Craig Alan Miller - A Time For All Things - The Life of Michael E. DeBakey-Oxford University Press (2019)

Praise for A Time for All Things
“Amazingly detailed and powerful, A Time for All Things is a very important medical,
historical, and ethical document from which there are enduring, important lessons to be
learned.”
—Renee C. Fox, PhD, Professor Emerita, Sociology,
Annenberg Professor Emerita of the Social Sciences,
University of Pennsylvania, Pennsylvania, PA
“An icon in American medicine, Michael E. DeBakey was a towering figure in surgery
and in health policy. This extensively researched book provides insights into the
powerful role that DeBakey played in shaping the field of vascular surgery, as well as the
forces that in turn shaped him—from family, to war, to politics, to professional rivalries.
Spanning decades of an amazing life, the stories of DeBakey’s dedication to altruistic
patient care, academic excellence, and dedicated service to both the profession and our
nation will inspire physicians, policymakers, and patients alike.”
—Claire Pomeroy, MD, MBA
President, Albert and Mary Lasker Foundation, New York, NY
“A Time for All Things gives a thorough insight into the academic career of one of the
most influential professors in American medicine and politics. Michael E DeBakey made
seminal contributions as surgeon, inventor, teacher, and political influencer during his
whole life. It was a privilege for me to have met with Michel E DeBakey, a true Medical
Statesman, and I can strongly recommend this amazing book.”
—Bertil Hamberger, Professor Emeritus, Karolinska Institutet, Stockholm, Sweden
“Michael E. DeBakey was a surgeon, educator, and medical statesman. Craig Miller has
superbly chronicled a life of accomplishments, honors, and surgical achievements.
Miller’s efforts in archiving the facts of DeBakey’s storied career will be a treasure for
both the surgeon and the lay reader.”
—Charles H. McCollum, MD
Professor of Surgery, Baylor College of Medicine, Houston, TX
“Dr. Miller captures the amazing story of Michael E. DeBakey, from his learning to sew
with his mother, foreshadowing his becoming the one of the most technically proficient
surgeons in the past 100 years. It is well written and referenced, with an amazing
collection of photos of DeBakey, his family, friends, colleagues and contributions.
DeBakey’s story is that of the epic evolution of vascular surgery, aortic surgery, and
open-heart surgery, as well as the history of surgery in Houston. This inspirational
biography reads like a historical medical novel, and is essential for surgeons, aspiring
surgeons, and innovators from all walks of life.”
—E. Christopher Ellison, MD, FACS
Academy Professor, Robert M. Zollinger Professor Emeritus,
Department of Surgery, The Ohio State University, Columbus, OH
“A Time for All Things is a superb telling of Michael E DeBakey’s amazingly long,
dashing career—in surgery, in education, and deeply in national public policy. None of
these aspects is slighted by Miller’s telling, but the Washington insider aspects may be
most surprising.”
—Donald Lindberg, MD, Director Emeritus,
National Library of Medicine, Bethesda, MD
“Dr. Craig Miller’s masterful biography of Michael E. DeBakey describes a figure who
is truly larger-than-life and whom many, including myself, consider the greatest surgeon
of the 20th century. Dr. DeBakey was also a great scholar, innovator, and inventor, and
had not only tremendous surgical skills, but also empathy for his patients. His
remarkable career spanned nearly all of the 20th century and then to the 21st. This
biography is a fine contribution to one of the most noteworthy individuals of the last 100
years.”
—Antonio M. Gotto, MD, DPhil
Dean Emeritus, Weill Cornell Medicine
Provost for Medical Affairs Emeritus, Cornell University
New York, NY
“A superb rendition of the ubiquitous professional and personal life of a most remarkable
man. This book is a very readable account of DeBakey’s influence and participation in
the evolving science of cardiovascular surgery over seven decades, as well as his
influence on the societal and political milieu of the time—enhanced by facts and events
little known to even his closest colleagues.”
—William L. Winters, Jr., MD, MACC, MACP
Emeritus Professor of Cardiology, Institute for Academic Medicine,
Full Emeritus Member, Department of Cardiology,
Houston Methodist Research Institute, Houston,TX
“Michael E. DeBakey was so much more than ‘just’ the greatest surgeon of the 20th
century. His profound impact on social politics, disease prevention, education, research
funding, health care access, and information technology changed the way modern
medicine works forever. Craig Miller brings to life this brilliant personality in his
beautifully written biography.”
—Matthias Loebe, MD, PhD, Director of Thoracic Transplantation,
University of Miami, Miami, FL
“In this very readable biography, Miller has brought to a wider audience the remarkable
life of the legendary man I knew and worked with for over 30 years. As he was to so
many young surgeons, he was my inspiration, teacher, surgical father, and loyal
supporter. All these qualities and more are revealed in this remarkably thorough and
accurate account. Through extensive research of original archived sources, many
interviews, and the use of extensive first-person quotations, the details of this legendary
figure’s life are revealed. For scholars of the national politics of medicine, this book will
be a revelation as the author covers DeBakey’s influence in Washington spanning almost
70 years in incredible detail. This is a significant and historically important contribution
to the history of surgery and the nation.”
—Gerald M. Lawrie, MD, FACS
Michael E.DeBakey Distinguished Chair of Cardiac Surgery,
Houston Methodist Foundation, Houston, TX
A Time for All Things
The Life of Michael E. DeBakey
CRAIG ALAN MILLER, MD, FSVS, FACS

Heart, Lung, and Vascular Surgery
Riverside Methodist Hospital/OhioHealth
Michael E. DeBakey Fellow
National Library of Medicine
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ISBN 978–0–19–007394–7
eISBN 978–0–19–007396–1
Contents
List of Figures
Foreword by George P. Noon
Foreword by James S.T. Yao and Roger T. Gregory
Preface
Acknowledgments
1. Lake Charles: 1908–1926

2. Tulane University: 1926–1935
3. Strasbourg, Heidelberg, and New Orleans: 1935–1942
4. Washington, D.C. and New Orleans: 1942–1948
5. Houston: 1948–1951
6. Houston—1951–1956: Decadus Mirabilis, Part One
7. Houston—1956–1960: Decadus Mirabilis, Part Two
8. Houston: 1960–1969
9. Houston—1969: The Artificial Heart
10. Houston: 1970–1989
11. Houston: 1990–2008
12. Epilogue
Index
List of Figures
1.1 Shiker and Raheeja DeBakey, circa 1910. Courtesy National Library
of Medicine.
1.2 Michael DeBakey at about age 2, circa 1910. Courtesy National
Library of Medicine.
1.3 DeBakey family passport application photo, March 1921. Left to
right: Shiker, Goldie, Lois, Selena, Michael, Raheeja, Selma, Ernest.
Courtesy Michael M. DeBakey.
1.4 The DeBakey home at 1005 Broad Street, Lake Charles. Courtesy
National Library of Medicine.
1.5 Ernest, Michael, and Shiker DeBakey in the vegetable garden at the
Broad Street home, circa 1922. Courtesy National Library of
Medicine.
2.1 The academic dormitory at Tulane University in the 1920s. Courtesy
Tulane University Archives.
2.2 DeBakey as an undergraduate at Audubon Park, near Tulane campus.
Courtesy National Library of Medicine.
2.3 DeBakey as an undergraduate at Tulane. Courtesy National Library of
Medicine.
2.4 Charles Odom (left) and DeBakey in Lake Charles, August 1929.
2.5 Alton Ochsner. Courtesy National Library of Medicine.
2.6 Rudolph Matas in the study at his home on St. Charles Avenue.
Courtesy Archives of the American College of Surgeons.
2.7 DeBakey as an intern at Charity Hospital, 1932. Courtesy Tulane
University Archives.
2.8 DeBakey’s hand-drawn sketch of the sleeve-valve transfusion
apparatus. Courtesy National Library of Medicine.
2.9 The DeBakey roller pump. Note tubing flange. Courtesy Baylor
College of Medicine Archives.
3.1 Diana “Dolly” Cooper passport photo, 1935. Courtesy National
3.2 Michael DeBakey passport photo, 1935. Courtesy National Library of
Medicine.
3.3 Rene Leriche with his trainees in Strasbourg, circa 1935. Leriche is
bottom row, second from left; DeBakey bottom row, third from left.
Jean Kunlin is far right; Jao Cid dos Santos fourth from right.
3.4 DeBakey with Ernst Schanz and Vada Odom, Heidelberg, 1936.
3.5 Vada Odom and DeBakey, Heidelberg, 1936. Courtesy National
4.1 The Army Medical Library, “Old Red Brick.” Courtesy National
4.2 Wartime photo of DeBakey and his first son, Mickey. Courtesy
4.3 American and British medical officers in front of the Hotel Excelsior,
Rome, March 1945. DeBakey is bottom row, extreme right. Courtesy
4.4 DeBakey as full Colonel, US Army. Courtesy National Library of
Medicine.
4.5 Alton Ochsner and DeBakey at first annual meeting of the Society for
Vascular Surgery. Atlantic City, July 1947. Courtesy National Library
of Medicine.
5.1 Baylor University College of Medicine under construction, circa
1947. Courtesy Baylor College of Medicine Archives.
5.2 Ben Taub. Courtesy Henry J. N. Taub.
6.1 Intraoperative photograph showing early bifurcated homograft repair
of abdominal aortic aneurysm. Courtesy Baylor College of Medicine
Archives.
6.2 Operative details in first successful repair of descending thoracic
aortic aneurysm, January 5, 1953. Courtesy Baylor College of
Medicine Archives.
6.3 Michael E. DeBakey, MD, Chairman, Department of Surgery, Baylor
University College of Medicine. Courtesy National Library of
Medicine.
6.4 Baylor Department of Surgery, 1956. Fifth from left, George Morris;
sixth from left, John Ochsner; seventh from left, E. Stanley Crawford.
Fourth from right, Denton Cooley. Courtesy National Library of
Medicine.
6.5 Artist Frank Netter’s depiction of multiple shunt surgical approach to
aneurysm of the entire aortic arch, from CIBA’s Clinical Symposium
“Surgery of the Aorta,” March–April 1956. Courtesy Elsevier.
6.6 DeBakey and team in the operating room at Methodist Hospital, with
television camera. Courtesy Baylor College of Medicine Archives.
6.7 First successful thoracoabdominal aortic aneurysm repair; October
19, 1955. Courtesy Baylor College of Medicine Archives.
7.1 The Baylor bubble oxygenator. Courtesy Baylor College of Medicine
Archives.
7.2 Operative photograph and diagram from first successful repair of
aneurysm of the aortic arch, August 24, 1956. Courtesy Baylor
College of Medicine Archives.
7.3 DeBakey at his semicircular medical center office desk. Courtesy
7.4 The DeBakey family at Christmas in the home on Cherokee Street.
7.5 Working vacation in Hawaii, 1956. Courtesy National Library of
Medicine.
7.6 Operative drawing of first successful repair of aneurysm of the entire
aortic arch, March 21, 1957. Courtesy Baylor College of Medicine
Archives.
7.7 DeBakey on his first visit to the Soviet Union, 1958. Courtesy
8.1 Princess Lilian of Belgium observes DeBakey at work in the
operating room at Methodist Hospital. Courtesy National Library of
Medicine.
8.2 DeBakey with the Lasker Award. Courtesy National Library of
Medicine.
8.3 DeBakey in his office at Baylor, early 1960s. Courtesy National
8.4 DeBakey with Mary Lasker. Courtesy National Library of Medicine.
8.5 DeBakey delivers final report of the Presidential Commission on
Heart Attack, Cancer, and Stroke to President Johnson, December
1964. Courtesy National Library of Medicine.
8.6 The Duke and Duchess of Windsor with DeBakey, 1965. Courtesy
8.7 Anxious moments for the Methodist OR team during the Marcel
DeRudder operation, April 21, 1966. Courtesy Baylor College of
Medicine Archives.
8.8 The DeBakey family in Lake Charles, 1960s. Left to right: Lois,
Michael, Shiker, Selma, Selena. Courtesy National Library of
Medicine.
9.1 Ben Baker’s drawing of the dual ventricle artificial heart model from
September 1968. Courtesy National Library of Medicine.
9.2 Liotta and Cooley with Haskell Karp following implantation of the
artificial heart. Note large external power and control mechanism.
Courtesy Baylor College of Medicine Archives.
9.3 Schematic drawing of the Karp artificial heart submitted by Liotta to
Herb Smith in April 1969. Compare to Baker’s original drawing
(Figure 9.1). Courtesy Baylor College of Medicine Archives.
10.1 George Noon, DeBakey, and Danny Kaye in the Methodist Hospital
operating room. Courtesy George Noon.
10.2 DeBakey with comedian Jerry Lewis. Courtesy National Library of
Medicine.
10.3 Michael, Katrin, and Olga DeBakey. Courtesy National Library of
Medicine.
10.4 DeBakey at dedication of Alkek Tower and unveiling of bust
commissioned by Lilian and Leopold of Belgium, May 11, 1978.
11.1 Diagram showing anatomy of coronary artery bypass performed on
Boris Yeltsin, November 3, 1996. Courtesy National Library of
Medicine.
11.2 DeBakey presenting Boris Yeltsin with Russian-language copy of The
Living Heart. Courtesy National Library of Medicine.
11.3 DeBakey with an early artificial heart and the MicroMed LVAD.
11.4 The Congressional Gold Medal Award ceremony, April 3, 2008.
12.1 Charles McCollum, DeBakey, and George Noon at the Congressional
Gold Medal Award ceremony. Courtesy Charles McCollum.
12.2 Photo by author.
Foreword
By George P. Noon
The story of Michael E. DeBakey parallels the most potent century in

medicine. As one of the fortunate surgeons who worked by his side in the
surgery suite and the laboratory, I recognize his genius in pushing the
advances of his chosen field of cardiovascular surgery—from the roller
pump he built while still in pre-medical school, to the Dacron graft that has
saved millions of lives so far, to the development of several iterations of
ventricular assist devices that may someday morph into a total artificial
heart.
While many people know of Dr. DeBakey as the surgeon, the medical
educator, the inventor, and the medical statesman, few realize that he was,
above all, a doctor who sought to help his patients. When he visited them
before surgery, he recognized their anxiety and relieved it with a touch of
his hand and a promise to do the best he could. It was for his intellect and
the talent in those strong hands that the patients sought his care.
He was a taskmaster whose demands on students and residents became
legend in Houston’s Texas Medical Center. However, those who knew him
recognized that those requirements aimed to produce some of the best
surgeons in the world, many of whom went on to break new ground
themselves.
I first met Dr. DeBakey as a student when I was working in the
department of surgery laboratory. He advised me to apply for his residency
program after I graduated from Baylor College of Medicine in 1960. In the
seven years of training, I learned not only surgical skills, but also the
importance of attention to detail and to the patient.
The more than 40 years I worked with and for him were exhilarating as
he took us to new heights in the treatment of heart and vascular disease and
in the development of life-saving pumps called ventricular assist devices.
His patients ranged from national leaders to house keepers. They all
received the careful attention they deserved.
As I worked with Dr. Craig A. Miller on this biography, I was surprised
to see him craft the story of Dr. DeBakey during his long life. Even though
Dr. Miller never met Dr. DeBakey, he managed to mine the treasure house
of records kept over the years to construct an honest description of the man
and the full, fruitful life he lived.
This is the only ever biography written of Dr. DeBakey, and as his friend
and colleague, I am honored to be part of this effort.
George P. Noon, MD
Professor of Surgery
Division of Transplant and Assist Devices
Meyer-DeBakey Chair in Investigative Surgery
Baylor College of Medicine
Houston, TX
Foreword
By James S.T. Yao and Roger T. Gregory
Michael Ellis DeBakey was a world famous figure, hailed as both the
“Father of Vascular Surgery” and the “Greatest Surgeon of All Time.” Much
to our surprise, no biography had ever been written on his life.
In 2016, the DeBakey Medical Foundation and the National Library of
Medicine moved together to select a Michael E. DeBakey Fellow to assess
the archives of Dr. DeBakey. On the strength of a recent biography of
another surgical giant, Robert Zollinger, Dr. Craig A. Miller was chosen to
compose the most comprehensive biography possible on Dr. DeBakey.
Dr. Miller began to collect information from massive archives located in
the National Library of Medicine, in addition to archives located in
Houston, Texas. He conducted interviews with Dr. DeBakey’s family
members, close friends, and colleagues. Further, he gathered and reviewed
information about Dr. DeBakey’s time spent in “post-graduate” study with
Professors Leriche and Kirschner in Europe.
This exhaustively researched and well-written biography not only covers
Dr. DeBakey’s early life and development, but also his college experience
and medical training at Tulane. Dr. DeBakey volunteered for military
service in WWII, and together with Daniel Elkins, published one of the
early surgical books that focused on vascular surgery.
In 1948, Dr. DeBakey was heavily recruited for the Chair of Surgery at
Baylor. The civic and academic leaders desperately wanted to develop a
world-class medical center to accompany the rapidly growing city of
Houston, Texas. Dr. DeBakey finally accepted this position after
considerable deliberation, and quickly recruited a Houston-born surgeon,
Denton Cooley, to join his staff. This dynamic duo developed many new
and daring operations for aortic aneurysms, of both the abdominal and
thoracic aorta. Of significance is that Dr. DeBakey performed the first
successful carotid endarterectomy during this early period.
When the Houston team was successful in operating on lesions of the
aortic arch, it was clear that they had addressed atherosclerotic disease of
the entire aortic tree. Their attention was also directed at developing a
usable and durable aortic prosthetic graft (dacron). The problem of kinking
and angulation of the graft limbs was solved by crimping—a novel, perfect
solution.
In 2008, Dr. DeBakey developed severe pain at the base of his neck, and
self-diagnosed the problem as an aortic dissection, a condition that he had
categorically defined and classified. After a CT scan confirmed his
condition, he was successfully operated on by Dr. George Noon and
survived. Dr. DeBakey died on July 11, 2008, 50 days before his 100th
birthday.
Of course, Dr. DeBakey was many things other than a surgeon. He was
also a historian, politician, inventor, researcher, educator, visionary builder,
and many other lesser-known roles. . . such as a pool shark! Dr. Miller’s
spectacular biography capture these many facets of his character in
beautiful language, and is a must-read for vascular surgeons in particular.
Dr. DeBakey is probably the only physician in history whose name you
could hear spoken in any common household. There will never be another
Dr. DeBakey, and we are grateful for Dr. Miller’s contribution that explores
the life and legacy of the world’s greatest surgeon.
James S. T. Yao, MD, PhD, FACS
Professor Emeritus of Vascular Surgery
Northwestern University Feinberg School of Medicine
Chicago, IL
Roger T. Gregory, MD, RVT, FACS

Department of Surgery
Eastern Virginia Medical School
Norfolk, VA
Preface
In the spring of 2014, I was deeply involved in the research and

composition of my most recent book, a biography of the noted surgeon
Robert M. Zollinger. While perusing the archives at the Ohio State
University in Columbus I came across a cache of letters between Zollinger
and the famous Dr. Michael DeBakey. The correspondence was remarkably
engaging, full of warmth and humor not typically associated with these two
great surgical leaders. I ascertained that they had been good friends, from
the time of their service in the US Army in World War II through the next
half century. When I had finished reading the letters, I thought to myself
that when I was done with the Zollinger project I would look forward to
reading a biography of Dr. DeBakey.
Michael DeBakey was a world-famous figure, far better known to the
general public than Zollinger. In my own clinical practice as a vascular
surgeon I spoke his name several times a day in the operating room, so
ubiquitous are the surgical tools he helped create or perfect. Still, when I
came to reflect on it, I realized that my actual knowledge of the man and his
contributions was limited. Hence, I looked forward to immersing myself in
his life story.
To my enormous surprise, I soon realized that none had been written. I
later learned that several would-be biographers—talented and accomplished
professionals—had taken up the task over the years. Their efforts had not
come to fruition, however, despite—or perhaps because of—Dr. DeBakey’s
titanic and far-reaching contributions. My interest soon pivoted from
reading a chronicle to becoming the chronicler.
I contacted the Baylor College of Medicine in Houston, where Dr.
DeBakey spent most of his career, in order to find where his archival papers
were kept. At this point a major obstacle arose. I learned that Dr. DeBakey’s
records comprised two independent and decidedly separate collections.
One, the contents of his offices at the Texas Medical Center, resided in the
Baylor archives. Although an effort was under way, these had not yet been
catalogued, and they were not open to researchers. The other, derived from
his home office, belonged to Mrs. DeBakey. This cache was in a different
location but was presumed to be in a similar state. Reflecting Dr.
DeBakey’s long life and career, both archives were gigantic: thousands of
documents and artifacts, filling hundreds of boxes.
At this point, with access to primary sources severely restricted, the task
appeared hopeless. I moved on to other projects.
About two years later I found myself at the National Library of Medicine
(NLM) in Bethesda, Maryland, researching one of these projects and
comparing notes with one of the curators. We were discussing the size of
various personal archives when my counterpart mentioned, in an offhand
way, that I “should see their DeBakey Collection.” I stopped cold and the
hair on my neck stood up. “Your what?!?”
As it turned out, the NLM had acquired the “home office” collection
from Mrs. DeBakey. It was, indeed, colossal—but now fully catalogued, in
the most professional manner. I forgot all about the subject I had been
researching and spent the rest of the day immersing myself in these
fascinating papers and artifacts. I was also informed that the DeBakey
Medical Foundation was newly sponsoring Michael E. DeBakey
Fellowships in the History of Medicine. In December 2016, I was honored
to be named among the first group of such scholars, with my goal a
biography of the scholarships’ namesake.
Over the next two and a half years I researched the life of Dr. DeBakey at
various sites, including New Orleans, Houston, Washington, Strasbourg,
and Florence. The main effort was, however, via the NLM collection and,
subsequently, the Baylor archives. This latter access was achieved through
the kind intercession of five of Dr. DeBakey’s former trainees, all of whom
occupy senior positions at the Texas Medical Center and had followed and
supported my efforts in commemorating their mentor.
I also personally interviewed scores of Dr. DeBakey’s family members,
colleagues, trainees, and employees in an effort to gain and secure the
perspective of those surviving who knew him best. They provided unique
and abundant insight.
From the start my goal has been to compose the most accurate and
comprehensive biography of Dr. DeBakey possible. In chronicling a life of
such richness and scope it is inevitable, though, that some information and
individuals will be excluded, by oversight or necessity. To the extent that
this has occurred, the fault is mine alone. I hope that any such voids will be
excused in light of the magnitude of the task.
—Craig A. Miller, MD
Dublin, Ohio
July 2019
Acknowledgments
During the course of researching and writing this book it has been my
distinct privilege to work with a number of individuals whose assistance
and contributions have been of inestimable help.
Many sojourns to the Texas Medical Center in Houston allowed me the
honor of spending considerable time with many of Dr. DeBakey’s former
colleagues and trainees. I am particularly indebted to George P. Noon and
my good friend Charles McCollum, without whom this biography would
not have been possible. I am also grateful for the time and assistance of
Claire Bassett, William Winters, Gerald Lawrie, Kenneth Mattox, Joseph
Coselli, O.H. “Bud” Frazier, Louis Green, Henny Banning, and Kitch Taub
II, among many others. Dr. Noon’s administrative assistant, the delightful
Pam Miller, deserves particular praise for tolerating my innumerable
inquiries and unfailingly directing me to the proper individuals and
resources when all hope seemed lost.
Dr. DeBakey’s living children, Michael, Denis, and Olga, generously
provided unique, invaluable details and insights into the domestic life of
their illustrious father.
Many thanks are extended to the administrations of the Baylor College of
Medicine and the Houston Methodist Hospital for their cooperation in my
research efforts. I would like to extend particular thanks and recognition to
JoAnn Pospisil and Benjamin Gorman from the Baylor Archives for their
help in accessing and navigating the enormous DeBakey collection.
The late John L. Ochsner gave a lengthy and memorable interview at his
namesake clinic in New Orleans in January, 2017. Other physicians who
contributed included Dr. DeBakey’s close associate for many years, Antonio
Gotto, Jr., of Weill Cornell Medical College, Norman Rich of the
Uniformed Services University of the Health Sciences, Jacques Cinqualbre
of the University of Strasbourg, Bertil Hamberger of the Karolinska
Institutet, James Yao of Northwestern University, Roland Hertzer of the
Deutsches Herzzetrum Berlin, Lazar Greenfield from the University of
Michigan, Julie Swain of the Mt. Sinai Health System, and Matthias Loebe
of the University of Miami. I would also like to thank Hiram Polk of the
University of Louisville, E. Christopher Ellison of the Ohio State
University, and David B. Hoyt of the American College of Surgeons for
their support.
I am also indebted to Herbert Smith for his reminiscences of medical
photography and illustration in the Department of Surgery at Baylor, Arnold
Schwartz for his recollections of cardiovascular research and the
investigation of the artificial heart implantation in 1969, Claudia Feldman
for her memories of her father, Louis, the master artisan of the machine
shop, and John Liddicoat, who was a Baylor surgery resident during the
halcyon days of the 1960s.
Renee Fox and Judith Swazey, authors of the landmark sociological work
on transplantation, The Courage to Fail, graciously reviewed the text
regarding the artificial heart controversy and offered helpful suggestions.
Her Royal Highness, Princess Esmeralda de Rethy of Belgium, kindly
gave her perspective of her mother’s lengthy friendship and collaboration
with Dr. DeBakey.
I owe a special debt of gratitude to the Medical History Division of the
National Library of Medicine, in particular Jeffrey Reznick, John Rees, and
Rebecca Warlow, for their help with the DeBakey papers in Bethesda. The
late Donald A.B. Lindberg, Director Emeritus of the Library, provided
immense help both in reviewing the manuscript and in sharing his
memories of Dr. DeBakey’s important role at this great institution. I also
thank Judy Chelnick of the Smithsonian Institution for her insight into the
artificial heart.
Those whose help was incalculable in researching the early life of Dr.
DeBakey in Louisiana included Ann Case of the Tulane University
Archives, Pati Threatt of the Frazar Library at McNeese State University in
Lake Charles, Hans Rasmussen of Louisiana State University, Mary J. Holt
of the Matas Library, and local Lake Charles historian Adley Cormier.
I leaned heavily on the work and advice of Sanders Marble, senior
historian of the U.S. Army Office of Medical History, regarding the sections
covering Dr. DeBakey’s military service during World War Two. Francine
Netter was helpful in illuminating aspects of her famous father Frank’s
interactions with Dr. DeBakey, and J. Patrick Walter of Dallas shared his
insights into the early years of the American Board of Surgery. Kristin
Rodgers lent her expertise in the Robert M. Zollinger Collection at the Ohio
State University Medical Heritage Center to help illuminate the friendship
between DeBakey and this other towering figure of twentieth century
surgery.
I would be remiss in failing to acknowledge the important contribution to
this book of the work of Don A. Schanche. Schanche was an accomplished
writer and editor who conducted a series of in-depth interviews with Dr.
DeBakey in the 1970s, evidently in preparation for a biographical work
which was to be co-authored by his subject. That project never came to
fruition, but the information collected by Schanche from the interviews has
proved to be invaluable in the composition of the present volume.
A special acknowledgement is reserved for Marta Moldvai and Tiffany
Lu, my editors at the Oxford University Press, as well as Craig Panner,
editor-in-chief, and Sujitha Logaganesan, production editor, for their
unfailing support through the composition and production of this biography.
I would like to extend particular thanks to the Debakey Medical
Foundation for their generous sponsorship of the Michael E. DeBakey
Fellowships in the History of Medicine at the National Library of Medicine,
as well as their direct support of this project.
I also give my heartfelt thanks to my wife, Mandy, and my children,
Mackenzie, Kellen, and Jack, for their love and encouragement.
1
Lake Charles: 1908–1926
Along the cool sequester’d vale of life,

They kept the noiseless tenor of their way.
1.1 November 2, 1996

KLM Flight 287 rolled to a seamless stop on the tarmac and settled on its
wheels under the translucent Moscow sky. A contingent of American heart
surgeons and support staff blinked and stretched. Their leader was famous
for dozing off as soon as the wheels were up on any flight of length, and
more than one of his retinue had mimicked that feat on this last leg of their
journey from Houston via Amsterdam.
This was not the first sojourn to Russia for their Chief—that had been
back in 1958, when the country had another name and quite another polity.
Many other visits had followed, accompanied by accolades and fetes,
mostly with a Cold War political undertone he neither shared nor
acknowledged. By nature he was fond of reflecting on change and history,
and he did not miss the significance of returning to this place, both of them
now so different, in a position to alter the life path of a man who, himself,
was responsible for much of this country’s metamorphosis.
The President of Russia, Boris Yeltsin, was suffering from congestive
heart failure and severe coronary artery disease. The situation was grave; he
was not expected to live without open-heart surgery—coronary bypass—but
it was not clear that he could survive the procedure itself. The leading
Russian heart surgeons and cardiologists had asked this Houston team to
come to Moscow to assess the risks and provide recommendations on how
to proceed. In the geopolitically charged climate of the immediate post-
Cold War period, bringing in a coterie of Americans as consultants on the
medical care of the most powerful man in Russia provoked all manner of
responses on both sides of the Atlantic. The world’s major news
organizations focused on the story, covering every aspect. This fuss was of
little consequence to the team from Texas, however. They were there to do a
job, and their very presence in the Russian capital was as much of a
validation as any that they were the most qualified group in the world for
the task.
Skilled and experienced as the American team was, there were no
illusions among any as to the main reason for their being summoned to this
distant place for such a desperate endeavor. That was the aged, somewhat
stooped, but still-imposing figure to whom they all deferred instinctively.
As the rolling stairway approached the plane, his prominent gray brow
furrowed and his dark brown eyes took in the familiar scene through thick
spectacles. Those eyes had witnessed more than 60,000 surgical operations,
and he was widely regarded as not only the father of modern cardiovascular
surgery but also the greatest surgeon of the twentieth century.
If time and change were on his mind that afternoon, Dr. Michael Ellis
DeBakey might well have wondered at how far he had come from the small
southwest Louisiana town of Lake Charles, where he had been born 88
years before.
1.2 Mise en Scene

Lake Charles is a brackish basin on the Calcasieu River, 30 miles north of
the Gulf of Mexico and 200 miles west of New Orleans. The lake is about
five feet deep in most places and a little more than a mile across. Located at
the southern end of western Louisiana’s longleaf pine belt, it sits in a place
of tropical heat and humidity, surrounded by the fertile, marshy savannahs
and abundant woodland that such a climate fosters. Lake Charles is said to
be named for an early settler to the region, Charles Sallier, who emigrated
from southern Europe in the early 1800s. By similar tradition, the Calcasieu
River derived its name from that of a local Attakapas Native American
chieftain who is otherwise lost to history. His name passed through a
distinctly French transliteration, Quelqueshue, before taking its present
form. The Gallic version is occasionally encountered yet today.1
The Lake Charles region was not clearly included in the massive
Louisiana Purchase—the extent and borders of which were barely defined
or even comprehended at the time—but after the War of 1812, the ultimate
destiny of the area was inevitable.
In 1840, Imperial Calcasieu Parish was created, encompassing the Lake
Charles vicinity and beyond. A few years later, the parish seat was
established on a patch of partially occupied land at the eastern shore of the
lake. That small community took the name of its neighboring body of water
in 1867 and became incorporated as the town of Lake Charles.2
After the Civil War, Lake Charles’s numerous forests helped the fledgling
timber industry expand substantially, matching the demand for construction
materials needed for the rebuilding and growth of the nation. Timber was
the dominant industry of the region into the twentieth century.
The 1910 United States census noted 11,449 residents in Lake Charles,
Louisiana, nearly double that of the accounting a decade before.3 By all
reports the expanding community had evolved by this time from a swampy
prairie town into a recognizable small modern city. Along with the growth
of the populace, commerce flourished, and educational and cultural
institutions emerged and thrived. The proud and determined townsfolk even
shrugged off an enormous fire that destroyed the old city center in April
1910.4 With newfound wisdom they—like the similarly afflicted citizens of
Chicago and San Francisco earlier—took the opportunity to replace the
destroyed downtown wooden structures with more permanent ones of brick,
stone, and concrete. Overall, as the new century took root, things were
looking decidedly up for the largest city in Southwest Louisiana.
Four of the newcomers helping to swell the ranks of that 1910 Lake
Charles census were 25-year-old Shiker DeBakey, his 23-year-old wife
Raheeja, and their young sons, Michael, aged 2, and an infant, Ernest. The
young family lived in a small house attached to their clothing and dry goods
store at 1004 Railroad Avenue, in the city’s Second Ward.
1.3 Battle Row

Shiker Dabaghi was born on May 25, 1885, in the town of Jdeidet
Marjeyoun, in what was then the Ottoman Turkish province of Syria—now
southeastern Lebanon. The Dabaghi family had long been prominent in this
town and in nearby Hasbaya, as they remain today. Members of the ancient
Maronite Christian church—whose adherents have inhabited the Mt.
Lebanon region since the ninth century—the Dabaghis were known for
their success in business and the professions of medicine and law. Shiker
was one of seven sons of Markes George Dabaghi and his wife, Tana Zarb.
Four of the brothers would immigrate to the United States by 1920. Shiker
was the first.5
Shiker initially visited America as a child.6 Fascinated by the vast,
prosperous country he encountered, the young boy resolved to return there
permanently when his age would permit it. Treatment of the Maronites by
the Turkish government was unpredictable and often harsh—the bloody
Mount Lebanon Civil War, which featured numerous instances of massacres
of Maronites, had raged just 25 years before Shiker’s birth—and there can
be little doubt that this threat also motivated him, along with many others,
to emigrate. While still a teenager, he left his family in Marjeyoun behind
and, accompanied by his cousin Abraham Dabaghi, returned to the United
States for good in 1901, departing from Beyreuth (Beirut) on February 14
and reaching New York on March 15.7 Upon arriving in America, Shiker
Anglicized his last name to the phonetic spelling “Debakey,” as did most of
the immigrants who shared it.* He stayed for a time in New York City after
arriving, then went on to the Midwest—Ohio and Iowa, according to family
tradition. He supported himself by working at various jobs, often peddling.
Later he became a traveling dry goods wholesaler. In any setting, though,
sales turned out to be a vocation that suited him well.
On one of these traveling sales circuits, Shiker came across the town of
Lake Charles, Louisiana. The growing community, which aggressively
trumpeted itself nationwide as a place of opportunity, appealed to him and
many others as a spot to settle and begin to build a livelihood and family.
There were a number of French-speaking people in Calcasieu Parish, and,
like many others from Lebanon, Shiker was fluent in that language. This
gave him an occasional edge as a salesman and in forming new friendships
with some of the locals. On top of that, he could not have missed the fact
that a considerable community of immigrants from his homeland existed in
Lake Charles.
At this time there were pockets of Lebanese immigrants throughout the
United States, especially in Iowa, Tennessee, and Oklahoma. In these
communities those who were already established were sometimes of great
help to the newcomers.8
When Shiker arrived in Louisiana he was directed toward a successful
Lebanese shopkeeper in a nearby town who, it was known, was willing to
give new arrivals from the old country goods to sell on consignment, from
which they could earn a subsistence wage. Thus Shiker began in Lake
Charles by peddling borrowed goods. On the strength of his affability,
honesty, and hard work, however, it was not long before he began to make a
name for himself in town.9
Shortly after coming to Lake Charles, Shiker was introduced to another
native of Jdeidet Marjeyoun, young Raheeja Zorba.
Raheeja, who had been born on December 25, 1887, had immigrated to
the United States earlier and at an even younger age than Shiker, arriving at
Ellis Island on August 7, 1898.10 The following year her mother Helen, then
age 60, immigrated to the United States as well, joining her daughter in the
Midwest. The meeting of Shiker and Raheeja, which may have been
arranged by family and friends, occurred in Oklahoma.
At some time, probably in 1907, the young couple from the same small
Middle Eastern village—who had travelled 6,000 miles to find each other—
were married. They moved into the house and store at 1004 Railroad
Avenue in 1909. Helen came to Louisiana with her daughter and lived with
the family.11
By all accounts, the neighborhood around Railroad Avenue in Lake
Charles, Louisiana, in the early part of the twentieth century was a colorful
one. There was a Southern Pacific Railway depot about five blocks west of
the DeBakey store.12 The tracks ran through the center of the dirt street, and
the sidewalks were planks.
For decades Lake Charles’ most notorious quarter—known as “Battle
Row”—was located here.13 In its heyday, dozens of saloons, legal brothels,
and gambling houses thrived. The area had started to simmer down
considerably in the first years of the new century, though. By the time the
DeBakey family moved into the neighborhood, much—though not all—of
the Wild West nature of the district had been tamed.
The Railroad Avenue community in 1909 was a vibrant one even without
the fading vice. There were scores of legitimate shops and storefronts, well
established and thriving: grocery stores, dry goods markets, cafes, and
restaurants.
The neighborhood had a decidedly Mediterranean flavor, with a few
immigrant families from Syria and more from Italy.14 Many of the shops
had attached single-family dwellings, either behind the street-level
businesses or above, with porches overlooking the thoroughfare. The
DeBakey business and abode at 1004 Railroad Avenue was a duplex
structure, not more than five years old. It is likely that the family lived in
one half of 1004 while their shop occupied the other.15
This store was Shiker DeBakey’s first foray into independent business in
America, after the better part of a decade of peddling and traveling sales
work. He had saved money over the years while establishing his reputation
in Lake Charles, and this frugality helped push him toward success.
Although Shiker had had limited formal education back in Lebanon, he
possessed an innate intelligence that meshed well with his other attributes.
He worked long hours, regularly rising before dawn and toiling late into the
evening. He never took vacations. He read material of all kinds in an effort
to broaden his knowledge. He kept meticulous records and paid great
attention to detail. All these qualities would later be prominent in his
successful children.
Shiker and Raheeja DeBakey would eventually have six of these: four
daughters and two sons. Michael came first, on September 7, 1908.*,16
1.4 Beginnings
In later life, Michael DeBakey and his siblings would remember childhood
in Lake Charles as pleasant and relatively uneventful. Their father could be
a strict disciplinarian, holding his children to his own work ethic and drive
for perfection once they had grown old enough to understand them. Shiker
kept his solid resolve wrapped in the proverbial velvet glove, though, and in
these later recollections, the DeBakey children consistently related that they
never had cause to doubt his affection.17
Raheeja offered a softer contrast. Her father Mousa (Moses) had been a
priest in the Maronite Church, and her family had a long history in the
clergy. Not surprisingly, then, she was more religious than her husband and
inculcated in the children her own concept of charity and consideration for
the well-being of others as the basis not just for spirituality, but as an
approach to everyday life:
The impression we drew was that Christ was trying to teach the people God’s word—to love
each other and be kind to each other, to help each other. We didn’t understand why, but
philosophically, you see, this is the Golden Rule. As you grow older, you understand this
better.18
Balanced between these defining characteristics of his parents, Michael

eventually internalized them both. As he grew and matured, his own
personality began to emerge as an offset amalgam of his father’s driving
perfectionism and his mother’s overarching compassion (see Figure 1.1).
Figure 1.1 Shiker and Raheeja DeBakey, circa 1910.

Early events helped shape the future Michael DeBakey in ways only
appreciated in hindsight. Perhaps his earliest waking memory, from
preschool days, was of sitting in front of his mother as she sewed. Raheeja
was highly skilled in the many different facets of this art, and sometimes
taught the neighborhood girls while she sewed for her family. As often as he
could, Michael sat cross-legged on the floor, staring transfixed as she
worked:
I couldn’t have been much more than 4 or 5. I was always asking questions, and bothering her,
but she was very patient with me . . . she’d get me a crochet needle and show me how to
crochet. I caught on very quickly and I was crocheting. . . . I loved to do things with my hands.19
In this way, a very young Michael learned how to sew by hand, literally
at the feet of his mother (Figure 1.2). Before long, he acquired the ability to
knit and crochet. Then he mastered the difficult technique of tatting,
working with a bobbin to create homemade lace. After the family acquired a
sewing machine Michael became skilled on that, too, and prided himself on
the straight lines he could produce. Perhaps most remarkably, given his
young age, he kept at it. By the time he was 10 years old, Michael was
cutting patterns and sewing some of his own clothes.
Figure 1.2 Michael DeBakey at about age 2, circa 1910.
There were other early hints of a far-off future and an intense, innate
curiosity. When his son was a renowned surgeon decades later, Shiker liked
to relate a very different story from the preschool years.
One morning, father and eldest son took the family’s horse-drawn buggy
to the surrounding countryside to hunt quail. Shiker set up a small camp by
the buggy and went off to bag his game, leaving his young son at a safe
distance from the shooting. He soon returned with a handful of dead birds,
which the sheepish but intrigued Michael examined carefully as his father
returned to the hunt. Soon Shiker was back with another crop of quail, but
he stopped in his tracks when he encountered Michael with blood on his
hands, along with a hunting knife and a stunned expression. Shiker initially
thought that Michael must have cut himself, but a quick examination
revealed that that was not the case:
Finally, he made me confess that I had cut open one of the birds, and he saw where I had cut it
open. He said, “Well, why did you do this, what were you trying to do?” And I said, “I was
trying to find out how they fly.”20
Before Shiker’s business success provided enough wherewithal to buy a

motor car, the same single-horse, canopied buggy carried the growing
family around the town and parish.
On Sundays, this meant to church and beyond. There were, of course, no
Maronite services in Lake Charles, but the DeBakeys felt that the Episcopal
liturgy and ceremonies had significant similarities to their own, so they
attended that denomination’s Church of the Good Shepherd.
In the morning, Shiker read to the family from the Bible as they sat at the
breakfast table. After the brief buggy ride to church, the children attended
Sunday school while their parents worshipped with the main congregation.
Afterward they frequently made charitable deliveries to poorer, usually
black neighborhoods or the Baptist orphanage, which was a short ride from
the church. Every weekend Raheeja gathered bundles of clothes and baked
goods for this purpose. On one memorable occasion Michael lost his
favorite cap in this way, but he learned a more important lesson from his
mother:
I said, “Why did you give away my cap? That’s my favorite cap and I liked it so much.” And she
said, “It was getting old. Besides, you have some other caps and some new ones.” I said, “But I
don’t like any of those. I liked the other one.” She said, “You must try and understand that these
people are badly in need of help and they need some clothes and I gave this to them because
they need it. And you don’t. Maybe you liked it, but you don’t need it.”21
Once these altruistic endeavors were complete, the family often spent the
rest of the day in the country or at one of the nearby lakes or rivers,
bringing bread in a picnic basket and collecting fish and crabs to boil. They
would return home in the evening, contented, laughing and chatting,
listening to the rhythmic clatter of the horse’s hoofs on the road as the sun
settled over the bayous beyond town.22
In 1914, the DeBakeys moved to a larger building on the next block, at
1114 Railroad Avenue.23 They would live there for the next eight years and
maintain a business in the space for many years afterward.
Almost as soon as he had any money at all, Shiker began investing in
property.24 In October 1914, he obtained a permit for a new $3,000
building, which most likely became 1112 Railroad Avenue, a property
constructed that year next to their own shop and home. He rented this out as
a drug store for the next two decades, and it would be the site of a defining
moment for Michael.25
In the meantime, the DeBakey family continued to grow. After Michael,
the other children arrived in measured succession. Ernest was born on
February 17, 1910. The first daughter, Goldie, arrived on February 12,
1912. Three more girls followed: Selena, on September 20, 1913; Selma on
December 3, 1915; and the youngest child, Lois, who was born on July 6,
1920.
Once the older children had grown enough to perform tasks about the
house, the rhythmic rituals of weekday home life for the DeBakeys began to
crystallize.
The adults in the home spoke both French and Arabic, but English was
the primary language in the DeBakey household. Occasional French
phrases crept into conversation (and Michael picked up some of these), but
his father was especially proud of his US citizenship and wanted to
Americanize himself and his family as much as possible.26
The last to bed in the evening, Shiker was also the first to rise before
dawn, usually by 4 o’clock. He used this solitary, silent time to read and to
review his work plans for that day and beyond. An hour or so later Raheeja
and the children would appear. Michael was usually the first of the young
ones about. Chores were the initial order of business. Michael’s primary
tasks in the morning were to collect firewoodfor the stove and fireplace and
to grind coffee beans for his mother to roast in the pre-dawn twilight.
Sometimes he helped his mother with the cooking. The family ate breakfast
together, then the school-aged children—who had already made their beds
and cleaned their rooms—polished up their homework and headed to
classes on foot.27
Lake Charles had one high school at the time, and six grammar schools—
four for whites and, in that segregated era, two for blacks. These were city
schools and spread through the wards. During their time on Railroad
Avenue the children attended the First Ward School, also called Goosport
School after the neighborhood in which it was located.
In some of the grammar school classes two grades were taught in a single
room by the same teacher: one grade was instructed while the other sat
performing rote work or reading silently. Then the teacher shifted her
attention to the other group and the roles of the classes were reversed. This
awkward back-and-forth continued throughout the day. This was the case
for Michael’s fifth-grade class.28
By the time he had reached this point, Michael was well ahead of most of
his classmates in their academic endeavors. Sometimes he would correct the
blackboard work of his teachers, especially in mathematics. Anything less
than a perfect score on any test was an aberration, not to mention a likely
source of censure from his father (Shiker did not reward excellence—he
expected it—but he did scorn and sometimes punish anything less,
especially if he thought it derived from laziness or lack of effort). About the
only instances of less-than-perfect marks for Michael appeared under the
category of deportment, where he sometimes struggled. Usually this was a
function of boredom, but he eventually found a better outlet than disruption.
Michael’s fifth-grade class happened to be the junior one in the two-class
room, and, with his own work completed, he naturally began peeking in on
the other class’s lecture. Before long the teacher, Miss Inez Schindler,
noticed this. In the manner of excellent educators immemorial, she
recognized that her top student was intellectually beyond his assigned work
and bored. She asked Michael if he wanted to take a test that would allow
him to skip the grade and move straight into sixth. He responded with
enthusiasm and recorded a perfect score.29
1.5 Boyhood
Despite his academic success, young Michael DeBakey was not a socially
awkward bookworm. Like his father, he made friends easily. One close
playmate was Morys “Pee Wee” Hines, who was about a year younger than
Michael and lived around the corner.30 Michael and Pee Wee, along with
Ernest and other neighborhood boys, ran around and played sports such as
football and baseball in the sandlots near Railroad Avenue. They went to the
movies every few weeks. They also liked to hunt and fish. Sometimes the
boys went on camping trips and slept under mosquito netting, fishing
during the day.31
When Michael was about 10 years old, his father bought him a more
serious weapon: a .22 caliber rifle. In Shiker’s eyes his eldest child’s
academic performance merited the indulgence. Not long afterward Ernest
asked for one, too, and—being an exceptional student himself—was
similarly rewarded. Soon the brothers were out hunting small game—
mostly ducks—in the fields around Lake Charles. They also laid traps for
the small animal pests—squirrels, rabbits, frogs, even nonvenomous snakes
—that infiltrated their property, and Michael continued his explorations into
amateur biology by dissecting what they caught. He had no qualms or
misgivings in childhood about killing these animals. As he later said,
everyone did it, and shooting was fun. Hitting your mark was even more
fun.32
Shiker DeBakey loved the region—its people, its physical features, and,
especially, its food. Although the food of his native land is justifiably
renowned on its own merits, Shiker took to the Cajun and Creole dishes of
his adopted home like a local. In turn, Raheeja became skilled in these
cooking styles, as well. A love of this food suffused their children, too,
especially Michael, who favored it his whole life.33
As the oldest, Michael was looked up to by all his siblings and charged
with a special responsibility by his parents as well. He was expected to lead,
and not always just by example. Mostly he found this an annoyance, as he
was frequently blamed for the minor transgressions of his brothers and
sisters. This particularly applied to Ernest who, although sharing a special
bond with his older brother, did not feel obligated to obey him. When
Shiker came to his eldest son about this sibling misbehavior, he had little
tolerance for Michael’s excuses: if Ernest or the girls did not obey his
orders or entreaties, Michael was not trying hard enough. When the younger
children were punished for their actions, Michael was, too.
On some occasions the eldest son champed at this bit. Although he was
developing self-discipline, that did not mean Michael always accepted
punishment well from exterior sources. In one such instance he felt the bite
of parental correction too harsh and decided to run away. He had no plan,
except to walk east on the railroad toward New Orleans. Michael did not
make it far before darkness and hunger brought on irresistible second
thoughts, of course, and he was soon back home.34
Even Michael would conclude that some of the discipline wrought on
him was justifiable, though. In addition to the various outdoor activities he
indulged in as a typical American boy of the early twentieth century,
Michael also enjoyed reading—more than any of those other pastimes.
Once he could read proficiently it did not take him long to devour all the
books in the house. His introduction to the local library was
transformational: Michael checked out the maximum number of books
allowed every day and could be seen trundling home every afternoon, arms
barely containing all his borrowed volumes.
This worthy habit was, of course, encouraged by his parents, but on some
occasions it led Michael into harm’s way. Before leaving for work on one
summer morning, Shiker had assigned his eldest the task of washing some
windows in the house. When he returned unexpectedly in the middle of the
day he found Michael lounging on his bed, reading one of his many library
books. The windows had not been addressed, and there was hell to pay.
Shiker got his “special strap” and applied it to his son with conviction.
There was no injury—except to pride—but the pain was real enough.
Shiker then told a crying Michael, “Go wash your face now and go get to
those windows and wash ’em.” It was not a lesson that would need
repeating.35
As long as it did not interfere with specifically assigned tasks or bedtime,
though, Michael’s love of books was welcomed by his parents. They
encouraged this in their other children, as well. When his sisters were old
enough to read, all the children could sometimes be seen together, reading
on the porch.36
On one trip to the library, Michael spotted a sizable set of volumes that
he quickly realized was something almost inconceivably marvelous. The
books seemed to cover every topic imaginable. To his disappointment,
however, he was informed by the librarian that they could not be checked
out. At the evening meal he remarked on this and when asked the title of the
wonderful work he replied, “Encyclopedia Britannica.”
Shiker bought a set for the family straightaway.
When Michael was about 10 his father considered that he was old enough
to start helping in the business. He began with simple tasks—making
deliveries, sweeping the floors, and general tidying up. This was on
weekends, as well as some weekdays during the school year before and
after classes.37 By this point Shiker’s own pharmacy and dry goods
businesses were thriving, but he was also receiving income from some of
the properties he owned. Tragic circumstances associated with one of these
rental properties would leave a deep impression on young Michael
DeBakey.
In 1914, Shiker had put up a brick building at 1112 Railroad Avenue,
next to his own dry goods store. Over the years he rented this out, usually as
a drug store.38 In 1916, a traveling pharmaceutical salesman named C. W.
Outhwaite took the space. He placed an experienced druggist, John F.
Conrad, in charge of the shop.39
Conrad was a middle-aged bachelor who mostly kept to himself. In the
back of the building there was a room that he used as an apartment,
complete with a bed, bathroom, and stove. Young Michael, living next door,
helped in the Outhwaite Drug Store as well, doing similar chores to those
he performed at his father’s place. Michael and Conrad got along well. The
older man was reserved but friendly, and he offered to show Michael how to
mix ingredients to make calomel powder and other medications. He also
taught him how to read prescriptions, make pills, and perform other
apothecary duties of the era. These tasks were far more interesting to a 10-
year-old than sweeping floors, of course. Michael became very fond of the
kind pharmacist who answered his many questions so patiently. But John
Conrad was harboring a secret: he was an alcoholic.
Michael never saw him drunk. He never saw him drinking. He only
found out about this aspect of his friend from conversations between his
parents; given Michael’s age at the time he may not have understood what it
all was about in any case. His mother Raheeja was kind to Conrad. She was
kind to everyone, but Conrad was easy to like: affable and pleasant, if
somewhat introverted. She brought soup to him in his little back room and
helped keep the space tidy. Shiker, however, had great difficulty tolerating
individuals who succumbed to what he perceived as the moral weaknesses
of alcohol or tobacco. One of Shiker’s brothers was an alcoholic and had
not had much success in life, and this may have helped to shape this
perception. Raheeja did not share his view, and this was one of the few
sources of disagreement, if not necessarily friction, in their lives. She would
point out that the Bible, and Christ in particular, did not condemn these
activities. What difference did it make to Shiker if Conrad, or anyone else,
for that matter, took a drink or smoke, as long as no one else was hurt by it?
Shiker grumbled that such people were “lazy and no good.”*,40
In the late summer of 1918 Conrad began having health problems. What
these might have been—or if they were a euphemism for his alcoholism—is
not known, but Conrad asked another druggist to help with the pharmacy
until he could recover. Early on the morning of Monday, September 9,
while he was sweeping the floor, Michael heard a loud noise in the back
room. He ran to the door and looked in. Conrad lay sprawled across his
little bed, right arm extended. A .38 revolver was on the floor next to him,
smoke still swirling from the barrel. Blood flowed freely from a hole in his
temple.42
In tears, Michael called his father. The coroner came and made the
obvious ruling. Michael remembered crying at Conrad’s funeral the next
day.
It was Michael DeBakey’s first experience with death, and it left him
unsettled for months, if not longer.†
1.6 Odyssey
In due course, the DeBakeys replaced their well-traveled buggy with that
soon-to-be-ubiquitous technological advance called the automobile. The
family’s first car was probably a Ford, and, despite its early appearance on
the roads of Calcasieu Parish, any fond memories of it were eclipsed by the
next example. This was a majestic mobile emblem of Shiker’s business
success, a gigantic Cole V8.43
Around this time Shiker established the DeBakey Real Estate Company,
and, in 1920, built 1110 Railroad Avenue. This was a duplex one-story brick
structure emblazoned with the family name on the façade.44 It would serve
the area as a grocery store, restaurant, and furniture store in the years to
come. At this point, with 1114, 1112, and now 1110 Railroad Avenue in his
ledger, Shiker owned most of the block and had plans for more. The
February 23, 1920, edition of the Lake Charles American Press trumpeted
more news:
A modern picture and vaudeville theatre will be built on Railroad Avenue near Boulevard. When
completed the building will cost about $25,000. The theatre will consist of a parquet and
balcony which can seat 800 persons. Mr. DeBakey says the theatre will cater to both white and
colored patronage.46
The theatre was completed in the fall of 1920.

Flush with his conspicuous success, Shiker decided to return to his home
country of Lebanon for a visit in 1921.
Following the collapse of the Ottoman Empire with the end of the World
War I, Lebanon had come under control of France via a League of Nations
mandate. The area had seen significant chaos and destruction in the war, but
was probably as stable and safe for the family to visit as it was likely to be.
Shiker decided that they would see France, Egypt, and Italy in addition to
Lebanon and that he would even bring their big Cole V8 car with them.
They would be gone for six months.47
Shiker gathered the family together for the requisite passport picture. In
this, the only known photograph to depict the entire family, Shiker appears
poised and proud, seven-month-old Lois perched calmly on his lap with
arms crossed. Except for a pensive Michael, the other children appear
amused. Raheeja alone looks somewhat glum, as well she might with the
specter of international travel with an infant and five other children in the
offing (see Figure 1.3).
Figure 1.3 DeBakey family passport application photo, March 1921. Left to right: Shiker, Goldie,
Lois, Selena, Michael, Raheeja, Selma, Ernest.
Courtesy Michael M. DeBakey.
Shiker arranged for a renter to run the 1114 Railroad Avenue store and
sold him the inventory. On April 1, 1921, they were off.
Twelve-year-old Michael kept a diary of the epic trip, recorded in a small
ledger book in pencil.
We left Lake Charles at 11:10 PM, Friday, April 1, 1921. We arrived in New Orleans 6:50 AM.
We got on the steamship “Missouri” 2:30 PM. We ate supper 7:30 PM. After supper we went to
see them put our car on the ship. It was about 8:25 PM. They had a hard time because it was so
big.48
Michael dutifully recorded the details of the Atlantic crossing, although
the majority of the trip was uneventful. Multiple diary entries read, “The
day passed and nothing happened interesting,” but there were some mildly
intriguing incidents to punctuate the boredom. On one day he examined the
boat’s engine, and the technically minded young man pronounced it a three-
cylinder. On another he saw two stowaways caught and remarked that the
captain locked them up and put them on bread and water rations.49
The Missouri crossed the Atlantic by way of Cuba and the Canary
Islands. The family disembarked at Le Havre on Sunday, May 1. It had
taken them exactly a month to get to France from Lake Charles.50
After two days of exploring the old port city, the family boarded the
southbound train. Michael observed a single horse struggling to pull their
Cole V8 up from the wharf to the station. Shiker had originally planned to
drive the car through France but authorities instructed him that this would
entail duties. He was not willing to pay these fees and instead had it shipped
ahead. The train, destined for Marseilles, stopped for only an hour in Paris,
where any limited sight-seeing the family may have enjoyed was spoiled by
rain.51
The DeBakeys spent nine days in Marseilles, touring the parks, zoo, and
the famous basilica Notre Dame de la Garde. Michael sent a letter to the
American Press that was published. In this he revealed that, “The funny
thing of the people here is that 90 per cent of their drinking is wine.” After
this, they journeyed to Beirut via Alexandria, Egypt, and Jaffa, Palestine.52
From Beirut the DeBakeys traveled overland some 100 kilometers to
Jdeidit Marjeyoun. They spent the next three and a half months in Shiker
and Raheeja’s hometown. The foresight to bring their automobile along
paid dividends at this point, as they were able to drive to Damascus and
other locations to sight-see with relative convenience. For the most part
these driving trips were not suited to the younger children, but Michael was
old enough to be well-behaved and appreciate what he was seeing.
Alongside his parents he sat wide-eyed, trying to take it all in:
It expanded my whole understanding. . . . I met all kinds of different people, and people who
spoke different languages and dressed differently and behaved differently.53
One of the different languages he encountered was, of course, Arabic.

Michael made an effort to learn the language while his family was in
Lebanon, memorizing the alphabet and learning some basics of grammar.
After the family returned to Louisiana a hopeful Shiker even offered to pay
for correspondence courses so that Michael could continue the endeavor,
but his more practical-minded son decided it was not worth the effort,
thinking that such knowledge would only rarely be put to use. On a host of
later occasions DeBakey would be reminded of how wrong that assessment
was, and he once lamented, “that shows you the ignorance of a child.”54
Michael continued writing letters to the newspaper as well as to his old
teacher, Mrs. Schindler (which were also published). In August, he wrote:
I want you to put these jokes in the paper. When we were in the custom house a man asked us
“Were you in America?” We said, “Yes.” He said, “In what part, Brazil or New York?” (S.A. or
N.A.). We told him New York. He says, “Did you see my brother in Buenos Aires?” We told him
no. That shows of what use is geography.
The country here is growing little by little, but it is very tiresome for women. Ever since I’ve
left the U.S. I haven’t seen nothing like the stars and stripes.55
Michael celebrated his 13th birthday in Lebanon on September 7, 1921.

Ten days later, he and the family began the long journey back to Louisiana.
On the return trip, the DeBakeys had a bit more time for the City of Light,
as duly reported in the American-Press:
We spent two days in Paris. We took an automobile and drove around the city. Paris is a very
pretty city. All the buildings are even. It is not like some cities, one building high and the next
one low.
While we were in Paris there was a big fire. Two stores burned. Each store took a block, so it
was a real big fire. They haven’t a very good fire department here.56
After arriving in New York the family took an overnight train to

Washington, D.C., the first of what would be many trips to the nation’s
capital for Michael over the decades to come:
We arrived in Washington, D.C. 7:20 AM. I saw the Capitol. I saw the White House and I saw
where the Senate meets. I saw where Abe Lincoln was shot in Ford’s Theatre and I saw where
he died across the street. Washington D.C. is the cleanest city I have seen in all my travels. I saw
Washington’s Monument. . . . Washington D.C. is a very beautiful place.57
The family reached New Orleans by train on Friday, October 28, heading
home to Lake Charles the next day. They had been gone exactly six months.
The DeBakeys’ overseas trip had an immense impact on their eldest son.
Besides exposing him to a vast variety of different cultures, languages,
topography, flora, fauna, and everything else he would never have
experienced in Southwest Louisiana, this tremendous experience ignited in
Michael an abiding love of travel. When he had the means and position to
indulge this passion, years later and almost exclusively in a professional
capacity, he did so fully. Decades afterward, DeBakey pointed to this trip as
one of the most important events of his youth.
1.7 Broad Street

The half-year hiatus might have blunted the head start Michael had gotten
in his education with the skipping of a grade (he was back in seventh grade,
where he had been in the spring), but he had no trouble returning to focus in
the classroom once he was there. Michael made the honor roll consistently,
which required at least an 85 percent in all subjects, plus what must have
been a challenging 90 percent in deportment.58
Michael had always been a prodigious reader, but sometimes he had
gotten involved in juvenile novels like the Rover Boys series, which were
popular for decades.59 Now, as he moved into the high school years, an
appreciation of the English language as a medium of pure artistic
expression began to emerge.
Around this time Michael first read Thomas Gray’s great poem, “Elegy
Written in a Country Churchyard.” Originally published in 1751, this
powerful work, with its profound reflections on the meaning of life and
death, was enormously popular in the nineteenth century. That renown has
waned somewhat over the years, but quotes and references from the poem
remain in common use: the phrase “far from the madding crowd,” also the
name of Thomas Hardy’s famous novel, is taken from the Elegy. So is
“paths of glory,” echoed in the title of Stanley Kubrick’s classic anti-war
film, and the expression “kindred spirit.” As an attestation of the poem’s
fame in the nineteenth century, when Abraham Lincoln was asked to
provide a biography of his early life for publication in the presidential
election campaign of 1860, he replied, “It can all be condensed into a single
sentence, and that sentence you will find in Gray’s Elegy: ‘The short and
simple annals of the poor.’ ”60
The beauty of expression and depth of meaning of Gray’s Elegy appealed
to Michael in a way that nothing he had ever encountered before in
literature or any other artistic medium had or, arguably, ever would. The
magnificent cadence of its classical iambic pentameter, the melancholy but
hopeful text, Gray’s seemingly effortless selection of just the right words
overwhelmed him. This, then, was what was meant when people talked of
“genius.”
From this point on Michael paid special attention to language. He paid
attention to how he used it himself, setting his standards unforgivingly high.
He paid attention to how it was used by others, too, employing the same
lofty criteria. He frequently found fault in both sources.
Early on, the very brilliance of Gray’s Elegy created a quandary for him.
It seemed to have leaped from the poet’s pen onto the page fully formed,
not so much a work of art as a revelation. Despite his appreciation—and
even affection—for the poem, he knew he could never match that ideal; for
him it was a challenge to write well at all, at the start: “I’d sit sometimes for
HOURS on the first paragraph, scratching and changing and going back.”61
To approach the level of artistry of the Elegy seemed hopeless, and the
evidence of Gray’s effortless composition weighed heavily.
Everything changed, though, when Michael encountered a book at the
Lake Charles library that did not merely contain the Elegy—as many
compendiums did—but was about it. This was most likely Reginald Heber
Holbrook’s Gray’s Elegy, with Literary and Grammatical Explanations and
Comments, and Suggestions as to How it Should be Taught.62 It was an
admiring paean to the poem, but, more importantly, it was also a handbook
for teachers. As a result, Holbrook’s book contained in-depth analysis,
including a discussion of Thomas Gray’s process of composing the Elegy.
As he read it, to Michael’s surprise, he learned that this great work of
literature had not simply leaped from Gray’s mind into immortality as he
had thought. The poet had had to work at it—for years, even—crafting the
language, shaping the verse, navigating into blind alleys and out until the
final result was the timeless gem of English literature.63
The fact that the Elegy was not a revelation to Gray was, itself, a
revelation to Michael DeBakey. If anything he now harbored a greater
respect for the poet and especially for the work he had mustered to compose
his magnum opus. The underlying message, too, was clear, and resonated
outside of poetry and even art: outstanding achievements were the result of
outstanding efforts. In many ways, this simple but vital philosophical
construct became the cornerstone of DeBakey’s persona. The measure of
his lifelong adherence to it—tested in the crucible of his father’s
perfectionism—begins, by all odds, at this point.
In 1923, the DeBakeys moved again, this time from their familiar
neighborhood on Railroad Avenue to a much more spacious residence at
1005 Broad Street, in the most affluent community in Lake Charles (Figure
1.4). Much later DeBakey recalled the house in detail and with affection:
There was a big wide porch all the way around the house, with a swing on the side and the front.
A large lawn in front of it. It was really a three-story house: two stories and a big attic. There
were a total of six bedrooms upstairs. I even had my own bedroom. I remember I was the
envy of a lot of boys around because I had an electric fan on the ceiling with three speeds. I’d
sleep all night on low speed in the summer time.64
Figure 1.4 The DeBakey home at 1005 Broad Street, Lake Charles.
With eight people in the household, the task of homemaking was a full-
time one for Raheeja. Absorbed in his increasingly successful business
enterprises, Shiker needed help around the property as well. He was an avid
gardener, but had little time to pursue this interest. The DeBakeys hired an
African American couple as servants and provided them with a small house
in the back yard. The man worked for Shiker, mainly in the garden, and his
wife helped Raheeja. She mainly assisted with the laundry and cleaning,
since Raheeja liked to handle the cooking herself. This couple stayed with
the DeBakeys for years.65
Much later DeBakey asserted that he did not observe any racial
prejudice, while growing up in Lake Charles, directed against his family or
against African Americans. He was careful to stress that he himself had
never felt any discrimination based on his ethnicity. To the extent that this
was a function of his youth and relative incapacity for characterizing human
behavior is a matter for speculation; after all, there were two “colored”
ward schools separate from the white ones he attended. By his own report it
was only later, in New Orleans, that DeBakey first noticed and recognized
racism directed against hospitalized African Americans, and he was both
offended and repulsed.66
There were only three houses on their block, and the lot was large, with
150 feet of street frontage, 200 feet deep. With the luxury of this sizable
property, Shiker set up his gardens: flowers in the front and side yards,
vegetables in the back. The vegetable garden was about 100 by 125 feet
across. Michael and Ernest were set to work here, as well, and their father’s
attention to detail found another outlet. The rows had to be straight, and so
he made the boys lay them out with a string pulled taut. The DeBakeys
raised a wide variety of crops in the vegetable garden: corn, eggplant,
tomatoes, peppers, okra, radishes, and more.67 They planted seeds of squash
and cucumber which they had brought back from Lebanon. This garden
became a year-round affair and provided fresh vegetables for their own and
their neighbors’ tables in every season. Michael found the work appealing:
he continued gardening whenever he could throughout his life. Ernest
considered it a chore and observed that once he was done with his father’s
garden he’d never set foot in another!68
In those days, competitive gardening was considered a wholesome thing
for teenaged boys. With his emerging drive to be the best, just about
anything competitive was sure to pique Michael’s interest. The DeBakey
boys entered a tri-parish contest, headquartered at the local bank. Prizes
were awarded for garden layout, for particular crops, and for the most
money deposited into special accounts set up at the bank. The money could
come from sales of crops or odd jobs done about town that benefitted the
civic interest. With his string-straight rows Michael was a shoo-in for the
layout prize, and he also collected blue ribbons for his corn and tomatoes.
On top of that, he also raised the most money, depositing $61.20 in
proceeds. These efforts earned him a $30 silver Elgin pocket watch from a
local jeweler, $10 in cash from the bank, and a bushel of apples (his
winning specimens were put on display at the bank). Despite Ernest’s
misgivings about the whole enterprise, he took home third place, good
enough for a $10 watch and a pair of skates. The winners even made the
paper in a story entitled, “Michael DeBakey Gets Capital Prize in Garden
Contest”69 (see Figure 1.5).
Figure 1.5 Ernest, Michael, and Shiker DeBakey in the vegetable garden at the Broad Street home,
circa 1922.
Shiker indulged the technical as well as agrarian interests of his eldest
son, which were so much like his own. He bought Michael a build-it-
yourself crystal radio kit, and they both were delighted when the completed
set actually began to emit sounds.70
On a grander scale, Shiker purchased for his boys a used and frankly
broken-down Studebaker, of about 1910 vintage. He expected them to
tinker with it, as they did, but was probably surprised when they actually
got the thing to run.
This took some doing and required the purchase of a few parts. Michael
predictably found some books on the subject at the library and familiarized
himself with the mechanics of the car in detail.
I used to work in the backyard with it. Take it down. Clean it. Take the parts out. Clean it and
gasoline it and oil it well. Put the parts back. Finally, I learned a lot about the way the motor
operated, and I could fix it myself. I’d go down and buy certain parts and fix it.71
Michael was particularly fascinated by the sleeve valve, a design found

in engines of the first part of the twentieth century. In this type of
mechanism metal sleeves sit within the cylinder. As the piston moves, ports
in the sliding sleeves line up with holes in the walls of the cylinder at
specific times during the engine’s cycle to expel combustion gases and draw
in air. Michael read about the valve and internalized the information. A
decade later, he would recall and apply it in a very different set of
circumstances on the wards of New Orleans’ Charity Hospital.
The boys found that, with a few minor adjustments to the engine, they
could significantly improve the old car’s performance. In this time before
government-administered driving licenses, the DeBakey boys could be seen
cruising through Lake Charles in their “hopped up” car or, as likely, racing
the other local boys on a makeshift track they had set up in the country. This
whole episode was the beginning of Michael’s lifelong fascination with fast
cars and driving.72
The tools the boys used to work on their pet project belonged, of course,
to their father. He kept them in a backyard shed he had built. Naturally each
tool had its allotted space on the wall or bench. There was even a mounted
drawing indicating where each tool or other object belonged. Woe to the son
who borrowed a tool without returning it to its rightful spot, properly
cleaned: “He’d raise hell if he came in looking for a tool and it wasn’t in the
right place.”73
These tools also were brought to bear in the construction of various small
wood furniture items—coffee tables, flower stands, etc.—which Michael
and Ernest also took pleasure in sketching out, designing, and then building
during these years. The drawing part of these activities held a special charm
for Michael—he was unusually skilled with the pen and pencil.74
Not every pastime had such tangible and useful results. Somewhat
uncharacteristically, in the mid-twenties, the straight-laced Shiker had
opened a billiards parlor at 1108 Railroad Avenue, alongside his other
properties75 He also set up a pool table in the house on Broad Street.
Naturally the boys were enthralled by this amusement, and they developed
considerable skill in it. Years later Michael would allow that Ernest was the
better player: “He played it quite intensely, and I used to play just for the
fun of it.”76
Michael displayed an early aptitude, if not exactly a gift, for music. With
considerable encouragement from his father, he took lessons on the violin in
his grammar school days and learned to read music and pick out tunes on
the family piano. Later, in high school, he wanted to switch to the
saxophone so he could play in the school band (his old friend Pee Wee
Hines played in this band, as well). Shiker was initially reluctant, but finally
was convinced when his son agreed to continue with the violin, too.
Michael played both these instruments in the school orchestra.77 He kept
playing the saxophone in bands up into college, until the time constraints
applied by his many other activities left no opportunity.78
Raheeja’s mother Helen, who had always had a special affection for her
eldest grandson, passed away on October 22, 1924, at the age of 78 and was
buried in Lake Charles at the Graceland Cemetery.79
Many years later, when he had achieved great success and his intellect
was celebrated in a multitude of circles, it was a common occurrence for
casual acquaintances or those who knew him only by repute to assume that
the erudite Michael DeBakey was not athletic. Although there may have
been some truth to this in his later years, there is abundant evidence that this
was not the case in his youth. Michael continued playing the usual
neighborhood sports he had enjoyed with the Railroad Avenue
neighborhood boys on an interscholastic level in grade school, high school,
and beyond.
When he was still at First Ward School, in sixth grade, Michael ran for
the track team and placed first in the city in the 50-yard dash and the broad
jump.80 On the high school track team he ran the 100-yard dash. He was too
small to play football, but Michael did play guard on the Lake Charles High
School Wildcats basketball team. In those days this position was primarily
defensive, and in later reminiscences DeBakey allowed that it was his
competitive tenacity, rather than any innate talent, that benefitted him in the
back court. He also observed that he probably led the league in fouls.81
In the 1920s, though, baseball was by far the most popular sport in
America. Probably every capable lad in the country played it in one form or
another. In the late winter of 1921, just before the DeBakeys left on their
trans-Atlantic journey, the already-legendary Babe Ruth himself passed
through Lake Charles. In those days, major leaguers would often go on
barnstorming trips through the country in the off season, drumming up
interest and collecting appearance fees. On March 16, 1921, Ruth and
fellow Hall-of-Famer Rogers Hornsby squared off at the head of their
respective squads, the New York Yankees and St. Louis Cardinals. Ruth’s
Yankee team also boasted future trivia-question answer Wally Pipp, the first
baseman who fell ill one day in 1925 and was replaced by a journeyman
named Lou Gehrig—who then did not miss a game for the next 13 years.
The exhibition drew thousands to the Athletic Park across from the
Southern Pacific depot on Railroad Avenue, and it is possible that the
DeBakey family was among the throng (Ruth did not disappoint, swatting a
mammoth home run in the fourth inning of the Yankees’ win).82
Smitten by the national pastime as much as the next teenage boy, Michael
became catcher on the Wildcats’ high school baseball team. It was not a
position of glamour. Although he was supposed to wear a catcher’s mask,
he often neglected this safety measure and then the game became as much a
threat as a sport. On one occasion, a near-calamity almost permanently
altered the course of his life.
While he was playing catcher without a mask on, one of the batters
tipped a pitched fastball, which continued on its slightly altered course and
struck the unprepared Michael in his right eye. The resulting injury caused
the eye to swell and close, and left him blind on this side for several days.
There was real fear on the part of the physicians involved that he might lose
his eye. They gave Michael a patch to wear. After a few tense days he
recovered sight, although he later noted that his vision never fully recovered
in that eye. He also blamed the injury for vision changes that required him
to wear glasses later. The young man’s enthusiasm for baseball naturally
waned.83
Michael had been good in mathematics since his first introduction to the
subject, and high school was no different. As his capacities grew and his
talents matured, Michael’s father took note and soon recognized that the
young man now could be put to work in the more intellectual facets of the
family business, beyond deliveries and sweeping floors. Shiker owned texts
on accounting that he had bought for himself and studied, and he now gave
these to Michael to read, so that he could try his hand at keeping the books.
Though pleased and proud in his father’s trust in him for such an important
task, Michael was soon to learn that this was another scenario in which he
would fall short in the endless pursuit of perfection.
If I made a mistake in addition he would really give me hell about it. Just no excuse for it. All I
had to do was check it. “If I could find the error in addition or subtraction—something like that
—you could have done it, too.” Well, that taught me without my realizing it at the time. And I
became, myself, insistent upon being accurate about everything.84
As the DeBakey children came up through the Lake Charles schools

behind Michael, they propagated the family’s reputation of scholarship.
None could quite match the eldest brother’s performance, of course—he
had led the way and remained the standard bearer—but the siblings’ talent
was recognized. Ernest excelled in his own right and established a separate
reputation as a scholar. Selma and the youngest, Lois, were the best students
among the four daughters, regularly appearing among the honor rolls of
their schools. Their teachers must have wondered if there was any end to
the string of bright DeBakey children.85
In later years DeBakey would be asked on many occasions what had
motivated him to pursue a career in medicine. Before he became used to the
question he expressed a particular uncertainty, but on one occasion
identified the catalyst he would later recite consistently.
It’s hard for me to say. I don’t know really. I’ve thought about this . . . it’s hard to assess all the
factors, you see, that influenced you. I was, I’m sure, influenced by my relationships with the
doctors in the community whom I got to know because of my father’s drugstore and the fact that
we served them. And I used to run errands for them. They got to be friends with my father and
I’d see them and, somehow, the work they did appealed to me.86
These physicians may well have provided the stimulus, but whatever the
motivation, by the time Michael was preparing for the next step in his
education beyond Lake Charles High School, he was determined to become
a doctor.
With his excellent academic record, the opportunities for collegiate study
were plentiful for Michael DeBakey. Some of his teachers suggested he
consider applying to the famous northeastern schools: in their opinion his
chances for admission were good. Michael’s parents, however, were
reluctant to see him travel that far away at such a young age: he would not
turn 18 until the start of his freshman year. They thought he should stay
closer to home—for college, at least. After that, if he really did want to go
to medical school he could look further afield. Even then, there was a
perfectly reasonable—indeed, in some ways ideal—alternative that
answered all these bells and more and was just a few hours drive away.87
The origins of Tulane University can be traced to 1834, when seven
young physicians in New Orleans founded the Medical College of
Louisiana. In 1847, the state legislature created the University of Louisiana
and absorbed the little Medical College as its Department of Medicine.
Initially the only other subject taught was Law, but shortly thereafter other
academic divisions began to arise.88
The university closed during the Civil War and reopened to hard times in
the difficult period of Reconstruction. Its long-term viability was in
question due to financial concerns, but salvation came in the form of
wealthy New Orleans businessman-turned-philanthropist Paul Tulane. He
established a trust and donated large tracts of land in the city for educational
purposes. Rather than create a new institution, the trust’s leaders opted to
support the existing University of Louisiana, which was renamed Tulane
University of Louisiana in 1884.
Over the ensuing years the university grew both in size and in the scope
of its academic endeavors. In 1885, the graduate school opened, and the
following year saw the founding of H. Sophie Newcomb Memorial College,
named in memory of the daughter of philanthropist Josephine Louise
Newcomb. This became the first coordinate women’s college in an
American university.89
By the time young Michael DeBakey was considering his next steps after
Lake Charles High School, Tulane was firmly established as one of, if not
the premier university in the South. It also had a medical school, equally
highly regarded. On any real reflection, the choice was easy. The principal
of Lake Charles High School wrote a glowing letter of recommendation to
Tulane for his gifted student, and this was shortly answered by one of
acceptance.90
There were a few celebrations and ceremonies for Michael to attend
before closing out his childhood in Lake Charles and heading for college.
On May 22, 1926, his high school orchestra, 42 pieces strong, performed a
rather lengthy program at the Central School auditorium to signal the end of
the school year. In the middle of the concert Michael played a special
saxophone number with 11 other players. If the review from the paper was
accurate, the show was very well received, “though the audience was
small.”91
The following week the orchestra was also on the bill as the 88 members
of the 1926 graduating class were honored in the 31st annual Lake Charles
High School commencement. Pee Wee Hines and Michael joined forces on
the saxophone for a rendition of a whimsical number called “Laf’n’Sax.”92
Afterward Michael gave one of the two valedictory speeches; his was
entitled “Carrying the Wildcat Spirit Through Life.” The text was mostly
taken from a published collection of commencement addresses, tailored to
the occasion by Michael.93 Due to his many future achievements, however,
the otherwise formulaic remarks seem almost prescient.
No matter how young we may be both in years and experience, we yet have a goal toward which
we have long ago set our feet; we have an ambition toward the gratification of which all our
energies have for years been directed. With that supreme ideal ever-preeminent in our minds we
step out upon the mountain of the world’s progress, determined to climb for that and only that as
long as we may live. And we shall surmount every obstacle if we carry with us that same wild
cat spirit that has many times brought our school to victory out of the very jaws of defeat by
fighting until the last whistle blew.
Ignore the obstacles and they are already half overcome. Longfellow says:
“We have not wings, we cannot soar,

But we have feet to scale and climb
By slow degrees, by more and more,
The cloudy summits of our time.
“Oh, pause not then—nor falter

For fate is in your hand,
Climb over, onward, upward,
To where your feet would stand.
The rocks are rough and rugged,
But victory is sublime,
Step bravely, boldly forward,
And climb, and climb, and climb!’ ”94
After the applause and some further benedictions the diplomas were
handed out and high school was over. A new chapter in Michael’s life was
about to begin, in a city he barely knew, among people he did not know at
all.
A few weeks later Shiker DeBakey drove his firstborn child to college.
As father and son loaded into the Cole for the drive to New Orleans,
Michael was undoubtedly regarding his future with excitement and
trepidation, as would any 18-year-old headed away from home for the first
time. At the end of their road lay an alluring mystery. The Big Easy, with its
glamour and history—at the same time frenetic Jazz Age metropolis and
silky antebellum memoir—must have seemed a daunting if not necessarily
inhospitable host. With the exception of a few extraordinary periods,
however, Michael would call this city home for the next 22 years.
Notes
1. Ellender A. A Brief History of Calcasieu Parish [F 377.C2 E4 1941]. McNeese State
University Frazar Memorial Library Archives Collection.
2. Ferguson, SA. The History of Lake Charles. Master’s Thesis, Louisiana State University,
1931. http://ereserves.mcneese.edu/depts/archive/FTBooks/ferguson.htm (accessed
September, 2017).
3. “United States Census, 1910,” database with images, FamilySearch
(https://familysearch.org/ark:/61903/3:1:33S7-9RNT-KKP?cc=1727033&wc=QZZQ-
ZZ2%3A133638601%2C134982101%2C135039701%2C1589089524: 24 June 2017),
Louisiana > Calcasieu > Lake Charles Ward 2 > ED 36 > image 21 of 88; citing NARA
microfilm publication T624 (Washington, D.C.: National Archives and Records
Administration, n.d.).
4. Cormier, A. Lost Lake Charles. Charleston, SC: The History Press, 2017:e-edition loc557.
5. George DeBakey, personal communication, June 2017.
6. Interview, Don Schanche with Michael DeBakey, Houston, January 3, 1972. DeBakey,
Michael E. Michael E. DeBakey Archives. 1903–2010. Located in: Archives and Modern
Manuscripts Collection, History of Medicine Division, National Library of Medicine,
Bethesda, MD; MS C 582. Series 1:2:8.
7. “United States Passport Applications, 1795–1925,” database with images, FamilySearch
(https://familysearch.org/ark:/61903/3:1:3QS7-L96B-7971?cc=2185145&wc=3XZ9-
GPD%3A1056306501%2C1056503801: December 22, 2014), (M1490) Passport
Applications, January 2, 1906–March 31, 1925 > Roll 1527, 1921 Mar, certificate no. 4126-
4499 > image 198 of 810; citing NARA microfilm publications M1490 and M1372
(Washington, D.C.: National Archives and Records Administration, n.d.).
The exact date of Shiker’s immigration is not firmly established. Census records—not
altogether reliable in any case—conflict on this point. In the 1910 census the year given is
1902. The 1920 census indicates 1907. There is a note in Dr. DeBakey’s papers, in his hand,
stating that his father arrived in the United States in October 1900. The source of this date is
not indicated. Perhaps the best source—that utilized here—is Shiker’s passport application
from March 1921, on which he gives the date of embarkation from Beirut (“Beyrouth”) as
February 14, 1901. Abraham Dabaghi, his cousin, settled in Iowa. Shiker also modified his
middle name. In later life he used the middle name “Morris,” which does not occur among the
people of his community in Lebanon. As noted elsewhere, Arabs do not have middle names,
but use the father’s first name by convention when necessary. Shiker’s father’s first name was
variously recorded as Morcus and Markes, each variants of the biblical name Marcus, or Mark
—the Gospel author—which was and is a common name among Christians in the region.
Shiker’s naturalization document, dated November 4, 1911, records his name as “Shiker
Markes DeBakey,” and a marriage license from 1963 states “Shiker Mark DeBakey.” Later in
life he also sometimes spelled his first name “Shaker.” The motivation for this change may
relate to an attempt at adopting a spelling that more closely matched the pronunciation of his
name in its original Arabic form.
8. Saloom YN, Turner IB. Roots of the Cedar: The Lebanese Heritage in Louisiana. Louisiana
Library Association Bulletin 1994;57(1):31–42.
9. The Mediterranean Oral History Project Collection, Collection No. 108, Box 1, Folder 15,
Archives and Special Collections Department, Frazar Memorial Library, McNeese State
University. According to the recollections of Ann Mowad Vestal, who was interviewed on
May 21, 1998 for this oral history project, her father, John Mowad, had been present at the
Crowley meeting and offered to underwrite the young stranger, which allowed the
consignment contract to proceed. John and Shiker became friends, and later the Mowad family
moved to Lake Charles, opening their own dry goods store. In the early 1930s, Mowad rented
1114 Railroad Avenue from the DeBakeys for his business.
10. “New York Passenger Arrival Lists (Ellis Island), 1892–1924,” database, FamilySearch
(https://familysearch.org/ark:/61903/1:1:JXH4-Y6K: December 6, 2014), Martha Zarba,
August 7, 1898; citing departure port Havre, arrival port New York, ship name La Bretagne,
NARA microfilm publication T715 and M237 (Washington, D.C.: National Archives and
Records Administration, n.d.).
11. Mrs. Helen Zebra (sic) Dead. (October 22, 1924). Lake Charles American Press, 29.
12. Ferguson SA. The History of Lake Charles.
http://ereserves.mcneese.edu/depts/archive/FTBooks/ferguson.htm (accessed September
2017). The Southern Pacific Railway donated Railroad Avenue to the City of Lake Charles in
1914.
13. Barras LG. Lake Charles Street Names and Other Memorabilia of the Lake City [F 379.L2
B377 1992]. McNeese State University Frazar Memorial Library Archives Collection.
14. McMahon M. Mill Town: Prostitution and the Rule of Lumber in Lake Charles, Louisiana,
1867–1918. Louisiana History 2004;45:151–171.
15. 1909 Sanborn Fire Insurance Map, Lake Charles, Calcasieu Parish, Louisiana. New York,
Sanborn Map and Publishing Co., Ltd., 1909.
16. Cormier, loc 952. Hans Umberger, personal communication, October 19, 2017. Margie
Collins, personal communication, October 20, 2017.
17. Wendler R. DeBakey Sisters Teach Logic and Language of Medicine. Texas Medical Center
News, May 1, 2008.
18. Interview, Don Schanche with Michael DeBakey, Pierre Hotel, New York City, February 5,
1972. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series
1:2:9.
19. Interview, Don Schanche with Michael DeBakey, Houston, January 3, 1972. DeBakey
Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 1:2:8.
20. Ibid. On July 20, 2008, the Lake Charles American Press published a series of reminiscences
of local residents to commemorate DeBakey’s death. A Mr. Fern Foster related that he had
heard this story from S. M. DeBakey and in that version this event had happened in Iowa.
1:2:9.
23. Lake Charles, Louisiana City Directory Vol. V 1915. Asheville, NC: Piedmont Directory Co.,
1915.
24. Court House Budget: Tuesday’s Real Estate Transfers. B. D. Louviers to S. M. Debakey, lot 4
of nw, nw, and sw, nw, 30-10-5, $460. Lake Charles American Press, 1907, November 22,
1907.
25. Day-by-Day Record of a Year’s Activity in Calcasieu Parish (June 23, 1915). Lake Charles
American Press, 27.
26. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 5:15:46.
Shiker had initialized his naturalization in Lake Charles on May 10, 1909 (he was described at
that time as “24, merchant, white, dark complexion, 5’5”, 142 lbs., dark hair, brown eyes”).
The process was completed November 4, 1911.
1:2:9.
28. Ibid.
30. Ibid.
31. “United States Census, 1910,” database with images, FamilySearch
(https://familysearch.org/ark:/61903/3:1:33S7-9RNY-CVQ?cc=1727033&wc=QZZQ-
XK8%3A133638601%2C134935101%2C138580701%2C1589089261: June 24, 2017),
Louisiana > Orleans > New Orleans Ward 2 > ED 18 > image 14 of 18; citing NARA
microfilm publication T624 (Washington, D.C.: National Archives and Records
Administration, n.d.).
32. Interview, Don Schanche with Michael DeBakey, Houston, Texas, August 13, 1972. DeBakey
1:2:9.
35. Ibid.
36. SoRelle R. Milestones for Dr. DeBakey. Circulation 1994;198:1255–1256.
1:2:9.
38. Real Estate Transfers (September 25, 1914). Lake Charles American Press, 4.
39. Drug Store Sold: New Iberia Man Purchases R.R. Ave. Establishment (December 14, 1916).
Lake Charles American Press, 12.
1:2:9.
42. John F. Conrad Is Suicide: Ill Health Drives Man to Take Own Life (September 9, 1918). Lake
Charles American Press, 1. In the newspaper story of this event, J. M. McKee, the other
druggist, is identified as the individual who found Conrad’s body. It is noted, however, that “a
small boy” had been helping out at the store. In his telling of the story DeBakey did not
mention another adult being present. The newspaper article may have been crafted to prevent
identification of a minor in such circumstances. Conrad was buried in Graceland Cemetery
(now Orange Grove Cemetery) in Lake Charles.
43. Debakey Family to Spend Six Months on Syrian Journey (March 30, 1921). Lake Charles
American Press, 20.
44. DeBakey Building (January 7, 1920). Lake Charles American Press, 5.
46. Modern Theatre for Railroad Ave. (February 23, 1920). Lake Charles American Press, 3.
47. Debakey Family to Spend Six Months on Syrian Journey (March 30, 1921). Lake Charles
American Press, 20.
49. Ibid. Triple-expansion steam engines were common well into the twentieth century. In these
machines, steam from the boiler expands in three different stages. Steam flow is regulated by
sleeve valves, devices which Michael DeBakey would also later encounter in automobiles and
eventually apply to his early transfusion apparatus.
51. DeBakeys Write Again (May 27, 1921). Lake Charles American Press, 3.
52. Ibid. The Jaffa riots, violent clashes between the local Arab and Jewish populations during the
British mandate—which left nearly 100 dead—had occurred less than three weeks before the
DeBakeys’ one-day sojourn in that town.
54. Ibid.
55. Michael DeBakey Letter: Syria Grows Little, But Is Very Tiresome for Women (September 20,
1921). Lake Charles American Press.
56. With Lake Charles Travelers Abroad (October 31, 1921). Lake Charles American Press, 12.
The Paris fire that the DeBakeys witnessed consumed the gigantic Magasin du Printemps
department store. It was subsequently rebuilt and occupies the same space today.
58. Central Honor Roll (March 21, 1921). Lake Charles American Press, 6. Central Honor Roll
(December 8, 1921). Lake Charles American Press, 8.
Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 1:2:8. The Rover
Boys was a series of 30 juvenile novels intended for boys. They were written by Edward
Stratemeyer under the pseudonym Arthur M. Winfield in the first decades of the twentieth
century. Stratemeyer, who wrote more than 1,000 books, was also responsible for the Bobbsey
Twins, Tom Swift, Hardy Boys, and Nancy Drew series.
60. Donald DH. Lincoln. New York: Simon and Schuster; 1995, 18.
61. Interview, Don Schanche with Michael DeBakey, Houston, January 3, 1972; interview, Don
Schanche with Michael DeBakey, Pierre Hotel, New York City, February 5, 1972. DeBakey
Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 1:2:8, 1:2:9.
62. Holbrook RH. Gray’s Elegy, with Literary and Grammatical Explanations and Comments, and
Suggestions as to How it Should be Taught. Lebanon, OH: C. K. Hamilton & Co., University
Publishers, 1886.
63. Ibid.: “The teacher may well give sufficient time to these suppressed stanzas. They are
“behind the scene” affairs, which are always interesting—especially as connected with any of
our popular poems. They also indicate by what scrupulous rigor of rhetorical pruning
immortality is secured to literary effort.”
1:2:9. Unfortunately the names of these family servants have not come to light, although there
is evidence that the man was named Abe. They do not appear on census records from the time
and place. DeBakey later related that the wife passed away first, and her husband remained
with the DeBakeys. When he subsequently developed heart trouble Shiker took him to New
Orleans for treatment.
66. Ibid.
67. DeBakey Boys Show What Can Be Raised Here (May 27, 1926). Lake Charles American
Press, 10.
69. Michael DeBakey Gets Capital Prize in Garden Contest (August 26, 1922). Lake Charles
American Press, 4.
1:2:9.
71. Ibid.
1:2:9.
74. Ibid.
75. Lake Charles 1925. Dallas: John F. Worley Directory Co., 1925.
77. “Captain Kidd” Holds Sway at Central Tonight: High School Talent to be Seen in Comic
Opera (December 18, 1925). Lake Charles American Press, 2.
Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 1:2:8, 1:2:19.
79. Mrs. Helen Zebra (sic) Dead. (October 22, 1924). Lake Charles American Press, 29. Mrs.
Zorba’s grave is in the Orange Grove Cemetery, Lake Charles.
80. School Field Meet (April 19, 1920). Lake Charles American Press, 16.
82. In Walloping Contest As 2500 Gaze at Ruth Yanks Win Yesterday (March 17, 1921). Lake
Charles American Press, 2. Personal communication, Brandon Shoumaker, Southwest
Louisiana Genealogical and Historical Library, October 2, 2017.
83. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 1:2:10,
19.
85. Honor Roll at Central School (1927, March 8). Lake Charles American Press, 22.
1:2:9.
88. Case AE. Tulane University. New Orleans: Arcadia Publishing, 2016: Ebook 2016, loc 159.
89. Ibid., loc 127.
1:2:9.
91. Hi School Concert: Fine Program Given at Central Saturday Night (May 24, 1926). Lake
Charles American Press.
92. Laf’n’Sax was made popular by the Canadian group the Six Brown Brothers, who were a
well-known musical act in this era. Vermazen B. That Moaning Saxophone: The Six Brown
Brothers and the Dawn of a Musical Craze. Oxford: Oxford University Press, 2004.
93. Painton EF. The Commencement Manual. Chicago: T. S. Denison and Co., 1915: 258.
94. Class of 1926, Lake Charles Hi, Now a Memory (May 29, 1926). Lake Charles American
Press, 1, 8. The quote is from “The Ladder of St. Augustine,” a poem published in 1858 by
Henry Wadsworth Longfellow.
*
The capital “B” in DeBakey occurs sporadically but appears in documents by 1910.
*
Michael was called “Michel” interchangeably in childhood and throughout life by some family
and friends (he was confirmed in church as “Michel” in April 1925). This version of the Biblical
name is common among Lebanese Maronites, borrowed from the French. Middle names are not in
general use in Arab cultures, and it is not clear that Michael was initially provided one by his parents.
Multiple sources from his childhood recorded his middle initial as “S,” which would be in keeping
with the Arab convention of employing the father’s first name for this purpose when necessary. In
later documentation the initial “E” appears, along with the middle name Ellis—a family name; the
first examples of this are from the mid-1920s. If Michael had a government birth certificate, it may
well have been destroyed in the 1910 Lake Charles fire, which consumed the courthouse and many of
its records. Louisiana did not require birth certificates until 1918.16
*
The DeBakeys did keep whiskey in the house, but this was only to camouflage the taste of castor
oil for the children. The effect was incomplete with Michael, who could not stand the smell of
whiskey throughout his life due to its powerful mental connection to that childhood supplement.41
†
Fifty-four years later, DeBakey said he could still see the image of the dead Conrad: “it’s
indelibly imprinted in my mind. I can still visualize him lying on this bed with his arm out.”45
2
Tulane University: 1926–1935
Knowledge to their eyes her ample page,

