant.”

The reason: All the animal data suggested that implant patients faced a future of unbroken misery in a tangle of medical complications. “What sort of world are you condemning a man to, tethered to this big machine? In one sense you might be prolonging his life, but in another sense, you are prolonging his death, making it an agony.

“It would be different if we were making progress,” he says. “But we’re not. We stopped putting them in animals because we were just killing them.”

DeBakey uses the Jarvik-type heart as a bridge, to give an ailing heart temporary respite before a donor heart is located. A permanent mechanical replacement for the real thing is five to 10 years away, he believes. It awaits discovery of a system for overcoming the blood’s natural tendency to reject foreign objects. “I don’t see an immediate solution to that,” he says.

DeBakey fights the clock. Today he must dash from the calf valve implant to a luncheon, and from there to a faculty meeting (he is also chancellor of the college) and then to a swirl of business appointments, patient examinations and, of course, evening rounds.

He bounds up eight or nine flights of stairs between tasks, thumping the stairs in heavy white surgical boots custom-designed by a grateful patient, a bootmaker, to help DeBakey stay on his feet for long hours.

His day dawns long before sunrise and ends after the streets are empty. Often the end of one day converges with the beginning of another. When a patient is in trouble, DeBakey sleeps at the office; his house, shared with his second wife and young daughter, is an attractive but modest colonial a few blocks away.

“I enjoy work,” he explains. “I don’t want to stop. Why should I? Work is life.”

Coffee, Banana for Breakfast

Breakfast is a cup of coffee, heavy on the sugar, and a banana. Lunch and supper are an accident --a sandwich here, an apple there. Moderation is the secret to a vital and long life, DeBakey believes, but his is the sort of catch-as-catch-can diet that makes the heart-diet specialists cringe.

The pace has not slackened for half a century. DeBakey seldom naps, never vacations, sleeps no more than five hours a night. He scorns golf as “just wasted time” tramping after a little ball.

DeBakey is a stickler for detail, in his work and his writing. Each of the hundreds of medical manuscripts he has written is a precise work painstakingly produced in longhand. There are few revisions, no second drafts, no ghost writers.

“I have been accused of being a perfectionist in many things,” he says. “The term is usually meant in a pejorative sense. In my writing and in all my work, I keep high standards, and I expect those around me to come up to those standards.

“If you were on the operating table, who would you prefer to do the work--a perfectionist, or somebody who was not much for detail?”

DeBakey hates to lose a battle with death, no matter what the odds. Resident doctors, nurses, even surgeons, tremble at the news of the death of a DeBakey patient. They learn to steer clear, tread gently, speak softly. Michael DeBakey is then in his darkest, foulest mood.

“If I go home after operating and I lose a patient that day on the operating table, it’s hard for me to sleep that night,” says DeBakey. “I keep thinking about what I could have done or what I might have done to stop it. You keep going over everything in your mind, every detail. Only time gradually erases the pain.”

DeBakey’s parents, Morris and Raheeja, were Christian Lebanese immigrants who settled in Lake Charles, La. They were affluent by any standards. Their children grew up in a large house with a chauffeur, maids, butlers, gardeners.

DeBakey was given a car while in college and sent to Europe to finish his education at the height of the Depression, but the DeBakey children were kept mindful of their blessings, and of the hard-scrabble poverty all around.

“Each Sunday after church, we’d take clothing to the orphanage,” DeBakey recalls. “Our father and mother would give the clothes she made and sometimes give the things we wore that she thought we had outgrown. She’d fix them up and give them away.

Gave Away Hat

“I remember so well I had a cap I liked, and my mother put it in the things she was taking to the orphanage. I complained. I loved the cap. She said I had two or three of them and I didn’t need this one. ‘These children don’t have any caps,’ she said. It made a great impression on me.”

Today, DeBakey gives much of his money to charity and research.

The most important practical gift passed on to him from his mother seemed fairly insignificant at the time.

“My mother loved to sew and taught others,” both neighborhood children and family; she never charged for the instruction.

“That’s how I started. She saw that I was interested, so she taught me how to sew and how to cut patterns and how to use a sewing machine, how to crochet and knit and how to tat,” the nearly lost art of lace-making. “Not many girls know how to do that today.”

Dr. Robert Moser, former editor of the Journal of the American Medical Assn. whose wife was a DeBakey patient, says the home-taught skill proved to be important.

Manual Dexterity

“The (sewing) probably contributed a great deal to developing his manual dexterity,” says Moser. “He is one of the most dexterous cardiovascular surgeons in the world, comparable to a very, very good 35-year-old surgeon. In addition, he has the excellent judgment that goes with his years--a rare combination.”

In the evenings when DeBakey is home early enough to be a daddy, he teaches the same skills to his 9-year-old daughter.

“(Olga) is sewing now. She sews and cuts patterns. I watched her sewing the other day, and she had the thimble on the wrong finger. I had to show her how to put the thimble on and how to use it.”

Beginning at age 3, Olga saw her father at work in the operating room. Will she become the next DeBakey surgeon? “Who can say?” he says. “She already knows the parts of the heart.”

None of DeBakey’s sons from his first marriage became doctors. Barry, Denis and Michael are businessmen. Ernest is an attorney.

One of DeBakey’s most well-known inventions is the Dacron graft.