Rich with the spoils of time.
2.1 LaSalle Hall

The trip from Lake Charles to New Orleans was 200 miles east along State
Route 2, the Old Spanish Trail.1 It was a five-hour journey in the
DeBakeys’ car.
One of the first stops Michael and his father made in New Orleans was at
a bank. Shiker had a number of business associates in the city, and he
introduced his son to many of them, but the trip to the bank was not social.
His father set up (and deposited a substantial amount of money in) an
account in Michael’s name.* An explicit admonition came along with this
generosity: the money had to last—it would not be replaced: “He made it
clear to me that I was responsible for the way I spent that money.”2
Michael had been to New Orleans before, of course—as a point of
departure and return during the trip to Lebanon, for one—but never longer
than a day or two and certainly never on his own. This transition to self-
reliance was the classic rite de passage of youth. His father’s faith, born of
the young man’s maturity and obvious academic prowess, helped assuage
any trepidation Michael might understandably have harbored: “He put me
on my own and he expected me to be on my own. This, I think, shows the
kind of relationship he had with me and in a sense the confidence he had in
me.”3 Still, the sight of his father driving away must have been a difficult
one for Michael, who had just turned 18.
Tulane University was located in the neighborhood known colloquially
as Uptown. The campus was verdant and lush, shaded by hundreds of
southern live oaks, and located directly across Lake Charles Avenue from
the entrance to the city’s Audubon Park. In 1926, there were twin three-
story Dutch Renaissance-style dormitory buildings for men, side-by-side on
the northwest perimeter of the main university quad. One was for
undergraduates and was known as the “Academic” dormitory. Just a few
yards away stood a similar one for medical students.*
The Academic dormitory was divided into three Halls: LaSalle, Bienville,
and Gayarré. Each of these could accommodate 16 students.4 The
university’s Bulletin glowingly reported: “The houses are well-constructed
and well-furnished; they have water service throughout and tiled
bathrooms, with porcelain tubs, on each floor; they are heated by steam,
electrically lighted, and provided with fire escapes. There is an abundance
of light and air.”5 Each room came with an enameled iron bed (mattress and
other bedding not included), stationary washstand, oak chiffonier-wardrobe,
and 16-candlepower electric light. All this, plus board in the form of
breakfast and dinner, came at a cost of $220–240 for the academic session,
depending on the room selected.6 Meals were given at the Refectory,
located directly adjacent to the dormitories (Figure 2.1).
Figure 2.1 The academic dormitory at Tulane University in the 1920s.
Courtesy Tulane University Archives.
In his freshman year Michael lived in room 13 in LaSalle Hall.7 Settling

into his new environs, he may well have reflected on the substantial
academic journey he had taken from Lake Charles to college.
In 1926, there were several ways to gain admission to the College of Arts
and Sciences at Tulane. Some of these involved examinations and special
exemptions. Michael was admitted by Certificate, which meant that he had
graduated from one of “certain accredited schools” with all the proper
courses and grades, in addition to accompanying certification of his
“conduct and studious habits.” Fifteen units of study had to have been
completed in high school—a unit being defined as a full-year course with at
least five classes a week, drawn from a list of approved subjects. Michael’s
application listed 16 units in total, more than enough for admission not only
into the undergraduate school but also, as it happened, into the pre-medical
course of study.8
At this point in time Tulane, like many other universities over the years,
permitted entrance into its medical school to students after just two years of
undergraduate education, provided their course work was satisfactory. In
fact, a two-year pre-medical course, with both prerequisites for admission
and a course curriculum, was already fully established at Tulane and quite
popular (nearly half the students in the freshman class before Michael’s
were in this course). At the time when Michael enrolled, students who
completed the pre-medical course were awarded their bachelor of science
degree midway through the four years of medical school. This was the track
he entered.
In 1926, the cost of tuition was $90 per semester for students in the pre-
medical course. There were additional fees in the first term, though, for use
of the gymnasium, admission to sporting events, the weekly student paper
Hullabaloo, the yearbook Jambalaya, and other “student events.” In
addition, there was a “medical attendance” fee—essentially health
insurance, mandatory for non-residents of New Orleans—and lab breakage
deposits. All told, this brought the September bill to $135.9
Michael’s first-year class schedule comprised chemistry 1, English 1,
French 1, mathematics 1 and 2, zoology 1 and 2, and physical training. This
met his pre-medical requirements.10
Chemistry 1, a general inorganic course, was taught in the Richardson
Chemistry Building, which was located about 200 yards across the quad
from Michael’s dormitory. The orange brick structure dated to the time of
the university’s move to Uptown in 1894. Professor H. W. Moseley taught
with the perennial classic, Smith’s College Chemistry.11
Michael’s English and French classes met in the imposing, four-story
Gibson Hall, the ivy-covered centerpiece of the university. This
Romanesque monolith faced the Audubon Park entrance along a
semicircular drive path arcing northward from St. Charles Avenue. The
language classes were introductory level. The English course covered prose
in the first semester and poetry in the second, while the freshman French
classes were nuts-and-bolts lectures and reading assignments on grammar,
pronunciation, and the like.
The first half-year of the zoology course covered fundamental properties
of living matter and classification of animals. Physical training consisted of
two half-hours per week of supervised exercise. It was a requirement of all
freshman, unless they had an excuse from the University Medical Officer.12
The fall term mathematics 1 class was a survey in pre-college concepts
like algebra, logarithms, and series. The second term covered trigonometry.
Although much of the first-term material, especially, was review, Michael
would find that replicating the results he had grown accustomed to in Lake
Charles would be more challenging in New Orleans.
Most of the incoming freshmen at Tulane did not hail from Orleans
Parish, but plenty had been born and raised in the area and were only too
happy to show their more provincial classmates the ropes.
When I went to college I was wanting to try everything. I was very eager to find out about life,
and New Orleans was a good place to find it out. A lot of my classmates were older and more
experienced than I and many of them lived in New Orleans, so they knew all about the city. I
was eager to try all of these things.13
On his very first night out as an adult in New Orleans, Michael’s new
friends naturally took him to the French Quarter. The Vieux Carré was
experiencing a kind of Bohemian Renaissance in the 1920s—largely due to
an influx of writers and artists charmed by its Old World atmosphere and
low rents—but Storyville was not that far in the past and much of the area
retained the grit and squalor into which it had spiraled over the preceding
decades.*
I went downtown with the boys and I saw these cribs for example. They took me down there. I
had never seen that before. They told me that these were whores, prostitutes. And I was
ashamed, in a sense, to inquire. I thought they obviously knew what this was all about and I
didn’t. So I just sort of kept my mouth shut and went along trying to find out more about it,
faked a little bit. And gradually, you see, I progressively learned about what goes on.14
Michael found the gratuitous live shows to be more repulsive than

entertaining and soon began avoiding the boys’ trips to these venues. He did
not much care for gambling, either, but did enjoy going to the fights. He
was also fond of the speakeasies they attended—not so much for the
Prohibition-era illicit booze or the smoking, but for the jazz. Michael had
developed an appreciation for the style while playing the saxophone back in
Lake Charles:
They had these little bands, combos and so on, and I’d go down there with them and sip a beer. I
could get by with that. It wasn’t very good beer, either. But I’d sip it and they had somebody
singing. . . . I had already developed a taste for jazz. I played jazz.16
Whiskey was also popular in these illegal bars, although the quality was
somewhat suspect. Not that Michael would have been able to tell the
difference.
I took it when I got to college with the boys, because I wanted to be part of the gang, and I sure
as hell didn’t want to be ostracized in any way, so I’d drink this terrible rot-gut whiskey that
they had and it just made me sick. It didn’t do anything for me. So I decided I couldn’t do it. I
finally found I could have a good time without doing it.17
The festivities among Michael’s new college buddies were not limited to
weekend excursions on the squalid streets of the Quarter. Impromptu parties
and “bull sessions” were apt to spring up unpredictably in the Academic
Dormitory.
Students walk in at any hour of the day or the night . . . or they’ll call you and tell you to come
on over to the other end of the hallway, we’re having a little party, you know, bring beer in.18
Michael found these diversions entertaining at the time. Although he

recognized that he was now among “some pretty bright chaps,” he had
always outperformed the competition in the classroom, and he had every
reason to think that his usual degree of excellence would continue
unabated.19 As the term neared its end in December and he prepared to
return home for Christmas break, though, a nasty surprise blunted his
yuletide celebrations.
Mathematics had always been a strong subject for Michael—maybe the
strongest—and he had typically achieved perfect scores with little effort. As
a result, he was stunned and mortified when he received his semester grade
of 83.20 Michael approached the instructor, hoping that there might have
been a mistake in the grading or at least for some elucidation of his errors.
The information that he had scored the highest in the class was of little
comfort.
I went to see him and I wanted to know what did I miss? I thought I had gotten them all. He
said, “Young man, I want to tell you something. There’s no question that you did better, far
better, than any other student in this class, but there were only seven students in this class that
passed.” There were about thirty of us in the class. And I said, “Well, I’m glad to know that I
passed, but”—I mean, I was very nice about it: I wasn’t going to argue with him, But on the
other hand I did point out to him that I would like to know where I had failed. So he pulled out
the papers and showed me. I was shocked that I had made these mistakes. I mean, as soon as he
showed me I realized it very quickly. God, how did I do this?21
Michael knew that his father would not respond well to this news—after
all, he was paying $135 per semester. Michael’s other grades did not set the
world on fire, either; certainly not by the standards everyone had come to
expect. His highest score—88—was in English. Next was zoology: an 87.
He made 82 in chemistry and 80 in French.22 These were all more than
respectable numbers, actually, but his parents’ dissatisfaction—and the blow
to his own pride—were not assuaged by that salve. He harbored a concern
common among great achievers: “I just couldn’t think of the possibility of
failure: that would be the end of my life.”23 This was not failure, but it felt
close to it. Michael decided to make a change.
I realized that I couldn’t do all of these things that I wanted to do, going out with the boys at
night and so on. So I began to sort of change my lifestyle. I began to go out for other things, like
going out for the band, and playing sports, and really only going out one night a week: Saturday
night.24
Michael’s athletic exploits were confined to the intramural leagues at

Tulane, where he played basketball, handball and, perhaps surprisingly,
baseball.25
Figure 2.2 DeBakey as an undergraduate at Audubon Park, near Tulane campus.
Tulane had both a university orchestra and a marching band, and Michael
performed in both outfits through his first three years on campus (Figure
2.2). He became a member of Kappa Kappa Psi, the National Honorary
Musical Fraternity for College Bandmen.26 The marching band, which had
only been founded a few years before, performed at Tulane Green Wave
football games and often traveled with the team to away games.27 The
orchestra played frequent concerts at the school and sometimes hit the road
for performances as far away as Mississippi.28
Michael did not allow his growing time commitments to eliminate his
social life—sometimes the two were even complementary. Like most
college boys, he enjoyed the company of the opposite sex. He went on
many double dates. He also attended cotillions and even debutante balls. On
later reflection, he mainly remembered the uncomfortable clothes these
occasions demanded. The young man’s evening dress of choice in that time
and place was poorly suited to the sultry climate:
The formal attire in those days was a white linen suit. We put on a white linen suit and got
dressed up that way. After a couple of hours you didn’t look like much, either. We didn’t have
air-conditioning.29
Michael’s more constructive extracurricular outlets—such as the bands—

were driven by his subpar first-term academic performance, but the true
focus of his new effort was his classroom work. His courses after the first of
the year were continuations of the fall semester subjects. He was
determined to excel in all of them. It was at this point that he began, like his
father, the habit of rising very early and staying up beyond midnight,
maximizing the time to read and study.
The second term in zoology concentrated on animal biology. It was at
this point that Michael was exposed for the first time to the principles of
gross anatomy, histology, physiology, embryology, genetics (then called
“heredity”), and evolution. He found them all to be intriguing, and his
natural disposition toward the life sciences was at last indulged deeply.
Michael particularly enjoyed the laboratory side of the zoology
experience.
I was fascinated with some of the experiments we were performing, like stimulating the growth
of little frogs, tadpoles, by putting in the water thyroid extract and forcing them to grow more
rapidly. It was fascinating to watch the effect of this.30
The young man’s interest in zoology caught the attention of his course’s
charismatic and dynamic professor, Edward S. Hathaway. At 40 years of
age, Hathaway was among the younger members of the Tulane faculty. To
Michael’s good fortune, he was another in the line of outstanding educators
who shaped these school years. Unlike many university academics,
Hathaway devoted his time and efforts primarily to teaching rather than
research—although he produced several important papers during his long
career. Hathaway was well aware that most of his undergraduate students
were in the pre-medical course, and he took their education in biology and
zoology as a personal responsibility.31
Michael naturally gravitated toward someone of Hathaway’s character.
He affected me first by the fact that he was dedicated to his work and he was so enthusiastic
about it he transferred that enthusiasm to me. He was very open and easily accessible. He was
quite scholarly and yet not stuffy. He had that ability to transfer, so to speak, this sense of
enthusiasm for learning . . . he kind of opened my eyes to sort of the academic world.32
Michael’s enthusiasm for the class and its professor was reflected in his
continued high performance for the second semester: his final grade was 85.
Unsurprisingly, his performance in the other classes of his second term
improved nearly across the board: he scored a 95 in mathematics, a 90 in
chemistry, an 85 in French, and a 90 in physical training.33
Michael’s lowest score of the term was an 80 in English (Figure 2.3).
Despite this, he developed a relationship with the course’s talented
professor, Roger P. McCutcheon, similar to the one that he had forged with
Hathaway.34 At 37 years of age, McCutcheon was even younger than the
zoologist, and he also saw something special in Michael.
(He was) a very, very nice man and I was very fond of him. And even though I was not majoring
in English, he liked what I did, he tried to encourage me. He told me one time, “You know, I
wish you weren’t interested in science.” He said, “You really ought to go into English literature.
You have a way of writing and understanding that I like very much. I think you have a talent for
it and I think you ought to go into it.”35
Figure 2.3 DeBakey as an undergraduate at Tulane.
2.2 Sophomore
With the second term over, most of the premedical students went home for
the summer. Their regular courses would resume in September. Rather than
returning to Lake Charles, though, Michael elected to stay at Tulane. In the
summer school of 1927, he took a class entitled college physics, which was
good for five hours of credit.36
Michael moved to room 16 in LaSalle Hall for his sophomore year.37
Ernest, who had graduated from Lake Charles High School back in May,
joined his brother at the Academic Dormitory that fall. He was starting
classes in the College of Pharmacy.38
Physics 1 was part of the standard pre-medical course. By taking the
summer school offering Michael satisfied this requirement before starting
his sophomore year. The other classes he took in the sophomore track
included year-long sessions in English 2, French 2, and philosophy. The
hard sciences were represented by half-year classes: zoology 3 in the first
term and chemistry 5 in the second.39
Zoology 3 was taught in the fall term, again by Hathaway. The class was
entitled “mammalian anatomy” and mainly consisted of a detailed study of
the anatomy of the cat.
In this subject Michael was able to apply, for the first time, his
considerable artistic skills to a scientific use: anatomic drawing. He now
developed to great effect a stippling method he had experimented with back
in high school. Michael also demonstrated impressive dexterity in a
meticulous dissection technique.
I used surgical tools to do the dissection. And I did detailed dissection. I would dissect out of a
cat all the muscles, for example. I would dissect out all the nerves, all the arteries. All the way
down, you see, and lay it open and make it just like the book showed it.40
Hathaway noticed the quality of Michael’s drawings and dissections and

even had his other students take time from their own efforts to admire them.
Shortly after the beginning of the first semester of Michael’s sophomore
year, Hathaway approached him with an offer to become a Student
Assistant in the Department of Zoology, primarily to take advantage of
these artistic skills. This was a paid position, although he hardly needed the
money, and Michael was appointed on October 11, 1927.41
I prepared all of the animal work for him. He used to bring the cats in and I’d chloroform them
and then do the dissections, and then show them how—to those who were taking that particular
type of class. Then I did some professional drawing for him, for example, in embryology: they
wanted the chick embryo in the various stages. I took it from the egg stage to the fertilization
and then thru to the various stages of the development of the embryo. Actually drew them from
the cross-section slides, and they used them for many years. Very tedious work, but I was paid
for it, made money.42
The extended study hours Michael instituted for himself—early morning

and late at night—were paying dividends. His first term scores for the
1927–1928 school year were: English 2, 90; French 2, 77; philosophy 1, 92;
and zoology 3, 95.43
Nevertheless, Michael was growing discontent with the continued
distractions of the Academic Dormitory. He discussed with his father
moving into one of the many boarding houses that dotted the neighborhoods
around the university and perhaps obtaining an automobile for the next
academic year. He would be beginning his medical studies then, and, for
one thing, the Tulane Medical Library was located several miles away, on
the school’s downtown Medical campus. Shiker DeBakey, justly proud of
his son’s continued academic successes, listened with a sympathetic ear.44
Michael’s scores for the second term were also excellent, except for
French. He graded out at 93 in the organic chemistry class, 90 in
McCutcheon’s English 2, 93 in philosophy 2, and 75 in French.45
At this point Michael’s school record officially transferred to the Tulane
School of Medicine. As per the program then in place, he would remain on
course to graduate with a bachelor’s degree with his matriculating
classmates in 1930, but all his further classwork would be in the Medical
School.
Before that, however, Professor Hathaway—who still harbored thoughts
of corralling this young pupil into his own field—provided Michael with
further opportunities for increased responsibility:
During the summer, I became a full-time instructor. There were lots of students that came there
in the summer to do graduate work, that took courses, and so he put me in charge of one of the
courses. I kept about two or three days ahead of them.46
For this second summer at Tulane, Michael moved into one of the
boarding houses he had discussed with his father. Lists of these that the
university considered “desirable” were kept by the Registrar, and monthly
rents were in the $40 range. It was more expensive than the dormitory, but
the freedom from near-constant distraction more than made up for that. He
also enjoyed the greater sense of adult living that these arrangements
provided.* There were occasional moments when the new environs meshed
poorly with his advanced zoology responsibilities, however.
I used to go out in the summer, on Sunday, into the marshes down south of New Orleans and
collect reptiles of various kinds.
One time I came back—I was staying in a boarding house—and I had collected a bunch of
snakes. I used to catch them with a forked stick and put them in a gunny sack. In this boarding
house we had our dinner on Sunday at noon—and I got there just in time. They were sitting at
the table and I wanted to get my dinner, so instead of going to the laboratory with the snakes, I
went to the boarding house.
I put my gunny sack down just behind the door and I had hardly sat down before I noticed the
landlady looking with a frightened expression on her face. In the door that led into the dining
room there was a snake out there, he’d gotten out somehow. Fortunately, I jumped up and
caught it again and put it back in the gunny sack. She really raised hell with me about it, and she
was so upset that I had a hard time convincing her that this would never happen again.47
Despite Hathaway’s best efforts to keep his fearless protégé in the field of
zoology—he even arranged for Michael to do research at the then-new
Woods Hole Oceanographic Institution in Massachusetts—medicine was
the only calling the young DeBakey would ultimately heed.
2.3 Richardson Hall

Registration for the fall term in the School of Medicine occurred in late
September 1928. Unlike the undergraduate college, the medical school
divided its academic year into trimesters. Tuition for the entire first year
was $250; with the usual fees and deposits this swelled to $305. Medical
students were required to purchase their own microscopes, too.49
The first two years of medical school at Tulane were spent on the
Uptown campus. Most classes were held at the five-story Richardson
Memorial Building, a brick-and-limestone affair that harmonized in style
with its neighbor, Gibson Hall, and dominated the east side of the oak-
shaded main quad. Anatomy, physiology, pathology, bacteriology, and
pharmacology classes were all held here.50
Michael’s first classes as a medical student began on Thursday,
September 27, 1928.51
By long tradition in medical education, the first class was in the Gross
Anatomy Laboratory. Other courses included histology—studying the
makeup of tissues at the microscopic level, for the most part—embryology,
organology, and biochemistry.52
When the scores were tallied at the end of the year Michael had
performed very well again. He earned a score of 90 in his classes on
biological chemistry, embryology, and histology. He recorded 89 in
organology. The gross anatomy grade was distributed through the year as
the anatomic sections were studied; he scored in the 80s in each. The
overall average for the year was calculated at 87.4.53
By all odds, this was an excellent start to Michael’s medical education.
Still, he was somewhat disappointed—not so much in his performance as in
the manner in which the information was being imparted. He found the
then-current style of teaching, in which the students were passive absorbers
of the lesson, stultifying.
It was largely pedagogical in the sense that it was a presentation of lectures by the professors
who came before the class, read the lectures, sometimes would go to the blackboard and make a
drawing of what they were talking about. In fact, it was so much that way that we had what the
students had done before—of taking the lecture down. There were students who could take it
down and type and had typed these and we could buy them before you started the course.54
Back in Lake Charles, the DeBakey family was doing well in the eldest
son’s absence. Selma and young Lois began a steady string of appearances
on the scholastic honor roll.55 Shiker continued to lease the drug store he
had built at 1112 Railroad Avenue (where Michael had witnessed the
suicide of John Conrad).56 Later the DeBakeys would themselves run the
Red Star Drug Store on the site. Shiker also purchased some property at the
corner of Ryan and Clarence Streets close to downtown Lake Charles and
erected another building here, which became 1200 and 1202 Ryan Street.57
He set up two new businesses in this structure: the Economical Drug Store
and an automobile service station and garage.
Michael taught summer school again in 1929. In late August he returned
to Lake Charles for a visit with several friends from medical school,
including the Odom brothers, first-year student Guy, and Michael’s second-
year classmate, Charles (Figure 2.4).58
Figure 2.4 Charles Odom (left) and DeBakey in Lake Charles, August 1929.
The Odoms were from Harvey, Louisiana, in Jefferson Parish just across
the Mississippi River from New Orleans. Their father had been coroner of
the parish prior to his untimely death during the influenza pandemic of
1918. In addition to the two sons, he left behind a widow, Marion, and
daughter, Vada. Like the Debakeys, the Odom family owned and operated a
drug store.59
The Odom boys were bright, gregarious, and athletic. They played sports
and held leadership positions in both college and medical school at Tulane.
Michael got to know them well, along with their mother and sister. When he
returned to the university for his second year of medical school
(concurrently his senior year of college) Michael lived with the Odom
family in Harvey and continued to do so for the next two years.60
Michael’s sophomore year of medical school was mainly a continuation
of study of the basic sciences of medicine. Tuition held steady at $250 for
the year—although a month after school started the “Black Tuesday” stock
market crash would drastically alter the meaning of that value for many.61
Shiker’s fortunes were secure back in Lake Charles, however, and Michael
felt no economic pressure beyond the ingrained DeBakey frugality: he was
one of the very few Tulane students who drove his own car.
The sophomore year began with an hour-long lecture on physiology. This
was one of the most important courses in the curriculum and included
lengthy lab sessions. Based on the official description, the objects of the
exercises needed to be mindful of their own well-being: “To illustrate
certain phases of the physiology of circulation, respiration, the nervous
system, and the sense organs, students serve as the subjects of experiments.
Where this is not feasible, lower animals are used.”62
The other first-term classes were bacteriology and neuroanatomy.
Michael scored 90 and 89 in these courses, respectively, and 91 in
physiology.63
In the winter he finished with grades in the 80s for classes in
pharmacology, materia medica and prescription writing, physical diagnosis,
and pathology.64
The spring trimester, which ran from late March to early June, offered a
course called “Introduction to Surgery.” Michael finished this with a score
of just 71, the lowest score of his entire medical school career.65
Nevertheless, this would turn out to be perhaps the most important course
Michael DeBakey would ever take. The class description read in part,
In the second year a didactic course is given by Prof. Ochsner, at the Richardson Memorial,
Tulane Campus. The function of this course is to correlate the pre-clinical sciences and clinical
surgery, so that the student may be better able to understand the practical application of the
fundamental sciences.66
This course was key to the edification and ultimate realization of Michael
DeBakey for two reasons. It represented the primary exposure, within his
chosen career, to a fundamental synthesis of two of his defining
characteristics: practical intellectual inquiry and “hands-on” manual
dexterity. Even more importantly, he fell under the singularly compelling
spell of “Prof. Ochsner.”
2.4 Ochsner
Edward William Alton Ochsner was a study in contrasts. He was a northern
man, born and bred, who would come to define surgery in the South. He
was a connoisseur of simple tastes, pastimes, and language whose intellect
and sophistication won admirers and leadership positions among physicians
worldwide. Perhaps most remarkably, he was a consummate empiricist who
rode intuition to champion the prevailing view in the most important public
health debate of his century.
Born in Kimball, South Dakota, on May 4, 1896, Alton (as he came to be
known) was the last of seven children of a prominent family. He had six
sisters, the youngest seven years his senior. He was unavoidably doted on
but shrugged this off to become an intelligent, self-sufficient boy with the
appropriate dash of good-natured mischief. The family was close and would
gather around on special occasions to savor home-made ice cream or a
special treat: popcorn in milk.67
The similarities of Alton Ochsner’s early life to that of his future protégé,
Michael DeBakey, are striking. Like Michael, he was a relatively privileged
youth due to the success and industry of his parents: the Ochsners had the
first central heating and indoor plumbing in Kimball. Young Alton played
sports with success and enjoyed making music on the cornet. In early
adulthood he realized he only needed a few hours’ sleep a night. Of course,
he also excelled in the classroom.
Ochsner matriculated at the University of South Dakota. His trajectory
toward becoming a physician was a direct one. The family had a history of
producing doctors. His father’s cousin, Albert John “A. J.” Ochsner, was a
highly successful surgeon in Chicago with a national reputation. He had
been a founder of the American College of Surgeons and later a President of
that and other significant surgical organizations. Consequently, he knew
many leaders of American medicine and was well-acquainted with medical
education throughout the country. A. J. directed Alton toward Washington
University in St. Louis. After receiving his MD degree there, Alton interned
at the University’s Barnes Hospital, then joined his older cousin in Chicago
as a surgical apprentice. Recognizing that the young man needed some
years of training and experience, A. J. Ochsner arranged for Alton to study
abroad for two years in what was known as an “exchange residency.”68
In that era surgical education in European university hospitals tended,
with a few exceptions, to be superior to that in the United States. Alton
trained in Zurich and Frankfurt, two of the most highly regarded centers,
and he visited many other clinics. Naturally, he made significant
connections with many surgeons on the Continent, including Professors
Martin Kirschner from Koningsberg and Ferdinand Sauerbruch of Munich.
In addition, he met and married Isabel Lockwood, his partner for the next
45 years.
After returning to the United States, Ochsner accepted a position on the
faculty of the University of Wisconsin. He anticipated a long and rewarding
career in Madison and was surprised and intrigued to be asked, in January
1927, to interview for the position of Chairman of Surgery at Tulane
University of Louisiana. He was just 30 years old.69
In 1926 (as Michael DeBakey was settling into his undergraduate role on
the Uptown campus), the long-time Professor and Chairman of the
Department of Surgery at Tulane School of Medicine, the legendary
Rudolph Matas, was contemplating retirement. In anticipation, other
members of the surgical faculty began jockeying for position: by academic
tradition, one of them was likely to be promoted to take over for their
illustrious chief. A number of these distinguished surgeons—Idys Mims
Gage, Urban Maes, and Isidore Cohn, among others—were trainees of
Matas and had special cause to covet the position. As it happened, however,
the administration was considering another approach.
The preceding year a highly regarded internist had been recruited to
Tulane as Chair of Medicine, supported by a grant from the Rockefeller
General Education Fund. By this contract, he agreed to forego the
potentially lucrative pursuit of private practice patients and devote all his
time and energies to developing the services at Tulane. The early returns on
this arrangement looked good, and the Medical School Dean, C. C. Bass,
decided to approach the soon-to-be-vacant surgery chair similarly.
Unsurprisingly, though, the elimination of private practice patients caused a
number of potential candidates to withdraw from consideration.70
A few years before this search began, Bass hired an internist who had
trained alongside Alton Ochsner in St. Louis. This man suggested to the
Dean that his friend might be an excellent candidate for the surgery
position. Ochsner was very young, of course, but his brief academic record
was pristine, and the experience of the European exchange residencies was
most impressive.
Ochsner accepted Bass’s invitation to an interview in New Orleans in
January 1927. He left blizzard conditions in Madison on an express train
and arrived a day later in balmy southern Louisiana. The scene was straight
out of a travelogue, complete with swaying palm trees—the first he had
ever seen. Ochsner’s visit lasted several days and was punctuated by the
offer to conduct a teaching clinic. This was an educational technique that
Matas had made famous in repeated demonstrations of his clinical prowess
and awe-inspiring intellect. The young candidate was understandably
reluctant since he would inevitably be compared in an unfavorable light to
the outgoing chief (who would himself be prominently present at the
conference), but Ochsner ultimately acquiesced. He had made something of
a name for himself at Wisconsin by virtue of having developed a method of
visualizing the upper airways of the lungs on x-ray in the diagnosis of the
infectious disease bronchiectasis. This involved anesthetizing the back of a
patient’s throat (with cocaine) then having them attempt to swallow barium.
The anesthetized pharynx could not coordinate swallowing, and the barium
would go into the trachea and bronchi, where x-rays could pick it up and
demonstrate the disease process. In front of Matas and several hundred
other medical professionals at the Charity Hospital Amphitheater, Ochsner
demonstrated his technique on an unfortunate bronchiectasis patient. To his
horror, though, the developed bronchogram x-ray showed nothing—the
barium had gone into the stomach. Aghast, Ochsner stated that such a thing
had not happened to him before, and he had no idea why his technique had
failed.71
Chastened, and sure he had lost any chance at the position, Ochsner
returned to Madison to continue his career at the University of Wisconsin
(Figure 2.5). Soon after, to his astonishment, he received a letter from Bass
informing him that he had gotten the job. The rest of his successful
interview aside, Ochsner’s honesty and forthrightness about the failure of
his x-ray technique had impressed the most important segment of his
audience.*
Figure 2.5 Alton Ochsner.

By the time Michael appeared for his Introduction to Surgery class in the
spring of 1930, Ochsner had had time to establish himself as the Chief of
Surgery at Tulane. Matas was still around, which could have been difficult,
but he was primarily involved in his private practice, as well as in writing
and negotiating the politics of surgical associations. He made a scrupulous
and tactful point not to interfere. Moreover, he liked the new young chief
and endeavored to support him. There were other machinations brewing
that would give Ochsner trouble before long—far beyond his control or
even comprehension—but he was building a reputation in New Orleans as a
strong clinical surgeon as well as a dedicated researcher and educator.
One of Ochsner’s areas of immediate pedagogic focus was the
modernization of medical education from textbooks to up-to-date journals:
“I felt that learning medicine from textbooks was obsolete,” he observed.
“By the time a textbook has been written, it was old, and I felt that the
students should get their information from current periodicals.”73 His hope
was that this would be a habit the students would adopt in their future
careers. He also created his own slide presentations, which covered surgical
disease in a unique and systematic way.
Confronted with the stark contrast between the dusty, pedantic lectures of
some of the senior basic science faculty and Ochsner’s dynamic and
innovative teaching methods, Michael, among many others, came away
impressed.
Dr. Ochsner was a great teacher. He made his own lectures. You could follow his lecture because
it was so well thought out. He had developed it. This was not taken from a book. It was original.
It was his teaching. He was the first teacher I had who tried to integrate what was known in the
basic science area with what is known clinically, and I was fascinated by this.74
Ochsner was, at this point, 34 years of age. He stood five-and-a-half feet

tall, with black hair and a “dark smudge” of a moustache, purportedly
cultivated in an effort to appear more seasoned.75 Despite his youth he
spoke with unaffected clarity and command, projecting and inspiring
confidence. As much as Michael liked and admired McCutcheon and
Hathaway and envied the world of pure academics they so charismatically
represented, Alton Ochsner was, in the parlance of a later era, a game-
changer. Here was an individual who exemplified the attributes of the other
professors—in addition to some all his own—but did so in Michael’s
chosen field.
And, indeed, this first encounter with Ochsner played an important part
in Michael’s final determination to become, of all the medical specialties, a
surgeon.
Surgery fascinated me from the very start because it was a mechanical thing and I’ve always
been fascinated with mechanical things, something you use your hands with. (When) I came into
contact with Dr. Ochsner for the first time, he had a great influence. Dr. Ochsner was a very
vigorous, very enthusiastic type of person who had tremendous industry and attitude.76
2.5 Downtown
The second year of medical school came to a close. Michael had now
fulfilled the requirements for a Tulane Bachelor of Science degree by the
criteria of the combined program. On June 11, he donned cap and gown for
the Academic Processional and Commencement Ceremony at the then-new
Municipal Auditorium near the French Quarter. Ernest DeBakey also
graduated at this time from the College of Pharmacy.
Ernest possessed similar academic skills to those of his older brother, and
he performed well throughout the three-year pharmacy program. The
DeBakey brothers were not carbon copies, however. During his university
career in New Orleans—college and, later, medical school—Ernest was not
one to pass up a good time. He continued to hone the skills he had
developed with the billiards cue. At Tulane he possessed, by all accounts,
considerable prowess and was not shy about using this talent to supplement
the money his father sent him to live on.77 Nevertheless, he kept his grades
up—high 70s to mid-80s, for the most part.78 Ernest became vice president
of his class and of the Pharmacy Honorary Fraternity, Kappa Psi. After
graduation he returned to Lake Charles to run his father’s Red Star Drug
Store.79
On the day after commencement Michael took the Louisiana State Board
of Medical Examiners test, which he passed easily.80 Not long after, he also
passed Part One of the National Board examination.80
With the scientific basis of the profession presumably mastered, the final
two years of medical school comprised instruction in clinical medicine. At
Tulane, the junior- and senior-level courses—both lectures and ward work
—were given at the Downtown campus. By a lucky coincidence for
Michael and his classmates, in December 1930 the Medical School moved
its main facilities from the antiquated and overcrowded Josephine
Hutchinson Memorial Building on Canal Street to the glittering new 10-
story Hutchinson Memorial on Tulane Avenue, adjacent to New Orleans’
venerable landmark, the monumental Charity Hospital.81
Charity was among the most famous healthcare facilities in the world. It
was also one of the oldest. The roots of the institution could be traced to
1736, when it was founded as L’Hôpital des Pauvres de la Charité in what is
now the French Quarter. Of course, several iterations of the physical
structures had come and gone, and the location had changed, but the main
building at this time was still nearly a century old. At over 1,700 beds,
Charity was also one of the largest and busiest hospitals in the United
States. Naturally, this volume of patient care meant that the opportunity for
teaching and clinical research was virtually unrivalled.82
Over the years, the private Tulane University Medical School and the
state-owned and -operated Charity Hospital had nurtured an ambivalent,
complex relationship. As the only medical school in New Orleans, Tulane
was essential to Charity for its provision of professors and trainees to care
for the immense numbers of patients. Conversely, since Tulane had no
university hospital there was no other comparable clinical substrate for
education and research. For decades, the association of these two
institutions balanced on surprisingly flimsy foundations. It was only in the
late 1920s that Tulane was formally given a 500-bed Teaching Service by
the Charity Hospital Board of Administrators.83
The Tulane professors were appointed as “house officers”—a term most
frequently associated with resident trainees—by this same board (Ochsner’s
title at the hospital was Chief Visiting Surgeon). The Charity Hospital
Board was a collection of political appointees and therefore subject to the
whims of elected officials. Before this point in time that fact had never been
of much consequence, but in 1928 an entirely different sort of politician
was elected governor—Huey P. Long.
In addition to Charity, Tulane had two other affiliated sites in New
Orleans where students were educated in actual patient care settings: an
outpatient clinic at the new Hutchinson Building, and the Touro Infirmary.
Located a block from the intersection of St. Charles and Louisiana Avenues
in the city’s Garden District, Touro had been founded as a private charitable
hospital in the 1850s from funds bequeathed for the purpose in the will of a
philanthropist, Judah Touro. Prominent members of the Jewish community
administered the hospital from its beginning, although it was officially
nonsectarian. Much smaller than the downtown behemoth, Touro Infirmary
was nonetheless well-appointed in its own right.84
On the Surgery Service at Charity, the medical students were assigned to
wards in groups of three or four. They were given patients to “work up,”
taking histories and performing physical examinations, as well as carrying
out simple tests. There was also an animal lab, in which surgical procedures
were demonstrated and practiced.
The students rounded with their professors every morning from 8:30 to
9:30, except Sunday. Ochsner was scheduled to lead the teaching rounds
himself on Wednesdays and Saturdays. On other mornings the students
followed one of the other surgery faculty members. Friday morning rounds
were led by a professor of considerable charisma in his own right; one who
had come to be close with Ochsner. He was a clinician and educator of
formidable skill as well: Idys Mims Gage.85
Gage was born in South Carolina in 1893. After graduating from Tulane
Medical School in 1917, he served as a medical officer in World War I, then
returned to train in surgery under Matas. When that great leader stepped
down Gage might well have been considered for his position, but he
consistently evidenced a refreshing modesty in administrative ambition.
Gage took an instant liking to Ochsner on his arrival in New Orleans,
choosing to support him unequivocally, and the two became close friends
over the years (Ochsner’s third son was named Mims Gage Ochsner). Gage
was noted for his mischievous sense of humor in addition to his excellence
in both the diagnostic and technical aspects of clinical surgery.86
Under the guidance of Gage, Ochsner, and the other surgical faculty, the
students gained a deep and broad experience in clinical surgery. The
laboratory and ward experiences, in addition to the lectures, were
supplemented by extensive readings in a number of texts. Of course
Ochsner emphasized the importance of keeping up with current periodical
journals in the never-ending effort to remain au courant.
Ochsner had assembled this impressive, multifaceted didactic course in
surgery in the few years he had been at Tulane. By many accounts he had
spent nearly every waking moment at his office in the Hutchinson or at
Charity, building his program and devoting all efforts to the University and
its obdurate, indispensable hospital partner. The trouble was that, in the fall
of 1930—as Michael began his clinical courses in medical school—
Ochsner was no longer even allowed to practice at Charity Hospital.
2.6 Charity
After Huey Long’s election as governor, he placed Arthur Vidrine, the son
of one of his minions, at the head of the Charity Board. Although Vidrine
was a physician, he was not yet 30 and had had very little postgraduate
training. He began to clash with Dean C. C. Bass almost immediately, and
since he had control over which Tulane professors got privileges at Charity,
he held the trump card. In addition to power, Vidrine coveted prestige that
his qualifications did not warrant. He asked Bass for the vacant Chair of
Otolaryngology, despite no meaningful education or experience in the field,
and was rebuffed.* Undeterred, he then approached Ochsner about a
professorship in the Department of Surgery, with similar results.87
On the basis of these and other conflicts Vidrine, and by extension Long,
nurtured new grudges which only exacerbated the chronic tension between
Charity and Tulane. In the spring of 1930 (when Michael was taking his
Introduction to Surgery course), Ochsner was offered the Chair of Surgery
at the University of Virginia. Frustrated by the politics in New Orleans, he
seriously considered the position and sent a letter to his friend Allen
Whipple, a prominent surgeon at Columbia University, voicing his
displeasure and soliciting the New Yorker’s opinion.88
By means which have never been elucidated, a copy of Ochsner’s letter
to Whipple got into the hands of Huey Long, and, true to his Machiavellian
nature, the Kingfish put this windfall to villainous use. In September 1930,
he produced the letter in a meeting of the Charity board and used its
“disloyal” language and tone to get Ochsner stripped of his title and
privileges at the hospital. Consequently, shortly after Michael began his
third year, the teaching rounds with Ochsner at Charity came to an end. This
ban had no impact on his lectures at the Hutchinson building, of course, and
Tulane soon subsidized beds at the Touro Infirmary for his surgical patients,
but Ochsner’s inability to practice at the city’s main teaching hospital was a
severe impediment to his ability to function as Professor of Surgery. He
came close to leaving Tulane for less politically turbulent waters at the time,
but eventually decided to stay the course in Louisiana and focus what time
he might have spent at Charity on research instead. The front- and back-
room machinations of Louisiana politics spun the wheel of fortune back in
his favor soon enough, and Ochsner was reinstated at Charity two years
later. He never forgot this demonstration of the precarious nature of his
position, however.*,89
Michael’s final grades for his third year of medical school, in the
academic year 1930–1931, continued to be commendable. He scored in the
80s across the board in gynecology, physical diagnosis, obstetrics,
pediatrics, internal medicine, and surgery.90
His academic performance through the first three years of medical school
was sufficient to garner Michael election into the local “Stars and Bars”
Chapter of the academic medical honorary society, Alpha Omega Alpha. At
Tulane this honor was reserved for the top 10 students entering their senior
year.91
Tulane medical students who had completed their third year were offered
the opportunity to serve as externs, or temporary interns, at various local
hospitals for the summer.92 Since he did not spend his summers at home in
Lake Charles anyway, Michael decided to pursue one of these positions. On
July 1, he moved into Mercy Hospital for the summer.
2.7 Mercy
Mercy was a small hospital on Annunciation Street in the Lower Garden
District. It had been opened in an eighteenth-century mansion in 1924, and
it was not affiliated with Tulane.95 Despite its size, or perhaps because of it,
Michael was able to broaden his clinical experiences during these few
months. It was at Mercy that he had his first experiences participating in the
operating room.
I actually began giving anesthetics, using drip ether on a (pediatric) patient who was going to
have a tonsillectomy. Naturally I was very much concerned, so I was very slow about it and the
surgeon was pushing me.96
Before long Michael was taking his place at the operating table. In the
manner of medical students in every era, he had been practicing the manual
aspects of surgery, trying to develop dexterity and grace. He was champing
at the bit for a chance to put these nascent skills to the test.
I was assisting a man who was doing a hernia operation, and I kept thinking the whole time he
was doing this—as he was doing it—I could do it better. He was tying a knot and fumbling
around. I knew I could tie that knot better because I had been practicing tying knots. And I
wanted to tie that knot. All the time I was assisting him, I was thinking to myself how I could
better do it.97
At Mercy Hospital Michael also helped to staff the little emergency

room. On a memorable occasion he was assigned to perform a small
operative procedure on a young child, and he quickly learned the invaluable
lesson that no surgery is minor.
They brought a little child in with an abscess on his face. And it was pointing and you could see
pus under it and all you had to do was nick it. We used to use local anesthesia which was called
ethyl chloride spray, which would freeze the tissue. You’d push a button and out of it would
come a spray under pressure. Ethyl chloride is also a general anesthetic if you inhale its fumes,
and was used as such.
So I put a towel around this little baby, with an opening, and the hole exposed the little abscess.
The rest of his face was covered up. I took the spray and sprayed it, and then I just nicked it and
got all the pus out, put a little dressing on and took the towel off, and the child was . . . looked
like he was dead. He was actually sound asleep, but I didn’t realize it at the moment. I had given
him a general anesthetic because the towel was over him and the fumes had gotten under the
towel. I had put him sound to sleep, but he looked dead. I was about the most frightened person.
I’m sure I turned white—just absolutely terrified—and I couldn’t say anything. His mother was
there, and fortunately about that moment he started taking a deep breath. I turned around to her
and I said, “He’ll wake up in just a few minutes.” My heart was racing. It must have been going
200 beats a minute. It was a great lesson to me. I realized what I had done—this child could
have died.98
2.8 Bull Pen

Michael’s senior year of medical school at Tulane began on September 23,
1931.99 The senior year surgery curriculum shifted from hospital ward work
to evaluation of patients in the outpatient clinic setting. In addition, Gage
taught a weekly course in surgical pathology, which correlated gross and
microscopic pathologic findings with the clinical features of surgical
diseases. There were two other elements to the senior surgery experience
that were the special brainchildren of Ochsner.
Once a week a “surgical seminar” was conducted by Ochsner, in which
senior students presented a thesis paper which they had researched on some
special subject. This was, of course, a valuable exercise in the writing and
presentation of research articles.
The second special contribution of Ochsner to the senior students’
surgical education—and discomfiture—went by the innocuous official
name of “Diagnostic Clinic.” On Tuesdays and Thursdays in the Miles
Amphitheater at Charity Hospital, senior students presented actual clinical
cases. The students were introduced to the patients a half hour or so before
the conference, and then they had the brief intervening period to determine
a diagnosis and develop an appropriate therapeutic recommendation. After
the case presentation Ochsner himself (and occasionally Gage) would lead
the educational discourse, which mainly consisted of probing questions
derived from their encyclopedic knowledge of surgical diseases. The
probing generally continued until an area of weakness in the student’s fund
of knowledge was revealed and thoroughly exposed in the uncomfortable
setting of his peer community. The stated goal of this exercise was for the
student to “gain experience in presenting cases before a group, and learn to
conduct himself under difficulty.”100 In time Ochsner’s Diagnostic Clinic
would become known as the “Bull Pen,” and the trial by fire in the crucible
of the Charity Amphitheater would be a lasting memory for every Tulane
medical graduate.101
No record of Michael’s performance in the Bull Pen setting has survived.
His senior thesis for the seminar class, constructed on the foundations of
research in the periodic literature—as was Ochsner’s intent—was devoted
to the deleterious physiologic effects of tobacco smoking.102 If Michael
chose this topic on his own, it was a fortuitous selection. As it happened,
this particular clinical creed was the standard that Ochsner would bear, to
his everlasting credit, into innumerable conflicts in the years to come.
2.9 Matas
It was also during Michael’s remarkable senior year of medical school that
he attracted the attention of Tulane’s most prestigious and accomplished
graduate and teacher, Professor Rudolph Matas.
Matas was one of the towering figures of nineteenth- and early twentieth-
century American surgery. His long life and extraordinary career were
marked by innumerable surgical innovations and scholarly
accomplishments. By all accounts Matas, who was fluent in six languages,
was also among the most erudite individuals in the history of modern
medicine.
A native Louisianan, Matas was the child of Spanish immigrants. His
father was a physician. During his youth the family lived in many locales in
the United States and abroad, but Matas returned to the state of his birth to
study medicine at the University of Louisiana (that forerunner of Tulane
University). After graduating in 1880, Matas became an intern at Charity
Hospital. He was named demonstrator in anatomy at the medical school, as
well as editor of the New Orleans Medical and Surgical Journal, at the
remarkably young age of 23. He published his first significant paper, a
demonstration of fundamental anatomy that appears at a conspicuously late
date in the world literature, the following year.103
Matas became Chief of Surgery at Tulane in 1895, a post he retained for
more than 30 years. His contributions to the advancement of surgical
science were myriad: he invented or developed intravenous fluid therapy,
spinal anesthesia, and positive pressure ventilation, to name just a few.
Matas authored more than 600 scientific articles in his lifetime.104
Unfortunately, Matas’s personal life was not marked by the conspicuous
favor that attended his professional career. Although his marriage was
happy, his only child was stillborn. In mid-career, Matas lost his right eye as
a result of an infection contracted while he was draining a patient’s pelvic
abscess. These events, along with his wife’s death from pneumonia in 1918,
cast long shadows over Matas’s life.105 Nevertheless, he retained a
fundamentally positive, intellectually curious outlook.
As noted earlier, by the early 1930s “The Governor” (as he was
nicknamed) was retired from Tulane, although he maintained a private
practice and continued to be very active in professional societies. He also
continued writing, and his compositions were notable for their grace and
literary style. Matas and his successor, Ochsner, although separated by
decades in age and continents in culture, were cut from similar professional
cloth and got along well.
Ochsner’s admonition that the medical students should focus their
attention on the new information constantly being broadcast in medical
journals was responsible for the crossing of paths of Rudolph Matas and the
young Michael DeBakey.
In terms of collections, the Tulane medical library in the 1930s was—for
a modern medical school—adequate at best. Being at the Hutchinson
building on the downtown campus, it was also virtually inaccessible for
first- and second-year students and not all that convenient for
upperclassmen, either. Ironically, there was an outstanding medical library
not that distant, at 2255 St. Charles Avenue. That was the home address of
Rudolph Matas.106
The professor lived in an enormous three-story mansion on that
fashionable street. Pink and purple wisteria draped artfully over the fluted
neoclassical columns along its façade. Matas had accumulated a staggering
number of books and journals in his personal collection over the years, from
all over the world. His array of foreign medical literature was especially
impressive. According to multiple sources, the immense weight of Matas’s
personal library necessitated periodic reinforcement of his home’s
foundation to prevent collapse (Figure 2.6).107
Figure 2.6 Rudolph Matas in the study at his home on St. Charles Avenue.
Courtesy Archives of the American College of Surgeons.
Of course the librarians at the Hutchinson facility were well aware of the
scope of Matas’s personal library. When inquiries were made for items that
were lacking in their own stacks, they became accustomed to calling on
Matas’s live-in secretary and librarianto see if the requested material might
be among the professor’s holdings. In the 1931–1932 academic year, one of
the most consistent sources of such inquiries was the senior medical student
named DeBakey.
It is likely that many of the articles Michael was researching at the time
were for his senior surgery thesis on the physiology of smoking, but he did
take to heart at a young age Ochsner’s charge of canvassing the literature
completely, so the breadth of the requests he made may well have been
considerable. As it happened, so many of his requests were forwarded to the
Matas home that the great Professor became intrigued and inquired,
himself, about the identity and circumstances of the borrower:
He said to the librarian one day, “Who is this young man who keeps borrowing my books?” I
was getting twenty and thirty of his books every week and he wanted to know who this fellow
was. It was very unusual. So she told him and he said, “I would like to meet this young man.” I
was eager to meet him. So I went up and he brought me in. His house had virtually been
converted into a library. He took me into the little place where he had his own study, which had
been the dining room. He had a little goatee, a twinkle in his eye, very charming. And he said I
have some very fine sherry, how would you like to have a little small glass of sherry? And I said
I would like that; that would be delightful. So we sat down and he wanted to know a lot about
me, my background, who my father and mother were, where we lived.108
This first meeting was the opening of a dialogue that continued through
the rest of Matas’s life. For the time being the icon and the ingénue met on
an informal, semi-weekly basis at the mansion on St. Charles, sipping
sherry or sarsaparilla from the Professor’s large ice box and discussing new
papers that appeared in the literature from around the world.
2.10 Transfusion
While a medical student on clinical rotation Michael saw a blood
transfusion for the first time. In the days before blood banks, this procedure
bore some semblance to a major operation; indeed, much of the time it was
performed in the operating room. With a very few exceptions, transfusion
was direct from donor to recipient. Each patient had a needle placed into an
arm vein, then the donor’s blood was either pumped directly into the
recipient via a syringe and rubber tubing or, with some early commercial
devices, into an intervening bottle containing sodium citrate and saline
solution to inhibit clotting. In even more primitive versions, a syringe was
simply filled with donor blood and injected into the recipient. In any case,
the procedure was not notable for its elegance: needles were frequently
dislodged, blood inevitably splattered everywhere, and clotting mid-
transfusion was the norm. Death was not rare. Small wonder that Michael
thought he could improve on the process.
At that time they did it in a very awkward way. They had to do it direct from an individual. They
had to take it out with a syringe and then inject it and I said well there must be better way to do
it than that. That just is terrible---blood all over the place. So I went to work on a blood
transfusion machine.109
Drawing on his brief prior experience, Michael—just 23 at this time—

recalled the sleeve valve concept he had become familiar with from his
tinkering with automobile engines. He recognized that that ingenious design
could be used in this very different arena. In these engines, it will be
recalled, metal sleeves which sit within the cylinder slide as the piston
moves, causing ports in the sleeves to line up with holes in the walls of the
cylinder at specific times during the engine’s cycle to expel combustion
gases and draw in air.*
Michael reasoned that this design should work with any fluid, including
blood, and that the intake and exhaust phases of the engine were analogous
to the two limbs of the transfusion process. Together with one of his
medical school classmates, William Gillentine, Michael set to work
adapting automotive engine technology to the hospital ward.111
As the two discussed the project, their ideas began to coalesce on paper.
They envisioned two metal cylinders which fit together snugly. The inner
cylinder would be mostly solid, but with a flow channel in the center,
extending to an opening in the side—it would function as a piston. The
outer, hollow cylinder (the sleeve) would have two ports, a top one for
receiving the donor blood and a bottom one for expelling to the recipient.
Sliding the piston up or down exposed its side hole to the appropriate sleeve
port depending on the stage of operation. The piston attached to a syringe.
Accordingly, after attaching the sleeve ports to rubber tubing connected to
intravenous needles in the two patients, the transfusionist would merely
slide the piston to expose the donor port, pull back on the syringe to fill it
with donor blood, then slide the piston forward, automatically covering the
donor port and opening the recipient one, then finally expelling the syringe
contents. In practice there was not even any need to move the piston; the
pulling back and pushing down on the syringe plunger did it automatically
because of the friction involved and the viscosity of blood.
Drawing the thing up on paper was relatively straightforward; creating a
functioning example was another story. DeBakey and Gillentine approached
the Charity Hospital carpentry shop first, but were told that the work
involved was beyond their limited capability.112 They were referred to
several machine shops and scientific instrument repair facilities in town.
One of these was the Marine Instrument Laboratory of F. A. Smith, on
Girod Street near Lafayette Square. They paid Smith $20 to produce a
prototype.113
As Michael’s senior year of medical school drew to a close, he had
already secured a position as a trainee at Charity Hospital for the academic
year from July 1, 1932 to June 30, 1933. His final grades averaged 87.6
across the eight courses: he scored an 87 in the general surgery course IV
and an 82 in the combined general surgery/orthopedics course V. This was
his finest overall academic performance since his first year of medical
school. On June 8, 1932, he put on the academic hood, recited the ancient
Oath of Hippocrates, and became—at long last—Dr. Michael DeBakey.114
A few weeks later he sat for Part II of the National Board examination,
which covered internal medicine, surgery, obstetrics and gynecology, and
public health. His score in surgery was a 90, and his overall average for the
exam a sparkling 85.75. He passed easily.115
2.10 Interne
In the early 1930s, what has come to be known as graduate medical
education—internship, residency, and fellowship programs following the
completion of medical school—was remarkably ill-defined and even more
poorly regulated across all specialties. The first steps toward a recognizably
modern form of postgraduate training had come from the surgeons,
particularly the professional descendants of the great William Stewart
Halsted. Halsted had observed the German system of residency first-hand
and brought it with him to the Johns Hopkins Hospital in the late nineteenth
century, where it was also embraced by the great internist William Osler.*
From there the new system spread across the United States as its superiority
became clear. In time, the other specialties came on board as well.
Despite these advances, elements of the new training regimens were far
from ideal. For one, the duration of internships and residencies remained
fearfully nebulous for decades—the length of time an individual was
required to continue as a trainee was entirely up to the program director. In
surgery, in particular, the training period could extend up to a decade.117
The first halting steps toward standardization of residencies began in the
1920s, and in internships even earlier, but the training environment that
DeBakey and his 66 fellow “internes” (the French spelling then employed
at Charity) entered into on July 1, 1932, was markedly different from the
regimented, standardized programs of today.†,118
DeBakey’s internship at Charity Hospital was not focused on surgery (as
were some in academic medical centers, particularly on the East Coast) but
included rotations on several specialties in internal medicine, as well as
obstetrics, gynecology, and other fields not necessarily surgical. His friends
and fellow new graduates, Bill Gillentine and Charlie Odom, were among
the “pups” who joined him on this deeper foray into the responsibilities of
clinical care.119
The huge population dependent on Charity Hospital made for ample
opportunities to learn every imaginable aspect of patient care. In the 1932–
1933 fiscal and academic year, the hospital admitted a staggering 55,437
individuals, which was nearly twice the already enormous figure of just six
years before. On top of that, the adjacent outpatient clinics saw 402,221
patients (the population of the city of New Orleans in the 1930 census was
458,762).120
For DeBakey, this was a godsend. Freed from any significant distractions
and living—as did all the internes—in the hospital itself, he focused all his
considerable energy on learning and even sought out extra opportunities
beyond the already taxing assigned responsibilities:
When I was a resident at the hospital—an interne—the boys used to check out on me. In those
days everybody was assigned a service—a certain number of patients from a certain area. And
you had that assignment all the time. You didn’t have it just eight hours a day. We lived right
there in the hospital. So whenever they went out on dates or anything like that, they had to sign
out on somebody. And I used to let them sign out on me because I was there and I liked to do the
work. At night, there was a lot of work to do—all the emergencies and things like that. I was
working all night. I loved to stay there and get as much work as I could and do as many
operations, so I had a tremendous experience.122
Since the wards were fairly choked with patients, it was inevitable that
there were some in need of blood transfusion almost every day. This gave
DeBakey and Gillentine plenty of opportunities to put the first version of
their new sleeve valve transfusion syringe to the test, once they had proved
it worked in animal lab experiments and had gotten approval from the
administration (Figure 2.7).
Figure 2.7 DeBakey as an intern at Charity Hospital, 1932.

Courtesy Tulane University Archives.
The first use of the new instrument was on November 4, 1932.123 Before
long word got around about the young internes and their new, improved
method of transfusion. The demand for their services escalated, and the
indications were diverse. As DeBakey and Gillentine later noted, “All types
of conditions have been treated, including postoperative hemorrhages, and
infections, complications of pregnancy and the puerperium, typhoid fever,
osteomyelitis, malignant cachexia, primary anemia, secondary anemias of
various origins, traumatic injuries of the viscera, bacterial endocarditis,
hyperemesis gravidarum, bichloride poisoning, any primary disease or
secondary complication, in short, for which transfusion might be
indicated.”124
DeBakey was especially concerned about the possibility of traumatic
hemolysis from the device: the destruction of fragile red blood cells. This
issue would be at the forefront of many of his future research endeavors,
too, but it appears not to have been a significant problem in the sleeve valve
syringe.
By April 1933, the two internes had performed 75 transfusions on 52
patients, with great success.125 They were ready to begin reporting their
results, with the help of some well-known faculty.
Ochsner, who was back from his Charity exile, introduced DeBakey and
Gillentine at the April 10 Quarterly Meeting of the Orleans Parish Medical
Society. They delivered a paper, “A New Syringe Method for Blood
Transfusion” in a 20-minute presentation and demonstrated the device to
enthusiastic approval. The published version of this paper appeared later in
the year in the New Orleans Medical and Surgical Journal. This was
Michael DeBakey’s first publication.126
Urban Maes, at this point the Chairman of Surgery at the new Louisiana
State University School of Medicine, also became aware of the transfusion
efforts of DeBakey and Gillentine and suggested they publish a paper in a
national journal about their new device. He penned a brief letter to the
editor of the American Journal of Surgery in New York as an introduction.
The article, “A Syringe-Sleeve-Valve Transfusion Instrument: A New
Method of Transfusion of Unmodified Blood,” appeared in the American
Journal of Surgery in March 1934.127
Academic considerations aside, not a week had passed after their first
successful human transfusion with the new syringe before DeBakey and
Gillentine began searching for a large-scale manufacturer for their machine.
Neither of the internes had had any prior experience that was remotely
similar to the patenting, licensing, and manufacture of a novel scientific
instrument. Their eyes would soon be opened, and any preconceived
notions they might have had about the ease of the process quickly dispelled.
They first approached the established northeast medical manufacturing
firm of Becton, Dickinson, and Company. Located just outside New York
City, this manufacturer had been in business since the 1890s and was one of
the leading producers of thermometers, hypodermic needles, and, notably,
syringes. Ochsner made the initial overture, and in response DeBakey
received an introductory letter from the company’s Research Department
Manager, Oscar Schwidetzky*:
November 9, 1932
Dear Dr. DeBakey:
Alton Ochsner was kind enough to write us regarding the blood transfusion apparatus which you
have devised.
We are very much interested in blood transfusion apparatus (sic) and are very anxious to see
the outfit which you have constructed.
No doubt an arrangement—fair to Becton, Dickinson & Co. and fair to you—can be worked
out.
Very truly yours,
Becton, Dickinson & Co.
O. O. R. Schwidetzky
Manager Research Dept.128
On receipt of this very encouraging letter DeBakey and Gillentine

composed a response that consisted of a detailed description of their
instrument, complete with drawings, and an accounting of its clinical
success (Figure 2.8). They forwarded one of their prototypes under a
separate cover.129
Figure 2.8 DeBakey’s hand-drawn sketch of the sleeve-valve transfusion apparatus.
The internes must have been surprised and disappointed by the next letter
from Schwidetzky, dated November 21. After acknowledging the novelty of
their design, the research manager went on to point out that there was a
similar device already available, which utilized a stopcock to adjust
direction of flow rather than a sleeve valve. He also tactfully noted that
their blood–metal interface was less forgiving than one employing glass and
less gracefully asserted that Becton-Dickinson’s own existing transfusion
device, which dated to 1922, was, in any case, superior to all. Schwidetzky
closed by admonishing the inventors to “take our advice and don’t spend a
penny on patent papers.”130
Not long after this, as their success with transfusions on the wards
continued, DeBakey and Gillentine decided to ignore the pointed advice of
Mr. O. O. R. Schwidetzky and pursue a patent. They enlisted the services of
a New Orleans attorney who discovered that between patent search fees,
government charges, and legal compensation for preparing the application,
the cost would be $170. This exorbitant price tag appears to have convinced
the impoverished internes to put their patenting ambitions on hold, at least
temporarily.*,132
On the other hand, Becton-Dickinson’s rejection, although disappointing,
did not cow DeBakey and Gillentine in their effort to get the invention on
the market. In January 1933, they sent out a barrage of letters of
introduction to various other manufacturers touting their idea. Their
introductory paragraph read:
We have designed a blood transfusion apparatus which has proven clinically to be entirely
satisfactory, and is looked upon by able clinicians here to be the best and most practical syringe
transfusion method in use at present.133
Among the firms DeBakey and Gillentine targeted were George B.

Pilling and Son Company of Philadelphia, J. Sklar Manufacturing Company
of Brooklyn, the MacGregor Instrument Company of Needham,
Massachusetts, and V. Mueller and Company of Chicago.134
As was the case with Becton Dickinson, the internes’ efforts met with
staunch, if not necessarily surprising resistance. After expressing initial
interest, Pilling refused even to consider the device until it had been
patented. Sklar indicated, like Becton-Dickinson, that there was already a
device on the market of an essentially identical design (there was not).
MacGregor lamented that they thought the sleeve valve syringe had merit,
but they were contractually obligated not to market a transfusion device
other than the one they were already manufacturing. With the nation in the
throes of the Great Depression the risk of investment in new ideas was, to
some companies, clearly insurmountable.135
V. Mueller was the exception.
The Chicago company, which manufactured hospital and office furniture
in addition to surgical instruments at its West Side factory, qualified its
initial interest by invoking the by now familiar patent hurdle. Unlike the
other firms, though, Mueller offered to help. They did their own patent
search, which showed that the concerns of the Becton-Dickinson and Sklar
representatives, if they were genuine, were unfounded. Mueller went
further, too, and also recommended that DeBakey and Gillentine register
their device with the American Surgical Trade Association. This was a sort
of gentleman’s agreement among manufacturers of surgical instruments—
not statutory or in any way enforceable—to respect the priority rights of a
new apparatus for five years. There were other legal hoops to be jumped
through and much ink to dry, but V. Mueller gradually came on board.136
Of greatest importance, they agreed to build the thing.
Not long after DeBakey and Gillentine’s article appeared in the American
Journal of Surgery in the spring of 1933, requests for examples of the new
transfusion device began descending on the internes at Charity Hospital.137
V. Mueller moved rather quickly, all things considered, and had
production models of the transfusion set—piston, sleeve, syringe, needles,
and tubing, all in a special case—commercially available in 1934.138 They
may have been even faster if the evanescent DeBakey had not also invented
a new type of transfusion needle—and published another article in the
American Journal of Surgery about it, in December 1934.139
Before that year was out DeBakey had already moved beyond the sleeve
valve concept in blood transfusion technology, developing and enhancing a
method of controlled fluid transmission that remains among the most
ubiquitous of medical machines today. Two decades later that machine also
helped make possible the twentieth century’s greatest revolution in surgery.
As an interne DeBakey managed to catch the attention of Ochsner in
ways beyond the spectacular transfusion successes. On one memorable
occasion, his keen perception helped avoid a potentially grave outcome.
I remember very well, one day after I had done a thyroidectomy at Charity, he called me and
told me I ought to come over because the patient wasn’t doing very well, and I went over and
found out that he wasn’t. The neck was distended, and I immediately opened up the wound
because the patient was having a great deal of respiratory distress and evacuated a large clot.
The ligature on the superior thyroid artery had slipped, and this was the cause of the bleeding.
Had it not been for the fact that Dr. DeBakey was such an alert intern, the patient might have
succumbed. I realized then what a valuable man Mike was going to be.140
Ochsner was not the only department chair to recognize DeBakey’s

capabilities during that internship year. He was offered residency
opportunities to train in internal medicine and otolaryngology by the heads
of those specialties, too.141 His choice was settled while he was still in
medical school, though, and DeBakey never wavered.
It was during his internship that DeBakey first consciously recognized
the institutional racism that had surreptitiously surrounded him through his
life. The realization was a stark and painful one.
It seemed to me the Negroes didn’t get, in the hospital, the same kind of attention that even the
poor whites got. The thing that distressed me more than anything else was that we had a
tuberculosis ward. Well, the Negro tuberculosis ward was just dirty and inadequate and
crowded, whereas the white tuberculosis ward had a new building. And they were much better
taken care of. And, you know, it’s a curious thing. You aren’t aware of it because you grow up
with this. And later, you begin to realize that they’re not even considered human beings. I used
to say, “This is terrible. This is no way to take care of them.”142
2.12 Assistant in Surgery

DeBakey’s internship year came to a close in June 1933. After a year of
multidisciplinary medical training, he would now focus entirely on
mastering the art and science of surgery, under the guiding hand of
Professor Alton Ochsner and his faculty. In the Tulane academic hierarchy
he now held the position of Assistant in Surgery—the equivalent of a
modern junior resident.
That same month DeBakey completed the final installment of the three-
part National Board of Medical Examiners test and was informed on July 7,
the first week of his surgery residency, that he had passed.143 Having also
successfully completed the Louisiana State Boards, he could now apply for
a license to practice medicine.
Then, as now, the life of a resident trainee was a delicate balance between
caring for patients, learning how to do that job properly, and—unlikely as it
must have felt—teaching those on a lower rung of the educational ladder. In
surgery programs there was the added dimension of needing to acquire the
skills and judgment to perform operations and improvise in surgical
situations. Academically ambitious trainees added to their burden with
efforts at research and writing.
DeBakey was among the best of his cohort in the required elements of
clinical surgical training, and his head start in surgical technique from
Hathaway’s zoology labs paid enormous dividends in the operating room,
but it was in these latter capacities as a blossoming surgeon-scientist that he
really shone.
In the 1933–1934 academic year DeBakey enrolled in the graduate
school at Tulane, majoring in surgery with a pathology minor.144 His goal
was to secure a master’s degree, which was a two-year course. Since he had
already obtained his doctorate in medicine, the motivation for these further
advanced studies likely involved solidifying his research credentials for a
career in academics. Taking on this extra work, in addition to his
responsibilities as a trainee in surgery, was certainly extraordinary.
DeBakey also registered for classes in French and German at this time,
although he withdrew before grades were assessed.145 Under the combined
spell of Ochsner and Matas, he may reasonably have considered that better
knowledge of these languages would be of benefit to him in the future since
so many of the leading surgical centers of the era published their work in
European journals.
At the end of the first year in this track DeBakey recorded a B in the
surgery course. The second year of the pathway was primarily focused on
the development of a master’s thesis, but also involved—in DeBakey’s case
—passing both a required language reading exam (in French) and a class in
the chosen minor field (pathology).
His thesis title was “Peptic Ulceration: An Evaluation of the Relative
Protective Value of Alkaline Duodenal Juices.” It was later published in the
February 1937 edition of the journal Archives of Surgery.146 DeBakey did
not attempt to hide from his family the amount of toil these master’s
courses added to his workload as a surgery resident:
March 24, 1935
Dear Father,
I have been averaging about four hours of sleep every night lately. I work until 2:00 A.M. and
get up in the morning at 6:00 A.M. This is because I am trying to get my thesis finished by April
1st. Everyone else has two years to do this. I am going to do it in two weeks. This is the only
thing anyone working for a master’s degree writes in two years. I will have written about fifteen
articles besides this and part of a chapter in a textbook in this same period of time.
Your loving son, Michael147
Although it would have been more accurate to note that he also had two
years to compose his master’s thesis, DeBakey’s offhand accounting of his
compositional record in this letter was correct. Between 1933 and 1935, as
a surgical trainee (in the academic year 1934–1935, he was promoted to
Instructor in Surgery—the equivalent of senior resident), DeBakey wrote
more than a dozen articles and a book chapter.148 The papers ranged in
topic from transfusion to tetanus. Some were repetitive, and most were of
minimal significance—an exception being his co-authorship on an
important paper with Ochsner on liver abscesses—but the aggregate
indicated a future presence and ambition to be reckoned with.
While working in the lab on a project in 1934, DeBakey was faced with
the problem of creating, in an investigational setting, a fluid pulse-wave to
mimic arterial blood flow. The circumstances of this experiment are not
known with certainty, but what seemed at first to be a straightforward
technical issue—how to move a fluid rhythmically—soon revealed itself to
be a major challenge.* DeBakey knew that the solution would involve a
pump of some kind, but this was not a concept that lent itself to any of his
prior knowledge from automotive designs or elsewhere.
DeBakey’s initial review of the medical literature yielded minimal useful
information. He was at an impasse until he encountered an old friend and
neighbor from the Academic Dormitory, Charles Ernest Schmidt, who went
by his middle name and was a 1928 graduate of the School of
Engineering.149 Schmidt heard enough about the problem to get involved,
and he directed DeBakey back to the Uptown campus, where, he asserted,
the engineering library would be of much greater help.
The answer turned out to be a rotary pump.
As far as is known, the first roller pump was patented in 1855, by Rufus
Porter of Washington, D.C. and J. D. Bradley of Vermont. Based on the
language of their patent grant, the inventors were as motivated to receive
credit for their use of elastic India rubber as a conduit as they were for their
helical rotary pump. As to practical uses for their device, Porter and Bradley
“contemplated its application to the purposes of stomach pumps, and as an
apparatus for injections.” It is unclear if any of these pumps were ever
manufactured.150
The Tulane medical library may not have contained the references, but
roller pumps had, in fact, been used in clinical medicine since the late
nineteenth century.
Eugene E. Allen of Grand Rapids was issued a patent in 1887 for a rotary
blood transfusion pump.151 The Journal of the American Medical
Association lauded the invention, declaring, “Seldom has the ingenuity of
an inventor brought to the aid of the physician and surgeon a more useful
instrument . . . in meeting the conditions necessary for the ready
transmission of blood from the veins of one body to another.”152 A Chicago
manufacturer named Truax marketed a similar device soon after, and, in the
1920s, in Kiel, Germany, an inventor named Alfred Beck produced a series
of roller pump transfusion machines.153
Roller pumps had a less extensive history in the world of
experimentation. There were some primitive precursors, but the first
productive laboratory use of a recognizable roller pump in a physiologic
model appears to have been reported by L. E. Bayliss and E. Mueller in
1928.154 Their model employed a less-than-practical 11 rollers. This paper
appeared in the Journal of Scientific Instruments, which was likely too
obscure to have been encountered by DeBakey in his literature search. The
same cannot be said of C. M. Van Allen’s article in the Journal of the
American Medical Association in 1932, in which he described a roller pump
employing the “milking principle.”155
Regardless of where he drew the inspiration to apply a rotary pump to his
experimental problem—or whether he came up with the design
independently—DeBakey soon encountered an issue that none of the old
patent applications or periodical pieces had touched upon. As the rollers
compressed it, the tubing began to creep inexorably down its own
longitudinal axis—the friction of the rollers pulled the tubing along as they
spun. This effect—which greatly impaired the efficiency of the pump—
proved to be an enormous headache.
DeBakey’s solution was elegant in its simplicity: he created a flange on
one side of the tubing itself, which then fit between the housing of the pump
and a semicircular clamp. When the clamp was screwed into place, the
tubing was pinned, and the roller action would not impel it forward.156
With the “creeping tubing” problem solved, DeBakey turned to the best
method of obtaining a life-like pulse wave. He experimented with different
roller configurations, as Bayliss and Mueller had in the previous decade. He
eventually settled on two rollers, located 180 degrees apart. This design
created the sought-after pulse-wave and also eliminated any need for valves
since at least one roller would be compressing the tubing at any time—
therefore reverse flow was impossible without inverting the roller action.*
The whole thing was moved by hand via a crank arm (Figure 2.9).
Figure 2.9 The DeBakey roller pump. Note tubing flange.

Almost immediately, DeBakey realized that this new device would be

even better for transfusions than the sleeve valve syringe. He tested it for
this purpose on lab animals, and his beliefs were confirmed. Soon he was
on the wards with his prototype—built in the New Orleans machine shops
—performing a dozen or more transfusions a day. One of the first of these
performed with the new pump was also one of the most memorable and
unquestionably brought great attention to him and his improved method.
Shortly after I started using it, there was a doctor’s wife who had a gynecologic condition where
she was sort of bleeding from the uterus. It was following delivery. They couldn’t stop the
bleeding. She kept on bleeding. She nearly bled to death. And they couldn’t get blood into her
fast enough. They called me to come and help them. She was in another hospital which was
several blocks away, the Hotel Dieu. I got there and she was white as a sheet and really almost
bled to death. And we had donors lined up for her, so I lined them up and started my transfusion
almost immediately. In a matter of a few minutes, I had replaced her blood, and she was
breathing again and doing well. Her blood pressure came up. They all felt I had saved her
life.158
DeBakey wrote up the results of the first 100 transfusions with the new
pump for the New Orleans Medical and Surgical Journal, where they
appeared in the December 1934 issue.159
Having learned from the syringe saga, DeBakey took out a patent
application for the new invention. This was granted on October 29, 1935.160
Both DeBakey and “Ernest” Schmidt were named as owners, indicating the
contributing role of the engineer in the pump’s design. One-third of the
patent was assigned to another Tulane surgical trainee named George Lilly,
who had used the instrument many times on the wards.
2.13 Diana
At some point in late 1934, Michael caught a glimpse on the Charity wards
of a striking brunette nurse. In the crisp white uniform and cap of the era,
she carried herself with authority, assurance, and grace. This was 25-year-
old Diana Cooper. Michael was entranced, but needed to maintain an
austere professional façade.
It was an incremental thing at first, not a dramatic, fiery romance. Diana was a registered nurse,
doing graduate work at LSU and working part-time at Charity. I was on the eighth floor, she was
on the seventh, and I had some patients down there. She was the nurse administrator of that
floor, so I couldn’t have ignored her if I’d wanted to, and I didn’t want to. It was quickly
apparent that there was much more to her than beauty.161
Diana had been born Dorothy Cooper on March 5, 1909, in Big Spring,
Texas.*,162 In her infancy she moved with her mother to Lafayette,
Louisiana, where her mother’s family lived.163 Diana’s father, Benjamin
Sampson Cooper—with whom she remained close—was a six-foot, 200-
pound railroad man and sometime police officer who returned to his native
North Carolina not long after Diana’s birth and later relocated to Northern
Kentucky.164
Diana’s single-parent childhood must have been fraught with challenges,
but she persevered and eventually prevailed. After finishing high school she
attended the Southern Baptist Hospital School of Nursing in New Orleans,
graduating in 1930.165 For a short period of time she lived with her father in
Kentucky, then returned to Louisiana to work at Charity and take classes at
LSU and Tulane. † ,166 True to her hardscrabble background, Diana went
about her work with a no-nonsense, tough-as-nails attitude, tempered by an
underlying tenderness that matched her nursing assignment well. There was
no doubt that she was in charge on her ward, but also no question that she
loved the patients and the job.
Michael admired Diana’s commitment to patient care as a measure of her
dedication to her work, as well as a reflection of her personal empathy. The
example of his mother Raheega, whose character was practically defined by
compassion, could not have been far from his mind:
After they reach a certain point and become administrators, many nurses look down on patient
care. But Diana’s whole personality was to nurse, to take care of the patients. The way she
moved around the floor I knew that she wanted to help people, to do things for them. She had a
need to help others, and nursing fulfilled that need for her.169
Diana also had her own defining characteristics. As Michael began to

notice and appreciate these, his interest in the seventh-floor-administrator
grew:
I found myself going down there not just to see patients, but to see Diana. I had never had any
romantic attachments before. I saw a lot of people, had a good time and didn’t lead a monastic
life, but I was pretty disciplined about it. I couldn’t let anything interfere with my studies or my
work. So I was lucky to have it all under one roof; after I met Diana my work and my social life
were both at Charity Hospital.170
2.14 Instructor
In the first part of 1935, plans began to come together for DeBakey to travel
to Europe for an extended period in order to take advantage of unique
opportunities on the Continent for advanced surgical education. If any
evidence were needed to demonstrate his special place in the training
program at Tulane, these arrangements surely suffice: no other resident
during this period was considered for similar appointments.
The prime mover of these plans was Ochsner. He had spent meaningful
time training in Switzerland and Germany in the early 1920s, of course, and
was cognizant that many of the leading lights in cutting-edge surgery were
in Europe. Given DeBakey’s obvious interest in diseases of the
cardiovascular system, Ochsner set about arranging a period of training for
his young protégé in the clinic of France’s leading surgeon—and one of the
early pioneers of surgical treatment of the vascular system—Rene
Leriche.171 Matas also knew Leriche and may have been involved in
helping to secure DeBakey’s spot at the clinic, which was located in the
university town of Strasbourg, near the German border.*
In April, Ochsner got confirmation from Leriche that the arrangements
could proceed. DeBakey noted this proudly in a subsequent letter home and
revealed that plans were afoot for him to spend some time in a similar
capacity in Germany, too:
Dear Parents,
. . . Dr. Ochsner recently received a letter from Dr. Leriche in Strasbourg, France. Dr. Leriche is
the best known surgeon in France and is known all over the world. He is professor of surgery
there. He told Dr. Ochsner in his letter that he would be very happy to have me come to his
clinic and would give me as much work as I wanted. I am thrilled at the thought of being able to
work with him for a year. Dr. Ochsner is also planning to get me one of the best places in
Germany. I think he has been very nice to me. Of course he wants me to get all this training so
that I will be better equipped and will be of greater value to him. He has some very big plans for
me when I get back.172
Ochsner also knew a number of German surgeons well. Among these was
Martin Kirschner, who had moved from his clinic at Konigsberg to the
University of Heidelberg, where he ran a busy service. Although it was not
finalized until DeBakey was already in France, Ochsner also secured a
position for his protégé in Kirschner’s unit similar to the one at Strasbourg,
to begin in early 1936.
Even as Michael’s relationship with Diana began to take on serious
undertones it became evident that not everyone was entirely pleased by the
growing ardor of their romance. At the first of the year, shortly after
Michael first broached the subject of continuing his surgical education
abroad, he received a letter from his father. This dealt almost exclusively
with Michael’s selection of a wife and the timing of any contemplated
marriage:
Dear Michael,
We received your letter yesterday. You say from the conversation you had with Dr. Ochsner, his
advice to you is that it would be better to go across to France this year. I think I have to come
down to New Orleans sometime before June and talk to Dr. Ochsner myself and get all the
details.
Now I want you to understand this. Your mother and I will be glad to see you get married.
Nothing will make us happier than to see you and your brother and sisters married. If you have
this in your mind, it would be better for you to get married before you go to school abroad.
We want you to marry the girl you love and the girl that suits you, not that suits us. But you
must look at the matter with a futuristic view. You are a doctor by profession and you are
supposed to know a lot of things.
So think this matter over and I faithfully hope and trust God will show you what is best for
your future and you will see whether I am right or wrong.
Most affectionately yours174
If DeBakey had a response to his father’s Polonius-like message it has

not survived. Since no names were mentioned there might not have been a
reply, but the stirring of the pot was not finished.
Over the years since the first visit of Charles and Guy Odom to the
DeBakey home in Lake Charles in the summer of 1929, the two families
had grown close. They obviously had much in common as proprietors of
pharmacies with sons in the medical school at Tulane. Mrs. Odom and her
daughter Vada stayed with the DeBakeys at the Broad Street house during
cross-country trips to Texas.175 Michael, of course, had lived at the Odom’s
home in Harvey during medical school (although, given his schedule, it is
questionable how much time he actually spent there). Later, when Selma
came to Sophie Newcomb College, she also lived with the Odoms.176
Vada was a 16-year-old freshman at Newcomb in the fall of 1931, when
Michael was beginning his senior year in medical school. She obviously
had known him for some time—two years at least—and the dashing,
brilliant young scholar had evidently captured her imagination. By the time
Vada was ready to graduate, in 1935, she was of an age to consider such
matters seriously, and Michael—now a physician—remained dashing,
brilliant, and conspicuously single. He was also close at hand.
Whatever misgivings Shiker had about his son’s conjectured mate in his
January letter evidently did not apply to Vada Odom. On June 16, 1935,
Michael wrote home:
Dear Father,
I received your letter about Vada. I like Vada a great deal and I’m sure she likes me. Nothing
would make her mother happier than if I married Vada. But father, I’m not ready for marriage
yet. I’ve still got a long road to travel. In the next two years I’ve got to do five years’ work.
Marriage and study don’t mix. At present I’ve got to keep my mind on my work. I’m still young
yet. I won’t be 27 years of age until September and Vada is only 20 years of age so we both have
plenty of time. Besides I may meet some Syrian girl that I may like better. So I don’t think it is
wise to rush into something that is so serious.
In that summer of 1935, Michael rented an apartment that he shared with

his brother Ernest, who was taking a class in anatomy. Ernest had decided
that the life of a pharmacist was not for him and sold his interest in the Red
Star drug store in Lake Charles.178 He enrolled in the Tulane College of
Arts and Sciences for the 1934–1935 session in order to finish up his pre-
medical coursework, and he was preparing to start medical school in the
fall. Remembering his younger brother’s vigorous—and sometimes tawdry
—undergraduate social life, Michael was suitably impressed by Ernest’s
new focus.
Dear Parents,
Ernest has certainly been studying. He has surprised me. I never expected he would study like
this. It made me very happy to see the change in him. I am sure now he will do very well. His
teacher Dr. Smith who liked me very much says Ernest has an excellent mind and has made him
instruct the other boys in the class. I was very proud of him when I heard this.179
In June, Michael’s sister Goldie came to New Orleans for a visit of about
two weeks. The trip appears to have been both recreational and clinical. Her
brother and Ochsner performed a small operation on Goldie—removal of a
cyst from her mouth. She also saw another, unidentified physician in an
unnamed specialty and Michael duly reported back to Lake Charles on this
encounter, in general terms.
. . . We have finally found out what is causing Goldie’s troubles and will be able to correct it.
The doctor I took her to is very kind and one of the best in his specialty in the country. He has
diagnosed her condition and says that it has always been the cause of her trouble. He will
prescribe her treatment.180
Across the ocean (and most of France) in Strasbourg, Rene Leriche had
only an approximate date on which to expect young Dr. Michael DeBakey’s
arrival. As it happened, Leriche’s general approach to all matters was
sufficiently laissez-faire that he probably did not give it much thought: after
all, this was just another unknown foreign trainee recommended by a
colleague of note, and there were many of these. Back in New Orleans,
however, there were i’s to dot and t’s to cross.
DeBakey obtained a passport for about $10 (he was recorded as having
brown hair and eyes and standing five feet nine-and-one-half inches tall).
He also arranged transatlantic passage aboard the French steamer
Champlain, leaving on August 16 at 11:30 PM. The ticket cost $127.50.181
There were no stipends or scholarships involved in DeBakey’s training
period in Europe: the costs were borne by his father. A month before
leaving, Michael thanked Shiker for the upbringing that had brought him to
the brink of this rare opportunity and provided insight into the special
relationship that had emerged between himself and Ochsner—a bond not
that different from the paternal one he was extolling.
Dear Father,
Dr. Ochsner left on his vacation this morning. . . . He gave me his picture and I gave him one of
mine. He told me I was the only one he felt was true and loyal to him and that he could always
depend on. He said he wanted to thank you and mother for bringing me up like this and making
me what I am. I thanked him for all that and told him that no one realizes and appreciates more
than I do what my father and mother have done for me and that if I amount to anything they
deserve all the credit. I know now that I have very few people I can call real friends. I shall
always remember the many things you have told me which I never really appreciated before. I
know now that the only real friend I have is Dr. Ochsner. He has advised me and treated me like
I was his son.
I have everything I need—my passport, visa and baggage.
DeBakey returned home to Lake Charles to spend some time with his
family before beginning the train ride to New York, where the Champlain
would embark. The itinerary took him through Chicago, and he took the
opportunity to cross paths with the manufacturer of his sleeve valve
syringe, V. Mueller himself. The train left on August 9. As he had when he
was a young boy, Michael kept a diary of his transatlantic trip and started
writing before he left the country.
Aug. 9 I begin this with my departure from Lake Charles, La., for better or for worse depending,
of course, upon whose eyes may unguardedly peruse it.
My train journey to Chicago was somewhat lengthy but comfortable and not unpleasant
(possibly because I met no one to converse with). I arrived in that village of gangster fame in the
evening of Friday Aug. 10th, and registered at the select Blackstone hotel (as business is bad
they are not so select thus accounting for my staying there).183
In Chicago Michael sent a cable to Diana. He did not record the content
of the message, but did note that he was “anxiously awaiting a reply,”
which finally came when he was in the dining car during the trip to New
York. Michael was on his way to France—but Diana was already there.
She had finished her graduate studies that summer and accepted a
position at the American Hospital in Neuilly-sur-Seine, a western suburb of
Paris. On her arrival in early August, Diana was greeted in French by the
directress of nurses. There was visible disappointment when the new hire
could not reply in kind. Since Diana was from New Orleans, the assumption
had been that she could already speak French. As Diana remembered, “I
thought I’d lost the job before I even started, until she sort of sighed and
said, ‘Well, the first thing we must do is find a tutor for you.’ ”184
It is a matter of speculation as to whether the couple had arranged this
happy circumstance of both obtaining employment in France at the same
time. Although Strasbourg and Paris might appear contiguous from the
vantage point of Louisiana, the distance between the cities is considerable
—some 250 miles. Such a physical separation would seem unlikely to
foster romance, and the positions may have been entirely coincidence. This
was the public stance; it never needed defense.
In New York Michael checked into the Montclair Hotel on Lexington
Avenue at 49th Street. He rested, readied himself for the long trip overseas,
and absorbed the bustling atmosphere of the Big Apple. He went to the
movies, caught a baseball game at the Polo Grounds with the Cardinals’
Dizzy Dean on the mound, and patronized a bookstore (DeBakey bought
While Rome Burns by Alexander Woollcott and a volume by the great
Lebanese-American writer Kahlil Gibran). Beyond these diversions,
though, he did not find much to his liking.
I can’t say that my sojourn in New York has been particularly enjoyable. I simply do not like
this immense city with its towering skyscrapers and cold foreboding edifices. I am actually
vehement in my dislike and disapproval (although I realize it is immaterial). People here cannot
really enjoy life—that is an art that has escaped them. Life passes them by with not even a “bon
jour”. However, with all due fairness, I must say that I did meet a few nice people.185
DeBakey took advantage of an invitation to tour the nearby Becton-

Dickinson factory and was pleased and proud to see his transfusion needles
being manufactured. He also met and dined with the research manager who
had tried to talk him out of pursuing the sleeve valve syringe, Oscar
Schwidetzky, as well as Mr. Becton himself. On the evening of his
departure DeBakey enjoyed a Russian dinner and then headed to the pier
for the midnight embarkation.
Like most of the passengers, Michael stood on the deck as the ship cast
off and the dazzling lights of Manhattan gradually dwindled and sank below
the horizon. The sight and its connotations were enough to move a mind
less pensive than his, and Michael allowed himself to be absorbed in the
moment.
The Champlain departed amidst shrieks of bon voyage, frantic waving, and here and there a
parting tear.
This parting scene aroused in me conflicting emotions of sad departure and anticipative joy
and I stood at the deck rail until long after every one had retired, profoundly contemplating what
the future held in store.186
Notes
1. Old Spanish Trail Association Archives, Louis J. Blume Library, St. Mary’s University, San
Antonio, Texas. http://library.stmarytx.edu/ost/yearbooks/p02.html (accessed December
2017). When the federal numbered highway system came into being in 1927, this route
became US 90.
3. Ibid.
4. Case AE. Tulane: The Campus History Series. Charleston, SC: Arcadia Publishing, 2017: e-
edition Loc. 451.
5. Bulletin of the Tulane University of Louisiana 1909; 10(5): 17.
6. Bulletin of the Tulane University of Louisiana, 1926. University Archives, Howard-Tilton
Memorial Library, Tulane University.
7. Application for Admission, Tulane University of Louisiana, Michael E. DeBakey, September
1926. University Archives, Howard-Tilton Memorial Library, Tulane University.
Memorial Library, Tulane University. There were 33 “approved” high school subjects.
1926. University Archives, Howard-Tilton Memorial Library, Tulane University. The first
semester ran from September 23 to December 21, 1926; the second from January 31 to June 8,
1927.
10. Ibid.
12. Ibid.
13. Ibid.
15. Widmer ML. New Orleans in the Twenties. Gretna, LA: Pelican Publishing, 1993: e-edition
Loc. 102–4.
17. Ibid.
18. Ibid.
20. Register of Graduates and Matriculates, School of Medicine, College of Medicine, Tulane
University of Louisiana, Michael E. DeBakey. University Archives, Howard-Tilton Memorial
Library, Tulane University.
University of Louisiana, Michael E. DeBakey.
24. Ibid.
25. Ibid.
26. Henriques CB, Baird BP. Jambalaya 1930. The Tulane University of Louisiana, 1930: 119.
27. Ibid.
1:2:9.
1:2:9.
31. Carmichael GT, Childs MW, Deiler FG, and Kloter KO. Obituary: Edward Sturtevant
Hathaway. Mosquito News 1984;44:3.
32. Interview, Don Schanche with Michael DeBakey, Pierre Hotel, New York City, March 6, 1972.
DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 1:2:10.
Memorial Library, Tulane University. McCutcheon had a long career in academia. He became
Dean of the Graduate School at Tulane and held that post until 1954. Thereafter he was head
of graduate studies at Vanderbilt University. McCutcheon wrote several scholarly books on
English literature.
University of Louisiana, Ernest G. DeBakey. University Archives, Howard-Tilton Memorial
1:2:8.
41. Michael E. DeBakey vertical personnel files, Tulane University of Louisiana, 1927. University
Archives, Howard-Tilton Memorial Library, Tulane University.
47. Ibid.
49. Ibid.
Memorial Library, Tulane University. The Richardson Memorial Building remains intact today
and is now home to the Tulane School of Architecture.
1:2:9.
University of Louisiana, Michael E. DeBakey. The overall grade (87.4) is not the arithmetical
average of DeBakey’s grade values (86.8) so either this calculation was in error or some
weighting or subaveraging methodology may have been employed.
1:2:9.
55. Central Honor Roll (February 26, 1926). Lake Charles American Press, 19.
56. Real Estate Transfers (November 5, 1925). Lake Charles American Press, 6. Sheriff’s Sale
(June 13, 1929) Lake Charles American Press, 63.
57. Worley’s Lake Charles (Louisiana) City Directory 1927–28. Dallas: John F. Worley Directory
Co., 1928.
58. Society Notes (August 23, 1929). Lake Charles American Press, 44.
59. Congress of Neurologic Surgeons: History: Honored Guests: Guy L. Odom 1974, Vancouver.
https://www.cns.org/about-us/history/biography/3086 (accessed December 29, 2017).
1929 and 1930. University Archives, Howard-Tilton Memorial Library, Tulane University.
62. Ibid.
64. Ibid.
65. Ibid.
67. Wilds J, Harkey I. Alton Ochsner, Surgeon of the South. Baton Rouge: Louisiana State
University Press, 1990: 13.
68. Ibid., 24.
69. John L. Ochsner, personal communication, January 2017.
70. Salvaggio J. New Orleans’ Charity Hospital: A Story of Physicians, Politics, and Poverty.
Baton Rouge: Louisiana State University Press, 1992: 106.
71. Wilds J, Harkey I. Alton Ochsner, 63.
72. John L. Ochsner, personal communication, January 20, 2017.
77. Michael M. DeBakey, personal communication, November 2017.
University of Louisiana, Ernest G. DeBakey.
79. At Pharmacists Meet: Druggists of Lake Charles Attend State Session At Lafayette (May 13,
1931). Lake Charles American Press, 15.
The National Board of Medical Examiners was established in 1915 in an attempt to
standardize physician accreditation across the country. In the era in question there were three
steps to the exam process: Part One was administered during medical school and covered
basic biomedical sciences. Part Two was given at the completion of medical school and tested
the fundamentals of clinical medicine. Parts One and Two were both in essay format. Part
Three, offered at the end of internship, was a combined oral examination and observation of
patient encounters. The exam was not universally recognized as a requisite for licensure for a
number of years, and some state medical board exams persisted until the 1970s.
81. Salvaggio J. New Orleans’ Charity Hospital, 106.
84. Ibid., 74.
88. Ibid., 107.
91. Social Life in Lake Charles: Michael DeBakey Honored (December 16, 1931). Lake Charles
American Press, 34.
95. Alexander Allison’s New Orleans. Louisiana Division, New Orleans Public Library.
http://nutrias.org/~nopl/exhibits/allison/nores75.htm (accessed January 2018).
96. Interview, Don Schanche with Michael DeBakey, Houston, Texas, August 14–15, 1972.
97. Ibid.
98. Ibid.
100. Ibid.
103. Miller CA. Dr. Rudolph Matas: Learned Trailblazer, Father of Vascular Surgery. Bulletin of the
American College of Surgeons 2016;101:4.
104. Ibid.
105. Cohn I, Deutsch H. Rudolph Matas: A Biography of One of the Great Pioneers in Surgery.
Garden City, NY: Doubleday and Co., 1960: 357.
106. Rudolph Matas papers, Manuscripts Collection 868, Louisiana Research Collection, Howard-
Tilton Memorial Library, Tulane University, New Orleans, LA 70118. Box 10, folder 38.
108. Ibid.
109. Ibid.
110. Hempson JG. The High-Speed Internal-Combustion Engine. London and Glasgow: Blackie &
Son, 1968: 290–322.
113. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 2:4.
116. Miller CA. Dr. Rudolph Matas.
117. Miller CA. The Big Z: The Life of Robert M. Zollinger. Chicago: American College of
Surgeons, 2014: 44.
118. Report of the Board of Administrators of the Charity Hospital to the General Assembly of the
State of Louisiana, 1933.
119. Ibid.
120. Ibid.
123. DeBakey ME, Gillentine WH. A Syringe-Sleeve-Valve Transfusion Instrument: New Method
of Transfusion of Unmodified Blood. American Journal of Surgery 1934;23:579–582.
124. Ibid.
125. Ibid.
126. DeBakey ME, Gillentine WH. New Method of Syringe Transfusion. New Orleans Medical
and Surgical Journal 1933;86:100.
127. DeBakey ME, Gillentine WH. A Syringe-Sleeve-Valve Transfusion Instrument, 581.
128. Letter O. O. R. Schwidetzky to M. E. DeBakey, November 9, 1932. DeBakey Archives,
National Library of Medicine, Bethesda, MD; MS C 582. Series 2:4:28.
129. Letter M. E. DeBakey and W. H. Gillentine to O. O. R. Schwidetzky, November 12, 1932.
130. Letter O. O. R. Schwidetzky to M. E. DeBakey, November 21, 1932. DeBakey, Michael E.
131. Cassidy C. Images of America: Hasbrouck Heights. Charleston SC: Arcadia Publishing, 2006:
123.
132. Letter Alexander and Dowell to Ridgely Moise, Esq., January 31, 1933. DeBakey Archives,
National Library of Medicine, Bethesda, MD; MS C 582. Series 2:4.
134. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 2:5:26,
29, 35, 39.
135. Ibid.
138. Ibid.
139. DeBakey ME. A New Blood Transfusion Needle. American Journal of Surgery 1934;26:592–
593. Somewhat surprisingly, this needle was manufactured by Becton-Dickinson.
Baton Rouge: Louisiana State University Press, 1992: 148.
1:2:9.
142. Ibid.
145. Ibid.
146. DeBakey ME. Peptic Ulceration: The Relative Protective Value of the Alkaline Duodenal
Juices. Archives of Surgery 1937;34:230.
147. Letter M. E. DeBakey to S. M. DeBakey, March 24, 1935. DeBakey Archives, National
Library of Medicine, Bethesda, MD; MS C 582. Series 2:5:15.
148. Hinman EH, Faust EC, DeBakey ME. Filarial Periodicity in the Dog Heartworm, Dirofilaria
Immitis, After Blood Transfusion. Proceedings of the Society for Experimental Biology and
Medicine 1934;31:1043–1046.
149. Sanford JB, Coon HS. Jambalaya, 1928. The Tulane University of Louisiana. 1928.
150. Bradley R, Porter JD. Elastic-Tube Pump. Patent No. 12753. United States Patent Office,
1855.
151. Allen EE. Instrument for Transfusion of Blood. Patent No. 365327 A. United States Patent
Office, 1887.
152. Herdman WJ. The Surgeons Pump. JAMA 1887;9:59–60.
153. Boettcher W, Merkle F, Weitkemper H. History of Extracorporeal Circulation: The Invention
and Modification of Blood Pumps. Journal of the American Society for Extra-Corporeal
Circulation 2003;35:185.
154. Bayliss LE, Müller EA. A Simple High-Speed Rotary Pump. Journal of Scientific Instruments
1928;5:278–9.
155. Van Allen CM. A Pump for Clinical and Laboratory Purposes Which Employs the Milking
Principle. JAMA 1932;98:1805–6.
156. DeBakey M. A Simple Continuous-Flow Blood Transfusion Instrument. New Orleans Medical
and Surgical Journal 1934;87:386–389.
157. Cooley DA. Development of the Roller Pump for Use in the Cardiopulmonary Bypass Circuit.
Texas Heart Institute Journal 1987;14:116.
159. DeBakey M. A Simple Continuous-Flow Blood Transfusion Instrument.
160. DeBakey ME, et al. Roller Pump. Patent No. 2018998. United States Patent Office, 1935.
161. Don A. Schanche papers. MS 3306. Hargrett Rare Book and Manuscript Library, The
University of Georgia Libraries.
162. Death Certificate for Diana Cooper DeBakey, February 11, 1972, File No. 11353. Texas
Department of State Health Services; Austin Texas.
163. 1910 United States Census. Place: Lafayette, Lafayette, Louisiana; Roll: T624_516; Page: 5A;
Enumeration District: 0069; FHL microfilm: 2340473.
164. United States, Selective Service System. World War I Selective Service System Draft
Registration Cards, 1917–1918. Registration State: North Carolina; Registration County:
Wilson; Roll: 1766155. 1930 United States Census. Place: Fort Thomas, Campbell, Kentucky;
Roll: 738; Page: 3B; Enumeration District: 0034; FHL microfilm: 1374529.
165. Michael M. DeBakey personal communication, November, 2017.
166. Register of Graduates and Matriculates, College of Arts and Sciences, Tulane University of
Louisiana, Dolly Belle Cooper. University Archives, Howard-Tilton Memorial Library, Tulane
University.
167. Ibid.
168. Ibid.
170. Ibid.
172. Letter M. E. DeBakey to parents, April 29, 1935. DeBakey Archives, National Library of
Medicine, Bethesda, MD; MS C 582. Series 2:5:15.
173. Letter R. Matas to R. Leriche, July 25, 1935. DeBakey Archives, National Library of
174. Letter S. M. DeBakey and R. DeBakey to M. E. DeBakey, January 3, 1935. DeBakey
175. Letter M. E. DeBakey to parents, June 26, 1935. DeBakey Archives, National Library of
176. Letter Dean H. Sophie Newcomb Memorial College to S. DeBakey, September 22, 1933
177. Letter M. E. DeBakey to S. M. DeBakey, June 16, 1935. DeBakey Archives, National Library
of Medicine, Bethesda, MD; MS C 582. Series 2:5:15.
178. Louis Prejean New Owner Red Star Drug Store (March 30, 1934). Lake Charles American
Press, 21.
Medicine, Bethesda, MD; MS C 582. Series 2:5:15. Wilbur Cleveland Smith was both
Professor of Gross Anatomy and Director of Athletics at Tulane. He later became Dean of the
LSU School of Medicine.
181. Ibid.
182. Letter M. E. DeBakey to S. M. DeBakey, July 17, 1935. DeBakey Archives, National Library
186. Ibid.
*
DeBakey later recalled this as being several hundred dollars, but he could not remember the
exact amount.
*
Unlike the undergraduate college, Tulane Medical School was already coeducational at this time.
The medical dormitory housed men only, however.
*
Storyville was the city’s notorious red-light district, intentionally based on European port city
examples and established by ordinance of the City Council in 1897 (it was nicknamed for one of the
authors of the law). Prostitution was still illegal, but tolerated in the 38-block district. Jazz music also
developed and thrived here. After a 20-year run, Storyville was shut down in a reform wave in
1917.15
*
This was most likely at 519 Lowerline Street, in a neighborhood southwest of the Tulane
campus. The registrar recorded this as Michael’s address at the time of his registration for his junior
year, on September 26, 1928. Later in the school year he moved to 6025 Coliseum. Both houses still
exist.48
*
Later it was determined that the cocaine Ochsner had used for his demonstration at Tulane was
outdated and had lost its potency. When a successful Ochsner bronchogram was completed, the
patient coughed the barium back up in an unpleasant coda to the technique.72
*
Vidrine told an incredulous Bass that he could “read up on” the field.
*
Ochsner’s reappointment at Charity Hospital came in September 1932. Long harbored deep
animosity toward Tulane both for its exclusive nature, which ran counter to his populist beliefs and
policies, and—paradoxically—the university’s failing to award him an honorary degree. He
championed the creation of a new medical school (which, in truth, was needed) under the auspices of
Louisiana State University (LSU). Exasperated by Long and Vidrine’s harassment, Bass successfully
lobbied the American Medical Association’s Council on Medical Education to withhold the necessary
accreditation from LSU. That new medical school’s incoming head of surgery, former Tulane
professor Urban Maes, demanded a resolution of the Charity–Tulane standoff and the return of
Ochsner to the Charity staff.93 This subsequently came to pass, and LSU received its accreditation a
few months after Ochsner’s reinstatement. Ochsner later reflected that his two years away from
Charity “identified me with the worthwhile people in this state, the people who hated Huey Long. . . .
It also gave me a chance for two years to do research that I couldn’t have done otherwise. It was a
fortuitous thing, although it seemed a horrible blow at the time.”94
*
The sleeve valve automotive engine was invented around the turn of the century by Charles Yale
Knight, who disliked the excessive noise of conventional poppet valves. Sleeve valve engines were
much quieter but more expensive to manufacture. By the 1920s, the largest number were produced
by the Willys Company of Toledo. It is not clear how DeBakey became aware of the sleeve valve
design. Studebakers, such as the one his father gave him to tinker on, did not have sleeve valves. The
make of automobile his father provided him while he was in college is not known. That car, or
another of his father’s, may have employed a sleeve valve design, such as the popular Willys-Knight
model.110
*
Matas and Halsted were close friends, a relationship based on justified mutual admiration. When
Matas needed an operation in 1903, he traveled to Baltimore to have it performed by Halsted. The
nature of this procedure was unknown for decades—even in his reverent biography of Matas, Isidore
Cohn admitted that it was a mystery—but it was later revealed that at autopsy Matas was noted to
have undergone a right orchiectomy—removal of the testicle. Presumably this was done for cancer or
the fear of it.116
†
Charity Hospital formally adopted residencies, replacing the previous “house physician” and
“house surgeon” system, in 1937.121
*
Schwidetzky had invented the still-ubiquitous ACE (“All Cotton Elastic”) bandage some years
before this.131
*
This would be approximately $2,500 in 2020.
*
The lab work in question may have been a project involving the injection of parasite-laden blood
into a dog (Hinman, E. H., Faust, E. C., & DeBakey, M. E. Filarial periodicity in the dog heartworm,
Dirofilaria immitis, after blood transfusion. Proceedings of the Society for Experimental Biology and
Medicine no. 31 (1934), 1043–1046. In the article it was reported that the DeBakey-Gillentine
syringe was used for this purpose.148
*
Later, the twin-roller design was also found to be least destructive to blood cells, an unintended
but significant benefit.157
*
In her younger years, including her time at Charity, she also sometimes went by “Dolly” or
“Dolly Belle.”167
†
In the school year 1933–1934, Diana took both Greek and English literature classes at Tulane,
the latter with DeBakey’s former professor, Roger McCutcheon.168
*
On July 25, 1935, shortly before DeBakey’s departure for France, Matas sent a letter to Leriche
which stated, “Dr. DeBakey is recognized among our recent graduates as an able, hard-working and
ambitious student with marked tendency to originality and inventiveness, as shown by a simplified
apparatus for blood transfusion which he has devised. I trust that with these qualities he will prove
worthy of your esteem and of the honor of fellowship in the Leriche guild of surgical devotees.”173
3
Strasbourg, Heidelberg, and New Orleans: 1935–
1942
A youth to Fortune and to Fame unknown.
3.1 Paris
The route of SS Champlain across the Atlantic from New York to Le Havre
took seven days. DeBakey counted his good fortune at having a cabin to
himself. On the morning after departure he was awakened by fresh salt air
and the “swishing of the briny sea.”1 The cabin steward delivered a
telegram from his family at home that read “All well wishing you bon
voyage good luck good health.”2
At first DeBakey mainly kept to himself. Most of the passengers were
French, and, despite his classes, his conversational command of the
language was spotty. He read While Rome Burns in his cabin and went to
the cinema. He socialized enough to play Keno for the first time, “causing
my fortune to diminish by seventy cents.”3
The ship settled into port at Le Havre at 10 PM on Friday, August 23.
DeBakey wasted no time in reaching the gangway: “I was amongst the first
to set foot on land. Imagine my unbounding joy when the first person I set
eyes on was lovely Diana, as prim and neat as ever and beaming with a
beautiful smile of welcome. A happy reunion. She had come up from Paris
to meet me.”4
The couple caught a fast train to the Ile de France, and DeBakey checked
into his hotel in Paris, the Royal Villier, in the early morning hours. The
next day he called the valet to ask for a bath to be drawn, which turned out
to be 5 francs extra. The valet spoke no English, so DeBakey had to ask for
this apparent luxury using the French word for bath, “bain.”
He seemed to understand but immediately asked me with a gracious smile what color I desired,
brown or black. Of course, I was somewhat perplexed. He rather had me there. But, I reasoned, I
am in a strange country among strange customs and possibly the baths here are more suitable in
those colors. I immediately regained my equanimity and responded that I would have the brown
as black was not good for my disposition.5
A few minutes later a waiter appeared at the door with a glass of brown
beer.*
DeBakey had only spent a few days in Paris as a child during the family
trip in 1921, but he made up for any missed sight-seeing opportunities this
summer by staying more than two weeks in the city before moving on to
Strasbourg. Diana accompanied him on the majority of these excursions,
“and it is for this reason that it was so enjoyable.” Since she had only been
in France for three weeks herself, the novelty of these experiences was
shared (Figure 3.1 and Figure 3.2).6
Figure 3.1 Diana “Dolly” Cooper passport photo, 1935.
Figure 3.2 Michael DeBakey passport photo, 1935.
They took in the Louvre, the restaurant at the Hotel Ritz, the Folies
Bergere, and other familiar tourist sites, and Diana proudly showed him the
modern and expansive American Hospital. DeBakey also made the rounds
of several French clinics but “was not favorably impressed with their
methods.”7
DeBakey was surprised at the high cost of living in the city, noting the
hefty prices of everything from cigarettes to gasoline. One night the couple
went with some American friends to the Casanova Club, a “Russian
cabaret” on rue Fromentin in the Ninth Arrondissement. This was a pricey
jazz club, a frequent venue of the legendary Gypsy guitarist Django
Reinhardt. “We had one gin fizz apiece and it cost 240 francs. Such
extravagance!”8
September 7 was DeBakey’s 27th birthday. By this point he had grown a
moustache—as Ochsner had at a similar age—in order to appear older than
his years. He and Diana had birthday dinner and climbed 367 spiral stone
steps (as Diana counted them) to the ramparts of Notre Dame Cathedral.
The privilege cost 2 francs and was “very fatiguing.”10
The vacation could not last forever, of course. On September 10,
DeBakey took the train to Strasbourg. Diana saw him off, and the parting
was an emotional one: “I know how I will miss her.”11
Seven hours later the train pulled into the Gare de Strasbourg, the old
city’s 400-foot Gothic cathedral looming over the surrounding landscape of
Alsace as it has for centuries. DeBakey made his way to the venerable
Hôtel Maison Rouge at the famous Place Kléber and checked in for the
night.12
The next morning he crossed the Ill River toward the university district to
the south and proceeded to Clinique Chirurgicale A, where Leriche’s
service was located. There he was cordially met by Alberto Saldarriaga,
another foreign trainee who hailed from Colombia, as well as the great man
himself, Professor Henri Marie René Leriche.13
3.2 Leriche
At this point in time Leriche was 55 years old. Born in a small village along
the Loire River in central France in 1879, Leriche initially considered a
military career. At the University of Lyons, however, he chose surgery as
his field of specialty and never looked back. After finishing his training and
being appointed to an academic position at the university, Leriche spent
some time in 1913 in the United States, striking up an enduring friendship
with William Halsted, among others. He also renewed his acquaintance
with Alexis Carrel, another French surgeon whom he had briefly known in
Lyons. Carrel had immigrated to America to continue pioneering work in
vascular surgery, especially the suturing of blood vessels.*,14
Like many French surgeons, Leriche was overwhelmed with the
experience of World War I, and it was during that conflict that he became
interested in the concept of the autonomic nervous system—in particular
the “sympathetic nerves”—as a cause of pain syndromes. † This work built
on earlier prewar investigations he had done involving the role of these
nerves in arterial disease.16
In 1924, Leriche accepted the post as Chair of Surgical Clinic A at the
University of Strasbourg. There he continued his many clinical and
laboratory investigations, publishing his results prolifically. In the ensuing
years Leriche developed the operation of sympathectomy—the division of
sympathetic nerves at various points in the body—to a model of surgical
precision. He applied this procedure successfully to a variety of clinical
indications and increasingly to his initial subject of interest: arterial
insufficiency of the extremities.
Occlusive disease of the arteries has gone by many names over the years:
thrombo-obliterative disease, arteriosclerosis, atherosclerosis—but by
whatever name it is called, the malady has been a scourge to mankind for
thousands of years: Egyptian mummies have been shown to possess the
characteristic pathology.17 A major cause of heart attacks, strokes, and limb
loss, this affliction has caused untold suffering and death over the centuries,
and the fundamental underlying cause remains elusive, despite decades of
well-funded research at the highest levels.
Until quite recently in human history the clinical nature of arterial
occlusive disease and, in fact, many of the attendant deleterious effects, has
been poorly understood. Medical and surgical efforts at addressing the
disease were, in the main, ineffective—and sometimes actively
discouraged. The first hesitant scientific steps toward surgical attack of
arterial occlusive disease occurred in the early twentieth century, primary
among them being Leriche’s preferred operation of sympathectomy.
In his initial efforts Leriche had divided the sympathetic nerves very
peripherally, around the vessels he was interested in affecting (this was
known as “periarterial sympathectomy”).18 Later he and others moved the
site of division more centrally, near the sympathetic ganglia, which flank
the vertebral column along the posterior aspect of the thoracic and
abdominal cavities. In particular, surgeons focused on the sympathetic chain
and ganglia in the lumbar region, which are responsible for nerve-mediated
constriction in the leg arteries so commonly found to be affected by
occlusive disease. As he developed this technique, Leriche came to believe
that removal of the occluded artery at the time of sympathectomy
diminished the postoperative pain felt by patients and typically included
this resection (“arterectomy”) in his procedures.19
Leriche was fully—and humbly—aware of the theoretical and technical
limits of his pet operation. As he noted in an article in Annals of Surgery
from 1928, “The surgery of the sympathetic system meets two kinds of
difficulties—those which spring from our physiologic ignorance, those
which spring from our pathologic ignorance. On one side we do not know
the exact significance of the branches we cut. On the other side we are
ignorant, as a rule, of the cause and the exact mechanism of the diseases we
wish to cure.”20
In 1923, Leriche described a constellation of symptoms—and the
underlying physiologic derangement responsible for it—that would come to
bear his name. The Leriche syndrome describes clinical manifestations of
occlusion of the aorta and/or its major pelvic branches, the iliac arteries.
Exertional pain and weakness in the hips and thighs, as well as impotence
in men, are characteristic. Leriche even presciently speculated that the best
treatment for this would be re-establishment of blood flow through the
occluded region, although he recognized that this was beyond the technical
capability of surgeons in the 1920s.*,21
At this juncture, therefore, Rene Leriche was one of the world’s leading
authorities on the surgical treatment of vascular disease. Patients with such
maladies were referred to his clinic from all over Europe, and his laboratory
regularly reported important new research. It was this expertise at the
cutting-edge that Ochsner hoped DeBakey could tap into during his time in
Strasbourg, then bring back with him to New Orleans.
It was DeBakey’s good fortune that Leriche happened to be working in a
place as beautiful, and rich in culture and heritage, as Strasbourg. Located
in the province of Alsace along the Rhine River in the extreme eastern
portion of France—and thus on the border with Germany—Strasbourg has
been both benefactor and victim of its geographic position at the
intersection of two great rival nations and cultures. The city and region have
changed hands many times over the years, and the successive regimes have
left their stamps on the area’s identity. Both French and German are spoken
here, in addition to the area’s own language, Alsatian.
Leriche himself had come to the University of Strasbourg in 1924
because of the outstanding reputation of the medical school. Some of
Europe’s greatest physicians had been educated there, and the faculty did
clinical and investigative work at the highest level. In addition, with more
than 50 buildings at the time, covering some 70 acres, it was one of the
largest medical centers in the world.
The list of illustrious graduates of the school is a long one and includes
such luminaries as Goethe, Metternich, Emil Fischer, and Oscar
Minkowski. Prominent figures in medicine who took their education at the
university comprise an equally impressive sample: Louis Pasteur, Paul
Ehrlich, Albert Schweitzer, and Wilhelm Rontgen, to name a few. Leriche
had not been educated at Strasbourg, but he added his name to the imposing
list of the University’s contributors to medical science as a professor.
DeBakey hoped to add his as a student.
3.3 Clinique Chirurgicale A

After the pleasantries had been exchanged, Saldarriaga directed DeBakey to
the Pension Elisa on rue Goethe, Place de l’Université, where he might be
able to stay semi-permanently while he was in Strasbourg.*,23 At the
pension he met another foreign assistant, an Italian surgeon named Cavalli
and his wife. He also met the Alsatian woman who ran the pension, and she
welcomed him into her little enclave.
I lived with a woman, very interesting woman who had lost her husband during the war and she
ran this pension—owned the house and so had put it out for rent. She was a rather motherly
woman and she sort of took over for me. She treated me almost like a mother did. Sometimes on
Sunday she’d ask me if I didn’t have anything to do would I like to go to the show with her or
go to something with her—have dinner or something like that. Or she’d fix me something and
we’d eat together. Very, very sweet lady. I was very fond of her.24
In this period, Leriche typically had a dozen or so trainees at the Clinique

Chirurgicale A at any one time (Figure 3.3). They hailed from near and far,
and they were the youthful cream of the crop in their surgical communities
at home. In addition to the Italian and Colombian he had already met,
DeBakey would soon come to know Jean Kunlin, the Chef de Clinique—
essentially the Chief Resident—who was from nearby Schiltigheim. René
Fontaine was also from Alsace. João Cid Dos Santos was the son of an
eminent professor in Lisbon. There were two assistants from Greece,
Nicolas Christeas and C. Eliades. Adolphe Jung was German. Although
other Americans trained under Leriche over the years, DeBakey appears to
have been the only one present during his sojourn in Strasbourg.25 He later
observed that, “They didn’t think too much of the Americans anyway. There
was not any anti-American feeling; it was just that there wasn’t any great
admiration for us. I mean in medicine.”26
Figure 3.3 Rene Leriche with his trainees in Strasbourg, circa 1935. Leriche is bottom row, second
from left; DeBakey bottom row, third from left. Jean Kunlin is far right; Jao Cid dos Santos fourth
from right.
The main building of Clinic A had been completed back in 1881 and held
205 beds.27 There were two operating pavilions, one of which had a large
amphitheater to accommodate audiences for both lectures and surgical
operations. The facility had multiple labs, including surgical pathology
facilities and spaces designed for experiments. An outpatient clinic was
attached, plus a separate building for infectious cases. Leriche favored a
pale blue color for the finishes in the operating rooms, as well as the
linens.28
DeBakey’s role as an assistant étranger was not much different from that
of Assistant in Surgery, or even Instructor in Surgery, at Tulane. He
participated in the evaluation and perioperative care of patients, was a first
assistant in the operating room—usually to Leriche, but sometimes to
Kunlin or others—and helped out in the experimental lab. Having expected
the facilities at Strasbourg to be superior to those at the New Orleans
hospitals, he was surprised to find out that this was not the case.
I found them to be rather provincial to be perfectly honest with you. I was amazed, for example,
they were still operating with gloves that we thought belonged in the autopsy room. This was an
economic thing with them. They had to wear these heavy rubber gloves because it was more
economical and they wore longer. I thought their research laboratory was very poorly equipped
compared to ours. I worked in their research laboratory and it was kind of in an out house where
they kept some of the animals in the basement. It wasn’t too clean.29
The routine of the clinic was much less rigorous than what DeBakey had
gotten used to under Ochsner, a reflection of Leriche’s relaxed persona.
Work began around eight-thirty or nine in the morning, and continued until
about 2 PM. In true French fashion, the mid-day meal break extended until 6
PM, after which work resumed until sometime around 9 PM.
Leriche himself was a skillful operator in procedures that interested him
—and he performed the lumbar sympathectomy procedure with particular
élan. As Debakey later recalled, “He liked to do that. He did it
beautifully.”30 Like Ochsner, Leriche was very kind and considerate to his
patients. He also had an energetic sense of humor. With a high forehead,
determined chin, clear blue eyes, and tousle of dark hair, his appearance
reminded DeBakey of Beethoven, or “a portly French chef.”31
The young American was especially impressed at Leriche’s sophisticated
tastes. In a sense, here was the consummate Frenchman—taking particular
pleasure in good food, wine, music, and art (Leriche counted among his
friends Henri Matisse, a former patient whose portrait of the surgeon is a
classic). He was also a talented lecturer, if somewhat given to digression
along the lines of his refined appreciations.
He told about this painting, The Anatomist. This famous painting by the Dutch painter. (The
subject) was a doctor, and he was the physician who was in charge of public health in Holland at
the time Napoleon overran them.
He said that Napoleon was in his carriage driving along the roadway along one of the canals
and this man had instituted the sanitation policy that the roads would be blocked for a certain
period of time when they would be washed and cleaned. And during the time that they were
blocked, the rule was nobody was to pass.
The carriage driver got out and said you’ve got to move this; we need to go on this road. And
the guard said it doesn’t make any difference how important he is; he could be Napoleon. You
can’t get across this road, this is the order. The carriage driver got out and told him he is
Napoleon. And the guard started shaking a little bit and said well what am I going to do? I have
orders. He said you better come and tell Napoleon. So he walked up with him to the carriage and
told Napoleon, and Napoleon said who ordered it? And he told him that it was the doctor that
was in charge of all the sanitation. Well, Napoleon was very impressed with this and he told his
driver, let’s find another way.*,32
By his own admission, DeBakey would have had trouble picking up the
details of a complex lecture like Leriche’s when he first arrived in
Strasbourg. The spoken French he faced at the university was far more
sophisticated than anything he had encountered while growing up in Lake
Charles or as a student at Tulane. After “two or three months” he counted
himself fairly fluent in the language, although he still had difficulty with the
many accents that prevailed in the Clinique. Others had an even more
difficult time and took measures to improve their French that DeBakey
found somewhat scandalous. One of the Greek fellows, who was a
newlywed and brought his bride along to Strasbourg, lived on the path that
DeBakey walked between his pension and the clinic. They often strolled
together. One day the other assistant asked DeBakey how he had gotten so
fluent in French in such a short period of time. DeBakey reminded his
friend that he already knew some of the language before coming to
Strasbourg, but practice and study were really the keys. This approach did
not appeal to the Greek surgeon, who remarked that he had heard about
another way.
He said, “They tell me that the best way to learn is to get you a girl.” And I said, “Well, I don’t
know about that. Maybe it is,” but I said, “You really need to study some, too.” So about a
month later we were walking again together and he said, “You know, I think I’m making some
progress with French, don’t you?” I said, “Yes, I think you are.” He said, “Well, I’ve got me a
girl.” And I said, “Is she helping you?” “Oh, yes,” he said. She helps me a lot.”
I was amused by this. Explain to your wife on a honeymoon that (you) already had a
mistress!34
Leriche’s group of assistants became a close one and socialized
frequently. After about six months had passed DeBakey noticed that nearly
all his colleagues had mistresses and thought nothing of taking them out on
the town among their co-workers.
DeBakey, of course, had Diana back in Paris—a relationship he
characterized as “totally proper—and all too occasional.”35 On weekends
when he had no official responsibilities he would take the train to see her.
Sometimes he struggled to disengage from his work.
I spent my time with Diana talking about what I was doing with Leriche. It became a little
tedious for her. Once we were walking through the Tuileries, and I thought she was engrossed in
what I was saying because she had such a happy smile on her face. She was always happy. But
after hearing nothing but surgery all afternoon she finally turned and stamped a foot on the path.
“Now, listen. It’s time for you to forget about that now. Stop thinking about surgery. You’re with
me now, not Leriche, and I want to have a good time!”36
Michael and Diana were growing closer, despite the distance between
Paris and Strasbourg: “That’s about the time we knew we were in love, and
decided to be married when we got back to New Orleans.”37
3.4 Le Sang Pur

When he had trained in Europe in the early 1920s, Alton Ochsner had been
surprised at how rarely blood transfusions were performed there. His cousin
and mentor A. J. Ochsner anticipated this and had insisted that Alton pack
one of the primitive transfusion apparatuses of the time in his luggage for
the overseas trip. That foresight paid big dividends when Alton was able to
save the lives of a number of patients by means of transfusion, earning the
respect and gratitude of his teachers (not to mention the patients).38
DeBakey took a page out of his mentor’s book and brought his own
sleeve valve syringe transfusion device to Europe. These machines had only
just been brought out commercially by V. Mueller Company (by August
they had manufactured 145 of them) so nobody in Strasbourg had ever seen
one.39 As was the case with Ochsner’s experience, the surgeons at the
Clinique were not overly enthusiastic about transfusions. They had their
own transfusion service and had undoubtedly seen many bad reactions, but
they also balked at the bloody, awkward techniques.*
DeBakey’s smooth, effortless method of transfusion quickly convinced
any doubters, and, before long, he was performing the service all over
Strasbourg, not just in Clinic A. He was asked to discuss his method at an
annual transfusion symposium held at the University, and this led to his first
papers published originally in a foreign journal.40
DeBakey had V. Mueller send a few of the transfusion sets to him in
France so his colleagues could continue using his device after he left. He
had one of the cases specially engraved to his French Chief (in English):
“To Prof. Rene Leriche: As a token of esteem and sincere and grateful
appreciation. Michael DeBakey.”41
Even as DeBakey was displaying the sleeve valve transfusion device to
great effect in France, plans were moving forward back at home for the
roller pump.
The A. S. Aloe Company in St. Louis was the enthusiastic manufacturer
of the machine. In stark contrast to the reluctant suitors for the sleeve valve
syringe, Aloe’s only negotiation sticking point was the royalty (which they
insisted be 10% of the selling price). While in Strasbourg, DeBakey—no
longer a neophyte in the business—conducted the contractual bargaining
and directed a few minor refinements to the design of the device. By late
May 1936, Aloe’s president told DeBakey, “The instrument is finished and I
don’t believe that we would know how to make it any better.”42
While in Strasbourg, DeBakey corresponded with his friends and family
in the States on a frequent basis. His first letter back to Ochsner was mailed
at the end of August, less than a week after he arrived in France and while
he was still enjoying Paris with Diana. In his reply Ochsner could not resist
the temptation to tease his young protégé about the self-consciously
baroque vocabulary he sometimes used.
September 11, 1935
Dear Mike:
I certainly enjoyed your letter of August 30 and am happy to learn that everything has gone so
well with you since leaving here, although I had to get out the dictionary to decipher some of the
words before I knew just what you had done.43
The big news from home concerned the spectacular assassination of

Huey Long, the populist politician who had gotten Ochsner black-listed
from Charity Hospital. Long had slithered from his gubernatorial platform
to a seat in the US Senate in 1932. His political aspirations were limitless,
and his tactics ruthless. On September 8, 1935, Long was shot at the
Louisiana State House in Baton Rouge by the son-in-law of a judge he had
just maneuvered out of office. The assassin was a Tulane medical school
graduate, who had himself been slain on the spot by the senator’s
bodyguards. The Kingfish survived the initial injury and made it to the
operating room. There, by a remarkable circular providence, the available
surgeon happened to be Arthur Vidrine, the ill-trained crony’s son that Long
had placed at the head of Charity Hospital. Accounts vary as to the
operative events, but the outcome was not open to debate: Long died from
his wounds.*
Through the fall Ochsner kept DeBakey up to date regarding the
reception of their shared research work at the various regional and national
surgical meetings, as well as stray gossip about the Department.
October 17, 1935
Things here are rocking along very nicely. I don’t know whether I told you that I have been
asked to talk before the Clinical Congress and am giving a resume of our work on peptic ulcer,
which will include your investigations. . . .
Dr. Gage is feeling splendid. I don’t know whether you know he has cut out smoking entirely
and this, together with the fact that he had all his teeth removed; I think is responsible for his
feeling so well. As a matter of fact, he is so foxy around here that I have insisted upon his
smoking again, because he is just about as frisky as a young colt in the spring.44
As the year 1935 drew to a close Ochsner happily announced the receipt
of an unsolicited positive report on DeBakey’s performance from Leriche
himself and began to inquire about concrete plans for the immediate future
of his protégé in Europe.
December 30, 1935
I was so happy the other day to have a letter from Professor Leriche, telling me how well you
are getting along and how happy he is to have you in the Clinic. I thought it was extremely nice
of him to write to me, because it wasn’t necessary for him to do so and it was certainly an
indication that you are making good, a thing, of course, which I knew you would do.
Mike, have you any idea where you want to go next year and when you want to be going? I
think it is about time to start making arrangements for your next clinic, but would appreciate
your letting me know what your plans are as far as Strasbourg is concerned.46
During his time overseas DeBakey also exchanged letters with his family
in Louisiana, of course. He seems to have confided his tentative wedding
plans to his mother, who persuaded him not to bring the matter up until he
had returned to the United States. Shiker, in particular, would much rather
hear about his son’s professional successes in far-away France:
December 9, 1935
Please write Daddy & tell him about your work because he loves to read your letters. The other
day he wanted to show your letter to Dr. McKinney. . . . I want you to keep your mind on your
work and be happy.47
While Michael was honing his advanced surgical skills in Europe in the
fall of 1935, his brother Ernest was working his way through his first year
of the Tulane College of Medicine. Ernest’s courses were similar to what
his brother had faced back in the fall of 1928, with a concentration on
anatomy. Ernest was on Christmas break at the family home in Lake
Charles when near-tragedy struck.
On one cold day in early January, the African American couple who lived
in the DeBakeys’ outbuilding had a fire going. A can of gasoline was
spilled, and, in an instant, the structure and everything inside of it was in
jeopardy. Ernest happened to be at home and, hearing the shouts of the
couple, ran across the yard and into the outbuilding to help. His clothes
caught fire and he was badly injured, with full-thickness burns on his legs
and torso.48
At first Ernest was cared for by the family’s local physician, who
prescribed bed rest and baths every few days. This continued for about six
weeks. Shiker arranged for nurses to help with Ernest’s care, but even so,
the magnitude of the injuries was too great for him to be at home.
Ochsner arranged for Ernest to be transferred to the Touro Infirmary in
New Orleans. There he underwent more aggressive dressing changes,
followed after about 10 days by skin grafting. Ernest’s wounds
subsequently healed rapidly.49
Beyond the obvious pain and psychological distress of his burns, Ernest
was mainly depressed about having missed a significant chunk of his
freshman year in medical school. Despite his best efforts at catching up (he
did not get back to school until April) at the end of the year several of his
classes were incomplete. By means of summer school and “conditional
examinations” offered by Tulane for such exceptional circumstances, he
was able to finish his first-year studies, with great effort, before the
sophomore year began in the fall of 1936.50
In February, Ochsner suggested that DeBakey would best be served by
spending time in the clinic of Martin Kirschner. Ochsner had just learned
that this was now in Heidelberg: “but that doesn’t make any difference
because Heidelberg is as delightful as Tubingen.”51
3.5 Alsace
Later that month DeBakey transcribed lengthy sections of his diary for a
letter to his father, who had them published in the Lake Charles American
Press, like those from the family trip 15 years before. The three-column
article appeared in the February 21, 1936, issue. After a few paragraphs
outlining the geography, history, and architecture of Strasbourg and Alsace,
DeBakey delved into the culinary customs of the region:
The city also boasts of being the great center of Alsatian gourmandizing and here again there is
a commingling of both Celtic and Teutonic comestibles. Such apparent inconsistencies as frog’s
legs and cabbage or snails and sauerkraut meet and embrace in the same casserole. As a matter
of fact, one of Strasbourg’s claims to fame is that sauerkraut originated here.
A lavish menu is offered everywhere and usually begins with distinctive h’ors d’oeuvre
Alsacien, a potage or bisque d’ecrivisse (creamed crawfish soup) followed by succien: plates of
trout and carp. Alsatian partridge may then appear, as notable an indigenous specialty as local
pate de foie gras and sauerkraut. This bird, as festive a fowl as our own Thanksgiving turkey, is
chosen for its plumpness and meaty tenderness.
The goose liver appears not only at meals but in toothsome snacks munched from time to
time and often accompanied by mighty mugs of beer. Both the beer and the wine of Alsace flow
as peacefully together as they do along the banks of the Rhine.52
A few weeks later a new publishing feather arrived for DeBakey to place
in his academic cap. Before leaving New Orleans, he had assisted Ochsner
in the composition of a chapter on diseases of the liver for a new textbook
of surgery. This was compiled and edited by Frederick Christopher of
Northwestern University, and Ochsner imposed a temporary moratorium on
his polemics against textbooks because of the promise that this would be a
constantly updated volume.* In March of 1936, DeBakey received word
that two copies of the new book were being sent, at his request, to
Strasbourg. One was for Leriche, of course: there was no better means of
demonstrating to the Professor his rising eminence in his homeland.
DeBakey had a third copy sent to his family in Lake Charles.53 The rewards
from this effort were not purely academic. Just a few days later a check
arrived by mail from Isabel Ochsner. In her elegant script she concluded
some personal remarks (including the information that the newly frisky
bachelor Mims Gage had a new love interest) with the note, “Alton says to
tell you that the enclosed check is from the Saunders Pub. Company for
Christopher’s.” 54
DeBakey finished his time as a trainee under Professor Rene Leriche at
the end of April 1936. He had been there a little less than eight months. It is
no exaggeration to say that he had made a strong impression on his
colleagues in France, both in and out of the Clinique. As Matas had posited
in the letter to Leriche, DeBakey did indeed become a member of the
distinguished fraternity of the great surgeon’s acolytes. Many of these men
became leading lights in the growing field of vascular surgery as the
century unfolded: as we will see, his close friends Kunlin and dos Santos
would make towering contributions. None of Leriche’s many brilliant
trainees, however, approached the level of achievement of the bespectacled
American with the tailored suits and pencil-thin moustache.
By mid-April DeBakey had heard from Ochsner that he was accepted at
Kirschner’s Clinic in Heidelberg. Fortunately, this was only 70 miles from
Strasbourg. He planned to be there in the first week of May.
A few days later, however, another letter arrived from Ochsner.
DeBakey’s father, who had come to know Ochsner well during Ernest’s
burn treatment in New Orleans, had contacted the Chief directly. He was
very concerned about the possibility of war in Europe. He hoped to enlist
Ochsner in convincing his son to return to the United States when the
Strasbourg period was complete.55 The Spanish Civil War would erupt to its
full horrific effect in July of 1936, but storm clouds had been gathering for
months: DeBakey’s roller pump patent assignee, George Lilly, had signed
off on a letter from December 1935 with the admonition: “in the mean time
you had better give yourself a gas mask for a present this Christmas.”56
Safe and secure in his Rhine Valley academic cocoon, DeBakey must
have wondered at the strange alarms his father could be heeding in still
farther flung southwest Louisiana. He could not have missed the newspaper
headlines that spring, though. Based on the change of original plans, a
compromise was evidently reached: DeBakey would continue on to
Heidelberg, but his time in Germany would be considerably truncated. He
could not pass up the opportunity to work with, and learn from, a man like
Kirschner, even for just a few months. He would return to the United States
in September 1936.
3.6 Germany
Martin Kirschner was born in Breslau, Germany (now Wroclaw, Poland),
and educated at several institutions, including the University of Strasbourg.
He was drawn to the field of surgery and became professor at the University
of Konigsberg, where the young American “exchange resident” Alton
Ochsner crossed his path.57 Later he moved to Tubingen to lead the
Department of Surgery. In 1934, he was elected President of the German
Society of Surgery and took up his post as the head of surgery in
Heidelberg.
Kirschner wrote extensively and described innovations across many
fields of surgery. He performed the first successful pulmonary artery
embolectomy, pioneered the field of stereotactics in an operation he devised
for trigeminal neuralgia, and was a leader in the scientific approach to
trauma. Kirschner wires (“K wires”) are still used commonly in
orthopedics.58
Ochsner did not mince words in his evaluation of the German surgeon: “I
have the utmost respect for Kirchsner and believe that he is one of the
greatest surgical minds living today. I am happy that you are having this
experience with him, because it is going to be of immense value to you in
later life.”59
As DeBakey was soon to find out, Kirschner was known for his highly
disciplined and even militaristic “Prussian” personality, which was reflected
in the operation of his surgical service. The contrast with Leriche could not
have been more stark.
[Leriche] didn’t pay too much attention to things like promptness, and if the operation started at
nine-thirty instead of nine it didn’t matter to him. His lectures were often delayed, too. And this
set the whole tone.
Kirschner was a strong disciplinarian He started in the morning at seven o’ clock sharp—right
on the minute. We always started x-ray conference and reviewed the patients for the day, and
this was promptly at seven. If any man walked in after he started—no excuse was acceptable.
His father could have died; your wife could have died, or anything else. They had no excuse for
being late. So everybody was scared to death of him.60
DeBakey quickly shifted lifestyle gears to adapt to this new milieu and
soon found that it suited him better than Leriche’s laissez-faire.
In the meantime, though, he had to learn German. Other than the brief
course he had taken at Tulane a few years earlier, he had no experience with
the language. Immersed in it as he was, it only took about six weeks for
DeBakey to become sufficiently serviceable to communicate in the Klinik
or on the street.
As in Strasbourg, DeBakey found lodgings in Heidelberg at a pension.
One of his most lasting memories of this place centered on a particular
communal meal at the boarding house in which the lodgers were served a
concoction called lung soup: “I guess about the only thing you can do with
a lung is make a soup out of it. I thought it was terrible. I couldn’t eat it.”61
Because of the rigidly regimented nature of Kirchsner’s service, as a new
young foreign trainee DeBakey was not given a great deal of responsibility.
Kirschner barely even acknowledged him at first. But DeBakey observed
carefully. He was favorably impressed by the tight schedule and highly
organized surgical team, and he took note of Kirschner’s strict, military
style with his trainees, admiring the efficiency. These were things he would
take with him. He also was impressed by Kirschner’s use of exercise
therapy to get his postoperative patients up and moving around soon after
their procedures.
Another innovation was Kirschner’s use of music, both on the wards and,
especially, in the operating room. The postoperative exercise treatments
were accompanied by marching music, which seemed to be helpful. In the
operating room, soft classical compositions prevailed: Kirschner often used
local and regional anesthetics in his operations, even open abdominal cases,
and felt that the music helped soothe his patient’s fears. Sometimes the
patients listened to the music through earphones while the surgeons worked.
DeBakey had never encountered music in the surgical suite before but
agreed with the advantages and determined to include it himself when he
reached a position in his career to do so.62
It was while he was in Heidelberg that DeBakey’s roller pump
transfusion apparatus came on the market.63 The Aloe Company sent one to
him in Germany, and, as he had at Strasbourg, DeBakey made himself very
popular among the hospital personnel with his ability to transfuse patients
quickly and cleanly.
Since Kirschner paid him little mind at first, DeBakey made the
conscious decision to focus his attention on the other residents and fellows.
As disciples of the Professor, they could impart his ideas and techniques
and were far more approachable. Among these were Oberärtze Dozent
Zugschwerdt Oskar Stör and Oberassistenten Fritz Linder and Rudolph
Zenker. Another of the assistant surgeons was Friedrich “Fritz” Ernst
Schanz.64
Schanz had just returned to Germany from some time spent in London.
He spoke English fairly well, which was a great help to DeBakey, and came
from a well-to-do family (Figure 3.4). He was one of the few surgery
trainees who drove his own automobile, a DKW Zweitrakt. The two men
swiftly became good friends. The May Wine Festival was celebrated only a
few weeks after DeBakey’s arrival, and Schanz drove his new American
companion to a number of cities and towns along the Rhine, sampling the
food and drink and flirting with the fraulein. DeBakey later recalled that at
the end of the day “I felt that I had consumed all the wine I needed for the
rest of my life. Indeed, it was a long time after that before I tasted wine
again.”65 On Friday evenings they often took Schanz’s car to the larger
town of Mannheim, about 10 miles away. There Schanz would deposit
DeBakey at a bier stube while he met with members of his local political
organization. After some time Schanz and his comrades would reappear and
join DeBakey for beer and sausages. Late at night, the physicians drove
back to Heidelberg.66
Figure 3.4 DeBakey with Ernst Schanz and Vada Odom, Heidelberg, 1936.
It was only later that DeBakey realized the members of Schanz’s group
were Nazis. In some sense, in his youth, the flip side of DeBakey’s
enormous scientific curiosity was an almost equal naïvete regarding things
political. He saw the Nazis marching in the streets, carrying shovels instead
of rifles, but by his own later admission he paid them little attention.
DeBakey was also aware of prejudice against the Jews during his brief time
in Germany but, in a sobering reflection, did not feel that it was much
different from what was to be found back at home. One manifestation of the
new political wave came to the door of his ivory tower, though, and could
not be ignored.67
DeBakey noticed that a large number of tubal ligations and vasectomies
—sterilization procedures—were performed at the Klinik. He assisted in
some of these operations, too. One day he summoned the temerity to ask
Schanz about this high volume of what, at the time, were relatively
uncommon operations and was informed that the majority were court-
ordered. Aghast, DeBakey pushed Schanz further: Why? By whom?
“There is a tribunal of three judges appointed to decide whether they
should be sterilized,” Schanz said. “They fall into a variety of categories. If
they’re insane, for example. Or if there is some genetic defect. Or if they
are of Jewish extraction with certain other conditions.”68
DeBakey was “astonished and appalled.” He had met some of these
patients. The other qualifications for sterilization would have been difficult
for him to identify, but none of them seemed insane to him. The whole thing
was outrageous and hideous. That was the end of his participation, or even
observation, of the sterilization procedures. The veneer of young DeBakey’s
political naïvete was gradually cracking.
Not all of DeBakey’s spare time was spent with Schanz. There were a
number of American students at the University, and they could be easily
found at the restaurants and beer halls around the school or in the shadow of
the landmark sixteenth-century red brick Heidelberg Castle. On one
occasion a newly graduated Vada Odom even visited, probably on a
Continental tour, and stayed long enough to have her photograph taken with
DeBakey, Schanz, and the probably less-than-enthused Diana—who may
have made a special trip over from Paris (Figure 3.5).*,69
Figure 3.5 Vada Odom and DeBakey, Heidelberg, 1936.
Kirschner eventually warmed up to DeBakey and even invited him to his

home for meals. In the years to come DeBakey always held Kirschner in
high regard and clearly modeled his future persona and surgical service
more on the German’s, but in his shortened sojourn at Heidelberg he did not
spend enough time with the Professor to develop the paternal bond that he
had with Rene Leriche.
DeBakey did not return directly to the United States when his time at
Heidelberg came to an end in August 1936. He went from the old university
town on the Rhine some 200 miles southeast to the Bavarian capital of
Munich, where, through the auspices of Ochsner and his new-found
continental colleagues, he was able to visit the Chirurgische Universitäts-
Klinik München.71 From there he took the train north to Berlin to meet the
famous Ferdinand Sauerbruch.
Sauerbruch was a true surgical giant, every bit the stature of Leriche or
Matas. His reputation as a fierce taskmaster exceeded even Kirchsner’s. A
star pupil of the legendary Mikulicz, he had paved the way for successful
operations on the thorax by inventing a special negative-pressure chamber
that allowed surgery to proceed without the atmospheric pressure collapsing
the lungs. He then made numerous other contributions to surgical science
and ended up treating such luminaries as a young Lenin and an old
Hindenburg. From 1928 on, he was head of the Surgical Department at the
Charité hospital in Berlin, and this was where DeBakey met him in late
August.*,72
Prior to his arrival in Berlin, DeBakey had managed to secure letters of
introduction from Matas, Ochsner, Leriche, and Kirschner. These messages
preceded him to the Charité, and, when he arrived there the weight of their
impact—four of the world leaders in surgery extolling this unknown trainee
—was clear: when he introduced himself at the academic office
Sauerbruch’s secretary, to his surprise, remarked that he was expected and
she would notify the Professor of his arrival immediately!73 Despite his
fearful reputation Sauerbruch greeted DeBakey warmly. After politely
inquiring about the health and professional circumstances of the authors of
the impressive letters of introduction, he invited the young American to join
him in the surgical suite to witness some procedures.
He had five tables in that room; five operating tables. He would go from one patient to the next
patient, to the next patient. For example, if one of the patients was having a thyroidectomy he
had one or two of his assistants prepare the incision and exposure. He’d come in, put his finger
around the thyroid, grab the blood vessels that he found with a big clamp and then cut it out. I
mean in five minutes he’d have that thyroid out. And then he’d pack it and move to the next one.
Let his assistants clean it up.
He had a gastric resection. He was there twenty minutes. He was moving from one patient to
another. He was only in the operating room about an hour and a half. He changed gloves and he
motioned to me and I followed him out. That was an extraordinary experience. I’ve never seen
anything like it.74
After this tour de force the two shared lunch in the Professor’s office.
Sauerburch apologized for not inviting DeBakey to join him at his home for
dinner; unfortunately, he had an official function to attend. It was a brief but
pleasant visit, and, despite what he had been led to expect about the
intimidating thoracic surgeon, DeBakey remembered that, “He was very
kind to me.”*,75
The next day DeBakey departed Berlin. He was headed back to America,
almost exactly a year after he had left. Diana, having resigned her position
at the American Hospital, joined him on the trip back. Their wedding plans
were well afoot by this time. The couple departed from France together
aboard the German luxury liner SS Bremen, arriving in New York City on
September 4.†,77
3.7 Homecoming
A welcoming party awaited DeBakey in New Orleans, thrown by Ochsner
and the Tulane Department of Surgery. DeBakey had been reinstated as an
Instructor in Surgery in July, and would receive a much-welcomed salary
increase in November. In the meantime, though, there was other business to
address.
In the second week of October, barely back in the country for a month,
Michael and Diana traveled to her father’s home in Dayton, Kentucky, a
suburb of Cincinnati. They were married there on October 12, 1936.78
DeBakey sent out announcements to his colleagues at home and abroad,
and soon the congratulatory messages began to roll in. The Ochsners sent a
special Western Union Wedding Greeting telegram, which read,
“Congratulations and best wishes on your wedding Stop We all wish we
could be with you and are in spirit Stop Let us know when you arrive so we
can have the rice ready Stop Best wishes and regards from everyone in the
department—Isabel and Alton.”79 Many others from among DeBakey’s
American friends and colleagues followed suit. Leriche, Kirschner, and
Ernst Schanz also sent their best wishes from across the Atlantic.80
DeBakey’s parents mailed a congratulatory letter and a $500 check.81
Back in New Orleans, the DeBakeys found a suitable apartment at 4719
Baronne Street, two blocks north of St. Charles Avenue and about midway
between the Tulane campuses.83
They had no honeymoon. The Ochsners were going on another European
trip themselves around this time, and they offered to let Michael and Diana
stay at their home while they were gone. This was in the shaded, upscale
part of the western Audubon neighborhood at 428 Lowerline Avenue. This
would not be a proper vacation, of course, but the Ochsners had an
excellent cook, and at least Diana would be spared that chore for a few
weeks. The catch was that the Ochsner children would still be at the house:
they were not coming on the overseas trip. The DeBakeys agreed to this
less-than-ideal substitute honeymoon arrangement and thus became
temporary babysitters to the Ochsner brood.84 Two of these, the eldest son,
Alton, Jr. (“Akky”) and the middle son, John, would be future surgical
trainees of DeBakey. Many years later John Ochsner would remember
hanging from young “Mike” DeBakey’s arm as he flexed: “He had a pretty
good sized bicep for a thin guy and my brother and I used to jump up on it,
grab it, and sit on it! Of course, I thought he was a very strong man.”85 He
also recalled that these temporary replacement parents were not always
minded by the Ochsner children, “I also remember Diana DeBakey trying
to get my younger brother to do something and he turned to her and said,
‘You don’t own me,’ and watching Dr. DeBakey laugh.”86
After DeBakey returned from Europe he continued to follow the sales of
his sleeve valve syringe and began to collect funds from the roller pump,
too. If he had ever had designs on achieving wealth through these devices,
he was surely disappointed.
V. Mueller and Company, manufacturers of the syringe, sent him a
reckoning of his royalty account in September 1936. This showed that, due
to their forwarding him about a dozen sets, along with such incidentals as
needles, valves, etc., he actually owed them $151.09! The last DeBakey-
Gillentine transfusion syringe apparatus to be manufactured was sold in
August 1940.87
Aloe and Company sent out royalty checks to the roller pump patent
holders DeBakey and Schmidt (and assignee Lilly) in the spring and fall of
1937. The first small checks were greeted with enthusiasm; later the
inventors began to wonder if they were “getting gyped.”88
The designs for these devices were ingenious, and their efficacy
unquestioned by those who used them or observed them in action. The
problem was the timing of their release. By the late 1930s, methods of
blood storage—anticoagulation and, especially, refrigeration—had
improved to such a degree that actual patient-to-patient direct blood
transfusion was becoming obsolete. The concept of a “blood bank” became
a reality in this period, and all the concerns of the reluctant prospective
manufacturers back to Becton-Dickinson’s Oscar Schwidetzky actually
materialized with the march forward of technology.
The DeBakey modified roller pump was not to be relegated to the
footnotes of medical history, though. Although its utility as a transfusion
device was short-lived, the pump would turn out to be of enormous value in
an altogether different use.
John Heysham Gibbon was a 27-year-old Fellow in Surgery at the
Massachusetts General Hospital in February 1931. Although he was
technically assigned to do research in the laboratory at the time, on one
memorable day that month he was summoned for patient care duties by the
Chief, Edward D. Churchill. A patient recovering from gall bladder surgery
had taken a distinct turn for the worse, and all hands were on deck. With
increased heart and respiratory rates and falling blood pressure, she was
correctly diagnosed with a postoperative pulmonary embolism. A large
blood clot had formed in the deep veins of her legs or pelvis and broken
loose—traveling through her venous bloodstream like a malevolent log
floating down a river—until it had lodged in her pulmonary arteries, the
vessels carrying blood from the right side of the heart to the lungs. There it
had blocked the blood flow, preventing her blood from being oxygenated
and putting enormous strain on her heart.89
Sometimes patients survived an event like this; often they did not.
Churchill had her moved to the operating room for close monitoring. The
operating team hovered by, ready to move immediately if necessary. Their
hesitation was born of caution: the operation to remove the clot, pulmonary
embolectomy, was a desperate one and not to be attempted unless death was
otherwise inevitable (Martin Kirschner had done the first successful such
operation in 1924).90
Gibbon’s job was to monitor the patient’s vital signs every 15 minutes.
He did this from her arrival in the operating room at 3:00 PM for 15 straight
hours until the next morning, at 8:00 AM. The OR team stood by at the
ready the entire time. At that 8:00 hour the patient’s respirations stopped
and her blood pressure could not be measured. Churchill and his team
immediately went to work. In 6 minutes and 30 seconds they opened the
chest, exposed the pulmonary artery, removed the clot, and clamped the
arterial incision closed. Despite this herculean surgical effort for the era, the
patient succumbed.
During his long vigil that night, Gibbon had ample opportunity to reflect
on how, in theory, the necessary operation could be performed without such
enormous risk and without waiting until the patient was almost dead to even
attempt it.
Watching the patient struggle for life, the thought naturally occurred to me that the patient’s life
might be saved if some of the blue blood in her veins could be continuously withdrawn into an
extracorporeal blood circuit, exposed to an atmosphere of oxygen, and then returned to the
patient by way of a systemic artery in a central direction. Thus, some of the patient’s
cardiorespiratory functions might be temporarily performed by the extracorporeal blood circuit
while the massive embolus was surgically removed.91
That night Gibbon found the task that would define his life: the search for
a means of cardiopulmonary bypass, a mechanism by which the entire
function of the heart and lungs might be duplicated by machines while the
bypassed structures were surgically addressed.
The fundamental challenge broke down to two issues: the pumping of the
blood (replicating the function of the heart) and gas exchange (adding
oxygen and removing carbon dioxide from the blood, simulating the
function of the lungs).
The experiments were painstaking and progress was gradual. There were
bugaboos with each of the primary problems of pumping and gas exchange.
A particular frustration arose from controlling the movement of the blood:
the pumps that Gibbon used were limited in capacity and were damaging to
the red blood cells. These were so-called finger cot pumps. They
surrounded the rubber tubing through which the blood moved and were
alternately compressed and expanded by compressed air. Because the blood
could move in either direction with this method, flap valves had to be
present in the tubing, which added to the inconvenience, deviated from
physiology, and threatened more injury to the cells.
At the American Medical Association annual meeting in St. Louis in May
of 1939, Gibbon exhibited his primitive heart-lung machine. One of the
interested observers was DeBakey, who was demonstrating his own roller
pump nearby. The two men introduced themselves and began talking.
Gibbon told his new acquaintance about the challenges involved with his
apparatus, particularly the finger cot pumps. DeBakey showed him the
roller pump with his flange modification and explained that it was simpler
than Gibbon’s machine, less likely to injure the red blood cells, and capable
of moving greater volumes. It also did not require valves. Gibbon was
suitably impressed and asked if he could get a model of the roller pump.
After the two returned home DeBakey sent him one.92
By the latter part of that year Gibbon had already published and
presented on his new cardiopulmonary bypass device, which incorporated
DeBakey roller pumps.93
3.8 Instructor in Surgery

DeBakey naturally wanted to write up the research work he had done
overseas, particularly the papers he had already published in French, which
only required translation.
By a lucky coincidence, Ochsner was editor of a new journal, Surgery,
which needed quality articles to get off the ground and establish a
reputation. Ochsner suggested that an article DeBakey had written with
Leriche for the European journal Medicina Contemporanea on the surgical
treatment of the skin disease scleroderma might be a good contribution.
This article, “The Surgical Treatment of Scleroderma: Rationale of
Sympathectomy and Parathyroidectomy,” did appear in the first edition of
Surgery in January 1937.94
DeBakey also decided to edit some of his own diary, which contained
lengthy descriptions of Strasbourg and the University Hospital, into an
article about Leriche’s Clinic. At this point in time, medical journals
frequently published papers of this nature; “travelogues” that allowed their
readers a glimpse of the inner workings of a well-known hospital or clinic.
Ochsner thought this might also be a valuable addition to one of the early
editions of Surgery.95
The co-editor of Surgery was Owen H. Wangensteen, the Chief of
Surgery at the University of Minnesota, already a figure of note and before
long a legendary surgeon and scientist in his own right. Ochsner sent
Wangensteen DeBakey’s manuscript on the Strasbourg clinic. This
contained such self-conscious prose as: “Celebrated throughout the surgical
world for his prolific and fructiferous activities, his unceasing originality of
thought, his numerous perspicuous disquisitions, and his perennial
expositions on the surgery of the sympathetic system, Professor Rene
Leriche has made this clinic a cynosure for students from all corners of the
world.”96
In his written reply, Wangensteen politely indicated that the paper was
fine, but he was not enamored by the florid style. He memorably noted: “I
have gone over the DeBakey manuscript which is very well done despite
the many obvious polysyllabic cacophonies.”97
The article was not published in Surgery, but eventually appeared, with
the title “The Clinic of Professor Rene Leriche,” in the New Orleans
Medical and Surgical Journal.98 Alberto Saldarriagga, the first co-fellow
DeBakey had met in Clinic A, who was now back home in Colombia, was
listed as co-author. Despite Wangensteen’s withering assessment, DeBakey
did not change a word from his handwritten manuscript (which came nearly
unaltered from his diary).
DeBakey and Ochsner combined forces on a dizzying number of original
research papers after Michael’s return from Europe. Although DeBakey was
still technically a trainee at this point—Instructor in Surgery—Ochsner had
obviously grown quite close to him and began to rely on his skill and
judgment more and more—both in the laboratory and on the wards. Both
men rose very early in the morning, and Ochsner, whose home on
Lowerline was closer to the Uptown Tulane campus, would pick DeBakey
up in the predawn hours and drive him to Charity and the Hutchinson
Building.99
Some of their papers involved experiments in the lab and some did not,
but all required exhaustive background research, and DeBakey approached
this with a unique zeal. John Ochsner related the reminiscences of his
father’s long-time secretary, Gertrude Forshag, who knew DeBakey well.
When he prepared a paper for publication, he got every piece of material available on the
subject. The library had a rule about the number of books a person could check out at one time,
but this did not daunt him. He simply checked the books out in the names of secretaries and
medical technicians in the department. He would walk up and down the table checking the
material.100
Forshag remembered more details about DeBakey from this time,

particularly with regard to his unusual culinary habits.
Dr. DeBakey was always very thin and she was astounded at the amount of food he could eat.
The department used to send a porter out to get lunch. Dr. DeBakey would order a poor-boy
sandwich, which was a whole loaf of French bread filled with meat and cheese. He would also
drink two cokes while eating the poor-boy. After eating and drinking all of this, he was always
ready to have candy or cake, or maybe some fruit that someone had brought from home. It was
amazing to see all the food he could eat and not gain an ounce.101
After World War II, it was common to see art and photography divisions
in major university surgery departments, but before that time the nuts and
bolts of assembling research articles for the top academic publications were
performed by the authors themselves. In the late 1930s, at Tulane, it was not
an unusual sight to see DeBakey, or even Ochsner—who had always made
his own presentations—in the darkroom, developing photos or composing
lantern slides. On one occasion, a young staff member who was searching
for the Chief called into the darkroom. Ochsner responded that yes, he was
in the studio, doing some enlarging. The junior man asked if he could send
something in to be enlarged. Ochsner said, “Sure, what is it?”
“My pay check.” 102
In 1937, the DeBakeys moved from their apartment on Baronne to
another at 7401 Burthe Street, just a few blocks west of the Tulane Uptown
campus. This neighborhood was much more familiar and not far from the
Ochsner residence.103
What Ochsner and DeBakey did not finish during their extended hours of
the ordinary work week, they continued to tackle on weekends. On
Saturdays they wrote at the Surgery Department office next to Charity, and
on Sunday afternoons the composition moved to the Ochsner home on
Lowerline Street. When the writing was finished they indulged in an
Ochsner family traditional repast. As John Ochsner recalled:
He and Daddy would work every Sunday, all afternoon. They would sit in dad’s office and write
papers. They’d start around noon and go to about five in the afternoon. And then when they’d
quit, they’d sit downstairs with a tumbler of milk and mama would make some popcorn. They’d
take that popcorn and put it in the milk with a long ice tea spoon and eat it. They’d ask me to
have some and I’d say, no, you just ruined the milk and you ruined the popcorn!104
Although their scholarly approach to the composition of research articles,

and certainly to the conduct of the research itself, was shared and
complementary, the writing styles of the two men could not have been more
different. In contrast to DeBakey’s elegant, ornamental style, which early in
his career could be opaque and even pretentious, Ochsner favored a
straightforward prose that dispensed with flourish in the interest of pure
communication.
He taught me something about scientific writing. I was never a great admirer of his style of
writing, because it was not in the more classical style. It was very simple, straightforward. I
remember one time I wrote an article and he said, “You’ve got too many words. A polished
lobby.” I liked to try to find the word that I thought fitted best. So I was constantly thumbing
through a book of synonyms and checking the dictionary and getting the shades of meaning of
various definitions that were given. He would not agree with this; he said there wasn’t any point
in finding another word, when you could use a very simple word. So he did teach me something
about that.105
One of the articles co-written by the two during this period is of interest
because of the pivotal role DeBakey would play in the years to come in
advancing its nominal subject, “The Surgical Treatment of Coronary
Disease.”106 In these years before the ability to revascularize the heart
directly through surgery, the authors identified three existing modalities for
the relief of angina pectoris and coronary disease. These were sympathetic
nerve sectioning (which seems at the time to have been considered for
every possible indication), thyroidectomy (to diminish the metabolic
demands placed on the heart), and stimulation of collateral circulation to the
heart by abrasion—essentially roughing up the heart tissue to induce the
growth of new blood vessels. None of these approaches has survived, of
course, but in retrospect their descriptions exude a noble desperation.
Articles by the duo that were of greater clinical importance at that time
and beyond concerned the problem of liver abscesses. These pockets of
infectious material frequently appeared after patients suffered from
appendicitis or perforated hollow viscera, such as ulcers of the stomach or
duodenum. In the pre-antibiotic era any serious infectious disease was
potentially life-threatening, and even after the advent of antibiotics
abscesses usually required drainage for resolution. Ochsner presented a
comprehensive paper on so-called subdiaphragmatic or sub-phrenic
abscesses—those found outside the liver, in the spaces of the abdominal
cavity—back in 1933, reporting on data culled from more than 3,000 cases
found in the world literature, including 50 new ones of his own.107
After this, Ochsner had decided to cover the entire topic of liver
abscesses in the most definitive way possible, in two articles for the
American Journal of Surgery. The first of these, “Liver Abscess, Part 1:
Amebic Abscesses. Analysis of 73 Cases,” appeared in 1935 and was co-
written with DeBakey, just before his departure for the European
sojourn.108 The second installment, “Pyogenic Abscess of the Liver: II. An
Analysis of Forty-Seven Cases with Review of the Literature,” by Ochsner,
DeBakey, and a junior resident named Samuel Murray, came out in the
April 1938 issue of the American Journal of Surgery.109
In addition to the reporting of dozens of new cases of these lesions, this
trilogy of papers examined and analyzed the accumulated data of all the
published world cases of the entities discussed. As such, they were
complete, up-to-date summaries of the known information regarding
subdiaphragmatic and hepatic abscesses, with encyclopedic, comprehensive
annotations for reference (the “Pyogenic Abscess” paper alone referenced
229 separate sources).110 Moreover, in each case the authors made
compelling arguments for what they advocated as the best treatment options
available (in summary—surgical drainage of the abscesses in a manner that
avoided contamination of the pleural space around the lung or the peritoneal
space around the abdominal viscera). No scholarly articles published on
these subjects—before or since—have ever matched their scope, and the
fact that they were written in an era predating, by decades, electronic
literature searches or computerized data analysis represents an astonishing
achievement. No meaningful article on these topics omits them as a
reference, even 80 years later.
Nevertheless, another set of papers by Ochsner and DeBakey during this
period of the late 1930s into the early 1940s would have even greater
significance. Much later it would be seen as a bellwether to one of the
greatest global public health concerns of the entire century.
3.9 Tobacco
Before the 1930s, lung cancer was rare. In fact, into the first decades of the
twentieth century it was a “reportable” disease, so unusual that it was
considered incumbent on a physician who encountered the condition to
publish about it or report it to a government health authority. A publication
from 1912 noted that only 374 cases of lung cancer had ever been reported
in the world and went so far as to say, “On one point, however, there is
nearly complete consensus of opinion and that is that primary malignant
neoplasms of the lung are among the rarest forms of disease.”111
Slowly and insidiously, that began to change.
At first, the increase in cases of lung cancer was barely noticed, hidden
among government mortality statistics and autopsy series reports in the
pathology literature. A few scattered clinical reports, mainly in German-
language journals, hinted at the new problem and even suggested its true
cause, but these were not widely read or discussed.
In 1933, though, Evarts Graham, a noted surgeon at Washington
University in St. Louis (one of the institutions where Ochsner had trained)
reported the first successful “pneumonectomy,” or surgical removal of a
lung, for cancer.*112 In and of itself this was a ground-breaking
achievement, one of the early highlights in the young and gradually
expanding field of thoracic surgery. Beyond that, however, it served as an
impetus to others to seek out similar cases for the new, spectacular
procedure. Ochsner himself had the Tulane residents canvass Charity
Hospital, looking for patients with the disease who might be amenable to
the aggressive operation. They found them, too. There were not many at
first but, as the 1930s unfolded, more and more appeared at Charity and
throughout the world.
Ochsner’s entire medical school class was summoned one day in 1919 to
see the autopsy of a lung cancer patient because, as the Professor said, “they
might never see another one.”113 It was 17 years before he did, in 1936—
but he encountered eight more in just the next six months. Early in this new
epidemic of lung cancer—and even later, when the evidence was far beyond
reasonable doubt—some had wondered if the phenomenon of the increased
incidence was real or merely a reflection of an increased awareness and
recognition of the disease. A tidal wave of new cases put such
considerations to rest among the sensible: the rise in cases was genuine.
Ochsner performed the first pneumonectomy for lung cancer in the South
on April 22, 1936. By 1938, he had performed seven. The results were not
especially encouraging, but he felt justified in continuing since death was
the inevitable outcome without surgery. He also felt that he should report
the results of the efforts, after the fashion of the liver abscess papers.
As in the last two of the earlier publications, DeBakey did the lion’s
share of the background research. When he was complete, the authors were
able to report 79 cases of pneumonectomy for lung cancer from the world
literature and add seven more of their own (by the time the article made it to
press, they had added two more to their series).114 In the paper they made
some technical recommendations and included details about diagnosis and
pathology, but the bombshell came from their consideration of the cause of
this disease and why its incidence had increased so greatly in recent years:
“In our opinion the increase in smoking with the universal custom of
inhaling is probably a responsible factor, since inhaled smoke, constantly
repeated over a long period of time, undoubtedly is a source of chronic
irritation to the bronchial mucosa.”115
This was not an entirely new idea: as far back as 1923 there had been
speculation in the literature that smoking was a factor in the production of
bronchogenic carcinoma.116 The earlier authors had advanced no proof of
this, of course, and Ochsner and DeBakey were on shaky scientific ground
with their assertion, too. Other theories had been advanced over time as the
serious nature of the situation became apparent: one thought was that the
influenza epidemic of 1918, which had injured the bronchi of innumerable
individuals, had thus predisposed these victims to malignancy. Another
concept was that the horrific poison gas of World War I had contaminated
the atmosphere. Still another theory postulated that automobile exhaust was
the cause of all the new cancers.117
The physicians actually treating the disease had a focused perspective,
though, and the sensible among them realized that it was both impossible to
ignore the correlation of smoking with the presence of the disease—
virtually all who came to treatment were long-term smokers—and illogical
not to make the causal connection. Not all agreed, however—and some of
the most damaging dissension came, not long after, from a surprising and
powerful source.
Ochsner presented this first paper from Tulane on the emerging new
problem of lung cancer at the Clinical Congress of the American College of
Surgeons in New York in October 1938.118 The paper was received with
respect, if not enthusiasm, and its condemnation of tobacco smoking as a
likely etiology for pulmonary malignancy did not elicit much response. But
DeBakey and, especially, Ochsner—who harbored an almost obsessive
animosity toward smoking and blamed it for far more than lung cancer—
were not finished, by a long stretch.
As their clinical experience continued to grow, in the next two years, the
Tulane duo followed this first paper up with two more published in the
national journals.119
In the first article, which appeared in Ochsner’s own Surgery, the two
surgeons politely refrained from even considering the cause of the disease,
focusing on the technical aspects of its surgical treatment. It was in the next,
published in the American Medical Association’s Archives of Surgery, that
they came out with both barrels blazing.
Well aware that actually proving a causal relationship between tobacco
smoking and lung cancer would be exceedingly difficult, DeBakey and
Ochsner decided instead to expose and publicize the dramatic correlation
between sales of cigarettes in the United States and the rate of death from
lung cancer.* They obtained the sales figures from the US Department of
Commerce and the death numbers from the Public Health Service. The data
were striking—especially depicted as a graph in which the two curves of
increasing cigarette consumption per capita and increasing rate of death
from lung cancer were essentially parallel.120
Ochsner presented this compelling data at the American College of
Surgeons meeting in October 1940.121
To Ochsner and DeBakey’s surprise, their position was attacked at this
conference by none other than Evarts Graham, the surgeon who had
performed the first successful pneumonectomy. Graham, who was himself a
heavy smoker, agreed that the correlation between lung cancer deaths and
rate of smoking was impressive but pointed out that he could generate an
identical graph using the production of silk stockings in place of the
consumption of cigarettes. Graham’s point was that correlation did not
necessarily imply causation, which was true as far as it went.122
With the advantage of hindsight it is easy in this drama of cancer and
cigarettes to cast DeBakey and, especially, Ochsner (who staked a major
part of his career on his anti-smoking convictions) as dauntless crusaders
battling the forces of greed and ignorance to inevitable victory and glory.
The reality is not so simple, though. They certainly did come down on the
right side of history and, eventually, science. However, the majority of
physicians sided with Graham and the other naysayers for years, even
decades. Many, if not most, physicians smoked themselves—conferences,
including ones on lung cancer, were noted for the heavy clouds of smoke
drifting over the meeting rooms—and did not believe they experienced any
deleterious effects. Even Mims Gage, despite his close friendship with
Ochsner, was a smoker and confessed to ruining many garments, as well as
nearly immolating himself, by attempting to hide or extinguish cigarettes in
his pockets when he saw the Chief approaching.123 Ochsner and DeBakey
were esteemed by their colleagues in the academic world for their integrity
and obvious contributions, but the anti-smoking position made them
outliers. Some even saw their stance as eccentric or crackpot.
When he realized that he could not prove a causal relationship, DeBakey
began to drift away from consideration of the smoking problem. “I drew
back in the sense that I didn’t have the data. There’s no question in my mind
that smoking is harmful to you in some respect, though I can’t prove that it
causes cancer of the lung, that’s all.”124 Ochsner, by contrast, never
wavered from his zealous fight against tobacco, and ultimately became
better known for that than for any of his other contributions to medical
science. In response to the doubters, whose numbers dwindled with the
passage of time (both by attrition and the force of argument) until they were
mostly stakeholders in the tobacco industry, Ochsner related a tale that he
insisted—with a wink—came from Russian legend.
There was a certain Russian count who suspected his comely young wife of infidelity. Hoping to
arrive at the truth, he made a production of informing her that he had to leave on an extended
trip. In reality, he merely took up temporary residence at a nearby home to spy on her. The very
next night a young officer arrived at his home and left with his laughing wife in a sleigh. They
sped to the officer’s chalet. The count followed, and watched by candlelight through the
bedroom window as his wife and the officer disrobed and embraced passionately. The couple
then extinguished the candle and the room went dark. “Proof! Proof!” lamented the count,
pounding his brow. “If only I had proof!”125
In a footnote of pathos and classical tragedy, Evarts Graham eventually

came to agree with Ochsner and DeBakey’s assessment of the role of
smoking in lung cancer, apologizing for his “facetious” silk stocking remark
and admitting that he “may need to eat humble pie.”126 To his great credit,
Graham became another vocal and public crusader against tobacco.
Unfortunately, he was too late to save himself. Graham died of lung cancer
in 1957.*
3.10 The Lab

Both DeBakey and Ochsner were eager to grow the field of thoracic surgery
at Tulane and Charity in the late 1930s. The explosion in the number of
lung cancer cases in that period was the most dramatic impetus, but there
were other disease entities that begged such expertise, such as cancer of the
esophagus and a few nonmalignant pulmonary and esophageal maladies.
The techniques of rigid bronchoscopy and esophagoscopy were coming
into their own in the diagnosis of these disorders, and Ochsner arranged for
DeBakey to travel to Chicago in the fall of 1938 for specialized training. He
spent a few weeks there with one of the leaders in this field.128 In a letter to
Leriche, DeBakey whimsically described his mini-fellowship as “mes
vacances que j’ai fait a Chicago.”129 After this, he performed all the
endoscopic procedures in the Department of Surgery.
DeBakey was now doing enormous amounts of experimental animal
surgery in the lab, operating more there than in the Charity operating rooms.
At first, the projects were under Ochsner’s direction.
I liked to write, I liked to do research and he’d assign me some of the research work in the lab. I
ultimately became head of the research laboratory—I ran it. I’d sometimes do as many as thirty
dog operations in a day, and that’s really how I developed the concept of organizing my surgical
work so that I could do things. I’d have four operating tables . . . I learned to use my technique
in a more effective way. I became technically quite adept. I was doing the basic things in
surgery, cutting and tying and so on.130
In fact, Ochsner sometimes grew concerned that DeBakey spent too

much time in the lab and writing and not enough taking care of patients. As
he later observed, “(DeBakey) didn’t like to operate. I literally had
difficulty getting him to go into the operating room. He wanted to write. He
would love to do something until he mastered a technique. Then he lost all
interest in it. He didn’t care much about teaching, either.”131
By his own admission DeBakey was a perfectionist even at this early
stage of his career, possessed of an “intolerance of mediocrity and
carelessness. I was that way as a resident.”132 As an Instructor in the
Department of Surgery he was required to give lectures to the medical
students several times a week, in addition to helping educate the interns and
junior surgical trainees. His extraordinarily high standards and impatience
with those who did not meet them earned him at this time a sobriquet which
would stick with him among legions of trainees to come: “Black Mike.”133
One reason for DeBakey’s avoiding the operating rooms at Charity in the
late 1930s may have been their unsettled, and for a time even nonexistent,
status.
Among Huey Long’s several pet projects—before his dramatic demise—
was the construction of a new Charity Hospital in New Orleans. As noted
earlier, the centerpiece of the existing institution in the 1930s was fully a
century old; cracking both literally and figuratively under the strain of age
and an overwhelming patient volume (the hospital typically housed upward
of 2,000 individuals).*134 In 1933, Charity had applied to the federal
government for funds to construct a new hospital via the Public Works
Administration, President Franklin Roosevelt’s New Deal program for
large-scale public construction projects.135 Long, however, was engaged at
that time in a political feud with Roosevelt and—in his inimitable,
serpentine manner—brokered a new law through the Louisiana state
legislature prohibiting the use of federal funds for such a purpose (although
he was a US Senator at the time, Long was still firmly in charge of
Louisiana state politics). Consequently the Kingfish actually quashed his
own plan rather than allow Roosevelt a portion of the credit in its
realization. Fate intervened by means of the bullet in Baton Rouge,
however, and, with Long’s death, the Charity project took on new life.
Louisiana’s state ban on federal funding was lifted, Long’s former political
team threw their weight behind Roosevelt’s re-election in 1936, and federal
money was duly appropriated through the Works Progress Administration. †
Old Charity was razed early in 1937, and a dazzling 20-story “New
Charity,” the tallest building in the city, was opened to great fanfare in
1939. It was the second largest hospital in the United States.137
Ochsner had been interested in diseases of the leg veins for a number of
years. In the early 1930s, he had written several papers on the physiology of
venous insufficiency as well as its diagnosis and treatment. When DeBakey
returned from Europe, with his interest in vascular diseases reinforced by
his time with Leriche, it was natural for the two to join forces against the
problems of diseased veins and blood clots. Ochsner later remembered:
In the 1930s DeBakey and I, because of an observation made on Grand Rounds at the Charity
Hospital, became interested in the role of sympathetics in thrombophlebitis. A female patient
had been transferred from the obstetrical service because of massive venous thrombosis of the
left lower extremity. The surgical residents hated to see one of these patients admitted to our
service because they occupied one of our active surgical beds and there was little we could do
for them. They remained in the hospital for four to six weeks, were discharged, usually with
massive edema, to the outpatient department. They were followed for weeks, months, even
years, and sometimes the rest of their lives because of the disabling postphlebitic sequelae.
Although the paradox we observed that morning on Grand Rounds must have been observed
previously, no one had ever called attention to it.138
The paradox they noted was that the patient’s affected leg was painful,
cold, and white (a condition neatly summarized by the still-used Latin
diagnostic term phlegmasia alba dolens) while the rest of her body was
feverish. As an apostle of Leriche, DeBakey quickly theorized that the
sympathetic nerves might be mediating the deleterious limb effects and
suggested anesthetizing them with a local agent to see if that might help.
When this was done the patient’s symptoms swiftly, if transiently, resolved.
Ochsner and DeBakey took these observations into the lab and developed
an experimental model of the phlegmasia disease process, then
demonstrated that the main source of the clinical manifestations was spasm
of the very small arterial vessels known as arterioles. When this spasm was
relieved by sympathetic nerve block, the symptoms improved.139
Next the two surgeon-scientists tackled the problem of venous blood
clots themselves. They knew that some thromboses of leg veins were
relatively benign, with essentially self-limited clinical courses, and that
others were ominous and could be associated with migration into the lungs,
the frequently fatal entity known as pulmonary embolism. Going back to
the original work on the subject by the great German pathologist Rudolph
Virchow, they defined two separate types of venous thromboses but
extended his work further into the clinical realm. They named the benign
type “thrombophlebitis,” implying by nomenclature that the clot caused an
inflammatory reaction in the vein. These lesions, they argued, were
relatively safe from the specter of embolization, although they tended to be
more symptomatic. The inflammation made the “white thrombus” of this
process adherent to the vein wall and thus unlikely to dislodge and migrate.
On the other hand, the second type, “phlebothrombosis,” presented real
danger. These “red thrombi” were not associated with inflammation of the
wall and thus adherence was not a characteristic: they could easily break off
and lead to life-threatening cardiopulmonary emboli. They also could be
asymptomatic because of the absence of inflammation. Ochsner and
DeBakey affiliated this type of thrombus with the immobility and
associated tendency to forming blood clots (“hypercoagulability”) of
postoperative surgical or trauma patients.140
DeBakey published a number of other papers with and without Ochsner
in the late 1930s and early 1940s that revealed the breadth of his surgical
interests and ingenuity, even if they did not all become classics. Several
were on the subject of his long-term interest—transfusions—including an
editorial on the reported Soviet solution to the problem of blood storage: the
transfusion of cadaver blood. Other papers, written in the lengthy, well-
referenced style that was now DeBakey’s signature, covered the topics of
bezoars and, reminiscent of his master’s thesis, perforated gastroduodenal
ulcers. Always thinking of ways to innovate, he wrote articles on new types
of surgical clips and clamps for lung and bowel procedures. He also
developed a radical rethinking of the scalpel. In this latter paper, published
in the American Journal of Surgery in 1940, DeBakey proposed a surgical
blade with a rounded, rather than pointed tip, which would allow for a
wider range of angles to approach the tissue (he reckoned that a
conventional scalpel could only address the tissue at angles ranging from 15
to 45 degrees, whereas his new design allowed from 15 to 90 degrees).141
Mims Gage was married in 1937, to the love interest Isabel Ochsner had
mentioned in her letter to DeBakey. It was a typically hot New Orleans
summer day, in the time before air conditioning was common. The
bridegroom, dressed appropriately, was sweltering. When the crowd threw
rice at the newlyweds, much of it got under his collar and stuck to his
perspiring skin. Gage discreetly asked DeBakey to drive him to Michael’s
apartment for a quick shower and change before leaving for the
honeymoon. Once there, DeBakey told Gage he was going to stop by the
hospital to do some work while Gage freshened up.
Hours passed and DeBakey did not return. Gage, stuck at DeBakey’s
apartment, did not know what to do. His bride wondered if she was being
left at the altar after her wedding, which would have been a unique twist on
the old cliché. DeBakey finally called to say that he was in the Emergency
Room, as a patient for once. In his haste he had crashed his car and broken
his wrist.142
There are stories of DeBakey’s fast driving from every phase of his life.
People who knew them both and were their passengers thought that only
DeBakey drove faster than Ochsner. Since DeBakey and Gertrude Forshag
lived close to each other and often worked late in the same office, he
frequently drove her home on weeknights. This was a white-knuckle affair
for Ochsner’s secretary, and the wonder is why she continued doing it.
DeBakey became instantly impatient if a car in his way did not move aside
quickly enough after a blast from his car horn, and he would accelerate and
pass it in the opposite lane even if there were oncoming traffic. Forshag
remembered thinking they would be in a collision many times, but they
never were.143
Including Forshag, DeBakey had a relatively small circle of friends in the
late 1930s. The Ochsner family was obviously of great importance to him,
and all the Ochsners and DeBakeys of these generations remained close
throughout their lives. Alton Ochsner—and Mims Gage, too—were paternal
figures, given their ages and relative professional statures. DeBakey’s
parents and, by extension, his siblings came to revere both of these mentors
of Michael’s, especially through their treatment of Ernest for his burns.
There were also, of course, contemporaries who were close with
DeBakey in this period. William Gillentine, co-inventor of the sleeve valve
syringe, who was a trainee in internal medicine at Charity and Tulane and
eventually joined the faculty, remained a close friend. So did Charlie Odom,
who also stayed on at Charity as a staff surgeon, actually attaining the rank
of Senior Visiting Surgeon before DeBakey (his brother Guy became a
neurosurgeon, enjoying a long and illustrious career at Duke University).144
George Lilly and “Ernest” Schmidt, who helped with the roller pump, were
also good friends. Of course DeBakey kept in touch with the other trainees
from Leriche’s and Kirschner’s clinics, including Alberto “Saldi”
Saldariagga, Joao Cid Dos Santos, Adolphe Jung, Jean Kunlin, and Ernst
Schanz.
A new arrival at Tulane and Charity in 1937 was the young neurosurgeon
Dean Echols, who had already been among the first to describe the
physiology of spinal cord compression by herniated intervertebral discs.
Echols and Debakey soon recognized that they were kindred spirits; both
serious clinical surgeons and researchers with concordant personalities.
Echols, however, had a dry sense of humor that was much more developed
than DeBakey’s.
On one occasion, Echols called DeBakey and asked him to come over to
see his new car. When DeBakey arrived at Echols’ home, he found the
neurosurgeon next to the new vehicle, holding a hammer. DeBakey asked
why he had a hammer, and Echols replied, “Watch.” Then he pounded the
tool down on the car. DeBakey, aghast, asked why on earth he had done
such a thing. A smiling Echols answered, “Now I don’t have to worry about
the first dent.”145
At another setting Echols was performing a lumbar disc operation, the
procedure he had helped pioneer, on a patient who happened to be the
president of a local labor union. The anesthetic was a lumbar regional
block, so the patient was awake. When Echols was done, he decided to
tease the union man. “Oh my God, it’s 12 o’ clock,” he exclaimed. “I’m
almost finished, but not quite. We’ve formed a doctor’s union and this is my
lunch break. I’ll just put a sterile dressing on the wound and come back in
an hour to finish.” The patient started yelling, “No, don’t do that! I’ll pay
you time-and-a-half overtime! Don’t leave me!” Echols sighed and shook
his head: union rules were union rules. He took off his gown and gloves and
left. Soon enough, of course, the union man realized that he had been
tricked.146
In 1937, the ##American Board of Surgery (ABS) was incorporated. In
concert with the general trend of the decade toward standardization of
postgraduate surgical education and assessment of expertise, the ABS was
formed with three stated purposes: first, to conduct examinations of
appropriately qualified candidates; second, to issue certificates to those who
completed the examination process successfully; and, third, to set standards
and to broaden and improve the opportunities available for the graduate
education and training of surgeons.147
The prime movers in the founding and governance of the Board were the
leading academic surgeons, and so Ochsner was a big proponent of the idea
(he was grandfathered in without having to take any exam, as were many
senior surgeons and anyone holding the academic rank of assistant
professor or above).148 If Ochsner thought it was necessary for him to take
the examinations, then DeBakey really did not have a choice in the matter.
He applied to take the test and, based on his qualifications in training and
experience, was accepted.
The test was administered in two parts. The first part was an all-day
written examination in two sessions. There were six or seven essay
questions (depending on the session) intended to measure the candidate’s
knowledge about common diseases across the spectrum of the practice of
general surgery. As has always been the case for examinations of
significance, the examinees passed around copies of previous tests in hopes
of gaining some upper hand (the questions on Part One changed every year,
so, at most, the examinees got a sense of the type of inquiries to expect).
DeBakey exchanged old tests with George Lilly, Charlie Odom, and others
of his approximate cohort.149
DeBakey passed the first part of the exam on April 4, 1939, without
difficulty, then steeled himself for the far more stressful second part. As the
ABS grew and demand for its certification increased, these exams were
administered at more and more centers across the country, typically at
university hospital settings. DeBakey traveled to Atlanta’s Grady Memorial
Hospital, affiliated with Emory University, for his second exam, which was
given on November 15, 1939.150
One of the most important elements of the test was the clinical
evaluation, in which the candidate was given several minutes to examine
and question an actual hospitalized patient and to review pertinent clinical
information, such as lab values and x-rays, before submitting to the
examiners’ inquiries. In a sense, this was similar to the method of Ochsner’s
Bull Pen, but with more far-reaching consequences. Seldom has an
examinee in any testing environment had such remarkable good fortune as
attended DeBakey on that day in Atlanta:
My patient was a black man, about 40 years of age, who had had an emergency appendectomy
for acute appendicitis about 10 days earlier. Since then, he had persistent pyrexia and
leukocytosis.* His chief complaint was feeling “poorly,” with abdominal discomfort, especially
when lying on his right side. On examining the patient, I noted moderate tenderness along the
right costal margin and acute localizing tenderness over the right 12th rib. On reviewing the x-
ray of the chest, I observed some moderate elevation of the right diaphragm.
My examiners, Drs. Fred Rankin and Harvey Stone, were both nationally recognized as top
leaders in American surgery.
Dr. Stone began by asking me to offer a diagnosis, along with my rationale for it. I presented
the findings and, on that basis, stated that I was reasonably sure the diagnosis was subphrenic
abscess. At that point, Dr. Rankin interrupted to tell Dr. Stone that he had read the article
“Subphrenic Abscess,” written by Dr. Ochsner and me, which had just appeared. . . .
Dr. Rankin concluded with, “This young man knows more about this subject than we do.” Dr.
Stone, who had not yet seen the article, replied that he looked forward to reading it, commended
me on my presentation, and added: “Fred, I don’t see any point in continuing with this
examination.” I was then cordially dismissed, to my distinct relief.*,151
DeBakey was awarded ABS certificate number 172.152

In that same year the DeBakeys moved from their apartment building on
Burthe Street to a duplex home address at 6034 Prytania Street, on a
picturesque block in the familiar Audubon neighborhood, more befitting
Michael’s rising social status.153 They also needed more space because of
the arrival, on July 20, 1939, of their first child, Michael Maurice DeBakey.
Young Michael, who was nicknamed “Mickey,” was baptized at St.
Andrew’s Church in New Orleans on November 5, 1939. The
sponsors/witnesses were Alton Ochsner, William Gillentine, and Lois
DeBakey.154
In the late 1930s, the DeBakey presence at Tulane and Newcomb was at
its apogee. Selma graduated in 1937, and Lois in 1940. Both of their
academic records were excellent; Lois made Phi Beta Kappa.155 After the
painful and difficult delays associated with his burns around Christmas
1935, Ernest finished medical school on time in 1939. He then served an
internship at Charity before going to St. Louis to study thoracic surgery for
a year under Evarts Graham at Washington University. He then returned to
complete his training at Tulane under Ochsner.156
Back in Lake Charles, Shiker was far from dormant. In the fall of 1941,
he decided to put up an ambitious five-store theater building on his property
in the 1000 block of Ryan Street. Fed up with the expenses of hiring others
to do the various construction tasks, he decided to be his own contractor.
Shiker pledged to install the plumbing, heating, electrical, roofing, and
trimming work all on his own. Soon labor union pickets were patrolling his
work site, but Shiker insisted that he would finish the job without their
personnel, even if he had to “lay every brick himself.”157
As their experience with thoracic surgery grew, the Tulane surgeons
began to tackle increasingly tougher cases, even venturing into the virtual
terra incognita of thoracic vascular surgery. The stakes in these operations
were as high as they could be.
On one occasion, which DeBakey would relate for the remainder of his
life, the surgeons came close to needing more blood than even their
standard precautionary 10 pints. The event serves as an excellent illustration
of the relationship between DeBakey and Ochsner in this period, as well as
the Chief’s consummate grace under pressure. The scene is the operating
amphitheatre at Charity Hospital in the late 1930s. The seats are filled with
visiting surgeons attending a conference in New Orleans. Ochsner, assisted
by DeBakey, is operating on an infected patent ductus arteriosus.*
I was assisting Dr. Ochsner, and during the procedure and following his instructions, I was
attempting to dissect and free up the aorta, with my index finger on my side of the vessel in
coordination with his efforts on his side, when I suddenly realized, with a gripping terror, that I
had entered the aorta. The infection had made the wall of the vessel very friable. In a whisper
that must have expressed my trepidation I informed Dr. Ochsner of my concern. His equanimity
and self-control were reflected in his calm response and his instruction to me to leave my finger
there. He then deftly placed occluding sutures around the opening, and as he tied the last suture,
he asked me to remove my finger carefully. I am sure you can understand my sigh of relief in
observing that there was no hemorrhage. He had met this challenge so skillfully that no one
realized that a near-fatal accident had occurred.158
As indispensable as it was to the survival of the patient, Ochsner’s

composure during and, especially, after the case buttressed his young
assistant’s confidence at a critical time. In recounting this story, DeBakey
intimated that if Ochsner had upbraided him for the mistake it might have
crushed his spirit to tackle such difficult problems or even continue in
surgery at all. Instead, the Chief thanked him for his assistance and
reassured him that he had performed well.
3.11 Assistant Professor