“I used to go to the department store in downtown (Houston) and buy a yard of material at a time. Back in the early 1950s, they had these sheets of synthetics--nylon, Orlon, used as substitutes for cotton and linen. One day I went down and couldn’t find the material I was looking for. All they had was Dacron. So I bought Dacron.

“On my wife’s sewing machine I would sew the edges, take two pieces and make a tube. It would have a seam, of course, but that didn’t matter.”

It was soon proved in experiments that Dacron, fashioned into tubes, made superb artificial causeways for the blood. “Unlike other materials, the body did not reject Dacron, and tissue was attracted to it. It would hold onto it.”

1954 Surgery

DeBakey and a team of surgeons placed the first Dacron graft in a human patient on Sept. 2, 1954. The patient survived for 13 years. Others have survived more than a quarter-century.

In time, DeBakey convinced a commercial manufacturer that the device could be easily produced in seamless form, in much the way athletic tube socks are knitted, and an industry came into being.

DeBakey ranks his work with the Dacron graft as far more significant than his experiments with the artificial heart. “Coming back to the developments of the last 30 years, the artificial heart is certainly useful and important, but has it had wide impact? I think not. How many people will receive an artificial heart? Not many, relative to the millions with heart disease.

Thousands Helped

“But look at the literally thousands and thousands of patients who have had (Dacron graft) replacement for aneurysms of the aorta and other major arteries, not just in this country, but elsewhere. Its impact has been enormous.”

DeBakey’s surgical philosophy is directed toward patching up the body, making small but necessary changes, rather than removing whole organs or performing marginally valuable transplants. DeBakey has performed more than 75 heart transplants, and his record is excellent, but he prefers to make alterations--adding a valve here, a bypass there--that can make an ailing heart pulsate just as well as an entire replacement.

Not all of DeBakey’s innovations have proved workable. A gas-driven cardiac pump was developed over a period of years in collaboration with other surgeons, but it was never perfected to DeBakey’s standards.

DeBakey’s longtime collaborator, Denton Cooley, a brilliant technical surgeon, placed it in the heart of a patient without DeBakey’s knowledge or consent.

The operation violated the terms of a federal grant for the research. DeBakey was furious, believing that Cooley had also violated an unwritten code of trust between them and needlessly endangered a life. The patient died of complications.

The resulting dispute led to Cooley’s widely publicized separation from Baylor. The pump has not been used since.

DeBakey’s fame has brought him patients from all corners of the globe. He has treated royalty and the salt of the earth at Baylor--where has practiced since 1948--and at far-flung foreign hospitals. He does not shy away from ticklish cases, even though the risk of failure may be great.

Marshal Tito of Yugoslavia was one of his patients. He had an occluded leg artery. Jordan’s King Hussein has called on him from time to time, as have a few presidents and pontiffs. Albert Einstein refused treatment for an aneurysm. “We could have saved him,” DeBakey still insists.

The Duke of Windsor, formerly King Edward VIII of England, was granted a few extra years under DeBakey’s treatment.

A Good Patient

“(Edward) had an aneurysm, but he was a good patient. He responded very well and was nice to the nurses and technicians. Everybody enjoyed him, especially his sense of humor.

“The duchess was a bit stiff, I thought. She finally responded very well, but I had to be very firm with her a couple of times about the way to take care of the patient. She would make suggestions that were not in the best interest of the patient, and I would tell her so. Poor soul! She ultimately had a series of brain strokes that made her virtually a vegetable.

“I always thought they were both very sad people. I think deep down, in his heart, he knew he had made a mistake” in renouncing the throne for the divorced duchess. “Maybe she knew that too, but she never let on.”

When it comes to romantic matters of the heart, DeBakey is a soft touch. As a young intern-resident, he fell hopelessly in love with a nurse he met at the New Orleans Charity Hospital. She was Diane, the one who became his wife and later died of a massive heart attack. To this day, the recollection is poignant. “It was so sudden,” says DeBakey, his voice growing faint. “To me, it doesn’t seem that long . . . . Has it been 15 years? Time goes by.”

He met his current wife, Katrin Fehlhaber, at a party in California. She was a German movie actress. After a few years of courtship, they were married in 1975.

DeBakey burns with frustration when he talks about bureaucracy, insurance companies and malpractice lawyers.

“These days, you have to put up with all kinds of third-party players--insurance people, lawyers, accountants. They question your ethics. They put obstacles in your way, while you try to do your job. You almost need a full-time assistant who does nothing but paper work. They are always second-guessing you.

“Many of these (regulatory) government agencies are manned by non-medical personnel who review pieces of paper and decide whether the treatment is needed or not, whether or not the government is going to pay for it.”

Opposes Profit Motive

DeBakey heaps his strongest invective on doctors who are more concerned with profit than with their patients.

“That is an unpardonable sin. I cannot condemn it too strongly. The patient must always come first, always. That is why we are here. It is not the money or the prestige, or anything else. It is to save lives, to heal.

“A scientist must be a humanist first, somebody who seeks to help humanity. That is fundamental. I don’t think that is just some vague concept of philosophy. If you go back in history and study the great scientists, you’ll see they were truly dedicated, compassionate, humanistic individuals.

“They were not detached from their fellow man.”