On October 8, 1940, DeBakey was promoted to Assistant Professor of
Surgery at Tulane, signaling a formal completion of his training period and
a transition to permanent faculty status.159 This was a remarkable and
laudable achievement for the immigrants’ son from Lake Charles. From
every academic perspective it was also eminently well-deserved. But if the
new professor thought—as he had every right to—that the promotion
indicated a move toward professional stability, he had a few more surprises
in store.
By the late 1930s, Alton Ochsner enjoyed an international reputation as
an outstanding academic surgeon. His patient care was exemplary, and he
performed the most complex and difficult surgeries on a regular basis, with
excellent results. His contributions to the world literature, in both bench and
clinical research, covered the spectrum of surgical physiology and disease
and were widely praised (despite his unpopular stance against smoking).
His trainees, especially DeBakey, were proving themselves to be
outstanding surgeon-scientists, and their own achievements made it clear
that they had been educated by a master.
Despite all this conspicuous success, though, Ochsner never forgot the
events of 1930 that resulted in his ouster from Charity Hospital and the
demonstrated precariousness of his seemingly powerful position. He also
never forgot that there were some who refused to accept him, even all these
years later, because he was an outsider to New Orleans, a city renowned for
its tight-knit cadre of “old families” and connections.
For these reasons Ochsner did not feel secure at Tulane. For other reasons
he thought that he could improve still further on patient care for the people
of the city and parish.
After the Huey Long fiasco, Ochsner had lobbied for Tulane to build its
own university hospital, to get out from under the politics of Charity. He
was understandably mistrustful of the unpredictable Board of
Administrators who might at any time, on a whim, truncate or eliminate the
500 beds allocated to Tulane. They had already proved they would strip
privileges from the professors, and not just Ochsner: other physicians had
had their credentials “not renewed” from time to time, for unclear
reasons.160
Ochner was not able to muster enough support for a Tulane University
Hospital to become a reality, but he was not deterred in his efforts to find
another way.
In addition to the local community hospitals, large city general hospitals,
and university-affiliated teaching hospitals that typified medical care in the
1930s, there were a number of institutions which relied on a very different
model of what would now be termed “healthcare delivery.” These were
private specialty clinics, which provided expertise in multiple fields,
particularly surgery. The Mayo Clinic in Minnesota, the Lahey Clinic in
Boston, and the Cleveland Clinic were some examples of the form. By
measures of performance, including outcome, these clinics excelled in
patient care—a fact that was not lost on the public: their volume of surgical
cases was enormous.
Ochsner was well-acquainted with the Mayo brothers, Frank Lahey, and
George Crile from the Cleveland Clinic, and he certainly knew about their
accomplishments. Given his frustrations with the politics of his position, it
was probably inevitable that he would consider a system that was modeled
after those of his colleagues. Ochsner discussed the idea with Mims Gage,
DeBakey’s neurosurgeon friend Dean Echols, and others.161
In 1938, an orthopedic surgeon named Guy Caldwell was brought onto
the Tulane staff. He had toyed with the idea of a multispecialty clinic in his
prior situation and mentioned this in a conversation with Echols. Advised
that Ochsner would likely respond enthusiastically to such a proposal,
Caldwell approached the Chief. Ochsner’s reply was, “Guy, that’s what I’ve
been dreaming about. We’ve got to do it!”162
Ochsner, Caldwell, and Echols recruited the urologist Edgar Burns,
otolaryngologist Francis LeJeune, and ob/gyn man Curtis Tyrone into their
fold.
Wanting to keep this new clinic a part of Tulane, the five surgeons
approached the medical school administration, including Dean C. C. Bass.
This idea was rejected because it was thought, wisely, that it would foment
jealousy and discord among the nonmember faculty. Somewhat
surprisingly, though (and to their delight) the surgeons were allowed to keep
their university credentials as they founded this independent venture.163
And a venture it was, requiring, not in the least, substantial capital. The
five founders did not have the wherewithal to accomplish this, and it was at
this point that Ochsner’s period of ostracism from Charity really paid off.
During those two years, he had only been able to treat patients at the Touro
Infirmary. Since this was a private hospital, it catered to a different
socioeconomic class of patient than the Charity Hospital: he operated on a
lot of rich people. That same social stratum, although not forgetting that
Ochsner was an outsider—and a Northerner, to boot—could not help but
notice that he was an adversary of their hated nemesis, Huey Long. With the
old cliché, “enemy of thy enemy” in play, Ochsner found himself popular
among the city’s well-heeled. One of these ran a local bank that provided
funds to start the Clinic.164
Although Ochsner himself humbly suggested the new enterprise be called
the New Orleans Clinic or Southern Clinic, the other four recognized that
whatever they called it, the public would consider it the Ochsner Clinic, so
why not just name it that officially? This choice also helped the public
equate the new institution with those famous, eponymous clinics like the
Mayo.
As Bass had predicted, the medical community—even apart from the
Tulane faculty—did not react favorably to news of the new endeavor. No
similar group arrangement existed in the region—the vast majority of
physicians kept private, solo practices—so the Ochsner Clinic was seen by
many doctors as an overt threat. Some of the threatened sent a messenger to
the homes of the five founders on April 13, 1941. That was Maundy
Thursday, the day in Holy Week on which Judas betrayed Christ. At each
home, the messenger delivered a small leather sack which contained 30
silver dimes and a note reading, “To help pay for your Clinic. From the
Physicians, Surgeons, and Dentists of New Orleans.”165
The general surgery contingent of the Ochsner Clinic at its opening on
January 2, 1942, consisted of Alton Ochsner, Mims Gage, and Michael
DeBakey.166
Three weeks prior to the opening of the Ochsner Clinic the entire world
had been thrown into chaos and confusion with the Japanese attack on Pearl
Harbor and the United States’ sudden plunge into World War II.
The members of the Department of Surgery at Tulane University were as
stunned and addled as the rest of the country, but the ones who wondered
what it meant for them had an example to heed from the previous war.
In World War I, many of the medical schools and some large city
hospitals assembled units comprised of their own personnel, under the
auspices of the Red Cross, for the war effort. These generally contained the
staff and supporting equipment to sustain a free-standing hospital. Absorbed
into the US Army Medical Corps, these units became known as Base
Hospitals. Tulane University provided such a unit, organized by Matas in
early 1917, which became Base Hospital 24. The Tulane hospital reached
France in March 1918, and was stationed in the south-central part of the
country for most of what was left of the war.167
After Pearl Harbor many of these units were essentially reactivated (in
some cases younger officers from the previous units were still in the
Reserves and the mobilization was especially seamless). The numerical
designations of the units were kept from the prior conflict, but the term
“Base Hospital” was changed to “General Hospital.”
The Tulane unit was one of those earmarked for reactivation and,
accordingly, was to be designated General Hospital Number 24.
Reactivation did not come immediately for the hospital, however. Given the
country’s precipitous entrance into the war, as well as the strategic
circumstances of the fighting, most of the numbered general hospitals were
not actually activated for several months after Pearl Harbor—they were not
needed yet, and no one in the Army wanted a bunch of doctors sitting on
their hands with nothing to do for a potentially extended period of time.
This gave the personnel time to prepare for the rigors to come.168
DeBakey’s first book was published in early 1942. The topic of the book
was particularly pertinent in the light of world events. Entitled The Blood
Bank and the Techniques and Therapeutics of Transfusions, it was co-
written by Robert A. Kilduffe, who was a pathologist in New Jersey.169 The
book was produced by the C. V. Mosby Company out of St. Louis.
Although DeBakey and Kilduffe were both well-represented in the
literature of transfusion and were good choices to author such a text,
existing correspondence suggests that they were not close friends and never
moved beyond the polite camaraderie of collaborators.
DeBakey was the junior of the two writers, but his by-now easily
recognizable stamp is to be found throughout the work. At more than 500
pages, the book is an impressive snapshot of the state of the art of blood
transfusion at the time of its printing. There are several chapters each on
blood typing and banking, sections on plasma transfusion and storage, and a
comprehensive discussion of adverse reactions.
A lengthy introductory chapter on the history of blood transfusion bears
the unmistakable imprint of the junior author, and several chapters list
literally hundreds of references, certainly another DeBakey trademark. The
chapter “Methods and Techniques of Transfusion” describes the many
various devices and procedures developed up until that time. Naturally, a
particular emphasis was placed on DeBakey’s two contributions to the field,
the sleeve valve syringe and the continuous-flow roller pump.
Rudolph Matas reviewed the book at length for the March 1942 issue of
the New Orleans Medical and Surgical Journal. He noted the detailed
reviews of the sleeve valve and roller pumps and offered some typically
insightful reminiscences of his own, conjuring images of the previous
pumps he had worked with.
The book is timely, new and crisp like a loaf still warm from the bakery.
In utilizing the milking tube in this appliance we recognize an old but highly modernized
acquaintance, known in the 90s as the Allen Surgical Pump, or the “compressible rubber tube
aspirator and injector,” improved by Chas. Truax, the leading instrument manufacturer in
Chicago. . . .
This reviewer used it at that time . . . when blood transfusion was still more historical than
real and when we were inaugurating intravenous infusions with saline and other composite
artificial sera, for shock and hemorrhage at the Charity Hospital. It is remarkable that the simple
principle of the “milking tube surgical pump” should have been completely forgotten for nearly
forty years, only to reappear in the recent suggestions by a number of authors who have found
its most useful application in the direct transfer of blood from giver to patient, and of which the
instrument devised by Dr. DeBakey is the simplest and most efficient, if we may judge by the
success that has attended its use in his very large experience and that of others here and
abroad.170
In July of 1942, the Tulane Army medical unit, General Hospital Number
24, was activated.171 It was commanded by Colonel Walter Clifford Royals,
a 1917 graduate of the Tulane School of Medicine, where he was a
classmate of Mims Gage.172 The outfit consisted of 42 physicians, of whom
10 were Tulane faculty and 30 more were graduates of the medical school.
Gage, at age 48, was going to war with his old classmate and the 24th as the
unit’s Chief of Surgery.
Michael DeBakey, at age 33, was not.
Ochsner did not want either Gage or DeBakey to go to war. They were
outstanding clinical surgeons, and were of enormous value to their
community and to the Departments of Surgery at both Tulane and his new
Ochsner Clinic (the Chief himself was considered “essential personnel” for
the university and had no choice but to stay).173
Mims Gage was Ochsner’s best friend and the namesake of his son. He
had experience as a medical officer in World War I, held seniority in the
Departments, and insisted upon serving. Ochsner really could not refuse
him. Although he realized that they would all be pressed harder by Gage’s
absence, Ochsner was convinced that he and his young protégé could pick
up the slack: “I knew that as hard a worker as Dr. DeBakey was, we would
have no difficulty.”174
During the months after the declaration of war, when the members of the
24th knew that their unit would be called up but activation had not actually
transpired, the plan was for DeBakey to stay in New Orleans while Gage
left for the Army with so many others. DeBakey was to be declared
“essential,” too—and thus exempt from the draft, but also unable to
volunteer so long as he remained on the faculty.175 When the 24th’s actual
activation happened on July 15, though, he had overwhelming second
thoughts.
DeBakey went with Mrs. Gage to the train station to see her husband and
the others in the unit off on their way to Ft. Benning, Georgia. At the
station, an errant baggage cart ran over Mrs. Gage’s foot, and, after the train
had left, she asked DeBakey to drive her to the hospital for x-rays to be sure
it was not broken. On this short trip DeBakey revealed to Mrs. Gage that he
felt duty-bound to join the service. His parents had come to the United
States from a distant and very different place. They had been seeking their
fortune—like so many others—and had found it, along with a home they
could embrace and celebrate. Among their many life lessons, Shiker and
Raheega had made sure that all of their children were aware of the debt they
felt to the new country for their opportunity and success. With that new
homeland in peril, embroiled in what was already unfolding as the greatest
conflict in human history, how could he stay at home and make no
contribution to the effort?176
Shortly thereafter DeBakey made the same entreaty to Ochsner.
I went to see Dr. Ochsner and I said, “Dr. Ochsner, I’ve just got to talk with you about this. I
appreciate your wanting to make me essential. Maybe that’s the right thing to do. But I said,
“You know, I’ll never be happy with myself—I could never live with myself—if I don’t have
some part in this war as a surgeon!” And he said, “Well, let me think about it.”
Well, we talked again and finally he told me, “Mike, I’m going to let you volunteer.” But he
said, “You know I think you’re making a mistake. I think I’m making a mistake, because I have
such tremendous regard for you that I feel that I cannot go against your conscience and against
your will. So I’m going to let you volunteer.” So I volunteered.*,177
Although Gage wanted him with the Tulane unit and even interceded on
his behalf to that end, by the time DeBakey enlisted on September 11, 1942,
it was too late for him to join the 24th General Hospital at Ft. Benning.178
His wartime destiny would not be among his friends and colleagues from
New Orleans.
Having just turned 34, with a promising career on hold for service to the
country he and his immigrant parents cherished, DeBakey donned the
uniform of the United States Army for the first time, late in that distant
summer of 1942. He would wear it for four more years and put his time in
the military to the greatest possible use. He joined the Army as a young
surgeon trying to make a name for himself. When he finally returned to
civilian life, long after most of his fellow citizen-soldiers, there were few
physicians of importance in the country who did not know the name
Michael DeBakey.
Notes
1. DeBakey, Michael E. Michael E. DeBakey Archives. 1903–2010. Located in: Archives and
Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine,
2. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582.2:5:15.
DeBakey admired the writing of Alexander Woolcott, who was a well-known figure at the
time, particularly for his essays and dramatic criticisms in The New Yorker. DeBakey
mentioned three films in the diary of his trip: “Pursuit,” “The Girl Friend,” and “Page Miss
Glory.” They were all new releases in the summer of 1935. DeBakey characterized them as
“not very good.” Cinematic posterity has agreed with his assessment.
4. Ibid.
5. Ibid.
6. Ibid.
7. Ibid.
8. Ibid.
9. Ibid.
10. Ibid.
11. Ibid.
12. Ibid.
13. Ibid.
14. Rutkow IM, Rutkow BG, Ernst CB. Letters of William Halsted and René Leriche: “Our
Friendship Seems So Deep.” Surgery 1980;88(6):806–825.
15. Cohn I, Deutsch H. Rudolph Matas: A Biography of One of the Great Pioneers in Surgery.
Garden City, NY: Doubleday and Co., 1960: 368.
16. DeBakey ME, Saldariagga A. The Clinic of Professor Rene Leriche. New Orleans Medical
and Surgical Journal 1938;90(10):606–609.
17. Thompson RC, et al. Atherosclerosis Across 4000 Years of Human History: The Horus Study
of Four Ancient Populations. The Lancet 2013;381(9873):1211–1222.
18. Leriche R. Removal and Sectioning of Perivascular Nerves in Certain Painful Syndromes of
Arterial Origin and in Some Trophic Disturbances Lyon Chir 1913;10:378.
19. Leriche R. Sur Une Nouvelle Opération Sympathique (Section Des Rameux Comunicantes):
Efficace Dans Les Syndrome Douloureux Des Members. Lyon Med 1925;135:449–452.
20. Leriche R. Surgery of the Sympathetic System. Indications and Results. Annals of Surgery
1928;88(3): 449–469.
21. Leriche R. Des Oblitérations Artérielles Hautes (Oblitération De La Terminasion De L’aorte)
Comme Causes Des Insuffisances Circulatoires Des Membres Inférieures. Bull Mem Soc Chir
(Paris). 1923;49:1404–406.
22. Leriche R. De La Résèction Du Carrefour Aortico-Iliaque Avec Double Sympathectomie
Lombaire Pour Thrombose Artéritique De L’aorte. Le Syndrome De L’oblitération Termino-
Aortique Par Artérite. Presse Med. 1940;54–55:601–604.
25. Germain MA. René Leriche, pionnier de la chirurgie vasculaire. e-mémoires de l’Académie
Nationale de Chirurgie. 2007;6(3):81–95.
27. DeBakey ME, Saldariagga A. The Clinic of Rene Leriche.
28. Germain MA. René Leriche.
30. Ibid.
33. Mitchell D. Rembrandt’s “The Anatomy Lesson of Dr. Tulp”: A Sinner Among the Righteous.
Artibus et Historiae 1994;15(30):145–156.
36. Ibid.
37. Ibid.
38. Wilds J, Harkey I. Alton Ochsner, Surgeon of the South. Baton Rouge: The Louisiana State
University Press, 1990: 26–28.
40. DeBakey ME, Saldarriaga A. Quelques precision sur la technique de la transfusion de sang
pur. A propos de plus de trois mille transfusions. Rev de Chir (Paris) 1936;74:612. DeBakey
ME. Une Nouvelle Seringue Pour La Transfusion Du Sang Pur. Strasbourg méd 1936;96:210.
41. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 2:5:29. At
around the same time DeBakey also had a set made up for his American Chief. This case
engraving was more effusive and read, “To Alton Ochsner, Professor of Surgery, Tulane
University. In grateful appreciation and acknowledgement of his constant encouragement, his
patient tutelage, his contagious enthusiasm, and his inspiring influence, from his ardent pupil,
Michael DeBakey.”
42. Letter H. F. Baer to M. E. DeBakey, May 27, 1936. DeBakey Archives, National Library of
43. Letter A. Ochsner to M. E. DeBakey, September 11, 1935. DeBakey Archives, National
44. Letter A. Ochsner to M. E. DeBakey, October 17, 1935. Ibid.
Baton Rouge: The Louisiana State University Press, 1992: 128.
46. Letter A. Ochsner to M. E. DeBakey, December 30, 1935. DeBakey Archives, National
47. Letter R DeBakey to M. E. DeBakey, December 9, 1935. DeBakey Archives, National Library
49. Letter S. M. DeBakey to M. E. DeBakey, February 2, 1936. DeBakey Archives, National
University of Louisiana, Ernest G. DeBakey. University Archives, Howard-Tilton Memorial
51. Letter A. Ochsner to M. E. DeBakey, February 11, 1936. DeBakey Archives, National Library
52. Former Lake Charles Student Writes Story About Old Strasbourg (February 21, 1936). Lake
Charles American Press, 35.
53. Letter W. B. Saunders Co. to M. E. DeBakey, March 20, 1936. DeBakey Archives, National
Library of Medicine, Bethesda, MD; MS C 582. Series 2:4.
54. Letter I. Ochsner to M. E. DeBakey, April 1, 1936. DeBakey Archives, National Library of
55. Letter A. Ochsner to M. E. DeBakey, April 20, 1936. DeBakey Archives, National Library of
56. Letter G. Lilly to M. E. DeBakey, December 11, 1935. DeBakey Archives, National Library of
57. Wilds J, Harkey I. Alton Ochsner, 35–36.
58. Schmitt W. Martin Kirschner on the Occasion of his 100th birthday. Zentralbl Chir
1979:104(21):1434–1437.
59. Letter A. Ochsner to M. E. DeBakey, June 17, 1936. DeBakey Archives, National Library of
61. Ibid.
64. DeBakey Collection. Baylor College of Medicine Archives. Houston, TX. 1:3:2. These three
eventually became chiefs of surgery at their own institutions: Stör in Hamburg, Linder at
Heidelberg, and Zenker in Munich.
65. Heidelberg Alumni International Revue “Alumni Spotlight.” DeBakey Collection. Baylor
College of Medicine Archives. Houston, TX.2:1:2.
67. Ibid.
Diana also traveled to see DeBakey while he was in Heidelberg. Vada Odom did, too—
including during a visit from Diana, which must have caused some awkward moments. Vada
Odom went on to lead a long and notable life. After graduating from Newcomb in 1935, she
married a businessman named Reynolds. They were present in Honolulu at the bombing of
Pearl Harbor in December 1941. On the Tulane Law School website (an endowed scholarship
bears her family’s names), she is eulogized thusly: “Vada Odom Reynolds was a civic activist
and philanthropist, who gave time and energy as a volunteer to Tulane University, as well as
many other charitable causes and organizations.” Vada Odom Reynolds died in 2003, at the
age of 88.
70. https://law.tulane.edu/admissions/endowed-scholarships (accessed March 21, 2019).
DeBakey and Ochsner also attempted to arrange a visit to Professor Victor Schmieden at the
Johann Wolfgang Goethe-Universität, Frankfurt am Main, but it appears that this meeting did
not take place due to Schmeiden being on holiday.
72. Cherian SM, Nicks R, Lord RS. Ernst Ferdinand Sauerbruch: Rise and Fall of the Pioneer of
Thoracic Surgery. World Journal of Surgery 2001;25(8):1012–1020.
74. Michael DeBakey: an oral history [sound recording]/interviewed by Larry W. Stephenson,
November 23, 1986; April 6, 1992. https://oculus.nlm.nih.gov/cgi/t/text/text-idx?
c=oralhist;cc=oralhist;rgn=main;view=toc;idno=101164651 (accessed February 2018).
76. Cherian SM, Nicks R, Lord RS. Ernst Ferdinand Sauerbruch.
77. Passenger Lists of Vessels Arriving at New York, New York, 1820–1897. Microfilm Publication
M237, 675 rolls. NAI: 6256867. Records of the US Customs Service, Record Group 36.
National Archives at Washington, D.C. Year: 1936; Arrival: New York, New York; Microfilm
Serial: T715, 1897–1957; Microfilm Roll: Roll 5860; Line: 9; Page Number: 70.
78. Michael M. DeBakey, personal communication, November 3, 2017.
79. Ochsner, Alton and Isabel. Telegram to Dr. and Mrs. M. E. DeBakey. Personal collection of
Michael M. DeBakey.
81. Letter S. M. and R. DeBakey to M. E. DeBakey, October 11, 1936. DeBakey Archives,
82. Letter R. DeBakey to M. E. DeBakey, July 18, 1936. DeBakey Archives, National Library of
83. Faculty and Staff Biographical Record, Tulane University News Bureau, Michael E. DeBakey,
85. Ochsner JL. Interviews and Reflections with Dr. John Ochsner. Congenital Heart Disease
2009;4(1):71–73.
86. Ibid. Akky Ochsner was away at boarding school during the DeBakeys’ “honeymoon.”
89. Shumacker HG. John Heysham Gibbon, in Biographical Memoirs: National Academy of
Sciences, Volume 53. Washington, D.C.: National Academy Press, 1982: 219–220.
90. Schmitt W. Martin Kirschner.
91. Gibbon JH. The Development of the Heart-Lung Apparatus. Review of Surgery 1970;27: 231–
244.
The St. Louis Session. JAMA 1939;112(1):50.
93. Gibbon JH. The Maintenance of Life During Experimental Occlusion of the Pulmonary
Artery. Surgery, Gynecology and Obstetrics 1939;69: 602–614.
94. DeBakey ME, Jung A, Leriche R. The Surgical Treatment of Scleroderma: Rationale of
Sympathectomy and Parathyroidectomy (Based upon Experimental Investigations and a
Clinical Study of 26 Personal Cases). Surgery 1937;1(1):6–24.
95. Letter A. Ochsner to M. E. DeBakey, July 29, 1936. DeBakey Archives, National Library of
96. DeBakey ME, Saldarriaga A. The Clinic of Professor Rene Leriche.
97. Letter O. H. Wangensteen to A. Ochsner, July 7, 1937. DeBakey Archives, National Library of
98. DeBakey, ME, Saldarriaga A. The Clinic of Professor Rene Leriche.
100. Ochsner JL. “Michael E. DeBakey, M.D.” Manuscript copy of address given to the author
January 20, 2017.
101. Ibid.
102. Ibid.
106. DeBakey ME, Ochsner A. The Surgical Treatment of Coronary Disease. New Orleans Medical
and Surgical Journal 1938;90(9): 520–529. The paper contains the sentence, “It is indeed
amazing that a disease of such vital significance and relatively frequent occurrence,
particularly among physicians, should be relegated to almost complete desuetude for over a
century and a quarter,” which can safely be said not to have sprung from the pen of Ochsner.
107. Ochsner A, Graves AM. Subphrenic Abscess: An Analysis of 3,372 Collected and Personal
cases. Annals of Surgery1933;98(6): 961–990.
108. DeBakey ME, Ochsner A. Liver Abscess, Part 1: Amebic Abscesses: Analysis of 73 Cases.
American Journal of Surgery 1935;29(2):173–94.
109. DeBakey ME, Ochsner A. Pyogenic Abscess of the Liver: II. An Analysis of Forty-Seven
Cases with Review of the Literature. American Journal of Surgery 1938;40(1):292–319.
110. Ibid.
111. Adler I. Primary Malignant Growths of the Lung and Bronchi. New York: Longmans, Green &
Company, 1912.
112. Graham EA, Singer JJ. Successful Removal of an Entire Lung for Carcinoma of Bronchus.
JAMA 1933;101.
114. Ochsner A, DeBakey M. Primary Pulmonary Malignancy: Treatment by Total
Pneumonectomy; Analysis of 79 Collected Cases and Presentation of 7 Personal Cases.
Surgery, Gynecology and Obstetrics 1939;68:435–451.
115. Ibid.
116. Fahr A. In discussion on Teutschlaender. Brochialkrebs. Verhandl d deutsch Path Gesellsch
1923;19.
117. Ochsner A, DeBakey M. Carcinoma of the Lung. Archives of Surgery 1941;42:209–258.
118. Ochsner A, DeBakey M. Primary Pulmonary Malignancy, 435–451.
119. Ochsner A, DeBakey M. Surgical Considerations of Primary Carcinoma of the Lung: Review
of the Literature and Report of 19 Cases. Surgery 1940;8(6)992–1023. Ochsner A, DeBakey
M. Carcinoma of the Lung. Archives of Surgery 1941;42:209–258.
120. Ochsner A, DeBakey M. Carcinoma of the Lung.
121. Letter Evarts Graham to Alton Ochsner, October 28, 1940. Series 1: General Correspondence,
1919–1957, Alton Ochsner, 69:494. Evarts A. Graham Papers, Bernard Becker Medical
Library Archives, Washington University School of Medicine.
122. Ibid.
126. Letter Evarts Graham to Alton Ochsner, October 28, 1940. Series 1: General Correspondence,
1919–1957, Alton Ochsner, 69:494. Evarts A. Graham Papers, Bernard Becker Medical
Library Archives, Washington University School of Medicine.
128. DeBakey ME. Carcinoma of the Lung and Tobacco Smoking: A Historical Perspective.
Ocshner Journal 1999;1(3):106–108.
129. Letter M. E. DeBakey to R. Leriche, December 9, 1938. DeBakey Archives, National Library
of Medicine, Bethesda, MD; MS C 582. Series 2:4.
131. Interview, Don Schanche with Alton Ochsner, n.d. DeBakey Archives, National Library of
134. Report of the Board of Administrators of the Charity Hospital to the General Assembly of the
State of Louisiana, 1933.
136. Ibid., 118.
137. Charity Hospital. The Alton Ochsner Papers. Historic New Orleans Collection. New Orleans,
Louisiana.
138. Ochsner A. “Early personal experiences in the development of vascular surgery.” Alton
Ochsner Papers. The Historic New Orleans Collection. MSS 220. Box 220, folder 3.
139. Ochsner A, DeBakey M. Treatment of Thrombophlebitis by Novocain Block of Sympathetics:
Technique of Injection. Surgery 1939;5:491–497.
140. Ochsner A, DeBakey M. Therapy of Phlebothrombosis and Thrombophlebitis. Archives of
Surgery 1940;40:208–231.
141. DeBakey ME. Canned Blood Transfusion. Surgery 1938;3(1):136–137. DeBakey ME.
Continuous Drip Transfusion. Surgery 1938;3(6):914–915. DeBakey ME, Ochsner AO. A New
Clamp for the Devine Colostomy. Surgery 1939;5(6):947–949. DeBakey ME, Ochsner AO. A
New Clamp for Aseptic Anastomosis in Gastrointestinal Surgery. Surgery 1941;10(5)826–831.
DeBakey ME. An Autolocking Silver Clip. Surgery 1941;9(6):938–940. DeBakey ME,
Ochsner AO. Bezoars and Concretions. Surgery 1939;5(1):132–160. DeBakey ME, Ochsner
AO. Acute Perforated Gastroduodenal Ulceration: A Statistical Analysis and Review of the
Literature. Surgery 1940;8(5):852–884.
January 20, 2017.
143. Ibid.
144. Congress of Neurologic Surgeons: History: Honored Guests: Guy L. Odom 1974, Vancouver.
https://www.cns.org/about-us/history/biography/3086 (accessed December 29, 2017.
January 20, 2017.
146. Ibid.
147. Ritchie W. Basic Certification in Surgery by the American Board of Surgery.What Does It
Mean? Does It Have Value? Is It Relevant? A Personal Opinion. Annals of Surgery
2004;239(2):133–139.
148. Walker JP. A History of the American Board of Surgery: Vignettes from the Certifying
Examination: The Edgar J. Poth Memorial Lecture. American Journal of Surgery
2015:210(6):972–77.
150. Series 5: American Board of Surgery, 1935–1957, Minutes, 69:494. Evarts A. Graham Papers,
Bernard Becker Medical Library Archives, Washington University School of Medicine.
DeBakey did not record the date of his Certifying Examination by the American Board of
Surgery, but the contemporary minutes of the Board indicate that the only time this test was
given in Atlanta during the period in question was November 15, 1939. Rankin and Stone are
also known to have been present for the exam at Grady Memorial Hospital.
151. DeBakey ME. Kismet or Assiduity? Surgery 2005;137(2):255–256.
152. Ibid.
155. Thomas Overton Bell and Lois DeBakey are Honored at Tulane (April 5, 1940). Lake Charles
American Press, 45.
156. DeBakey Graduates (June 9, 1939). Lake Charles American Press, 18.
157. S. M. DeBakey Builds Five-Store Theater in 1000 Block of Ryan (October 27, 1941). Lake
Charles American Press, 30.
158. Wilds J, Harkey I. Alton Ochsner, 107. DeBakey delivered these remarks at Ochsner’s
memorial service in New Orleans on October 3, 1981.
160. Letter G. Forshag to M. E. DeBakey, July 26, 1936. DeBakey Archives, National Library of
162. Ibid.
167. The Medical Department of the United States Army in the World War. Volume Two:
Administration American Expeditionary Forces. Chapter 24: Base Hospitals: Base Hospital
No. 24, p. 650.
168. Smith CK. United States Army in World War Two: The Technical Services. The Medical
Department: Hospitalization and Evacuation, Zone of the Interior. Washington, D.C.: US
Government Printing Office, 1956:156.
169. Kilduffe RA, DeBakey ME. The Blood Bank and the Techniques and Therapeutics of
Transfusions. St. Louis: C. V. Mosby, 1942. Kilduffe was editor of the American Journal of
Clinical Pathology and also wrote a series of medical detective stories—”The Doctor’s
Scotland Yard”—for the American Medical Association’s public health magazine, Hygeia.
170. Matas R. Review, The Blood Bank and the Techniques and Therapeutics of Transfusions. New
Orleans Medical and Surgical Journal 1942;94(9):456–457.
171. Smith CK. United States Army in World War Two: The Technical Services, 157.
January 20, 2017.
January 20, 2017.
179. Ochsner A. “Early Personal Experiences in the Development of Vascular Surgery.” Alton
Ochsner Papers. The Historic New Orleans Collection. MSS 220. Box 220, folder 3.
*
The French word for beer is biere; DeBakey reflected that, “I was far from complimented on my
French pronunciation.”9
*
If Leriche did not meet Rudolph Matas on this trip, he certainly did when Matas was invited to
address the French College of Surgeons in Paris in October 1922. At that time Leriche presented a
paper on the same panel in which Matas delivered a report on the surgery of aneurysms.15
†
The sympathetic nerves—so-called because of their capacity to initiate concordant physiologic
effects among various organs and systems in response to external stimuli—are generally responsible
for the phenomena loosely termed “fight or flight.” Thus, the effects of sympathetic nerve stimulation
include increased heart rate, pupillary dilation, muscle contraction, and, crucial to this consideration,
constriction of blood vessels.
*
Leriche eventually identified a case of symptomatic occlusion of the aortoiliac arterial segment
that he could treat by means of lumbar sympathectomy and arterectomy. He published this in 1940.22
As we will see, Leriche’s observation as to the best theoretical management of the syndrome was
correct, and he lived to see it accomplished.
*
At that time pensions were approximately the European equivalent of American boarding
houses, such as the ones DeBakey had lived in while a student at Tulane.
*
In telling this amusing story nearly 40 years after it occurred, DeBakey appears to have
conflated the details, unless they were erroneous in the initial telling. The painting in question is
clearly Rembrandt’s masterpiece The Anatomy Lesson of Dr. Nicolaes Tulp. Tulp was, in fact, a
magistrate and public health official in Amsterdam, but he died in 1674, long before Napoleon
Bonaparte was born. Tulp did institute public health policies to protect against the plague in the
1630s. In 1633–1634, during the Thirty Years’ War, Amsterdam was besieged by the Spanish forces
of Don Fernando, a Roman Catholic Cardinal and Governor of the Spanish Netherlands. He would
appear to be an attractive candidate for the role of the important carriage passenger in Leriche’s
story.33
*
At this point the Landsteiner blood groups A, B, and O were well-known, but the Rh factor had
yet to be discovered.
*
Urban Maes and James Rives, LSU surgeons and former Tulane Professors of DeBakey’s, had
been summoned from New Orleans to attend Long’s case. They were involved in a minor motor
vehicle accident on the way which prevented their arrival in Baton Rouge until it was too late. In his
subsequent letter to DeBakey, Ochsner refers to a “rumor” that Long had actually been killed by an
errant shot from one of his bodyguard’s firearms. This rumor, among others, has persisted, and—as
with other assassinations—the true story remains controversial to some.45
*
This has proved to be the case: several editors (including DeBakey and Ochsner himself) as well
as 19 editions later, the Textbook of Surgery remains a standard.
*
Vada Odom went on to lead a long and notable life. After graduating from Newcomb in 1935,
she married a businessman named Reynolds. They were present in Honolulu at the bombing of Pearl
Harbor in December 1941. On the Tulane Law School website (an endowed scholarship bears her
family’s names) she is eulogized thusly: “Vada Odom Reynolds was a civic activist and
philanthropist, who gave time and energy as a volunteer to Tulane University, as well as many other
charitable causes and organizations.” Vada Odom Reynolds died in 2003, at the age of 88.70
*
The 1936 Olympics, in which the African American athlete Jesse Owens dominated the track
competition to the dismay of the Nazi leaders, were held in Berlin from August 1 to 16, just before
DeBakey visited.
*
Sauerbruch’s contributions to medical science were many and of undeniable significance.
Unfortunately his reputation was indelibly tarnished by his ambiguous career during the National
Socialist era. Sauerbruch was put in positions of responsibility by the regime, including as head of
the Reich Research Council and as a member of the Academy of Military Physicians. In both these
capacities he appears to have approved of, or at least countenanced, experiments on concentration
camp prisoners. On the other hand, Sauerbruch criticized the Nazis privately and even intervened on
behalf of some academics being persecuted by the state. He also publicly called for an end to the
forced sterilizations. After the Allied victory Sauerbruch was brought up on war crimes charges
which were, however, dismissed for lack of evidence. He suffered cognitive deterioration in the
ensuing years and had to be stopped from practicing at the Charité in 1949.76
†
On July 6, DeBakey composed a letter to his parents asking for their permission to get married.
His mother replied that any asking, or granting, should transpire in person. She also asked that the
couple not return to America together.82
*
Pneumonectomy had been performed before by others, at least nine times. None of the patients
survived, however.
*
Double-blind, placebo-controlled trials that—combined with statistical methods—could
mathematically prove causation would be both impossibly complex and unethical, including the
possible risk of causing cancer in test subjects. As Graham himself later pointed out, such testing
would require subjects to be quarantined for decades, with tobacco tar continuously applied to the
bronchial mucosa of the test group (and placebo to the controls) through some undefined
experimental mechanism.
*
Graham’s first pneumonectomy patient from 1933, who was also a physician, was cured of his
disease and actually outlived Graham.127
*
The Maintenance Department at Charity answered 11,680 calls in the fiscal year 1931–1932.136
†
The Works Progress Administration (WPA) was a separate federal entity from the Public Works
Administration (PWA). Although they were both responses of the Roosevelt Administration to the
economic hardships of the Great Depression, the PWA focused on the construction of large-scale
public projects like dams, bridges, and airports. The WPA concentrated on smaller-scale efforts and
was primarily engaged in putting low-skilled labor back to work, also funding arts and artists in the
various media.
*
Fever and elevated white blood cell count.
*
Rankin was a founding member of the ABS. He had been on the staff at the Mayo Clinic, and at
this time he was practicing in Lexington, Kentucky. Stone was on the faculty at Johns Hopkins
University, where he had a long and distinguished career.
*
The ductus arteriosus is a fetal blood vessel that connects the pulmonary artery to the aorta. In
utero the ductus allows blood to be shunted past the uninflated lungs. After birth it rapidly closes off.
When this closure does not occur, blood reverses direction from the fetal configuration and is shunted
from the aorta to the right ventricle, resulting in congestive heart failure and pulmonary hypertension.
The first successful surgical closure of a patent (open) ductus arteriosus was performed by Robert
Gross at Boston Children’s Hospital in 1938.
*
In Ochsner’s own view of the events, “I told him that I admired him for his feeling and, of
course, that he should go but that at the same time I didn’t know how I was ever going to be able to
carry on. Fortunately for me and the university, two very fine men became available at this time. The
good Lord was looking after me, but it took two excellent men to replace Mike.”179
4
Washington, D.C. and New Orleans: 1942–1948
The boast of heraldry, the pomp of pow’r
4.1 Gulfport
During the 10 months between the attack on Pearl Harbor and his
enlistment in the Army DeBakey was far from inactive, even if his efforts
were confined to the home front. In addition to his clinical and professorial
duties at Tulane and the Ochsner Clinic, he researched and wrote articles
with topics germane to military surgery, even as the nation’s medical
community pivoted to a wartime posture.
In March 1942, DeBakey published a comprehensive discussion of
thoracic injuries in the popular journal Surgery, Gynecology and Obstetrics.
At 35 pages with nearly 500 citations, “The Management of Chest Wounds”
was in keeping with the scope of the previous epic papers on abdominal
abscesses and lung cancer. He followed this up in May with a timely article
in the International Medical Digest entitled, “The Plasma Bank.”1
During that spring of 1942, the American College of Surgeons also put
together a sequential program of 27 “War Sessions” throughout the nation.
In effect, this was a kind of barnstorming tour of the country, with the goals
to educate and familiarize the American medical community with the
changes that were coming to civilian practice, the pressing need for medical
personnel in the military, and the state of the art regarding trauma care. The
tour commenced in Louisville on March 4 and concluded in Oklahoma City
on May 28.
These were all-day affairs held at large and prestigious hotels. The
faculty of the sessions generally consisted of surgeons with academic
credentials or private practitioners with high profiles in the College. High-
ranking members of the armed forces’ medical contingent, focusing on
recruitment, were also well-represented. One of these, Navy Captain
Frederick Hook, attended and spoke at every one of the 27 meetings. The
scientific presentations took the form of panel discussions. DeBakey
participated in the March conferences in Nashville and New Orleans, also
joining the whole West Coast leg of the tour. This started in Denver on April
4, meandered through Salt Lake City, Portland, San Francisco, Los Angeles,
and Phoenix, and wrapped up in Dallas on April 24. He mainly discussed
chest wounds, which was natural since his review article on the topic had
just been published the previous month.2
For DeBakey this was a chance to contribute to the national war effort
but also to become better acquainted with the other surgeons on the tour.
Such prominent men as Howard Naffziger of the University of California in
San Francisco and Barney Brooks of Vanderbilt lent their time and expertise
to the effort.* By this point DeBakey was reasonably well-known among his
peers nationwide from his publications and presentations with Ochsner, but
this opportunity helped spread his notoriety further. One member of the
entourage with whom DeBakey struck up a friendship was the well-traveled
Navy representative with the unlikely name of Captain Hook.
Once the decision had been made to enlist, and the disappointment at not
being able to join Tulane’s General Hospital had abated, DeBakey realized
he had a number of alternatives to consider in regard to his military service.
Although he was primarily just happy to be in uniform, as with most
young officers (or prospective ones) the question of rank was an important
one for DeBakey. Naturally, he hoped and expected something
commensurate with his professional status, as well as his training and
experience: he noticed that Mims Gage had re-entered the service as a
Lieutenant Colonel. The problem was that the military branches had rigid
guidelines as to the ranks that newly commissioned medical officers could
be assigned. In the Army, such physicians under the age of 37 became first
lieutenants unless they were over 30 years old and board certified or had
completed an internship—plus three years’ specialty training—in which
case they were commissioned as captains.4 DeBakey fell into this category,
and he was not especially pleased about it. He briefly considered joining the
Navy, and even contacted Hook—who had moved from Washington to the
naval station at Oakland, California—about enlisting. Hook let DeBakey
know that the Navy had similar rules regarding new commissions, and,
given his age, the best he could get was a Senior Grade Lieutenancy. Hook
had been suitably impressed by DeBakey on the War Sessions tour and tried
to convince his young colleague to join him out west, “If the Army still
refuses to give you a Majority, my advice would be that you take the
Lieutenancy in the Navy and then depend upon an early promotion to two-
and-a-half stripes. It would certainly be nice to have you out here with
me.”†,5
DeBakey considered his options carefully. Around this time, he learned
that one of the Tulane department chairs, Colonel Robert A. Strong, was to
be head of a military base hospital only about 90 miles from New Orleans,
near Biloxi, Mississippi. This was at the new Army Air Forces Technical
Training School at Gulfport Field.
The Gulfport Field unit had been activated in April and, after several
months of construction, opened for recruits just as DeBakey enlisted. The
primary purpose of the base was to train aeronautical mechanics for the
Army Air Forces, so much of the 1,200-acre Field was covered in hangars
and other buildings tailored for this form of education. In addition to these,
a full-sized “station” hospital of some 900 beds had been built. This facility
needed, among other things, a chief of the new surgical service.7
Many at Tulane thought DeBakey would be a perfect choice for the job.
There was some concern among those with military experience, however,
that the Gulfport position required a rank higher than the captaincy
DeBakey was expected to be given. Ochsner called some friends in
Washington, D.C., including Colonel Fred Rankin, about the potential issue.
Rankin, the same physician who had examined DeBakey for the American
Board of Surgery in Atlanta three years before, was at this time the Chief
Surgical Consultant to the Army Surgeon General in Washington. He
asserted that DeBakey’s rank as Captain did not preclude his possible role
as surgery chief at Gulfport, and sent a letter to Strong confirming this.
DeBakey accepted the commission and prepared to move to Mississippi.8
By late September DeBakey, along with his small family, had moved into
a cottage on the coast proper, at 608 E. Beach Boulevard in the town of
Gulfport. The cottage was small but new, and it had a sizable yard for little
Mickey to play in. DeBakey observed that the appointments were good, the
hot air heating efficient, and that “we are really more comfortable than in
New Orleans.”9 Some familiar faces helped add to the comfort level at the
base. In addition to Colonel Strong, there were several other Tulane
physicians on the station hospital staff, and they provided each other a sense
of familiarity among the regimented vicissitudes of their new lives in the
Army. DeBakey considered this little cadre of colleagues to be a “nice
group of fellows.”10
For the first several weeks there was not much to do on the surgical
service. As a station hospital, the Gulfport facility was meant to deal with
straightforward medical issues that arose among the members of the base
and their families, as well as those of other Army installations in the region.
The necessary surgical supplies and equipment did not arrive until nearly
the end of the year, however, so the surgeons had to bide their time in the
interim. DeBakey’s days were not squandered, though. He was ordered to
Washington, Atlanta, and several other places to give talks, attend seminars,
and even perform some surgery. At Camp Shelby near Hattiesburg he was
invited to perform surgical repair of an arteriovenous aneurysm involving
the brachial artery and attendant veins, an abnormal dilated connection of
blood vessels in the arm that was the result of a stab wound. He reported to
Mims Gage that, “It was an easy dissection and for once everything went
off well as a demonstration.”11 In Atlanta, DeBakey witnessed discussions
on several issues of military surgery, including the particularly irksome
problem of pilonidal sinuses.*
Since Gulfport was only 90 miles from New Orleans, DeBakey had
ample opportunity to return home when the need arose. At this point he
drove a 1941 Buick Super Sport Coupe.12 With its 125-horsepower, eight-
cylinder engine, and DeBakey at the wheel, the Buick could cover those 90
miles in short order. He returned to New Orleans on several occasions while
based in Mississippi.
Gertrude Forshag kept DeBakey abreast of the latest news from the
Tulane Surgery Department, as well, including ongoing pressure from his
Chief to publish. Through her, Ochsner communicated continued requests
—for an article on phlebography, a new chapter for the Christopher’s
textbook, and even an obituary for Dr. Charles V. Mosby, the head of the
publishing company that produced DeBakey’s book on blood transfusion:
December 5, 1942
Dear Captain,
I hate to bother you, because I know how it must be with all your arduous duties, but anyway
we want something and you know how that is. Dr. Ochsner and Dr. Wangensteen think that they
should have an obituary of Dr. Mosby in SURGERY, and each one suggested to the other that he
would be glad to do it but that he would do whatever the other one wanted (I know this sounds
involved and wouldn’t think of sending it to anybody else, but knowing your powers for
clearing up all sorts of intricacies, I do not hesitate to send it to you, whereas I would hesitate
sending it to a lesser light). Well, anyway knowing your gift for writing as well as your
supercolossal vocabulary, Dr. Ochsner thought that you would do a superb job. So, how about
it? It would be awfully nice if you could do it pronto.13
Just after Thanksgiving, Mims Gage wrote from the 24th General
Hospital, stationed at Fort Benning, Georgia.
Dear Mike,
Well, it has been some time since I had the pleasure of airing to you (or you airing to me) my
thoughts and trials. . . .
We are still here holding the fort together. I do very little except sit in the chief’s office. I have
operated on patients about five times since the 15th of July. I do an occasional hernia, and one
pilonidal sinus. . . .
The only sad thing about the entire unit is that you are not with us. I would give almost
anything I possess, if you were only along with us. I need you every day to help me get over the
bumps. But with all my efforts and growling they would not turn you loose until the unit had
departed. Well such is life of Tulane.14
By the end of the year the station hospital had opened and was almost
immediately flooded with patients suffering from upper respiratory
infections. DeBakey himself had to take some time off to recover from
pneumonia (his old friend Bill Gillentine, co-inventor of the sleeve valve
syringe, observed during this time that, “Mike is my only friend who is in
constant danger of working himself to death”).15
Back in New Orleans Ernest DeBakey, who had joined the reserves while
a senior medical student, was called to active duty in the midst of his
surgical training. Like his brother, he also joined the Army Air Forces.
Ernest was sent to Randolph Field near San Antonio, Texas, to learn
Aviation Medicine. When this education was completed, the younger
DeBakey brother was sent to join a squadron in the China-Burma-India
Theater of Operations.
As the calendar tuned to 1943, DeBakey continued organizing and
preparing the Gulfport Station Hospital’s Department of Surgery for some
unknown future, occasionally performing a few minor operations. He seems
to have already recognized that his time in Mississippi might turn out to be
brief, as was obliquely suggested in a letter from Forshag: “The other night
I had a dream that the D.C. affair had been settled in your favor. Am
keeping my fingers crossed for you, that is, if you are still interested in
getting it. . . .”16
4.2 1818 H Street

If Gertrude Forshag did not know what “it” was from DeBakey, she may
well have known from her boss. Alton Ochsner’s conversations with the
Army medical brass in Washington regarding his protégé’s rank in the
service had alerted one of the discussants, Colonel Fred Rankin, to
DeBakey’s enlistment. In addition to being a founding member of the
American Board of Surgery, Rankin was at this time sitting President of the
American Medical Association. He had his finger firmly on the pulse of the
nation’s medical community. Rankin was fully aware of the young Tulane
surgeon’s contributions to the literature and rising profile in the profession.
Moreover, he could not have helped remembering DeBakey’s sterling
performance at the Board of Surgery certification exam in Atlanta. That fall,
Rankin made it clear to Ochsner that he wanted DeBakey with him at the
Army Surgeon General’s Office in Washington.17
Rankin was in charge of the Surgical Consultants Division, which also
consisted of another Tulane surgeon, Ambrose Storck, and B. Noland
“Nick” Carter of the University of Cincinnati.
The concept of an organization of consultants in surgery in this war was a
nebulous one from the start: ill-defined as to structure, authority, and
purpose. There had been a similar group in World War I, but the American
presence in that conflict had been so brief that it never had much impact,
whatever the intent. Moreover, surgical specialization, which would be one
of the factors that eventually made the Surgical Consultants Division of
such vital importance in World War II, had barely taken hold by the time of
the earlier conflict.
The directives that were issued periodically regarding the function of the
Surgical Consultants offered ample room for interpretation. In attempting to
summarize the many roles of the Surgical Consultants for their official
history after the war, Carter wrote, “The various functions of the Surgical
Consultants Division can best be outlined and presented under the headings
of personnel, equipment and supplies, public relations and liaison, review of
manuscripts and literature, education and training, and consultation.”18
Any vagueness of mission was not to be long-lived once the office came
under the command of Rankin, though. His positions of national eminence
in the medical profession were not bestowed by accident: the fact that he
rose to them without a formal academic appointment was all the more
impressive. A natural leader and charismatic, forceful personality, Rankin
was blessed with the capacity to craft ideas of both practical utility and
sweeping scope and to impart them with incontestable passion and sincerity.
Although a Washington outsider, he moved as easily among generals and
politicians as he always had among physicians. Erudite but sometimes
gruff, he was not above a well-crafted expletive when he felt the occasion
benefitted from that approach.19
At first Rankin’s assignment in February 1942 as Chief Consultant in
Surgery was in the Surgery Branch of the Medicine and Surgery
Subdivision, which was under the Professional Services Division of the
Army Surgeon General’s Office. The Branch occupied two small rooms in
the office and the personnel were just Rankin, Carter, and Storck. By
August, the Surgery Branch had come under a new Medical Practice
Division of Professional Services. Confusing reorganizations would
continue throughout (and even after) the war, but this was the existing
structure when Rankin, newly promoted to Brigadier General in December
1942, summoned DeBakey to Washington.* Storck had been directed to
serve as Consultant in General Surgery for the European Theater of
Operations, opening up the spot for DeBakey.20
DeBakey’s orders arrived on Saturday, January 23.21 By mid-week he
had loaded up his essentials, kissed Diana and Mickey goodbye, and was on
the road for Washington, roughly 1,000 miles away. The weather was
uncommonly wintery throughout the south in early February of 1943, which
made the drive tedious and treacherous. When DeBakey reached the
District of Columbia he found it covered in snow.21Arrangements had been
made for him to stay at the Roger Smith Hotel, a well-known landmark in
Washington.22 The hotel was catty-corner from the structure that housed the
Army Surgeon Generals’ office at the time, the new 13-story Maritime
Building at 1818 H Street.23 The convenience was obviated by the Smith’s
policy at this point—driven by the enormous demand for accommodations
in war-time Washington—that guests could only stay for a week. As a
result, DeBakey spent much of the time during his first few days in the city
seeking out more permanent quarters.
There was a little cafeteria on the same block as the hotel and Surgeon
General’s Office. DeBakey had his breakfast there during these first few
days in the capital and got to know the girl at the cash register well enough
that she knew of his lodging plight:
I’d been looking and looking for a place to stay. Couldn’t find a room anywhere. So I walked in
one day and she said, “You know, there’s a place right around the corner here where the janitor
used to stay in this building. He used to have a room.” And she said, “Why don’t you go see?
Maybe that room’s available.” Well I dashed out of there and went over there to see the man
who rented this apartment. And he said, “Yes, it’s available.”24
The room, which was in the basement of the apartment building, had a
shower with a toilet and a cot—not a bed; it was “very primitive.”25
Nevertheless, DeBakey was glad to get it.
When he checked in at the Surgeon General’s Office, DeBakey was
instructed to “go down to Personnel.” There he encountered a brusque
Regular Army Colonel of the old school who was “bitter with life. Oh, this
war had really destroyed his Regular Army, and he was pretty bitter about
the whole thing. All the civilians coming in and removing it: the nice life
they had before. So he didn’t like anybody.”26 Even though Basic Training
was provided at Gulfport, this was for enlisted men and DeBakey had had
no such instruction. He did not know how to wear his uniform or salute.
The Colonel absorbed this, sized him up, and announced that DeBakey
needed to go to a camp in Maryland for six weeks’ worth of officer training.
Back in the Surgical Consultants office, DeBakey encountered General
Rankin, and informed his commanding officer that Personnel had told him
to head out for orientation for a month-and-a-half. When Rankin heard this
he exploded. This was one of those scenarios when the well-placed
expletive could be put to good use. Rankin got the Personnel Colonel on the
phone and didn’t let up, “What’s this business about DeBakey going to Fort
such-and-such?! I didn’t go to a lot of trouble to have him transferred from
the Air Force up here to the Army to waste six weeks taking an orientation
course. I don’t give a damn if he learns anything about the Army. That ain’t
what I brought him up here for!” The shell-shocked Colonel lamely
muttered that DeBakey must have misunderstood: of course, there was no
need for him to go through Basic Training. Rankin replied, “Well, I’m glad
to hear that. Then forget about it. Sorry I called you.” He turned around to
DeBakey and growled, “Colonel so-and- so says you’re just a goddamn liar.
Never intended to send you over there.”27
Rankin had acclimated to the Army quickly. Time would tell if DeBakey
would, too.
By this point—a year into its existence—the broad, vague mission of the
Surgical Consultant’s Division had crystallized considerably under Rankin’s
leadership. Perhaps the most important aspect of the division’s role turned
out to be the assignment of personnel, due to the far-reaching consequences.
There was a pervasive notion that many of the problems and issues
involved with the delivery of excellent surgical care to the soldiers could be
solved simply by putting the right men in the right places. As events
demonstrated, this belief was precisely correct.
In the summer of 1942, provisions were made for the appointment of
more Surgical Consultants, under the auspices of Rankin’s group in
Washington. These were to be distributed in both the Service Commands in
the United States and the Field Commands located (or soon to be) in
overseas theaters of operation.*
There were nine Service Commands that encompassed the continental
United States, with headquarters distributed throughout the country. The
mission of the Service Commands was broad, including supply
procurement, recruitment, and all the various administrative and
maintenance duties necessary to care for the personnel and property of the
Army within the national territory. One of the assignments of the Service
Commands was the running of the Army hospitals on the home front, in
Army parlance known as the Zone of the Interior.* Accordingly, the
Surgical Consultants Division assigned each command a Consultant in
General Surgery.
Surgical Consultants were also assigned to the Field Armies: the First,
Third, Ninth, and Fifteenth in Europe; the Fifth in North Africa/the
Mediterranean; the Seventh, which eventually served in both these theaters;
and the Sixth, Eighth, and Tenth in the Pacific. The duty of these
consultants was “to supervise the treatment and transportation of patients
from aid stations through the evacuation hospitals.”29 Furthermore, theater-
wide Consultants across the range of surgical specialties were assigned to
both the European and North African (later Mediterranean) Theaters of
operation.
It was the job of the Surgical Consultants Division in the Surgeon
General’s Office: Rankin, Carter, Storck (and, after January 1943,
DeBakey) as well as their specialist colleagues to determine the best fit for
each of these important positions and make recommendations as to
personnel assignments accordingly. † The task was enormous and
immensely time-consuming. Of course, many of the recommendations
could be made purely on personal knowledge of the individuals in question,
and this was the preferred method when feasible. Other selections relied
more on word-of-mouth and professional reputations. Curricula vitae and
other written reports and records filled in blank spaces for some who were
considered, but these means were necessarily less reliable. As if this human
resource workload were not enough, the Washington office was also tasked
with the assignment of surgical personnel to the hospitals in the Service
Commands (in overseas settings this important duty fell to the Theater
Consultants or the Chief Surgeons of the Armies).
When the dust settled, the Surgical Consultants Division had made
hundreds of assignments. Some were conspicuous in their success, such as
Elliott Cutler of Harvard’s Peter Bent Brigham Hospital as Chief
Consultant, European Theater of Operations (ETO) and Edward Churchill,
of the Massachusetts General Hospital, as Chief Consultant, North African
Theater of Operations.31 Not every decision played out well, of course, but
the success rate was an impressive one, and the outcome confirmed the
concept that matching the right person to the right position would solve
most of the clinical and administrative problems automatically.*
In addition to the issue of personnel, one of the first problems the
Surgical Consultants Division dealt with after its formation in early 1942
was that of medical and surgical equipment. An intensive canvassing of the
existing surgical instruments, devices, sutures, and other materials began,
with an eye to eliminating the obsolete and extraneous and replacing or
supplementing them with the new and useful.
The predecessors of the medical officers in World War II had made a
laudable, if ill-fated, attempt to provide for their potential professional
descendants in this respect. As was noted in the volume on medical supply
in the Official History of the Medical Department of the United States in
World War Two,
Shortly after the end of World War I, the Medical Department examined its surplus supplies and
made plans to establish an adequate War Reserve.
In April 1924, The Surgeon General submitted to The Adjutant General a detailed statement,
elaborating the necessity for reserves of medical supplies and listing the types and quantities
which should be stored. “The Medical Department,” he declared, “becomes upon mobilization,
responsible for the immediate provision of adequate hospital facilities and care. There is no
training period. Sickness and injury wait for no man.” 33
As time passed and the threat of a major future war seemed to diminish,
the impetus to keep these equipment caches in good shape (and their
maintenance well-funded) began to wane. By the mid-1930s, the good
intentions of the physicians from the Great War and years afterward had
been largely squandered, just as the Surgeon General had warned against.
This was to be a sad, recurring theme in the years ahead.
On one occasion, DeBakey was sent to a station hospital in North
Carolina that counted among its facilities a warehouse full of items held in
reserve according to that intent of 1924.
Somebody finally thought up the idea of going to this warehouse to see what we had in it that
had been packed and crated from World War One. So I went there and we opened it for the first
time. We opened box after box, crate after crate. The surgical instruments were all rusted to the
point where you couldn’t do anything with them. You couldn’t open a clamp, a hemostat; you
couldn’t use any of the knives. You couldn’t open the scissors, they were so rusty. So none of
the instruments could be used for anything. They had to throw it all away. This stuff had been
there for twenty-five years, crated in this warehouse. Nobody had taken the trouble to check on
it at any time. So that was the end of this. Burn it all up, throw it all away.34
Besides the obvious waste of the equipment and the accumulated costs to
house it over the years, the decay of the well-intentioned caches of medical
equipment from World War I did not help the problem of providing
adequate supplies to the Army physicians in World War II.
Reviews of equipment lists were tedious but essential, as were the
numerous conferences the Consultants had with the Supply and
Procurement representatives. The lists contained many examples of
unnecessary or redundant instruments and, perhaps worse, often lacked
items that any reasonable surgeon would deem essential. For example, large
stateside General Hospitals were issued 12 surgical kits, each of which
contained a rib spreader for thoracic cases. Consequently, these hospitals
would be provided far more of these specialized devices than would ever be
necessary. Meanwhile, hemostats, forceps, and other more commonly used
instruments were too few or even missing altogether. The Consultants
labored to make the necessary changes, also adding such vital new items as
gastric suction apparatus and x-ray equipment.35
Rankin’s office painstakingly reviewed and adjusted these equipment
lists for units in every theater of the war. The task was an ongoing one and
required constant vigilance and reevaluation.
An esoteric problem with the provision of large numbers of surgical
instruments to the Army related to the fact that many of these had been
imported from Europe—especially Germany—before the war. This avenue
was obviously now no longer available. As a result, American
manufacturers had to be employed in this specialized process, and the
Consultants engaged representatives from these companies in the critical
aspects of retooling their factories, retraining their workers, and providing
raw materials. As much as possible, the supply lists were also tailored to
ease the pressure on the manufacturers. In fact these companies rose to the
occasion handsomely and soon were providing instruments of equal or
superior quality to those that had previously come from overseas.36
4.3 Spreading the Word

After DeBakey left for Washington in late January 1943, Diana took
Mickey to Lake Charles to stay with her in-laws until a suitable home could
be found in the Washington area. For a young boy—just in his fourth year
—this was something close to paradise. The house on Broad Street was big
and comfortable, with chickens, cows, and other animals cavorting about
the wide yard. When it was cold his grandfather hung rugs on the walls to
keep the warmth in, and when the weather turned mild the family watched
the passersby from the porch swing. But even with the delightful smell of
Raheega’s kibbeh filling the air, Diana and her son waited anxiously for
word that Michael had found a house for them near the capital.37
The vague directives as to the functions of the Surgical Consultants
Division did not expressly require that members of the unit attend medical
conferences and engage in discussion and research regarding surgical
matters. Nevertheless, DeBakey and his colleagues were primarily
academic physicians, steeped in the tradition of exchange of ideas, and for
them performing these kinds of activities was as natural as breathing. There
was also consideration that keeping up collegial relations between the
Surgeon General’s office and the important medical organizations would
pay dividends in terms of support and cooperation in the main aspects of the
mission.
The Division presented papers at meetings of a number of organizations,
among them the American Surgical Association, the American Medical
Association, and the Southern Surgical Association. Other papers, not
strictly surgical or even scientific, were prepared for dedication ceremonies,
industry meetings, commencements, and even radio programs. By war’s
end, some 175 such papers were written, most by DeBakey.38 He also
composed many, if not most of the speeches given by the Surgeon General
of the Army.39 These were delivered at a host of different functions: state
and national medical societies, service command hospital conferences, still
more dedications. The goal of the addresses, both the scientific and general,
was to keep the public, and most especially the medical profession, aware
of the accomplishments and ongoing efforts of the Army Medical Corps.
Sometimes they were purely patriotic and the constant composition could
be taxing: “I’ve been so assiduously occupied with . . . a virtual flood of
‘ “star-spangled’ ” speeches to write that I’ve had little time for anything
else. If speeches and addresses are essential to the war effort then I’m
certainly doing my bit. . . .”40
The Consultants wrote a number of articles for publication in the medical
and surgical journals, too, but the bulk of the papers emanating from the
Medical Corps came from the “rank-and-file” physicians. By Army
Regulations, any paper written by medical officers had to be reviewed by
the Surgeon General’s Office before it could be considered for publication
in any outlet. This task devolved on the Consultants office, and it was a
hefty one: the average number of papers reviewed each year averaged
850.41
As a student, trainee, and even young Assistant Professor, DeBakey had
not had much experience in pure administration. What little he had been
exposed to, such as medical student instruction and composition of resident
curricula, he did not particularly enjoy or embrace. Now, however, his job
in the Army was 100%, undiluted administration. He engaged in virtually
no direct patient care. To his surprise, DeBakey found that he liked it and
was good at it. He also discovered that it was much harder work than he
ever imagined: “I thought I was doing my duty and I was highly motivated.
It was a challenging thing for me. I accepted that as such and I wanted to be
successful in dealing with it. I worked harder or as hard then as ever.”42
The sheer volume of work could sometimes seem overwhelming.
DeBakey always left the Consultants’ office with a briefcase full of papers
which demanded his attention, taking them home to continue his work into
the night. He found that not everyone shared this devotion to duty.
There was a Regular Army fellow by the name of Nemo, who had graduated from Tulane. The
fellow took a liking to me because he was a Tulane graduate—and I was—and secondly,
because we were in the same car pool together for a while. I’d come down and pick him up on
my way to the car pool to go home.
(He) never had a single thing on his desk; never took anything home. Sometimes I’d get down
there before he was quite ready and his desk was clean as a whistle. Nothing in his “in” basket at
all. I’d take a bulging briefcase of work home. And I said to him one day, “Nemo, I wish you
would tell me something. How in the world do you get all of your work done during the day?
Look, I’m still carrying work home. I can’t get it all done.’’ And he said, “Well, I’ll tell you. I
never take any work home. When I leave here, that’s it. I’ve put in my full day.” And I said,
“What do you do?” He pulled out the right lower-hand drawer of his desk, and it was full of
papers. “At the end of the day, I put all the papers that I haven’t gotten to there.” I said, ‘‘ Well, I
know, but the next day you’ve got to get to them, so you’re just piled up.” He said, “No. I never
touch those papers unless somebody hollers for something. You’d be surprised how many of
those papers never have to have any action taken on them at all. When that drawer gets full, I
take those papers out and throw them away!”43
In addition to helping cull the submissions to the Bulletin of the US Army

Medical Department, the Consultants Division—and DeBakey in particular
—were responsible for much of the content of the interservice periodical
Health of the Army. This was part of the monthly Progress Report of the
Army Service Forces and contained analytical articles and statistics related
to the titular subject. Naturally, this was a classified document. DeBakey
wrote the articles for Health in conjunction with a statistician and
epidemiologist named Gilbert Beebe.44
In civilian life, Beebe had worked on logistical problems involving
delivery of medical care. At this point he was a captain, also assigned to the
Office of the Surgeon General, as head of the Analysis and Reporting
Branch of the Control Division—an organization formed to oversee the
efficient administration of Army medical functions and personnel. Beebe
and DeBakey developed a close working relationship that benefitted the
monthly Health report and would lead to further fruitful endeavors.
The Control Division also published the Army Service Forces reports,
and in this way DeBakey came to know an attorney named Tracy Voorhees
who led that organization.45 In addition to being a practicing lawyer, before
and during the war Voorhees had served as President of the Long Island
College Hospital. After Pearl Harbor he was assigned to the Judge Advocate
General’s Department, then detailed to the Office of the Surgeon General to
the Control and Legal Divisions in 1943.46
Voorhees was intrigued and impressed by DeBakey’s work on Health and
befriended the young surgeon, 18 years his junior. The two frequently took
meals at the exclusive Metropolitan Club—of which Voorhees was a
member—just a block from the Surgeon General’s Office on H Street.47
If they had had their druthers, the academic surgeons in the Consultants
office would have led wide-ranging research projects, investigating
numerous unanswered clinical questions across the evolving discipline of
military surgery and drawing from the vast resource of information that
constituted the personnel of the US Army. Somewhat surprisingly, though,
from the start of the war active-duty Army physicians were discouraged
from conducting any research at all.48 One reason for this was that there
was a tendency for physicians to perform isolated studies without proper
scientific controls and the like, and so resources and time could be wasted.
More importantly, though, there was already an official government body
that was to be responsible for such investigations, notwithstanding the fact
that it was a civilian organization. This was the National Research Council
(NRC) and its Division of Medical Sciences.
The NRC was created in 1916 under the overall charter of the National
Academy of Sciences. Its existence was formalized under an executive
order from President Woodrow Wilson which read, in part, that the mission
of the Council was, “To stimulate research in the mathematical, physical,
and biological sciences, and in the application of these sciences to
engineering, agriculture, medicine, and other useful arts, with the object of
increasing knowledge, of strengthening the national defense, and of
contributing in other ways to the public welfare.”49 Since it was created
during World War I, the main focus of the Council at that time was research
for military purposes. Now that the nation was at war again the work of the
organization swung that way once more.
One of the first interactions the NRC had with the Surgical Consultants
Division did not involve research but the development of field manuals.
Early in the war the NRC took up the task of preparing manuals for field
officers dealing with the various medical and surgical conditions thought to
be of significance in a military setting. Naturally, some of these were arenas
of interest to the Consultants, as well. Rankin’s team was also in a position
to have access to the latest information from the field, which they could
bring to bear in the composition of these manuals. Eventually, the Surgical
Consultants Division either wrote outright or contributed significantly to a
number of these handbooks.50
This early collaborative work led to a closer relationship between the
organizations. The NRC welcomed DeBakey and the others at gatherings of
its Surgical Committee, as well as subcommittees on burns, blood
substitutes, infections, and other topics. The Army representatives shared
what information they could on the care of the soldiers, and the NRC
helped provide direction and resources for their research projects. Later
DeBakey lamented the lost opportunities that an overzealous focus on
security foisted on this otherwise-well-intentioned liaison.
Security regulations, unfortunately, were too often interpreted and applied with extreme severity,
and medical documents that would have been of the greatest usefulness to research workers
were classified far beyond the limits required by military security . . . complete integration of
ideas and purposes was almost never achieved.51
As a frequent attendee at the NRC Medical Division committee meetings,

DeBakey got to know a number of the Council officers well. In days to
come, even after the war had ended, these relationships would prove to be
of great value.
One example of the problem with isolating researchers from the best data
available arose in consideration of the treatment of burn injuries. At the start
of the war, the recommended local treatment for these injuries in both
civilian and military settings was tannic acid. This substance was
erroneously thought to improve the outcome of burns when applied
topically, a belief that derived from a paper published in the 1920s.52 By the
time the United States entered World War II, many in the American surgical
community had expressed grave reservations about the safety and efficacy
of the treatment. In the absence of anything better, however, the NRC
continued to recommend its use, even up to 1943. In the meantime, the
Surgical Consultants Division had already issued circulars prohibiting the
use of tannic acid on burns, a result of data provided from North Africa by
Chief Consultant Edward Churchill, which demonstrated not only its
ineffectiveness, but also its actual danger. Instead, the Consultants
recommended simple petrolatum pressure dressings, which had been shown
to work to considerable advantage in the aftermath of the Cocoanut Grove
fire in Boston in November 1942.*,53
Another instance in which the NRC acted too slowly for the surgeons’
tastes (and, more importantly, the soldiers’ good) involved the use of the
sulfonamides in the care of wounds. These drugs, identified in the previous
decade as effective in treating some bacterial infections, were among the
first antibiotics to be discovered and used therapeutically. After Pearl
Harbor, reports from the physicians who treated casualties from the attack
were glowing in their assessment of the sulfa drugs’ ability, when
administered systemically or topically, to prevent infection and help heal
wounds. The reports also noted—importantly—that adequate surgical
treatments had been performed, but this information did not make the
headlines.55 Even before the war, the NRC’s Subcommittee on Surgical
Infections had recommended that oral sulfas be given as soon as possible
after wounding to prevent infection. Now, under pressure from the Pearl
Harbor reports (but without good scientific data) the NRC recommended in
favor of topical sulfa treatment, and all soldiers were given first-aid kits
with both sulfa pills and powder for sprinkling into wounds.56
After clinical studies stateside were completed, the NRC finally reported
—in September 1944—that the sulfas did not seem to make any difference
in infection rates in wounds predisposed to develop such complications—
although they still did not recommend against topical administration. By
then, however, the Surgical Consultants Division, using data obtained—
again—from Edward Churchill in the Mediterranean and European
Theaters, had recognized that the sulfas were of no value in infection
prophylaxis and had stopped putting them in first-aid kits.57
Another misread lesson from the aftermath of Pearl Harbor was the
apparent success of the use of plasma alone as a treatment for traumatic
shock. After the battle, many of the wounded had appeared to have
recovered from the effects of shock and survived due to the intravenous
administration of this blood component. Since plasma could be stored dry
for long periods of time, the solution to a vexing problem appeared to be
immediately at hand, even at the start of the war. If reconstituted plasma
could be used to resuscitate shock patients, then the issue of dealing with
whole blood, with all its attendant problems of storage, transportation, and
typing, might be avoided. As with most such things, the plasma panacea
was too good to be true.
It was the North African Theater Consultant, Churchill, who once more
showed the way. Studies and observations he conducted among his patients
demonstrated conclusively that plasma was no substitute for whole blood in
the resuscitation of wounded soldiers who suffered from traumatic shock.
Whole blood not only restored the circulating volume (as plasma did), it
also re-established the all-important capacity of the blood to carry oxygen
to the tissues. Plasma still had its uses, such as in the immediate treatment
of wounded near the front lines, but whole blood was far more effective in
resuscitation.58
Faced with this fact, the Consultants and surgeons in the field struggled
to make the collection and distribution of whole blood a reality. In May
1943, the Consultants released Circular Letter Number 108, detailing the
methods of transfusion for the field. Transfusion sets were devised and,
after Army red tape was circumnavigated, shipped overseas so that the
armies could collect their own blood. This was not enough, though, once
the real fighting began for the Americans, and, in August 1944, “bleeding
centers” were set up on the home front where eager, patriotic donors could
line up to provide the life-saving fluid for the boys at the front.59
As was the case with the sulfas, the NRC committees involved with
transfusions discussed the problems and made recommendations, but the
Surgical Consultants in the Theaters and in Washington moved at their own,
swifter speed. Once the data from the field were gathered, the necessary
actions were taken at the necessary times.
4.4 Lessons of the Past

DeBakey was one of the few to recognize at the time that the local
application of sulfonamides into battle wounds had a recent historical
precedent.60 Following their civilian custom, the Allied surgeons of World
War I at first tried to sterilize contaminated wounds with antiseptics rather
than debride them of devitalized tissue. This worked no better than the
topical sulfas, which—ironically—were eventually found to delay and
impair healing, acting as retained foreign bodies. Later, the World War I
surgeons came to the realization that debridement was of paramount
importance and that antiseptic dressings might be of some salutary effect
afterward.
DeBakey came by this knowledge from the extraordinary expedient of
having read about it. Unknown to most American surgeons in World War II,
there had been a definitive Official History of the efforts of their
predecessors, the 15-volume Medical Department of the United States Army
in the World War.61 The instillation of antiseptic agents into wounds was
discussed in this work in detail, and, as DeBakey remarked, “If we had read
of, or had remembered the many and futile attempts in World War One to
sterilize wounds by means of antiseptics, we should have known better than
to have put our faith in any extraneous substances, including the
sulfonamides, on which we leaned so heavily in the early days of World
War Two.”62
The World War I Medical History, the most comprehensive such
description of a military medical service ever produced up to that time, had
been published over eight years, from 1921 to 1929. By the time it was
complete, though, more than a decade had elapsed since the end of the war
and most American physicians had forgotten, or tried to forget, all about it.
Few, indeed, would have considered at that point that the history books
might be of value in another world war to come. So they mainly went
unread or forgotten.*
DeBakey found the books at a building that had become one of his
favorite haunts soon after his arrival in Washington. This was the Army
Medical Library, located at the intersection of Independence Avenue and
7th Street on the National Mall. A glowering brick Romanesque colossus, it
had been built back in 1887, to hold the Surgeon General’s Library, the
Army Medical Museum, and the voluminous Civil War medical records.
Local wags referred to it as “Old Red Brick.”64 Even before the library had
moved to the Mall site (it had previously been located in Ford’s Theater,
which the Government had bought after Lincoln’s assassination to prevent
its becoming a place of public amusement) the institution’s leaders had
declared its mission, “to contain every medical book published in this
country and every work relating to public health and state medicine.”65
Based on its collection, this directive must have been adhered to, and, by
the time DeBakey visited it for the first time in early 1943, it was one of the
world’s greatest libraries. It was not, however, in one of the world’s greatest
buildings (Figure 4.1).
Figure 4.1 The Army Medical Library, “Old Red Brick.”

The funding received by the library appeared to have been entirely

consumed in the acquisition of items for its collection. In truth, since it was
owned by the Army, the fact that it had any appropriations allotted at all
was something of a miracle. There was no indoor plumbing; an outhouse
served as privy. Fire was an ongoing threat. When it rained the roof leaked
badly enough that tarpaulins were used to cover and protect the books.
Everyone who used it loved the library but abhorred its circumstances.
DeBakey spent many hours at “Old Red Brick,” doing research for his
various projects in the Surgeon General’s Office. When these were done,
and even when they were not, he often wandered the stacks with no special
task at hand, absorbing the musty beauty of the accumulated collection of
knowledge. For all his travels and gathering responsibilities, he was not so
very different from the schoolboy who checked out every book he could
every day from the Lake Charles public library.
One of the problems that the US Army had dealt with and nearly
eliminated in World War I, thanks to vigilance drawn from hard lessons
learned by their Allies, was trench foot. This entity, really a spectrum of
manifestations related to exposure of the feet to cold and moisture over
prolonged periods, has gone by many names over the years. Milder forms
were sometimes called the quaint and ancient name “chilblains.” English
civilians relegated to damp subterranean air raid shelters during the Blitz
referred to “shelter leg.” The evocatively accurate “immersion foot” was
sometimes described, especially in cases related to shipwreck. “Trench
foot” was the term that emerged from the muddy ditches that characterized
the protracted and static, dug-in battles of World War I.66
Trench foot and cold injury in general had plagued military campaigns
for time immemorial and been well-described by physicians traveling with
the troops from the nineteenth century onward. Napoleon’s legendary
battlefield surgeon, Dominique-Jean Larrey, had written extensively about
the devastating problem in his wartime memoirs, placing a special emphasis
on the issue of moisture in combination with moderate temperatures. More
observations, albeit less careful and scientific, followed from subsequent
conflicts.67
In the first winter of World War I the British forces suffered terribly from
cold injuries and trench foot (the term came into use in this period).
Thousands of men were rendered hors de combat, most permanently
disabled, if they even survived. As the causes came to be recognized and
preventive measures applied, the incidence of the problem slackened
considerably. Not least among the considerations leading to the British
military’s aggressive prophylaxis against trench foot was the recognition
that the disease took a mighty toll on the fighting strength of the army: few
men with the diagnosis ever returned to duty.
By the time the United States entered the war, the British experience with
trench foot—mirrored by the French—allowed the American forces to
avoid the problem. In large measure this was through effective techniques
of prevention. In January 1918, months before the main bulk of the
American Expeditionary Force made it into the field in Europe, a General
Order was issued which outlined the causes of trench foot, delineated the
actions that were to be employed by American troops to prevent it, and,
significantly, charged organization commanders with the responsibility for
the implementation of these measures.
Largely because of this, the incidence of trench foot in the American
Expeditionary Force in World War I was remarkably low. Just 2,064 men
were admitted to the hospital with the diagnosis, or 1.17 cases per 1,000
troops per year.68
All of this information was readily available to anyone who chose to
peruse the surgical volume of The Medical Department of the United States
Army in the World War. Few did, but Michael DeBakey was one of them.
Well-versed in the history of trench foot, and, as a result, fully cognizant
of the threat that the malady posed to the US military in overseas theaters,
DeBakey made a personal crusade of warning on behalf of the Surgical
Consultants Division against the potential catastrophe that could visit an
unprepared Army. The fact that his repeated admonitions went unheeded
due to an uncanny “impenetrable indifference” on the part of those with
direct responsibility to implement his recommendations constitutes one of
the most baffling and disheartening episodes of the entire war.69
The first real hint of trouble came from the Aleutians in the spring of
1943.* A brief campaign was waged there in May to retake islands held by
the Japanese in this westernmost extent of Alaska. Reports of large numbers
of cases of trench foot and cold exposure—more than 1,000 hospitalizations
—reached the Surgeon General’s office soon afterward. This information
made its way to the Consultants Division, where, DeBakey later noted,
“The immediate implications of this experience in terms of future
operations in Europe were more acutely appreciated by those who were
informed on the experiences with cold injuries among military forces of
previous wars.”70
A multiservice conference on the problem of cold exposure was held on
July 29, 1943. Representatives from the US Army and Navy, as well as their
United Kingdom counterparts (in addition to a number of civilian experts)
attended. It was determined that the environmental exposure problem in the
Aleutians had been due to inadequacies in both cold weather clothing and
education in its use and that War Department publications on prevention of
cold injury were inadequate. Furthermore, “The conference recommended
that military personnel should be trained in the prevention of cold injury.
Preventive measures and basic first-aid measures were outlined.
Representatives from the Offices of the Surgeons General of the Army and
the Navy were appointed to prepare articles on immersion foot, frostbite,
and trench foot and to draw up instructions for the prevention and treatment
of these injuries so that as much information as possible might be
disseminated concerning them.”72
DeBakey and the other Consultants went to work evaluating the current
directives and policies regarding protection against injuries of this sort and
reviewing the most up-to-date medical literature on the subject. They
corresponded closely with the medical and command officers in the
Aleutians and other arctic areas such as Greenland. Only three weeks later,
they produced a memorandum coalescing the problem into key areas for
remedy and offering to do the remedying. By mid-October they had
produced two articles on trench foot and frostbite for the Bulletin of the US
Army Medical Department, which theoretically reached every medical
officer in the Corps, emphasizing proper training and equipment to prevent
these conditions.73
DeBakey was aware from the history of World War I and his own brief
experience in the Army that the prevention of these cold-induced injuries
would be as much the responsibility of Command as of the Medical Corps.
The Consultants were purely advisory in this capacity. The problem was
that the Surgeon General’s Office had no direct way to influence the
command staff at this point. Since the March 1942 reorganization of the
Army into three new branches—Army Ground Forces, Army Air Forces,
and Services of Supply—the Surgeon General no longer reported directly to
the Chief of Staff and Secretary of War. Instead he was under the
Commanding General of the Services of Supply (later renamed the Army
Service Forces) who then reported up the chain of command. The Army
Ground Forces and Army Air Forces, which included the fighting men and
their officers, were entirely separate branches. On top of all this, clothing
was the particular responsibility of the Quartermaster General. These
apparent organizational minutiae would have profound effects on the
delivery of medical care in the United States Army in World War II.74
The Consultants had no way of knowing whether their recommendations
were being put into effect, but they must have had a degree of anxious
optimism as they awaited medical reports from the field with the next wide-
scale deployment of US troops to a cold-weather region in Italy in the
winter of 1943–1944. If so, any hopes were quickly dashed. Trench foot
devastated the Fifth Army in Italy: there was a case of the condition for
every four battle casualties. The Consultants’ recommendations had been
ignored. Even more crushing, the British, who had paid attention to their
own history, suffered virtually no cases in the same theater.75
The frustration in the Surgical Consultants Division was palpable. In
response, a thorough statistical evaluation was made of both the American
and British experiences with trench foot in Italy. By June 19, 1944,
DeBakey was ready with a memorandum for the Surgeon General. This
once again outlined the proper methods of prevention of the problem and
reminded any who cared to read it that the Division had warned about this
possibility the previous summer—and even showed how to prevent it.76 A
War Department Circular was prepared, as well as a Technical Bulletin for
distribution to all medical officers in the Army. As if these were not enough,
a comprehensive article was also published in the Health of the Army. This
concluded with the ominous sentence: “A winter campaign in northwestern
Europe could create a trench foot problem of major importance if the lesson
of Italy were not heeded.”77
Perhaps predictably by this point, trench foot began to appear again with
alarming frequency among the American troops in the ETO in November of
1944. On December 9, the Consultants prepared another memo to the
Surgeon General restating the “essential principles of control and
emphasizing the command responsibility for their application.”78 Even the
“we told you so” aspects of the memo failed to generate enough interest or
attention among command. By winter’s end, the United States Army had
suffered a staggering 45,000 cases of trench foot.79 Nearly all of these men
were permanently off the firing line, and many were disabled for life—an
entirely preventable loss.
In the 1945 fiscal year report of the Surgical Consultants Division,
DeBakey discussed the trench foot problem in detail from its first
appearance. He might well have been expected to vent his anger and
disappointment about this avoidable tragedy. In light of the circumstances,
DeBakey was remarkably restrained.
During the two winters when American forces were suffering heavy casualties from trench foot
much was written, said, and done about this condition. In fact, an uncritical observer might
readily conclude that despite all that was done a high incidence of the condition resulted and that
trench foot, after all, is not preventable. Any historian or student of the subject who in the future
may be reviewing the trench foot experiences of American Armies during this war in order to
maintain a proper perspective must constantly ask himself two questions.
1. What was the situation at the time this publication was printed or this action taken?
2. Was the information in this publication of this action felt by line officers and soldiers in the
field at a time when it would be effective?80
At the time of this report there was still expectation of a prolonged

Pacific campaign, including fighting in northern latitudes, and the usual
warnings were again passed along. The atomic bombings obviated any need
to witness if the admonitions would have finally been heeded.
4.4 Lessons of the Present

The ultimate delivery of penicillin to the soldiers of the US Army entailed
much more satisfactory circumstances than the trench foot fiasco or even
the experience with sulfa drugs.
By the beginning of the war, penicillin was being investigated
aggressively in both the United States and Great Britain. The main barrier
to research was its scarcity, a result of the technical difficulty in extracting
the drug from the Penicillium mold. By the time the Surgical Consultants
Division became involved with penicillin in early 1943, ingenious methods
had been devised in American industry to mass produce it, and lack of
available drug was not so much of an issue (the Consultants also sat on the
Surgeon General’s Penicillin Board, which controlled release of the drug to
hospitals while its scarcity was still an issue).81
In league with the NRC’s Council on Medical Research and a wartime
federal agency of almost unlimited resources, the Office of Research and
Development, the Consultants Division put together a program for
investigating penicillin and standardizing the therapeutic procedures
associated with its use.* The work was to be done at general hospitals in the
Zone of the Interior. Starting with just two hospitals in the spring of 1943,
investigations were made into the proper indications for the use of
penicillin, the best routes of administration, correct doses, lengths of
treatment, and so forth. Eventually, many general and station hospitals were
involved in the project. This was in stark contrast—and to a certain extent
was a result of—the sulfonamide experience.
As the data came into the Division, they were quickly compiled and
analyzed. Before the end of the year, reports on the clinical performance of
penicillin in these investigative settings began to appear in technical
bulletins, circulars, and the Bulletin of the Army Medical Department. In
June 1944, DeBakey participated in a panel discussion on penicillin at the
annual meeting of the American Medical Association in Chicago, where he
presented extensive data on “the treatment of over 1,500 cases of surgical
infections of various kinds.”82 The upshot of all of this was that the
antibiotic medications had their place, especially by systemic administration
in the treatment of invasive infection (and penicillin was best among them
in that regard), but they could not replace the principles of good surgical
technique and judgment.
When it became clear that a large-scale invasion of enemy territory was
forthcoming—although no one outside of high command knew exactly
when, of course—plans for managing a massive influx of casualties began
to be formulated. The Surgeon General’s office commenced focused
preparations in the fall of 1943. A civilian economist and expert in human
resources from Columbia University, Eli Ginzberg, was assigned to lead a
new Resource Analysis Division. As he recalled: “I received only one
directive: to see to it that every battle casualty would be sent to the general
hospital where the specialists were best qualified to treat him, with the
proviso that the hospital selected would be as close to possible to the
patient’s home.”83
Ginzberg and his new division worked closely on achieving this objective
with DeBakey and other specialty consultants. By this point, and with the
direct input of the Surgical Consultants Division, important hierarchies in
the delivery of military medical care had been established: smaller and
more numerous station hospitals (such as the unit at Gulfport Field where
DeBakey was briefly assigned) were fine for run-of-mill issues, but
centralized General Hospitals were designated for more complex cases and,
especially, battle casualties. There were also defined Specialty Centers for
the more unusual patients requiring expertise in neurosurgery, plastic
surgery, and vascular surgery. Ginsberg’s problem, then, became one of
logistics: moving large numbers of wounded men from their debarkation
points at the coastal ports—New York, San Francisco, and elsewhere—to
the designated General Hospitals that suited their particular needs,
hopefully near their homes. Ginzberg was the perfect man to lead the job,
and with his knowledgeable and talented colleagues—he and DeBakey
became good friends—the goal was accomplished magnificently.
A Medical Regulating Office was established for the purpose of assigning
the wounded to their most appropriate facilities. This office received
information on the nature of the patient’s condition on arrival at the coastal
installations, identified and reserved the appropriate hospital space, and
arranged the transportation there. Given the enormous numbers involved,
the performance of the system after the invasion of Europe was exceptional.
For a period of some six months, casualties from overseas were received at the ports at the rate
of about 1,000 daily. For a few months they numbered almost 2,000 a day. Yet, day after day,
within an average of 72 hours of their arrival most of the injured men were on their way by train
or plane to the general hospitals selected as appropriate for them.84
Predictably, the General Hospitals began to be choked by the casualties

that were no longer in need of acute care but could not be sent home or
back to their units. Of course, this problem had cropped up in World War I
and been solved quite well by means of Convalescent Hospitals, but this
expedient had been forgotten—along with almost every other lesson from
that period—and the whole system had to be reinvented.*
In civilian life, medical practice centers on the ideal of providing the best
possible care to the individual. However, the role of the military surgeon
has always been based on the reality that the raison d’être of the Army in
wartime is to fight. Consequently, and in varying measures contradictory to
his or her conscience, the physician’s duty is to keep in service (or return to
it) as many of the fighting force as possible. Difficult decisions had to be
made based on this very different ethical calculus. A case in point involved
herniated disks as a cause of debilitating back pain. In civilian practice, the
work of Dean Echols and others had shown that surgery could be effective
in treating the problem, but in the military, the issue was not as clear.
DeBakey later observed:
As time progressed it became more and more apparent that operative treatment of herniated
nucleus pulposus was not a very satisfactory method of handling such patients in the Army, and
that, while a certain proportion of them returned to duty, most of them did not remain at full
duty. They were really of little or no use to the Service, and, in most instances, left with
disabilities that required pensions. In other words, the Government accepted an obligation in
caring for these patients for the rest of their lives. . . . The Army had to consider this problem in
the cold light of realism and adopt the policy that would conform best with the needs of the
military services.86
This same problem arose with regard to a number of other diagnoses that
would have triggered instant consideration of surgical therapy in the civilian
arena. Among these were ligamentous injuries of the knee, varicose veins,
and—especially—pilonidal sinus.
A large number of American soldiers were treated for pilonidal disease
during the war. Many, but by no means all, were drivers. Thus the term
“Jeep disease” entered the informal military lexicon. Affected soldiers
usually presented to the physician with either an abscess or draining sinus
in the coccygeal region. The proper treatment for this was controversial at
the time and, indeed, remains so up to the present day. For unclear reasons,
pilonidal disease seems to have been much more prevalent in the military
during the war years. Again, in civilian life, the surgeons treated this
problem aggressively, but the results of a similar approach in the Army
were poor. There were several different procedures employed, but they all
shared the dubious quality of tending to result in lengthy hospitalizations
for the soldiers. In fact, striking numbers were never able to take up their
duties again. As a result, after the Surgical Consultants analyzed the data, a
directive was issued (in September 1943) identifying exactly which
operations should be performed in which clinical scenarios.
Nevertheless, outcomes remained unacceptable. Eventually, through a
War Department Technical Bulletin, all surgical treatment for the disease
was prohibited aside from simple incision and drainage of any abscesses.87
Near the end of the war DeBakey calculated that in the year after the
directive was issued, some 425,000 hospital days (or 1,192 man-years) were
saved by adopting the strict nonoperative policy.88
4.5 The Auxiliary Surgical Groups

Medical specialization proved to be of great importance in optimizing
clinical outcomes in the Zone of the Interior, and it was no less key in the
overseas theaters.
At least since warfare and surgery began to take on their modern guise,
and especially since World War I, there had been a push to move definitive
surgical treatment of the seriously wounded as close to the battlefield as
possible. This feeling was not universal, though. One counterargument was
that the wounded who required immediate surgery to survive would not be
likely ever to return to duty so, from a military standpoint, resources
dedicated to treating them were wasted, including the efforts of scarce
Army surgeons. Those scarce surgeons were also placed in greater danger
by being close to the action. Before the United States entered World War I,
however, the Medical Corps of their British and French allies had
demonstrated that these concerns were without basis and that the presence
of advanced surgical care close to the lines actually increased the efficiency
of the whole system by reducing hospital stays and infection rates. The
boost in morale to the soldiers in knowing that such care was close by was
also a benefit. The Americans were convinced and, in response, instituted
Mobile Hospitals, modeled on those of their European Allies.89
Although the period of American involvement in the war was brief, it
was long enough for the Medical Department to duplicate the results of the
Allies as far as the forward surgical teams were concerned. The idea
remained current in the Army in subsequent years, unlike so many other
lessons learned “the hard way.” The Mobile Hospitals were slightly
modified and renamed Surgical Hospitals in the early 1920s. To augment
these, a new organization was created in 1929, the Auxiliary Surgical Group
(ASG).90
The ASG’s were conceived as teams of surgical specialists who could be
moved about and inserted wherever necessary, depending on the flow of
battle and the nature of the casualties suffered. The ASG’s official Table of
Organization and Equipment (T/O&E), defining the unit’s personnel,
structure, and equipment, was revised in 1940, but little change was made.
Most importantly, the mission remained the same.91
Shortly after the establishment of their office, the Surgical Consultants
recognized the enormous potential value of the ASG’s as a means of
providing definitive, specialized surgical care to the seriously wounded near
the battlefield, particularly in scenarios where the ordinary medical support
might be overwhelmed with casualties. As a result, “An immense amount of
time was consumed in the selection of medical officers to fill these
teams.”92 Assignments were made in a fashion fundamentally similar to the
designation of personnel for the Theater and Service consultants—based on
personal knowledge of the individuals, professional reputation, and training.
Teams were composed of general surgeons, neurosurgeons, thoracic
surgeons, plastic surgeons, orthopedic surgeons, and anesthesiologists.
Great care was taken in assuring that these men were as highly trained as
possible; on average they possessed three to six years of what would now
be called postgraduate surgical education. By the end of fiscal year 1943,
four teams had been assembled and a fifth was in the works.93
The ASG’s provided one means of achieving the goal of “forward
surgery,” but there were others as well. In order to grasp how the different
elements fit together within the military medical whole it is necessary to
examine the path of a wounded soldier from the front line to the rear in the
US Army Combat Zone in World War II.
The wounded were picked up on the battlefield by Company Aid men
and taken to Battalion Aid Stations. From here, in most cases, they were
sent directly to Clearing Stations. At the Clearing Stations the wounded
were given pain medication, dressings were secured, and it was determined
if there was ongoing hemorrhage. Those deemed too severely injured to be
sent further to the rear by ambulance, such as those with penetrating
abdominal or chest wounds, compound fractures, or unstable blood
pressures—shock—were immediately sent to Field Hospitals. Here
transfusions were given and emergent surgical treatment was available.*
Those stable enough at the Clearing Stations to be transported were sent
further to the rear to Evacuation Hospitals. Patients who made it to the
Clearing Station but did not fall into these first two categories and might be
expected to return to the line in 10 days or so were kept in smaller units
attached to that Station.94
From this point, any further transportation to the rear took the patient out
of the Zone of Combat, either to a General Hospital in the Zone of
Communications (for example, in the ETO, in England) or to the Zone of
the Interior in the continental United States. All who were interested in
moving definitive surgery forward recognized that the most advantageous
place to do it was at the Field Hospital echelon. Improvisations to this end
occurred widely. In the Pacific Theater (where, incidentally, the nature of
the conflict prevented many of the highly thought-out concepts from the
Surgeon General’s Office from ever being implemented) a “Portable
Surgical Hospital” was developed.96 In the ETO, Elliot Cutler and his
Consultant in General Surgery, Robert Zollinger, conceived a Mobile
Surgical Hospital, capable of moving from battlefield to battlefield and
augmenting the Field Hospitals, or even Clearing Stations, as needed.97
This, too, was where the Auxiliary Surgical Groups were eventually
applied.
The first utilization of the ASG’s was in the North African campaign, but
it was piecemeal and ill-coordinated. Part of the problem then and afterward
related to the question of command of the units, which technically fell to
the Field Army Surgical Consultants. Notwithstanding this, it was in the
Sicilian campaign in 1943 that the concept came to fruition. There the
ASG’s performed yeoman duty in supplementing the Field Hospital
platoons (despite some grumblings from the Field Hospital surgeons that
the presence of the ASG’s implied they were unqualified or doing a poor
job).98 When the full weight of the US Army was finally unleashed in
Europe after D-Day in June 1944, the ASG’s proved to be of immense value
and unquestionably saved the lives of thousands of soldiers.
Colonel Edward Delos “Pete” Churchill was the outstanding Chief
Surgical Consultant for the North Africa and Mediterranean Theaters of
Operations and oversaw the initial deployment of the ASG’s, as well as the
first attempts of the US Army Medical Corps to deal with large numbers of
battle casualties in general. His reports back to Washington were always
models of effective communication and invariably delivered information
that allowed the consultants to formulate policies and craft communiques of
real practical value to the other surgeons in the field. It was Churchill’s
reports that shaped the policy of sulfa administration, burn treatment, and
whole blood transfusion. DeBakey developed an abiding respect for
Churchill, whom he certainly knew by repute in civilian life as Chief of
Surgery at the prestigious Massachusetts General Hospital. As early as
1943, DeBakey was corresponding with Churchill about military surgery
matters. He often peppered these missives with heartfelt compliments and
sometimes-obscure literary allusions. In one letter DeBakey described
reviewing some original data from World I and was inspired to quote his
favorite poem, Gray’s Elegy: “It was a rather thrilling experience to gaze
upon these crinkled, musty, and age-stained pages with their penciled
notations. I could not help but recall those famous lines, ‘Full many a gem
of purest ray serene The dark unfathom’d caves of ocean bear;’ and feel that
here lies an opportunity to bring a ‘gem’ to light”.99
Probably Churchill’s greatest contribution during his career in the
military was the concept of phased wound management, which he
developed both from his appreciation of the history of military surgery and
from his experiences with mass casualties in North Africa and Italy. This
idea arose in response to the realities of the battlefield and, as DeBakey
remarked, “recognized the factors in the military that precluded ideal
surgical practice and compensated for them by a rational timing of surgical
measures to conform, in general, with the tactical necessities of the military
situation.”100
There were three phases in Churchill’s formulation. The first was initial
wound surgery in the forward areas, the goals of which were preservation of
life and minimization of later wound infection. The second was reparative
surgery, visualized as performed for the most part in the Zone of
Communications, whose objective was shortening the period of wound
healing, restoring early function, and minimizing permanent disability. The
third phase, a focus of the stateside hospitals in the Zone of the Interior, was
concerned with the correction of deformities and rehabilitation in
general.101
Churchill applied these principles to the extent he could in his own
theaters and effectively communicated them to Washington, where they
were appreciated and eagerly embraced by DeBakey and the other
Consultants. He eventually published his ideas in a classic of military
surgery literature, “The Surgical Management of the Wounded in the
Mediterranean Theater at the Time of the Fall of Rome,” which appeared in
the Annals of Surgery in 1944.102 Rankin called this, “One of the finest
dissertations on management of wounds which has been submitted through
the Office of the Surgeon General of the US Army.”103 Eventually
Churchill’s views were codified in War Department Technical Bulletin
Medical (TB Med) 147, “Notes on the Care of Battle Casualties,” which
appeared in March 1945.104 This communique, which was written by
DeBakey and Churchill together, also served as an authoritative and
comprehensive update on the standard management of particular types of
wounds, and it remained in effect in this capacity even into the Korean
War.*
DeBakey was promoted to Major in the spring of 1943, not long after
arriving in Washington. This was a rank commensurate with his position in
the Surgeon General’s Office, at least at first. Although he was deeply
immersed in his work, the great distance from Diana and Mickey was
difficult to bear. Eventually he found a suitable place for all of them, a cozy
two-story red brick home in a newly developed neighborhood established
primarily for servicemen with families. This was just across the Potomac
River in Arlington, Virginia, at 1425 Longfellow Street, about seven miles
from his office on H Street.105 The back yard was a hill, and what
limitations this imposed on Mickey’s using it as a playground were
mitigated by his father’s green thumb: soon the knoll was covered in
ripening tomato plants.106
On weekends, if he was not traveling to the Service Command units or
on other such stateside journeys, DeBakey sometimes loaded the little
family into the Buick or one of the olive-drab Army sedans from the motor
pool and took them around to see the sights of Washington. Explaining the
landmarks to his young son, who was in kindergarten in 1944, must have
brought to mind his own first experience with the capital city on his
family’s return from the Middle East trek in 1921.
Mickey was, however, a threat to the carefully laid out tomato garden.
One day he and some neighborhood friends “had a tomato fight with all we
could pick and throw.” Diana, of course, administered a mother’s discipline,
such as it might be to her—at the time—only son, but the real punishment
came when Father returned home: “He was furious. I remember it as the
only time I ever got the belt spanking for my mischief.” Perhaps recalling
the long-ago afternoon in Lake Charles when he himself suffered the same
punishment for reading a book instead of cleaning windows, “Dad cried as
he spanked me, I remember.”107
Mickey replanted the tomato garden, with some squash as well. It was
the beginning of a life-long avocation, shared with his father and
grandfather (Figure 4.2).
Figure 4.2 Wartime photo of DeBakey and his first son, Mickey.
The pace of visits by DeBakey to the Service Command installations

increased throughout 1944. In early February of the year, he visited
facilities in Nashville and Galesburg, Illinois. In September, he flew all the
way to Sacramento to inspect a Vascular Center where Ambrose Storck, his
former Tulane colleague (and predecessor at the Surgical Consultants
office) was then plying his trade. In the fall DeBakey crisscrossed the
nation, managing to tour facilities in five separate Service Commands.108
These frequent visits by DeBakey and the other Washington-based
Surgical Consultants fostered a close relationship with the Service
Command Consultants. In October 1943, Rankin arranged a two-day
symposium in Washington for them, at which the various issues then at
hand were discussed. The meeting was such a success that the decision was
made to turn it into an annual affair. The events of the war meant that only
one more symposium was held, in 1944. This was even more organized,
scientific, and successful. DeBakey delivered a presentation on one of the
tasks he was charged with—and approached with the greatest enthusiasm—
the History of the Medical Department in World War II.109
4.7 Short Snorter

It was also helpful for their close working relationship that the Surgical
Consultants Division and the Service Command surgeons were in relative
proximity geographically. In addition to frequent visits, they could keep in
touch by phone or mail with little difficulty. Perhaps most importantly, the
Service Commands were under control of the Army Service Forces, just as
the Surgeon General’s Office was. The overseas Consultants, by contrast,
rarely visited the Washington office (or were visited by them), were far-
flung, and could only be addressed through Command channels.
Consequently, directives from the Surgeon General’s Office were
sometimes received by the theater consultants with the resentment of
perceived interference, if they were received at all.
In reviewing the work of the Consultants after the war, Noland Carter
reflected that:
In retrospect, one of the most serious defects in the maintenance of the most effective relations
between the Office of the Surgeon General and the theaters of operations was the lack of a
closely knit liaison which can best be had by an interchange of personnel. Considerably better
teamwork could have been effected had there been more frequent visits by members of the
Surgical Consultants Division to the various theaters, and vice versa. In retrospect, it seems
unbelievable that during the entire war only two visits were made to foreign theaters of
operations by members of the Division and that only a few more were made by surgical
consultants from oversea theaters to the Office of the Surgeon General.110
Edward Churchill and Elliot Cutler, Chief Consultant for the European
Theater of Operations, did visit Washington and the Surgeon General’s
Office, but, as Carter noted, these were unusual events. Men of their stature
were too important in their places to be spared away for long (in his official
diary Cutler recorded meeting with “General Rankin and Colonel Carter
and Major DeBakey” on August 15, 1944, in the Consultants Office in
Washington).111
The main means of communication between the Theater Consultants (in
fact, all medical officers overseas) and their Washington counterparts were
the monthly transmissions known as Essential Technical Medical Data
reports, which came from the field to the Surgeon General. These each
contained a section on surgery. The Consultants Division composed
responses to each of the reports to aid the solution of innumerable problems
that arose in the field. The system was one of indirect communication, but it
eventually developed into a reasonably effective one.112
Nevertheless, as Carter pointed out, nothing could replace actual site
visits.
It was for this reason that plans were drawn in late 1944 for DeBakey to
be sent to Europe to visit the medical facilities and personnel of the
Mediterranean and European Theaters of Operation.
It took some time for the orders and other paperwork to go through
(among the unusual requests was a stipulation that DeBakey be allowed to
bring a camera with him). Arrangements were completed by the end of
January, and DeBakey left Washington on January 28, flying to
Newfoundland. From there he crossed the Atlantic to the Azores, then on to
Casablanca and, finally, Naples.113 DeBakey was now a Lieutenant
Colonel, but enjoyed the privilege of traveling in the name of the Surgeon
General, who was a major general, with two stars on his epaulets. This gave
DeBakey the power to bump anyone off a full transport plane who was
below this rank, including (one-star) brigadier generals.114
DeBakey was joined on the transatlantic flight by a surprising number of
individuals significant to the war effort. Edward Churchill was on the plane,
as was Richard Meiling, a specialist in air transport of the wounded who
would become Assistant Secretary of Defense for Health and, later, Dean of
the College of Medicine at the Ohio State University. Perrin Long, an
expert on infectious diseases and penicillin from the Johns Hopkins
Hospital, made the trip, as did Howard Rusk, one of the early proponents of
physical medicine and the architect of the Army’s rehabilitation program.
Filling out the passenger list were George Lyon, a Navy commander who
specialized in gas warfare, and Charles Proctor Cooper, an executive with
AT&T who was Chairman of the Board at New York’s Presbyterian
Hospital and a major player in medical politics on the East Coast. This was
heady company for the young Colonel, still just 36, but DeBakey remained
friends with a number of these men over the years to come.*
By this time the medical facilities of the Mediterranean Theater of
Operations (MTO), which DeBakey visited first, had moved to Italy. Sicily
had been liberated in August 1943, and the Italian mainland was invaded
the following month. Fighting had continued nearly unabated since then as
the Americans and British battled against a determined German defense,
pushing up the peninsula. Now, as DeBakey arrived in early February 1945,
combat continued in the mountains at places like Monte Belvedere and
Monte Castello north of Florence.
On arriving in Naples, Churchill was reunited with his officers and
friends, and DeBakey joined them for highballs and dinner, where the new
arrival was entertained by lurid tales of the Casablanca prostitutes.115
The British counterpart to the American MTO medical Corps, the Central
Mediterranean Forces Army Surgeons, had scheduled a Congress, covering
all aspects of military medicine and surgery, for February 12–16 in Rome.
DeBakey, as well as Churchill and many other Americans from the Fifth
Army medical services, were invited to attend. This meeting was held at a
large dental clinic on Viale Regina Marguerita which had been built with
funds donated by the American industrialist George Eastman.116
On February 13, a number of Army Medical Corps officers, including
DeBakey, traveled across the Tiber to the Vatican for an audience with Pope
Pius XII. The Pope congratulated the physicians on continuing their
devotion to learning by gathering at the Congress in the midst of the chaos
and overwhelming tasks of the war, then closed with a benevolence from
Ecclesiastes: “The skill of the physician shall raise him to eminence among
men, and in the sight of great men he shall be praised; the gifts of the king
shall be reserved for him.”118
DeBakey bought “a couple dozen” rosaries from a vendor outside the
Vatican and managed to get a Papal blessing on them. When he returned to
New Orleans after the war, he gave the beads to the Sisters of Charity, who
were overwhelmed: “They started crying. . . . I couldn’t have done anything
better.”119
The Congress came to a close on Friday, February 16. The next morning
about 30 American surgeons gathered at the nearby Excelsior Hotel,
headquarters of the Fifth Army and in peacetime a ritzy property on
fashionable Via Venuto (Figure 4.3). There they discussed the British
presentations and debated some topics that were not covered at the
conference (DeBakey was asked to render his opinion about the proper
placement of intestinal stomas after injuries to the colon).*,120
Figure 4.3 American and British medical officers in front of the Hotel Excelsior, Rome, February
1945. DeBakey is bottom row, extreme right.
DeBakey was suitably impressed by the level of care and military

efficiency he observed throughout the MTO, which at this time was
essentially the Fifth Army. This was no surprise, since he had high regard
for the unit’s Consultant Howard Snyder, a thoracic surgeon from Kansas,
as well as the theater consultant Churchill.
DeBakey next went with Churchill to Florence. There he encountered
Tulane’s own 24th General Hospital and noted that “they are beautifully
situated.”121 North of the town he had the extraordinary opportunity to
observe the legendary, successful assault by the US Army’s 10th Mountain
Division on the German position atop Monte Belvedere.122
From here DeBakey flew to Paris on March 6, where he checked in with
the European Theater Chief Surgical Consultant, Elliott Cutler.123 He also
had a brief reunion with his old Professor, Rene Leriche, who was now at
the Collège de France in the capital. DeBakey and Cutler joined Leriche for
dinner at his home on Rue de l’Alboni in the shadow of the Eiffel
Tower.†,124
During his tour of Europe DeBakey made use of Army Service Exchange
Ration Cards issued to him by the Theater commands. DeBakey’s cards
allowed him to purchase some items of everyday use, such as soft drinks or
matches, every week. Some sundries such as razor blades could only be
purchased every two weeks, while still other lesser used or longer lasting
items such as toothpaste or shaving cream could only be sold to him every
four or eight weeks. While on his European tour DeBakey consistently
filled his ration card for candy, chewing gum, and tobacco. Fruit juice was
another favorite. His ration for beer went completely unused.125
On March 9, DeBakey left Paris to continue the liaison visits at the First
Army headquarters.126 There was great excitement at their destination
(which moved to the Roer Valley town of Düren on the same day). Just two
days before, the First Army’s Ninth Armored Division had captured an
intact bridge across the Rhine River at the town of Remagen. German
attempts to destroy the bridge had failed, and everyone on both sides
recognized that this was a major—and extremely lucky—break for the
Americans. Establishing a bridgehead at Remagen would prevent the
Germans from reorganizing east of the river for a coordinated defense of
their homeland. Panic-stricken, German high command used all the military
technology at their disposal in an attempt to blow the bridge after the
Americans had taken it, including new jet bombers, frog men, and even V2
rockets. Freshly on the scene, DeBakey was asked if he wanted to go have a
look at what was suddenly the most famous and important bridge in the
world.
I said, “Yes, sir, I would.” When I got there, the Germans were still firing to try and destroy the
bridge. And the engineers had put up a pontoon bridge across. They were sending personnel and
Army vehicles and so on across this pontoon bridge. I went over in a jeep on this pontoon
bridge. They were doing it in specified intervals, not on a regular basis, but on an irregular basis,
because the Germans were still trying to zero in to destroy the bridge.127
After crossing the river DeBakey found a German military hospital in the
town. It was still filled with wounded, as well as their doctors and nurses.
A large number of them were amputees. That’s why they couldn’t remove them. And they had
infections and it was a sight to behold. A very poorly treated group, largely because they didn’t
have penicillin. They were unable to control infection like we could. It was a civilian hospital
building that they had taken over and used as a military hospital. Some of the German doctors
were still there and the nurses and so on. They left them there to take care of the patients. I guess
they were glad to be left too.128
While with the First Army DeBakey visited evacuation hospitals, field
hospitals, a convalescent hospital, and the Third Auxiliary Surgical
Group.129
While DeBakey was with the First Army, the surgical consultant to the
unit, Colonel J. Augustus “Gus” Crisler, pointed out that the Chief Surgeon
of the outfit, a Regular Army man, had a tendency to hold large numbers of
his operating teams in reserve during periods of combat, which Crisler
thought was an error. The concern was to avoid overcommitting precious
resources in case a still-greater onslaught of casualties should arise in some
sector. Although this sounded reasonable on the surface, in actual practice
the policy was counterproductive since the concern for hypothetical
casualties resulted in treatment delays for the soldiers who actually were
wounded and in large numbers of surgeons who were left idle in the rear.
DeBakey had seen the Fifth Army dealing with much larger casualty
numbers in Italy and committing all their surgical resources to the fray, so
his assessment concurred with Crisler’s. DeBakey’s report would not be
finished for weeks, but Crisler evidently made mention of his findings to
the Chief Surgeon, and before long trouble was brewing.130
In a few days DeBakey moved on to the Ninth Army, which was also at
the Rhine at this point. Here he spent time with more of the medical units,
including the Fifth Auxiliary Surgical Group. With the Ninth Army he even
got as close to the front as the Collecting and Clearing Companies and a
Battalion Aid Station in the area of the 75th Infantry Division.131 The sights
he saw on these encounters were sobering and etched themselves on his
memory.
I was up with them when battles were going on, and saw soldiers with their brains falling out of
their heads, and mangled, and everything else. It was a terrible thing to see what war does. You
really see what a terrible, terrible thing war is when you see these youngsters, eighteen,
nineteen, twenty years old out there lying in the field completely mangled, dead, or barely
breathing. Some of them suffering and wishing they were dead. That really was terrible.132
Back in Arlington Diana was passing the time, but not without some
hardship. The family’s second son, Ernest Ochsner DeBakey, had been born
on January 6, 1945.133 With her husband traveling overseas just weeks after
his birth, the burden of the new child must have been considerable (Mickey
was now five-and-a-half and in kindergarten). Diana herself was suffering
from what she described as “milk leg,” an old term for a postpartum form of
one of her husband’s special clinical interests, thrombophlebitis. Rankin
telephoned Diana frequently to check in (she called him “The General”).
Friends as well as family visited, too. The baby’s namesake, Michael’s
brother Ernest, was in Washington for a brief stay at this time, along with
his new wife, the former Rosabelle, whom everyone knew as “Ro.”134
Ernest had completed his tour of duty in the China-Burma-India Theater
and been rotated to Florida, where he was married in 1943. He felt his
surgical talents were being wasted where he was, though, and asked his
brother to arrange a meeting with Rankin. Ernest was hoping to get out of
the Air Force and into the Army, as Michael had done in his transfer from
Gulfport. Rankin’s esteem for the elder DeBakey brother was obviously
high, and he offered to arrange a transfer to any hospital Ernest had in mind,
assuming they had a vacancy. Ernest chose Ashford General Hospital at the
resort of Greenbrier in White Sulphur Springs, West Virginia. This was one
of the Vascular Centers, and the chief of that service was his brother’s
friend, Daniel Elkins of Emory University.135
At one point during DeBakey’s tour of the US Armies, Mickey, who was
apt to be ill at this age, fell alarmingly sick. Diana, as a trained nurse, was
not given to panic, but her maternal fears were as real as any layperson’s.
Her experience also told her when illness was potentially grave.
She bundled him up and put him in the car and took him over to General Rankin’s apartment.
She didn’t know what else to do. She was scared to death he was dying. She knocked on the
door and General Rankin came in his robe; he wasn’t fully dressed. But he was very kind to her.
He didn’t get upset with her at all. She was carrying the child in her arms and said, “I’m scared
to death he’s going to die and I didn’t know what to do.” He told her, “Let’s take him
immediately to the Walter Reed Hospital.’’ So he got dressed very quickly and took her with the
child to Walter Reed Hospital. Had him admitted and then raised hell about getting penicillin.136
Rankin was, of course, able to secure some of the scarce drug for the boy.
Young Michael DeBakey spent a few days at Walter Reed in an oxygen
tent, but recovered uneventfully. As might be supposed, Diana had a special
appreciation and affection for Rankin after this event: “My wife after that
was just devoted to him. Devoted to him.”137
After his liaison with the Ninth Army, DeBakey moved to the Third on
March 23, 1945. The Surgical Consultant to this Army, which was under the
conspicuous command of Lieutenant General George S. Patton, Jr., was
DeBakey’s long-time friend and colleague from Tulane, Charles Odom.
Odom had started the war with Louisiana State University’s 134th General
Hospital, but had eventually become Surgical Consultant to Patton’s
Seventh Army. When the Third Army was assembled under “Old Blood and
Guts” in 1944, Odom took over the same position in that unit. It is unknown
what role DeBakey may have played in Odom’s appointment as Surgical
Consultant to the Seventh and Third Armies, but these positions were
ordinarily assigned by his group.138
In mid-March 1945, headquarters of the Third Army were located at
Fondation Pescatore, a retirement home in Luxembourg City that more
closely resembled a palace, complete with spires and casemates.139 When
he heard his old friend was visiting, Odom insisted that DeBakey join him
for the week in General Patton’s inner circle at the Fondation.
Like most Americans, DeBakey was familiar with the complex and
contradictory persona of Patton: an obvious military prodigy with damning
personal qualities. These included celebrated braggadocio and brutishness
(he was nearly as famous for slapping a shell-shocked soldier in Sicily as he
was for liberating the island). To his surprise, DeBakey found the fearsome
general to be erudite and affable.
I must say that my stay there changed my opinion of him, because before you thought of him as
a flamboyant soldier, but actually he was a scholarly soldier. Every night at dinner he laid out a
beautiful table—with silverware, china, tablecloths, linen. After the dinner we’d sit around the
fireplace. It was in the winter. We’d sit around the fireplace and have an after-dinner drink and
he would then tell us historical stories about previous campaigns. He would point out why
critical battles took place where they took place, repeatedly over the centuries. It was because of
the natural geography, they were either critical to the defense of a place or critical to an invading
army’s progress. And he told about these: all the battles in Italy, for example, and the south of
France, moving into Germany. He would tell us where these critical points were previously. He
knew his history beautifully—military history. He was really a military scholar, and when he sat
there talking he talked like a professor. He did it in a way that was fascinating and most
interesting, and none of the flamboyant aspect of him appeared there. This was a kind of
scholar.140
Although his overall impression was strongly positive, on one occasion

DeBakey was witness to the legendary Patton temper. The general traveled
with his own cook, who knew precisely how his boss liked his food
prepared. One evening at the Fondation the cook became ill, and his
replacement prepared roast beef in a manner far from Patton’s liking.
We were sitting around the table, this group of six or seven of us when the waiter, who was a
soldier, brought the tray on which the roast beef was on, to show him. He looked at this thing
and gosh he got mad and flared up and started cursing the soldier and cursing whoever it was
and wondered “What in the hell happened to it? The cook knows better than this.” This poor
soldier, you know, he was so frightened his knees were shaking. Finally, one of his aides said,
“General, I’m sorry that you didn’t know this, but the cook, your regular cook was taken sick
and there’s a new cook there.” “Well, goddamn it, why didn’t he find out how I wanted this
done? Take it back.” He was mad as hell. We all sat in stunned silence. There wasn’t anything
we could do. Finally, the boy brought back something else. We sat there and ate, but the dinner
had been ruined. There wasn’t much to say. It wasn’t long after that we went back and sat down
like we usually did by the fireplace. He had a cigar and we were sitting around and pretty soon
he mellowed again as though nothing had happened.141
The American armies continued east into Germany in early April, on the
final race toward Berlin.
During this time DeBakey returned to Paris for a meeting with Colonel
Cutler, somewhat sooner and in a decidedly less comfortable mode of
transportation than he would have preferred. The brewing trouble from his
concerns about the First Army had boiled over.
After hearing about DeBakey’s as-yet unwritten criticisms, the Chief
Surgeon of the unit took great offense. Rather than consider the possible
advantages of altering his policies to address the concerns, he complained
to medical headquarters in Paris that he was being undermined. He went on
to indicate that the criticisms of his well-thought-out ideas might give aid
and comfort to the enemy and threatened to have the interloper DeBakey
court-martialed. Cutler, accordingly, summoned DeBakey to Paris for a
meeting that would include General Paul Hawley, the Chief of Surgery for
the European Theater.
Getting from the Rhine to Paris in a rapid fashion was somewhat tricky in
April 1945. As DeBakey remembered it, his new friend and dinner
companion provided a two-seater airplane for the purpose.
Patton loaned me his private little plane to fly me back to Paris. It was only a little grasshopper
plane—a single motor plane. Well, I had heard stories about some of these planes being shot
down by the Germans, and on our way over to Paris from the front we were flying at fairly low
levels. We were flying about 2,000 feet. I was sitting behind the pilot in this two-seater plane—
the pilot motioned me to look back. And he couldn’t tell whether it was one of our planes or not,
so he started down. That’s what they do: go down and get closer to the ground and sort of zig-
zag. I could just see the German plane shooting me right in the back. I guess it’s about the
scaredest I’ve ever been. Well, pretty soon we saw this plane came and passed us up to one side
above us and wag his wings. It was an American plane, and God, what a sigh of relief.142
DeBakey met with Hawley and Cutler on April 7. He reviewed with them
his findings regarding the First Army policies. By this time—nearing the
end of his liaison tour of the MTO and ETO—DeBakey had compiled
enormous amounts of data regarding the surgical care of the American
soldiers in Europe. He had no difficulty at all in demonstrating from the
First Army’s own data that the Chief Surgeon’s policies had created massive
inefficiencies in the delivery of effective care that were seen nowhere else
in the US Army. Moreover, they almost certainly contributed to unnecessary
loss of life and limb. Hawley listened, then told DeBakey that he had
already suspected everything he had just heard—still, it was stunning to see
it so clearly demonstrated. He and Cutler would advise the First Army Chief
Surgeon to abandon his threats of court-martial, since the data that would be
presented would make him look the worse. They sent DeBakey back to his
tour of the units in the field, which he finished with the Seventh Army.143
DeBakey’s final report after his return to the States, dated April 17, 1945,
was effusive. He pointed out that his reception at the various sites was
uniformly a welcoming one and that visits by representatives of the Surgeon
General’s Office were favorably viewed by the surgeons in the field.
DeBakey noted the improvements in blood transfusion that had occurred—
with some room for improvement remaining. In addressing the management
of wounds in the theaters, he noted that his own Technical Bulletin 147—
which had just gone out in March—was being followed closely, and he
singled out Edward Churchill (the bulletin’s co-author) for special praise,
invoking his phased wound management concept.
The therapeutic adjuncts and basic surgical principles utilized in the program of wound
management developed by the theater surgical consultant and his consultant staff and presented
in various publications of the Office of the Chief Surgeon are being effectively applied by the
surgeons in the Army hospitals. The development of this rational program of wound
management and its successful application have been largely achieved through the profound
influence of the theater surgical consultant and his staff. The attainment of such a high standard
of surgical practice and the gratifying results achieved form a signal tribute to his broad vision,
his untiring educational efforts, and his trenchant surgical judgment.144
All was not sweetness and light, however. Still fuming over what he
considered to be his shabby treatment for simply reporting the facts about
the First Army’s surgical service, DeBakey opted for the last laugh. He and
Gil Beebe wrote up the efficiency data he had gathered from the overseas
Armies and published them in Health, in an article entitled, “Disposition in
the Forward Area.”145 The most damning numbers demonstrated that,
despite having similar hospital admission rates to those of the other Armies,
the First Army only managed to return to active duty a relative fraction of
the admitted soldiers.
Now Health was a secret, classified document that went to the Commander-in-Chief of each
Army in each theater. And there was this article. So he saw it. This fellow came up for a
promotion and didn’t get it. That in a sense wasn’t vengeance, it was a kind of a, let’s say,
reward in reverse that he got for his other thing.146
On the first of May 1945—one week before V-E Day—DeBakey sent a

letter to Alton Ochsner, updating his former (and, technically, still-current)
chief with tales of his experiences and exploits. In addition to detailing the
fearful toll the war had taken on some of Ochsner’s favorite old cities in
Germany, DeBakey summarized his European tour.
I returned home last week from my overseas trip which carried me over practically all of our
fighting fronts in Europe. It was a most enjoyable, instructive, and exciting tour. I saw many
awe-inspiring sights, met certain impressive personalities such as the Pope and Patton, and
observed at first hand the links in the chain of the surgical care of the wounded from the
battalion aid station to the general hospital. I went across the Remagen bridge before it collapsed
and subsequently crossed the Rhine again at the launching of this offensive. It was, indeed, a
most eventful trip, jampacked with kaleidoscopic experiences.147
4.8 Following Up
When DeBakey returned to the United States in mid-April, the war in
Europe had only a few more weeks left in its bloody course. No one at the
Surgeon General’s Office was considering going home just yet, though.
Plans were under way for pivoting to a full concentration of Allied forces
against what was left of the Japanese Empire. The horrific Battle of Iwo
Jima had just ended, and any illusions about the ease of an invasion of the
Japanese home islands were being swept away at that very time on the
beaches of Okinawa.
DeBakey’s own efforts in the spring of 1945 were mainly concentrated
on further analysis—with the assistance of Gilbert Beebe—of the reams of
data he had collected on his 10-week European mission.148 Eventually their
work with this data would lead to an important book on the science of
military medical logistics.
The initial experience of the ASGs had had its rough spots—with
confusion as to their proper use and resentment by the field hospital
surgeons that they represented an indictment of their ability to care for
patients properly. Once these difficulties had been overcome, however, the
ASG’s were a big success, in both the Mediterranean and European
Theaters. For this reason an effort was under way by the end of the war to
make them, in essence, a permanent feature of the Army. The best manner
to accomplish this was, however, a controversial matter.
The Army Ground Forces—in other words, the command officers—
wanted a new 60-bed mobile surgical hospital to be established that would
contain assigned surgeons along with their teams. The Army Service
Forces, represented primarily by the Surgical Consultants Division,
believed that the ASG model worked so well that it deserved to be kept
intact. Conferences were held on the subject of mobile surgical hospitals
beginning in the spring of 1945. From the start, the lines were drawn
between the Regular Army officers and the civilian surgeons. In the
background was the consideration of how the new organization might affect
the delivery of forward surgery in the Pacific.149
At meetings held in mid-June 1945, the Ground Forces began discussion
from the position of a proposed T/O & E in which there were four surgeons
—two surgical teams—assigned to each of the new mobile surgical
hospitals. The Surgical Consultants, represented by Nick Carter and Charles
Odom, pointed out that this would be a waste of surgical talent since such a
configuration of personnel guaranteed idle surgeons. They argued that the
ASG’s should be retained and could provide the surgical teams as needed—
the model that had proved so successful in Europe.150
The Ground Forces’ counterargument revolved around the hypothetical
unavailability of the personnel in question, as well as concerns about the
issue of command difficulties between the proposed new hospital and any
attached officers (which had, in fact, been an issue with the ASG’s). There
was also the more practical consideration that the War Department was not
likely to approve a new organization that could not actually perform its
function as drawn up.
DeBakey took up the fight for the Surgical Consultants Division at a June
16 conference, which was held in the office of General Raymond Bliss,
Chief of the Operations Service and Assistant Surgeon General and thus
part of Service Forces. Not much new ground was broken at this
conference, except that brass were present on both sides (the Ground Forces
were represented by General Frederick Blessé, who was their main
representative in this). An ominous announcement for the Consultants
Division was that the T/O & E for the ASG’s had been eliminated.151
On June 28, DeBakey sent a letter to Edward Churchill which contained
some optimistic, if not entirely realistic discussion on the matter.
We have been engaged in much discussion and some controversy concerning a recently
proposed T.O. & E for a 60 bed surgical hospital to be used in the same manner as you have
used the platoon of the Field Hospital. The big difference, however, and the main point of issue
is that this proposed hospital has attached to it surgical teams as organic personnel. We have
strongly opposed it for this reason since, obviously, this concept moves in the opposite direction
of flexibility of specialized personnel which your experience has demonstrated is essential to
efficient operation. I think we have been able to stop it but I would appreciate your comments
on the matter.152
The choice of Churchill to buttress the Consultants’ position was a clever

one. As Harvard professor and Chief of Surgery at the Massachusetts
General Hospital in civilian life, Churchill’s opinion carried great weight
anywhere. The time he had spent as Chief Consultant to the North African
and Mediterranean Theaters only enhanced his reputation. Moreover, he had
served closely with General Blessé overseas when that officer was Chief
Surgeon of the Fifth Army (and then the North African Theater). Churchill
responded as DeBakey might have hoped: “You asked for comments
regarding the use of Surgical Teams as organic personnel in a 60 bed
surgical hospital. It is my belief that the present system or one similar to it
that pools Surgeon Specialists so that they may be deployed in the forward
areas if the tactical situation would permit, is far preferable than finding
specialists by assignment to units.”153
DeBakey managed to get Tracy Voorhees, his attorney friend who was
Director of the Control Division, to forward a version of Churchill’s
remarks to Surgeon General Norman Kirk on August 10, just in advance of
a key meeting that would likely decide the issue.154
That meeting was held on August 11, 1945, under the auspices of Major
General Russell Maxwell of the Logistics Division, G4. This was the
section of the War Department that would make the final decision regarding
whether to create the new hospital unit. DeBakey was present, accompanied
by Lieutenant Colonel A. F. Lipton from the Surgeon General’s Office.
There were also representatives of the Air Force, Mobilization Division of
the Service Forces, two other G4 representatives, and General Blessé.155
Maxwell made some opening remarks to the effect that the meeting was
to come to a decision on the proposed new 60-bed surgical hospital and to
hear the arguments for and against the idea. Then General Blessé took the
floor.
After reiterating the Ground Forces’ position, Blessé dropped the
bombshell that he had already discussed the matter with Surgeon General
Kirk, who had agreed that the T/O & E should be authorized as planned.
DeBakey, who must have been nonplussed, went next. His arguments had
been severely undercut by the apparent support of his boss for the other
side’s position. Nonetheless, he articulated the surgeons’ points that the
proposed mobile surgical hospital would be inefficient and unnecessary and
would certainly waste surgical talent. He also invoked Churchill’s
endorsement of his position (DeBakey later noted with evident thinly veiled
disgust that Maxwell had had to ask who the Surgical Consultants even
were).
Lipton followed and completed the sabotage by the Surgeon General’s
office, pointing out that during his long experience with assembling T/O &
E’s he had believed that War Department policy was for any new unit to be
complete and capable of performing its mission. In an anticlimactic
observation, the Air Force representatives then agreed that the new hospital
unit was desirable. A disappointed DeBakey came away from the
conference with “the distinct impression that G4 would decide to approve
the T/O&E.”156
He was right. The order was published on August 23, 1945, as T/O&E 8-
571 Mobile Army Surgical Hospital (MASH), coopting the ASG’s old
number. DeBakey moved on from the authorization of what became the
MASH units, but the sting of the defeat lingered. Soon afterward he wrote
Churchill that “there is a long and sad story behind this which is better
discussed between lobster and beer.”157 A few months later he continued the
postmortem: “Attached herewith is a copy of T/O&E 8-571 on the Mobile
Army Surgical Hospital which was authorized despite our vigorous protest.
Certainly this is an example of official blindness to facts bathed in the
bright light of experience. . . . “158
Several tasks quite different from his wartime work began to take up
more and more of DeBakey’s time in the summer of 1945 and afterward.
Their accumulated weight eventually led him to remain in the service for a
full year after the end of the war, long past the time when he could have
been discharged.
These tasks were of varying immediacy and complexity, but all seemed
to require the cooperation of individuals and services not necessarily
predisposed to work together for a greater good. They included
coordinating the ongoing care of the wounded soldiers who remained
hospitalized or in need of surgery beyond the cessation of hostilities, as well
as the development of a Follow-Up Agency to take advantage of the
unprecedented opportunity for long-term study of the servicemen’s health.
Not long after he had started these efforts on their way and returned
home, DeBakey found himself back in Washington to help a Presidential
Commission streamline federal medical care, which turned out to play a
role in the ultimate disposition of his cherished Army Medical Library.
Before any of these tasks were undertaken, though—or even realized as
endeavors in need of attention—the job of recording what had transpired in
the wartime Medical Department was recognized as being of utmost
importance.
Probably no single individual realized as well as DeBakey that the US
Army Medical Corps had failed the troops miserably in World War II from
an ignorance and indifference to the lessons learned in prior conflicts.
DeBakey was determined that this should never happen again. He
understood that success in this would require active vigilance going
forward, but the first place to begin was the composition of an accurate
record of what had taken place in World War II.
Thankfully, others felt similarly, and the Army Surgeon General had
actually reactivated the Historical Branch in his office before Pearl Harbor
—in August 1941.159 After the United States entered the war Colonel Albert
G. Love was called out of retirement to lead this branch. Love had been in
the Surgeon General’s Office for a number of years after World War I and
had written a remarkable book in 1931 called War Casualties which
outlined “a system for estimating, on the basis of our casualty experience in
past wars, the requirements for medical service including hospitalization
and evacuation of front line casualties.”160 This book appears to have been
as undeservedly ignored as the official History of the Army Medical
Department, with equally dire consequences.
At first, the task of producing a medical history for the new war had been
assigned to a subcommittee of the NRC but, by March 1944, the Surgeon
General opted to take full responsibility for the effort. DeBakey was
assigned to the work, and he had, as noted earlier, spoken of it at the
gathering of the Service Command Consultants in Washington in October
of that year.161
It was obviously a task of gigantic proportions to write the History of the
Army Medical Department in a world war. Significant delegation of duties
was essential, and in as many cases as possible the leaders of the divisions
or sections in question were asked to write their own histories. Many agreed
to do so, although in some cases it took significant time before the
assignments were completed. In this way, for example, B. Noland Carter
wrote the History of the Surgical Consultants Division in Washington, and
Charles Odom wrote the History of the Third Army Consultant.
In September 1945, both Rankin and Carter left the Surgical Consultants
Division. By default, DeBakey was “left holding the bag” and became head
of the office.162 That fall he was promoted to full Colonel—which required
special intervention by Surgeon General Kirk since DeBakey had only been
Lt. Colonel a short time—and was also awarded the Legion of Merit for his
work in the Surgical Consultants office (Figure 4.4). These accolades were
welcome, but they did not ease the burdens of the position—which he
described in a letter to Rankin, now back home in Lexington, Kentucky.
I find my time is being taken up with so much administrative and personnel matters that I am
able to devote very little of it to the history. This has disturbed me so much that I’m beginning to
worry about it. I have tried in every way possible to dispose of these matters but it seems
practically impossible. More and more people are constantly streaming through the office and I
have not gotten to the point where I can be rude. Besides I doubt that it would work.*,163
The most significant of the personnel issues, and the one which was of
greatest importance in the ongoing care of the soldiers, involved the
demobilization of the Army Medical Department.
Figure 4.4 DeBakey as full Colonel, US Army.

After the Japanese surrender in August there was an understandable rush
on the part of the members of the Medical Corps, along with everyone else,
to be discharged. They had served their time and earned the right to go
home. Many of those who had been stationed overseas had not seen their
families for three years or more. But there was a problem: there were still
many thousands of troops in the hospitals, and some still needed surgical
operations. If all the physicians left the Army, these men would be
abandoned.
The issue ultimately devolved on the surgical specialists, and among the
most threatened were plastic surgery patients. DeBakey did some
calculations and found that, at the end of the war, there were still 11,000
servicemen awaiting plastic and/or hand surgery. On average, each was
expected to require 2–3 more operations, meaning 30,000 that had yet to be
performed. About 3,000 such procedures were done in the specialty centers
each month, so simple arithmetic revealed that it would 10 more months to
finish them—if everyone stayed. If half the surgical specialists left, as was
anticipated, the backlog would drag to years.165
To prevent this and similar problems, DeBakey became determined to
keep as many of the stateside specialists in uniform as he could while also
returning key overseas surgeons to the Interior. DeBakey believed that he
could succeed in corralling the needed doctors by appealing to their sense
of duty—especially if the appeal were sweetened with the offer of a grade’s
promotion. After winning the Surgeon General over to the idea, DeBakey
approached Tracy Voorhees, whom he knew had the ear of the Secretary of
War. Voorhees got permission to adopt the plan, and DeBakey identified
about 100 specialists whose retention would ease the crisis. To his later
recollection, none of these one hundred or so surgeons refused: “I was
really tremendously impressed with that. I thought this was the most
patriotic thing I had ever experienced. Certainly, it reassured me that the
medical profession were fine people. And that’s how we got it done.”166
Later, in August 1946, the Medical Advisory Committee to the Secretary
of War was formed, with Voorhees again playing an important role. The
primary mission of this group was to ensure that medical care in the Army
stayed up to the civilian standards it had reached during the war. Edward
Churchill was chairman, with DeBakey and Eli Ginzberg among the
members. In particular, the goal was that specialty care for the soldiers
continued at a high level.167
During the course of the war the immediate tasks at hand were of such a
vital nature that few physicians in the military thought much about the
possibilities of long-term research, especially extending to the postwar
period. Some, however, began to realize that there were unusual
opportunities in front of them. As early as November 1943, members of the
US Archives office contacted the NRC about the enormous quantities of
medical records which were being accumulated, suggesting that they may
be of value in future research. Nothing came of this, however.168 DeBakey
was apparently the first to devise a concrete plan for the long-term follow-
up of the health of wartime military personnel. This came in an important
memo to the Surgeon General dated March 5, 1946.
In the memorandum DeBakey highlighted the tremendous opportunity
that was at hand: “an enormous amount of material of great clinical value
has accumulated in the records kept in Army hospitals and dispensaries and
in medical installations of other branches of the Armed Forces. It can be
fairly said that no similar amount of material has ever been accumulated,
and it is doubtful whether a similar amount will ever again be available.”
He then convincingly argued for the establishment of a Medical Follow-Up
Agency. DeBakey also discussed the type of medical conditions that might
be tracked over time and even outlined possible administrative structure and
funding.169
The response to DeBakey’s note was immediate and enthusiastic. A week
after receiving it, Surgeon General Kirk contacted the President of the
National Academy of Sciences, Dr. Frank Jewett, suggesting that a
conference be arranged between representatives of the Academy (and its
NRC); the Surgeon Generals of the Army, Navy, and Public Health Service;
and the Chief Medical Officer of the Veteran’s Administration. The purpose
of the conference was to consider future interactions between the NRC and
the federal medical services, in particular the follow-up agency proposed in
DeBakey’s memo.170
A preliminary meeting was held on March 29, and a subsequent, full-
scale conference at the NRC building in Washington three weeks later.171
Edward Churchill was again the Chairman, and the attendees were a “who’s
who” of American science and medicine.
They included Henry Beecher, anesthesiologist from the Massachusetts
General Hospital and Churchill’s overseas commands; Elliott Cutler; Louis
Dublin, vice president of the Metropolitan Life Insurance Company; R. E.
Dyer, Assistant Surgeon General of the Public Health Service; Major
General Malcolm Grow of the Air Force; the noted physiologist Andrew Ivy
from Northwestern University; former Army Surgeon General James
Magee, now representing the NRC; Paul Magnusson, Assistant Medical
Director of the Veterans’ Administration (VA); and Lewis Weed, Chairman
of the NRC’s Division of Medical Sciences, among many others. There
were 43 attendees in all.172
Churchill called the meeting to order, and asked DeBakey to read his
memo word-for-word.
What followed in the way of a discussion was a vehement endorsement
of the idea by every attendee who took the opportunity to speak, which was
most of them. They mainly identified areas in their own fields where the
DeBakey follow-up concepts would be of value. Hugh Morgan, the former
Chief Consultant in Medicine who had returned to academia, noted the
“immense value” of such a program in longitudinal study of numerous
medical conditions. William Menninger, a leading psychiatrist, saw the
“great need” for studies of this nature in a variety of conditions ranging
from combat-induced psychoneuroses to the psychology of war heroes. Air
Surgeon Grow observed that there were unknowns pertinent to conditions
associated with flying, like chronic otitis, which might be answered.173
Insurance man Dublin, recalling the tentative plan to do something
similar after World War I (which came to grief) was rhapsodic about this
chance at redemption. He stated that there was “nothing comparable to this
opportunity in the entire world” and that to miss it would be “utterly
tragic.” Milton Winternitz from Yale went even further, pointing out that
this was the most inspirational meeting he had ever attended.174
Churchill appointed a subcommittee to draft a consensus resolution,
which condensed the discussion of the unique opportunity that had arisen,
then recommended formation of a committee by the NRC to consider the
best means of bringing the follow-up program to fruition. The group
unanimously adopted the resolution.
DeBakey and Gilbert Beebe were given the task of preparing a formal
report on the follow-up agency to serve as a “basis for action.” At this point
both men were temporarily assigned to the NRC by the Surgeon General,
and DeBakey moved his office from the Pentagon to their building on
Constitution Avenue.*,175
The report was delivered in mid-June 1946. DeBakey and Beebe
recommended appointing a panel of prominent civilian physicians to
oversee the agency, as well as full-time researchers from the NRC, with
expertise in statistics and study design, to guide implementation of the
studies. Once approved, the research could be carried out by the VA,
medical schools, or other appropriate institutions such as research-oriented
municipal hospitals. With regard to the all-important funding of the agency,
DeBakey and Beebe recommended the “broad financial participation” of
“all the interested federal medical agencies” as well as liaisons with private
fund sources.176
The report was received with enthusiasm at the meeting of the
Committee on Veterans’ Medical Problems and only slightly modified
before approval. In a burst of alacrity seldom seen in the District of
Columbia, the Follow-Up Agency had moved from a nebulous idea in a
three-page memo to a concrete reality in less than months.
Within a few weeks the VA had promised $850,000 to the National
Academy of Sciences. This money would be used to establish a permanent
Committee on Veterans’ Medical Problems, fund research at a number of
veteran’s hospitals, and create an office of follow-up at the NRC. Gilbert
Beebe was hired by the Council to handle statistics in this office, and
eventually became Director.*,177
While the discussions and planning meetings for the Medical Follow Up
Agency were taking place, Diana gave birth to a third DeBakey son, Barry
Edward. He was born at Washington’s Garfield Memorial Hospital on April
18, 1946.178 He joined Mickey, who was now six, and 15-month-old Ernest.
4.9 Going Home?

DeBakey was discharged from the Army on September 4, 1946, one week
short of four years following his commission—and three days before his
38th birthday.179 He had been in Washington for more than three-and-a-half
years. Now it was time to return to Tulane and the Ochsner Clinic.
Arrangements were made to move the household from Longfellow Street in
Arlington back to New Orleans. DeBakey still had some administrative
loose ends to tie up, however—chiefly his role as a member of the
Secretary of War’s Medical Advisory Committee. This group submitted its
final report in November 1946, detailing recommendations on maintaining
an adequate medical work force in the military.180
Effective July 1, 1946, DeBakey had been promoted to Associate
Professor of Surgery at Tulane.181
He was eager to get back to his civilian surgical interests—both research
and clinical—but there were still some important papers to be written and
lectures to be given from the experiences of the Surgical Consultants
Division. These would continue, in fact, for the next few years.
DeBakey had given scientific speeches on an intermittent basis during
the war, typically on broad topics of general surgical interest. Some of these
included, “Current Observations on War Wounds of the Chest,” at the
American Association for Thoracic Surgery meeting in Chicago in May
1944, and “Current Considerations of War Surgery,” at the Southern
Surgical Association in Virginia in December of the same year.182 With the
fighting over, he shifted some of his focus to tentative retrospective
analyses of what had transpired in the Medical Corps.
Edward Churchill invited DeBakey to give a presentation in October
1946 at the Massachusetts General Hospital as part of the centenary
celebration of the first demonstration of ether anesthesia. His talk was
entitled “Military Surgery in World War Two: A Backward Glance and a
Forward Look.” Later published in the New England Journal of Medicine,
this paper—which summarizes the record of the Medical Department (and
the Surgical Consultants in particular)—has become a classic.*
In the years that followed DeBakey gave many lectures at the Medical
Service Officer Basic Course in the Walter Reed Army Medical Center,
covering such subjects as “Cold Injury,” “The Organization of Surgical
Services in the Zone of Interior,” and “The Standards of Military Practice in
the Army.”183
One of DeBakey’s publications of lasting importance from this period
was “Battle Injuries of the Arteries in World War Two: An Analysis of 2,471
Cases,” a collaboration with one of Churchill’s junior men from Harvard
and the MTO, Fiorindo Simeone.184 This article was the largest such series
presented up to that time, by far. DeBakey culled most of the data that
comprised its text from his European liaison trip in early 1945.185 This
paper advocated ligation of arterial injuries in the field hospital setting, due
to the constraints of the battlefield and inadequacy of repair techniques then
available. DeBakey and Simeone also provided the evidence to back up the
recommendation, showing that ligation and arterial repair led to nearly the
same amputation rates. Along with the section on such wounds from TB
MED 147, the DeBakey/Simeone article guided the US military’s treatment
of arterial injuries into the Korean War.
On the postwar home front, DeBakey dealt with the culture shock of
returning to the private sector and re-establishing himself as a civilian New
Orleans surgeon. He had not been in an operating room with any kind of
regularity since before moving to Gulfport. † DeBakey’s professional time
was, of course, divided between the Ochsner Clinic and his Tulane
responsibilities.
The old crew was back together, with a few changes. Ochsner, of course,
had remained in the city during the war. “The Governor,” Rudolph Matas,
was far beyond his clinical years, but remained at hand to dispense his sage
observations and splendid sentences. Mims Gage returned from his time
with the Fourth Service Command in Atlanta, where he had earned the
Legion of Merit, too.186 Charles Odom was back in town, as well. He had
been sent to Texas soon after the war ended and thus was absent when his
patron, General Patton, suffered the spinal cord injury that resulted in his
death. Odom joined the Louisiana State University (LSU) faculty on his
return to New Orleans, which turned him into a rival for the Tulane
contingent. He soon found himself on the losing end of a political battle at
LSU, however, and—relegating his wartime adventures to memory—quit
surgery to become coroner of Jefferson Parish, just as his father had
been.187
In his immediate postwar years at Tulane and the Ochsner Clinic,
DeBakey focused on two areas for civilian academic research and
publication: thoracic surgery, especially related to lung cancer, and a new
vascular physiology model known as “hemometakinesia.”
This idea, also called by the rather friendlier name “the borrowing-
lending hemodynamic phenomenon,” referred to the notion that the volume
of blood in the various parts of the body is constantly shifting in response to
stimuli—and via mechanisms—not necessarily well-defined or understood.
In this way, for example, blood is temporarily “borrowed” from the rest of
the body by an anatomic area, such as an infected toe. The toe becomes
engorged with blood—red and swollen—to fight the infectious agent. When
the infection is resolved and the extra blood is no longer needed, the toe
returns it to the “lending” body. The main thrust of the concept revolved
around arterial insufficiency, and hemometakinesia was an attempt at
physiologic justification for the use of sympathectomy, a la Leriche, in its
treatment. DeBakey and his co-authors suggested that the vasodilation
caused in the affected limb by the procedure resulted in a kind of surgically
induced “borrowing.”188
DeBakey presented a paper on hemometakinesia at the inaugural meeting
of a new organization called the Society for Vascular Surgery, in Atlantic
City, New Jersey on June 8, 1947.189
This association, which arose naturally from the growing application of
surgical techniques to vascular disease, was the brainchild of James Ross
Veal, a surgeon at Georgetown University. When Veal communicated his
idea to a number of surgical leaders in the late 1930s, it was received with
enthusiasm. Due to the war, however, it took a number of years to gain
traction. Eventually an organizational meeting—attended by DeBakey—
was held in San Francisco in 1946. At that point it was decided that the first
annual meeting would take place the following year, on the Sunday before
the American Medical Association’s national conference. In addition to
holding such annual meetings, the Society would advocate for the
development of the new specialty by promoting any and all related teaching
and research. Thirty-one Founding Members were named, and Alton
Ochsner was elected the first President (Figure 4.5).190
Figure 4.5 Alton Ochsner and DeBakey at first annual meeting of the Society for Vascular Surgery.
Atlantic City, July 1947.
Despite DeBakey’s advocacy, the concept of hemometakinesia—unlike

the Society for Vascular Surgery—did not catch on. This was primarily
because the main reason for its invocation—sympathectomy—was shortly
to be eclipsed by superior methods of treating arterial occlusive disease.
A few weeks after the first Society for Vascular Surgery meeting
DeBakey received a call from Tracy Voorhees asking him to work on yet
another government committee. It was an important one. The Commission
on Organization of the Executive Branch of the Government was the
brainchild of President Truman, and it was to be chaired by former
President Herbert Hoover (thus earning the informal sobriquet, “Hoover
Commission”). The ambitious objective of the group was to evaluate the
Federal Executive Branch for correctable inefficiencies, and Hoover had
asked Voorhees, a long-time friend, to head up the Committee on Federal
Medical Services. Voorhees selected 15 individuals, mostly physicians, to
serve on the committee. In addition to DeBakey, there were a number of
familiar names, such as Churchill, Hawley, William Menninger, and Hugh
Morgan.191
Reasoning that their role was to figure out where in the federal
government inefficiency and waste could be cut in regards to medicine, the
committee determined that the old proverb about an ounce of prevention
equaling a pound of cure was true: “In medical care the most expensive and
damaging policy is to continue to center expenditure on hospitalization and
the care of diseases while neglecting research, preventive medicine and
public health.”192
They created seven task forces, each focusing on a different aspect of
healthcare delivery. DeBakey served on the groups studying Hospitalization
and Organization.
It was soon obvious that the amount of work DeBakey would need to
perform for this commission would require him to be in Washington on a
full-time basis again. He told Voorhees, who arranged for Herbert Hoover
to write a letter to Tulane obtaining a leave of absence for him.193 DeBakey
virtually moved into the Hays-Adams hotel, overlooking the White House
and Lafayette Square, near his old office on H Street.194 In a sense,
DeBakey never permanently left Washington again.
In order to study the federal hospitals and organization of government-
run medical care fully, DeBakey and his colleagues were obligated to dig
deep into the apparatus and visit representative examples, which cast them
all over the country.
Now that meant for the medical services all of the government’s activities in medicine. So we
had to look into the Public Health Service, and what it was doing. In addition to the Army, Navy,
and Air Force and the Veterans Administration and the National Institutes of Health, the
National Science Foundation, and then even beyond that to other government agencies that had
something to do with medicine. The Department of Agriculture, of Labor. They all had some
medicine in them. The Department of Interior. They have the Indians and the Indian hospitals
and so on.
I spent a lot of time traveling. What I learned essentially was that you can’t really assess in
Washington from reports what’s going on in the field. You’ve got to get out there and see it—to
visualize it, to understand better what you read in the reports and what the data really means.195
In an observation of waste that would have significant repercussions for

DeBakey in the future, the Committee on Federal Medical Services’ final
report noted that:
In Houston, we found V.A. building a $25 million NP [Neuropsychiatric] hospital, immediately
adjacent to the Navy Hospital, because the Navy decided to retain as an NP center a hospital
built during the war. This was built under an arrangement that it would revert to V.A., and for
the past two years only about 10 per cent of its constructed capacity has been required for Navy
personnel. Under unified planning, Navy would not need this installation, and the entire cost of
the new VA Hospital could be saved.196
Work on the Committee extended for more than a year. The final report
(which DeBakey indicated he “virtually wrote”) was delivered on
November 1, 1948.197 Its basic thesis was that the federal government’s role
in the delivery of healthcare as it then existed was egregiously
uncoordinated, guided by no central organization or plan, and lacked even a
definition of the extent of its responsibility. The remedies the Committee
proposed were radical by any measure.
They recommended the institution of a new National Bureau of Health,
to be included in the cabinet-level Department of Health, Education, and
Security that was assumed would also be a Hoover Commission
recommendation.* This was followed by the real eyebrow-raiser: a
recommendation that all the military hospitals in the continental United
States, as well as all the VA and Public Health Service facilities, be placed
under the control of the new Bureau.
Needless to say, the officials in charge of these various facilities and
institutions did not embrace the recommendations with enthusiasm.
Several other sensible recommendations were also made, including—of
utmost importance—adequate funding for medical research:
Since the Federal government now has wards totaling one-sixth of the nation to which it gives
varying degrees of care, and since it faces an enormous growth in veterans hospitalization as
World War Two veterans grow older, the Treasury can be protected best by using every means to
prevent disease rather than by unlimited hospitalization to treat it. This will also promote both
national welfare in peace and a stronger manpower to preserve her security in war. The highest
priority in Federal medical expenditure should, therefore, go to the research, preventive
medicine and public health fields. We must not just treat patients. We must, and to a large degree
we can, if we will, control disease.198
The Committee approached their mission with the clear-eyed focus of

objective scientists, which most of them were. As with DeBakey and the
First Army inspection tour report, the fact that they were goring many a
powerful ox was quite beside the point. Unlike in that earlier instance,
though, this time the weight of emotionless data was not enough to carry
the day. The bulk of the Committee’s sound recommendations were
rejected. The service branches were vehemently against any integration of
their functions and far too powerful to consider any compromise.
Near the end of the war, DeBakey had started to consider seriously
whether something could be done about the Army Medical Library, where
he spent so much time. He was not alone. In fact, many had raised their
voices for years about it. As far back as World War I, tentative plans had
been discussed to move the library into a new structure near the Walter
Reed Hospital in Bethesda, Maryland.199 The American Medical
Association had issued a resolution calling for a new building in 1933, and
the Library’s centennial celebration in 1936 had precipitated a wave of
sentiment along similar lines.200 Concerns were brought to Capitol Hill, and
Congressional committees heard sufficient testimony in favor of a new
facility that an act was passed in 1938 authorizing the Secretary of War to
embark on the project.201
Nothing much happened until 1940, when funds were earmarked for
architectural fees and the Surgeon General and Secretary of War were
authorized by Congress to select a design firm.202 In the fall of 1941,
President Roosevelt signed a bill increasing the budget for the project and
allowing for purchase of a site on Capitol Hill near the Library of
Congress.203 A few weeks later, however, Pearl Harbor directed the
attention of the War Department, and the nation, to other extremities. In the
shock of an existential struggle, building a new Army Medical Library fell
low on the list of priorities.
Near the end of the war, DeBakey discussed the future of the institution
with the Assistant Surgeon General, Raymond Bliss. He was told about the
protracted efforts to find a new home for the collections, and Bliss even had
a painting of the World War I-era design concept on his office wall. The
problem, Bliss said, was that the Library received its funds from the Army
and could never compete with guns, tanks, and the like when the budget
knives came out: “This was the soft part.”204
Having learned this sad fact, DeBakey reasoned that the solution was to
extricate the Library from the Army. That way it would not have to compete
with the more tangible national defense items in the military budget.
Besides, it really was a resource for the entire country—in fact, the world.
For some time the Army Medical Library had been the largest medical
library on the planet: at the start of the war it held more than 1,000,000
items and more than 400,000 books. The Library subscribed to some 3,500
periodicals and had the world’s largest collection of medical incunabula
(books printed in or before 1500).205
While the conflict raged, the Library continued to perform its mission
and even shipped its historical collection to a branch facility in Cleveland
for safekeeping. Items were available on loan to any medical officer, and
those stationed outside Washington could avail themselves of the materials
through their local hospital library. Items considered too fragile or valuable
for lending were copied via Photostat or microfilm.206
After the end of the war, since many more physicians in the country were
now aware of the great resources at the library, its utilization increased
dramatically over prewar levels.207
An Association of Honorary Consultants to the Army Medical Library
was formed in 1944, and it began having annual meetings to discuss issues
related to the institution. The question of a new building came up every
year, but other than commentary as to cost, site, timing, and so forth,
nothing of significance occurred at these meetings to bring the thing closer
to reality.
The Army Medical Department made near-annual requests to the War
Department for the funds to build a new Library, but to no avail. In
rejecting the request in 1946, the Special Assistant to the Secretary of War
stated, “budget severities to which the War Department is now being
subjected make it extremely difficult to provide funds for this purpose in
next year’s War Department budget.” That Assistant was Tracy Voorhees.208
DeBakey himself became a member of the Honorary Consultants
association in 1946 and remained acutely aware of these ongoing
struggles.209 So when the opportunity arose for him to make a contribution
to the Hoover Commission, he made sure to include a mention of the
Library’s plight.
The recommendation for a new structure for the Army Medical Library—
and a new status as the National Library of Medicine—appeared
unobtrusively on page 72 of the November 1948 report from the Committee
on Federal Medical Services. It was included among the functions of the
proposed Bureau of Health’s academic section: “The Division of Research
and Training . . . would be administratively responsible for the present
Army Medical Library (for which a new building is urgently required). This
latter would become a National Medical Library.”210
Despite Herbert Hoover’s approbation, little came of his Commission’s
Library recommendation after their report was released. But there was
another time coming, and another Commission. The tide had quietly, but
inexorably turned.
Work on the wartime History of the Army Medical Department
proceeded at a glacial pace. Before the war ended, in February 1945,
Colonel Love, the Medical Department’s official historian, had
optimistically indicated that the history would be completed six months
after the end of the war in the Pacific.211 This turned out to be impossible to
accomplish for any number of reasons: the scope of the project, confusion
and overlapping of assignments, and, not least, a general disinterest in
rehashing the events of the war among those who had just taken part in it.
One of the more disruptive elements was an ongoing flux in the very
defining elements of the project: How many volumes were there to be?
How many series?
By July of 1948, the overall control of the project had somehow come
under the aegis of the Historical Division of the Army Medical Library.
Cuts were made: a proposed eight-volume Administrative History was
pared to four due to “increased costs, personnel limitations, and the time
element involved.”212 The Clinical series did appear to be on track:
projections were for around 16 volumes, with separate editions covering
internal medicine, general surgery, thoracic surgery, etc. Most of these
volumes were expected to be published in 1949, a prediction which turned
out to be wildly overoptimistic: in fact, the first appeared in 1952, and the
rest began trickling out in 1955—a full decade after the war’s end. Some
were not released until the 1960s. The stated goal of rapidly releasing the
History of the Army Medical Department in World War II, in contrast to the
delayed appearance of the version from World War I, was rather badly
missed. Long after the shooting had stopped, the military medical men had
relearned yet another lesson from their predecessors: it was not as easy to
write the history of what had transpired as it seemed.
In the meantime, DeBakey continued on his path of academic surgery in
New Orleans: patient care, teaching, and research spiced up with what
seemed likely to be fairly frequent appearances on Washington-based
committees shaping federal and military medical policy. There was no
question that his years in the capital city had elevated DeBakey’s profile
among his peers. He could count among his friends and colleagues generals,
leaders of industry, deans of prestigious medical schools, and chairmen of
surgery departments across the land. These men had shared his company
and seen his work first-hand. The depth of his intellect, talent, and capacity
for work could not have had a better wartime stage.
In mid-February 1948, DeBakey received a letter at his office in New
Orleans from the Baylor University College of Medicine. He was puzzled
by the envelope, which indicated that the school was in Houston. He did not
know much about the Baylor medical college, but he had thought it was in
Dallas. The letter read in part:
February 12, 1948
Dear Dr. DeBakey:
The Baylor University College of Medicine is preparing to appoint a new Chairman of its
Department of Surgery. This Professorship is expected to be on a full-time basis, and the new
appointee will have the support of the Medical College and the Texas Medical Center in
building up, what we hope will be, a Department of Surgery in keeping with the greatest
aspirations for the development of medical teaching and research in this community.
Nominations have been requested from some of the country’s leading surgical educators, and
several prospects are being considered.
Your name appears among the most favored nominees, and I should like to know if you wish
to be considered for this appointment.
Yours very truly,
Warren T. Brown
Professor of Psychiatry
And Associate Dean213
Notes
1. DeBakey ME. The Management of Chest Wounds (Collective Review). International Abstract
of Surgery (Surgery, Gynecology and Obstetrics) 1942;74:203–237. DeBakey, ME. The
Plasma Bank. International Medical Digest 1942;40:311–318.
2. Bulletin of the American College of Surgeons, 1942. The American College of Surgeons
reckoned that a staggering 1 in 5 American medical personnel attended at least one of the
sessions, and nearly every physician who had not actually made it to the meetings had been
reached through journals and newspaper reports.
3. Ochsner EA, Gage IM, DeBakey ME. Scalenus Anticus (Naffziger) Syndrome. American
Journal of Surgery 1935;28:669.
4. Coates JB, Wiltse CM, eds., Medical Department, US Army, Personnel in World War II:
Procurement, 1941–45: Medical, Dental, and Veterinary Corps. Washington, D.C.: Office of
the Surgeon General, Department of the Army, 1964: 174.
Bethesda, MD; MS C 582. Series 2:4.
DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 1:2:11
7. United States Air Force, “592nd Technical School Squadron, Gulfport Field, Army Air Forces
Training Command” (1943). World War Regimental Histories. 202.
9. Letter M. E. DeBakey to I. M. Gage, December 7, 1942. DeBakey Archives, National Library
of Medicine, Bethesda, MD; MS C 582. Series 2:4.
10. Ibid.
11. Ibid.
12. Letter H. Halbedel to J. J. Harry, October 3, 1942. DeBakey Archives, National Library of
Medicine, Bethesda, MD; MS C 582. Series 2:4.
13. Letter G. Forshag to M. E. DeBakey, December 5, 1942. DeBakey Archives, National Library
14. Letter I. M. Gage to M. E. DeBakey, November 29, 1942. DeBakey Archives, National
15. Letter W. H. Gillentine to M. E. DeBakey, December 15, 1942. DeBakey Archives, National
16. Letter G. Forshag to M. E. DeBakey, n.d. DeBakey Archives, National Library of Medicine,
Bethesda, MD; MS C 582. Series 2:4.
DeBakey also later noted that Rankin may have remembered him from a time when he had
served as Visiting Professor at Tulane in the late 1930s. DeBakey picked Rankin up at the
airport and served as chauffeur and guide for him in New Orleans, as he usually did for
visiting dignitaries to the Department of Surgery.
18. Carter BN, ed. Medical Department, US Army, Surgery in World War II Activities of Surgical
Consultants, Volume One. Washington, D.C.: Office of the Surgeon General, Department of
the Army, 1964: 4.
20. Carter BN, Medical Department, US Army, 7.
21. Letter M. E. DeBakey to G. Forshag, January 25, 1943. DeBakey Archives, National Library
23. Scheirer GA. Notes on the Army Surgeon General’s Office in Washington 1818–1948. 1948:
29. https://archive.org/details/14120360R.nlm.nih.gov (accessed April 2018).
The cafeteria was likely in the Hurley-Wright building, which housed the Railroad
Commission and other agencies. This was next to the Surgeon General’s Offices at the three-
way corner of 18th Street, H Street, and Pennsylvania Avenue. The description of the location
of DeBakey’s basement room matches the Premier Apartment building at 718 18th Street, next
to the Hurley-Wright.
25. Ibid.
26. Ibid.
27. Ibid.
28. Millett JD. United States Army in World War II: The Army Service Forces. The Organization
and Role of the Army Service Forces. Washington, D.C.: Center of Military History United
States Army, 1987: 23–39.
29. Carter BN, Medical Department, US Army, 10–11.
30. National Library of Medicine. General History of Medicine Oral Histories. Michael DeBakey:
An Oral History. Interviewed by Larry W. Stephenson, November 23, 1986; April 6, 1992: 20.
32. Ibid., 7–11.
33. Wiltse CM et al., eds. Medical Department, US Army, Medical Supply in World War Two: The
Medical Supply System. Washington, D.C.: Office of the Surgeon General, Department of the
Army, 1964: 7.
An Oral History. Interviewed by Larry W. Stephenson, November 23, 1986; April 6, 1992: 30–
31.
36. Ibid., 18.
37. Michael M. DeBakey, personal correspondence, March 4, 2018.
39. Interview, Don Schanche with Michael DeBakey, Pierre Hotel, New York City, n.d. DeBakey
40. Letter M. E. DeBakey to E. D. Churchill, July 10, 1944. Edward Delos Churchill papers,
1840–1973. H MS c62. Harvard Medical Library, Francis A. Countway Library of Medicine,
Boston, Mass.
43. Ibid.
44. Ibid.
45. Interview, Don Schanche with Michael DeBakey, Pierre Hotel, New York City, June 15, 1972.
46. Voorhees TS (Marble S, ed.) Lawyer Among Army Doctors.
http://history.amedd.army.mil/memoirs/VorheesTraceyStebbins.pdf (accessed April 2018).
48. DeBakey ME. Military Surgery in World War Two: A Backward Glance and a Forward Look.
New England Journal of Medicine 1947;236(10)346.
49. Executive Order 2859—National Research Council of the National Academy of Sciences May
11, 1918. http://www.presidency.ucsb.edu/ws/index.php?pid=58834 (accessed April 2018).
51. DeBakey ME. Military Surgery in World War Two, 347.
52. Davidson EC. Tannic Acid in Treatment of Burns. Surgery, Gynecology and Obstetrics
1925;41:202–221.
53. Faxon NW, Churchill ED. The Cocoanut Grove Disaster in Boston: A Preliminary Account.
JAMA. 1942;120:1385–1388.
54. Moore FD. A Miracle and a Privilege: Recounting a Half Century of Surgical Advance.
Washington, D.C.: Joseph Henry Press, 1995: 66.
55. Ravdin IS, Long PH. Some Observations on the Casualties at Pearl Harbor. United States.
Naval Medical Bulletin. Washington, D.C.: Government Printing Office, 1942: 15:2.
58. Churchill ED, “Memorandum on Whole Blood Transfusion,” March 24, 1943, and “Whole
Blood Transfusion Report,” April 14, 1943, Edward Churchill Papers, Harvard Medical
Library, Francis A. Countway Library of Medicine, Boston, Mass.
61. United States Surgeon General’s Office. Medical Department of the United States Army in the
World War. Washington, D.C.: Government Printing Office, 1921–29.
63. Cannon JW, Fischer JE. Edward D. Churchill as a Combat Consultant: Lessons for the Senior
Visiting Surgeons and Today’s Military Medical Corps. Annals of Surgery 2010;251(3):567.
64. Smith BH. The Passing of the “Old Red Brick.” Military Medicine 1971;136(4):383–386.
65. Schneider D, Lilienfeld DE, eds. Public Health: The Development of a Discipline. New
Brunswick, NJ: Rutgers University Press, 2011:576.
66. DeBakey ME. Cold Injury. Presented to Medical Service Officer Basic Course, Army Medical
Service Graduate School, Army Medical Center, Washington, D.C. July 2, 1951.
67. DeBakey ME. History: The Torch That Illuminates. Military Medicine 1996;12:711.
68. Whayne TF, DeBakey ME. Cold Injury (Ground Type). In Medical Department of the United
States Army in World War II. Washington, D.C.: Government Printing Office, 1958: 47.
70. Ibid.
71. Robert M. Zollinger, MD Collection, Spec. 199301. Zollinger, Medical Heritage Center,
Health Sciences Library, The Ohio State University. Series 5:86:93. This was Circular Letter
12.
73. Ibid., 34.
74. Millett JD. United States Army in World War II: The Army Service Forces,23–39.
76. Whayne TF, DeBakey ME. Cold Injury (Ground Type), 63.
77. Carter BN, Medical Department, US Army, 35. These were War Department Circular 312,
Sect. IV, July 22, 1944, and Technical Bulletin 81, August 4, 1944.
78. Ibid., 36.
79. Whayne TF, DeBakey ME. Cold Injury (Ground Type), 67.
81. Ibid., 21.
82. Ibid., 20–21.
83. Ginzberg E. The Shift to Specialism in Medicine: The US Army in World War Two. Academic
Medicine 1999;74(5):522.
84. DeBakey ME. The Organization of Surgical Services in the Zone of the Interior, 9.
85. DeBakey ME. Specialty Centers in a Military Hospital System, IV-C-1.
87. Carter BN, Medical Department, US Army, 44. This was War Department Technical Bulletin
(MED) 89, Pilonidal Cyst and Sinus, dated September 2, 1944.
89. Marble S. Forward Surgery and Combat Hospitals: The Origins of the MASH. Journal of the
History of Medicine and Allied Sciences 2014;69:1:68–100.
90. Ibid.
91. Ibid.
93. DeBakey ME. History, The Torch, 712.
94. Cutler EC. Experiences of an Army Doctor in the European Theater of War. American Journal
of Surgery 1947;73(6):641.
95. Hanser SA. Uses and Operation of a Field Hospital. Bulletin of the US Army Medical
Department 1945;84:2–4.
96. Woodard SC. The Story of the Mobile Army Surgical Hospital. Military Medicine
2003;168:503.
97. Miller CA. The Big Z: The Life of Robert M. Zollinger, MD. Chicago: The American College
of Surgeons, 2015: 111–113.
98. Annual Report to the Surgeon General from the Third Auxiliary Surgical Group for the Year
1944:34. http://history.amedd.army.mil/booksdocs/wwii/3dASG/3dASG1944.html (accessed
April 2018).
99. Letter M. E. DeBakey to E. D. Churchill, October 8, 1943. Edward Delos Churchill papers,
Boston, Mass.
101. Ibid., 341.
102. Churchill ED. The Surgical Management of the Wounded in the Mediterranean Theater at the
Time of the Fall of Rome. Annals of Surgery 1944;120(3):268–283.
103. Ibid., 268.
104. TB MED 147: War Department Technical Bulletin. Notes on Care of Battle Casualties. War
Department, Washington 25, D. D., March 1945.
106. Michael M. DeBakey, personal correspondence, March 3, 2018.
107. Ibid.
108. DeBakey Collection. Baylor College of Medicine Archives. Houston, Texas. 3:6:5.
110. Ibid., 9–10.
111. Robert M. Zollinger, MD Collection, Spec. 199301. Zollinger, Medical Heritage Center,
Health Sciences Library, The Ohio State University. Series 5:86:91.
113. Churchill ED. Surgeon to Soldiers: Diary and Records of the Surgical Consultant Allied Force
Headquarters, World War II. Philadelphia: J. B. Lippincott Company, 1972: 405.
115. Churchill ED. Surgeon to Soldiers, 406.
118. DeBakey Collection. Baylor College of Medicine Archives. Houston, Texas. 2:127:4. The text
of the Pope’s speech is available at the Vatican website: https://w2.vatican.va/content/pius-
xii/en/speeches/1945/documents/hf_p-xii_spe_19450213_medici-chirurghi.html.
119. Winters WL, Parish B. Reflections: Houston Methodist Hospital. Houston: Elisha Freeman
Publishing, 2016: 72.
121. Letter M. E. DeBakey to A. Ochsner, May 1, 1945. DeBakey Collection. Baylor College of
Medicine Archives. Houston, Texas. 2:127:4.
123. Cutler EC (Arima JK, ed.). Medical Department, US Army, Surgery in World War II Activities
of Surgical Consultants, Volume Two: The Chief Consultant in Surgery. Washington, D.C.:
Office of the Surgeon General, Department of the Army, 1964: 326.
125. DeBakey Collection. Baylor College of Medicine Archives. Houston, Texas. 3:6:5.
126. Cutler EC (Arima JK, ed.). Medical Department, US Army, Surgery in World War II Activities
of Surgical Consultants, Volume Two, 326.
127. Akça T, Aydın S. René Leriche and ‘‘Philosophy of Surgery” in the Light of Contemporary
Medical Ethics. Ulus Cerrahi Derg 2013;29:131–138.
129. Ibid.
130. Memorandum, M. E. DeBakey to the Surgeon General re: Report of Visit to the European
Theater of Operations, April 17, 1945. DeBakey Collection. Baylor College of Medicine
Archives. Houston, Texas. 3:6:5.
Archives. Houston, Texas. 3:6:5.
135. Letter D. DeBakey to M. E. DeBakey, January 29, 1945. DeBakey Archives, National Library
136. Keefer LE. Shangri-La for Wounded Soldiers: The Greenbrier as a World War Two Army
Hospital. Reston, VA: Cotu Publishing, 1995: 115–117.
138. Odom CB. Medical Department, US Army, Surgery in World War II Activities of Surgical
Consultants, Volume One: Third US Army. Washington, D.C.: Office of the Surgeon General,
Department of the Army, 1964: 295.
139. Province C. Patton’s Third Army: A Daily Combat Diary. New York: Hippocrene Books,
1992: 300. The Chapel of the Fondation Pescatore is where Patton recited the prayer for good
weather during the Battle of the Bulge.
141. Ibid.
142. Ibid.
143. Cutler EC (Arima JK, ed.). Medical Department, US Army, Surgery in World War II. Activities
of Surgical Consultants, Volume Two, 327.
Archives. Houston, Texas. 3:6:5. DeBakey happily noted in a letter to Churchill that Rudolph
Matas had “acclaimed it in his inimitable eloquent style as the finest work on war wound
management that has yet appeared.” Letter M. E. DeBakey to E. D. Churchill, May 3, 1945.
Edward Delos Churchill papers, 1840–1973. H MS c62. Harvard Medical Library, Francis A.
Countway Library of Medicine, Boston, Mass.
145. “Disposition in the Forward Area.” Monthly Progress Report, Section 7: Health. Office of the
Surgeon General, Headquarters, Army Service Forces, War Department. April 30, 1945.
147. Letter M. E. DeBakey to A. Ochsner, May 1, 1945. DeBakey Collection. Baylor College of
Medicine Archives. Houston, Texas. 2:127:4.
148. Churchill ED. Surgeon to Soldiers,425.
149. Marble S., Forward Surgery and Combat Hospitals, 68–100.
150. Memorandum Col. C. B. Odom to for Col. B. N. Carter, T-O Mobile Army Surgical Hospital,
June 13, 1945. Memorandum Col. B. N. Carter to Lt. Col A. F. Lipton, T-O Mobile Army
Surgical Hospital, June 13, 1945. Memorandum for the Record, Col. B. N. Carter, Table of
Organization of Proposed Surgical Hospital, 60 beds, June 14, 1945. Edward Delos Churchill
papers, 1840–1973. H MS c62. Harvard Medical Library, Francis A. Countway Library of
Medicine, Boston, Mass.
151. Memorandum for the Record, Eli Ginzberg, Surgical Hospitals, June 16, 1945. Ibid.
152. Letter M. E. DeBakey to E. D. Churchill, June 28, 1945. Ibid.
153. Letter E. D. Churchill to M. E. DeBakey, n.d. Ibid.
154. Memorandum T. S. Voorhees to General Kirk, August 10, 1945. Ibid.
155. Memorandum M. E. DeBakey to R. W. Bliss, August 13, 1945. Ibid.
156. Ibid.
157. Letter M. E. DeBakey to E. D. Churchill, August 17, 1945. Ibid.
158. Letter M. E. DeBakey to E. D. Churchill, April 26, 1946. Ibid.
159. A New Approach to the Medical History of World War Two. Bulletin of the US Army Medical
Department 1944;77:68.
160. Love AG. War Casualties: Their Relation to Medical Service and Replacements. Army
Medical Bulletin 1931;24:2.
161. A New Approach to the Medical History of World War Two.
162. Letter M. E. DeBakey to F. W. Rankin, October 11, 1945. Fred W. Rankin, M. D. Scrapbooks,
1930–1954. Department of Surgery, College of Medicine, and Special Collections, University
of Kentucky. Lexington, Kentucky.
163. Ibid.
165. DeBakey, ME. The Organization of Surgical Services in the Zone of the Interior, 7–8.
167. Voorhees TS (Marble S, ed.) Lawyer Among Army Doctors, 91.
168. Report of a Survey of Medical Records Created by the Federal Government. Washington,
D.C.” National Research Council, Division of Medical Sciences. January, 1945.
169. DeBakey, ME. Memorandum to the Surgeon General Re: Establishment of a Long-Term
Clinical Research Program on Army Material, March 5, 1946.
https://profiles.nlm.nih.gov/ps/access/FJBBVW.pdf (accessed April 2018).
170. Berkowitz ED, Santangelo MJ. The Medical Follow-up Agency: The First Fifty Years 1946–
1996. Washington, D.C.: National Academy Press, 1999: 2.
171. National Research Council, Division of Medical Sciences. Conference on Postwar Research,
April 18, 1946. https://profiles.nlm.nih.gov/ps/access/FJBBVV.pdf (accessed April 2018).
172. Ibid.
173. Berkowitz ED, Santangelo MJ. The Medical Follow-up Agency, 3.
174. National Research Council, Division of Medical Sciences. Conference on Postwar Research,
April 18, 1946. https://profiles.nlm.nih.gov/ps/access/FJBBVV.pdf (accessed April 2018).
175. Berkowitz ED, Santangelo MJ. The Medical Follow-up Agency, 5.
176. Ibid., 7.
177. Ibid., 12.
180. Voorhees TS (Marble S, ed.) Lawyer Among Army Doctors, 91.
University of Louisiana, Michael DeBakey. University Archives, Howard-Tilton Memorial
182. Carter BN, DeBakey ME. Current Observations on War Wounds of the Chest. Journal of
Thoracic Surgery 1944;13(4): 271–293. DeBakey ME, Carter BN. Current Considerations on
War Surgery. Annals of Surgery 1945;121(5):545–563. This was also published in
Transactions of the Southern Surgical Association 56:161–179.
Service Graduate School, Army Medical Center, Washington, D.C. July 2, 1951. DeBakey
ME. The Organization of Surgical Services in the Zone of the Interior, with a Consideration of
Specialty Centers. Presented to Medical Service Officer Basic Course, Army Medical Service
Graduate School, Army Medical Center, Washington, D.C. April 20, 1951. The Standards of
Military Practice in the Army. Presented to Medical Service Officer Basic Course, Army
Medical Service Graduate School, Army Medical Center, Washington, D.C. February 11,
1952.
184. DeBakey ME, Simeone F. Battle Injuries of the Arteries in World War Two: An Analysis of
2,471 Cases. Annals of Surgery 1946;123:534–579.
186. In Memoriam: Idys Mims Gage. Orleans Parish Medical Society Bulletin 1958;29:2.
187. Congress of Neurological Surgeons: Honored Guests. Guy Odom 1974, Vancouver.
https://www.cns.org/about-us/history/biography/3086 (accessed April 2018).
188. DeBakey ME, Burch G, Ray T, Ochsner A. The Borrowing-Lending Hemodynamics
Phenomenon (Hemometakinesia) and Its Therapeutic Application in Peripheral Vascular
Disturbances. Annals of Surgery 1947;126:6:850–865.
189. Lilly GD. The First Ten Years of the Society for Vascular Surgery. Surgery 1957;41:1–5.
190. Yao JT. Society for Vascular Surgery—The Beginning. Journal of Vascular Surgery
2010;51:776–779. The stated objectives of the Society were “to promote study and research in
vascular disease; to define more clearly the role of surgery in these diseases; to pool the
experience and knowledge of the membership in order to standardize methods of studying and
management of these diseases; to standardize the nomenclature of these diseases; to promote
and encourage adequate teaching of these diseases to students, interns, and residents; and to
encourage hospitals to develop special training for young surgeons interested in the field.”
191. Report to the Commission on Organization of the Executive Branch of the Government by the
Committee on Federal Medical Services. HathiTrust Digital Library.
https://babel.hathitrust.org/cgi/pt?id=umn.31951000438705p;view=1up;seq=12 (accessed
April 2018).
192. Ibid.
194. Ibid.
195. Ibid.
April 2018).
197. Ibid.
198. Ibid.
199. The New Army Medical Library and Museum Building: Some Further Steps Toward This
Goal. Army Medical Bulletin 1941:56:87.
200. Ibid., 88.
201. Letter F. Rogers to M. E. DeBakey, February 6, 1956. MS C 205, National Library of
Medicine. Office of the Director. Deputy Director Records, 1936–1969, Modern Manuscripts
Collection, History of Medicine Division, National Library of Medicine, USA. 5:17.
202. The New Army Medical Library and Museum Building: Some Further Steps Toward This
Goal. Army Medical Bulletin 1941:56:88.
203. Army Medical Library and Museum Building. Army Medical Bulletin 1941:58:159.
205. Army Medical Library Service for Members of the Medical Department. Army Medical
Bulletin 1942:63:168–170.
206. Ibid.
207. Army Medical Library. Bulletin of the US Army Medical Department 1947;7:1:21.
208. Letter F. Rogers to M. E. DeBakey, February 6, 1956. MS C 205, National Library of
Medicine. Office of the Director. Deputy Director Records, 1936–1969, Modern Manuscripts
Collection, History of Medicine Division, National Library of Medicine, USA. 5:17.
209. Michael E. DeBakey and the National Library of Medicine.
https://circulatingnow.nlm.nih.gov/2017/03/16/michael-e-debakey-and-the-national-library-of-
medicine/ (accessed April 2018).
April 2018).
211. Progress in the Medical History Program. Bulletin of the US Army Medical Department
1945;85:31.
212. The United States Army Medical Department in World War Two. Bulletin of the US Army
Medical Department 1948;8:11:920.
213. Letter W. T. Brown to M. E. DeBakey, February 12, 1948. DeBakey Archives, National
*
DeBakey, Gage, and Ochsner had written an article on the scalenus anticus syndrome, now
known as thoracic outlet syndrome, in 1935. In that paper they coined the term Naffziger syndrome,
although Naffziger himself did not publish his own work on the problem for another three years.3
†
DeBakey thought that if he had joined the 24th General Hospital he would have been inducted as
a major.6 Two-and-a-half stripes refers to the sleeve insignia of a Lieutenant Commander.
*
The discussants recommended excision and primary closure of the pilonidal sinus, which
amused and annoyed DeBakey because it was being presented as new information. At Tulane the
same procedure had been performed for years, on the basis of studies conducted by Gage.
Throughout the war this clinical problem would prove to be vexing—much more than in civilian
practice.
*
For ease of reference, the organization will be called the Surgical Consultant’s Division
throughout this text, a convention also adopted in the Official History of the Medical Department.
*
In World War II, after March 1942, the US Army was divided into the Army Ground Forces,
Army Air Forces, and Services of Supply (renamed the Army Service Forces in March 1943). The
Medical Corps was one of seven Technical Services in the latter.28
*
Three zones were defined. In addition to the Zone of the Interior in the United States proper, the
operational theaters consisted of a self-explanatory Zone of Combat and intermediate Zone of
Communications.
†
Due to the nature of military organization and reporting it is difficult to determine what tasks
were performed by which individuals within a unit, the Surgical Consultants Division being no
exception. As junior man in the office, many of the more labor-intensive activities would have
naturally devolved on DeBakey, and he later related that, “If there was any writing to do I had to do
it, and there was a hell of a lot to be done.”30
*
Ambrose Storck was specifically requested by Cutler to serve as Consultant in General Surgery
in the ETO. His stay there was brief. Storck was succeeded in this position by Lt. Col Robert M.
Zollinger in 1943. Mims Gage left Tulane’s 24th General Hospital to become Consultant in the
Fourth Service Command in Atlanta in July 1943, before that unit finally left Ft. Benning the
following month for Italy. DeBakey’s old friend Charles Odom became Consultant for the Third
Army.32
*
Many of the casualties of that night club fire were treated at the Massachusetts General Hospital
(MGH), and the horrific nature of the disaster was partially mitigated by the significant advances in
burn treatment that resulted. The Chief of Surgery at the MGH was Edward Churchill, who left
Boston to join the service shortly after the fire.54
*
Chief Consultant Churchill noted that The Medical Department of the United States Army in the
World War was not among the books provided to overseas hospital units.63
*
There were earlier instances of immersion foot in naval personnel and, certainly, cold injury in
high-altitude airmen. The ETO issued a circular on the matter as early as January 1943.71
*
The Office of Research and Development directed work on guided missiles, radar, and many
other military, medical, and applied scientific projects. The office also oversaw the Manhattan
Project.
*
In a 1952 lecture at Walter Reed Army Medical Center, DeBakey remarked, “Here is another
ironic illustration of a lesson of history that should have been learned and was not. If at the outset of
World War Two we had read nothing more than the first volume of the history of The Medical
Department of the United States Army in the World War, we should have known and could have put
into immediate practice all the essential principles of this program, and of many others, and we
should have been spared the costly lessons we had to learn the hard way between 1941 and 1945.”85
*
Field Hospitals were versatile units that could function in a number of different configurations
and scenarios. As single units they had 400 beds, with 13 medical officers, 5 medical administrative
officers, 3 dental officers, 18 nurses, and 180 enlisted men. When used as forward surgical units
alongside Clearing Stations, the Field Hospitals were typically divided into three platoons of 100
beds each, with proportional division of personnel. As things evolved, in these settings each platoon
was reinforced by four surgical teams and one shock team from the ASGs.95
*
DeBakey also noticed that the principles of phased wound management, and of most of what
evolved into the consensus of proper treatment of battle casualties, had been summarized quite nicely
in the Inter-Allied Surgical Conference of Paris in 1917: another lost lesson from the Great War.
*
All of these travelers signed a one dollar 1935 silver certificate and marked it as a “Short
Snorter” for “Mike DeBakey.”117 Short snorters were bank notes signed by passengers on early
transoceanic flights as a kind of membership certificate in the club of those who had made such a
journey. If the named individual encountered a signer and could not produce the bill, he was
obligated to buy that signatory a drink. The term “Short Snorter” referred to a less than full shot of
liquor. Pilots had long referred to themselves by the term due to their need to remain sober.
*
Some of these physicians later formed the Excelsior Society, commemorating this meeting and
continuing to advance the science of military surgery. DeBakey was the last surviving original
member of this association.
†
During the early part of the war Leriche was President of the Conseil Supérieur de l’Ordre
National des Médecins, a physician organization created by the Vichy regime. A number of actions of
this council appear to have been motivated by a desire to limit the number of Jewish and foreign
physicians in occupied France, and Leriche’s presidency of the organization, which lasted until
December, 1942, is troubling for his legacy.127
*
According to one source, among the individuals who distracted DeBakey from his work was a
newly inducted surgery resident from Johns Hopkins named Denton Cooley. Cooley was hoping to
serve his two-year Army stint at a plum stateside installation such as Walter Reed Hospital. In the
tale, DeBakey told Cooley he would think about it. Cooley ended up at Linz, Austria. DeBakey
reported no memory of such an incident.164
*
The Surgeon General’s Office, and DeBakey, had moved from 1818 H Street to the Pentagon in
December 1945.
*
Beebe’s move out of the Army to the NRC precipitated a security clearance crisis. Although he
had worked with the most sensitive material on the health of the Army during the war, he was now
briefly denied access to military personnel records on the basis of the politics of former
acquaintances. DeBakey and Voorhees interceded on his behalf successfully. Beebe went on to a long
and distinguished career at the NRC, directing the Medical Follow-Up Agency until his retirement in
1977. He then worked for another 25 years at the National Cancer Institute. Beebe is credited with
ground-breaking work on the epidemiology of radiation exposure.
*
In this paper DeBakey praised the use of cigarettes in lieu of morphine for posttraumatic pain,
which must have horrified Alton Ochsner, if he saw it.
†
Much later DeBakey indicated that, during the war years, he had occasionally operated at Walter
Reed Hospital.
*
This came into being as the Department of Health, Education, and Welfare in 1953, supplanting
the old subcabinet Federal Security Agency.
5
Houston: 1948–1951
To scatter plenty o’er a smiling land.
5.1 Birth and Rebirth

In the spring of 1948, Houston bore little resemblance to the sprawling
metropolis that dominates southeastern Texas today, but there were tell-tale
signs of what was to come. At the start of World War II, the city had a
population of about 400,000. The main industries were shipping and oil,
along with cattle, rice, and cotton. As the war effort of the United States
ramped up to its overwhelming capacity, government money poured into
the town. A prime recipient of this largesse was the oil industry, which grew
in both size and complexity as the demand for ever-emerging
petrochemicals and their attendant technology expanded. With Galveston
Bay mere miles away, shipbuilding exploded in turn, as did the steel
business. Vast numbers of workers flocked to the city for the abundant new
jobs: in 1950, the population was half again what it had been at the time of
Pearl Harbor.1
Awash in this boom, the residents of Houston—especially those of means
—began to turn their attention toward the cultural enrichment of their
expanding city. Plans for museums, theaters, a symphony orchestra, and
even an opera house began to crystallize. The eager philanthropists could
not help but notice, too, that the community’s hospitals were substandard
for a major American city of the day. As it happened, designs to rectify this
situation had been afoot since before the war. Success may have many
fathers (and this story is no exception), but the eventual conspicuous
realization of a major medical center in Houston can be traced to the
generosity of a single individual, Monroe Dunaway Anderson.
Anderson made his considerable fortune in cotton and banking and
wisely protected it with a foundation dedicated to “the promotion of health,
science, education, and the advancement and diffusion of knowledge.”2 At
his death in 1939, the M. D. Anderson Foundation received some $19
million from the namesake’s estate. Anderson himself did not make specific
plans for the distribution of these funds, but they were managed by former
colleagues and friends who knew his intentions well, and these men began
to search for a project that might fulfill Anderson’s vision.3
Not long after, events began to unfold that would provide just such a
worthy cause. In the summer of 1941, the Texas legislature passed a law
which authorized a state cancer research hospital, appropriating funds
towards its construction. The Anderson Foundation trustees recognized this
opportunity and acted quickly, contacting the President of the University of
Texas. The trustees were persuasive, and, within a few months, the
University had announced that the new facility would be located in
Houston, and be named the M. D. Anderson Hospital for Cancer Research
of the University of Texas.4
The trustees had their eyes on a particular site for the cancer hospital, too,
one with the potential for practically unlimited growth. This was a 134-acre
“mosquito-infested forest” about three miles southeast of downtown
Houston, owned by the city.5 One of the area’s few medical facilities,
Hermann Hospital, was already located on the edge of this site, and the Rice
Institute (later University) was also close by. Both these institutions were
thus situated to benefit—and benefit from—what was already being
envisioned as a new medical center.
The first Director of the new Cancer Hospital was Ernst W. “Bill”
Bertner, a native Texan with a successful medical practice centering on
gynecologic oncology. In addition to being well-known by the faculty at the
University of Texas, Bertner enjoyed a significant profile in Houston and
was a long-time vocal advocate of the development of a medical center in
the city.6 These lofty goals dovetailed nicely with those of the Anderson
Foundation trustees, who, of course, knew Bertner well. These relationships
did not mean that all information was shared, however, and Bertner was as
surprised as the rest of the community when the local newspaper, the
Houston Chronicle, splashed the banner headline on May 9, 1943: “Baylor
To Move Medical Schools Here.”7
As DeBakey had recalled when he saw the envelope from Baylor
University College of Medicine on his desk, the facility had long been in
Dallas—in fact since its founding around the turn of the century. The
circumstances of its move to Houston—in the midst of the world war, no
less—revolved around a conflict involving its parent institution. Baylor
University, located about 100 miles south of Dallas, in Waco, was run by
the Baptist General Convention of Texas. Although the medical school
harbored no sectarian regulations regarding faculty or students, long-
simmering tensions between Dallas civic leaders (as well as some
physicians) and the Baylor administration finally reached a boiling point in
the early 1940s. A new medical center was planned in downtown Dallas,
too, under the auspices of a Southwestern Medical Foundation composed of
many of those Dallas leaders. The Baylor medical school was invited to be
a part of this, but only if its administrative control and sectarian affiliation
were relinquished.8
At this point, the M. D. Anderson Foundation stepped in and offered to
ease and expedite the move of the Baylor medical school to Houston
instead, with 20 acres of land, $1 million cash for construction, and another
$1 million for research projects over the next decade. Most importantly, the
M. D. Anderson Foundation had no interest in running the school. The
promise of cash and land, along with no administrative interference, would
have been hard to refuse even if the Dallas situation were not so untenable,
but, given the circumstances, the Baylor trustees moved swiftly. By mid-
July the school had not only officially moved to Houston, but was open—
albeit in a vacant former Sears and Roebuck warehouse.9
The ambitions of the Foundation trustees were far from sated with this
coup, however. One of the other facilities in town, Methodist Hospital in the
downtown residential district, was, by the end of the war, woefully
undersized for its mission. Its leaders—which included board member Mrs.
Ella F. Fondren, widow of a successful oil man—were struggling with the
many decisions attendant to the construction of a new facility. In March
1945, the M. D. Anderson Foundation offered land at their site, as well as
significant matching funds. Another well-heeled oil tycoon, Hugh Roy
Cullen, president of the hugely successful Quintana Petroleum, gave $1
million toward the effort, and the issues which had seemed so vexing to
Mrs. Fondren and her cohort suddenly vanished: the new Methodist
Hospital would also be built on the emerging campus.10
In November 1945, the nebulous idea of a Texas Medical Center
coalesced into a functioning board—a legal entity if not yet a physical
presence—with Bertner as president.
Wartime exigencies and governmental red tape delayed the construction
of a dedicated building for the Baylor University College of Medicine until
1947, and even then the Anderson Foundation’s gifts required
supplementation to get things under way. Cullen provided the necessary
money and the first structure in the Texas Medical Center, named for this
“King of the Wildcatters” and his wife, Lillie, was dedicated in April, 1948
(Figure 5.1).11
Figure 5.1 Baylor University College of Medicine under construction, circa 1947.
The Cullen building, four floors of offices, laboratories, and lecture halls,
was the first postwar air-conditioned structure in Houston. Among the
surrounding verdant foliage, its cream limestone Art Deco façade and terra
cotta roof stood out in stark and solitary contrast. The city had finished
extending the road from downtown to the medical school, Fannin Street,
only a few weeks before the dedication. Among the speakers at the
ceremony was Alton Ochsner.12
DeBakey’s first reactions to the letter from Baylor—aside from confusion
about its return address—were not particularly positive. What he had heard
about the medical school was limited, but not complimentary: he considered
it “a third-rate school.”13 As a result of his growing national notoriety, and
especially his high-profile service in the Surgeon General’s Office in the
war, DeBakey had received several offers for career advancement since
returning to Tulane and the Ochsner Clinic. B. Noland “Nick” Carter, his
immediate superior in the Surgical Consultants Division, wanted DeBakey
to come to the University of Cincinnati. The plan was that he would serve
as Carter’s right-hand man and take over as Chair of Surgery in a few
years.14 Others were also interested.
(Harvard) wanted me to come up and look at a professorship. I turned down one at Buffalo and I
turned down one in New York. I was very satisfied and quite happy and content with my
situation in New Orleans and I saw no reason to move unless I had something that really was
challenging to do.15
The Army had tried to convince DeBakey to stay on, too—even beyond
the extra year he had served.
They were willing to offer me a job in the regular Army as a brigadier general—I was then
colonel in the reserves—if I would stay and head up the surgery division of the whole Army. But
it was not quite what I wanted to do. I didn’t want to remain in administration, which I would
have virtually had to do. And I had this longing, so to speak, to get back to the clinical aspects of
surgery, and I turned it down.16
After DeBakey had passed on these alternatives, it seemed likely that

Baylor would receive a similar response, particularly given the school’s
mediocre reputation. Others with influence over him—and special insight—
could sense an opportunity, however.
I talked to Dr. Ochsner about it and he urged me to go see it. Now, he was very friendly with
some of the people in the (Texas) Medical Center and knew them well and he was quite
enthused about what they wanted to do.*,17
DeBakey composed an appropriately worded letter of response to the

faculty member who had contacted him, Warren Brown, in which he
incorporated several queries as to the state of the Surgery Department, the
school in general, and its clinical and research capabilities.18
Brown was a psychiatrist and Associate Dean of the Baylor University
College of Medicine. The Dean was Walter Moursund, who had held that
position since 1923. Unlike a number of the physicians on the faculty in
Dallas—especially the clinicians, who had practices in that city—he had
come along to Houston when the school moved and had soldiered through
the days of classes at the Sears and Roebuck Company warehouse.19 Now
he, along with the Board of Trustees and the few other professors who were
on the Houston campus, recognized that with the Cullen Building nearing
completion they needed to recruit some academicians to fill the numerous
vacant chairs and other positions.†
Brown’s initial letter had indicated that DeBakey’s name appeared
“among the most favored nominees” to head the Surgery Department.
Certainly it would have been an odd recruitment if he had been the only
individual approached. Surviving documents suggest that such was, indeed,
not the case.
William Longmire was a 34-year-old faculty member of the Department
of Surgery at Johns Hopkins University at this time, having completed his
surgical residency at that institution in 1946. A highly skilled operator as
well as possessing a brilliant analytical mind, Longmire was recognized by
academic surgeons nationwide as destined for greatness. He was on the
short list of many a search committee in the years immediately following
the war.
Longmire was contacted by Dean Moursund in early 1948, with regard to
his thoughts on the structure and function of the newly emerging
Department of Surgery at the Baylor University College of Medicine. There
probably was more to the discourse than consultation. On March 15,
Longmire wrote a 10-page outline of his recommendations.
Longmire praised the new Cullen building as a fit vessel for the
administration and preclinical studies, but was clearly concerned about the
“clinical material” available for the teaching of surgical residents. He noted
that the Jefferson Davis Hospital, a charity facility several miles away,
could serve the purpose of a teaching hospital temporarily, but it was too far
away to serve as the primary institution on a long-term basis. The nearby
Hermann Hospital might work, but, again, only temporarily. He went on to
suggest that most of the surgical subspecialties—neurosurgery, orthopedics,
plastic surgery, etc.—be under the administrative control of the Department
of Surgery, and their hospital chiefs also be the chairs of the academic
divisions.
Other recommendations involved administrative details of the Surgery
Department, particularly the office of the Chairman. Perhaps tellingly,
Longmire noted that
[t]hese suggestions are made with a view toward establishing a department of surgery that
could, within a few years, rank with the best in this country. I am certain that those interested in
the Baylor University School of Medicine and the Texas Medical Center would not want me or
anyone else to accept such a position without such aims for the department.22
On March 25, Brown sent two letters to DeBakey in New Orleans, one of
which was dated March 1. This first letter addressed a few of DeBakey’s
questions, but mainly deferred to the reasonable statement that the bulk of
the substantive decisions to be made considering the Department of Surgery
were being left up to the new chairman, whoever that turned out to be.
Brown indicated that he had set this letter aside in hopes that DeBakey
would visit Houston and discuss everything in person. Then, after three
weeks had passed, Brown was contacting him to make just such an
invitation.23 It is unclear what role, if any, Longmire’s letter (which arrived
during the intervening period) had in this process and its delay.
DeBakey had no less than four out-of-town conferences to attend in the
first weeks of April, so a date was finally set for him to visit Houston
beginning on Monday, May 3.24
Although the new chairman of surgery would be depended on to help
shape the department, medical school, and the Texas Medical Center in
general, other sources were also consulted to look at this same Big Picture
on an even wider scale. Two of these were Henricus Johannes Stander and
Alfred Blalock.
Stander was Gynecologist-in-Chief of the New York Hospital and
Professor at Cornell University Medical College. He was asked by Hugh
Roy Cullen to compose his thoughts on the proposed Texas Medical Center
after the wildcatter had toured Stander’s institutions.
In a letter from late March 1948, Stander made a number of observations
and recommendations apropos of his own experiences in New York. He laid
the necessary groundwork by recommending that any “Medical Center”
should consist of a medical school and hospital so as to be capable of
providing comprehensive patient care as well as multilevel medical
education and first-rate research. Stander acknowledged that Houston and
Baylor were well situated to accomplish this. He then suggested that for
every dollar spent on construction, two be kept for an operations
endowment. Stander thought that 1,200 beds would be necessary for
teaching 80 medical students per class.
Not all these beds would necessarily be in one hospital. In fact, several
hospitals, each with separate functions and services from the get-go, would
be ideal (the New York Hospital was a collection of formerly independent
institutions that had affiliated). The key thing was that the separate hospitals
not have overlapping capabilities (e.g., pediatrics would only be in the
Children’s Hospital, obstetrics and gynecology only in the Women’s
Hospital, etc.).
One of Stander’s most important recommendations, echoing Longmire,
was that the Professor of the Department in the University must be the
Chief of the Clinical Service in the University Hospital.
Cullen forwarded Stander’s recommendations to the Texas Medical
Center Board on April 19.25 This was two days after the other prominent
consultant, Blalock, had spoken to many of the Board members at a group
luncheon sponsored by the Houston Chamber of Commerce.
Blalock was one of the most recognizable figures in American surgery at
this time. He was Chairman of the Department of Surgery at the Johns
Hopkins Hospital—he had trained Longmire—and was renowned for his
part in performing the first successful “Blue Baby” operation. In this
procedure a shunt was constructed between the subclavian and pulmonary
arteries of the chest in an infant with the complex congenital cardiac
malformation known as tetralogy of Fallot (Longmire had assisted Blalock
in the operation, along with an intern named Denton Cooley). Although the
young patient had eventually succumbed, the operation had demonstrated
the “proof of concept’ and helped pave the way for a stunning series of
developments in the aggressive surgical treatment of hitherto-fatal
congenital heart diseases.26
At the luncheon Blalock used his own facility as a model for how the
Texas Medical Center might develop, just as Stander had done. Even more
vehemently than the New Yorker, Blalock emphasized the need for organic
growth and cohesion between the medical school and its university hospital.
He also dwelt on the topic of personnel, pointing out that the top individuals
in the nation in their specialties should be recruited, and they should be
given incentives—including remunerative ones, but also clinical and
research facilities—to stay and prosper. Blalock concurred with Stander and
Longmire that the Professor of a Department must be the chief of its clinical
service, and closed his address by again professing that, “One well-
organized, closely integrated medical school that is actually the foundation
upon which the center is organized is the best assurance of success.”27
5.2 The Dance

DeBakey’s visit to Houston in the first week of May was brief. He arrived
on Monday and by week’s end was home, having composed and sent off a
four-page letter to Warren Brown containing his thoughts on what he had
seen. DeBakey grouped these considerations into six categories: Facilities,
Budget, Personnel, Salary arrangement, Sub-Departments, and Clinical
Facilities. While in Texas, he had been given copies of both Stander’s report
to Cullen and Blalock’s talk to the Education Committee of the Chamber of
Commerce and had found much merit in each. He referenced them freely in
his letter to Brown.28
DeBakey indicated that he believed the medical school facilities in the
Cullen building were more than adequate: lab space was earmarked already
and administrative office arrangements promised to be suitable. The
Surgery Department budget was set at $50,000, and, although he hoped to
see provision for future growth as the department expanded, DeBakey was
also happy with this. He was likewise in favor of the plan to create both
full- and part-time clinical faculty, with the part-time staff mostly drawn
from local surgeons. Baylor was offering for the Professor of Surgery a base
salary of $10,000, plus a further $10,000 offset against any consultant fees.
The idea was to allow the new surgeon to concentrate on his academic roles
rather than worry about fees while at the same time cultivate a clinical
practice and the confidence of referring physicians. DeBakey found this
agreeable. With regard to organization, DeBakey agreed with Longmire’s
letter (which he most likely had not seen): “It is desirable to have the sub-
departments of orthopedics, urology, plastic surgery and neurosurgery under
the Department of Surgery.”29
Having read this far, Brown could have been forgiven for thinking that
DeBakey was ready to sign a contract. In fact, he was just about to fire a
salvo at the great weakness of the Baylor University College of Medicine at
this point in time.
Clinical Facilities. The most important and least satisfactory arrangement at the present time is
the provision for clinical facilities under the full management of the University. I believe the
Stander and Blalock reports are so specific concerning this matter that I need not say very much
about it, except to emphasize my full agreement with their concept and to point out again how
essential it is that the problem be solved promptly. As I understand it, at the present time the
university controls no hospital beds at all. No matter how pleasant the arrangements may be
informally, and how satisfactory they may seem formally, the position of all clinical departments
is weak under such an arrangement.30
DeBakey then quoted Blalock’s observation that the university’s hospital

facilities should be maintained primarily for the education of students and
performance of research and that the clinical instructors should have the
same control over the hospital beds as the chemistry or anatomy professors
enjoyed in their laboratories.
I do not know the best solution of the problem at the moment. The ideal arrangement would be a
university-controlled hospital for teaching purposes, and this may come later. I had the
impression that of the two large units now available for teaching purposes, the Jefferson Davis
Hospital might become available under an arrangement which would give the University
clearcut control of at least a certain proportion of the beds for teaching purposes.31
The problem of providing sufficient patients for the education of students

—as well as interns and residents—revolved around the existing hospitals
in Houston, especially the Hermann, Jefferson Davis, and Methodist
Hospitals. From the perspective of the Baylor University College of
Medicine, these each had characteristics that were attractive but aspects that
presented obstacles. The Hermann Hospital (the unnamed “large unit”
DeBakey referred to in his letter) was close by—within view of the Cullen
building, in fact—but whatever advantage proximity conferred was
obviated by a staff and administration that were, at the least, distrustful of
the school. Jefferson Davis was the community hospital for the indigent,
and as such was attractive as an analog to Charity Hospital in New Orleans,
although much smaller. As a potential source of “clinical material” for
education and research, the institution had the same kind of potential,
however, and this is likely why DeBakey mentioned it by name.
Unfortunately, Jefferson Davis Hospital was—as Longmire had noted—
some five miles from the Texas Medical Center and this presented obvious
challenges. The third facility, Methodist Hospital, was closing the doors at
its old location and moving into the Medical Center in the not-too-distant
future, but ground had not even been broken on the project yet, so nothing
could be expected on that front for years. Moreover, it was unknown
whether the Methodist Hospital Board—Mrs. Fondren and her group—
would even be receptive to the idea of converting their institution into a
university teaching hospital. As it happened there was another facility—the
local Navy Hospital—that was not even considered by the Baylor and Texas
Medical Center administrations at this point but would soon prove to be of
immense importance.
DeBakey wrote that he did not believe the problem of obtaining teaching
services was insoluble, although he confessed that he did not know what the
solution was. He consequently demurred as to a definitive answer in regard
to the timing and outcome of his decision and asked for “another
opportunity to discuss certain of the matters upon which I have
commented.” DeBakey closed by reiterating his interest in “the possibilities
of the University and Center” and thanking the Baylor representatives for
their interest in him.32
Brown composed a tactful and measured reply to DeBakey’s letter,
pointing out in his response that, “We are now proceeding with the plan to
acquire clinical facilities to be under the management of the separate
services of the University, and I am glad to say that to date, the outlook is
very bright.”33 He did not elaborate on what the plan was.
During this spring and summer of 1948, DeBakey was still a very active
member of Tracy Voorhees’s medical contingent in the Hoover
Commission, travelling frequently between New Orleans, Washington, and
other sites relevant to the committee’s work. According to his recollections,
he had already decided not to accept the Baylor position when he found a
letter from Dean Moursund on his return from one of these trips in late
June:
June 24, 1948.
Dear Dr. DeBakey:
I called you long distance yesterday but was advised that you were out of the city and would not
return until the 27th. It was my plan to come to New Orleans for further conference with you
relative to the position in Surgery. I still want to do so and ask that you kindly call me collect
upon your return to New Orleans.
Sincerely yours,
W. H. Moursund
Dean34
Moursund traveled to New Orleans to continue the recruitment of

DeBakey in earnest and in person. They met on June 30. DeBakey was
taken by the Dean’s charm, as well as his determination to accomplish the
things that were needed to elevate the Baylor University College of
Medicine to prominence. Most importantly, Moursund was clearly sensitive
to DeBakey’s particular concerns, and he expressed the conviction that they
could be satisfactorily met.
He was a very fine man. I really became very fond of him because he was a dedicated and
absolutely honest man and just dedicated to trying to get this school going. He came to New
Orleans to see me. We had a long talk about what was in my letter. And he said, “ ‘Well if I get
all of these things agreed to will you then come?”35
The following week a letter arrived from Moursund (addressed to

DeBakey at the Hays-Adams Hotel in Washington) formally offering the
position as Judson L. Taylor Professor of Surgery and Chairman of the
Department of Surgery at Baylor.*,36
The entire projected budget of the Surgery Department was laid bare in
this letter, as well. In addition to the $20,000 for the Chairman’s salary,
there would be funds for Elliott Hay and John Webb, holdovers as Assistant
Professor and Instructor from the prior proto-regime. Money was
earmarked for a student assistant in the dog surgery course and two
secretary/technical assistants, as well as equipment and supplies. The sum
total was $38,237.50. DeBakey was also afforded a month off for vacation
per year. This was probably the best deal the Baylor University College of
Medicine ever got in any contract—like his father, DeBakey simply never
took time off.37
DeBakey again consulted with Ochsner, who continued to advocate on
behalf of Houston. He told DeBakey that he hated to see him go, but it was
in his protégé’s best interests. Ochsner, at age 52, was not going anywhere
any time soon, and as long as he was at Tulane and the Ochsner Clinic,
DeBakey could never rise higher than second-in-command at either of these
places. Anyway, if he did not like it in Texas, he could always come back.38
Naturally DeBakey would not make a decision of this importance
without involving Diana. She was now pregnant with their fourth child.
Although Diana was happy in New Orleans she recognized the professional
(and social) opportunity this prospective position represented and supported
her husband in taking it.40
DeBakey responded on July 14, 1948.
Dear Dr. Moursund:
It gives me great pleasure to accept the offer, made in your letter of July 3, 1948, of appointment
as Judson L. Taylor Professor of Surgery and Chairman of the Department of Surgery at the
Baylor University College of Medicine. In accepting this appointment I should like to express
my sincere and grateful appreciation for the honor it signifies. I am fully cognizant of its great
obligations and responsibilities and I shall endeavor in every way possible to meet and fulfill
them to the best of my ability.
I hope to complete my duties here by Oct. 1, 1948 and should like to make the appointment
effective on that date. As indicated in conference with you, however, I have certain
commitments which were made between Tulane University and Mr. Herbert Hoover, and
between the University and the Department of the army which will require part of my time after
October 1, 1948. I have assumed from our discussion that arrangements for my fulfillment of
my obligations meet with your approval.
Let me say again that I look forward with much pleasure and enthusiasm to the opportunity of
joining your faculty soon and of participating in its development as one of the nation’s great
medical centers,
Sincerely yours,
Michael DeBakey, M.D.41
Newspapers in Houston and New Orleans reported the news of

DeBakey’s appointment. The New Orleans Item took the opportunity to
trumpet DeBakey as “one of the nation’s leading young surgeons” and
remind its readers that the appointment “carries with it recognition of New
Orleans as an outstanding center of medical teaching.”42 The Houston
Chronicle did not find need of mentioning the educational capacities of
DeBakey’s former home but did report his previous positions and
responsibilities in a concisely accurate manner.43
Houston is located in Harris County, Texas. The very conservative Harris
County Medical Society had a long-standing and absolute policy against
physician publicity, and, consequently, some members viewed the
Chronicle article with less-than-approving eyes—even though it originated
from Moursund’s announcement, not DeBakey’s. The Society would prove
to be one of the more consistent irritants with which DeBakey would have
to contend after his move to Houston.
When he arrived at Baylor, DeBakey moved into a first-floor office in the
Cullen building. He shared an exam room with the pediatrician Russell
Blattner, who became a friend but sometimes complained that the new
Chair of Surgery did not clean up the room after using it.44 Although he was
in a very real sense creating a Department of Surgery, DeBakey
encountered a few individuals already ensconced in the version that
predated his arrival. Before long it was clear that they would not be able to
toe the line in the new regime.
They had one full-time young man who really was kind of crazy. He was unstable. In fact, I had
to get rid of him. He was a doctor, but kind of nutty. He was hired before I got here. And there
was one secretary who wasn’t much better. She wasn’t nuts but she was stupid. That was the
Department of Surgery. So I had to get rid of this nutty fellow and get rid of the secretary
because she was stupid and start getting some new personnel.45
Over the next few months, while he considered staffing and other
problems at Baylor, DeBakey continued his work on the Medical
Committee of the Hoover Commission. This was nearing completion with
the submission of its report in November 1948. During this period, of
course, he was also faced with the practical matter of relocating his family
350 miles from New Orleans to Houston. Being naturally cautious in such
matters, DeBakey rented a house on Wichita Street for the initial months.
This was a compact two-story structure that could not comfortably fit the
family for long, however. Shiker came over from Lake Charles to help out
with the search for a permanent home: his long experience with real estate
and construction would stand them in good stead in the quest for a suitable
dwelling.46
In the meantime, Moursund and the Baylor Board were moving forward
with efforts to provide DeBakey and the other department chairs with
clinical services to run. Their first efforts focused on Hermann Hospital and
the city-county Jefferson Davis Hospital.
DeBakey later recalled that Moursund’s recruitment appeal in New
Orleans had included the suggestion, if not quite the promise, that a clinical
service would be provided for him at Hermann.47 This turned out to be a
good deal more difficult to deliver on than Moursund probably suspected.
Hermann Hospital was a private institution, named after another high-
minded—if somewhat eccentric—Houston philanthropist who predated his
like-minded midcentury peers by several decades. A number of other civic
landmarks still bear the name of real estate and cattle baron George
Hermann, including a municipal park he purportedly had constructed after
he saw New York’s Central Park. The swampy land from which the Texas
Medical Center was emerging had once been his property, too, and on the
edge of this forest the hospital bearing his name—constructed with funds
earmarked in his will to the purpose—had been built in the 1920s.48
The Board of Trustees and, especially, the physician staff of the Hermann
Hospital had no special reason to embrace the advent of the Baylor
University College of Medicine. These were people comfortable with the
status quo: the boon that the new institution might mean to the city was, in
their eyes, more of a threat. At the very least it spelled competition.
Nevertheless, the Baylor faculty was allowed to teach students there
(although, except for pediatrics, not provide patient care) and a promise had
apparently been made to Moursund to provide 20 beds for the new
academic surgery service.49 When push came to shove, though, a
combination of apathy and administrative misunderstanding—possibly
intentional—proved to be the order of the day.
In late November, DeBakey was able to communicate to Alton Ochsner
that there were “promising developments” with regard to the Hermann
situation, but just three weeks later he relayed that, “the situation at
Hermann remains unchanged. Considerable pressure was brought to bear to
have me accept compromises but I have stood my ground on the basis that
the principles involved were too fundamental.”50
What DeBakey primarily meant was the stipulation that the chair of the
university department must also be the chief of the clinical service—the
same point that Stander, Blalock, and Longmire had all made, too. He also
felt that the Hermann administration did not understand, in a broader sense,
the role of a general hospital in an academic medical center and the great
advantages that such a relationship might confer on their facility. The
Hermann administration pondered the situation and soon came up with
what they thought to be a solution.
The chief of staff of the Hermann Hospital and the chief of surgery came to see me. He said,
“Well, we’ve had the meeting and everything’s all set now. You’re going to be chief of the
teaching service.” And I said, “What do you mean ‘chief of the teaching service?” And he said,
“Well, you’ll be in charge of teaching on the service.” And I said, “Well, who’s going to be in
charge of the service?” “Well, this doctor so-and-so is going to be in charge of the service.” The
one that was there. And I said, “Well, I don’t understand that system.” I said, “You can’t have
two chiefs of service. There only should be one.” “We’ll have two chiefs. You’d be chief of
teaching and he’d be chief of the service.” And I said, “Well, I never heard of that before and I
don’t understand that organization.” I said, “Suppose I’m teaching on a patient he has operated
on and I have to say that what he did was wrong?” I said, “Do you think that would go over very
well?” “Oh, well, you know, there’s no reason why you would say that?” I said, “Well, from
what I’ve seen around here there would be good reason for me to say that.”*,51
Beyond the bizarre nature of the proposition from a didactic perspective,

DeBakey quickly perceived that his authority as Chairman of the Baylor
Surgery Department would hold no weight on the wards—any faculty he
appointed, for example, would have to be approved by the Hermann
surgical staff.
At this point—several months into his tenure in Houston (although much
of that time had been spent finishing up work on the Hoover Commission in
Washington)—DeBakey was reaching a frustrating crossroads. Accustomed
to full-throttle activity as a surgeon, educator, researcher, and—thanks to his
time in the Army—even administrator, he was befuddled and chafing at the
inertia surrounding him. It was hard to escape the conclusion that the
promises he had been made during the Baylor recruitment were not being
kept. DeBakey voiced his concerns to Ochsner and was told he could return
to his prior status in New Orleans at any time.52
DeBakey decided that the best path for his career trajectory was, indeed,
a return to Tulane and the Ochsner Clinic. Before leaving Houston, though,
he asked Dean Moursund to arrange a meeting with the Chairman of the
Houston Executive Committee of the Board of Trustees of the Baylor
University College of Medicine. That was Ray Dudley, another oil man—
the founder and chief of the Gulf Publishing Company—who was also, not
coincidentally, on the Board of the Hermann Hospital. DeBakey intended to
unburden his conscience and fill Dudley in on the true lay of the land.
Moursund came along.53
Dudley had been told by the rebuffed members of the Hermann staff that
Baylor’s new surgeon was a radical: uncooperative and dictatorial, possibly
even a communist. He greeted DeBakey coolly and proceeded to lecture his
new acquaintance on the value of change “by evolution, not revolution.”
DeBakey sat politely through this monologue, then took over.
“Now if you have finished telling me what you have to tell me, I’d like for you to listen to me
for a while. Let me tell you what I’ve got to tell you before I leave.” I had just had it about up to
here, you know, and I was leaving anyway and I didn’t give a damn. So I told him what the
situation really was: what the responsibilities were in terms of medical education and the quality
of education (there) was in the medical school. That they had a third rate medical school and it
was going to remain third rate the way it was.55
DeBakey went on to explain that the medical school graduates from

Baylor were forced to leave Houston in order to receive any sound
internship or residency training and that this fact reflected on the quality of
care that was being delivered to the community. He pulled no punches in
ascribing responsibility for this to Dudley and the other members of the
various boards, pointing out that they not only did not know what they were
doing, but they were ignorant of their own failings.
Unaccustomed to being castigated in this fashion, Dudley responded with
admirable grace. He sought and received confirmation of DeBakey’s
observations from Moursund, then turned the tables.
And he said to me, “Well, I didn’t know any of this, Dr. DeBakey. Nobody told me these things.
And I’m glad to know them.” He said, “I want you to promise me you’re not going to leave
Houston right now, until I have had a chance to look into this and had a chance to talk to you
some more.” I said, “Well, I’ll be glad to do that.” But I said, “To be perfectly honest with you, I
don’t plan to stay here too long, because I’m wasting my time and your money, and I don’t want
to do that. I came here to do a job. If I’m not given the resources and the support of the college
and the Trustees to do it, there’s no sense in my staying. Because I’ve got plenty of work to do
in New Orleans.56
Dudley came on board, which turned out to have greater impact on

Baylor than it did on Hermann. That hospital was, finally, a lost cause.
The effort to establish a site for a clinical service met with much better
results elsewhere.
On the same day DeBakey assumed the Chair of Surgery, October 1,
1948, Baylor announced that an affiliation with the Jefferson Davis
Hospital would commence the following summer. This relationship began
to be mapped out at a meeting of the Board of Trustees of the hospital in the
first week of November, which DeBakey attended.57 At this setting he was
made Chief of Surgery at Jefferson Davis. Soon afterward, DeBakey began
reorganizing the existing surgical residency at the facility, intending to
expand the program from three to seven trainees. He also received approval
for additional space in the hospital for a surgery research laboratory, which
would be the first in Houston.58
The existing three-year surgery residency at the Jefferson Davis Hospital
was, in DeBakey’s view, wholly inadequate. As he described things to
Ochsner,
[t]he situation here so far as residency training in surgery is concerned is simply incredible and
makes me lose faith in the manner in which the approvals have been made. There is no system
of graded residency and no understanding of basic science training. In most instances the staff
supervising the residency work consist predominantly of general practitioners and some of the
cases I have seen have been handled deplorably. The Board and the College should certainly
take cognizance of this situation. I am sure that a proper evaluation of the residency training
programs in surgery here would result in withdrawal of approval of all hospitals here—it is a
shameful prostitution of standards.*,59
At one visit to the Jefferson Davis Hospital for a surgical conference,

DeBakey was astonished when an untrained surgeon—one of the many
general practitioners performing operations in Houston at the time—gave a
presentation on his unique approach to inguinal hernias. Proudly reporting
that he had a zero percent recurrence rate, the earnest GP described
repairing the hernia by excising the testicle! 60
What these self-defining Renaissance physicians lacked in expertise they
made up for in pugnacity. As at Hermann Hospital, the “Jeff Davis” staff
had its own milieu, developed over the quarter-century since the
institution’s founding.* If anything, the city-county doctors controlled their
hospital even more than their Hermann counterparts, and they were not
about to succumb to the sweeping of this new broom and his ilk without a
fight. Through the end of 1948 and the first part of the new year, as the
August date for the Baylor-Jefferson Davis affiliation grew nearer,
DeBakey sensed the by-now familiar resistance he had felt since his arrival
in Houston. But he had a powerful new ally in this next fight.
5.3 Ben Taub

The Chairman of the Board of Managers of the Jefferson Davis Hospital
was Ben Taub. A 60-year-old native of Houston, Taub and his brother Sam
had inherited a number of stores and real estate holdings from their father, a
Jewish immigrant who had built a fortune from a small tobacco shop. Sam
became well-known and respected in financial circles (Figure 5.2). Ben,
who never married, expanded the family’s real estate holdings and served
on the boards of dozens of companies and organizations. He also focused
on philanthropic endeavors, particularly involving higher education (he
gave 35 acres for a permanent campus to the University of Houston) and
healthcare for the indigent.62
In his efforts to convert Jefferson Davis into a university hospital,
DeBakey decided to make an appeal directly to the head of the Board of
Managers. He made an appointment to meet with Taub at the magnate’s
unconventional office.
It was interesting to go back to his office because you go through what looks like a wholesale
tobacco warehouse. Of course, actually it’s not the warehouse, because the warehouse was in
another place, but this is where they had the various products on display. And you go through
this whole open kind of building with all the tobacco products and candy and that sort of thing.
And then finally you get in the back: his office is in the back: a roll-top desk, old fashioned
looking office, very cluttered. And obviously he knows where everything is. And he had me sit
down in a chair nearby him.63
DeBakey, whose appointment was scheduled for 15 minutes, got straight

to the point.
I expressed in general the point of view that a charity hospital in the community was a very
valuable source of teaching. But I said, “From your standpoint you’re really not interested in
teaching, except as a person who’s interested in improving the quality of the teaching of doctors
in the community. Because you’re primarily interested in what is in the best kind of quality care
you can give the poor sick. This is the way to do it, because you cannot teach poor quality.” And
I said, “You’re teaching the best quality you can. And your teachers know quality in a medical
school and they’re going to see that the standards of good medical care are being provided to the
patients because they’re teaching that. And that is why in any large community, the university
teaching hospital is where you get high quality care.”64
Taub listened attentively. After his allotted 15 minutes had elapsed,

DeBakey looked at his watch and prepared to depart. Taub asked if
DeBakey had somewhere he needed to be: If not, would he be willing to
answer a few questions the businessman had? The ensuing conversation
lasted more than an hour.
Figure 5.2 Ben Taub.
Courtesy Henry J. N. Taub.
Taub, who—like DeBakey—read extensively on many subjects, had

recently finished a book by the long-time head of the medical research
section of the Rockefeller Foundation, the erudite and eloquent Dr. Alan
Gregg (with whom DeBakey was acquainted). At one point in this book,
Gregg had mentioned that if he were ever to get sick in an unfamiliar place
he hoped to be taken to the local university hospital because he knew he
would get the best care in that setting.65 Now Taub saw sitting across from
him the incarnate means of achieving for his hometown the ideal Gregg had
articulated.
In a December 21, 1948, letter to Ochsner, an optimistic DeBakey
referenced this meeting with Taub: “My hospital situation is beginning to
look up. I had a most satisfactory discussion of the matter with the
Chairman of the Board of the Jefferson Davis Hospital and he assured me
that the Board would back me completely.” 66 In the months to come Taub
and DeBakey would act in tandem to move the city-county facility in the
direction of a university teaching hospital, skillfully employing outside
elements to achieve their goal. It was the beginning of a decades-long
working friendship that would leave indelible imprints on the city of
Houston and the Texas Medical Center.
The first surgical operation performed by Michael DeBakey in Houston
occurred on November 4, 1948.67 This was a ligation of the inferior vena
cava and both ovarian veins—a procedure performed in those days for
pelvic thrombophlebitis, often of infectious origin. Such was the case in this
instance, and—as DeBakey noted in a letter to Ochsner—the skills of the
new surgeon in town were the objects of attention.
I did my first operation on a case of phlebitis yesterday. A patient, whom I saw in consultation a
few days ago, that had a septic pelvis phlebitis, following an abortion, and was being treated
with anticoagulants. She developed one episode (of) pulmonary infarction and I recommended a
ligation. Since I was asked to perform the operation I did a vena cava ligation and bilateral
ovarian vein ligation. Fortunately, everything went off smoothly for I had an audience for the
operation and the patient has been doing very nicely.68
This procedure was done at still another small Houston hospital

unaffiliated with Baylor: Memorial Hospital, located on Lamar Street
downtown. DeBakey only performed a handful of surgical procedures at
Memorial, all in late 1948 and all involving the vascular systems. That same
month DeBakey scrubbed for his first surgeries at Methodist Hospital: a
mastectomy and lumbar sympathectomy.69 Despite the lack of a teaching
hospital (the operative cases at Methodist and Memorial were mostly
private patients), things were picking up clinically for DeBakey in Houston.
On December 22, he performed another aneurysm operation, this time at
Jefferson Davis Hospital. It was the first aortic aneurysm operation
performed in Houston by DeBakey, and the details were recorded.
R.M., a colored male, 46 years old, was admitted November 30, 1948, to Jefferson Davis
Hospital. He complained of a painful pulsating mass in the neck of one year’s duration. There
was a history of inadequately treated primary syphilis 27 years before.* The mass presented in
the left side of the neck above the sternoclavicular joint and pulsated vigorously.70
After admission the patient’s serologic test confirmed the diagnosis of

syphilis. The aneurysm was also noted to be enlarging, and the symptoms
were worsening. Based on this, the decision was made to operate. The only
imaging study available in that era was x-ray, which demonstrated deviation
of the trachea to the right and enlargement as well as calcification of the
aortic arch. Not entirely certain of what he would find, DeBakey took the
patient to the operating room.
An anterior thoracotomy was performed on the left side, removing a portion of the second rib.
Exploration revealed a sacciform aneurysm arising from the anterior superior border of the arch
of the aorta. In order to obtain better exposure, the medial portion of the clavicle was removed
subperiosteally and the sternum was split to the level of the second interspace. The flap thus
formed was retracted laterally. The base of the aneurysm, which was located between the
innominate and left common carotid arteries, was temporarily compressed and pulsation in the
mass ceased. A No. 24 French rubber catheter was encased in a polythene dicetyl phosphate film
and used as a ligature about the neck, which measured 2.0 cm in diameter. The pulsation in the
mass was obliterated. Apart from transient edema of the left arm, the postoperative course was
uneventful. The mass became pulseless and much smaller and there was complete relief of pain
when he was discharged on January 7, 1949.71
The encouraging early results of this procedure did not, unfortunately,

last. Two months later the patient died from hemorrhage after the residual
aneurysm eroded through the skin.
When this case was published DeBakey compared the procedure and
eventual outcome to a report from 1902, by the French surgeon Marin-
Theodore Tuffier. In that earlier report, Tuffier had ligated an aneurysm of
the ascending aorta and decided, for technical reasons, to leave the
aneurysm sac in place. Two weeks later the necrotic sac ruptured and the
patient died. DeBakey observed in his commentary that in his case at
Jefferson Davis, “the same error was committed as by Tuffier fifty years
ago. After the neck of the aneurysm was occluded by the ligature, the sac
should have been excised and the base sutured.”72
After hearing of DeBakey’s move to Baylor the old head of the Surgical
Consultants Division, Fred Rankin, told his former protégé that he hoped
“there will be an immediate abatement of this tropical fertility for a period
of years, at least until after you have moved to your new establishment.”73
The contrary was the case, however: at the time the family moved to
Houston, Diana was well along in her pregnancy for their fourth child. After
three boys, the DeBakeys were convinced that they were going to have a
daughter and had even picked out the name “Sis,” which was also the
nickname of Alton Ochsner’s daughter, Isabel. On December 15, however,
they were surprised—and “quite pleased”—by yet another son, born at St.
Joseph’s Infirmary. They managed to incorporate the Chief’s name, anyway,
calling the boy Denis Alton DeBakey. The proud new father remarked that,
“Like the old maid who stated that she came from a long line of old maids it
would seem that both Diana and I come from a long line of men.”74 Denis
was sickly in his first few months and even had to be hospitalized on
Blattner’s Pediatrics service at Hermann Hospital briefly, but he eventually
settled into normal health. When Rankin heard the news of the new son’s
birth he recommended to DeBakey that “you be content with a basketball
quintet and don’t go in for football.”75
The difficulties that attended an academic department of surgery
possessing no clinical service extended beyond the politics of
administration and even the teaching of residents, of course. Baylor also
had medical students whose education was certainly put in jeopardy by this
untenable state of affairs. While on what passed for their rotation in the
specialty of Surgery, the Baylor University College of Medicine students
spent their mornings in a lecture hall at the Cullen Building, then split up to
follow the physicians to the hospitals or their offices. They did not have
their own patients to care for and report on since there were no teaching
wards. In what must have been something like desperation, the school had
created a full-scale dog surgery lab as a kind of ersatz substitute for a
genuine medical school surgery experience. Students were taught to
replicate actual human surgical operations on dogs. When DeBakey learned
of this course he was horrified:
I have resolved to make a rather radical change in this particular feature of the curriculum next
year. As far as I am concerned it is a complete waste of time and money (as well as dogs) to try
to teach a junior medical student the technical details of a gastric resection when he has not
learned the simple principle of wound healing.76
In the spring of 1949, the tide began to turn once and for all for Michael
DeBakey at Baylor. Two events were paramount in cementing his decision
to remain in Houston, and he had a significant role in making both come to
pass.
With Ben Taub firmly in his corner, it might have seemed to DeBakey
that absorbing the Jefferson Davis Hospital into the academic apparatus of
the Baylor University College of Medicine was a fait accompli, but Taub
himself recognized that the old school physicians would resist even him. In
a tooth-and-nail fight, the Board of Managers would most likely prevail
over the votes of the staff, but a more elegant solution than a power play
was desirable: the assistance, if not necessarily affection, of these doctors
would be needed in the future. DeBakey had just the thing in mind.
An old friend of his, Basil MacLean, was a nationally known leader in
the field of hospital administration. DeBakey had known him since the
1930s, when MacLean had been an administrator at the Touro Infirmary.
MacLean had also served in the Surgeon General’s Office during the war,
and was at this time running Strong Hospital as a Professor of Hospital
Administration at the University of Rochester, New York.77 DeBakey
conceived the idea to have MacLean come to Houston, ostensibly as a
neutral paid consultant, to evaluate the Jefferson Davis Hospital and all its
machinations. This would be done with an eye toward recommendations for
the present and future disposition of the institution. DeBakey’s old friend
could be expected to recommend that the city-county hospital marry its
fortunes to the Baylor University College of Medicine—specifically,
Jefferson Davis would become Baylor’s teaching hospital and, when
practicable, be moved to the Medical Center. Taub thought it was a clever
idea and had the necessary arrangements made.
MacLean and his colleague Albert W. Snoke, another Professor of
Hospital Administration from Yale, came to Houston in July and performed
their inspection. Taub also arranged a dinner meeting between the
consultants and Hugh Roy Cullen at the old wildcatter’s home on the
evening of July 14.
At this point in time there was a movement afoot to build a dedicated
tuberculosis (TB) hospital in Houston. Cullen was involved in this project,
as he was with most large-scale plans related to improving healthcare in the
city. MacLean knew about the planned TB facility, too, and recognized an
opportunity that his host might embrace. Over dinner he suggested that
instead of building a whole new tuberculosis hospital that the old Jefferson
Davis Hospital be converted to the purpose and the bulk of the earmarked
resources directed instead at constructing a new city-county hospital in the
Medical Center (not coincidentally, near Baylor). Cullen responded
enthusiastically to the idea, as well as the recommendation that the charity
institution become a teaching unit of the university. That, plus a generous
pledge to the project, was enough to ensure that the whole story made the
front page of the local newspapers: Cullen Does It Again—Gives
$1,5000,000 for New Hospital.78
As predicted, significant resistance did arise among the Jefferson Davis
staff, but Taub and DeBakey were able to sweep it aside. Many of these
physicians were leaders of the Harris County Medical Association, which
was developing a robust collective antipathy to Baylor’s new surgery
chairman. From this point on, though, Jefferson Davis Hospital became one
of the main teaching hospitals for the Baylor medical school. It was already
in urgent need of expansion, and tentative plans were made for construction
of the next city-county hospital near the medical school in the Medical
Center. These plans would turn out to be a great deal longer in reaching
their fruition than anyone would have guessed at the time.
5.4 Houston VA
The second key event in the spring of 1949 was the transfer of the Houston
Naval Hospital, just across Holcombe Avenue from the Medical Center, to
the control of the Veteran’s Administration (VA)—and its subsequent
denotation as a “Dean’s Committee” institution under the control of Baylor.
It will be recalled that during the compilation of the Medical Committee
report for the Hoover Commission one of the salient examples of waste
involved the US Navy’s Houston hospital. Built at a cost of $12 million and
boasting some 39 separate structures, the facility, which was completed in
1946, only ever housed more than a few active-duty naval personnel. It was
woefully underused, and the majority of those who were treated there were
already veterans. Nevertheless, the VA made plans to construct an enormous
neuropsychiatric hospital directly adjacent to the Navy facility—and had
even begun acting on them, having purchased land for the purpose. The
Hoover Commission cited the absurdity of this duplication of effort, noting
that the original approval for the Navy Hospital had actually included the
provision that it be transferred to the VA at the conclusion of the war.79
News of the Commission’s report, including the federal hospitals fiasco,
made headlines in Houston and, in fact, all over the country when the report
was released in January 1949. President Harry S Truman was made aware
of the situation and, true to his no-nonsense form, ordered the Department
of the Navy to turn the hospital over to the VA. DeBakey later remembered
being in Washington, D.C., when he received a call from Paul Magnuson,
an orthopedic surgeon who had been a civilian consultant in surgery during
the war (and had also been on the committee that heard DeBakey’s proposal
for a VA Medical Follow-Up Agency at the National Research Council
[NRC] back in 1946). Magnuson was now Assistant Medical Director of the
VA, in charge of Research and Education. He informed DeBakey about the
VA takeover, which would have been an intriguing piece of information in
any case. DeBakey’s level of interest shot up dramatically, however, when
Magnuson asked if Baylor could provide the personnel to staff the new
hospital.80 In fact, medical schools were beginning to provide personnel for
VA hospitals all over the country.
In January 1946, Paul Hawley, Medical Director of the VA and former
Chief of Surgery in the European Theater of Operations (he, along with
Elliott Cutler, had heard DeBakey’s self-defense in Paris in the threatened
court-martial debacle) had announced a new program linking together the
administration’s hospitals and the nation’s medical schools. This was
intended as part of the effort to provide the best care to returning veterans,
as well as the optimum opportunities to complete the training of the many
physicians who were also re-entering the civilian communities. In this plan
the medical schools would assemble “Dean’s Committees” to administer the
hospitals and integrate their teaching, research and clinical care.81
The VA took over the Houston Naval Hospital on April 15, 1949, and
immediately ceded authority to Baylor’s newly minted Dean’s Committee,
which consisted of Moursund, DeBakey, Warren Brown, and internist
James Green.82 DeBakey’s title was Chief Consultant in Surgery (the Chief
of the Service was technically a VA surgeon named John P. Heaney), but
this term was misleading since his duties far exceeded a mere advisory role.
It was DeBakey’s responsibility to appoint the attending and resident staffs,
to formulate the undergraduate and graduate teaching curricula, and
generally to do whatever it took to organize and develop the surgery
service. As it happened, the Houston VA surgery service developed very
rapidly into a recognizable academic one, largely because it arose de novo
and did not have to face the obstacles of entrenched opinions and
preexisting behavior patterns.83
In the saga of Michael DeBakey and the Baylor medical school, the near-
simultaneous materialization of both the Jefferson Davis and VA Hospitals
as full-fledged university teaching facilities in the middle months of 1949
was barely short of miraculous. It takes no great stretch of the imagination
to envision him, frustrated and jaded by the unkept promises and unfulfilled
potential, packing up for the comfortable environs of New Orleans in that
same summer. Instead, DeBakey doubled-down on his unlikely Texas
gamble and never looked back, to the enduring glory of his new home and,
eventually, the benefit of untold thousands.
Even as he defined his position at Baylor, DeBakey continued to keep a
high profile in Washington, D.C. In 1946, he had been on the Medical
Advisory Committee to the Secretary of War, helping to make
recommendations intended to keep the military’s medical standards at a
high level in peacetime. On December 13, 1948—just weeks after finishing
his work on the Hoover Commission—he accepted a position on a new
Medical Advisory Committee to the Secretary of Defense, James
Forrestal.84 To a certain extent this was a natural progression from the
earlier Advisory Committee, as well as the Hoover Commission, since
Forrestal also wished to integrate the different armed forces medical
divisions into a unified department. This Committee also dealt with one of
the results of the duplication of federal medical services—a shortage of
doctors. After noting that unification of these medical services was the best
solution, the Committee recommended several other measures intended to
increase the voluntary enlistment of physicians and—by all means—avoid
the reinstitution of a dedicated selective service: the “doctors draft.”*
Keeping in touch with the power brokers in Washington paid certain
dividends at home. DeBakey was eager to get the surgery research labs at
Baylor, limited as they were at first, up and running. † He needed projects
and, especially, money. Aided by his persistent presence on Capitol Hill and
in the Pentagon, he was able to procure funding from the Army in early
1949 to study arterial injuries. DeBakey himself was the principal
investigator on this project, and he assigned three junior men to the study—
part of the contingent he was bringing in to construct the Department from
the ground up. These were William Amspacher and Robert Pontius, surgical
fellows who had completed their residencies, and a new Instructor in
Surgery who arrived in July 1949, Oscar Creech, Jr.86
Creech, a native of North Carolina, was an interne at Charity Hospital in
New Orleans at the time of Pearl Harbor. He dutifully enlisted in the Army
Medical Corps, eventually rising to the rank of Major. At the conclusion of
the war, Creech was one of the many physicians caught in the limbo
between high military rank with experience and incomplete civilian clinical
training. He initially intended to return to North Carolina and become a
general practitioner but, on passing through New Orleans, heard that
Ochsner was looking for residents at Tulane. Creech then abruptly switched
gears and decided to pursue a career in surgery. DeBakey got to know
Creech well while he was a resident at Tulane and developed a high regard
for him. Accordingly, when Creech’s training in New Orleans was
complete, he was offered a position at Baylor. DeBakey assigned Creech to
the Jefferson Davis Hospital, where he ran the new Thoracic Surgery
Service and the Cancer Clinic, in addition to the usual teaching and
investigative work.87
The Army helped underwrite other early research projects in the surgery
labs, focused on trauma. These included studies of renal failure in burn
patients and liver blood flow in shock. Other experiments looked at the
usefulness of the “clot-busting” thrombolytic substance streptokinase in the
treatment of blood in the chest cavity (hemothorax), the role of the adrenal
gland in the response to injury, and the alterations of serum electrolyte
concentrations in surgery patients.88
Now that he was firmly in control not only of the medical school’s
Department of Surgery but also two separate de facto university hospital
surgery services, DeBakey brought both his clinical organizational and
educational plans to bear. Naturally, the two were interrelated. These were
mostly derived from his experiences at Tulane, of course, but he also
inquired among his many friends in academia regarding their organization
and curricula, especially Edward Churchill at the Massachusetts General
Hospital.89 He was determined to raze the inadequate prior systems and
upgrade all aspects of surgical training, from the junior medical student
through the senior resident.
At Jefferson Davis Hospital, DeBakey’s reorganization meant that no less
than 10 surgical services fell under the umbrella of the Division of Surgical
Sciences and were thus under his authority as Chairman. These ranged from
General Surgery to Otolaryngology. They all had their own chiefs, of
course, but each reported to DeBakey.90
Since his own specialty was General Surgery, DeBakey had an obvious
interest in the administration and daily operations of this service. Prior to
his arrival, any number of surgeons (or general practitioners who did
surgery) might be “on service” at any time. The responsibility was so
diffuse that the patients might not even have a definite physician assigned to
them—or if they did, they might only encounter them in the operating
room. This was clearly an unacceptable system, and DeBakey meant to
change it. Each patient admitted to the General Surgery Service had to have
a specific surgeon in charge of his or her care. In those days in Houston and
elsewhere the hospital wards were separated not just by sex but also by
race. In DeBakey’s new system a senior staff member was assigned as chief
of the white or “colored” division for the period of time they were on
service, and junior members were in charge of the separate male and female
wards. This accomplished the goal of assigning clear responsibility for each
patient admitted. The new Thoracic Surgery division under Creech, and a
Pediatric Surgery one under Boyd Withers “B. W.” Haynes, Jr., functioned
in the same way.91
DeBakey also instituted a daily outpatient clinic, weekly surgical
conferences, Grand Rounds and Tumor Board meetings, and a
reorganization of the emergency department. These efforts resulted in a
marked uptick in efficiency as well as in the quality of care delivered. There
was need for it.
Soon after taking over the service, DeBakey was forced to deal with one
of the general practitioner surgeons who had gotten far over his head in the
operating room.
This doctor was so ignorant in surgery that he didn’t fully appreciate his own limitations. And
one day he operated on a patient who had a carcinoma of the pancreas. He was going to do what
is called a Whipple operation. This is an operation that consists of removal of the pancreas, then
putting things back together so that you connect the connections from the liver, like the bile
ducts, the intestinal tract—put the stomach and duodenum back together. It’s quite an extensive
and elaborate operation. And here he was attempting to do it. I didn’t know that he was
attempting to do it, until it was done. Obviously I couldn’t see everything that was going on in
the operating room every day and didn’t really intend to supervise it that way. I put these men on
their own with calm residents themselves that were confident. Now there was a confident young
man with him—a resident, but he was in a difficult position of having a staff man doing the
operation and trying to tell him what to do and so on, but at the same time the fellow went ahead
and made numerous errors.92
Eventually the journeyman surgeon tore the aorta and the patient
succumbed on the table from this and other surgically induced injuries.
Made aware of what had transpired, DeBakey called the physician to his
office and told him frankly that he could no longer operate on an
independent basis. He could assist a trained surgeon, but not wield the
scalpel himself.
Soon afterward, DeBakey received a call from another physician who
had encountered the fuming, demoted GP and been told about his
humiliating meeting with Baylor’s new surgery Chief. The bad news was
that the man was angry, was known to carry a gun, and had even killed with
it in the past. DeBakey contacted his would-be assailant immediately, again
summoning him to his office in the Cullen building:
And when he walked in I said, “Have you got a gun on you?” He said, “No, Dr. DeBakey.” He
said, “I usually carry a gun for protection, but I don’t have a gun on me.” I said, “Sit down. You
know when I talked to you, I told you this was confidential. I think it’s absolutely stupid on your
part to have told anybody about what I said. In the first place, nobody would have known what I
told you, because I had no intention of telling anybody.” I said, “Don’t you see what’s happened
now? You’ve placed yourself in jeopardy with your colleagues by what you’ve told them.” I
said, “I could easily take this, if you wanted to make an issue out of it. I have all the evidence. I
have the men who were with you in the operating room to testify. I have the autopsy record to
testify what was found. And I could bring this directly to the Board of Trustees of the institution
and have you kicked off the hospital—become a matter of public record, and it would destroy
you.”93
The GP was contrite and promised to obey DeBakey’s orders—which

were not to perform surgery except as an assistant to a properly trained
surgeon.
Thankfully not all of the resident experience consisted of nightmares like
the botched pancreatic surgery. After the “merger” with Jefferson Davis
Hospital there was much work to do in establishing a worthwhile surgery
training program.
DeBakey knew that the preexisting three-year surgery residency at the
city-county hospital was both substandard and on shaky ground with the
accrediting agencies. There was only one sensible solution: start from
scratch. He redesigned the program and resubmitted the paperwork to the
American Medical Association (AMA) Council on Hospitals and Medical
Education as well as the American Board of Surgery. With the help of a few
well-timed phone calls to friends in these organizations, DeBakey was able
to get a new four-year, graded residency approved within a few months. The
same approval was granted to the VA surgery residency at nearly the same
time: “These two institutions thus became the only hospitals, and for the
first time in the city of Houston, to receive full approval for a complete
graded residency program in Surgery.”94
At Jefferson Davis the new residency consisted of three trainees in each
of the first three years and two at the fourth-year level. The fourth-year
residents spent six months as Chief Surgical Resident and six months as
Thoracic Surgical Resident. In those days so-called “pyramidal” surgery
residencies were common. In these programs more residents started than
finished, so that a diagram of personnel was thought to resemble that
geometric figure, being wider at the bottom than the top (why it was not
called a triangle system is anyone’s guess). The idea was to increase
responsibility as the successful trainees passed through the program. In
order to create this responsibility, unfortunately, other residents had to go.
In the more pleasant instances this was voluntary, typically because a rising
resident had chosen a specialty or even a nonsurgical career. The more
common scenario, however, saw the unfortunate trainee in a scramble to
find another training program in which to finish his training. DeBakey’s
early Jefferson Davis surgery program was a fairly lenient version of a
pyramidal residency, only tapering from three trainees to two.95
The first surgery residency at the Houston VA Hospital comprised seven
surgery residents across the four years. Since there were few opportunities
to treat women or children there, exchanges were set up with Jefferson
Davis to remedy this inherent deficiency.
Perhaps the greatest beneficiaries of the Baylor University College of
Medicine’s new affiliations with the city/county and VA Hospitals—aside
from the patients—were the medical students themselves. Gone were the
days of morning-long lectures in the Cullen Building, replaced by ward
rounds, clinical conferences, and actual hands-on learning at the bedside.
Nearly every one of the patients in the two hospitals was available for
teaching purposes. DeBakey replaced the dog surgery course he loathed
with a class in surgical anatomy, complete with cadaver dissections,
coordinated with motion pictures of actual operations. True not just to the
spirit of Alton Ochsner but to his actual methods, DeBakey developed
quizzes and assignments that required the students to look up current
journal articles in the library. These same exercises in New Orleans nearly
20 years before had set the path for DeBakey’s entire career—they might
conceivably do the same for others. In any case, doctors needed to keep up
with the latest news, and they needed to know how to do it.
Perhaps out of deference to his mentor, or the knowledge that he was not
as temperamentally inclined to do it well, DeBakey never did institute that
most characteristic and legendary of Ochsner’s many teaching devices: the
“Bull Pen.”96
5.5 Cherokee Street

The search for a permanent house took several months. With three boys
under five years old to wrangle, Diana could not hope to canvass the area
on her own; her husband was barely available even to render an opinion. On
the spot for this precise purpose, however, Shiker was in his element. The
entrepreneur who had once proclaimed his defiant intention to lay brick and
pipe in a new store by himself was not cowed in any way by the prospect of
house-hunting in a strange city. His experienced eye could identify quality
and shoddiness with equal acumen, expertise born of a lifetime in the real
estate business. It was the elder DeBakey who first spotted an architect-
designed three-story home on Cherokee Street at the edge of Houston’s
affluent Southampton neighborhood. Solidly built of white-painted brick,
and adorned with forest-green shutters, a three-car garage with porte
cochère and charming gabled dormers, the 7,000-square-foot home seemed
to him ideal for the young family. His son was circumspect, though: this
colossus looked larger than their needs and was quite expensive—four years
in the Army had not done much to pad the family’s bank account. One
undeniable positive was the location: oak-lined Cherokee Street was
adjacent to the Rice University campus, less than two miles from the
medical center. The boys’ putative elementary school, Edgar Allan Poe, was
just a short bicycle ride away.
Pointing out that it was an excellent investment, Shiker generously put
the money down (which his son soon repaid), and the family moved in. The
boys loved the fact that they each had their own bedroom, and everyone
admired the large gardens with their fragrant magnolia trees. Soon tomato
and squash were growing in a side garden by the garage. Time was to prove
Shiker’s instincts correct: for some two decades running, DeBakey had
changed addresses on a nearly annual basis. Although he was to stay in
Houston for close to 60 more years, he never moved again.97
DeBakey’s sisters Lois and Selma, having graduated from Newcomb
College with excellent academic records, began working in the Department
of Surgery at Tulane and the Ochsner Clinic in 1941.*,98 They helped in the
research, composition, and distribution of publications, beginning to carve
out a role in the field of medical communications in which they would
excel. Having finished his training under Ochsner after the war, Ernest had
eschewed the academic life that his brother cherished and moved to Mobile,
Alabama, for a career in private practice.99 Although their professional
paths diverged somewhat, the surgeon brothers Michael and Ernest
DeBakey remained close.
Through the first half of 1949, DeBakey’s operative case load increased
gradually but steadily. He performed a fairly standard cross-section of
typical general and thoracic procedures of the time, with a particular
emphasis on the operation he had learned at the foot of Leriche:
sympathectomy. DeBakey’s own operative record recorded his experiences
in this way: 102
1-20-49 Left sympathectomy with stellate, 2nd and 3rd thoracic ganglion Jefferson Davis
1-31-49 Radical breast Methodist
1-31-49 Anterior thoracotomy for inoperable mediastinal tumor Methodist
1-31-49 Right lumbar sympathectomy Methodist
2-2-49 Removal mass in neck, carcinoma Methodist
2-12-49 Gall bladder and exploration Hermann
2-17-49 Lobectomy US Naval Hospital
2-19-49 Colostomy Hermann
2-24-49 Pneumonectomy—subphrenic US Naval Hospital
2-28-49 Resection right half colon and ileocolostomy Methodist
3-12-49 Left cervicothoracic ganglionectomy Methodist
3-14-49 Bilateral lumbar sympathectomy Methodist
3-16-49 Sympathectomy—left side Methodist
4-6-49 Abdomino-peroneal resection of rectum Hermann
4-7-49 Pneumonectomy—left Methodist
4-11-49 Bilateral lumbar sympathectomy Methodist
4-11-49 Splenogastropancreatic resection Beaumont, Texas
4-12-49 Segmental resection—left bronchiectasis Jefferson Davis
4-25-49 I&D abscess Hermann
5-2-49 Excision aberrant breast tissue Methodist
5-2-49 Decortication (3 wks after pneumonectomy) Methodist
5-5-49 Pneumonectomy—cancer lung Jefferson Davis
5-5-49 Mediastinal tumor Jefferson Davis
5-6-49 Cholecystectomy Methodist
5-13-49 Ca—lung—pneumonectomy V.A.
5-20-49 Mycotic aortic aneurysm Methodist
5-24-49 Left phrenemphraxis Methodist
5-25-49 Thoracoplasty Methodist
5-26-49 Posterior mediastinal Methodist
5-30-49 Cholecystectomy Texas
6-13-49 Left lumbar sympathectomy Methodist
6-16-49 Exploratory Hermann
6-17-49 Parathyroid Hermann
6-23-49 Pneumonectomy Methodist
6-24-49 Hernioplasty Methodist
6-25-49 Thoracoplasty Methodist
6-27-49 Pneumonectomy Jefferson Davis
6-27-49 Pneumonectomy Jefferson Davis
6-28-49 Aneurysm—right brachial V.A.
6-29-49 Thoracoscopy V.A.
The site of most of these operations was Methodist Hospital, where

DeBakey chose to focus his private practice as his Hermann Hospital
interactions grew wearisome. Although it was across town, undersized, and
rather dilapidated, Methodist appealed to DeBakey because of the friendly
and welcoming personnel and administration: “they had the right spirit.”103
Unlike their counterparts at Hermann, the Methodist folks at all levels
appreciated DeBakey, were looking forward to moving into the Texas
Medical Center, and turned out to be keen for an alliance with Baylor.
At almost the same time that DeBakey arrived in Houston, a new
administrator was hired for Methodist. Ted Bowen was a native of Alta,
Texas, who had been educated in hospital administration at Washington
University in St. Louis. There, Bowen had witnessed the key relationship
between the University and Barnes Hospital, its teaching facility. On arrival
in Houston, he was enthusiastic about establishing a similar connection
between Methodist and Baylor. As it happened, his wife June was hired as
DeBakey’s secretary, so Bowen quickly appreciated the presence of the
like-minded Chief of Surgery.*,104
Formal affiliation between Baylor and Methodist Hospital was completed
on October 3, 1950.105 The College of Medicine assumed responsibility for
professional services and the teaching program through a new Medical
Board composed of the Dean, the Hospital Administrators, and the Chiefs
of the Services including, of course, DeBakey. There were five services at
the start: the Division of Surgical Sciences, the Division of Medical
Sciences, the Division of Gynecology and Obstetrics, the Division of
Pediatrics, and the Division of Laboratory Sciences.
Small and antiquated as it was, Methodist actually had its own surgery
residency prior to DeBakey’s arrival. As with the preexisting Jefferson
Davis residency, this was not a true “graded” training program—the size of
the hospital prohibited sufficient clinical experience. DeBakey offered to
integrate the Methodist residents into Baylor’s program, however, and
rotate them through Jefferson Davis and the VA so they could have that
necessary exposure. When this was accomplished Methodist Hospital,
affiliated with Baylor, was approved for a one-year rotational surgical
residency by the accrediting agencies.
In December 1949 ground was broken for construction of the new
Methodist Hospital at the Texas Medical Center. The 300-bed facility was
complete by November of 1951.107
On June 28, 1949, DeBakey operated on a brachial artery aneurysm at
the VA Hospital.108 Judging by the diagnosis and the location where this
operation was performed, it was most likely employed to address the late
complication of a wartime penetrating injury—deterioration of the wall of
the vessel leading to aneurysm formation. This was a common diagnosis in
the Vascular Centers during the war and afterward, and DeBakey had
discussed it in surpassing detail in his definitive paper on arterial injuries in
World War II.109 He would have been well aware that any surgical repair of
a traumatic brachial artery aneurysm was an homage to a great watershed
moment in the history of vascular surgery, accomplished by one of his idols.
The history of surgical intervention for aneurysms was long and rich—
but conspicuous mainly for its lack of success. Abnormal dilation of blood
vessels was known even to the ancients, and the first descriptions of surgery
for aneurysmal disease date to the second century, AD, Greek surgeon
Antyllus. This intrepid pioneer advocated ligating arteries leading into and
out of the aneurysm, then opening the sac and evacuating the contents—
generally old clot. The sac was then packed open. He sensibly declined to
operate on aneurysms that were very large or not in the extremities.
Antyllus also wisely advised against resecting the aneurysm sac since this
obliterated the tissue holding the ligated arteries together and the ligatures
could be displaced, with disastrous results.110
The drawback of Antyllus’s approach was that it tied off not just the
aneurysm but the arterial blood supply to whatever happened to be
downstream from it: the foot, the hand, the brain. Many—if not most—
times the tissues beyond the ligation died from lack of blood flow and often
took the patient with them. Still, the work of Antyllus was not materially
improved upon for more than 1,500 years.
The next important step came from John Hunter, an eighteenth-century
Englishman who, along with his brother William, made seminal
contributions to surgery and circulatory physiology. Hunter performed a
successful ligation operation—not outwardly much different from
Antyllus’s—for an aneurysm of the popliteal artery in 1785. The distinction
in Hunter’s approach was that, based on his study of circulatory anatomy,
he ligated the artery well above the aneurysm in an effort to maximize the
chance that collateral circulation would prevent the development of
gangrene further down the leg. He also thought (correctly) that the artery
wall far removed from the aneurysm would be less likely to eventually
disintegrate from the ligature. Hunter performed several such successful
operations in that pre-anesthetic, pre-aseptic era.111
The next major advance came from none other than Rudolph Matas.
In the spring of 1888 Matas—just 28 years of age—treated a patient at
Charity Hospital in New Orleans for an aneurysm of the brachial artery in
the arm, the late complication of a shotgun wound. He had initially decided
to ligate the artery above the lesion. To his surprise, he noticed
postoperatively that there was still blood flow in the aneurysm, with a
palpable pulse. This clearly would not do, so he returned to the operating
room and ligated the artery below the aneurysm, too. Matas expected that
that would be the end of it—all the feeding vessels to the aneurysm should
be eliminated—although he also knew that the patient would be at risk for
losing his arm from gangrene. To his surprise, however, blood continued to
fill the aneurysm. Pacing about the operating room and thinking aloud,
Matas determined that the persistent flow indicated there were other arteries
that were continuing to provide blood flow to the forearm and hand around
the aneurysmal site. He reasoned that if he simply opened the aneurysm sac
and tied off the responsible branches from within, the lesion would be cured
but the all-important collateral flow would be maintained, and the patient
would be spared the dreaded specter of gangrene. He turned out to be
correct, and this procedure would come to be called
endoaneurysmorrhaphy, a technique still in use today. Many consider this
operation by Matas to be the beginning of modern vascular surgery.112
DeBakey did not record the technique he used to treat the aneurysm at
the VA in June 1949, and the operative report appears not to have survived.
He may have performed Matas’s operation, he may have simply resected
the aneurysm and sewn the artery back together—”primary anastomosis”—
or he may have employed some other variation. In contrast to Rudolph
Matas in Victorian Charity Hospital, though, DeBakey and his cohorts in
the postwar period had a larger—and rapidly expanding—armamentarium
of vascular surgical techniques that could be brought to bear.
Many of the leaders in American surgery had recognized by this time that
the technical methods of vascular surgery (as well as the patient population,
the perioperative care, and just about everything else) were quite distinct
from those of general surgery. This, of course, had been the impetus for the
creation of the Society for Vascular Surgery (SVS) back in 1947, of which
DeBakey was a founding member. The Society continued to meet on a
yearly basis at the time of the large AMA annual gathering, gradually
building up membership and expanding the program of presentations. In the
early years, the papers that were delivered at the SVS meetings tended to
focus on clinical matters rather than scientific research, but since everyone
involved was feeling his way in this new specialty, that was entirely
appropriate. Evolving techniques in the diagnosis and management of
vascular diseases were of greater interest than esoteric investigations into
the still-mysterious causes of these maladies. Besides, the more practical
matters of clinical care not only could be used to help patients immediately;
they were also beginning to yield to determined study—and no small
amount of luck.
5.6 Dos Santos and Kunlin

In Europe two major breakthroughs in surgical technique for vascular
disease were made in the postwar years. Both were the products of
providence in the setting of surgeons poised to exploit it. Remarkably, both
the physicians involved had been at Strasbourg under Leriche at the same
time as DeBakey.
The first advance came in Lisbon on August 27, 1946, when João Cid dos
Santos performed a successful arterial endarterectomy.
From the beginning of meaningful surgical experimentation on arteries in
the early twentieth century, it had been observed that any procedure which
resulted in the removal or destruction of the lining of the vessel—the intima
—led inevitably to thrombosis, even if the artery was occluded, or nearly
so, with atherosclerotic plaque. This observation ultimately became dogma,
and since a clotted artery was typically a clinical or experimental
catastrophe, surgeons universally avoided such techniques—even when it
seemed that they might be effective in re-establishing blood flow.
The patient of Dos Santos had an acute arterial occlusion in the leg, and,
at operation, the intent had been to remove what was thought to be the
responsible blood clot. Even this kind of operation had largely been
abandoned because it usually thrombosed postoperatively, too, but dos
Santos had been using the highly effective short-term blood thinner heparin
in vascular procedures with great success. He thought it might prevent that
awful outcome in this case. After removing what he thought was the
thrombus, dos Santos was thrilled with the intraoperative results—there
were good pulses everywhere, and he demonstrated that the artery was now
wide open with an arteriogram. The offending clot was sent to the
pathologists, and it was in their report—as has frequently been the case in
surgical advances—that the true nature of what had transpired (and its
significance) came to light.
Dos Santos had removed the occlusive thrombus, all right, but he had
also accidentally stripped off not just the intima of the artery, but some of
the media—the muscular layer of the vessel wall that is responsible for
autonomic constriction and dilation in healthier vessels. He had broken the
great cardinal rule and then some, yet the artery had remained open.113
The implications of this were dramatic. Not only was there a new
operation now available to surgeons—what dos Santos called
“disobliteration” but came to be more euphonically and enduringly termed
“endarterectomy”—but it had been shown that other procedures that
disrupted the all-important intima might still, in fact, work.
In 1947, dos Santos went to Paris to present his new idea at the Académie
Nationale de Chirurgie. His old mentor Leriche was one of many who gave
this presentation their rapt attention. Another surgeon who listened to dos
Santos with great interest was his former colleague-in-training at
Strasbourg, the Frenchman Jean Kunlin.
Kunlin had followed his teacher to Paris to continue his own academic
career. He and Leriche performed experiments at the Collège de France, but
their clinical work was at the American Hospital in Neuilly—the same
institution where Diane had worked in the mid-1930s. It was at this hospital
that Kunlin made his own great breakthrough, on June 3, 1948.114
As with dos Santos, the inspiration came in a clinical case that was
beyond the accepted therapies. Unlike the prior event, however, Kunlin’s
innovation was mostly intentional. The patient in question was under
Leriche’s care at the American Hospital. He had presented with ischemia of
the left foot and an occluded superficial femoral artery. The standard
treatment in this case—sympathectomy with arteriectomy—had been
utilized, but the clinical course was spiraling: a toe amputation site had not
healed and gangrene was beginning to advance. At this juncture Leriche left
Paris to attend a conference in Holland, leaving Kunlin in charge. The usual
approach after failure of the sympathectomy would have been a major limb
amputation to prevent death from infection. Naturally the patient wished to
avoid either outcome, so he permitted Kunlin to make a desperate, last-ditch
effort to save the leg.
What Kunlin had in mind was revolutionary, but it did have some
precedent. Early in the twentieth century Alexis Carrel and Charles Guthrie
had performed countless experiments in pursuit of the best method of
suturing blood vessels together.115 Their studies were a big reason for the
prevailing view that the intimal layer had to be preserved, and Carrel and
Guthrie’s own best results came from a conceptually simple and intuition-
satisfying technique that successfully connected the ends of divided blood
vessels together, apposing the intima to the intima: end-to-end
anastomosis.* This technique came to be used clinically to suture the
divided ends of an artery together, either directly if the ends could be
mobilized sufficiently to permit it or with an intervening tube such as a vein
if the distance to be traversed was too great. The modality was particularly
attractive in trauma scenarios and aneurysms, but it cannot be said to have
been in widespread use and had not been applied to arterial occlusive
disease such as was threatening Leriche’s patient.
Kunlin proposed to do just that. He had reason to hope for success, if not
exactly expect it. During the patient’s evaluation an arteriogram had been
performed. In this radiologic examination, which was only then coming into
common use and proving to be invaluable, the arteries are injected with a
substance that appears opaque on x-ray. As the blood carries this “contrast”
material through the vessels the anatomy of the arterial tree is visualized
with striking clarity.
In the case of the patient at the American Hospital, the arteriogram had
shown Kunlin that beyond the occluded femoral artery the vessels in the
lower leg were actually still open. Similarly, the artery above the area of the
occlusion appeared relatively unaffected by the obliterative disease.
Conventional wisdom regarding the mysterious arterial occlusive process
decreed that it was a global problem in an afflicted patient: the disease
affected all the arteries. Consequently, any attempt to address it surgically,
regardless of technical cleverness, was bound to fail: one could not
reconstruct every artery. Kunlin now disregarded this dogma and proposed
bridging the gap between what certainly appeared to be nearly normal
vessels above and below the occluded one, thus restoring blood flow to the
leg that was dying from lack of it.
In preparation for the radical procedure Kunlin was surely emboldened
by the example of João Cid dos Santos and his endarterectomy, not to
mention the Portuguese’s key technical addition of the anticoagulant
heparin. As important as these elements were, Kunlin added an altogether
original twist that further amplified the chances of clinical success and
ultimately became a standard technique: he abandoned Carrel’s end-to-end
anastomosis.
In the actual operation, Kunlin exposed the target arteries above and
below the previously resected superficial femoral. He then dissected a long
segment of the nearby greater saphenous vein for use as the bridging
conduit. Knowing that veins contain one-way valves that would prohibit
flow in the anatomic orientation, he reversed the direction of the vein. After
administering intravenous heparin to prevent the arteries from clotting as he
worked on them, Kunlin applied a tourniquet to stop the blood flow in the
operative field. At this point the scar tissue from the prior surgery forced
Kunlin to find a segment of femoral artery higher up into the groin than he
planned, and he found he could not simply divide the vessel and construct
an end-to-end anastomosis. Instead, he dissected out a segment of relatively
normal artery and made a longitudinal incision parallel to its axis. Then he
sewed the open end of the vein to the hole in the side of the artery: an end-
to-side anastomosis. Not only did this completely new technique allow for
selection of a particularly well-preserved section of artery to sew to, in an
analogy to John Hunter’s aneurysm ligation method it preserved any
collateral circulation that may have developed beyond a likely transection
point.* Kunlin then did the same thing at the other end, suturing the vein to
the popliteal artery just above the knee. When he released the tourniquet
blood flowed freely into the lower leg and foot: he had bypassed the
occlusion.
When he returned from Holland, Leriche was shocked by what Kunlin
had done (he was especially astonished by the brilliant conceptual leap of
the end-to-side anastomosis). He could hardly argue with the results,
though: the patient’s foot had healed up rapidly and was soon essentially
normal. It was the first arterial bypass operation, and it was a huge
success.116
These two new techniques developed in immediate postwar Europe—
endarterectomy and bypass—laid the foundation for all the dizzying
advances in surgery for arterial occlusive disease that were to come in the
next decades. DeBakey, of course, had known Kunlin and dos Santos well
during his time in Strasbourg and kept in touch with them over the
subsequent years. Even before publishing their cases they had sent
descriptions of their innovations to Houston.117 Here were the methods that
finally laid to rest sympathectomy and arteriectomy as definitive treatments
for arterial occlusive disease.* Characteristically, DeBakey, along with
others interested in vascular surgery on both sides of the Atlantic, began to
think of ways to apply these techniques to different clinical scenarios.
5.7 Outpatient Clinic

Even with the game-changing acquisition of the Jefferson Davis and VA
Hospitals as teaching institutions, not all was smooth sailing for DeBakey
as his first year in Houston drew to a close. An ongoing headache involved
the confusion of its Board as to what the true nature of the Texas Medical
Center should be and, especially, the place of the Baylor University College
of Medicine in it. DeBakey agreed with the earlier assessments of Blalock
and Stander, which he frequently cited: the medical school should be the
heart of the medical center. Any and all other institutions involved should
project from it like spokes from an academic hub. There seemed to be
constant threats to this position, however. One persistent bugaboo involved
nebulous plans to construct a Central Outpatient Clinic.
As early as May 1948, the Board of the Medical Center had drawn up
plans for such a clinic.120 The idea was to create a kind of clearinghouse,
where the outpatients of all the various institutions in the Medical Center
could come to be evaluated and treated. Theoretically the various hospitals’
separate outpatient services could then be liquidated—or consolidated,
depending on one’s point of view. The concept was loosely modeled on the
structure of the Mayo Clinic. Both the Medical Center and the M. D.
Anderson Foundation Boards embraced the idea. In the summer of 1949, a
proposal was announced to place the clinic alongside the new city-county
hospital, which was being planned for the Medical Center after the
MacLean-Snokes report—and Cullen’s pledge—had hit the papers a few
weeks before.121
To many the whole idea seemed ludicrous and even threatening. Leading
the way among this latter category were the Houston physicians who were
not affiliated with the institutions in the medical center. They clearly saw
that such a massive outpatient facility would draw all their prospective
patients away. Even those doctors located in the center foresaw serious
issues involving distribution of new patients, among other concerns.
DeBakey himself was horrified at the idea because it cut at the heart of the
concept of the academic medical center: if this plan were to come to
fruition, the Central Outpatient Clinic would inevitably assume the
dominant position rightfully occupied by the Baylor University College of
Medicine.122
The unpopularity of the idea among so many caused it to be shelved for a
while. Soon, however, another threat—somewhat connected—arose.
The first commitment to the Texas Medical Center back in 1941 had been
from the University of Texas, in the form of a promise to build the M. D.
Anderson Cancer Hospital. According to some accounts “Bill” Bertner,
President of the Texas Medical Center, had originally hoped to lure the
University of Texas Medical Branch away from Galveston, 50 miles away,
as the affiliated academic institution, and had been blind-sided by the
Anderson Foundation’s agreement with Baylor.123 Be that as it may,
Houston was full of influential people with strong ties to the University of
Texas.
One of these was Randolph Lee Clark, a surgeon who had been hired as
Director of the Cancer Hospital in 1946.124 Clark had been in the Air Force
during the war, mainly performing research. He had also taken some
training at the Mayo Clinic, where he absorbed ideas of medical education
and administration that dovetailed with the initial plans of the Medical
Center’s Board. At that time the Mayo Clinic did not have a medical school
and trained only graduate physicians. As DeBakey found out after arriving
in Houston, a similar plan had initially been considered for the Texas
Medical Center. One of Clark’s several titles was Chief of the University of
Texas Post-Graduate School of Medicine. Explaining the situation to Fred
Rankin, DeBakey observed,
[a]pparently when Baylor University moved here, there was some vague idea that Baylor would
do the undergraduate teaching and the so-called University of Texas Post-graduate School of
Medicine would do the postgraduate teaching. I learned about this curious arrangement after I
arrived here but it was such a fantastic idea that I did not take it seriously. . . . Let me make it
clear at this time that the University of Texas Postgraduate School of Medicine is purely a paper
organization. It has no students and does no teaching. Moreover it has no connection with the
University of Texas School of Medicine at Galveston or for that matter with any other school of
medicine. It sits high and dry alone as an entirely separate entity.125
Clark approached DeBakey personally about the Mayo-derived plan. He

suggested that Baylor and DeBakey handle teaching of the medical
students, while he and UT would train the residents. The two men together
would run a resurrected form of the Outpatient Clinic as a source of private
patients as well as teaching material.126
Although he responded politely that he would like to see the plan on
paper, DeBakey was obviously not likely to entertain a proposal that would
both undermine the Medical Center model and diminish his own role.
Clark did not provide the requested document in any case, but DeBakey
opted to leave no question in the matter. On January 27, 1951, he wrote a
withering, 12-page memo to Judge E. E. Townes, the new Chairman of the
Houston Executive Committee of the Baylor University Board of Trustees.
In the memo, DeBakey savaged the idea of dividing the responsibility of
medical education between the Baylor University College of Medicine and
the University of Texas Post-Graduate School, and thrashed the proposed
Central Outpatient Clinic. He closed by reminding the judge that the
distance between the medical school and its teaching hospitals was the last
obstacle to fulfilling the Blalock/Stander ideal of the Medical Center and
reiterating that, for this reason, the new Jefferson Davis Hospital should be
built near Baylor, “This is the key to the solution of our problem.”127
While ministering to the growing pains of his newborn Department of
Surgery DeBakey kept, as we have seen, one eye on Washington—
especially with regard to policies relating to military medicine and surgery.
He remained a member of several committees and subcommittees of the
’VA and NRC Council, contributed as best he could to the languid progress
on the Medical History of World War II, and agreed to give a number of
presentations on both clinical and logistical facets of wartime surgery at the
Army Medical Service Graduate School.128
Another result of these efforts was the publication of his second book, the
matter-of-factly titledBattle Casualties: Incidence, Mortality, and Logistic
Considerations, which appeared in 1952. The co-author was Gilbert Beebe,
the gifted statistician who was now well-ensconced at the NRC. DeBakey
and Beebe had been responsible for the lion’s share of the medical data that
filled the pages of the classified publication Health of the Army during the
war, and this book was an extension of that effort. Although it featured
forewords by the Surgeon General of the Army, R.W. Bliss, and retired
Colonel Albert Love, Director of the Historical Division in the Surgeon
General’s Office during the war, Battle Casualties was not a government
publication. The book detailed much of what was known (and declassified)
about death and wounds among American combat forces in the war, but
focused primarily on logistics, especially the distribution and utilization of
medical personnel in response to rapidly shifting care demands. As noted
previously, Love had written a similar treatise apropos of World War I in
1931; DeBakey and Beebe methodically extended the précis of that work
with more advanced statistical methods and analysis. The stated hope was
that their work might help guide American military medical planners in
future conflicts.129
DeBakey had also not forgotten about the plight of the Army Medical
Museum. He was still an Honorary Consultant to the Library, as he had
been since 1946. Almost as soon as the Hoover Commission tendered its
report in November 1948, DeBakey had joined the Medical Advisory
Committee to the Secretary of Defense, which also took up the Library as
one of its concerns. This panel recommended that the Library remain in the
Army—not a universal consensus among the informed, to be sure—but that
it be reclassified as a “civil function.” That would separate the Library’s
cost of operation—including desperately needed construction of a new
building—from the Army’s budget and avoid the competition with guns and
tanks that always meant the librarians were stuck with the leftover
crumbs.130
While all involved waited to see what would come of this, DeBakey was
asked to speak at the Seventh Annual Meeting of the Association of
Honorary Consultants to the Army Medical Library in October 1950. There
he gave an articulate discussion on the history and possible direction of the
institution in a talk entitled “The Future of the Army Medical Library.”
After recounting the recent and ongoing bureaucratic battles, DeBakey
offered that he had “come more and more to the conviction that the problem
of the library cannot be resolved without adequate legislation to define its
responsibilities and establish it clearly as the National Library of
Medicine.”131
Back in Houston, the Department of Surgery at Baylor was growing. The
number of operative cases at the Jefferson Davis Hospital alone increased
from 10,934 in 1949 to 14,500 in 1951.The residency programs were
expanding, too. In its second full academic year of existence (1950–1951),
the surgery training program at Jefferson Davis Hospital grew to four
residents per year for each of the first three years, with two senior residents
for the fourth and final year. The program at the VA expanded from 7 to 13
trainees. One year of residency was still approved at the small Methodist
Hospital with exchanges among the other two facilities under the umbrella
of Baylor.132
The undergraduate medical education in surgery firmed up, too, with a
recognizable resemblance to the Tulane curriculum DeBakey knew so well.
Oscar Creech unfortunately developed an “early pulmonary lesion”—
tuberculosis—at this time and took a year off from clinical duties for rest
and treatment, although he continued to do research. Creech’s absence was
felt keenly, but partly obviated by the temporary presence of DeBakey’s old
friend from Leriche’s Clinic, Alberto Saldarriaga of Bogota, who joined the
faculty for some extra experience as a Fellow in General Surgery. Another
skilled general surgeon named John M. Howard also joined the staff. He
had been trained in the Army and was highly thought of, but unfortunately
was soon given a temporary leave of absence to rejoin the service in
Korea.133
The investigative labs were getting busier as well. One of the important
research projects at the start of the 1950s was an Army-funded investigation
into the evaluation of plasma substitutes—especially the branched
polysaccharide dextran—for purposes of fluid resuscitation. Experiments at
Baylor and elsewhere showed that dextran was, in fact, effective in treating
acute shock.134 Such studies cleared the way for its use on the battlefield in
Korea.
Other studies that were under way by 1951 included investigations into
renal, pancreatic, and biliary physiology in surgical scenarios.135 These
projects were typical of the kind of research being performed in university
surgery departments and general surgery divisions everywhere at the time.
Now, however, DeBakey—buoyed by news of the ground-breaking
advances in technique in Europe—began to pivot his own interests—and
with them those of his Department—more toward vascular surgery. Of
course this subject had never been far from his mind—he had gone to
France primarily to learn sympathectomy from its master proponent, and he
was a founding member of the SVS—but the new approaches changed
everything. No longer was the goal just the improvement of symptoms—
noble as that may be. Now direct attacks on the disease processes
themselves, thought impossible for centuries, were within reach.
DeBakey was asked to write a recap of recent advances in surgical
treatment of “Diseases of the Cardiovascular System” for the Annual
Review of Medicine for 1950. Most of the paper discussed new procedures
for congenital heart disease, which were widely and appropriately hailed.
Incremental progress in the treatment of acquired valvular and coronary
heart disease was also featured in the article, but no more than three pages
were devoted to peripheral arterial occlusive disease and none at all to
aneurysms.136
All of that was about to change.
Notes
1. https://www.houstontx.gov/planning/Demographics/docs_pdfs/Cy/coh_hist_pop.pdf (accessed
May 25, 2018).
2. Kellar WH. Enduring Legacy: The M. D. Anderson Foundation and the Texas Medical Center.
College Station: Texas A&M University Press, 2014: 69.
3. Butler WT, Ware DL. Arming for Battle Against Disease Through Research Education and
Patient Care at Baylor College of Medicine. Houston: Baylor College of Medicine, 2011: 6.
4. http://digitalcommons.library.tmc.edu/ebooks/5/ (accessed May 15, 2018).
5. http://www.tmc.edu/news/2014/08/building-a-city-of-medicine-the-history-of-the-texas-
medical-center/ (accessed May 22, 2018).
6. Butler WT, Ware DL, Arming for Battle Against Disease, 46–47.
7. Baylor to Move Medical Schools Here (May 9, 1943). The Houston Chronicle, 1.
9. Winters WL, Parish B. Houston Hearts. Houston: Elisha Freeman Publishing, 2014: 2.
10. Ibid., 23.
11. Monument to Medicine (April 18, 1948). The Houston Chronicle, 1.
12. Winters WL, Parish B. Houston Hearts, 2.
14. Letter M. E. DeBakey to A. Ochsner, January 22, 1946. DeBakey Collection. Baylor College
of Medicine Archives. Houston, TX. 2:127:4.
16. Ibid.
17. Ibid.
18. Letter M. E. DeBakey to W. T. Brown, February 17, 1948. DeBakey Archives, National
19. Butler WT, Ware DL, Arming for Battle Against Disease, 14.
20. John L. Ochsner, personal communication. January 20, 2017.
22. Letter W. Longmire to W. H. Moursand, March 15, 1948. DeBakey Archives, National Library
23. Letter W. Brown to M. E. DeBakey, March 25, 1948. Ibid.
24. Letter M. E. DeBakey to W. Brown, April 19, 1948. Ibid.
25. Letter H. R. Cullen to Texas Medical Center Board, April 19, 1948. Ibid. Stander died of a
heart attack only two weeks later.
26. Blalock A, Taussig HB. The Surgical Treatment of Malformations of the Heart in Which There
Is Pulmonary Stenosis or Pulmonary Atresia. JAMA 1945;128:189–202.
27. Letter E. W. Bertner to H. J. Ehlers, April 19, 1948. DeBakey Archives, National Library of
28. Letter M. E. DeBakey to W. Brown, May 7, 1948. Ibid.
29. Ibid.
30. Ibid.
31. Ibid.
32. Ibid.
33. Letter W. Brown to M. E. DeBakey, May 13, 1948. Ibid.
34. Letter W. H. Moursund to M. E. DeBakey June 24, 1948. Ibid.
36. Letter W. H. Moursund to M. E. DeBakey July 3, 1948. DeBakey Archives, National Library
37. Ibid.
41. Letter M. E. DeBakey to W. H. Moursund, July 14, 1948. DeBakey Archives, National Library
42. Real Recognition (August 27, 1948). The New Orleans Item.
43. Baylor Names Chairman of Surgery Unit. (n.d.) Houston Chronicle. DeBakey Archives,
46. Michael M. DeBakey, personal communication, July 21, 2018.
48. http://library.tmc.edu/mcgovern/conducting-research/finding-aids/hermann-ic086/#d0e184.
50. Letter M. E. DeBakey to A. Ochsner, December 21, 1948. DeBakey Collection. Baylor
College of Medicine Archives. Houston, TX. 2:127:4.
52. Ibid.
56. Ibid.
57. Letter M. E. DeBakey to A. Ochsner, November 6, 1948. DeBakey Collection. Baylor College
58. Ibid.
61. https://www.chron.com/news/houston-texas/houston/article/Jeff-Davis-Hospital-several-
Houston-houses-4996185.php.
64. Ibid.
65. Gregg A. Furtherance of Medical Research. New Haven: Yale University Press, 1941.
68. Letter M. E. DeBakey to A. Ochsner, November 6, 1948. DeBakey Collection. Baylor College
70. Cooley DA, DeBakey ME. Surgical Considerations of Intrathoracic Aneurysms of the Aorta
and Great Vessels. Annals of Surgery 1952;135:665–667.
71. Ibid.
72. Ibid.
73. Letter F. Rankin to M. E. DeBakey, July 27, 1948. DeBakey Collection. Baylor College of
Medicine Archives. Houston, TX. 9:128:3.
75. Letter F. Rankin to M. E. DeBakey, January 20, 1949. DeBakey Collection. Baylor College of
76. Letter M. E. DeBakey to F. Rankin (n.d.). Ibid.
77. Snoke AW. Hospitals Health and People. Washington, D.C.: Beard Books, 1987: 92.
78. The Houston Press, Wednesday, July 20, 1949, 38:252:1. DeBakey Archives, National Library
April 2018).
81. Verville R. War, Politics, and Philanthropy: The History of Rehabilitation Medicine. Lanham,
MD: University Press of America, 2009: 88.
82. https://www.houston.va.gov/about/History_of_Research_Program.asp.
83. Annual Report of the Department of Surgery, Baylor University College of Medicine, Houston,
Texas, 1949–1950. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C
582. Series 3:9:43.
Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 1:2:15. In 1947, the
National Security Act was passed, which replaced the Secretary of War with the Secretaries of
the Army, Navy, and Air Force. The new Secretary of Defense replaced the Secretary of War
in the Cabinet.
85. Ibid.
Texas, 1949–50. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582.
Series 3:9:43.
87. Ibid.
88. Ibid.
89. Edward Delos Churchill papers, 1840–1973. H MS c62. Harvard Medical Library, Francis A.
Countway Library of Medicine, Boston, Mass.
582. Series 3:9:43.
91. Ibid.
93. Ibid.
582. Series 3:9:43.
95. Ibid.
96. Ibid.
97. Michael M. DeBakey, personal communication, July 21, 2018.
98. Ibid.
99. Keefer LE. Shangri-La for Wounded Soldiers: The Greenbrier as a World War Two Army
Hospital. Reston VA: Cotu Publishing, 1995: 115–117.
100. Denis A. DeBakey, personal communication, July 17, 2018.
University of Louisiana, Lois DeBakey. University Archives, Howard-Tilton Memorial
Publishing, 2016: 21–22.
Texas, 1950–1951. DeBakey Collection. Baylor College of Medicine Archives. Houston, TX.
2:107:10.
106. Winters WL, Parish B. Reflections, 22.
109. DeBakey ME, Simeone F. Battle Injuries of the Arteries in World War Two: An Analysis of
2,471 Cases. Annals of Surgery 1946;123:534–579.
110. Thompson JE. Early History of Aortic Surgery. Journal of Vascular Surgery 1998;28:746–752.
111. Friedman SG. A History of Vascular Surgery. Mount Kisco, NY: Futura Publishing, 1989: 33–
45.
American College of Surgeons 2016;101:4.
113. Da Gama AD. Celebration of the 50th Anniversary of Endarterectomy: The Operation of João
Cid dos Santos. Cardiovascular Surgery 1997;5:354–360.
114. Friedman SG. A History of Vascular Surgery, 99.
115. Menzoian JO, Koshar AL, Rodrigues N. Alexis Carrel, Rene Leriche, Jean Knulin, and the
History of Bypass Surgery. Journal of Vascular Surgery 2011;54:571–574.
116. Kunlin J. Le Traitement de l’Ischemie Arteritique par la Greffe Veineuse. Rev Chir
1951;70:207–235.
118. Carrel A, Guthrie CC. Uniterminal and Biterminal Venous Transplantation. Surgery,
Gynecology and Obstetrics 1906;2:266.
119. Testart J. Jean Kunlin (1904–1991). Annals of Vascular Surgery 1995;9:S1–S6.
121. Ibid.
123. Ibid.
124. LeMaistre CA. R. Lee Clark. In Memoriam. Cancer 1994;74:1513–1515.
125. Letter M. E. DeBakey to F. Rankin, March 7, 1950. DeBakey Collection. Baylor College of
127. Memorandum M. E. DeBakey to E. E. Townes, January 27, 1951. DeBakey Archives,
Service Graduate School, Army Medical Center, Washington, D.C. July 2, 1951. DeBakey
ME. The Organization of Surgical Services in the Zone of the Interior, with a Consideration of
Specialty Centers. Presented to Medical Service Officer Basic Course, Army Medical Service
Graduate School, Army Medical Center, Washington, D.C. April 20, 1951. The Standards of
Military Practice in the Army. Presented to Medical Service Officer Basic Course, Army
Medical Service Graduate School, Army Medical Center, Washington, D.C. February 11,
1952.
129. DeBakey ME, Beebe GW. Battle Casualties: Incidence, Mortality, and Logistics
Considerations. Springfield, IL: Charles C. Thomas Company, 1952.
130. DeBakey ME. The National Library of Medicine. JAMA 1991;266:1252–1258.
131. DeBakey ME. The Future of the Army Medical Library. Bulletin of the Medical Library
Assocication 1951;39:122–127.
2:107:10.
133. Ibid.
134. Ibid
135. Ibid.
136. DeBakey ME. Diseases of the Cardiovascular System (Surgical). Annual Review of Medicine
1950:79.
*
Alton Ochsner’s son, the noted cardiovascular surgeon John L. Ochsner, related that Bertner had
tried to convince his father to move the entire Ochsner Clinic to the Texas Medical Center. The elder
Ochsner had demurred, believing he owed too much to the city of New Orleans to leave it. But he
told them, “I’m going to do something better for you: I’ll send you a person who can really build
it.”20
†
Moursund’s health was fragile at this point, and Brown performed many of the duties of the
Dean.21
*
The late Judson L. Taylor was a long-time Houston surgeon who had joined the Baylor faculty.
A foundation in his name provided the funds for the new Chair of Surgery.39
*
DeBakey had been asked to consult on a case at Hermann in which a patient had undergone the
then-common ulcer procedure of gastroduodenotomy (also known as a Billroth I operation)—
removal of a section of duodenum and suturing back together the stomach and intestine. The patient
was recuperating poorly and complained of foul breath. DeBakey discovered that his stomach had
been accidentally connected to his colon.54
*
At this time the American Medical Association’s (AMA) Council on Hospitals and Medical
Education provided accreditation for graduate training programs. With regard to surgery residencies,
this task was subsequently taken up in 1950 by the Conference Committee on Graduate Training in
Surgery, under the auspices of the AMA’s Council, the American College of Surgeons, and the
American Board of Surgery.
*
The original hospital building had been built on Elder Street in 1924, and it still stands. It was
constructed on the site of a cemetery that contained the graves of many former rebel soldiers and
ostensibly took the name of the Confederacy’s President to appease the displeased families. In 1939,
the hospital moved to the Allen Parkway location that it occupied at the time of the discussed
events.61
*
In the pre-antibiotic era, syphilis was a major cause of aortic aneurysms. They were known as
“luetic aneurysms” from the Latin term for the disease.
*
While on this panel DeBakey suggested separating the medical services from the armed forces
entirely. This would have solved the problem but was considered too radical.85
†
In addition to the surgery research lab at Jefferson Davis, DeBakey had subsequently created
research facilities at the VA Hospital and on the fourth floor of the Cullen building.
*
Selma continued on to graduate school in the late 1930s, where she studied philosophy and
French. She then worked from July 1938 to February 1940 for a surgical practice in Chicago,
assisting with medical case analysis, literature review, and writing.100 Lois graduated from Newcomb
in 1940, with a degree in mathematics.101
*
While in St. Louis, June Bowen had known Ernest DeBakey, who trained in thoracic surgery
there under Evarts Graham. When she heard that she would be working for the new Chief of Surgery,
Dr. DeBakey, she excitedly assumed it was her old acquaintance. Her actual boss needed little
provocation to remind June of this mistake in a humorous fashion in the years to come.106
*
“Anastomosis” is a medical term derived from Ancient Greek, meaning “to furnish with a
mouth.” It describes the creation of artificial openings between anatomic structures (e.g., blood
vessels or intestines).
*
Carrel and Guthrie had published a description of experimental end-to-side vascular
anastomoses in 1906, but clinical application had not followed.118
*
As a devoted disciple of Leriche, the innately humble Kunlin was conflicted about his key role
in supplanting the operation made famous by his mentor. He later deflected the point by observing
that his goal and Leriche’s had been the same—the alleviation of pain due to arterial insufficiency—
so the fact that their means of achieving this objective diverged was immaterial.119
6
Houston: 1951–1956
Decadus Mirabilis, Part One
Full many a gem of purest ray serene,

The dark unfathom’d caves of ocean bear.
6.1 Homograft
A 60-year-old man was admitted to the Jefferson Davis Hospital in early
November 1952. He complained of severe back pain that radiated down
both legs. He also had a large, pulsatile mass in his lower abdomen. X-rays
showed a dilated abdominal aorta, clearly outlined by calcium in the vessel
walls: a sure sign of atherosclerosis. The diagnosis of aortic aneurysm was
unmistakable—even worse, it appeared to be responsible for his symptoms.
Having had two documented heart attacks the previous year, and plagued by
severe shortness of breath on exertion, this man was hardly the picture of
health. Any contemplated surgery would be attended by great risk.
Nevertheless, when DeBakey was brought into the case he saw no
reasonable alternative.1
At this point in time he and others had come to consider aortic aneurysms
highly fatal lesions: in some studies few patients survived as much as a year
after the ominous diagnosis was made.2 A patient with symptoms from an
aortic aneurysm seemed to be on the slipperiest of slopes: back pain was a
sign of impending—or even actual—rupture. The trouble was that a reliable
and safe surgical technique for treating aneurysms of this most essential of
blood vessels remained elusive.
Of course from Antyllus through Hunter to Matas the surgical treatment
of aneurysms of extremity arteries had eventually found a solid technical
foundation, but achieving similar results in aneurysms of the aorta proved
to be much more challenging. Operations were only rarely attempted, but,
when they were, the natural temptation was to attempt an analogous
approach: ligation.
Most aortic aneurysms arise in the lower abdomen, and although the
vessel could be surgically exposed in this region it was obviously unwise to
tie off the entire blood supply to the lower part of the body. The surgeon
might get lucky and operate on a patient who had developed collateral
circulation around the aorta, but much more often this process had not
occurred, and ligating the aorta resulted in paraplegia or death. Cognizant of
this, interested surgeons struggled to find alternative therapies. Partial
ligation was attempted, but was not successful: often the ligature ended up
eating through the aortic wall and the patient succumbed to exsanguination
just as rapidly as if their aneurysm had ruptured on its own.3
In desperation, conceptually different tacks were tried over the years: one
involved attempting to induce thrombosis in the aneurysm by inserting
metal wires into the sac (sometimes even connecting the wires to an
electrical current). Another consisted of wrapping the exterior aneurysm
wall in cellophane or a similar material in an attempt to prevent
enlargement and rupture, or cause fibrosis in the wall to stabilize the
lesion.4 These alternative approaches did not work particularly well, either,
but since the natural history of the disease process was thought to spell
inevitable death the effort seemed justified.
It is not known how DeBakey approached the abdominal aortic
aneurysms he treated in his first few years in Houston, but he probably
applied the most common method then in fashion: wrapping. Shortly before
his arrival at Baylor, however, a new technique had been introduced in a
very different arena, which would offer—for the first time—real hope for
patients with aortic diseases and their surgeons.
Robert Gross was the Chief of Pediatric Surgery at Boston Children’s
Hospital. He was already famous for having performed the first successful
ligation of a patent ductus arteriosus: a fetal communication between the
aorta and pulmonary artery that normally closes soon after birth. Shortly
after this, Gross became interested in another congenital vascular anomaly
called coarctation of the aorta, in which the vessel is severely narrowed in
the chest. He reasoned that the constricted segment could be excised and the
ends of the aorta sewn back together. Being meticulous and scientific, as
well as recognizing the risks involved, Gross had studied the problem in the
lab for a number of years before attempting such an operation clinically. He
finally performed a successful coarctation repair in May 1945.5
It was clear to Gross that simple excision of the coarctation and primary
anastomosis of the aorta was not always going to be possible—the distance
between the cut ends of the vessel could be too great. In fact, it was not
uncommon for the artery around the narrowing to become aneurysmal, and
this would make the approach impossible. He began to consider options for
bridging the gap that removal of large segments of the thoracic aorta would
create.* Together with surgery resident Charles Hufnagel, an unusually
talented researcher, Gross devised a method of harvesting and preserving
segments of cadaver aortas to serve as bridging conduits. Eventually, in
1948, Gross successfully implanted what was called a “homograft” in a
coarctation patient. By the following spring he was able to report the results
of 16 such implantations at the Society for Vascular Surgery (SVS) annual
conference in Atlantic City. Now the word was out.6
If a homograft could be used to traverse the gap in an aorta resulting
from resection of a coarctation, some wondered, could such a transplant
also be used in other disease processes? The first aortic malady to be
addressed by means of a homograft, after Gross’s coarctation work, was
occlusive disease.
The breakthrough came, as with the bypass technique, in Paris. In 1950,
Jacques Oudot was an assistant surgeon studying homografts at the
Anatomy Laboratory, Rue du Fer à Moulin.*,8 He was focused on grafts of
the terminus of the aorta, the “bifurcation” where the vessel divides into the
common iliac arteries. This was correctly thought to be a common site for
occlusion by atherosclerotic lesions. It was, in fact, what Leriche had been
talking about as long ago as 1923, when he speculated that replacement of
the aortic bifurcation (which he doubted would ever be technically possible)
might be curative of the syndrome that came to bear his name. After dozens
of experiments with preservation and implantation techniques in dogs, by
November 1950 Oudot felt ready to try the procedure on a human. The
patient in question was a 51-year-old woman with just such an occlusion of
the aortic bifurcation and gangrenous changes of her left foot. Oudot
removed the occluded aorta and replaced it with an aortic bifurcation
homograft (Figure 6.1). Although there were technical issues that arose, the
operation was proved to be possible, and the patient survived another three
years.†,9
In a landmark operation on March 29, 1951, Claude DuBost, another
French surgeon working in Paris, was the first to apply the same homograft
replacement approach to an aortic aneurysm. Dubost’s patient was a 50-
year-old man with a large aortic aneurysm which arose just below his renal
arteries. The surgeon removed the diseased segment then, using a six-inch
segment of aorta harvested from a recently deceased 20-year-old woman,
replaced the dilated vessel. Since his cadaveric aorta was a tube and not a
bifurcated conduit Dubost chose to sew it end-to-end to the right iliac
artery, then anastomose the patient’s left iliac artery end-to-side to the graft.
As with Oudot’s case, the patient not only survived the operation but did
well afterward, living another eight years.12
Although Dubost published the report of his successful aortic aneurysm
surgery in the March 1952 issue of the Archives of Surgery (the American
Medical Association’s [AMA] surgical journal), DeBakey appears not to
have been aware of it at the time the aneurysm patient was admitted to
Jefferson Davis Hospital in November.13 He would also not have known
about other similar cases performed by Russell Brock in London or Ormand
Julian in Chicago just days earlier (indeed, Schafer and Hardin at the
University of Kansas had actually predated Dubost by several weeks, but
their patient died less than a month after the procedure so the effort was not
considered a success).14 On the other hand, DeBakey was well aware of the
usefulness of aortic homografts—the work of Gross and Hufnagel was
widely hailed. The Baylor lab had even initiated some experiments in this
field in the 1950–1951 academic year, and these had expanded considerably
since then. When he evaluated the patient DeBakey realized that the time
had come for application of this new concept to the wide and treacherous
field of aortic aneurysms.
On November 6, 1952, under ether anesthesia the abdomen was explored through a left
paramedian incision. There was a healed duodenal ulcer. The fusiform aneurysm was exposed
and involved the aorta from a few centimeters below the renal arteries to the bifurcation. After it
had been completely mobilized, it was removed between clamps and replaced with an aortic
homograft including the bifurcation (Y graft). The period of total occlusion was 57 minutes and
of occlusion of the left iliac artery 77 minutes. Pulsations were good in both extremities.15
After establishing flow through the homograft DeBakey was
disappointed to see that, although the new aorta was clearly functioning
well, it was just as clearly too long. In his haste to get the graft into the
circulation he had neglected to trim it to the correct length. With every
heartbeat it folded forward and nearly kinked. DeBakey clamped the
arteries again, removed the redundant segment, and sewed the graft to itself
end-to-end. Next, concerned about the length of time the lower part of the
body had spent with diminished blood flow, DeBakey performed a lumbar
sympathectomy—a last gasp of the old treatment in the dawn of the new. In
the fashion of the time he then added an appendectomy for good measure.
Figure 6.1 Intraoperative photograph showing early bifurcated homograft repair of abdominal aortic
aneurysm.
The patient most likely developed a deep venous thrombosis on the day
after surgery, followed by a serious wound breakdown, but the subsequent
hospital course was, in the parlance of the profession, “uneventful.” He was
discharged on the 30th postoperative day.16
Scarcely able to contain his enthusiasm, DeBakey sent a letter to
Rudolph Matas back in New Orleans, before the patient had even been
discharged. He evidently felt that enough time had passed to feel safe in
announcing what he had accomplished:
December 1, 1952
Dear Dr. Matas,
I am writing you about a case of abdominal aortic aneurysm successfully treated by resection
and repair of aortic graft. So far as I know, no such case has yet been reported. Knowing your
interest in this problem and your contributions to the subject, I thought you should like to know
about the case.17
After describing the operative details DeBakey observed that it was

obviously too early to know if this new approach would work long-term,
but it had at least been shown to be feasible.
Only a few days after composing this letter to Matas, DeBakey
performed his second aortic resection with homograft placement, in this
case on a 72-year-old man. This time the aneurysm did not involve the
bifurcation so that a simple tube of preserved aorta was used to bridge the
defect.18 On this second case DeBakey had an assistant surgeon of some
capability to help him: a recent addition to the Baylor surgical faculty
named Denton A. Cooley.
6.2 Cooley
Cooley was a native of Houston, the son of a prominent dentist (in fact, he
had been delivered by Ernst Bertner).19 A gifted athlete, he played varsity
basketball while a student at the University of Texas in Austin. Cooley
became interested in medicine while an undergraduate and matriculated at
the UT Medical Branch in Galveston, eventually completing his studies at
Johns Hopkins University. He subsequently trained in surgery under Alfred
Blalock at Hopkins (as noted earlier, he had been the intern in the famous
Blalock-Taussig shunt “blue baby” case in 1944). In 1946, he served in the
Army at a hospital in Linz, Austria. Cooley completed his residency in
1950, then spent most of a year in England training with the noted thoracic
and cardiovascular surgeon Russell Brock.20
With his extensive education complete Cooley was eager to return home,
particularly now that there was a Medical Center in Houston under the
direction of family friend and physician Bertner, as well as a university
surgery program with an aggressive approach to thoracic and cardiovascular
operations. Blalock gave DeBakey a strong endorsement of Cooley’s
abilities, and the young man was hired on, beginning at Baylor with an
office next to DeBakey’s in the Cullen Building in June 1951. In his first
year his title was Instructor in Surgery, that nebulous academic position of
more than a resident but not quite a junior professor that DeBakey had held
at Tulane in the mid-to-late 1930s and brought with him to Baylor.
Standing a slender six-foot-four with blonde hair, blue eyes, and the face
of a matinee idol, the 31-year-old Cooley looked as if he had been sent to
the operating suite by Central Casting. His appearance, however, belied a
powerful intellect combined with preternatural surgical dexterity and, above
all, a towering ambition. The work ethic to match those aspirations was
perhaps not fully formed on his return to Houston, but Cooley soon learned
that to be in DeBakey’s surgery department meant to match the Chief’s
effort, if not his hours. As Alton Ochsner’s son John related, “Denton told
me when he first came he had a set of golf clubs in the car. Dr. DeBakey
saw them and said, ‘Get rid of those things, son, you’re not going to need
them while you’re here.’ ”21
Cooley arrived in Houston with a significant amount of experience in a
field where such a thing was rare at the time: cardiac surgery, especially of
congenital anomalies in children. He was explicitly charged with building
these areas at Baylor, which was negotiating a relationship with the newly
constructed Texas Children’s Hospital.
It was clear from the outset that Cooley did not lack in confidence.
Shortly after arriving, he was accompanying DeBakey and the surgery team
on rounds at the Jefferson Davis Hospital when another aneurysm patient
was presented. In this case the individual, a 46-year-old man, complained of
shortness of breath, hoarseness, and a pulsating mass above his right
clavicle. Cooley had treated a patient with a similar presentation at Johns
Hopkins Hospital in April 1950. That case had turned out to be an aneurysm
of the right subclavian artery, and Cooley had removed it and simply tied
off the ends of the vessel, which the patient had tolerated without sequelae.
After evaluating this new patient Cooley felt capable of taking him to
surgery as well, and did so on July 12, 1951. There he found that this
aneurysm involved the arch of the aorta and included the origin of the
innominate artery, or brachiocephalic trunk—the common channel that, on
the right side, provides blood to both the arm and the head. Cooley resected
the aneurysm and, again, simply tied off the two brachiocephalic branches
(the right carotid and subclavian arteries). Then he sewed up the lengthy
longitudinal hole in the thoracic aorta. Blood flow in the right carotid artery
was already severely impaired by the presence of chronic clot, which was
likely the only reason Cooley’s ligation approach did not result in
catastrophe. Instead, the patient was discharged from the hospital about two
weeks later, and the new surgeon’s abilities were confirmed in dramatic, if
somewhat lucky fashion.*,22
The same summer when Denton Cooley arrived in Houston another
surgeon who was destined to leave a lasting imprint on the university and
the profession made his first appearance in the city. Ernest Stanley
Crawford was a 29-year-old resident at the Massachusetts General Hospital
under Edward “Pete” Churchill. A native of Evergreen, Alabama, Crawford
had attended the University of Alabama and Harvard Medical School before
deciding on a career in surgery.23 His training had already been interrupted
by a two-year stint in the Navy, but on Churchill’s recommendation
Crawford went for a year as Research Fellow at Baylor under DeBakey.
Here he did some work related to magnesium metabolism in surgical
patients and was also put in charge of the Cancer Clinic at the Jefferson
Davis Hospital.24
This clinic had been placed under DeBakey’s Division of Surgical
Sciences with the reorganization that occurred when Baylor took over
Jefferson Davis’s clinical services. All surgical specialties contributed to the
Clinic’s efforts, as did several medical departments and a new radiation
therapist. In less than three years patient volume had increased by 40%.
Soon the Clinic received the equivalent of certification by the American
College of Surgeons.25
The Southern Surgical Association Annual Meeting for 1952 was held in
Hollywood, Florida, during the second week of December.27 DeBakey was
invited to discuss a paper on treatment of aortic aneurysms by means of
“progressive constrictive occlusion with wiring and electrothermic
coagulation” by one of the world’s foremost practitioners of those soon-to-
be-obsolete techniques, Arthur Blakemore of Columbia Presbyterian
Hospital in New York City. After Blakemore completed his comprehensive
review DeBakey gave the customary academic encomium, then described
the two cases of abdominal aortic aneurysm resection and homograft
replacement from Baylor. Complete with color photographs of the
aneurysms as well as the completed reconstructions, the presentation set the
ballroom/lecture hall abuzz. Blakemore, however, was something other than
rhapsodic in his counter-discussion of the cases from Houston.
Dr. DeBakey has presented two patients having arteriosclerotic aneurysms of the abdominal
aorta to demonstrate that it is feasible, on occasion, to excise the aneurysm and bridge the defect
with a preserved aorta graft which is sutured in place. Unfortunately, due to the large aneurysms
commonly encountered and the marked degenerative changes present in the aorta, the above
technique is rarely feasible.28
Blakemore’s response was disappointing, although not altogether

surprising: after all, he had staked many years of his career on the surgical
techniques DeBakey had swept aside in a few moments. The reaction of
Mims Gage, who was also in attendance, was more representative of the
rank-and-file: he told DeBakey that the new approach was “the greatest
advance since Dr. Matas in this whole field of aneurysms.”29
DeBakey’s jubilation of late fall 1952 was tempered heavily by the loss
of his sister Goldie. Her life had not been characterized by the conspicuous
success that attended some of her siblings’. She died suddenly and
unexpectedly at a hotel in Ft. Worth on Thanksgiving Day. Goldie was 40.30
6.3 Kansas Sheriff

Meanwhile, the opportunities to blaze more clinical trails continued to
come. Word of the successful abdominal aortic aneurysm repair was
spreading and, by the end of the year, had reached as far as the Hertzler
Clinic in Halstead, Kansas, about 30 miles northwest of Wichita.31
A 46-year-old man named Robert Allman, the sheriff of Allen County in
the southeast part of the state, presented in late December to this facility. He
complained of intense back, abdominal, and left groin pain that had been
worsening over the previous three months. X-ray studies revealed that he
was harboring a large aneurysm of the lower thoracic aorta. This aneurysm
was eroding the bodies of several vertebra, which explained the symptoms.
The patient reported a history of treated syphilis. Allman’s physicians had
read about Baylor’s successful aneurysm cases and telephoned DeBakey,
who agreed to bring him to Houston for consideration of surgery.*
On New Year’s Eve 1952, Allman was admitted to Methodist Hospital.
The evaluation in Kansas was relatively complete from the preoperative
standpoint of the day, and the only additional significant testing performed
at Methodist was an arteriogram, which confirmed the diagnosis and
defined the anatomy of the lesion more clearly. DeBakey sat down with
Allman and explained the situation.
To be sure, I had previously successfully performed a resection of a fusiform aneurysm of the
abdominal aorta, but it was not known whether or not this method could be successfully applied
to the thoracic aorta. When I discussed this matter with the patient, I was quite candid in telling
him that this had never been successfully done previously and that I had never attempted it
before in man, although we had done it successfully in animals. He was a large man, with an
outgoing personality and with much courage. He simply asked me if I thought it could be done
and if I thought he had a chance to come through the operation. I told him that I believed I could
perform the operation and that with God’s help he had a chance of recovery. He stated that he
realized he couldn’t go on living much longer the way he was and that he was willing to take the
chance if I was willing to perform the operation.32
On January 5, 1953, Allman went to the operating room.

In order to get access to the entire aneurysm, at operation DeBakey and
Cooley rolled the patient on his right side and performed a long
thoracoabdominal incision. They also resected the ninth rib and removed
the spleen. Now exposed, the aneurysm was found to be saccular, projecting
posteriorly, and about 8 centimeters across. It extended from the middle part
of the descending thoracic aorta to just above the celiac axis—the blood
supply to the liver, the now-absent spleen, and part of the stomach. One of
the great fears of addressing lesions of the thoracic aorta at that time—and
even now—is the potential for injury to the spinal cord from temporary
interruption of the arterial blood flow, which is often necessary to
accomplish the surgical task. Animal experiments had shown that the risk of
paraplegia was considerable and that ischemic injury to the kidneys and
other organs was also a threat. In an attempt to minimize the “clamp time,”
DeBakey and Cooley anastomosed the graft—a 6-inch segment of aorta
taken from a 21-year-old trauma victim six days previously—before
resecting the main part of the aneurysm. They also used a time-saving
technique they had grown fond of: “running” suture—what they described
as “through-and-through”—rather than the classic Carrel-style “interrupted”
separate stitches. The aortic clamps were only in place for 45 minutes out of
the four-hour operation, and Allman suffered no complications (Figure
6.2).33
Figure 6.2 Operative details in first successful repair of descending thoracic aortic aneurysm,
January 5, 1953.
The sheriff was discharged on January 18 and flew home to Kansas.*,34

By the time the Baylor team had performed seven cases of abdominal
aortic aneurysm resection with homograft replacement they felt that a large
enough series had been accumulated, with sufficient follow-up, to warrant
publication. The paper, authored by DeBakey and Cooley, was entitled
“Surgical Treatment of Aneurysm of the Abdominal Aorta by Resection and
Restoration of Continuity with Homograft.”35 It appeared in the September
1953 issue of Surgery, Gynecology, and Obstetrics, the publication of the
American College of Surgeons. The thoracic homograft case, on the other
hand, was a genuine breakthrough: the first such procedure ever reported.
For this reason DeBakey and Cooley wrote it up before assembling a series.
This article, “Successful Resection of Aneurysm of Thoracic Aorta and
Replacement by Graft,” was published in the Journal of the American
Medical Association on June 20, 1953.36
Others were at work on the new approaches, too. At the American
Surgical Association meeting in Los Angeles in April 1953, another
enthusiastic advocate, Henry Bahnson of Johns Hopkins, presented no less
than 12 such successful aortic aneurysm resection cases—six of them
thoracic and, in a huge first, one of them ruptured (the thoracic cases were
treated by aortorrhaphy, not homograft). These appeared to represent true
surgical cures. Bahnson explicitly pointed out that, by contrast, the wiring
method of Blakemore resulted in only 27% success, not to mention the fact
that, if that approach worked, it caused complete obstruction of aortic blood
flow. DeBakey and Cooley were on hand to lend their voices to the growing
chorus in favor of the novel techniques, mentioning the results of their own
cases (the reports of which were then still “in press”). Bahnson
acknowledged the important contributions of the team from Houston.*,38
Those with an open mind could see that the aneurysm resection-and-
replacement technique was a major advance (by this time DeBakey had
even used it successfully on an aneurysm of the popliteal artery behind the
knee).39 The development of the homograft was a key component in this
approach, of course, but clinical use of cadaveric vascular specimens
presented several distinct challenges. Some of these eventually proved to be
insoluble, but in the meantime Baylor strove to be at or near the forefront of
research in the field.
Gross and Hufnagel had already tackled the troublesome technical issues
of sterilization and preservation, but there was abundant room for
improvement, and experiments toward this end were under way in Houston
and elsewhere. Eventually lyophilization—freeze-drying—emerged as the
best method of preserving the grafts, and Oscar Creech had an ongoing
study of this method at the Veterans’ Administration (VA) Hospital. For a
while it was unclear even whether venous or arterial homografts were best.
Robert Pontius, supervised by DeBakey and Cooley, was working on this
problem in the lab: results eventually showed that the arterial versions were
superior. Insightful concerns arose regarding the possibility of the grafts
themselves developing atherosclerotic changes over time, and an ingenious
set of experiments was devised in which animals with homografts were
placed in an atherogenic state by experimentally induced hypothyroisism
and a high-cholesterol diet. Long-term human studies ultimately
demonstrated that the homografts did deteriorate—which certainly
contributed to eventual disenchantment with the procedures—but this took
years to be revealed and was not related to new-onset atherosclerosis.41
The biggest bugaboo with homografts, though, was not related to any of
these factors. In much the same way that organ donors became the rate-
limiting step in transplantation years later, from the start, the fundamental
overriding challenge with vascular homografts during their brief heyday
was availability. They were always in short supply.
The Army Medical Department, interested in the arterial graft concept for
battlefield injuries, funded a remarkable study at Baylor as early as 1951 in
which the aortas of hogs, cattle, and sheep were removed, preserved in
formalin, then implanted into dogs at varying intervals. The bizarrely
hopeful idea was that the problem of homograft procurement could be
circumvented by such “heterografts,” and postoperative arterial injury
patients might soon be recovering on the wards with the blood vessels of
animals. Soon it became apparent that this “Island of Dr. Moreau” approach
did not work, but not before DeBakey had actually implanted the aorta of a
hog in a patient to replace his external iliac artery.*,42
Eventually DeBakey devised a clever, if somewhat ghoulish strategy to
obtain cadaver arteries for surgical use at Baylor. He approached the
medical examiner about having his surgical residents perform postmortem
examinations at the Jefferson Davis Hospital. A substantial number of
deaths that reached the city-county hospital were acute traumas in young
people: automobile accidents or the “knife and gun club.” Their aortas were
frequently healthy and pristine. Much of the time the arrivals were in the
small hours of the morning, which did not upset the surgery residents since
they were already there and on duty. Naturally the unsuspecting examiner
and his team of pathologists were only too happy to have the help, and they
did not mind (or necessarily notice) if a particularly nice-looking segment
of aorta or iliac artery happened to find its way into one of the surgeon’s
glass tubes.44
No matter how large the hospital, nor how violent (and/or unfortunate) its
serviced population, though, the number of arteries harvested from cadavers
was never great enough. Efforts were made to alleviate the shortage in the
form of artery banks, established in major cities like Los Angeles, New
York, and London, but another, definitive solution was already on the way.
In the early 1950s, personnel changes were the rule rather than the
exception in the Department of Surgery at Baylor as DeBakey sought to
assemble the best cast to support his planned tour de force. John Howard
had gone to Korea in the Army, although he was expected back when his
two-year tour of duty ended. On the other hand, Oscar Creech returned
from his health-related leave in June of 1952 and was placed in charge of
surgery at the VA Hospital. With the expanding services at the facility—a
new Cancer Clinic, in November a new research building, now 16 general
surgery residents—this was no small task, but DeBakey had a known
quantity in Creech. B. W. Haynes provided a similar role at the Jefferson
Davis Hospital. George L. Jordan, Jr., like Creech a native North Carolinian
and graduate of Ochsner’s Tulane surgery program, also joined the Baylor
faculty in 1952. All of the faculty members, junior and senior, were
involved in surgical research.45
The Department of Surgery was at work on 30 separate research projects
in the academic year 1952–1953. Twenty of these sprang from the Division
of General Surgery. Reflecting the new focus on cardiovascular diseases, 12
of the projects related to problems in this field. In addition to the studies on
grafts noted above, work was done on venous thrombotic disease, cerebral
blood flow physiology, penetrating wounds of the heart, and pericardial
tamponade. Two cutting-edge studies were under way related to the
application of lowered body temperature—hypothermia—to scenarios of
thoracic aortic clamping and open heart surgery.46
This rapid expansion of the surgical research labs, both in terms of their
physical facilities and their projects, naturally reflected the inclinations of
the department’s chairman, but they also were an indication of the
increasing success of fund-raising efforts. Three separate grants from the
Army were awarded for the study of heart injuries, renal response to burns,
bacterial effects in shock, and plasma therapy. The Houston District Chapter
of the Texas Heart Association provided funding for the study of several
aspects of cardiovascular surgery. A number of private individuals provided
monetary gifts to the Department of Surgery as well. By far the most
notable of these came from Mr. Webb Mading.47
Mading, who owned a chain of drug stores, was a good friend of Ben
Taub’s. DeBakey would occasionally be invited to join Taub on his boat,
and he became acquainted with Mading on such an excursion. As fate
would have it, soon after this Mading developed gall bladder disease that
became debilitating. He also harbored cardiac problems, and his own
surgeon deemed him too high a risk to have his gall bladder removed. Taub
recommended DeBakey, who shepherded the suffering man through an
uncomplicated cholecystectomy. Mading went home pain-free and
immensely grateful. After a few weeks had passed, he noticed that DeBakey
had not sent him a bill for his fee and called the surgeon to inquire why. It
was at this point that DeBakey unveiled a wily technique he had learned
from Alton Ochsner for currying the favor of the philanthropically inclined.
I said, “Well, Mr. Mading, I’m not going to send you a bill because I really would prefer to have
you think in terms of services I rendered you as being something friendly. You’ve been a friend
of mine.” And so on. “But if you feel disposed to do something, I’d rather you, instead of paying
me, make a little contribution to the school for some things that we need.” Well, he was
tremendously impressed with this idea. He told Mr. Taub, “Find out what he needs.”48
Taub actually suggested that Mading buy an air conditioning system for
DeBakey’s house.* This generous offer was, of course, refused, and instead
a sizable cash donation was made to the Surgery Department. Not long after
Mading—who was a widower and childless—discussed provisions for his
estate with his good friend Taub. Unsurprisingly, it was suggested that he
include Baylor in his will. In this way, DeBakey’s academic division
became the Cora and Webb Mading Department of Surgery.49
DeBakey was elected President of the Southwestern Surgical Congress
for 1952, and in Dallas that October he delivered his Presidential Address
on “The Problem of Carcinoma of the Lung.” Together with a talk in
Houston the following April and an article co-written by Alton Ochsner for
the Journal of the American Medical Association, these represent the last
significant contributions he had to make on the subject.
I made my sort of exit with carcinoma of the lung by pointing it out as a health problem and an
epidemic-like type of problem that required public health measures. My work was entirely
cardiovascular from that point on.51
Ochsner, on the other hand, continued on in his crusade against smoking

with an increasingly louder voice over the years and decades to come.
In September 1952, Walter Moursund announced that he would be
resigning as Dean of the Baylor University College of Medicine as of
January 1.52 He had served as Dean for more than three decades, but his
fragile health was declining. Suffering from mitral valve disease due to
rheumatic fever, Moursund was nearly incapacitated by congestive heart
failure for years, but continued to provide leadership and engender steadfast
loyalty. Under his guidance and direction, which included the hiring of
DeBakey, Blattner, and others, the medical school took important steps
toward clinical and academic excellence.
DeBakey was placed in charge of a faculty search committee to find the
new Dean. He put together a four-page memo on “The Duties and
Qualifications of the Dean,” which stressed the role of the position as
liaison between the faculty and Board of Trustees—especially as champion
of the former. DeBakey also composed a kind of balance sheet for the
College of Medicine, listing qualitative assets and liabilities. This was
ostensibly to be used as a litmus test for any likely candidate, but it also
gives a unique insight into his thoughts about the institution at the time.
Assets
Location of Baylor University College of Medicine in a young and vigorous community of great
potentialities. Economy of area is well-balanced and sound.
Increasing awareness of what a medical school brings to a community, and active interest of
citizenry in the medical school’s contributions to community health.
Alert Board of Trustees who are keenly aware of the needs of the medical school.
Staff of the medical school made up of competent men with vision, pioneering spirit, and will
to succeed even against odds.
Opportunity to develop medical facilities unencumbered by tradition.
Support and potential support of one of the last financial frontiers in the United States of
America
1. Financial support by Houston chamber of commerce.
2. M.D. Anderson Foundation
3. Cullen Foundation
4. Jones Foundation, fellowship and scholarly subsidy.
5. Baylor Foundation
Affiliations with Houston hospitals, principally the city-county Jefferson Davis Hospital.
Central library facilities being constructed now.
Significant research contributions, research grants to scientists on Baylor University College
of Medicine staff.
Excellent geographic location of the medical College building.
Adequate medical school facilities for pre-clinical departments.
Pride of Houston in its Medical Center.
Liabilities
Difficulties associated with establishment of a medical college in a community which
heretofore has not had any medical school.
Confusion as to role of Baylor University College of Medicine in the Texas Medical Center.
The unfortunate dilemma of two medical schools in a single center, each with its responsibilities
to the center not clearly defined.
Real danger of developing a Medical Center with geographic unity but no functional unity.
Lack of consistently good public relations and of good professional relations.
Misunderstanding of Baylor’s motives, policies, etc.
Lack of understanding on part of public, potential lay support, as to great cost of good
medical education: That each medical student is “subsidized” even though he pays “full” tuition.
Lack of assured income to meet the schools expenses; in the adequate assured income and
insufficient endowment.
Lack of good teaching hospital facilities adjacent to medical school.
Lack of understanding on part of hospitals in Houston as to teaching and research
responsibilities as part of a Medical Center.
Lack of appreciation as to the meaning of the academic medicine and how it is needed to
improve general medical standards.
Lack of adequate space for clinical departments.53
The dean of the medical school at the University of Illinois in Chicago,

Stanley Olson, was ultimately offered the job and accepted it, taking over
for Moursund in early 1953. One of the casualties of the search was Warren
Brown, the psychiatrist who, as Assistant Dean, had been so instrumental in
DeBakey’s recruitment to Baylor. Brown evidently expected to be elevated
to the head role, and, when this did not materialize, he left the school and
Houston altogether.54
6.4 Generations
Over on Cherokee Street the DeBakey boys were growing up as fairly
typical children of the 1950s. They did not see their father much due to his
extraordinarily demanding schedule, but there were some exceptions to this,
which were treasured like the rare gems they were. DeBakey had enjoyed
hunting with his father and brother Ernest while growing up in Lake
Charles, but the opportunities for pastimes like that were few and far
between now. In reality, of course, if some free time ever came along he
would not pass it in what he perceived to be such a frivolous manner: there
was always another article or chapter to be written, committee agenda to
review, grant to apply for. Mickey later recalled one memorable exception.
I frequently complained to my mother how all my friends got to go fishing or hunting with their
fathers, but I never got to go anywhere except to the hospital or Baylor. I believe my mother
must had goaded him into it, and one day he told me that an old physician friend of his had
invited him to go duck hunting at one of his places in Louisiana and were taking their sons. I
remember I was pretty excited and thrilled about the whole weekend. We drove down to a little
town on the Louisiana-Texas border where Dad’s friend had a camp house and we spent the
night there. There were four physicians in the group, and I assumed that they were going to
bring their sons with them, but it turned out none of them did, so I was the lone 13-year-old in
the group. They spent most of the night regaling themselves about stories of them growing up in
Louisiana, and I promptly fell asleep after dinner.
The next morning at about 4:00 AM, we were up and drove out to the marshes, where we
broke into groups. I was with Dad and one other doctor friend of Dad’s in a small skiff, freezing
in the early morning mist. We waded out in the marshes, set out the duck decoys and then sat in
the small skiff, sipping coffee (I later learned strengthened with brandy). We sat patiently
looking at the sky, and then suddenly saw a flock approaching. I readied my shotgun, loaned to
me by one of Dad’s friends, and when the flock came by I stood up and fired off three rounds
quickly, hitting and bringing down two ducks. To this day, I was so surprised by the big smile on
Dad’s face that I did not know that he had not even fired a shot, apparently stunned at how quick
I was. That morning I bagged 8 of the 15 ducks we brought down and I looked forward to
arriving back home with our bags full.
However, it was not to be. We then learned that what was shot in Louisiana had to stay in
Louisiana, so our host cordially took them and gave Dad to take home several frozen, cleaned
ducks. We told my mother they were ours and proudly showed them off upon arrival at home as
Dad told mother how I had bagged them. Mother put them into the freezer, and I really do not
remember when or if she ever took them out again. For me though, the whole trip had the
highlight when I saw Dad smile at me when I made my shot. Dad was not one to laugh or smile,
or ever give a compliment, so I will always remember that look of pride he gave me that
morning.55
In his father’s absence Mickey grew close with his grandfather Shiker,
who still lived in Lake Charles but frequently visited his son’s family in
Houston. In the run-up to the 1952 presidential election, these two
discussed the probable outcome. Like most in Louisiana (and Texas, for that
matter) the elder DeBakey was a Democrat and was perplexed to hear his
grandson predict an Eisenhower victory. Mickey reasoned that the
Republican had been a trusted and successful general, and since the country
was at war again (in Korea) his instinct was that the people would prefer
Ike’s familiar and reassuring command. When the foretelling proved to be
accurate Shiker sent his prescient grandson a congratulatory telegram,
which Mickey kept for years.56
Taub was once quoted as saying DeBakey “didn’t care about money,” but
this referred only to the personal accumulation of it.57 It could never be said
that he was not resourceful when it came to procuring funds for the Baylor
Surgery Department, even in the early days. At first it was a constant
challenge to gather support for the new research labs, for teaching
materials, and to ensure that Baylor was competitive in recruiting new
faculty with regard to salaries. In this era before large government grants
for health research, private foundations—such as those mentioned in the
“Assets” ledger of DeBakey’s Dean Search balance sheet—were of
paramount value in funding the labs and researchers, but it was never
enough. The Army grants helped, too, but neither provided funding for
clinicians or teaching. Accordingly, DeBakey sought alternative strategies.
At Jefferson Davis Hospital he noticed that, despite the facility being a
charity institution, a significant number of the emergency room patients had
some form of insurance coverage. It was not uncommon for individuals to
be injured on the job, and such cases were frequently covered. Although the
interns and residents—Baylor trainees—did the actual work the private,
“visiting” doctors, who often played no role in the actual care beyond being
“on call,” filled out the forms and got paid. The compensation could be
considerable.
DeBakey realized that these funds could be pooled, then distributed both
to the physicians and to the academic and other missions of the hospital. He
approached Ben Taub and the Board of Managers about the idea, and they
backed him. Naturally there was a considerable amount of pushback from
the doctors whose direct pay was being cut off, but a large number of
physicians, such as internists and pediatricians, who had never gotten such
compensation were now receiving monies for themselves and their own
academic programs, so staff support on the whole was favorable.58
In addition to the furthering of the academic efforts at Jefferson Davis,
this fund, which was run by the Board, had one tangible result that all could
appreciate: it was used to buy air conditioners for the hospital. The city-
county facility had had none previously, despite efforts to acquire them
through channels.
We put that into the budget and the Board of Trustees tried to get it through, but they couldn’t
get the money from the city-country authority. It was rather interesting and it shows in a way
how politicians think. They were building a zoo for the monkeys in Hermann Park and they
needed to air-condition it because it was impossible to keep them alive in the zoo. So they spent
something like a million and a half or two million dollars for the air-conditioning units for the
zoo. We had only asked for about three hundred thousand dollars to air-condition the clinic. And
they ruled that they couldn’t. They didn’t have the money to do the air-conditioning for the
hospital, but they had no difficulty in finding money to air-condition the zoo for the monkeys.
This actually occurred. Well, we finally decided that we would take some of this money that we
had built up in our pool and buy some window units and we were able to get some firm to give
us a good price, for a good cause. This is what we did. So they helped us and that’s how we air-
conditioned the whole place.59
On May 6, 1953, the many years John Gibbon had devoted to

development of a heart-lung machine finally came to fruition when he
successfully used such a device for the first time in the repair of an
intracardiac atrial septal defect in an 18-year-old woman in Philadelphia.60
His group at Jefferson Medical College was widely known to be working on
such a machine, and since the implications of its successful development
were so vast—Gibbon initially thought of it as a temporary bypass circuit
for massive pulmonary embolism (as in the case in Boston that prompted
his interest) then realized such a device could be used to unlock the entire
field of open heart surgery—their progress was followed eagerly. DeBakey
paid special attention both because of his own enthusiasm for advancing
cardiovascular surgery and a certain paternal sense of pride: Gibbon
continued to use a version of the flanged-tube roller pump that DeBakey
had given him back in 1939.*
Gibbon had actually used the heart-lung machine in an operation that had
garnered national attention back in March 1952. That patient had not
survived, but the concept of cardiopulmonary bypass captured the
imagination of the media. The Houston newspapers did not fail to notice the
local connection, reporting at that time that, “Dr. Michael E. DeBakey, head
of the surgery department of the Baylor University College of Medicine,
invented an important part of a mechanical heart that made medical history
Friday in Philadelphia.” The paper closed its article by noting that, “Baylor
University has plans for the development of a laboratory for
experimentation with the new machine.” 61
Baylor was moving forward with other plans, as well. On May 25, 1953,
a few weeks after Gibbon’s successful use of the heart-lung machine, the
first surgical recovery room in Houston opened in the Jefferson Davis
Hospital. An early summation of the advantages attendant to this now-
ubiquitous amenity appeared in the Baylor Department of Surgery’s Annual
Report of 1952–1953. It highlights the special regard its instigators felt:
“Constant, alert nursing care and proximity to the operating room where
adequate help is available in case of emergency makes the patient’s life in
the immediate postoperative period much more secure and comfortable.”63
As the advanced thoracic and cardiovascular surgeries grew ever more
complex in the years to come, further refinements of this recovery room
concept would be in order.
In that same month of May 1953, DeBakey received a letter from Edward
Churchill inviting him to come to the Massachusetts General Hospital as
Visiting Professor in the Department of Surgery.64 This sort of honorary
sojourn is a common occurrence in academic medical circles, usually
reserved for figures of renown and influence. The visitor functions as a
temporary member of the faculty, giving lectures, being feted, and, in less
litigious and regulated eras now gone by, even operating on patients.
Several aspects of this particular experience were decidedly unusual,
however.
The initial conversations regarding the visit, which appears to have been
the first of its kind in DeBakey’s career, took place in the spring and
summer of 1952. Mounting circumstances, including the search for a new
Dean and a fearful escalation in warm-weather polio cases in Houston,
caused DeBakey to postpone the intended date of August.*,65
The situation in Houston was more favorable by the following spring,
and plans were made, but Churchill then suffered a stroke.
I am still not quite sure what hit me. I was walking down the street, I thought tending my own
business when the attack started. At any rate they soon found I had diabetes which is now under
control and with it what they hopefully say are spasms of the cerebral vessels. I have been on
anticoagulants to keep the spasms from initiating thrombi and so far seem to be surprisingly free
from neurologic deficits. The presenting symptom is paresthesia rather than palsy and these
seem to be getting better.67
Churchill convinced DeBakey that this stroke meant that his presence as
Visiting Professor—the official Latin term was Professor pro tempore—was
even more desirable than before. In fact, due to Churchill’s recuperation
DeBakey would be Surgeon-in-Chief, pro tempore, at the Massachusetts
General Hospital for the last two weeks of June 1953, a substantial period
of time for a visiting professor. He would be given a $500 honorarium from
the hospital’s Daniel Fisk Jones Memorial Fund.68 Frequently, Visiting
Professors would be offered the opportunity to stay at the home of the Chief
of Surgery, but the Massachusetts General had a penthouse suite actually
within the hospital that often served this purpose. Even before falling ill,
Churchill had suggested that DeBakey reside there during his visit, where
he could have a closer interaction with the residents. DeBakey one-upped
this offer by asking to actually stay with the residents in their living
quarters, “I wanted to associate with them and I wanted to sort of get close
to them and see their reactions and talk to them.”69 He may have recognized
the opportunity to do some recruiting for his own surgical staff, as well.
DeBakey arrived in Boston on the afternoon of Thursday, June 16, and
was picked up at the airport by Stanley Crawford, his Alabama-born
temporary Research Fellow from the prior year.70 The next two weeks were
a whirlwind of rounds, lectures, conferences, operative cases, and elegant
dinners. DeBakey renewed acquaintances not just with Churchill, but also
with Henry Beecher, the scholarly and scientific anesthesiologist he had
known in the war. He established new relationships with such physicians as
William McDermott, in days to come a renowned general surgeon, and the
thoracic surgeons Richard Sweet and J. Gordon Scannell.71 DeBakey had
expected the Harvard residents to be a talented lot, and he was not
disappointed, but he considered the junior staff “the finest array of surgical
talent that I have yet seen in a single surgical service.”72 The older staff was
a bit more conservative, though; even stuffy. He had a few chances to shake
them up.
On one occasion the surgery team was rounding and came upon a young
lady who was suffering from abdominal pain. She had been diagnosed with
both a hiatal hernia and gall bladder disease. It was not clear which of these
problems was causing her clinical manifestations. The older staff man
queried his trainees about which of the two diagnoses should be operated on
first: the gall bladder, which would be done by via an abdominal incision,
or the hernia, which was best approached at that time via the chest. The
residents debated, then solicited the opinion of Visiting Chief DeBakey.
Confused by the need for discussion, DeBakey observed that both the
lesions could be treated at one operation, via a single incision, so why not
fix both?
I said, “You use a mid-line incision and you can correct the hiatal hernia that way and remove
the gall bladder.” Well, that kind of shook them all up. So the chief resident said, “Dr. DeBakey,
will you do that operation for us?” And I said, “Sure. I’ll do more than that. You can do the
operation—it’s simple. I’ll help you do it.” And we did. We scheduled the operation and he did
it. I helped him and showed him the steps and he did a beautiful job.73
Unfortunately not every operative case in which DeBakey was involved

at the Massachusetts General Hospital had such a fortuitous outcome. On
the morning of June 30, an aneurysmectomy was scheduled in the surgical
suite. Although no details were recorded, DeBakey lamented in a letter to
the junior staff man Robert Shaw (later himself a distinguished vascular
surgeon), “I am still quite regretful that our aneurysm case turned out so
badly.”74
On the evening of July 1, 1953, DeBakey bid adieu to Churchill and the
Surgery Department at the Massachusetts General Hospital and caught the
short flight from Boston to New York City. After spending the next day
working on a film about aneurysm surgery—he and Cooley were
approaching 20 such cases now—DeBakey took a flight to Houston.75
These two weeks in Boston represented an experience of lasting import
for DeBakey. Not only was he given a close-up view of one of the world’s
great hospitals and surgical training programs—an example from which he
could derive enormous benefit as he continued to build his own—but the
honor of the Visiting Professorship was tangible evidence of his own hard-
won place among the elite of the nation’s academic surgeons.
6.5 Carotid
Shortly after returning from Boston, DeBakey was referred a patient from
his hometown of Lake Charles.* This was a 53-year-old school bus driver,
Charles Carter, who had been experiencing, for the past two-and-a-half
years, episodic right-sided weakness combined with difficulty in speech and
writing. These would be concerning symptoms in any patient, but given his
occupation they were particularly alarming—he had already had an instance
where he had not been able to stop the bus due to temporary paralysis. The
physicians in Lake Charles were at a loss as to a diagnosis, let alone any
treatment, and sent Carter to DeBakey in Houston for evaluation. He was
admitted to the Methodist Hospital on July 29.77
When DeBakey examined the driver he noticed that his speech was
somewhat slurred and hesitant and that he seemed, “sluggish.” The carotid
pulse on the right was normal, but the left side was weak. There were other
absent pulses, too, suggesting the presence of arterial occlusive disease. At
this point, as DeBakey later related, “it clicked with me.”78
He had recently been reading a report by the neurologist C. Miller Fisher
who worked, coincidentally, at the Massachusetts General Hospital.
Fisher’s article, from 1951, was an extensive study of stroke and stroke-like
symptoms in the setting of anatomic pathologic examinations. The paper
convincingly made the case that many such instances were caused not by
intracranial disease, as was widely thought, but by the carotid arteries in the
neck.* Fisher went so far as to predict that, “it is even conceivable that
someday vascular surgery will find a way to bypass the occluded portion of
the artery during the period of ominous fleeting symptoms.”79 DeBakey
thought that he had caught Charles Carter at just this point in time.
DeBakey felt the diagnosis so likely to be correct that he did not bother
confirming it with an arteriogram. Instead he sat down with the patient, as
he had with Sheriff Allman before his thoracic aneurysm surgery. Again a
new technique was going to be discussed, and again DeBakey was not
completely certain what he would do in the operating room.
The projected surgical treatment was discussed with the patient, who was told that, as far as I
knew, this operation had never been successfully performed on the carotid artery, but that I had
had considerable favorable experience with both endarterectomy and graft replacement in other
arteries, especially for circulatory insufficiency of the legs. He was also told that the surgical
risk was slight and that if the operation did not correct his condition, it probably would not
change it. He eagerly agreed to have the operation.81
Dos Santos’s technique of thromboendarterectomy had crossed the

Atlantic by this time. One of its main proponents was a young surgeon at
the University of California in San Francisco named Edwin J. Wylie.
Expanding on his Portuguese colleague’s approach to the femoral artery,
“Jack” Wylie had applied endarterectomy to arterial occlusive disease of the
aorta and iliac vessels—an alternative to the Oudot operation of resection
and grafting. DeBakey now considered the possibility of extending the idea
even further—into the carotid arteries. As he explained to Carter, he was not
sure if it could be done—he might need to replace the artery with a graft. In
fact, it might not be possible—or safe—to do anything at all. The operation
took place on August 7, 1953, at Methodist. DeBakey was assisted by an
Instructor, Leroy Brockman, and a resident, Yousif Al-Naaman.* He started
by making an incision vertically on the neck, along the line of the large
muscle known as the sternocleidomastoid. Retracting this muscle exposed
the common carotid artery at its bifurcation—the point where it divided into
two branches: the external carotid artery supplying blood to the face and the
internal carotid artery headed toward the brain. DeBakey placed a clamp
across the common carotid to occlude the flow, then opened the artery
lengthwise at the bifurcation, up into the internal.
Upon entering the lumen of the internal carotid artery a fresh thrombus was found completely
occluding the lumen of the artery which arose and was adherent to an atheromatous lesion
involving the common carotid artery at the bifurcation and virtually filling the lumen of this
artery. The atheromatous lesion was firm, somewhat ulcerated and necrotic and having a
yellowing to brownish color. It extended down below the bifurcation for about 2 cm and
immediately below it there was a partially organized and fresh clot filling much of the lumen of
the common carotid artery.82
DeBakey was able to remove the clot without difficulty. Retrograde

blood flow from the previously occluded internal carotid artery was
excellent—after injecting some of the blood thinner heparin (mixed in
saline solution) into the artery he stopped the backflow by tightening a
gauze “umbilical tape” around the small vessel. DeBakey then examined
the atheroma. He was looking for a transition zone between normal vessel
wall and disease, a “cleavage plane” as was often found in femoral or
aortoiliac endarterectomy. If such a zone was present, he could try that
procedure; if not, he would have to rebuild the artery or bypass it. He had
no expectations either way, but soon found that there was, indeed a plane.
The plaque peeled off easily, like shelling a walnut. Now “back-bleeding”
from the external carotid artery appeared, and was strong. The last thing to
check was the main artery, the common carotid. When DeBakey released
the clamp there was no flow, so he inserted a wire-loop (an instrument then
in vogue for femoral endarterectomy). More clot came out, then the forward
flow was strong. He injected heparin saline here as well, reclamped, then
sewed the artery up with a running silk suture.
At this point DeBakey chose to perform an arteriogram, with the patient
still on the operating table. This x-ray showed a wide open pathway from
the common carotid artery all the way up into the brain. Mr. Carter
recovered uneventfully; his neurologic status appeared to be slightly
improved at discharge eight days later. Within months he was driving a
school bus in Lake Charles again.83
The carotid endarterectomy DeBakey improvised for the first time in
August 1953, has been repeated on hundreds of thousands of occasions
since then across the world, with little variation in the original technique.
Indeed, this became (and remains) one of the most commonly performed of
all surgical procedures. Acceptance of the new operation was, however,
anything but immediate and universal. It was the evidence of its successful
clinical application that eventually drowned out the naysayers. Later the
import and sweeping success of carotid endarterectomy, an operation to
prevent the cruel and common scourge of stroke, brought with it an interest
in the origin of this surgical panacea.
Primacy has always held a special fascination in medicine and science in
general. Nowhere is it more assiduously sought after and embraced than in
the disciplines of surgery. This was not always the case. Many of the
dramatic advancements in modern surgical therapy occurred early in the
twentieth century before the means of rapidly disseminating new
information came into being. Other breakthroughs were anything but
sensational, arising slowly through stepwise evolution. The extraordinary
progress made in the field of cardiovascular surgery in the 1950s, however,
occurred at identifiable sites and was driven by high-profile individuals
with public personas. The revolution, as the saying goes, was televised
(sometimes literally).
For reasons that are not clear, DeBakey did not immediately publish an
account of his successful carotid endarterectomy. In later years he indicated
that he was reluctant to report the operation until the Baylor group had
compiled a series of the new procedures. While this would have been in
keeping with his typical cautious and scientific approach to novel
treatments, DeBakey had already made an exception to this unwritten rule
in order to establish primacy in a new operation: the descending thoracic
aneurysm repair of Sheriff Allman. That operation had been published as an
isolated case report, in the Journal of the American Medical Association, no
less. In the case of the carotid surgery, however, DeBakey felt differently.
When you do a successful case like that you wonder a little bit at first, you’re quite excited
about it, but then you wonder a little bit, whether you ought to rush into print and not have any
follow-up, not know what’s going to happen. So you feel like you ought to know a little bit
more about it.84
Others filled the vacuum that was created by DeBakey’s hesitation. Even
before the carotid endarterectomy on Charles Carter in August 1953,
attempts had been made to treat atherosclerotic lesions of the vessel. In
September 1951, a team in Buenos Aires had resected a segment of diseased
carotid in a patient with neurologic symptoms, reconstructing the artery
with an end-to-end anastomosis.85 Earlier in 1953, a group at Montefiore
Hospital in New York had tried something similar but found the artery to be
hopelessly occluded.86 Both these cases were published, but neither
involved endarterectomy and they did not garner widespread notice.
The initial carotid surgical procedure to reach a large audience occurred
at St. Mary’s Hospital in London, in May 1954. The surgeon H. H. G.
Eastcott was faced with a patient suffering similar symptoms to those of
Charles Carter, and arteriography had confirmed severe carotid disease. At
this time there happened to be a contingent of visiting American surgeons at
St. Mary’s, part of a large group attending a sectional meeting of the
American College of Surgeons in London. Among the visitors were both
DeBakey and Edwin Wylie from the University of California. Eastcott later
recalled that Wylie, the great advocate and pioneer of aortic and iliac
endarterectomy, suggested that such a procedure be attempted in this case.*
At operation, however, Eastcott performed a resection procedure similar to
that which had been done in Argentina three years before (he was unaware
of that prior case because it had not yet been published). Eastcott’s patient
did well—she was cured of her ongoing neurologic symptoms, like Charles
Carter—and the case appeared in the widely circulated journal Lancet.88
That brought the entire issue of carotid disease, stroke, and its surgical
treatment to the attention of the general medical establishment. Again,
however, the carotid surgery Eastcott performed was not an endarterectomy.
The first published instance of a procedure similar to DeBakey’s also
came from the Baylor group in 1956, when Denton Cooley, apparently
unaware of his chief’s prior case, reported his own in the Journal of
Neurosurgery. † ,89 Unfortunately Cooley’s patient, who had been
asymptomatic preoperatively (his disease was identified during
investigation of a “whooshing” sound he heard in one ear) suffered a stroke
during the procedure so it can hardly be considered a resounding success.
By April 1958, the Department of Surgery had accumulated a sufficient
number of surgically treated cases of carotid disease (and similar lesions in
the other cerebral branches of the aortic arch) to make a presentation on the
subject at the American Academy of Neurology annual meeting in
Philadelphia. The report noted 10 cases of endarterectomy, with a 90%
success rate (bypass grafts, thought to be in some cases a superior technique
at this early stage, were performed twice as often).90 Nevertheless, the
reception by the neurologists and internists there and elsewhere was chilly.
Oh, there was great resistance. Great resistance and great criticism of what I was doing. I had a
very difficult time. Sometimes it was that the patient, once he had a stroke, was not going to be
helped by it, that the best way to control this stroke was to put him on anticoagulants so it would
stop the embolization, that the lesions themselves were not that significant, that they often saw
lesions like that and they weren’t causing any trouble at all, and that’s true, it does occur. It’s the
usual sort of general conservatism that exists in the medical profession.91
In December, a similar paper, delivered to a friendlier audience at the

Southern Surgical Association gathering in Boca Raton, indicated that by
then 37 such endarterectomies had been performed in Houston, with a rate
of success of 92%.92
The result of the initial carotid endarterectomy was undoubtedly included
in these mainly statistical reports, but its first specific mention appears to
have occurred at the American Surgical Association meeting, also in Boca
Raton, in March 1961.
During the period of a little over seven and one-half years following our first successful
application of surgical treatment in a patient with occlusion of the left carotid artery, on August
7, 1953, we have employed this form of therapy in 372 patients with this type of extracranial
segmental occlusive disease, involving the innominate, carotid, subclavian, and vertebral
arteries.93
It is apparent, then, that DeBakey delayed reporting the first carotid

endarterectomy at the time from two motivations (Figure 6.3). The main
reason was a desire to see if the operation would prove safe and effective
repeatedly and over the long haul. The second was a reluctance to suffer the
slings and arrows of the skeptical neurologists until he could prove that the
operation was a good one. When both these considerations were satisfied,
the operation was reported along with the many that followed it in
Houston.*
Figure 6.3 Michael E. DeBakey, MD, Chairman, Department of Surgery, Baylor University College
of Medicine.
6.6 Hoover Redux

When the Medical Committee of the original “Hoover Commission”
finished up its work in November 1948, few if any of the members
probably expected that a second such undertaking would be convened less
than five years later. By one reckoning, some 70% of the first
Commission’s recommendations regarding the reorganization of the
executive branch of the federal government were enacted, yet it turned out
that much work remained to be done (with its radical suggestion of
centralizing the federal medical services, including those of the military, the
Medical Task Force had contributed more than its share toward the 30% of
recommendations that were not implemented).95 As the report of the second
Commission documented in vivid prose, across the federal landscape there
could still be found “a picture of a sprawling and voracious bureaucracy, of
monumental waste, excesses and extravagances, of red tape, confusion, and
disheartening frustrations, of loose management, regulatory
irresponsibilities, and colossal largesse to special segments of the public, of
enormous incompetence in foreign economic operations, and of huge
appropriations frequently spent for purposes never intended by the
Congress.”96
In the spring of 1953, the new President, Dwight D. Eisenhower, called
for a second commission to help remedy these woes and again tapped
Herbert Hoover to lead it. This time the Medical Task Force was headed up
by a Chicago executive named Chauncey McCormick—although as a
trusted confidant of Hoover’s, Tracy Voorhees was never too far away.*
DeBakey was asked to serve and naturally agreed. Many of the other
members of the Task Force were familiar to him. They included Edward
Churchill, Evarts Graham, Alan Gregg, Paul Hawley, and Basil MacLean.97
For DeBakey, service on the second Hoover Commission Medical Task
Force was a strikingly similar experience to that on the first. Again there
were frequent trips to Washington, D.C.—in addition to those he already
made as a member of multiple committees of the National Research
Council (NRC) and the Surgical Study Section of the National Institutes of
Health.† There were also site visits to be made and much writing to be done.
The work lasted nearly two years.
The final medical committee report, 88 pages in length, was presented to
Hoover and, by him, to Congress, in February 1955.99 Its main themes
were, again, the waste and lack of coordination present in the federal health
services and their potential amelioration by efforts at centralization. The
Task Force called for a federal Advisory Council on Health, reporting to the
President and composed of both health professionals and lay individuals. It
also made other recommendations—29 in all—which dealt with salient
issues affecting the VA, the Public Health Service, and considerations of
federal health insurance.100
Recommendation number 23 referred to a topic close to DeBakey’s heart:
the Army Medical Library. This had been renamed the Armed Forces
Medical Library in 1952, but the many issues with which it had struggled
over the decades were not eased by the new appellation.101 In this new
report, however, the library would not be an afterthought or footnote. An
entire chapter was devoted to its concerns. This summarized not only the
grandeur of the institution, but the disappointments of the past, the
challenges of the present, and a grand vision for the future.
The largest and most important medical library in the world is the Armed Forces Medical
Library in Washington. Originally organized for military use in 1836, this Library has become a
great national research institution far surpassing the nature, size, and level of activities required
by the Armed Forces. No newly created library could ever hope to duplicate the present
matchless collections. It is in fact the National Library of Medicine of the United States.
There is no clear statutory authority for the functions which it now serves. The Library is
ineffectively placed in point of administration, inadequately housed, and too poorly supported to
permit effective conduct of its functions.
For over 30 years the Library has needed a new building. It now requires an annual increase
of a mile of shelf space. Its collections are constantly threatened by loss from fire and have
undergone actual damage through exposure to weather and improper storage.
But the cost of maintaining this Library is not a fair charge on any or all of the military
establishments. Its appropriations compete in peacetime with the needs of the military to
maintain the skeleton of an effective fighting force. In time of war it is hopeless to expect the
preoccupation of the military to include the proper maintenance and continuing development of
a National Library of Medicine.
What is needed to enable the Library to function properly as a truly national institution is a
legal status with an administrative organization appropriate to a National Library of Medicine,
an effective building, an adequate budget, and an independent status just as is the case with
university libraries.102
Ever since the idea had been floated that the Army Medical Library
should not be administered by the Army (or, since 1952, by the Armed
Forces) the obvious follow-up question had been: Who should run it, and
how would it be funded? Answers had remained elusive for decades. The
Medical Task Force of the second Hoover Commission addressed these
concerns in Recommendation Number 23.
That legislation be enacted to establish a National Library of Medicine as a Division of the
Smithsonian Institution, with a board of trustees to be selected by the Board of regents of the
Smithsonian Institution.103
Tracy Voorhees asked DeBakey to accompany him to deliver the

Committee’s report to Herbert Hoover in person.
The 31st President lived at the Waldorf Towers in New York City, in a
suite on the 34th floor.* He welcomed Voorhees and DeBakey into the
tasteful, well-appointed apartment, and the three men had lunch
overlooking Manhattan. Afterward Hoover asked Voorhees to tell him what
had been learned. He was interested in the big picture from the Medical
Task Force—there were 16 other committees on the Commission that he
had to consider, and Hoover wanted his visitors to stick to the most
important points.
Voorhees said, “Well, I’ll just sketch out a few of the things and then I’d rather have Dr.
DeBakey talk about the thing. He’s done most of the work and he knows more about it than
anyone else.”‘ And Mr. Hoover said, “Well now, I’ll read the report so you don’t have to give
me a detailed report.” He said, “What I’d like for you to tell me, Dr. DeBakey, is what among
the various things that you have observed, what recommendations you feel have the highest
priority in terms of practicality and feasibility of getting done.” And I looked at him for a while
and I said, “Well, I think the one that I would give the highest priority to, that I regard as
feasible and practical and I regard as making the greatest contribution to the country is the
establishment of a National Medical Library.104
Hoover’s eyes lit up. Unknown to DeBakey at this time, the former
President also had a passion for libraries and had founded such an
institution at Stanford University, which bears his name. He asked DeBakey
a few more questions and indicated his full support and enthusiasm for a
6.7 Distal Arch

In the months after the operation on Sheriff Allman, DeBakey and Cooley
performed several more resections of the thoracic aorta for aneurysmal
disease and also amassed a significant number of cases of resection of the
abdominal aorta for both atherosclerotic occlusion and aneurysm. The aorta
was replaced by a homograft in all cases. The surgeons were eager to
extend the technique even further and address such lesions higher in the
chest, at the arch of the aorta. Of course saccular aneurysms—typically the
ones caused by advanced syphilis—were already being addressed in this
anatomic location by means of tangential excision and lateral aortorrhaphy.
Atherosclerotic aneurysms, however, were more frequently fusiform—
shaped like stubby cigars and affecting the entire circumference of the aorta
—and could not be treated that way. The whole segment needed to be
excised and replaced. Technical challenges of safely approaching the area
had been largely vanquished, but a greater fear loomed: experiments dating
back to Carrel and Guthrie had shown that even briefly clamping the aorta
in this area frequently caused neurologic injury due to interruption of the
blood supply to the spinal cord. DeBakey himself had witnessed this
complication in a patient who had undergone resection of a descending
thoracic aortic aneurysm, and, although the patient’s partial lower extremity
paralysis ultimately resolved, the warning was clear.105 The possible effects
of clamping the aorta on the organs downstream, especially the kidneys,
were also worrisome.
One of the methods under consideration to minimize these risks was
induced hypothermia—cooling the patient below normal body temperature.
The idea was that this would diminish metabolic demands so that a short
period of oxygen deprivation to the cells and tissues would not be injurious
(in his first reported carotid endarterectomy Cooley had put the patient’s
head in ice for the same reason).106 Studies on the effectiveness of
hypothermia techniques were ongoing at Baylor and other centers with an
interest in vascular surgery.
On January 31, 1954, a 31-year-old man named Malcolm McLeod was
admitted to Methodist Hospital complaining of left-sided chest pain, as well
as hoarseness and difficulty swallowing. McLeod was already familiar to
the Baylor surgery service. The preceding July he had undergone lateral
aortorrhaphy for a traumatic pseudoaneurysm of the descending thoracic
aorta stemming from a crush injury he had received while on active duty in
the Air Force back in March 1945 (the military doctors had known about
the pseudoaneurysm but could do nothing about it).* X-rays and an
aortagram confirmed that McLeod had developed another aneurysm, larger
than the first and now extending upward in the chest to involve the orifice
of the left subclavian artery.107
This was a new challenge. In order to resect and replace this aneurysm
not only would the aorta need to be clamped in the descending segment, but
also in the arch, between the origins of the left common carotid and the left
subclavian arteries. The left subclavian artery itself would also have to be
clamped to prevent back-bleeding, and, in any case, the flow in this vessel,
which provides blood not only to the left arm but also to the brain, would be
temporarily but unavoidably interrupted. The results might be catastrophic.
Still, there was no choice: if the aneurysm were left alone McLeod would
undoubtedly die.
On February 5, 1954, DeBakey and his team took McLeod to the
operating room. For two hours prior to the beginning of the procedure he
was cooled by means of a blanket containing circulating refrigerant. His
body temperature decreased from 99 degrees Fahrenheit to 87. DeBakey
and Cooley then entered the chest through the old incision and went to
work. Clamps were applied and the aneurysm resected. A matching
homograft, complete with part of a left subclavian artery, was then sutured
into place with a running 4-0 silk suture. The clamp time was 62 minutes,
nested in an operation lasting a little more than four hours. Two more hours
were taken in rewarming the patient.
Postoperatively McLeod developed bleeding from the resected aneurysm
site—not any of the three anastomoses—and required re-exploration, but
after that he recovered relatively uneventfully. Most importantly (other than
surviving) he had no neurologic impairment or organ dysfunction.
This was another global first: successful resection of an aneurysm of the
distal aortic arch with replacement by a homograft. DeBakey and Cooley
wrote it up for publication, as with the Allman case, in the Journal of the
American Medical Association. Their enthusiasm was somewhat tempered
by the fact that a subsequent second similar case had resulted in a fatal
outcome (which they dutifully reported in the paper) but the surgeons
soberly asserted that this death was from preexisting infection, not the
operation, and that the patient had suffered no neurologic injury from the
procedure. The main points of the article were that the operation was
possible, it had been done successfully at Baylor, and induced hypothermia
may have helped avoid ischemic injury to the spinal cord and other
structures.108
A few days after the article appeared DeBakey received a telegram from
Rudolph Matas in New Orleans, which read,
Dear Dr. Debakey this is a heartfelt message that I am sending you to congratulate you on your
magnificent victory unparalleled triumph in surgery which I just read in the journal of the
American Medical Association. I regard this success of yours as a miraculous performance
which has never been equalled in the history of surgery. I can’t tell you how much I rejoice in
your miraculous achievement.
R. Matas109
The whole impetus behind the race to find successful surgical treatments
for aortic aneurysms was the desire to prevent what was widely believed to
be the inevitable outcome of the natural history of the disease process:
rupture, followed by exsanguination and death. Later studies would
conclude that smaller aneurysms were unlikely to do this, but in this era
before sophisticated imaging studies such exceptions were not appreciated,
and all aortic aneurysms were considered to be life-threatening. The clinical
picture of a patient dying from aneurysm rupture was sufficiently fearsome
and memorable to invite that belief.
Early on in this era of vascular surgical experimentation it was
recognized that there was no special reason why the demonstrated success
of the resection-and-graft approach might not work in a patient whose
aneurysm had already ruptured, provided they survived long enough to
make it to the operating room (it was known that some patients lived for
hours or even days after the event). As noted earlier, Henry Bahnson of
Johns Hopkins recorded the first successful such case in March 1953.110 In
October of the same year, DeBakey had his first opportunity at duplicating
Bahnson’s achievement. He had to travel 800 miles to do so.
Word of the success of the Baylor group in treating aortic aneurysms had
continued to spread, both from publications and the old-fashioned
grapevine. One physician who had heard of the work was Dr. John
Matthews of Jefferson City, Missouri. He was caring for a 67-year-old
retired barber named George Cremer, who had presented to St. Mary’s
Hospital in that city with left flank pain, shock, and a pulsating abdominal
mass. The diagnosis of ruptured aortic aneurysm was clear, and, in the
absence of local surgical expertise in that rarefied field, Matthews had
treated the barber with supportive care, including transfusions. Although
these were temporarily helpful, Cremer’s condition gradually worsened.
With nothing to lose, Matthews contacted Baylor. DeBakey was planning a
trip to St. Louis for a meeting anyway, and he agreed to come to Jefferson
City with a homograft, in hopes of replacing the ruptured aorta.111
On October 2, 1954, DeBakey replaced Cremer’s ruptured aneurysm
with a lyophilized seven-inch aortic homograft. The operation took four
hours, but afterward Matthews remarked to a local newspaper reporter,
“Better a scar than a tombstone.”112 Unfortunately, Cremer got both,
developing renal and cardiac failure after the operation and dying on the
fifth postoperative day.
Only a few days later, on October 11, 1953, another ruptured aneurysm
case presented—this time at Methodist Hospital. Although the patient was
taken immediately to the operating room and underwent aortic replacement
successfully, he also died, of a myocardial infarction, three weeks later.
Less than a month afterward, another case presented at Jefferson Davis
Hospital, with sadly similar results.113
By this time DeBakey and his colleagues certainly had ample reason for
pessimism in regards to application of the graft replacement technique in
the treatment of ruptured aortic aneurysms, Bahnson’s example
notwithstanding. In late April 1954, however, their fortunes changed with
two cases in quick succession, both at Methodist Hospital. Each patient was
transferred from another facility (the second another referral from
DeBakey’s home town of Lake Charles, 160 miles away). The first case, a
55-year-old man, arrived on April 26 at Methodist with a three-month
history of back pain. Three days before he had experienced a sudden
worsening of the symptoms, accompanied by a tearing sensation in his
flank. He spent those days at an outlying hospital before being referred to
Baylor; he was in surgery an hour after arriving. The very next day the Lake
Charles case, a 50-year-old man, presented to his local hospital with a new
onset of abdominal pain and collapse. X-rays revealed the diagnosis, and he
was transfused while the local physician called DeBakey. The patient
managed to survive the ambulance trip to Houston, during which no
treatment was given other than sedation. He was also in surgery within an
hour of presentation.
The second of these April patients developed minor complications, but
both survived and returned to their normal lives. DeBakey and Cooley
wrote up these five cases in detail for an article in Postgraduate Medicine,
“Ruptured Aneurysms of Abdominal Aorta: Excision and Homograft
Replacement.”114 It was hard to derive any hard and fast conclusions as to
why the first three patients had died and the next two had survived, but that
was scarcely the point. The take-home message, confirming the results from
Hopkins and elsewhere, was that a ruptured abdominal aortic aneurysm
might no longer mean an immediate death sentence.
In April 1955, DeBakey received a call from Princeton, New Jersey,
about another patient with a ruptured aortic aneurysm. The call was from
Frank Glenn, a noted surgeon from Cornell and the New York Hospital
whom DeBakey had also known as the Surgical Consultant to the Sixth
Army during World War II. Glenn had been asked to consult in the care of
Professor Albert Einstein.
Several years before, in December 1948, the famous physicist had
undergone exploratory abdominal surgery at the Brooklyn Jewish Hospital
for recurrent episodes of pain. The surgeon in that instance was Rudolph
Nissen, a well-known thoracic specialist who had studied with Ferdinand
Sauerburch in Germany before the war. Einstein was found to be harboring
a large, nonruptured aortic aneurysm at that time, and Nissen had done the
proper thing: wrapped the anterior two-thirds of the aneurysm in
cellophane. Now, however, it was obvious to Glenn that the aneurysm was
leaking and that immediate surgery was necessary to save the great man’s
life. He also realized, to his credit, that he might not be the best individual
for the task: “Up to that time I had done only a few resections with
replacement by cadaver vessels.”115 Glenn contacted DeBakey in Houston.
It seems to me it was in the evening when he called. And he described his symptoms to me and
he said, “I think it’s a rupturing aneurysm of the abdominal aorta. It sounds like it.” He had
backache. He was shocklike. Temporarily he’d recover and get more shocklike and recover. I
said, “It sounds absolutely characteristic. Characteristic.” He had some tenderness in the
abdomen and it was a little swollen. I said, “He needs to be operated on immediately or he’s
going to die. There’s no question about it. He’s lucky that he’s lived this long.” He said, “Can
you do it?” “Of course, “I said. “Will you come up here?” I said, “Sure. I’ll bring my whole
team if you want me to.”116
When Glenn approached Einstein about the possibility of life-saving

surgery, however, the scientist refused, saying that he had lived a long and
full life, he was satisfied with what he had achieved, and he was prepared to
pass on: “I want to go when I want. It is tasteless to prolong life artificially.
I have done my share, it is time to go. I will do it elegantly.”117
6.8 Recognition
As the Baylor Department of Surgery headed into the mid-1950s, more
formal recognition of the remarkable work being done in vascular surgery
in Houston was becoming widespread. In February of 1954, DeBakey
served as Visiting Professor in Surgery at the Cleveland Clinic, another
feather in his cap after his similar stint at the Massachusetts General
Hospital the preceding summer.118 Even more gratifying was his selection
as recipient of the Rudolph Matas Award.
This was generally considered to be the highest honor in the field of
vascular surgery. Although it had been established in 1933, the Matas
Award had only been presented five times before. In 1954, it was given to
DeBakey and long-time Stanford surgery professor Emile Holman.
DeBakey’s citation emphasized his contributions to surgery of the aorta;
especially, of course, resection and graft replacement. This was a
particularly gratifying honor for DeBakey since it bore the name of his
great mentor and was presented at Tulane. In fact the presentation was
scheduled to be at his old medical school stomping grounds, the Hutchinson
Memorial Building, on April 6, 1954. Matas, however, was not in good
health, and since he wished to present the award personally to his former
student, arrangements were made for this to happen at the old Chief’s
famous mansion on St. Charles Avenue.
This was quite an honor for me to receive it from him personally and especially to have him
recognize me, having virtually known me since I was a medical student. He did it in his home
because he was having some trouble. He’d had a little illness and he didn’t want to go to the
meeting. And they had a formal meeting—a presentation together and you were presented it
there. He asked that the presentation be made by him personally, an exception to all the previous
methods of doing it. So I had to go to his home. And it was very touching.119
Just as he had on DeBakey’s first visit to the house some 20 years before,
Professor Matas offered his honored protégé a glass of sherry in celebration
of his achievements.120
DeBakey left New Orleans on a red-eye flight to New York the same
night, then flew to Beirut, Lebanon, the following day, April 7.121 He had
been asked to come to the Middle East on an invitation from both the US
State Department and the Middle East Medical Assembly. While in Beirut,
DeBakey participated in the Fourth Middle East Medical Assembly and
spent time at the American University medical school, mingling and giving
lectures on aortic disease as well as lung cancer to the medical students and
faculty. Although the facilities were underfunded, DeBakey found the
efforts here and at a nearby French medical school to be laudable. From
here he traveled with one of the young doctors from the American Hospital
by car to Syria, where he visited Damascus and also lectured at the Syrian
University Medical School in Aleppo. These facilities were in much worse
shape, and the educators were hamstrung by nationalistic governmental
regulations that required the medical students to be taught with Arabic
textbooks, which were years behind their French- and English-language
counterparts. DeBakey also had the opportunity to visit the awe-inspiring
ruins and archeological sites at Ba’albek, which he described as “mute
reminders of the splendor and glory of past civilizations.”122 After this
DeBakey moved on to Baghdad, Iraq, where he participated in conferences
and lectures at the Royal College of Medicine.123
He returned to Houston from Beirut on April 25, 1954, just in time for
the back-to-back successful ruptured aortic aneurysm cases, which came
into Methodist Hospital over the next two days.124 Although he noted the
relatively primitive state of medicine in the countries he visited, DeBakey
was impressed by the sincerity and enthusiasm toward modernization that
he observed on the part of the local medical professionals and government
officials, aside from the Syrian exceptions. In this period of relative
political difficulty for the United States in that region of the world, he saw
an opportunity for the country to improve its relations by the humanitarian
means of spreading American medical assistance. This was the first time
DeBakey voiced this view, which was to shape much of his future
international public life as well as his interactions with colleagues and
governmental agencies worldwide.125
DeBakey had barely touched down in Houston before he was overseas
again for a special sectional meeting of the American College of Surgeons
in London. On May 20, 1954, at the invitation of the Director of the
Department of Surgery at Guy’s Hospital, DeBakey delivered the annual
Carbutt Memorial Lecture (this was the day after Eastcott’s carotid surgery
at St. Mary’s Hospital).126 From here, DeBakey traveled with a number of
other American surgeons to Paris, where he saw his old teacher Rene
Leriche for a final time (Leriche died on December 28, 1955).127
DeBakey returned to Houston in the first week of June 1954. There he
helped Cooley and Creech put the finishing touches on a display for the
AMA’s annual meeting later that month in San Francisco. For many years
this meeting was one of the main events on the calendar of clinical and
academic physicians of every stripe. The Baylor Department of Surgery’s
Scientific Exhibit, “Aneurysms and Thrombo-Obliterative Disease of the
Aorta: Surgical Considerations,” won the prestigious Hektoen Gold Medal
for originality and excellence in presentation of investigative work, beating
out more than 200 other displays from 21 specialties.128 Apart from the
honor of garnering this prize, the Baylor group won important
acknowledgment and appreciation of the ground-breaking work they were
doing in Houston.
As noted, the SVS annual meeting coincided with the AMA conference
in these years, and the 1954 gathering was of particular interest to DeBakey.
Among all the other busy proceedings that spring, he served as President of
the SVS during its meeting at the posh Mark Hopkins Hotel in the City by
the Bay. By this time the little society had grown considerably, and more
than 800 physicians attended the meeting.*,129
Before long, the successful aortic aneurysm repairs in Houston led to a
steady stream of referrals from afar—elsewhere in Texas and even from
other states (as in the case of Sheriff Allman). Typically, DeBakey would
discuss these out-of-town cases on the telephone with either the patient in
question or the referring physician. If he felt the patient would best be
served by a trip to Houston for evaluation or definite surgery he would
arrange their admission to Methodist Hospital. On the appointed day they
would appear and be admitted, previously sight-unseen. Ultimately this led
to Methodist confronting an issue that would soon face the entire country.
I had a patient who was sent to me. This goes back to 1953 or ‘54. This patient turned up to be a
negro, and I had already made the reservation for him to be admitted to the hospital. When he
got there, they wouldn’t admit him.131
At this time there was a facility in the city called the Houston Negro
Hospital, which was staffed entirely by African American physicians and
served that population. The city-county Jefferson Davis Hospital treated
patients of all races, too. The remaining hospitals saw—nearly exclusively
—white patients.
DeBakey’s patient, however, had come from outside the state and had no
knowledge of any of this. Even though Methodist was expensive, he was
prepared to cover all costs. In the mind of DeBakey, there was no sensible
reason to exclude him. That did not mean, as it happened, that there would
not be considerable resistance.
I went to see the hospital administrator and told him that this man needed this kind of operation
and he needed to be put in the hospital for this purpose. So they said, “Well, we just can’t admit
him because we’d have a terrible problem on our hands with the staff.” I said, “Well, I think it’s
wrong. This is a Methodist Hospital. This is a Christian hospital. How can you say you’re a
Christian hospital and do this?”132
DeBakey threatened to confront the Board of Trustees about the matter.
Privately, he did consult with some of them. Away from the spotlight, they
agreed with him. He also learned that the discrimination was, in fact, not
statutory: “They had no policy of excluding Negroes. They hadn’t made a
policy. It was just the custom.”133
Since there was no bylaw prohibiting the admission of African
Americans to Methodist Hospital, the Board and Administration’s decision
in this and future cases would be based on conscience. Only time would
tell, but it was a reasonable expectation that certain elements of the staff and
clientele would be opposed to the idea. A tentative and temporary
compromise was reached. For the time being, in his unique position of
offering services that were unavailable in most of the country, DeBakey
would be permitted to admit black patients to Methodist Hospital on an ad
hoc basis. Other physicians followed suit over the months and years to
come and, gradually, this invisible barrier was eliminated.
Another vascular disease process that was color-blind and had defied
successful treatment since its initial description was arterial dissection. This
pathology, which mainly affected the aorta, was at least as threatening as
the aneurysmal and occlusive diseases that had, by this time, yielded
somewhat to surgical attack.
In dissection a small tear in the interior lining of the artery, the intima,
leads to blood flowing within the wall of the vessel. Like a snowplow, the
pulsatile, forward-rushing blood gouges through the muscular layer of the
wall, splitting it. Sometimes the abnormal column of blood will break back
through into the normal arterial opening, or lumen. This can diminish the
pressure on the dissected side and create a sort of “double-barreled” aorta.
Even if such “re-entry” does occur, though, the wall is severely weakened
and liable to become aneurysmal, and the internal splitting can block off
arterial blood flow into branch vessels, leading to acute ischemia of organs
or limbs. In large autopsy series reports the diagnosis of aortic dissection
carried with it a mortality of 75–90% within a few months, with most
patients dying in hours or days.134
Given their effective new surgical techniques for exposure and
reconstruction of the aorta, and the grim prognosis of the condition,
DeBakey and his group were understandably eager to address the problem
of aortic dissection. Their first chance came in the late spring of 1954.
A 58-year-old man was admitted to the VA hospital with a thoracic aortic
aneurysm. He was taken to the operating room on July 7, where a
thoracotomy was made in anticipation of excision and homograft
replacement. On opening the aneurysm the surgeons identified that he had a
dissection of the aorta. They resected the aneurysm and found that the
residual aorta was long enough to sew back together primarily, end-to-end.
Before doing this, however, they closed off the false lumen with interrupted
sutures into the cut end of the downstream aorta so that the blood flow on
unclamping would follow only the normal path of the true lumen. On the
resected aneurysm specimen they could clearly see the intimal tear that had
caused the dissection and then the aneurysmal degeneration. The patient
recovered uneventfully.135
This was another worldwide first—successful resection of a thoracic
aortic dissection—but DeBakey decided to accumulate a few more cases
before releasing the information officially. By the time the presentation was
made at the annual meeting of the American Surgical Association in
Philadelphia in April 1955—to a somewhat nonplussed audience—there
were six cases to discuss.*
As early as this first presentation, DeBakey and his team (the co-authors
were Cooley and Creech) identified two broad types of aortic dissections
based on what they felt were the best surgical approaches to correction
(Figure 6.4). The first type arose in the arch of the aorta, and since the entry
point of the dissection could not be directly approached with safety, the
Baylor group advocated dividing the descending thoracic aorta instead.
Then an artificial re-entry point could be created by cutting a hole in the
segment of wall separating the true and false lumens in the upper part of the
aorta, followed by obliteration of the false lumen in the lower part. The
second type of aortic dissection arose in the descending thoracic aorta and
could be treated with resection and approximation of the false lumen, then
homograft or primary closure, as was done in Miller’s case at the Houston
VA. Crucially, the Baylor team recognized the role of hypertension in the
development of the disease as well as its complications and advocated for
aggressive medical control of blood pressure.137
Figure 6.4 Baylor Department of Surgery, 1956. Fifth from left, George Morris; sixth from left, John
Ochsner; seventh from left, E. Stanley Crawford. Fourth from right, Denton Cooley.
6.9 Prostheses
Although the initial aortic dissection case in the first Baylor series had been
treated at the VA Hospital, four of the other five had been cared for at the
Methodist Hospital. The warm welcome DeBakey had received at this
facility from his earliest days in Houston was being amply rewarded, as he
funneled the majority of his private patients through Methodist’s doors. In
particular, he was admitting more and more of his vascular surgery cases
here. These numbers were growing rapidly, but there were other benefits to
the hospital, too. The vascular patients frequently had complex medical
problems and required the services of multiple consultants, so the full beds
benefitted everyone, like the proverbial rising tide that lifts all boats.
Moreover, these sick patients made excellent teaching material. At this time
Methodist still only supported a first-year surgical residency, but there were
more senior residents rotating over from the Jefferson Davis and VA
Hospital training programs to round out the clinical teams. In 1953, medical
students also began rotating through the hospital for the first time. New
surgery labs—well-appointed and generously staffed—were being built on
the hospital’s ninth floor, too.138
Business was booming at Jefferson Davis and the VA Hospital, as well.
The VA was designated by the government as a Center for Thoracic and
Cardiovascular Surgery, and more than 17,000 surgical procedures were
performed at Jefferson Davis Hospital in 1954, a 60% increase over the
number performed in 1948, before DeBakey took over.139
The Baylor postgraduate surgery training program continued to grow and
evolve. Internship consisted of two-month rotations on general surgery and
in the Jefferson Davis Emergency Department and one-month stints in the
surgical specialties of otolaryngology, orthopedics, plastic surgery,
neurosurgery, and urology. The surgery residencies were four years in
length at both Jefferson Davis and the VA. The first two years were alike in
structure to the internship, with rotations through the specialties and
Emergency Department at the city-county institution, although the residents
had greater responsibility for patient care. The experience in the Jefferson
Davis Hospital Emergency Hospital was uniquely valuable.
The variety and volume of traumatic cases encountered in this clinic is probably not exceeded
by any civilian hospital of comparable size. In fact nowhere else, except in actual military
combat, could such an extensive experience with trauma be obtained.140
The final two years of the residency were devoted exclusively to general
and thoracic surgery. Third-year residents rotated on the thoracic and
vascular service at Methodist Hospital, helping manage the private patients.
DeBakey had also arranged a rotation at the M. D. Anderson Hospital,
where the trainees gained experience in the surgical treatment of malignant
disease.141
It was not yet an integrated part of the surgery residency, but trainees
were actively encouraged to participate in clinical or laboratory research.
By the mid-1950s, the Baylor Department of Surgery was engaged in nearly
80 separate research projects. The majority of these were focused on topics
of interest in cardiovascular surgery: no less than nine separate projects
studied various aspects of the effects of induced hypothermia. Several other
studies investigated the properties of homografts. One project of particular
interest involved the use of braided nylon tubes for aortic replacement.142
As early as the late 1940s, several investigators began exploring the
possibility of using grafts made of plastic or fabric to replace diseased
arteries. As has been noted, homografts eventually tended to deteriorate,
and, in any case, there were not enough to meet the need.
The idea of artificial arteries was not new; attempts had been made to
bridge vascular defects with rigid tubes of glass and metal as far back as the
nineteenth century, and as recently as World War II. These efforts all proved
impractical, however. The materials would not become integrated into the
tissues and merely sat inertly in the body as unassimilated foreign objects
until they clotted off.
In 1947, a research fellow named Arthur Voorhees, who was working in
the New York laboratory of Arthur Blakemore (the advocate of aneurysm
wiring) noticed that silk suture inadvertently left in a dog’s heart became
encased in native tissue. He wondered if an entire tube of such material
might similarly become incorporated into the body if it possessed the right
characteristics. First he tried a silk handkerchief sewn into the shape of a
tube, using it to replace the aorta in another experimental animal. Too much
blood leaked through the silk—thereby exposing another potential problem
—but the concept actually worked for a while. Voorhees then set about
searching for a better fabric.
He managed to secure a bolt of Vinyon N—the synthetic polyvinyl
chloride polymer used to make parachutes—from its manufacturer. For the
next several years he performed a multitude of experiments with this fabric,
trying different configurations and anastomotic techniques. Fairly extensive
results were published in early 1952, but did not capture the imagination of
the active vascular surgical community.143 Later that year Vorhees (who
was still just a resident) was at hand when, as fate would have it, Blakemore
was faced with a ruptured aortic aneurysm and an empty artery bank. There
were no aortic homografts available. Voorhees quickly fashioned a Vinyon
N graft and the team sewed it into place. The patient was too far gone by
then and died despite their efforts, but the Vinyon N held up well. The time
seemed ripe for human trials (to his credit Blakemore had seen the light
with regard to the technical advances in aortic aneurysm surgery).144
By April 1954, when their work was presented at the American Surgical
Association meeting in Cleveland, the Columbia group had amassed a
series of 18 cases of aortic aneurysm excision followed by replacement with
a Vinyon N prosthetic graft.145 Their results were excellent, every bit as
good as the homograft data. Now people started to sit up and pay attention.*
Other labs began investigating different synthetic fabrics. If Vinyon N
worked well, it was reasoned, perhaps one of the other new materials would
work even better. This technology had expanded rapidly in the years after
the war, and several alternative synthetic fibers and fabrics were on the
market by the early 1950s.
Charles Hufnagel, the brilliant surgeon-scientist who had been heavily
involved in the early homograft work with Robert Gross at Boston
Children’s Hospital, undertook comprehensive experimental evaluation of
the new acrylic fabric Orlon as an arterial substitute. By early 1953, he and
his colleagues at Georgetown University had begun successfully implanting
Orlon grafts in patients.146 The grafts did their job, but they were not
without their drawbacks. In particular, they were difficult to handle under
surgical conditions and lacked elasticity. So the work went on.
DeBakey had been at the American Surgical Association meeting when
Vorhees presented the Vinyon N paper, and, with the rapidly increasing
volume of vascular cases that were being referred to Houston for treatment,
he was as interested in the subject of artificial arterial substitutes as anyone
in the field. The research project at Baylor on braided nylon tubes was
supported by the Mading Fund as well as the Houston Heart Association,
and the investigators were the surgery resident Milton Self along with
DeBakey, Cooley and Creech.148 Some investigations into the readily
available nylon as a prosthetic artery had already been done, with one
significant finding being that the material leaked directly through its
surface, just as Vorhees had seen with his first silk experiment. This
annoying—and threatening—aspect would be found with many of the
synthetics. Before long clinicians would learn to dip porous grafts in blood
(which would then clot microscopically) to minimize this effect, but in
these Baylor nylon experiments the grafts were coated on the outside in
vinyl plastic.
The results were eventually published in the Annals of Surgery in
November 1955.149 The discussion section of the article began with a rather
remarkable statement: “These experiments indicate that a braided nylon
prosthesis rendered impervious by application of vinyl plastic to its outer
surface may function satisfactorily as an arterial substitute. Of five
prostheses implanted into the abdominal aorta, four became occluded.”150
Thankfully, these implantations were in experimental animals.
Another synthetic material that had been introduced to the public by
DuPont in 1951 was the polyester Dacron. The initial mention of this fabric
as an arterial substitute appears to have been in a paper presented by
Hufnagel at the SVS meeting in San Francisco in June 1954, when
DeBakey served as President of the group. No data with regard to the new
fabric in this role were provided in the presentation, however.151
In the midst of the confusion over which of these new materials might
prove to be the best as an arterial graft, DeBakey decided to investigate as
many different ones as he could get his hands on. Eventually the Baylor
labs would perform experiments with Orlon, Nylon, Dacron, and a
polyvinyl sponge called Ivalon, in various forms and configurations.152
Procurement of these fabrics could prove challenging and, in a particular
instance, led to one of the enduring tales of DeBakey’s career.
It was sort of in a way serendipity because we didn’t know what type of material was the best. I
went down to the stores in Houston, I think it was Foley’s, and bought some sheets of material
that were in bolts. They had some Orlon, and Dacron, and Nylon, and one or two others that
were available then.*,153
DeBakey took the new material back to his home, rather than the lab. The
young boy who had learned to sew and tat at his mother’s knee was now
applying those lessons in life- and limb-saving endeavors, constructing
grafts of fabric to study in animal experiments and, soon thereafter, to
replace diseased blood vessels: “I would make tubes on my wife’s sewing
machine. I would cut the two sheets the size I wanted, and sew the
edges.”154
An article in the Baylor Line magazine from the spring of 1955 entitled
“A Stitch in Time” described DeBakey’s hands-on process with the briefly
favored synthetic Orlon.
From the x-ray films and other diagnostic tests, the surgeon can determine the location and size
of the aneurysm. Having done this, Dr. DeBakey then draws pattern on a folded piece of Orlon.
It may be curved, straight or Y-shaped. The latter is for bifurcation, or fork, of the abdominal
aorta.
Stitch along the lines which have been drawn the double thickness of cloth,
the material is then cut and treated with special plastic which makes Orlon
less porous. After it has been sutured into place, the blood flowing through
it helps the living tissues to grow in this matrix of cloth, until the repaired
section is as good as new. Meanwhile, the treated Orlon serves quite well as
a leak-proof vessel.157
One of the prominent patients who came to Houston for surgical

consultation during this period was Arthur O. Hanisch. The founder of
Stuart Pharmaceuticals in Pasadena (which developed the antacid Mylanta,
among other things), Hanisch had been referred to DeBakey by a local
doctor after the diagnosis of abdominal aortic aneurysm was made.
He arrived with his wife and his two sons virtually ready to meet his maker, because he had this
bulging aneurysm. And I said, “Well, yes, I think you ought to be operated on.” I told him what
we were doing with it. I think he was about the fortieth or fiftieth case that we had done. I told
him, “Now here are the statistics. It’s getting better all the time and I think your chances are
quite good, perhaps better than eighty per cent. If you leave it this way, you’re not going to live
much longer.” He said, “Well, I don’t care what the chances are, I want to take the chance.”158
DeBakey performed an aneurysm resection and homograft replacement

on Hanisch on July 19, 1954.159 The procedure went well, and in a few
weeks Hanisch was back in Pasadena recuperating. After some more weeks
had passed Hanisch noticed that he had not received a bill from Houston.
Of course, this was the DeBakey stratagem—borrowed from Ochsner.
He called me on the phone and he said “Mike (by that time he was calling me Mike) I just have
been through all of my correspondence here and I haven’t found a bill from you. There’s no
hurry about it: I just want to be sure it hadn’t been misplaced.” And I said, “No. You haven’t got
a bill. I didn’t send you a bill.” He said, “Why didn’t you send me a bill?” I said, “Because I
would rather have you think in terms of giving something to our department, rather than send a
bill.’’ He said, “Oh, I can do both.” I said, “No. No. I don’t want to send you a bill.” Well, this
appealed to him tremendously. Here is a doctor who didn’t want to bill him and he never had
this experience with doctors before.160
Hanisch donated more than $8,000 to the Baylor Department of Surgery

that year, but it was only the beginning.161 The California pharmaceutical
man would eventually donate “close to half a million dollars” to the
Department and, even more importantly, provide a connection of
inestimable value in the race to develop the ideal prosthetic arterial graft.162
In the meantime, however, there was much chaos and confusion
regarding which type of synthetic arterial substitute might be the best.
Different groups across the country studied different fabrics and materials.
Ormand Julian in Chicago (together with Ralph Deterling in New York)
was looking at Dacron.163 Paul Sanger in North Carolina favored Orlon,
and Sterling Edwards in Alabama was working with a chemist named James
Tapp on nylon grafts.164 Teflon was emerging as a possibility, too. These
disparate and uncoordinated efforts were soon addressed by a committee
formed within the SVS to study the issue. In October, this committee,
chaired by Oscar Creech, sent out a questionnaire to all the members of the
Society. Inquiries included which type of material they were using, where in
the arterial system grafts were being placed, and what tissue changes had
been observed.165 Work everywhere moved forward as the data gradually
trickled in.
Raheeja DeBakey passed away on Tuesday, August 3, 1954, at the age of
66.166 When she had begun feeling poorly several weeks before, Shiker had
taken her from Lake Charles to the Ochsner Clinic for care. Raheeja was
visited daily by Alton Ochsner and Mims Gage, both of whom had, of
course, known the family for some 20 years. Unfortunately, her condition
was beyond any treatment. After her death, Raheeja was interred at Hope
Mausoleum in New Orleans. DeBakey was inundated with cards, letters,
and telegrams of condolence from near and far. Several friends gave
donations to the American Heart Association and American Cancer Society.
More, including Ben and Sam Taub, donated to the Baylor Department of
Surgery in her name.167
The constant attention his mother had received from Mims Gage did not
escape the notice of Ernest DeBakey, who was now a very successful
general and thoracic surgeon in Mobile, Alabama. Deeply touched, Ernest
found a unique and poignant means of expressing his gratitude.
October 20, 1954
Dear Dr. Gage:
I fully realized that I could never repay you for the many favors and could never express my
gratitude.
I feel certain that the one thing that made my mother happy during her illness was your
frequent daily visits. I agree and wish to say many thanks.
I regard my years with you and Dr. Ochsner as the brightest experience that I will ever have
in my career. Your friendship has always been there when needed, your encouragement was a
strong pillar of support, and your patience and understanding were always a constant inspiration.
You gave much to me, and I in turn would like to do something for you, something which
would indicate in a small way the deep sincere appreciation I feel for all you have done for me. .
..
Unfortunately, fate has decreed that I will not have the opportunity of developing and
schooling any children of my own in this field. Consequently, I should like to have the privilege,
if the Lord is willing, of providing any financial help which may be necessary to make it
possible for your sons to be trained so the opportunity will be theirs to obtain the renown as man
and surgeons which you have achieved. . . .168
Ernest’s older brother was also deeply affected by the attention and care
that his own mentor Alton Ochsner had showered on their ailing mother.
Dear Chief,
I have tried repeatedly to write this letter to express my profound sense of gratitude, but on each
occasion it proved too inadequate to send you. . . .
For over two decades now you have been a constant source of inspiration, guidance, and
kindliness to all our family. Your warm-heartedness and strength of character have comforted us
on many occasions, and in this recent tragic family crisis you had been our tower of support.
Our indebtedness to you is immeasurable. It is profound and everlasting and can never be repaid
by us. But I believe you know there is no greater reward in life and you must derive much
satisfaction from the knowledge that you have attained it completely. All that we can do is say
from the fullness of her heart, God bless you always.169
Not long after this Mims Gage himself developed an abdominal aortic
aneurysm. Knowing as well as anyone that the best work in this field was
being performed by his protégé 300 miles away in Houston, Gage traveled
to Baylor. There DeBakey performed a successful aneurysm resection with
homograft placement. Afterward (and for years to come) Gage assured his
well-wishers that he was doing fine and that his libido had actually gotten a
jumpstart from the procedure. He insisted that his new aorta had come from
a deceased lady of the evening.*,170
Composition of the official history of the Army Medical Department in
World War II continued to grind on in the years after the conflict’s
conclusion. The volume on Vascular Surgery, co-edited by DeBakey and
Daniel Elkins of Emory University, was finally published in 1955.171
Although this appeared 10 long years after the war’s end, it was actually
one of the first volumes of the history to be published. Aside from editing
the work, DeBakey was credited with the lengthy chapter on “Acute Battle-
Incurred Arterial Injuries,” co-written by Fiorindo Simeone and mostly an
expansion of their landmark paper on the same topic from 1946. Other
prominent members of the American vascular surgery community
contributed significantly to the volume, and the final product made such a
long-term effort ultimately worthwhile. Surgery in World War Two:
Vascular Surgery comprised 16 chapters over more than 450 pages and was
by far the largest discussion of the topic of military vascular surgery
published to that point.
In July 1955, a distinguished visitor of unique talents visited Houston to
have a first-hand look at the marvelous new aortic operations. This was
Frank B. Netter, an artist of superlative talent who also happened to have
been educated as a physician. Netter learned early in his medical career that
his skills with the brush and pencil could be put to much greater use than
his clinical ability (and for much greater reward, as it turned out). He
entered into a long business relationship with the pharmaceutical company
CIBA, which astutely used his educational artwork as a vehicle to advertise
their products. Generations of medical students learned from Netter’s
informative and beautiful artwork, and practicing physicians kept up what
would now be called “Continuing Medical Education” through the in-depth
treatment of various disease processes in the periodical, Clinical Symposia.
DeBakey had already worked with Netter during the war, when the artist
served as a Captain in the US Army (spending a considerable amount of
time at the Army Medical Museum, too). The two men collaborated on
several CIBA releases detailing common war injuries and their treatment.
These were technical educational materials intended for military surgeons
and combined DeBakey’s streamlined prose with Netter’s dramatic and
memorable brushwork.172
Now, 10 years later, Netter was coming to Houston to renew his
friendship with DeBakey and document the new vascular procedures. The
local papers got wind of his presence, and the celebrated Netter found his
picture in accompanying articles on the pages of the dailies (one went so far
as to include the name of the hotel where he was staying).
Netter went into the operating room with DeBakey to observe the
techniques, sketching and taking notes. The results appeared in CIBA’s
Clinical Symposium for March–April 1956, entitled “Surgery of the
Aorta.”173 This 30-page booklet covered the topics “Aneurysm of the
Thoracic Aorta,” “Dissecting Aneurysm of the Aorta,” “Aneurysm of the
Abdominal Aorta,” “Occlusive Disease of the Aorta,” and “Constrictive
Lesions of the Thoracic Aorta,” with scholarly descriptions of all these
clinical entities and their surgical treatment, authored by DeBakey, Cooley,
and Creech. Netter’s unforgettable paintings—dozens of them—brought to
life both the desperate nature of these diseases and the herculean surgical
efforts that conquered them. For the Baylor Department of Surgery, this
Clinical Symposium reached a largely untouched audience. Countless
physicians across the world who would never have leafed through the pages
of the surgical journals or been privy to the deliberations of the surgical
societies now witnessed in vivid color and detail the miracles taking place
on the operating tables in Houston and saw a new chance for their
previously hopeless patients afflicted by these maladies (Figure 6.5).
Figure 6.5 Artist Frank Netter’s depiction of multiple shunt surgical approach to aneurysm of the
entire aortic arch, from CIBA’s Clinical Symposium “Surgery of the Aorta,” March–April 1956.
Courtesy Elsevier.
6.10 The March of Medicine
The achievements being made at Baylor in advancing vascular surgery were
becoming well known among the medical community by the mid-1950s;
effective publication and presentation in rigorous scientific journals and at
high-profile meetings, in addition to widespread trade circulation of
periodicals such as the CIBA Clinical Symposium were seeing to that. For
the most part, however, the lay public had little understanding or
appreciation of just what was being done. Much of what appeared in the
daily papers or magazines either described the advances in unsophisticated
terms that befuddled or were presented in a “gee-whiz” manner reminiscent
of science fiction. In December 1954, though, an opportunity arose to
present the new breakthroughs directly to the public with little room for
misinterpretation, albeit still more for sensationalizing.
In the 1950s, the CBS television network broadcasted a program entitled,
“The March of Medicine.” Produced in conjunction with the AMA, this
show was intended to pay tribute “not only to investigators whose research
has contributed to such advancements in medicine but also to the
institutions, laymen, and physicians who have lent their support to the
development of the science of medicine and surgery.”174 In December 1954,
the AMA held its clinical, or Interim Session in Miami and the leaders, no
doubt reflecting on the Baylor surgery presentation that took home the
Hektoen Award earlier in the year, recommended that the network takes its
cameras to Houston rather than South Florida.
Under the bright lights at Methodist Hospital, and before a nationwide
television audience, DeBakey—assisted by Cooley and Creech—performed
the first-ever televised resection of a thoracic aortic aneurysm with
homograft replacement (Figure 6.6).175 It was less than two years after the
first such successful operation ever in the world, also at Methodist.
Figure 6.6 DeBakey and team in the operating room at Methodist Hospital, with television camera.
Courtesy Baylor College of Medicine archives.
This operation was a success, and the broadcast helped cement the
Baylor Department of Surgery and Houston Methodist Hospital in the
public eye across the nation as the places to go for vascular surgery. This
was, obviously, a far cry from their backward status of just a few years
before. The administrations and rank-and-file at both these institutions
recognized the fact and were thrilled.
People knew where Baylor was in this country. Medical people knew where Baylor was. They
knew where I was and they knew I was at Baylor. Here this man from Baylor had won the Gold
Medal. This man from Baylor was visiting professor at MGH. This man from Baylor was put on
television nationwide. So people had to take notice of the fact that I was from Baylor.176
But not everyone in Houston was delighted.

Ever since DeBakey’s arrival—even before, in fact—the Harris County
Medical Society had, at best, mixed emotions about this outsider who had
come to energize the Baylor Department of Surgery. DeBakey’s soft-
spoken, polite public demeanor belied a whirlwind of activity and—to some
of the group—much of the ruckus smacked of that hobgoblin of the refined
profession: self-promotion. There were a few too many newspaper articles,
a few too many trumpeted firsts, and now, one too many television
programs. Many members already held grudges because they had been
displaced or otherwise inconvenienced by his insistence on adequate
training and accreditation.
DeBakey felt the resentment against him from the County Medical
Society and recognized it as a threat. With regard to the “March of
Medicine,” however, he held a trump card. The selection of Baylor,
DeBakey, and Methodist for the program had come from the AMA—he had
had nothing to do with it. He contacted the public relations division of the
AMA for assistance.
I called up and I said, “Look, these people are after me. What are you going to do? I want to be
sure that they understand. I told them that you’re the fellows that initiated this. I’m not doing
anything unethical. [This is] with the full cooperation of the AMA.” And he said, “Tell them to
go to hell.”177
Since the Harris County Medical Society was directly affiliated with the
AMA, and that organization had not only sanctioned the “March of
Medicine” visit to DeBakey’s operating room but actually initiated it, there
was nothing for the disgruntled members to do but swallow their
complaints.
Even as early as this, though, DeBakey’s unpopularity among the
physicians of Houston was becoming less of a concern as more and more of
his referrals began to come from out of the city, the state, and soon the
country. Even so, the annoyance created by the barking at his heels was
undeniable.
You have to be willing to tolerate the pressure of resentment, the pressure of unpopularity, the
willingness to tolerate a certain amount of this and go on with your own business. Now you can
do this so long as you have some measure of success in what you do. It can be very frustrating,
but you still can do it. And people say, “How did you stand all of this? How could you have
tolerated all of this?” Well, I guess, the only reason I could is because I was successful, I had
some measure of success in my surgical work, and it was being recognized as successful. And
that encourages you to go on.178
The greatest surgical successes attained by the Baylor Department of
Surgery by 1955 were in the field of aortic aneurysms. DeBakey and his
colleagues had been among the first to resect and replace aneurysms in the
abdominal aorta and had been the very first to do so in the thoracic aorta
and the distal aortic arch. But there were other aneurysms of the aorta
which they had not addressed yet.
One of the aortic aneurysms that could not be dealt with by the means
they had pioneered was the thoracoabdominal aortic aneurysm. As the name
implies, this lesion involves pathologic dilation of the aorta spanning the
chest and the abdomen, and even today these aneurysms represent some of
the most challenging of vascular disease processes to treat. That segment of
the aorta just below the diaphragm—the anatomic boundary separating the
abdomen from the chest—harbors orifices of the key visceral arterial
branches to the stomach, spleen, liver, kidneys, and intestines. Since this
segment is, by definition, included in thoracoabdominal aneurysms, such
lesions cannot be simply extirpated and replaced with tubes. Even if they
could somehow be revascularized—like the left subclavian artery was in the
case of the Air Force man, Malcolm McLeod—these visceral arteries could
not be safely clamped off for the period of time it would take to sew a graft
in, especially a graft with several such branches and, therefore, anastomotic
suture lines. Something entirely new was needed for thoracoabdominal
aortic aneurysms.
All of this was intuitional, but it was also learned the hard way, with a
patient who had been admitted to the VA Hospital in August 1955. The team
tried simply to clamp the involved arteries—the aorta, celiac axis, superior
mesenteric artery, and both renal arteries—remove the aneurysm, and sew
in a homograft containing the origins of these visceral arteries. The patient
survived a week, but succumbed to what would now be called multiple
system organ failure.
Another chance came a few weeks later when a 65-year-old man named
John Dean was admitted, also to the Houston VA Hospital, on October 13,
1955. X-rays demonstrated a large, fusiform thoracoabdominal aneurysm
extending from the lower chest to just below the renal arteries.
The Baylor team operated on Dean on October 19. The lessons of August
had been learned. DeBakey’s plan to avoid that prior outcome was intricate
but ingenious. In the actual event improvisation was necessary, but the team
was equal to the challenge. After DeBakey had dissected the aneurysm free
from the surrounding tissues he placed a temporary shunt, a tube made of
Ivalon, from just above the aneurysm in the normal thoracic aorta to just
below it in the normal abdominal aorta. The aorta was then doubly clamped
in the chest and divided between the clamps. In this way the lower part of
the aneurysm containing the orifices of the visceral arteries was still being
perfused in a retrograde fashion while the team commenced excision of the
lesion.* A homograft of the same area of aorta was brought into the
operative field. DeBakey then divided the patient’s left renal artery and
removed the part of the aneurysm attached to this vessel. He then
anastomosed the stump of the homograft left renal artery to the same vessel
in the patient. Next he sewed the bottom of the graft into the abdominal
aorta and released that clamp, moving it to the graft just above the left renal
artery anastomosis. Now the left kidney was being perfused via the shunt.
He did the same sort of thing sequentially with the right kidney, superior
mesenteric artery, and celiac axis. The visceral arteries and their end organs
were deprived of blood flow for times on the order of 30 minutes (the same
times had been more than 100 minutes in the August case). Finally,
DeBakey sewed the homograft to the aorta in the chest and removed the
shunt, allowing normal antegrade flow (Figure 6.7).179
Figure 6.7 Early successful thoracoabdominal aortic aneurysm repair; October 19, 1955. See text for
details.
The operation took more than eight hours, and Dean was transfused some
four and a half liters of blood.
He gave the surgical team a scare by only producing a few milliliters of
urine in the first postoperative day, raising fears of kidney failure, but this
quickly picked up and was soon normal. Dean was able to take food within
a week of the operation. He was discharged on January 4, 1956, “fully
recovered and in good condition.”180 In the meantime, the team performed
two more cases of thoracoabdominal aortic aneurysm repair, on November
10 and November 12, 1955. The surgical strategies in these instances were
similar. One patient survived and was discharged home, the other died from
complications of a bleeding ulcer.†,181
DeBakey presented all four of these cases at the American Surgical
Association meeting in White Sulphur Springs, West Virginia, in April
1956.183 The meeting was held at the luxurious Greenbrier resort, an old
and palatial hotel which had been transformed into the Ashford General
Hospital (Daniel Elkins’s command) during World War II.* The
presentation, authored by DeBakey, Creech, and George Morris, Jr., was
skillfully assembled and abundantly illustrated with photographs and
drawings of the operative tours de force. The reaction on the part of the
astonished listeners bordered on reverential.
John Gibbon of Philadelphia, who had known DeBakey since the
propitious AMA meeting in St. Louis in 1939, where he found the answer to
the problem of a blood pump for his heart-lung machine, was effusive (the
surgeon and Association historian Mark Ravitch later described it as “one
long hosanna”184).
I make no apology for getting up a third time this afternoon to pay tribute to one of America’s
and one of the world’s greatest surgeons. We have not only heard a description of one of the
most brilliant technical achievements that to my knowledge has been accomplished in the last
few years in the field of vascular surgery, but we have also heard a presentation by a man who is
extraordinarily modest about his achievements, and who not only in the technical field but in
the field of devotion to the interests of surgeons and surgery at large, and surgical education,
has had an extraordinary career. I think this Association should take note of the tremendous
achievements of this man.185
Henry Bahnson of Johns Hopkins, himself a pioneer of aortic aneurysm

surgery, continued in the same vein.
To hear a monumental and simply thrilling feat in surgical treatment emanating from Houston is
certainly not unusual and hardly remarkable.186
Even Arthur Blakemore, who had dismissed DeBakey’s presentation on

aneurysm resection at the Southern Surgical Association meeting in Florida
only three years before, paid homage.
Dr. DeBakey and his able associates have pursued relentlessly the old demon, aneurysm, up and
down the aorta. Today it may be safely stated they have staged the “last round up.” This final
conquest, embracing the ideal management for aneurysms of the abdominal aorta that involve
the visceral arteries, will go down in the annals of surgery as one of the very great advances in
vascular surgery. I take pleasure in congratulating Dr. DeBakey on a perfectly magnificent
achievement.187
Blakemore’s praise, along with that from these other giants of American
surgery, was generous and gratifying. It was not, however, entirely correct.
DeBakey and his team had now successfully treated aneurysms of the
aorta from the left subclavian artery to the iliacs. But there were other aortic
aneurysms, no less deadly than these, which had not yet been approached:
those in the ascending aorta just beyond its origin from the left ventricle of
the heart, and those involving the arch itself—where the three major arterial
branches to the head and arms arise. No amount of clever design or surgical
legerdemain seemed likely ever to conquer the challenges of these fearsome
lesions.
Even as the plaudits descended on him in the ornate opulence of the
stately Greenbrier, DeBakey was contemplating a way to do just that.
Notes
1. DeBakey ME, Cooley DA. Surgical Treatment of Aneurysm of Abdominal Aorta by Resection
and Restoration of Continuity with homograft. Surgery, Gynecology and Obstetrics 1953;
97:257–266.
2. Ibid.
3. Cooley DA, DeBakey ME. Surgical Considerations of Intrathoracic Aneurysms of the Aorta
and Great Vessels. Annals of Surgery 1953;138:377–386.
4. DeBakey ME, Cooley DA. Surgical Treatment of Aneurysm of Abdominal Aorta.
5. Turek JW, Gaynor JW. Historical Perspectives of the American Association for Thoracic
Surgery: Robert Edward Gross (1905–1988). Journal of Thoracic and Cardiac Surgery
2012;143:1003–1006. Gross’s procedure came after a similar one performed by a Swede
named Clarence Craaford. Gross believed Craaford had come up with the idea for his
operation after visiting the pediatric surgery laboratory at Boston Children’s Hospital, and he
closed the lab to visitors afterward.
6. Shumacker HB. The Society for Vascular Surgery: A History: 1945–1983. Manchester, MA,
The Society for Vascular Surgery, 1984: 70.
7. Murray, Lindsay. 2015. “A Thrill of Extreme Magnety”: Robert E. Gross and the Beginnings
of Cardiac Surgery. Doctoral dissertation, Harvard Medical School. http://nrs.harvard.edu/urn-
3:HUL.InstRepos:17295916 (accessed July 7, 2018).
8. Natali J. Jacques Oudot and His Contribution to Surgery of the Aortic Bifurcation. Annals of
Vascular Surgery 1992:6:185–192.
9. Ibid.
10. http://www.tl2b.com/2013/07/jacques-oudot-medecin-de-l-un-bleausard.html (accessed
August 4, 2018).
11. Natali J., Jacques Oudot, 185–192.
12. Dubost C, Allary M, Oeconomos N. Resection of an Aneurysm of the Abdominal Aorta.
Archives of Surgery 1952:64:405–408.
13. Thompson J. Early History of Aortic Surgery. Journal of Vascular Surgery 1998;28:746–752.
14. Ibid.
16. Ibid.
17. Letter ME DeBakey to R. Matas, December 2, 1952. Rudolph Matas papers, Manuscripts
Collection 868, Louisiana Research Collection, Howard-Tilton Memorial Library, Tulane
University, New Orleans, LA. 10:38.
20. Ibid., 59.
22. DA Cooley DA, DeBakey ME. Surgical Considerations of Intrathoracic Aneurysms of the
Aorta and Great Vessels. Annals of Surgery 1952;135:660–680.
23. Ernst CB. In Memoriam: E. Stanley Crawford 1922–1992. Journal of Vascular Surgery
1993;17:618–619.
2:107:10.
2:107:10.
26. DA Cooley DA, DeBakey ME. Surgical Considerations of Intrathoracic Aneurysms of the
Aorta and Great Vessels. Annals of Surgery 1952;135:660–680.
27. Blakemore AH. Progressive Constrictive Occlusion of the Aorta with Wiring and
Electrothermic Coagulation for the Treatment of Arteriosclerotic Aneurysms of the Abdominal
Aorta. Transactions of the Southern Surgical Association 1952;64:202–219.
28. Ibid.
DeBakey, Michael E. Michael E. DeBakey Archives. 1903–2010. Located in: Archives and
30. Tarrant County, Texas. Death certificate no. 56574 (1952), Goldie Marion DeBakey. Texas
Department of Health, Bureau of Vital Statistics. The cause of death was listed as suicide by
atropine poisoning.
31. DeBakey Collection. Baylor College of Medicine Archives. Houston, TX. 2:207:20.
32. Ibid.
33. DeBakey ME, Cooley DA. Successful Resection of Aneurysm of Thoracic Aorta and
Replacement by Graft. JAMA 1953;152:673–676.
36. DeBakey ME, Cooley DA. Successful Resection of Aneurysm of Thoracic Aorta.
38. Ravitch MM. A Century of Surgery: The History of the American Surgical Association.
Volume Two. Philadelphia: J. B. Lippincott Co., 1981: 999.
39. Letter ME DeBakey to R. Matas, January 14, 1953. Rudolph Matas papers, Manuscripts
40. Letter M. E. DeBakey to A. Ochsner, April 8, 1946. DeBakey Collection. Baylor College of
Medicine Archives.2:127:4.
2:107:10.
42. Letter ME DeBakey to R. Matas, January 14, 1953. DeBakey Collection. Baylor College of
43. Spencer FC, Grewe RV. The Management of Arterial Injuries in Battle Casualties. Annals of
Surgery 1955;141:304–313.
2:107:10.
46. Ibid.
47. Ibid.
49. Ibid.
51. Ibid.
54. Butler WT, Ware DL, 66–67.
55. Michael M. DeBakey, personal communication, August 15, 2018.
56. Ibid.
57. Thompson T. Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac
Frontier. New York: McCall’s Publishing, 1971: 34.
59. Ibid.
60. Gibbon JH. Application of a Mechanical Heart and Lung Apparatus to Cardiac Surgery.
Minnesota Medicie 1954;37:171.
62. Miller BJ, Gibbon JH, Gibbon MH. Recent Advances in the Development of a Mechanical
Heart and Lung Apparatus. Annals of Surgery 1951;134:694–708.
2:107:10.
64. Letter E. D. Churchill to M. E. DeBakey, May 26, 1953. Edward Delos Churchill papers,
Boston, MA.
65. Letter M. E. DeBakey to E. D. Churchill, July 29, 1952. Ibid.
66. George C. Polio Struck Terror in Houston and Across the Nation (June 6, 2016). Houston
Chronicle. https://www.chron.com/local/history/medical-science/article/Polio-struck-terror-in-
Houston-and-across-the-7964777.php (accessed July 7, 2018).
67. Letter E. D. Churchill to M. E. DeBakey May 26, 1953. Edward Delos Churchill papers,
Boston, Mass.
68. Letter D. A. Clark to E. D. Churchill, August 6, 1952. DeBakey Collection. Baylor College of
70. Ibid.
72. Letter M. E. DeBakey to D. A. Clark, July 13, 1953. DeBakey Collection. Baylor College of
74. Letter M. E. DeBakey to R. Shaw, July 17, 1953. DeBakey Collection. Baylor College of
75. Letter M. E. DeBakey to E. D. Churchill, July 9, 1953. Edward Delos Churchill papers, 1840–
1973. H MS c62. Harvard Medical Library, Francis A. Countway Library of Medicine,
Boston, Mass.
Texas, 1955. DeBakey Collection. Baylor College of Medicine Archives. Houston, TX.
2:107:11.
77. DeBakey ME. Successful Carotid Endarterectomy for Cerebrovascular Insufficiency:
Nineteen-Year Follow-Up. JAMA 1975;233:1083–1085.
79. Fisher M. Occlusion of the Internal Carotid Artery. Archives of Neurologic Psychiatry
1951;65:346–377.
80. Hunt JR. The Role of the Carotid Arteries in the Causation of Vascular Lesions of the Brain,
with Remarks on Certain Special Features of the Symptomatology. American Journal of
Medical Science 1914;147:704–713.
81. DeBakey ME. Successful Carotid Endarterectomy.
82. Ibid.
83. Ibid.
85. Carrea R, Molins M, Murphy G. Surgical Treatment of Spontaneous Thrombosis of the
Internal Carotid Artery in the Neck: Carotid-Carotideal Anastomosis: Report of a Case. Acta
Neurol Latin America 1955;1:71–78.
86. Strully KJ, Hurwitt ES, Blankenberg HW. Thrombo-endarterectomy for Thrombosis of the
Internal Carotid Artery in the Neck. Journal of Neurosurgery 1953;10:474–482.
87. Letter C. Rob to M. E. DeBakey, December 8, 1954. DeBakey Collection. Baylor College of
Medicine Archives. 9:17:1. Dr. DeBakey’s reply, dated February 7, 1955, adds to the
confusion: “I have had one similar case which I treated by thromboendarterectomy.
Unfortunately, a recurrence took place with thrombosis and occlusion about three months after
the operation.” It is not clear if DeBakey refers to the Carter case, misremembering the clinical
course, or is describing a different instance.
88. Eastcott HHG, Pickering GW, Rob CG. Reconstruction of the Internal Carotid Artery in a
Patient with Intermittent Attacks of Hemiplegia. Lancet 1954;2:994–996.
89. Cooley DA, Al-Naaman YD, Carton CA. Surgical Treatment of Arteriosclerotic Occlusion of
Common Carotid Artery. Journal of Neurosurgery 1956;13:500–506. DeBakey mentioned
Cooley’s case, but not his own, in an invited discussion at the April 1957 American Surgical
Association Annual Meeting in Chicago. The paper being discussed was “Surgical Treatment
of Atherosclerotic Occlusion of the Internal Carotid Artery,” by C. Lyons and G. Galbraith,
which described bypass techniques applied to this sort of lesion.
90. Fields WS, Crawford ES, DeBakey ME. Surgical Considerations in Cerebral Arterial
Insufficiency. Neurology 1958;8:801–808.
92. DeBakey ME, Crawford ES, Cooley DA, Morris GC. Surgical Considerations of Occlusive
Disease of Innominate, Carotid, Subclavian, and Vertebral Arteries. Annals of Surgery
1959;149:690–710.
93. DeBakey ME, Crawford ES, Cooley DA, Morris GC. Surgical Considerations of Occlusive
Disease of Innominate, Carotid, Subclavian, and Vertebral Arteries. Annals of Surgery
1961;154:698–725.
94. DeBakey ME. Successful Carotid Endarterectomy.
95. https://www.loc.gov/rr/record/pressclub/pdf/HerbertHoover.pdf (accessed August 28, 2018).
96. Ibid.
97. Report on Federal Medical Services Prepared for the Commission on Organization of the
Executive Branch of the Government by the Task Force on Federal Medical Services.
February 1955.
98. Ibid.
99. Ibid.
100. Ibid.
101. Reznick JS, Koyle KM. Images of America: US National Library of Medicine. Charleston,
SC: Arcadia Publishing, 2017: 61.
102. Report on Federal Medical Services Prepared for the Commission on Organization of the
Executive Branch of the Government by the Task Force on Federal Medical Services.
February 1955.
103. Ibid.
105. DeBakey ME, Cooley DA. Successful Resection of Aneurysm of Distal Aortic Arch and
Replacement by Graft. JAMA 1954;155:1398–1403.
106. Cooley DA, Al-Naaman YD, Carton CA. Surgical Treatment of Arteriosclerotic Occlusion of
Common Carotid Artery. Journal of Neurosurgery 1956;13:500–506.
107. DeBakey ME, Cooley DA. Successful Resection of Aneurysm of Distal Aortic Arch.
108. Ibid.
109. Telegram R. Matas to ME DeBakey, August 19, 1954. Rudolph Matas papers, Manuscripts
110. Bahnson HT. Treatment of Abdominal Aortic Aneurysms by Excision and Replacement by
Homograft. Circulation 1954;9:494–503.
111. Gets ‘Used’ Main Artery: Rare Operation, Transfusions Save Life of Retired Local Man
(October 4, 1953). The Sunday News and Tribune. Jefferson City, Missouri.
112. Ibid.
113. Cooley DA, DeBakey ME. Ruptured Aneurysm of Abdominal Aorta: Excision and Homograft
Replacement. Postgraduate Medicine 1954;16:334–342.
114. Ibid.
115. Cohen JR, Graver LM. The Ruptured Abdominal Aortic Aneurysm of Albert Einstein. Surgery,
Gynecology and Obstetrics 1990;170:455–458.
117. Pais A. Subtle Is the Lord: The Life and Science of Albert Einstein. New York: Oxford
Texas, 1955. DeBakey Collection. Baylor College of Medicine Archives.W2:107:11.
120. Ibid.
122. Letter M. E. DeBakey to R. Matas, June 14, 1954. Rudolph Matas papers, Manuscripts
Texas, 1955. DeBakey Collection. Baylor College of Medicine Archives. 2:107:11.
124. Cooley DA, DeBakey ME. Ruptured Aneurysm of Abdominal Aorta.
126. Ibid.
127. Letter M. E. DeBakey to R. Matas, June 14, 1954. Rudolph Matas papers, Manuscripts
129. Lilly GD. The First Ten Years of the Society for Vascular Surgery. Surgery 1957;41:1–5.
130. Shumacker HB. The Society for Vascular Surgery, 349–350.
1:2:9.
132. Ibid.
133. Ibid.
134. DeBakey ME, Cooley DA, Creech O Jr. Surgical Considerations of Dissecting Aneurysm of
the Aorta. Annals of Surgery 1955;142:586–612.
135. Ibid.
136. Ravitch MM. A Century of Surgery, 1033.
137. DeBakey ME, Cooley DA, Creech O Jr. Surgical Considerations of Dissecting Aneurysm of
the Aorta.
139. Ibid.
140. Ibid.
141. Ibid.
142. Self MM, Cooley DA, DeBakey ME, Creech O. The Use of Braided Nylon Tubes for Aortic
Replacement. Annals of Surgery 1955;142:836–843.
143. Voorhees AB, Jaretzki A, Blakemore AH. The Use of Tubes Constructed from Vinyon “N”
Cloth in Bridging Arterial Defects. Annals of Surgery 1952;135:332–336.
144. Smith RB. Arthur B. Voorhees, Jr. Pioneer Vascular Surgeon. Journal of Vascular Surgery
1993;18:341–348.
145. Blakemore AH, Voorhees AB. The Use of Tubes Constructed from Vinyon “N” Cloth in
Bridging Arterial Defects—Experimental and Clinical. Annals of Surgery 1954;135:324–333.
146. Hufnagel CA, Rabil P. Replacement of Arterial Segments, Utilizing Flexible Orlon Prostheses.
Archives of Surgery 1955;70:105–110.
147. Ravitch MM. A Century of Surgery, 1010.
149. Self MM, Cooley DA, DeBakey ME, Creech O. The Use of Braided Nylon Tubes.
150. Ibid.
151. Hufnagel CA. The Use of Rigid and Flexible Plastic Prostheses for Arterial Replacement.
Surgery 1955;37:165–174.
152. Crawford ES, DeBakey ME, Cooley DA. Clinical Use of Synthetic Arterial Substitutes in
Three Hundred Seventeen Patients. Archives of Surgery 1958;76:261–270.
155. Ibid., 66.
156. Michael M. DeBakey, personal communication, August 15, 2018.
157. “A Stitch in Time.” The Baylor Line, March–April, 955.
159. Letter ME DeBakey to JB Sibley, April 29, 1992. DeBakey Collection. Baylor College of
Medicine Archives. 9:121:9.
163. Hunter JA. Ormand C. Julian 1913–1987. Journal of Vascular Surgery 1988;8:195–197.
164. Sanger PW, Taylor FH, McCall RE, Duchesne R, Lepage G. Seamless Synthetic Arterial
Grafts; Preliminary Report on Experimental and Clinical Experiences. JAMA 1956;160:1403–
1404. Edwards WS, Tapp JS. Braided Textiles Tubes as Arterial Grafts. Surgery 1995;38:61–
67.
166. Mrs. DeBakey Dies in New Orleans (August 4, 1954). Lake Charles American Press, 1.
168. Letter E. G. DeBakey to I. M. Gage, October 20, 1954. Ibid.
169. Letter M. E. DeBakey to A. Ochsner (n.d.). Ibid. This letter is undated and unsigned but is in
DeBakey’s script. No such letter is among Alton Ochsner’s papers at the Historic New Orleans
Collection, and it is not known if it was ever sent.
171. Elkin DC, DeBakey ME, eds. The Medical Department, United States Army: Surgery in World
War Two. Vascular Surgery. Washington, D.C.: Office of the Surgeon General, Department of
the Army, 1955.
172. Netter FM. Medicine’s Michelangelo. Quinnipiac Press, 2013: 82–83.
173. DeBakey ME, Cooley DA, Creech O. Surgery of the Aorta. CIBA Clinical Symposium
1956;8:2.
175. Ibid.
177. Ibid.
178. Ibid.
179. DeBakey ME, Creech O, Morris GC. Aneurysm of Thoracoabdominal Aorta Involving the
Celiac, Superior Mesenteric, and Renal Arteries. Report of 4 Cases Treated by Resection and
Homograft Replacement. Annals of Surgery 1956;144:549–572.
180. Ibid.
181. Ibid.
182. Etheredge SN, Yee J, Smith JV, et al. Successful Resection of a Large Aneurysm of the Upper
Abdominal Aorta and Replacement with Homograft. The proximal extent of Dean’s lesion was
greater than that in the Oakland case, but by modern classification both would be considered
Class IV thoracoabdominal aortic aneurysms.
183. Ravitch MM. A Century of Surgery, 1048–1050.
184. Ibid.
185. Ibid.
186. Ibid.
187. Ibid.
*
Gross did not lack for temerity—he had performed the first ductus case while still a resident in
1938. His chief, the renowned pediatric surgeon William Ladd (who did not think the operation
should be attempted) was out of town. Naturally this caper created an enduring rift between the two
great surgeons. The first ductus patient, seven-year-old Lorraine Sweeney, was still alive as of 2015,
by far the longest survivor of a cardiovascular operation. After retiring Gross revealed that he had a
congenital cataract and only had vision out of one eye from birth.7
*
Oudot was also a world-class mountaineer and was the physician on the French team that was
the first to scale the Himalayan mountain Annapurna, also in 1950.10
†
Oudot chose a retroperitoneal approach, in which the contents of the abdomen were rotated to
the right to expose the arteries in their posterior anatomic location. This rendered the anastomosis of
the right iliac limb difficult, and it later thrombosed, probably from technical reasons. The
resourceful Oudot fixed the problem by attaching a new graft from the left limb to the right—
history’s first “extra-anatomic” bypass. Tragically, Oudot was killed in an auto accident while driving
to the Alpine resort of Chamonix in 1953.11
*
Some accounts of this case have suggested that Cooley’s surgical technique on the aorta
—“lateral aortorrhaphy”—was somehow unknown to DeBakey or beyond his capability, but—as
noted—he had performed a similar procedure, albeit ligating the base of the aneurysm only, in
Houston in December 1948, a year and a half prior. Alton Ochsner had also reported lateral
aortorrhaphy for thoracic aortic aneurysm in 1944, as had Andre Meyer and Olivier Monod from
Boucicault Hospital in Paris in 1948. DeBakey and Cooley presented a series of six such cases—
including the December 1948 instance—at the Southern Surgical Association Meeting in Hot
Springs, Virginia, in December 1951. The accompanying paper was published in the Annals of
Surgery the following May.26
*
Syphilitic aneurysms were distinguished from those due to atherosclerosis by several features:
they arose in younger patients, were almost invariably in the thoracic aorta, tended to be saccular
(bulging out of the side of the aorta), and frequently caused erosion of the vertebra. Atherosclerotic
aneurysms, by contrast, typically appeared in older patients, were most often found in the abdomen,
generally were fusiform (spindle-shaped), and rarely caused bony erosion. Surgeons of the time
considered the leathery walls of syphilitic aneurysms to be easier and safer to sew than the fragile,
crumbling vessels of atherosclerotic lesions—this was the concern of Blakemore and others in the
application of graft replacement techniques to atherosclerotic aneurysms.
*
Sheriff Allman lived a normal life in Humboldt, Kansas, until he developed lung cancer in 1962.
He then returned to Houston and underwent left pneumonectomy by DeBakey at Methodist Hospital.
Allman survived another 5 years before dying from rupture of his aorta below the 1952 homograft
repair in May 1967.37
*
The American Surgical Ass ociation is the oldest and most prestigious of the surgery
organizations in the United States. DeBakey had been elected to the Association in 1946, at the very
young age of 37. Alton Ochsner had been one of his sponsors. In gratitude, DeBakey wrote Ochsner:
“Again I find myself in what has now become an old position for me and that is, in your debt, for I
realize that I owe this honor to you. This is true not only from the immediate standpoint of your
sponsorship but also from the standpoint of my development which may have led up to it. It is
difficult for me to express adequately my grateful appreciation. I can only do so by my unbounded
loyalty and devotion which I am sure you understand.”40
*
The experimental heterografts either occluded or rapidly degenerated into aneurysms. It is not
known what became of the heterograft patient. Human arterial homografts were, in fact, used for
arterial replacement in the Korean War (where there was an immediate source of supply).43
*
DeBakey said he had wall units for his study and bedroom and—apparently forgetting about
Diana and the boys—said that that was all he needed! 50
*
Gibbon explicitly acknowledged his use of DeBakey’s pump in a paper read before the
American Surgical Association in 1951, “Recent Advances in the Development of a Mechanical
Heart and Lung Apparatus.”62
*
In the era before the Salk and Sabin vaccines, poliomyelitis was a dreaded diagnosis and was
known to spread most commonly in the summer. Texas frequently led the nation in the number of
cases of polio, and Harris County typically led the state. The summer of 1952 was the worst, with
more than 1,000 cases in the county. In a large-scale trial in July injections of gamma-globulin—
which had been effective in cutting the death rate from measles—were given to some 35,000 children
in Harris County. Disappointingly, the conferred immunity from these injections only lasted a few
weeks.66
*
Shiker, Raheega, and Selina still lived in Lake Charles at this point, and DeBakey had visited
briefly in May, also taking the opportunity to give a talk on the new technique of aortic aneurysm
repair for the local physicians.76 At this time Lois and Selma were working at Tulane and the
Ochsner Clinic in New Orleans and Ernest was in practice in Mobile.
*
The neurologist John Ramsay Hunt had made a similar suggestion in 1913, but, since surgical
techniques were not advanced to a level to consider applying his postulate to clinical scenarios, it
faded.80
*
A third assistant was noted on the operative note as “Cody.” There was no resident by that name
at Baylor in August 1953. This may represent a transcription error of the name of resident Van G.
Kaden.
*
None of the principles involved recorded whether DeBakey mentioned his own prior carotid
endarterectomy from nine months before. A letter from Eastcott’s colleague Charles Rob to DeBakey,
dated December 8, 1954, suggests that while the case was presented to the Americans, they were
likely not on hand for the actual operation: “I enclose a reprint which describes the case on internal
carotid artery occlusion which I showed you at S. Mary’s over last summer. We were able to deal
with it successfully and I thought this might interest you.”87
†
Interestingly, the Iraqi trainee Yousif Al-Naaman also assisted on Cooley’s case.
*
In 1975, DeBakey finally published a complete case report of the first carotid endarterectomy in
the Journal of the American Medical Association. Carter had lived 19 years after the carotid surgery
and died of a myocardial infarction in 1972.94
*
McCormick died in 1954 and was replaced by Theodore Klumpp, President of Winthrop-
Stearns, Inc., of New York.98
†
NRC Committees of which DeBakey was a member at this time included the Executive
Committee as well as those on Medicine and Surgery, Veterans Medical Problems, and Vascular
Surgery.
*
Hoover lived in this suite, in part, from 1933 until his death in 1964.
*
By definition, an aneurysm is an abnormal dilation of a blood vessel which involves all three
layers of the wall: the intima, media, and adventitia. A pseudoaneurysm, or false aneurysm, is a
similar lesion which does not.
*
Oddly, DeBakey’s Presidential Address from this meeting appears to be lost. Even the topic is
unknown. Most of the papers from the conference were published in the journal Surgery, but
DeBakey’s address is not among them. The program for the 1954 meeting does not give the title of
the address. Harris Shumacker of the SVS made a determined search for the speech while compiling
his history of the organization in the 1980s, but neither DeBakey nor his secretarial staff could find
any information in his voluminous office or home records. Moreover, neither DeBakey himself nor
any of the surviving members who attended the 1954 conference were able to recall the title or
subject matter.130
*
In his description of the event for the history of the American Surgical Association, Mark
Ravitch stated, “It was obvious that the membership had not much experience with the treatment of
the lesion.”136
*
Harris Shumacker was an invited discussant at the presentation of this paper and remarked, “ I
am afraid that most of us, including those of us who had been long interested in vascular
replacement, paid entirely too little attention to [the first paper] and did not attribute to it the
significance that this work merited.”147
*
The quoted interview occurred on June 15, 1972. In later recollections DeBakey related the story
somewhat differently: “I used to go downtown to the department store to buy a yard of cloth. And the
first time I went down there, I wanted to get Nylon. And they had run out of Nylon, and they said we
have a new material called Dacron, you want to try that? They didn’t know what I wanted it for”
(April 6, 1992).165 His son Michael offers up an entirely distinct description of the events: “There are
of course innumerable stories about Dad, some of them having become almost legends now. One that
is told and often printed, almost as a legend, is not really true. The story told and written about
frequently was that in the mid-50s when Dad was working on aorta bypasses to eliminate aneurysms,
he drove downtown to a large department store, Foley’s, and asked the sales lady for some good
material. She recommended a new material called ‘Dacron’ and Dad bought some and took it home
and on mother’s sewing machine made his first Y-shaped bypass material. The truth of the matter is
different. One Sunday, when I was at home in Houston visiting from college, Dad asked me if I had
any ‘wash ’n’ wear’ material. I told him that I had just been in New York and had purchased a pair of
Dacron boxer shorts at Brooks Brothers, to use on my travels. He asked to see them, promptly took
my mother’s scissors and cut out two Y-shaped pieces, and then sat down at my mother’s sewing
machine and sewed up the Y-shaped patch. He gave me back the pieces and said ‘I’ll get you some
more,’ and promptly left the house and drove over to the Baylor labs, where he arranged to have it
placed in a dog as an experiment. That was the beginning of the aorta bypass patch for aortic
aneurysms. It should be noted that I never got the shorts replaced. I guess Dad did not want to
mention his experiment was initially made out of his son’s shorts, and so the legend was born.”156
*
DeBakey later confirmed that this was actually true.
*
In actuality the aorta was too degenerated at the level of the celiac artery to be clamped without
disintegrating, and this vessel was not included in the retrograde perfusion through the shunt.
†
A similar aneurysm procedure had been performed in September 1954, at the Oakland,
California, VA Hospital. This aneurysm did not involve the right renal artery, however, and the left
kidney was removed. The report was not published until December 1955.182
*
Ernest DeBakey was assigned to this unit through the auspices of General Rankin in early 1945.
7
Houston: 1956–1960
Decadus Mirabilis, Part Two
Full many a flow’r is born.
7.1 Open Hearts

Over millennia, the heart has been held in special regard by a steady
succession of human societies and cultures. Aristotle, whose ideas
dominated Western thought for centuries, regarded it not only as the source
of heat, sensation, and movement in the body, but as the seat of intelligence
as well. Countless philosophers have echoed or cautiously refined that view.
Later generations of poets and artists depicted the heart as a symbol of love
and, by not much extension, humanity itself.
Physicians have viewed the heart as no less sacrosanct. The surgeons of
antiquity and up to the Victorian era realized that any effort they made to
address anatomic derangements of the heart, acquired or congenital,
inevitably met with disaster. As other organs and systems gave way to the
advance of scientific surgery in the twentieth century—even the brain,
realized for its true position of prominence—the heart remained virtually
untouchable. This was in the face of growing diagnostic sophistication and,
with it, an expanding grasp of the wide breadth of grievous diseases that
could assail it. An entire new medical field, cardiology, emerged with this
understanding. Although the pharmacopeia and other noninvasive methods
proved to be of immense value in the management of many of these
ailments, others were beyond such means. Many of the newly understood
diseases proved to be of purely anatomic origin, such as valvular stenoses
and insufficiency, as well as septal defects in the atria and ventricles.
Medicines could be palliative in many instances, but true cure would
require surgery.
Halting steps were taken in cardiac surgery in the 1920s, with efforts at
correcting mitral valve stenosis, a dreaded complication of rheumatic fever,
but they had enormous mortality rates and ushered in no widespread
blossoming of the field.*,1
The problems with operating on the interior of the heart in its physiologic
state were as difficult to overcome as they were easy to identify. It was a
moving target—constantly beating—and stopping its motion frequently
stopped it forever; it was obviously full of blood and could not be opened
without the risk of devastating hemorrhage; and—perhaps most daunting—
any manipulation at all could induce a fatal dysrhythmia. It was clear that if
surgery were ever going to address these structural cardiac diseases then
replacing the function of the heart long enough to work on it was going to
be necessary. In the meantime a few ingenious techniques were devised to
allow intrepid surgeons access to the inside of the most surgically
unforgiving of organs.
In Boston Robert Gross began repairing atrial septal defects by means of
an apparatus known as the Gross atrial well. The right atrium itself was
opened—while the heart was beating—and a rubber funnel sutured to the
opening. This created a pool, or well of blood, which became the isolated
working area for the surgeon. The defect was then closed with a suture line
performed by palpation under the surface of the well.*2
Another approach involved induced hypothermia and temporary
occlusion of the inferior and superior vena cavae—the two main veins
returning blood to the heart. In these circumstances, surgeons had about 10
minutes to work inside a mostly bloodless heart. That was enough time to
repair simple lesions like small atrial septal defects. The risks, however,
were considerable.
Inflow occlusion with hypothermia was first attempted at the University
of Minnesota, where a determined effort at advancing open-heart surgery
was under way. The main instigator of these efforts was C. Walton Lillehei,
who came up with yet another ingenious but startling technique known as
cross-circulation.4
In the early 1950’s, several labs other than Gibbon’s were actively
working to develop the heart-lung machine that he finally made a reality.
One of these was in the surgery department at Minnesota. On a particular
night, Lillehei was discussing the issues involved in cardiopulmonary
bypass with a resident whose wife happened to be pregnant. During the
discussion the physicians realized with a jolt that the wife was her fetus’s
oxygenator. Perhaps the same prenatal physiology could be temporarily
arranged after the birth of a child, in particular one with surgically
correctable cardiac defects.5 Experiments were performed on dogs in which
blood was pumped from the veins of a smaller animal (the experimental
patient) into the veins of a larger one (the “oxygenator”) and arterial blood
also exchanged, in reverse order. The daring technique worked, and soon
Lillehei was performing “cross-circulation” operations with success, using a
parent of the sick child as the oxygenator. The procedure allowed something
closer to an hour of open heart operating time, which was enough to permit
more involved repairs such as ventricular septal defects and the complex
anomaly known as tetralogy of Fallot (which Lillehei was the first to
correct successfully).6 The technique aroused great interest but was never
adopted by other clinics; the main concern was the real and frightening
possibility of 200% operative mortality—death of both the parent and
child.* By this time—1955—cardiopulmonary bypass machines were
nearing the point of broader clinical application, anyway, and such
hazardous methods were no longer necessary.
Gibbon’s first successful use of his heart-lung apparatus in May 1953
was, unfortunately, followed by two cases in which the patients did not
survive. Counting the first death before his lone success, that amounted to a
75% mortality rate. A disconsolate Gibbon decided not to continue with the
machine despite having devoted nearly two decades to its development. The
torch was picked up, however, by the active group at the University of
Minnesota in Minneapolis and another aggressive team at the nearby Mayo
Clinic in Rochester.†
The surgeons at Mayo, led by John Kirklin, directed the engineering
department to construct a modified version of Gibbon’s complex device,
which had been built in conjunction with technicians from IBM.8 In
Minneapolis, however, Lillehei and his colleagues, in particular a lab
resident named Richard DeWall (who had also worked on the cross-
circulation experiments) decided to take a different tack.
In Gibbon’s design the blood was oxygenated by thinning it out into a
film as it flowed over vertical stainless steel screens in the presence of
oxygen. The process was effective but in actual practice proved to be
awkward and expensive. DeWall instead built a bubble oxygenator, a
variation of a device originally invented in the 1880s.9 In this machine the
blood was combined with oxygen, as the name implies, by injecting into it
bubbles of the gas. Some of the diffused oxygen then combined with
hemoglobin molecules, which was the goal, but some remained in bubbles,
creating a foam. Obviously the blood could not be returned to the patient in
that state, but DeWall conceived a clever means of removing the bubbles
from the foaming blood. In the final design, venous blood was pumped
from the patient into the bottom of a vertical tube, where the oxygen mixing
occurred. The foaming blood ascended the tube, then spilled into a chamber
containing a steel sponge coated with the Dow Corning chemical “antifoam
A.”10 This took care of most of the foam, but DeWall added a tube coiled
into a helix through which the blood then descended, losing the rest of the
bubbles (at least the visible ones) before being pumped into the patient’s
arteries. Soon he had a working prototype backed by numerous successful
dog experiments. In May 1955, Lillehei used the new machine on a human
patient for the first time.13 Before long he began to pivot from his cross-
circulation technique to the DeWall bubble oxygenator cardiopulmonary
bypass machine.
In that year, the only centers in the world doing regular open heart
procedures were located 60 miles apart, at the Mayo Clinic and the
University of Minnesota. A steady stream of surgeons from around the
world began to pass through the two institutions to observe the goings on,
like pilgrims on the Hajj. One of these was Denton Cooley of Baylor
University.
On his return to Houston, Cooley had been charged with building a
cardiac surgery program at Baylor, and he had made considerable progress.
He directed a number of research projects, with their attendant presentations
and publications, but from the start Cooley was mainly a clinical surgeon.
Not long after arriving at Texas Medical Center he had performed the city’s
first Blalock-Taussig shunt, the “blue baby” operation which he had
witnessed in its first, dramatic application at Johns Hopkins. He had also
begun doing the operations devised by Robert Gross for coarctation of the
aorta and patent ductus arteriosus. Cooley operated on a large number of
cases of mitral and even aortic valve stenosis, as well.14 These were all
cardiac and thoracic vascular procedures that could be performed without
cardiopulmonary bypass. Naturally, Cooley was champing at the bit to join
the fray when he learned of the progress being made in true open heart
surgery by Kirklin and Lillehei in Minnesota.* With DeBakey’s approval
and the help of some technicians he had started experiments in creating his
own heart-lung device but had not made much progress. Cooley decided to
visit these two neighboring centers to evaluate their methods and see what
might make sense to adopt at Baylor. He went in June 1955.
At the University of Minnesota, Cooley was able to witness Lillehei
repairing a tetralogy of Fallot using cross-circulation (for one of the last
times). Even more impressively, he got a look at DeWall’s bubble
oxygenator. The machine had only been used twice by this point, and
Cooley did not get to see it “in action” in a human patient, but it showed
great promise and the enthusiasm of the surgeons was palpable. The
simplicity and relatively low cost of the mechanism were particularly
appealing.16
Cooley also visited Kirklin and observed surgery employing the Gibbon-
Mayo heart-lung machine. The proceedings were impressive, too, but
Cooley recognized that this apparatus was very complicated and would be
prohibitively expensive to duplicate.17 The DeWall-Lillihei bubble
oxygenator, on the other hand, was straightforward in both use and design,
and the component parts that were not already lying around the Baylor
surgery research labs probably could be found at a hardware store. The
take-home message from Cooley’s Minnesota sojourn was trifold and clear:
working heart-lung machines were on the scene, open-heart surgery was
now a reality, and the path of least resistance to starting a program at Baylor
would be the bubble oxygenator.*
Back in Houston work resumed on construction of Baylor’s own heart-
lung machine, but with a new vigor and clear direction. The model was the
DeWall device, and the first version in Houston was essentially a copy (in a
few years commercial versions of the University of Minnesota apparatus, as
well as the Gibbon-Mayo machine, would be available so that other medical
centers would not be forced to build their own).18
By the spring of 1956, the Baylor surgeons were ready to try out their
new machine. Although the vast majority of open-heart surgical cases done
in Houston during the first few years of cardiopulmonary bypass were
children with congenital heart disease, the first was an adult (Figure 7.1).
Figure 7.1 The Baylor bubble oxygenator.

A 49-year-old man was admitted to the Methodist Hospital on March 30,

1956, with congestive heart failure and a recent history of myocardial
infarction. The patient’s story and his physical exam suggested that he had
developed a rupture of the muscular septum in the heart that separates the
ventricles. This complication of heart attack was not rare, but it was
frequently fatal and poorly responsive to medical therapy. Surgery was the
only real chance. Cardiac catheterization confirmed the diagnosis, and
Cooley took the patient to the operating room on April 5. The patient was
placed on cardiopulmonary bypass without difficulty, and the right ventricle
of the heart was opened. A sizable defect in the interventricular septum,
about 2 by 3 centimeters, was clearly visible. Cooley opted to close this
hole with a piece of Ivalon sponge, suturing the plastic cloth to the edges of
the defect. Once the two holes in the heart—the septal rupture and the
surgical ventriculotomy—were closed, the patient was brought off the pump
without difficulty.20
Unfortunately, this patient died a few weeks later, after one of the sutures
in the septal defect closure came out, so the operation could hardly be
touted as a resounding success. However, the bypass part of the procedure
had gone smoothly, and this accomplishment drove home, in unmistakable
terms, the fact that at Baylor a powerful new weapon in the fight against
cardiovascular disease was at hand.
By the following summer the Houston group had performed more than
300 open-heart operations.21 Although most of these were done at the Texas
Children’s Hospital, all the Baylor-affiliated facilities were involved:
Methodist, Jefferson Davis, and the Veterans’ Administration (VA)
Hospitals.* Since there was only one heart-lung machine at first (within a
year another was built) the nascent pump team was called upon to shuttle
their precious and fragile apparatus between the facilities on a regular basis.
In one instance the bubble oxygenator was even loaded up and taken to Fort
Sam Houston for a case at the Brooke Army Hospital, where Cooley had a
special appointment.23
After acquiring some experience with its use, the surgeons and
technicians at Baylor—mainly Cooley—elected to make some
modifications to the DeWall-Lillehei bubble oxygenator design. It was felt
that stainless steel construction, which would allow for autoclaving between
cases and thus quick turnaround time, would be an advantage over the
DeWall plastic tube design (even though one of the selling points of the
original model had been its economical disposability).24 Some Baylor
iterations also featured DeBakey-type roller pumps rather than the
Sigmamotor mechanism. By 1957, the differences of the Baylor heart-lung
machine (affectionately referred to by the surgical teams as “the coffee
pot”) were considered significant enough by some to warrant its
independent manufacture and marketing. The “Cooley Oxygenator” was
produced commercially by the Mark Company of Randolph,
Massachusetts.25 Although the manufacturer did not sell many units of this
machine, in later years DeBakey regretted even allowing its production by
that name.
Actually it’s not right to call it that, and it shouldn’t have been called that. Because he really
didn’t develop it. It had already been developed and what we did in our laboratory is build a
little modification in the way it was put together.26
7.2 Ascending
After the onslaught of the postwar vascular surgeons, with DeBakey and
Baylor leading the way, by 1955, physicians could address most of the
aortic aneurysms they encountered using permanently curative surgical
methods. Most, but not all. The final frontiers were the ascending aorta and
the aortic arch, those critical first several inches of the vessel after its origin
at the left ventricle of the heart. None of the techniques developed and
deployed with such skill and determination to address aneurysms of the
abdominal or descending thoracic aorta was of use in this anatomic region.
It was true that tangential excision and lateral aortorrhaphy worked in
cases where the aneurysm was localized and saccular, even in the ascending
aorta, but the technique was useless in fusiform aneurysms. Such an
approach was also out of the question in the arch, where all the main arterial
branches to the arms and brain begin. The only solution for this area (given
the technology of the era) was complete resection of the aneurysm and
replacement by a graft.
This was just the approach that had succeeded in the abdominal and
descending thoracic aorta, of course. The problem was that, as with
thoracoabdominal aneurysms, simply clamping the aorta to remove a
segment and replace it with a graft would necessarily deprive vital tissues
and structures of blood and, especially, oxygen. As we have seen, DeBakey
had actually tried that method with an aneurysm of the visceral segment of
the abdominal aorta and found out the hard way that the kidneys could not
tolerate such an insult. No one needed to speculate on how the brain would
respond to 30 or so minutes without oxygen.
The Baylor group’s response to the thoracoabdominal problem had been
to develop the technique of temporary shunting to the visceral arteries and
to the aorta below the lesion. This, combined with cleverly manipulating the
clamp to minimize the time any single organ was ischemic, had worked
well. Naturally they were eager to try a modification of the method in the
forbidding case of an aneurysm involving the entire aortic arch. In 1955,
DeBakey and Cooley managed to resect such a lesion using a combination
of shunts and induced hypothermia. They performed the operation without
the blood thinner heparin, however (as was common at the time), and one of
the shunts—to the right carotid artery—thrombosed during the case. The
patient suffered a stroke from this and did not wake up after the operation.
He died six days later. They tried two more such operations, but neither
patient survived.27 Enthusiasm for the multiple-shunt technique in
aneurysms of the aortic arch was effectively quashed.
When the Baylor heart-lung machine came online, however, DeBakey
recognized an opportunity. He conceived a new plan that might allow
resection and graft replacement of aneurysms of the ascending aorta, the
arch, and more. In the mid-summer of 1956, he got a chance to put it to the
test.
On August 18, 50-year-old Warren M. Harrell was admitted to Jefferson
Davis Hospital with chest pain. The most significant finding on physical
exam was a pulsation on the right side of the thorax near the top of his
sternum. X-ray studies, including catheter angiography, confirmed an
aneurysm of the ascending aorta. Harrell tested negative for syphilis, but he
did have an interesting story to tell from a quarter-century past. Unlike most
such patients, Harrell knew all about his aneurysm. He said that it had been
diagnosed when he was 32 years old, seven years after he was kicked in the
same spot by a horse.
Whether the horse was the culprit was debatable, but what was not open
to question was the need for surgery: Harrell’s aneurysm measured a
startling 9 centimeters in diameter on x-ray, and the increasing pain was a
grim harbinger of impending rupture. No operation for aneurysm of the
ascending aorta had ever been performed successfully, but DeBakey and
Cooley had something the previous surgeons did not: the coffee pot.
On August 24, 1956, Harrell was taken to the operating room at Jefferson
Davis Hospital. The pump crew dutifully transported the bubble oxygenator
and pumps across town. In the early days these pumps had to be primed
with a dozen or more units of fresh blood, and often much of the day was
spent collecting this from suitable donors before the case could begin. After
the collection was complete and the bubble oxygenator primed, surgery
commenced.
DeBakey and Cooley entered Harrell’s chest by dividing the sternum and
the muscles between the fourth and fifth ribs on the right and the third and
fourth on the left. They surveyed the aneurysm. It involved the entire
ascending aorta, from just above the takeoff of the coronary arteries to the
origin of the innominate artery. The surgeons did not feel they had enough
normal aorta to clamp proximal to the innominate, so even though this
vessel would not be included in the repair they had to occlude it for control.
They put Harrell on bypass, placing two arterial return catheters, one into
the abdominal aorta through the right femoral artery—which would provide
blood flow to everything from the left common carotid artery down—and
another in the right common carotid artery, to perfuse that side of the brain.
In this case they gave the patient heparin. Then they secured two clamps on
the aorta: one just above the coronaries and one between the innominate
and left common carotid arteries. Last they put a clamp on the innominate
itself. DeBakey and Cooley then resected the aneurysm and sutured a
frozen homograft of the same segment in place (Figure 7.2).
Figure 7.2 Operative photograph and diagram from first successful repair of aneurysm of the aortic
arch, August 24, 1956.
Ten minutes after cardiopulmonary bypass was initiated Harrell’s heart

stopped beating.* DeBakey and Cooley did not have much choice but to
ignore the heart while they worked on the graft. They were naturally
concerned that it might be suffering ischemic damage during the operation
—their proximal clamp almost certainly obstructed the coronary arteries,
and, even if it did not, once the heart stopped beating there was nothing to
push blood into them—but animal experiments had shown that the heart
usually could tolerate such periods if they were brief enough. Once the
surgeons removed the clamps—but while Harrell was still on bypass—they
squeezed his heart by hand: open cardiac massage. With this the heart
firmed up, but began fibrillating. The surgeons administered two electric
shocks, and, to everyone’s relief, the heart went into normal sinus rhythm,
beating vigorously. DeBakey and Cooley then removed the bypass cannulae
and repaired the entry sites. Finally, they placed temporary chest tubes to
keep the lungs from collapsing in the early postoperative period and closed
the incisions.29
Harrell had been on the heart-lung machine for just 31 minutes while the
surgeons removed the large aneurysm and replaced it with the homograft.
This would be exceptional alacrity in any circumstance, but given the stress
of the novel operation and the instruments and techniques available at the
time, it is a remarkable example of pure surgical talent. By this point in
their careers together, and for some time previously, when DeBakey and
Cooley operated in tandem their combined mastery of the technical
elements of surgery astonished onlookers, especially other surgeons. One
remarked that “they operate like the building is burning down around
them,” while another noted that observing them at work was, “like watching
an octopus operate. There were hands everywhere.”30
Harrell’s recovery was uneventful, and he was discharged from the
hospital three weeks after the operation. DeBakey and Cooley had another
first to announce. Their paper, “Resection of Entire Ascending Aorta in
Fusiform Aneurysm Using Cardiac Bypass,” was published in the
November 17, 1956, edition of the Journal of the American Medical
Association.31
The two biggest lessons the surgeons felt they learned from this case
were (1) that the heart could apparently withstand a protracted period of
ischemia during such a procedure while cardiopulmonary bypass was being
utilized and (2) that separate perfusion of the carotid arteries via the pump
oxygenator could prevent central nervous system anoxic injury. The first
lesson may just have been good luck, but the second point was both
justified and key because it led directly to renewed consideration of that ne
plus ultra of aortic aneurysm repairs: those that involved the entire arch.
7.2 Half a Loaf

On Cherokee Street Diana was busy keeping the big house and raising the
four boys who, by the mid-1950s, were all in school. In the pre-dawn hours,
she often had coffee while the husband she still affectionately called
“Michel” fortified himself with his own cup and his preferred breakfast, a
banana. After he left for his long day, which frequently stretched into the
next, Diana was careful to set a routine for their sons to follow. Dinner was
always at 6:30 PM, and anyone who missed it had to fend for themselves
(she kept a plate of fried chicken, a bowl of soup, or some kibbeh in the
refrigerator for whenever “Michel” might return). In addition to the
homemaking, she found time to create a Baylor Wives Auxiliary Club for
the spouses of the medical school faculty. Diana even supervised the
assembly of a cookbook containing the wives’ various recipes, which was
then sold to fund various projects and social events, often for the residents
and students at the medical center.32
Diana was scrupulously economical, like many who had endured the
Great Depression. She had no qualms about finding bargain basement deals
for any number of household items, and her equally frugal husband was
appreciative. The large house on its courtly boulevard was tastefully
decorated, but by no means ostentatious.
DeBakey’s home office was on the ground floor, adjacent to the foyer, a
few steps to the left of the front door as one entered. Despite this central
location, the inner sanctum was strictly off-limits to anyone but the
patriarch and was behind a door kept locked in his absence. The office
comprised two rooms, each with wood paneling and, like most of the rest of
the house, hardwood floors. The first room off the foyer was the site of
DeBakey’s custom desk. This was a unique piece, except for its near twin in
his office at the medical center. Built by the Baylor carpenters, the desk was
constructed entirely of live oak and was circular; encompassing 270 degrees
of surface space with a hollow center for his leather upholstered swivel
chair. The design of the desk allowed DeBakey to surround himself with
books, papers, correspondence, or other materials depending on the task at
hand (Figure 7.3).
Figure 7.3 DeBakey at his semicircular medical center office desk.

Beyond the front room was a larger library with extensive built-in
bookshelves and cabinets housing voluminous files and records of both a
personal and professional nature.
Diana had a key to the office, but only went in once a week to dust—she
never attempted to straighten up because, despite the sometimes chaotic
appearance of the many scattered items, her husband had his own sense of
order and did not want his work disturbed. For the children the office was
absolutely off-limits. Nevertheless, a 12-year-old Mickey found his
mother’s key one day, and the young man’s curiosity got the best of him.
The room was filled with papers, books, files and stacks of yellow legal pads and No. 2 pencils
that he kept by the dozen in a mug on the desk, with an electric pencil sharpener. He wrote
everything out in a very precise longhand in an incredibly legible script. I noticed that two
prominent books were on the desk, a well-worn Webster’s Dictionary and a book of synonyms.
It looked to me like it was an incredibly organized disorder, even with books and files on the
couch, but he knew where everything was. I was amazed at how much stuff he had accumulated
there, but there was nothing much of interest to a 12-year-old.33
After finishing grade school Mickey was enrolled at the prestigious and
elite Kinkaid School, a private institution that educated the children of
many of the city’s leading citizens. He did not flourish in the new
environment, though, and at the suggestion of his teachers continued his
secondary education at a boarding school in Colorado Springs, to much
greater success.
Diana generally bore her husband’s frequent and extended absences with
grace, but at times the strain of raising the four boys essentially by herself
could exceed even her good humor and boundless patience. In later
reminiscences the limited angst she was willing to convey revolved
primarily around the impact these absences had on the boys.
I know he is completely dedicated to his work. Everything else is secondary. I would like to
change it. I would like for him to be more interested in being with me and being with the
children and taking us all out. But he is not that way, and nothing is going to change him, so I
accept it gracefully and get along as best I can.
He has never been home for a birthday party. Never gone to a graduation. Never made a father-
son banquet with any of our four boys. It’s been rough on them. But I used to tell them, “You’re
helping your father. You are making a sacrifice. There’s your father, operating. You’d like to
have him here at your birthday party. But just think what you’re contributing to what he does.
You’re making a sacrifice. That’s pretty big of you.” That didn’t always register when they were
little kids.34
Diana always kept a seat open for her husband at the local Episcopal
Church services, where the boys were acolytes. He never came, though,
observing that when he was with his patients on Sunday mornings he was
truly at his church, doing, in his own words, “the Lord’s work,” which his
wife had to admit was essentially true.
Years later, in a story of remarkable poignancy, Diana recalled an
occasion in which DeBakey’s devotion to his work took a heavy, if transient
toll.
Our oldest son, Mickey, was getting his badge as an Eagle Scout in a program at school. His
three little brothers were in the front row, ready to clap real loud. We had saved a seat for
Michel, because the badge was supposed to be pinned on by the Eagle Scout’s father. I called
before we left the house to remind him of the time, but he was in surgery. I called again from
school and he was still in surgery, but they said “We think he is coming out any minute.” I said,
“The moment he comes out, tell him we’re waiting for him at school.” Its only six minutes from
the hospital.
The scout master got up and said a lot of nice things about Mickey, and finally he said, “Will
the proud father of this wonderful scout come forward?” We waited. Everybody waited. I can
see Mickey now, a skinny little guy with his hands behind his back and his head down. You
could see the tears dripping on his shoes. This terrible hush, this quiet, seem to go on for hours.
Finally the scout master’s assistant stepped forward and said, “I’m a very good friend of
Mickey’s, and it seems his father has been delayed. I would like to pin his badge on.” So he did.
After it was over Mickey couldn’t be found. I looked for him. Then I drove home. He was in his
bedroom, lying on the bed, sobbing his heart out. That just about killed me.35
For his part, DeBakey did not make excuses for his time away from
home: his dedication to the work of advancing medicine and surgery
amounted to a sacred task—“his church.” That did not mean that he was
immune or inured to the pain such a calling could inflict on his family
(Figure 7.4).
She had to endure many things alone, because I had to give my first priority to medicine and
surgery. So I wasn’t often around when she and our sons needed me. I used to feel guilty
because I couldn’t be with them, or had to leave them to go to the hospital. I know it was very
difficult for all of them. Diana was a rare woman to be able to cope with that, but she managed it
with humor and honesty.36
Even when she was willing to enumerate the challenges of life with a
driven surgeon for a husband Diana expressed a sympathetic affection,
coupled with resolute dignity.
It’s hard to live with sometimes, but he has a lot on his mind. He is under terrific tension. Every
operation that he does takes a lot out of him. I know it takes its toll on him. As for me, I think
half a loaf is better than none.37
Figure 7.4 The DeBakey family at Christmas in the home on Cherokee Street.
7.4 Lieutenants
As the reputation and scope of the Department of Surgery at Baylor grew in
the 1950s, the appeal of the program both to potential trainees and faculty
members likewise escalated.
In the academic year from July 1, 1950 to June 30, 1951, the Department
faculty and staff (independent of residents and interns) consisted of
DeBakey, Professor and Chairman; three Assistant Professors (Oscar
Creech, Alexander Brodsky, and B. W. Haynes); an Instructor (John
Howard); one secretary; and one technical assistant.38
By 1954–1955, this service had expanded to include, in addition to the
Chief, Associate Professors Denton Cooley, John Howard, and Oscar
Creech; Assistant Professors E. Stanley Crawford and John Overstreet;
Instructor Robert Overton; and more than a dozen secretaries and
technicians.39
The positions of many of the staff and some of the faculty were
supported through research grants and funds. As the decade unfolded, the
number of public and private sources funneling money into the Baylor
surgery research labs continued to multiply impressively.
The prominent Houstonian C. J. Thibodeaux provided funds through his
foundation for development of the Baylor open-heart surgery program,
helping to support both clinical and research activities. World-class x-ray
equipment was obtained through the generosity of another philanthropist
named Benjamin Clayton after his chauffer underwent successful vascular
surgery. More than two dozen other private benefactors made significant
contributions to the Surgery Department in the mid-1950s.40
Uncle Sam was even more lavish and benevolent to the Department.
DeBakey’s service to the Army during and after World War II continued to
ease the task of obtaining funding from the military. Several research
projects, mainly involving issues in trauma and shock, were supported by
Army grants into the middle part of the decade. Other grants from the US
Public Health Service, American Heart Association, and Houston Heart
Association funded numerous investigations into the many new questions
arising from the blossoming field of cardiovascular surgery.41
Proper financial support for well-considered scientific investigation is
essentially a recipe for discovery and innovation, and the Baylor Surgery
Department research labs were no exception. Scores of scholarly papers
streamed from the Departmental offices, along with invitations for
presentations of every ilk, from coast to coast and beyond. In the two-year
period from July 1955 to June 1957, the Department was responsible for no
less than 223 presentations at local, regional, national, and international
conferences.42
In a representative month from this period, April 1956, the following
presentations were given by members of the Baylor Department of Surgery:
April 12—DeBakey M. E., Creech O., Jr., and Morris G. C., Jr.: Aneurysm of thoracoabdominal
aorta involving the celiac, superior mesenteric and renal arteries. Report of four cases treated by
resection and homograft replacement. American Surgical Association, White Sulphur Springs,
West Virginia. [This was the seminal presentation of the new techniques applied to hitherto-
incurable aneurysmal anatomy noted in the previous chapter.]
April 16—Usher F. C.: Use of lyophilized homografts of dura mater in the repair of inguinal
hernias. Southwestern Surgical Congress. Tucson, Arizona.
April 17—DeBakey M. E.: Aneurysms of the aorta and segmental occlusion of the aorta, iliac
arteries, and femoral arteries (Panel Discussion). American College of Physicians, Los Angeles,
California.
April 17—Morris G. C., Jr., Creech, O. Jr., and DeBakey M. E.: Acute arterial injuries in
civilian practice. Southwestern Surgical Congress. Tucson, Arizona.
April 18—Tuttle L. L. D., and Gordon W. B.: Functioning tumors of the adrenal cortex.
Southwestern Surgical Congress. Tucson, Arizona.
April 18—Cooley D. A. Cardiology (Panel Discussion). American Academy of Pediatrics.
Houston, Texas.
April 18—Cooley D. A. Aneurysms of the aorta during infancy—surgical treatment.
American Academy of Pediatrics. Houston, Texas.
April 18—DeBakey M. E.: Reparative surgery in the treatment of arterial disease. Sacramento
County Medical Society, Sacramento, California.
April 19—Couves C. M., Beall A. C., Crawford E. S., Moyer J. H., and DeBakey M. E.
Technical factors that alter renal function in translumbar arteriography. Federation Proceedings,
Atlantic City, New Jersey.
April 22—Cardiac surgery in the newborn. Texas Heart Association, Galveston, Texas.
April 22—DeBakey M. E. Diagnosis and therapeutic considerations of dissecting aneurysms
of the aorta. Texas Heart Association, Galveston, Texas.43
Through these mechanisms, formally academic but inherently publicized,

word continued to spread ever further and wider about the work being done
at Baylor. Many of the articles and presentations were delivered or co-
authored by residents or junior faculty. Naturally the burgeoning curricula
vitae of these individuals were noted by search committees in other
academic medical centers, especially those who were looking to tap into the
cardiovascular surgical magic that was unfolding in Houston.
John Howard, who had returned from a two-year stint in Korea in 1953,
was recruited to become Whitehead Professor of Surgery at Emory
University in Atlanta in the summer of 1955.44 Howard was a respected
clinician and researcher particularly noted for his interest and skill in
surgical education, and he would be missed.*
An even heavier blow came with the departure of Oscar Creech in July
1956.
Alton Ochsner, who turned 60 that year, was retiring as Chair of Surgery
at Tulane. He was not about to quit working, but the university had rigid
and rather antiquated rules—not uncommon in academia at the time—
regarding age-based forced retirement. The Ochsner Clinic, its tense-but-
symbiotic relationship with the medical school in full force, continued to
flourish and grow. Its namesake would continue his work there.
Tulane initially approached DeBakey about succeeding his old mentor.
Since he was an alumnus of not only the undergraduate and medical schools
but also of the surgery residency—and had, of course, also been a faculty
member, DeBakey was an obvious choice for the Tulane administration to
pursue. The fact that he had achieved first-rank academic status in his own
right was paramount. That he had done it by lifting an entire medical center
into notoriety and prominence, nearly single-handedly, made him all the
more attractive. DeBakey, though, did not seriously consider the offer. In
fact, he followed the example of Ochsner himself in an ironic parallel. Like
his mentor, who did not feel he could leave a New Orleans that had done so
much for him when the new Texas Medical Center came calling at the close
of World War II, DeBakey believed that his own accomplishments in
building Baylor surgery from scratch necessitated that he stay in Houston to
see the job through.45
Creech, himself also a Tulane alumnus, was the school’s ultimate choice.
He had made a name for himself as co-author on several of the important
papers on cardiovascular surgery that had come out of the department and,
in his seven years there, had risen from Instructor to Associate Professor of
Surgery. He was also a prominent figure in the Society for Vascular Surgery
(SVS), where he led the systematic investigation into prosthetic arterial
substitutes. Creech’s role in developing the residency programs at Jefferson
Davis and the VA Hospitals also made him a promising choice to succeed
the great educator Ochsner. In the careers of academic Chiefs there are
perhaps no more satisfying events than the leave-taking of subordinates to
become leaders of other departments. Although Creech was not technically
DeBakey’s trainee he was certainly a protégé, and the honor of his
appointment in New Orleans was lost on no-one in Houston.
Two new members joined the faculty around this time. One was James
McMurrey, a native Texan who had trained in surgery at the prestigious
Peter Bent Brigham Hospital. He had a special interest in the expanding
field of fluid and electrolyte physiology. Another Texan, George C. Morris,
Jr., was a medical graduate of the University of Pennsylvania. He had taken
his training in surgery at Baylor and was thus well known to all. After two
years in the military, Morris returned to Houston in July, 1956 as an
Instructor in Surgery and Assistant Chief of Surgery at the VA. He had
already been a co-author on the memorable first thoracoabdominal aortic
aneurysm paper and earned the John and Mary Markle Foundation
Fellowship in 1957. This was a much-coveted five-year grant to help
aspiring academic physicians pursue research work in the early years of
their career.46
In late May and early June 1956, DeBakey spent the better part of two
weeks in Hawaii (at the time still a US territory). It was probably the closest
he came to having a vacation in the entire decade, and he did take some
time to visit Maui and go deep-sea fishing (Figure 7.5). However, he also
gave no less than 11 presentations on thoracic and vascular surgery—
lecturing nearly every day—mostly to the Honolulu County Medical
Society.47
Figure 7.5 Working vacation in Hawaii, 1956.

7.5 Triumph of the Arch
When a 56-year-old carpenter by the name of Bryde Mitchell was admitted
to Methodist Hospital on March 12, 1957, he was met with battalions of
comforting smiles from the experienced staff. Those sympathetic faces soon
masked well-deserved trepidation. Mitchell was harboring a large aneurysm
of the thoracic aorta, the late result of a treated case of syphilis from nine
years before. The aneurysm was enlarging and causing him pain, and
arteriography after admission confirmed the worst fear: the aneurysm
involved the ascending aorta as well as the arch, including the origins of the
innominate and left common carotid arteries. Everyone at Methodist knew
that DeBakey had tried three times to replace aneurysms of this region, and
all three patients had died. No one needed to remind the Chairman about
this, of course, but he had a new plan of attack—born of the busy new
Baylor pump oxygenator.
In the three previous failed attempts, DeBakey had created temporary
shunts of plastic fabric from the native aorta to the carotid arteries to
provide blood flow to the brain and prevent stroke in addition to placing
separate shunts to perfuse the lower body and abdominal organs. In his new
plan, he determined to do exactly the same thing, but to use the output of
the cardiopulmonary bypass machine to provide oxygenated blood to the
isolated tissues and organs, instead of the patient’s aorta.
The operation took place on March 21. After opening the chest, the
surgeons placed Mitchell on bypass. They positioned return catheters from
the oxygenator in the innominate artery to feed the right arm and that side
of the brain, the left common carotid artery for the left side of the brain, and
the right femoral artery to perfuse everything distal to the left subclavian
artery. That artery and its branches, including the left vertebral artery, did
not receive direct perfusion in this configuration. Next, they clamped the
aorta a few centimeters above the take-off of the coronary arteries, then
distal to the left subclavian artery. Following this, they clamped the
innominate, left common carotid, and left subclavian arteries. The surgeons
then excised the isolated arch and replaced it with a freeze-dried analogous
homograft. They sewed the graft in with 4-0 running silk sutures—the distal
aortic anastomosis being performed first, followed by the left common
carotid, the innominate, and, last, the proximal aorta (Figure 7.6). Then they
removed the clamps and took the patient off bypass. The total pump time
was an impressive 43 minutes.
Figure 7.6 Operative drawing of first successful repair of aneurysm of the entire aortic arch, March
21, 1957.
To everyone’s enormous relief (not least his own) Mitchell’s

postoperative course was straightforward and without complication. He was
discharged 16 days after the operation and was back working as a carpenter
in a few months. The case was reported in the December 1957 issue of the
American College of Surgeons’ journal, Surgery, Gynecology and
Obstetrics, under the title, “Successful Resection of Fusiform Aneurysm of
Aortic Arch with Replacement by Homograft.”48 The authors were
DeBakey, Crawford, Cooley, and Morris.
With this case and its subsequent report, the conquest of surgical disease
of the aorta was fundamentally complete. There were refinements to come,
to be sure—and eventually a revolution in the whole approach to surgery of
the blood vessels when technology advanced far enough—but, by late 1957,
the main aortic diseases of atherosclerotic occlusion, aneurysm, and
dissection had yielded to surgical approaches in all anatomic locations.
These lesions, which had eluded the best efforts of surgeons for centuries,
had fallen one by one like besieged cities to an invading army—in less than
a decade. It was a worldwide effort by all means, but the Baylor
Department of Surgery under the leadership of Michael DeBakey
accomplished most of the seminal work in conquering these diseases.
Rudolph Matas, DeBakey’s role model and mentor and, in the eyes of
many, the father of vascular surgery, passed away on September 23, 1957,
at the age of 97.49 Although he was in poor health in his tenth decade (and,
in fact, blind) he was well aware of the spectacular accomplishments being
made in vascular surgery in these halcyon years and, as noted earlier, was
especially proud of the role of his protégé DeBakey.
Closer to home—in more than one way—was the death of Mims Gage a
few months later. Gage had been “stricken” while at the Southern Surgical
Association meeting in White Sulphur Springs. He had, of course,
undergone successful aortic aneurysm surgery by DeBakey a few years
earlier. Now Gage returned to Houston for carotid endarterectomy. As John
Ochsner remembered it, “Unfortunately, Dr. Gage suffered a basilar stroke.
I was a lab year resident and I know how devastating it was to Dr. DeBakey.
While Dr. Gage lay in a coma, it would almost kill Dr. DeBakey to make
rounds and see his friend and mentor in that state. Mrs. Gage told me that
Dr. DeBakey told her he felt that he had failed her. Mrs. Gage said she felt
much more sorry for Mike than for herself because she knew everything
was done well and it hurt her to see Mike so distraught.”50
7.6 National Library of Medicine

After the report of the first Hoover Commission’s Medical Task Force gave
a somewhat half-hearted recommendation for converting the Army Medical
Library into a National Library of Medicine in 1948, nothing much
happened to make this actually transpire. Interested parties continued to
make well-reasoned public arguments in favor of such a move, as in the
Cooper Committee’s report and DeBakey’s paper and speech, “The Future
of the Army Medical Library,” but the necessary clout to actually do
anything was lacking. The aftermath of the Second Hoover Commission
was a different story.
Unlike the first report, the 1955 version had the Library as a prominent
point of focus, and after it was delivered DeBakey and others involved did
not sit back to see what would happen. This time they brought pressure on
legislators to act. One of these, Senator J. Lister Hill, did not need much
convincing.
Hill, a Democrat, was at this time Chairman of the Senate Labor and
Public Welfare Committee, which dealt with important legislation on
healthcare matters, among a number of other things.51 His father had been a
celebrated surgeon in their home state of Alabama and had named his son
after the great English pioneer of antiseptic surgery, Joseph Lister.52 Hill
had already made an important contribution to the nation’s healthcare
system with the 1946 Hospital Survey and Construction Act, known widely
as the Hill-Burton Act, which provided federal funding for construction of
hospitals. After the delivery of the Second Hoover Commission’s report
DeBakey took up a content-heavy correspondence on the topic of the
Library with William Reidy, a professional Senate staff member assigned to
the Labor and Public Welfare Committee and thus a man capable of
bending Chairman Hill’s ear.
In November 1955, DeBakey sent Reidy a letter lamenting his
unavailability for a Washington meeting on the disposition of the Library.
He went on to state with some passion that
I have been concerned with this problem for almost a decade and I have become convinced
(that) in many ways it constitutes the most significant factor in the furtherance of medical
science in this country. I cannot adequately emphasize the important function it could serve the
people . . . I consider it of such importance that I should be willing to devote any time or effort
toward its fulfillment.53
A few weeks later DeBakey followed this letter up with an even more
emphatic one. He had found out that the Armed Forces, aware that there
was a plan afoot to take away their medical library and turn it into a
national one, were lobbying Hill and others against the effort. The military
reasoned that its library was of great significance to the work of its medical
branch and a major source of prestige. At the same time, the Department of
Defense dropped funding for a new library building from its construction
budget!54 DeBakey’s response, sent on December 20, was that the
importance of the facility to the military doctors was trivial compared to its
value to civilian medicine, which made use of the Library to a far greater
degree, anyway. He went on to pinpoint the dilemma that had plagued the
Library for so many years.
On the one hand the Armed Forces have strongly opposed its transfer or release of its operation.
On the other they have been unable to justify its operation as a National Medical Library on a
military basis. As a consequence it has suffered badly from inadequate housing and its growth
and development have been severely hampered. In my opinion this dilemma can be resolved
only by courageous action of Congress.55
DeBakey continued by restating some of the recommendations he had

been making for years and, a few weeks later, sent Reidy a manifesto
summarizing these entitled, “The Need and Significance of a National
Library of Health.”56 Reidy thought DeBakey’s recommendations were spot
on and promised to share them with Hill and another Senator who was
planning to sponsor the proposed library bill, John F. Kennedy of
Massachusetts.*
Hill and Kennedy introduced the bill to establish a National Library of
Medicine, S3430, into the Senate on March 13, 1956.57 A companion House
bill, H.R. 11524, was sponsored by Representative Percy Priest of
Tennessee.58 Hearings began on April 10 in the old Supreme Court
Chamber in the Capitol Building, the same room where such cases as
McCullough vs. Maryland and United States vs. The Amistad had been
heard and where the Dred Scott decision was rendered.59
Kennedy testified first, reading the bill into the record. DeBakey also
appeared before the committee, along with other witnesses such as the
director of the library, Frank Rogers. DeBakey covered the same ground he
had in his letters to Reidy and in his speech to the honorary library
consultants on the future of the Army Medical Library in 1950. Hill, in
particular, was forceful and persuasive. There was no meaningful
opposition to the bill. It moved quickly out of committee to the floor of the
Senate, where it passed on June 11.60
The House turned out to be a very different matter.
As early as April 1, an editorial in the Chicago Tribune had espoused the
idea of locating the library in Chicago.61 This was not, on the face of it, a
ridiculous proposal. Chicago had a legitimate claim as the center of the
American medical community at the time, for reasons beyond geography.
There were five medical schools in the Windy City, along with some 100
hospitals. Many medical societies and journals had their headquarters there
as well, including the American Medical Association (AMA) itself. The
city’s vaunted political machine went to work, and, at the urging of the
influential editor of the Journal of the American Medical Association,
Morris Fishbein, Mayor Richard J. Daley formed a 19-member Chicago
National Medical Library Center Commission.62
The fight over the Library’s location came to prominence when the
Speaker of the House, Sam Rayburn of Texas, blocked quick passage of
Priest’s bill. Gumming up the works were no less than 11 separate
alternative bills introduced to the legislature providing for the library’s
location in Chicago. The House Administration Committee then took up
arguments on June 19. This panel was chaired by a representative from
Illinois!63
Rogers and other noted librarians made counterarguments to the Chicago
location, pointing out that such a move would be tremendously costly,
would separate the library from other national health endeavors in
Washington, and would require a new staff completely unfamiliar with the
collection and its operations.
By mid-July the congressional session was drawing to a close, and House
leadership began pressuring committee chairs to shut down consideration of
controversial bills. It was a Presidential election year, and the Democratic
Convention was due to begin in just a few weeks (in Chicago, of all places).
Rayburn and the other party leaders did not want any bones of contention to
splinter unity of the caucus as they prepared to choose an adversary for
Republican President Dwight D. Eisenhower. The library bill would have to
be shelved.
Hill, who was monitoring the House machinations with obvious interest,
was naturally horrified at this turn of events. Since Rayburn was from Texas
(he represented the fourth congressional district, northeast of Dallas), Hill
considered that the Houstonian DeBakey might know someone with
influence over him. Reidy contacted the surgeon and explained their
dilemma.
We needed to get someone to influence Rayburn to let him bring the bill up because we were not
afraid of a floor fight. We had the votes and we needed to persuade Rayburn to get it out. So he
wanted to know if I could get somebody from Texas to persuade Rayburn—who had some
influence with him. So I called a few of the people that I know in Houston and asked them--how
could we get to Rayburn? And they virtually told me there was no way. Nobody in Texas had
any influence with Rayburn.64
DeBakey then recalled that he had actually had lunch with Rayburn in
Washington some time before, at the behest of one Dorothy Vredenburgh,
the wife of a former patient. Mrs. Vredenburgh was the Secretary of the
Democratic Party. She was to become rather famous for her vote calls in the
televised national conventions over several decades. A few years previously,
DeBakey had performed successful aortic aneurysm surgery on her
husband, and the grateful couple had indicated that if Dr. DeBakey needed
anything, or was ever in Washington, he should call on them. On such an
occasion Mrs. Vredenburgh had taken DeBakey to dine with Rayburn in his
office.
Now DeBakey contacted Mrs. Vredenburgh again.
I called her on the phone on a Sunday night. I’ll never forget. I said, “Dorothy, I hate to bother
you about this, but I think you can help us. I think you could do a great service to this country.” I
told her about it. Gave her the background on the library bill and so on. And I said, “All we need
to do is to get Rayburn to let this bill come up.’’ And she said, “Well, Mike, I don’t know
whether I can do it, but I sure will try.” And she did. And the next morning Reidy called me and
he said, “I don’t know how you did this, but I’m going to tell you this. Rayburn is going to let
this thing come to a vote.”65
Freed from legislative limbo, the bill was quickly passed by voice vote.
Notably, the bill did not specify the location of the library. Instead, this
important and unavoidably controversial decision was left to the library’s
future Board of Regents. President Eisenhower signed into law the National
Library of Medicine Act on August 3, 1956.66 Finally, the dream of decades
was becoming a reality.
The first meeting of the Board of Regents was held in Washington on
March 20, 1957, at the crumbling Army Medical Library building, “Old
Red Brick.” There were 17 members of the Board. Seven of these held
positions ex officio, while 10 were appointed. The appointed members held
terms ranging from one to four years—DeBakey’s was one of the latter.
There were two other surgeons on the Board, Isidore Ravdin of the
University of Pennsylvania, and DeBakey’s old friend Champ Lyons of the
University of Alabama.*67
The necessity for a new Library building had been obvious for many
years, and, as the Board members looked around their environs at this
conference, they needed no more reminders. The group was, obviously, all
in favor of proceeding (DeBakey himself “spoke feelingly to the point”
according to the minutes of the meeting). At the time, however, there was
an irksome freeze on the construction of new federal buildings. The Board
decided to go on record as advising the Surgeon General of the Public
Health Service (Dr. Leroy Burney, who was actually present and acting as
Chairman pro temp) that the new library should be at the top of new
construction priorities for his agency.69
Even though there was, as of yet, no funding for the new Library building
—and no timetable for its construction given the freeze—the Board opted to
consider sites anyway. As they developed the problem, it consisted of three
levels of location that needed to be determined: (1) the area—the city or
metropolitan region where the Library would be built, (2) the site: the
district or locale within that area, and (3) the location: the actual acreage. At
this time the Board of Regents believed that considerations 1 and 2,
selection of the proper site and area, were its own responsibility. It would be
the Library administration’s job to deal with part 3.70
Almost as soon as the topic was raised, the city of Washington was
advocated by several members of the Board as the answer to question 1.
After some discussion, however, the consensus was reached that a formal
evaluation of the different contenders needed to be undertaken.
The Board seriously considered four metropolitan areas, more or less:
Washington, D.C., Chicago, Denver, and Charlottesville, Virginia.
Washington had the major advantage of being a continuation of the status
quo, which would obviously be the cheapest alternative and keep in
proximity the federal agencies which were major users of the Library. The
very specialized and highly trained staff could also be kept intact. There
was a certain logic and propriety in setting a national library near the seat of
government, as well. To top it off, several highly influential and powerful
organizations, including the Association of American Medical Colleges and
the American Association of Dental Schools, were strongly in favor of a
District of Columbia location.71
Chicago’s aggressive approach and its advantages, detailed earlier, were
not to be dismissed out of hand. In the weeks to come, Mayor Daley
himself sent a letter to the Board and directed them to consider the
thousands of words that had been spoken on behalf of his city at the
congressional hearings.72
It is not clear who may have been advocating for Denver, which—at a
population of around a half million in its metropolitan region—was still
relatively small at this time and certainly distant from the main population
centers of the country. Smaller still was Charlottesville, 100 miles from the
capital city and home of the University of Virginia. Transportation issues
were mentioned, but it is unlikely that the attractive little college town was
ever under serious consideration.*
The second part of the location issue obviously bore a close relationship
to the first. The Board determined that characteristics of the selected site
needed to meet a number of important criteria, including proximity to a
medical center and efficient transportation. After considering these issues
and the site candidates, the Board elected to defer a final decision to the
following meeting.73
The second meeting of the Board of Regents of the National Library of
Medicine was held five-and-a-half weeks later, also at the Old Red Brick,
on April 27, 1956.74 No time was wasted in getting to the main point at
hand. Washington was the clear front-runner to be the selected site, but that
was not so simple in itself. In fact, no less than 10 different locales within
the District of Columbia were under consideration. That morning the Board
took a chartered bus to visit the four most eligible. These included a site on
Capitol Hill near the Library of Congress Annex; the Soldier’s Home area
north of the city; the Naval Medical Center in Bethesda, Maryland; and the
National Institutes of Health (NIH) headquarters site, also in Bethesda. The
group then returned to the Library to discuss these possible sites and the
others further afield.
The Chicago proposal was first on the agenda. The letters from Mayor
Daley, as well as another from the Chicago Commission’s chairman, were
read to the Board. One of the members gave a favorable report on his visit
to the proposed site in the medical district, near Cook County Hospital.75
Next, before anything else could be discussed, Isidore Ravdin made an
immediate motion that the National Library of Medicine be located in
Washington, D.C. DeBakey seconded it, and the motion was passed
unanimously. This short-circuited any further discussion of provincial
locations. Next, the pros and cons of the various sites in the District of
Columbia were briefly entertained.
In the eyes of many on the Board the site next to the NIH, which was a
golf course but on land owned by the Institutes, was best suited. Its
proximity to the great research facility was especially attractive. Oddly
enough, the Director of the NIH at the time, Dr. James Shannon, was not
thrilled at the prospect of the National Library of Medicine being built next
to his complex. Before this April 29 meeting Senator Hill had summoned
both Shannon and DeBakey to his office to see what kind of compromise
might be reached if the Board of Regents did, in fact, choose the site.
DeBakey remembered the conversation in this way:
HILL: Now Jim there is a difference of opinion here. Tell me why you don’t
want it at NIH?
SHANNON: I just want research people at NIH.
HILL: Well, Mike, what do you think?
DEBAKEY: Dr. Shannon is saying it is not a research institute, but I would
like to ask Dr. Shannon one thing: when you were doing research in New
York and were working on the kidney—whenever you worked on a new
project—what would you do first? You would go to the library to do a
little research, wouldn’t you?
SHANNON: Of course.
DEBAKEY: Then why do you say it isn’t a research institute?
HILL: Jim, I think he’s got you.76
Ravdin made another motion, again seconded by DeBakey, that the site
of the library be confirmed at the campus of the NIH. Champ Lyons
suggested a proviso be added to the effect that the decision was contingent
on 10 acres being made available there, and then the motion was
unanimously passed. The Board of Regent’s self-assignment of finding a
location and site was thus completed. They then drafted a letter to Surgeon
General Burney announcing their decisions and including the
recommendation that the new Library building be the highest priority for
the Public Health Service.77
Senator Hill secured $7.3 million for the planning and construction of the
new Library, and the dream that had for so long seemed unattainable was
almost within reach.
7.6 Dacron
The SVS’s committee on the use of prosthetic arterial grafts, chaired by
Creech, gave its report at the annual meeting of the group in Chicago in
June 1956.78
In all, 27 surgeons reported their experience. Since few described use of
synthetic grafts in the peripheral arteries, the committee was forced to apply
their conclusions to questions of aortic replacement only. Of the eight
materials considered—Vinyon “N,” Nylon, Orlon, Dacron, Teflon, Ivalon,
Fortisan (a cellulose product), and stainless steel—Dacron and Teflon
appeared to be the most satisfactory. The construction of the prostheses did
not seem to matter; fibers seemed to behave equally well whether they were
knitted, woven, or braided. Results among all the prosthetics were
comparable to the best homograft series. The committee closed its report by
calling for a new, systematic survey of experiences with synthetics in the
peripheral arteries.79
By the time Creech presented the committees results (shortly before he
left for Tulane) the Baylor group had pretty much given up using
homografts, unless the circumstances were exceptional. They had not yet
settled on a particular synthetic, but in that same spring, DeBakey and his
colleagues were making progress toward the elusive ideal arterial substitute.
Arthur Hanisch, the pharmaceutical tycoon who had undergone aneurysm
resection and homograft replacement by DeBakey in 1954, was leading a
normal, active life in Southern California. Like Mims Gage, he liked to kid
his friends that his homograft had been procured from a prostitute, which he
said led him to all sorts of bizarre urges (in this case DeBakey denied that it
was true).80 Hanisch also carried around with him at all times, like the
nuclear codes, a box containing an aortic prosthetic graft, in case his
homograft failed and he needed emergency surgery.81
Hanisch continued to be one of the Baylor Surgery Department’s main
sources of extramural funding, and, given his personal experience, it was no
surprise that he was interested in supporting research into cardiovascular
surgery. DeBakey had steered Hanisch and his donations toward arterial
prosthetics research. The Baylor team was targeting Dacron as a strong
candidate for further investigative efforts.
I told him that I had reached the point in all this work in the experimental laboratory on Dacron
grafts where I really needed some more help from someone who knew something about textiles.
I had been to various people and had been up to the DuPont on a number of occasions and seen
their medical director and so on, and I just couldn’t get the help I needed. I couldn’t get the
DuPont people to be very interested. They were afraid of suits. They didn’t want to get too
involved. They’d make material available to me, but they weren’t going to really work with me
on it. [Hanisch] said, “Well, you know, I’m involved in the textile industry.” I said, “Well, I
didn’t know that.” He said, “Yes, in Reading, Pennsylvania. We make socks.”82
DeBakey traveled to Reading to tour Hanisch’s facility, Infants Socks,

Inc., and speak with the managers. Once these men had heard his goals,
they realized that there was not much they could do to help DeBakey, but
there was another person in the industry he should contact. This was
Thomas Edman of the Philadelphia Textile Institute.*83
Edman, who had been born in Budapest, Hungary in 1923 (his original
last name was Eidlitz), was a Professor at the Institute. He was also a
graduate, having earned a degree in knitting at the school. After completing
specialized training at the Leicester College of Technology in England,
Edman had returned to Philadelphia and joined the faculty at his alma
mater. His reputation for innovation and ingenuity in the textile industry
was far-reaching and he was, in fact, the ideal individual to work on the
problem.84
DeBakey initially contacted Edman in April 1956.85 By this point in the
development of arterial prosthetics a number of characteristics were
generally considered to be desirable. Among these were the ability of the
fabric to withstand autoclaving for sterilization, the capacity to be cut
without fraying, and the strength to be held by arterial clamps without
damage. Flexibility and elasticity were also necessary: the graft would have
to conform to a patient’s arterial anatomy. In addition, the candidate
material must be capable of being manufactured in various graft sizes and
configurations, with bifurcations or branches. DeBakey communicated
these necessary characteristics to Edman, who went to work.
Edman started from the ground up by examining many different fibers
for fundamental suitability as arterial grafts. He immediately recognized
that most natural or “staple” fibers, which have a discrete length, would not
work because individual fibers could get into the bloodstream and cause
any number of undesirable results there. Synthetic fibers were continuous
and could, of course, be made in any length (such fibers are known as
“filaments”). That fact was obviously in their favor. Edman’s evaluation of
the various synthetic filaments yielded the same conclusion that some
surgeons such as DeBakey, Ormand Julian, and Ralph Deterling were
reaching: Dacron was the best material. Now he moved on to the optimal
method of constructing the grafts.86
Despite what the SVS report had concluded, Edman believed that
knitting was the best means of uniting the fibers into a fabric for this
particular purpose. Weaving could work, too, but braiding was troublesome
because it unraveled, especially when being sutured (in some of the early
braided and woven grafts, surgeons cuffed the ends to hold sutures better).
Edman was particularly interested in the challenge of constructing a
bifurcated, or “Y”-shaped graft. He noted the efforts that had already been
made to accomplish this and their drawbacks. Paul Sanger had assembled
an Orlon bifurcated graft at the North Carolina Textile School using necktie
knitting machines.87 Since the two limbs of the lower end were
substantially smaller than the main tube this required two separate devices.
The limbs were hand-sewn onto the larger graft, creating a seam—which
was inelegant, time-consuming, and thought to promote clotting. Sterling
Edwards, in conjunction with the Chemstrand Corporation in Alabama, had
developed a braided nylon bifurcation graft but this also required two
distinct stages to build. A clever innovation by this group, which turned out
to be of enormous importance, was to crimp the lower limbs. The nylon was
pushed together on a stent to create folds, then heated to retain the shape.
This crimping prevented grafts from kinking or collapsing when they were
bent, which turned out to be extremely useful when fitting the prosthetics
into anatomic configurations.*88
At first Edman used an existing hand-cranked, Swiss-made Dubied
Company knitting machine to make tubular grafts. He modified this device
by replacing its needle-and-jack mechanism with one employing long and
short needles. He also partially automated the drive. When it was complete,
the machine could knit a seamless tube graft of any reasonable size, and up
to eight of them at a time.
Edman found that the grafts bled less through their interstices if the
Dacron was constructed with the “Fluflon” false-twist texturing process, a
common technique used in preparing yarns.
The next step was the key breakthrough. Edman used his remarkable
understanding of knitting technology and mechanical engineering to design
and build a completely new machine that could assemble a one-piece
bifurcated Dacron graft with no seams. By June 1957, he had a device,
designed by him and built by the Queens Machine Corporation of
Brooklyn, which could produce 15 seamless bifurcated Dacron grafts in an
eight-hour work day.89
At Baylor, the surgeons had recognized the value of the Alabama
crimping procedure in keeping the prosthetic graft limbs from kinking.
Knitted tubes could not be simply squeezed together from the ends to cause
crimping, however. An engineer in the Department of Surgery named Ernest
Starks solved the problem by placing the grafts on a lathe, wrapping them
with thread in a spiral pattern, then compressing the ends. When the grafts
were baked in this conformation they held the crimp permanently.90
By mid-1957, the Department of Surgery at Baylor was almost
exclusively utilizing these new Dacron grafts—created at the Philadelphia
Textile Institute and finished in their own labs—in arterial reconstruction
surgery.91 By all criteria they were superior to the other grafts being
constructed and implanted across the world. In a war against cardiovascular
disease in which their contemporaries were shouldering muskets, the
Houston group suddenly had a howitzer. Placed in the hands of such gifted
and prolific surgeons as DeBakey, Cooley, Crawford, and Morris, the new
grafts allowed a measure of surgical attack previously unimaginable, and,
with these tools at their disposal (as well as the cardiopulmonary bypass
machines), virtually no arterial disease was considered unassailable.
The first full-scale report of Baylor’s experience with the new Edman-
constructed Dacron grafts came in the form of an exhibit display
presentation before the Annual Meeting of the AMA in San Francisco in
late June 1957.92 This was the same forum where their impressive aortic
surgery exhibition had won the Hektoen Award in 1954. Again, the
presentation relied heavily on graphic elements, with full-color
intraoperative photographs and anatomic drawings that would have made
Frank Netter proud. The group reported no fewer than 737 cases,
encompassing nearly every conceivable application of Dacron grafts to the
surgical treatment of arterial disease. 313 aneurysm repairs with Dacron
were reported—235 in the abdominal aorta, 51 in the thoracic aorta, and 27
in the peripheral arteries. A total of 424 cases of occlusive disease
underwent surgery involving the grafts, 243 in the periphery, 163 in the
abdominal aorta, and 18 in the thoracic aorta. When compared to the
Department’s previous experience with homografts—as well as the other
synthetics—the Dacron grafts were “superior in all respects.” In particular,
the rate of patient deaths and graft failures was substantially less. There was
not much point in comparing the Baylor results to those of any other
groups: the number of cases performed in Houston was orders of magnitude
greater.93
Arthur Hanisch stayed involved in the development of the Dacron grafts.
There was no question in the mind of any involved that they must be made
commercially available. Hanisch had hoped to keep their manufacture
within his own sphere, but there were other companies more suited to the
job. One that was suggested by the leader of the Reading factory was
George P. Pilling and Son Company (one of the manufacturers that had
rejected DeBakey and Gillentine’s sleeve-valve transfusion syringe back in
1933). Pilling had the two advantages of having their headquarters near
Edman in Philadelphia and being well ensconced in the field of medical
manufacturing. By the next year, Pilling was marketing the DeBakey
Dacron Vessel Prostheses in their catalog.
The modern era of cardiovascular surgery had come into being beyond
any question, and the site of the frontier was unmistakable. Barely a decade
before, this nexus had been a mosquito-infested forest a few miles
southwest of Houston, but now it was the world-famous Texas Medical
Center, home of the Baylor University College of Medicine’s Department of
Surgery.
7.7 Soviet Union

The very busy conference schedule of DeBakey and the rest of the Baylor
Department of Surgery only grew more hectic as the 1950s wore on. With
each passing month there seemed to be new results to present from the
bedside and the laboratory, or extensions of their ever-burgeoning clinical
series.
The renown of the group was rapidly becoming international. Indeed,
beginning in 1955, a parade of surgeons came to Houston from foreign
lands to observe and learn the new cardiovascular techniques, in addition to
working on research projects on the wards and in the busy labs. In the next
four years the Cardiovascular Surgery Fellowship attracted individuals from
England, Lebanon, France, Belgium, Argentina, Venezuela, Mexico, Iraq,
Colombia, Italy, Israel, Indonesia, and Australia.94 A few came from the
United States, too, but that was clearly not the focus—the program was
intended to spread the gospel of the new surgery to very distant shores.
Many of these Fellows went on to establish cardiovascular surgery clinical
and research programs in their home countries. Their own recognition that
these efforts would take years to come to fruition helped create an
international referral base for Baylor, as well: until they were ready to do
the work themselves, the graduated Fellows knew just where to send the
patients who were suffering from cardiovascular diseases—to their mentors
in Houston.
In October 1957, DeBakey traveled to South America to visit and lecture
in Argentina and then Mexico.95 In Mexico City, at the International Society
of Surgery conference, he put up the impressive Dacron results exhibit and
gave five lectures on the exciting new procedures for complex and difficult
aortic aneurysms. It was here that DeBakey met a contingent of surgeons
from the Soviet Union. One of these was Alexander Vishnevsky.
Vishnevsky was one of the foremost cardiovascular surgeons in his
country, and he had won the Leriche Prize at the same International Society
meeting in 1955 (DeBakey would win it in 1959).96 At this point in time
Soviet medicine was relatively primitive in comparison to the West—not
least so in the realm of cardiovascular surgery. Naturally—despite the
communication obstacles of the Cold War—Vishnevsky and his colleagues
were aware of the progress being made in the United States in this field, and
they listened to DeBakey’s talks with great interest. Afterward they sought
out this mustachioed magician who had solved so many of the seemingly
insurmountable problems of arterial surgery. Pleasantries were exchanged,
along with invitations to visit each other’s institutions.
Until the petitions became too numerous to accept them all, DeBakey
was always eager to travel for visiting professorships, named lectures, and
the like. He was especially pleased to go overseas for such engagements,
reasoning that they were further opportunities to demonstrate the new work
abroad and, not incidentally, also showcase his own surgical prowess (it
was common at the time for surgical visitors to operate on local cases).
Of course, travel between the two superpowers was not simply a matter
of an invitation between academics during those Cold War years. In fact,
things were even more uncomfortable than usual at the time of the October
1957 International Surgical Society meeting because the Soviet artificial
satellite Sputnik 1 had been launched earlier that month. This event had
precipitated a “Sputnik Crisis” in the United States based on the concern
that the space scientists of the Soviet Union had surpassed their American
counterparts and might be planning a dreadful new military threat from
above.*
As it happened, it was not until late in 1958 that the invitation to visit the
Soviet Union could be honored and the trip become a reality. DeBakey’s
visa, granted through the USSR embassy in Washington, allowed him 10
days to visit the country, from December 14 to 23.
The centerpiece event of DeBakey’s trip was the All-Russian Surgical
Congress in Leningrad. Vishnevsky was the Chairman of the Organization
Committee for the meeting. DeBakey flew from Houston to Moscow via
New York and Paris, arriving at 11 PM on Sunday, December 14, to snow
and a temperature of 10 degrees below zero. The next morning he boarded a
propeller plane for the four-and-a-half hour flight to Leningrad, where he
checked in at the lavish Hotel Astoria.98
The Congress had begun on that Monday morning, and Vishnevsky
picked up his distinguished visitor for a brief tour of the city and some
sessions of the meeting.
It was on the following day that DeBakey got his first glimpse of actual
operative surgery in the Soviet Union. This was at the clinic of Professor
Fedor Uglov in the First Leningrad Medical Institute. The hospital dated to
the nineteenth century, with high ceilings and wide corridors. The age of the
building was concerning, but DeBakey was impressed by its cleanliness.
The operating theater was also large, in the old European style, but the
equipment was modern and functional. Rather than changing into scrub
suits, the surgeons operated in their street clothes with sterile gowns over
top. They used iodine for skin preparation, both on the patient and for their
own hands.
DeBakey observed Uglov during two closed-heart procedures and
thought that the operations were done “with precision and dispatch.”99
After the operative demonstrations were completed, the visitors were led
to the experimental laboratories in the basement of the Institute. The Soviets
showed DeBakey a prosthetic vascular substitute, “some type of plastic,”
which he skeptically noted was “supposed to be absorbed in three
weeks.”100
On the next day DeBakey was invited to visit the Surgery Clinic of the
Leningrad Military Academy of Medicine, where he witnessed more
competent surgery and toured another research lab. Here DeBakey first
encountered a Russian heart-lung machine. This one had recently arrived
from Moscow, where it had been built at the Scientific Research Institute
for Experimental Surgical Apparatus and Instruments (in a country where
institutions seemed to compete for the lengthiest names, this one made a
compelling case for the blue ribbon). The scientists had only used this
machine, a bubble oxygenator, in a few animal experiments by the time of
DeBakey’s visit. He considered it to be well-designed and skillfully made.
On Wednesday evening, DeBakey took in a presentation of the famous
Kirov Ballet’s signature piece, Don Quixote, which he described as
“beautifully performed.”*101
A visit to the Leningrad Institute of Blood Transfusion was on the next
day’s agenda. DeBakey, of course, had a long history with the subject from
which this facility drew its name. In addition to collecting, preparing, and
distributing blood to the region, this Institute was a center for research on
blood substitutes, shock, and other clinical problems of a mostly
cardiovascular nature. One subject garnering the attention of the Institute’s
scientists was the preparation of products of autoclaved human serum for
intramuscular injection in patients with gastrointestinal ulcers. The
researchers reported a 90% success rate in healing the ulcers, which must
have strained DeBakey’s credulity, if not his politesse.
Later DeBakey was shown Professor Filatov’s Laboratory for Blood
Vessel Substitutes and Vascular Surgery. There were a few postoperative
patients here who had undergone lower extremity arterial bypass with
homografts, which the surgeons had begun using about a year before (they
had also started working with a polyvinyl prosthetic artery, which DeBakey
“did not consider promising”103). The professorthen presented a patient
whose arteriogram showed occlusion of the popliteal artery behind the
knee, as well as all the significant arteries from there down to the foot.
Filatov indicated a plan to perform endarterectomy in order to save the
patient’s dying limb and asked DeBakey his opinion of the strategy. If he
had not already witnessed repeated demonstrations that the Soviets were
well behind the West in terms of leading-edge cardiovascular surgery, this
would have convinced DeBakey (Figure 7.7). Endarterectomy was clearly
hopeless, if it could even be technically achieved. He politely remarked that
in Houston they had not had much luck with that approach to such cases
and suggested sympathectomy instead.
Figure 7.7 DeBakey on his first visit to the Soviet Union, 1958.
DeBakey had dinner with several of the Soviet surgeons and scientists in
the supper club at the Astoria, which, with its American jazz and dance
floor, reminded him of the glitzy Emerald Room at Houston’s postwar
landmark, the Shamrock Hotel.
Up to this point DeBakey, apart from a few pieces of gentle advice he
offered when queried, had been exclusively an observer. On Friday,
December 19, it was finally his turn to share information. He was given 30
minutes to speak at the Congress and was translated by a local bilingual
surgeon. The listening crowd was large and attentive. When the lecture was
over DeBakey showed five full-color operative films of some of his more
spectacular cases. When the last frames had spun off the reel he was met
with a thunderous ovation. His hosts saw that the talks in Mexico City had
been no illusion: the surgeons in Houston were clearly breaking new ground
in the most daunting of clinical scenarios.
DeBakey visited the Surgical Clinic at the Military Medical Academy on
Saturday morning. Here he observed a pneumonectomy, the most
interesting aspect of which was the surgeon’s closure of the bronchial stump
with tantalum clips.103
On Saturday afternoon DeBakey visited the battleship Aurora, which was
a training vessel by this time but had fired the shot that signaled the
storming of the Winter Palace during the Russian Revolution. Late in the
evening he was escorted to the train station for an overnight trip to Moscow,
500 miles away.
Arriving in the capital the next morning, he was taken by car to the
“rather modern” Soviet Hotel. There was not much time to settle in before
another physician arrived to conduct a tour of the city. DeBakey got to see
both the older and newer sections of Moscow, along with the famous sites
such as Red Square and the Kremlin. He was somewhat surprised to see
lines of customers at the large department store, Gum’s, apparently doing
Christmas shopping. There were even Christmas trees and lights.104
On the following day DeBakey went to visit Vishnevsky, who spent that
morning performing thoracic operations. Vishnevsky had an allergy to some
material in the surgical gloves and operated with his bare hands, frequently
washing them in iodine solution. In one case Vishnevsky connected an
arterial homograft in an end-to-end fashion to a native artery using not an
anastomotic suture but a ring with four tantalum hooks. The graft was
threaded into the ring and cuffed over the hooks. Vishnevsky then pulled the
end of the transected native artery over the cuffed ring, securing it to the
graft with the metal barbs.*
After lunch, DeBakey was taken to the Scientific Research Institute for
Experimental Surgical Apparatus and Instruments, which had built the
bubble oxygenator he saw in Leningrad. This was also the center for the
Soviets’ research into surgical clipping and stapling devices, such as the
tantalum examples he had seen. To his surprise, DeBakey saw little work
being done here on actual surgical instruments, despite the name of the
place. Most instruments that he did see in use in the USSR were of a prewar
design, if not older. In the animal surgery labs DeBakey was shown nylon
grafts anastomosed into dog aortas—in his words, ““circa 1954”—as well
as some truly bizarre work that sounds like something from a contemporary
science fiction film.
They proudly showed some dogs whose hind legs had been completely severed. Preserved from
several hours to 24 hours using refrigeration and blood perfusion with a bubble oxygenator, and
then reimplanted. The dogs were able to walk and run, although in a few slight dragging or
limping could be detected. They have tried homografting of whole organs . . . even the head of
animals but have been unsuccessful.105
DeBakey gave Vishnevsky three of the Baylor Dacron grafts to try

out.106
On December 23, DeBakey’s last day in Russia, he toured Professor
Boris Petrovsky’s clinic at the First Moscow Medical Institute. He spent the
morning observing thoracic surgery again—in one case the closure of a
patent ductus arteriosus with a tantalum clipping device—and the afternoon
touring labs and wards.
Before leaving that evening, DeBakey was sure to invite Vishnevsky to
visit Houston if he were to come to the United States. After stops in
Brussels and New York, DeBakey reached Houston a little after 9 PM on
Christmas Eve.
DeBakey’s overall impressions of the Soviet Union were generous,
although he recognized that they might be slanted, given the VIP treatment
he received. The standard of living was manifestly below that of the United
States, particularly with regard to consumer goods, but he believed (or was
told) that this was improving. The emphasis on education and the high
social status of academic professionals were certainly appealing to an
intellectual like DeBakey. Moreover, the people he encountered were
almost universally outgoing and friendly. In his estimation, the Russians—
particularly the youth—were especially fascinated by American culture and
positively predisposed to the West. In a similar vein to his thoughts after
visiting the Middle East in 1954, DeBakey considered the exchange of
medical science to be an effective means of connecting disparate cultures
and political philosophies via a deeper, underlying humanity.
All of the Russian surgeons I met expressed a genuine desire for closer associations with
American surgery. I am sure from this visit, as well as from visits I have had the opportunity to
make in other foreign countries, that there is a universality in the medical community and that
there is no better means by which our foreign relations can be improved than through exchange
brought about by visits of this kind.107
As it happened, DeBakey did not need to wait long to see these closer
associations come to pass. In January 1959, a contingent of Soviet surgeons
in the country for an academic surgery meeting came to Houston for a two-
day visit. They toured the Texas Medical Center facilities and observed
several operations (Vishnevsky himself had implanted the last of the grafts
DeBakey had given him just before departing Moscow). The group came
away suitably impressed by the advanced surgical work, their leader telling
the Houston Chronicle: “I am impressed by the excellence of the operations
I have seen here. Vascular surgery in Houston is being done better than any
place in the world.”108
7.8 Yes, Sir

As the medical school and the city of Houston itself grew, the hospitals
affiliated with Baylor continued to expand their services. In many ways, the
Department of Surgery led the charge.
At Jefferson Davis Hospital, the number of operative procedures
performed annually leapt from 10,667 in 1948 to 15,899 in 1957. Of course
the raw numbers did not reflect the fact that many of the operations done in
1957 were complex thoracic and cardiovascular procedures which were not
even on the radar in 1948. Despite the magnitude of these new operations
and the desperate conditions of the patients needing them, the operative
mortality rate decreased from 2.5% in 1948 to a scintillating 0.7% in 1957,
and this happy trend would continue. Perhaps most impressive of all, this
growth had been achieved with barely any expansion of the actual physical
plant of the hospital—negotiations on a new city-county hospital in the
Texas Medical Center having bogged down completely.109
Buoyed by a seemingly inexhaustible supply of patients, the Baylor
Surgical Laboratory at Jefferson Davis Hospital continued to focus its
research efforts on trauma throughout the latter part of the 1950s. Under
grants from the US Army and other sources, studies in the metabolic effects
of injury and surgery, which were important and popular subjects of
surgical research worldwide at the time, were under way.
George Jordan, Jr. was now Chief of the Surgical Service at the Houston
VA Hospital. Because its space allocation was controlled by the government
and the number of surgery beds was fixed, the clinical service could not
expand as rapidly as those in the other Baylor-affiliated hospitals.
Nevertheless, the patient load grew steadily during the late 1950s.110
The Baylor presence at Texas Children’s Hospital was “strengthened and
consolidated” as the decade wore on, largely because of Cooley’s work in
congenital heart surgery. This caseload was reaching unheard-of figures—
more than 400 operations in the first two years after the heart-lung machine
was introduced—and, although he did not participate much in bench
research activities, Cooley’s clinical experience in open-heart surgery was
now the largest in the world and growing.111
Many of the vascular procedures that were stunning the world were, of
course, being done at the Methodist Hospital. From July 1, 1955 to July 1,
1957, more than 17,000 operations were performed here, with about a 1%
mortality rate.112
In July 1955, the Baylor Affiliated Hospitals Residency Program was
initiated.113 In a sense, this was the last nail in the coffin of the old idea that
the Texas Medical Center be created in the didactic image of the Mayo
Clinic—with Baylor teaching medical students but the other entities
training interns and residents. The Baylor surgery residents (and those of
other specialties) had been spending rotations of various lengths at some of
the Houston hospitals for years, of course, but the system now became
formalized with official committees and contracts.
The primary teaching units for Baylor General Surgery residents
remained the Jefferson Davis and VA Hospitals, and, once the university
program accepted a trainee, he was assigned to one of these two “home
bases.”
In the third year, the resident spent three months on Dr. DeBakey’s
private service at Methodist, by now of course dominated by thoracic and
vascular surgical cases.
There was little question that the 90 or so days on DeBakey’s service at
Methodist Hospital represented the lynchpin of the entire training program.
This was the opportunity to shine for the Professor or, conversely, draw his
fearful and sometimes unremitting ire. Since DeBakey’s reputation and
renown were now practically unlimited, a resident’s entire future career
might well depend on his performance during those three months. During
the 1958–1959 academic year, one of the beleaguered residents on
DeBakey’s service had a familiar name.
John Lockwood Ochsner was the second son of DeBakey’s cherished
mentor, Alton. Although he would one day be celebrated as the
quintessential southern surgeon, John was actually born in Madison,
Wisconsin, in 1927, shortly before his father took Rudolph Matas’s place as
head of surgery at Tulane.114
John went to college and then medical school at his father’s institution,
where—he later remembered—his status as son of the Chief of Surgery
afforded him no special treatment.
Daddy loved to teach. He was a good orator; he knew the English language well. He had
didactic lectures for all the students and he’d be there early. If you were late coming in, he’d
make you sit down in the front, bring you up in the front. He said the only people who can come
in late are bankers. You’re a doctor; you’re not supposed to be late for anything. When I was a
student if I was late I never went in, I just listened to it from out in the hall. Because he’d march
you up and make fun of you.115
John spent time, along with some of his fraternity brothers, reading aloud
to the blind Rudolph Matas, who had lost his vision but not his love of
books and periodicals, at the “Governor’s” wisteria-draped mansion on St.
Charles Avenue.
These hours spent with the brilliant and iconic Matas no doubt left their
mark on John. His father’s influence was strong, too. Although he could see
the toll the long hours and professional struggles took on his father, they did
not deter the younger Ochsner from pursuing a career in surgery.* John
interned at the University of Michigan under his father’s close friend, the
great Frederick Coller, but became disillusioned by what he thought was
inadequate resident experience in the operating room. John telephoned
DeBakey to see about a position at Baylor. At the time, however, DeBakey
happened to be on his visiting professorship with Edward Churchill at the
Massachusetts General Hospital.116 John was drafted to serve in Korea in
any event, but there was no question about his acceptance in Houston.
It was 1956 before John Ochsner commenced his residency at Baylor. He
stayed at the DeBakey house for a few days after arriving. DeBakey, of
course, had been the Ochsner children’s babysitter (along with Diana, too,
during the awkward honeymoon of autumn 1936). John thought of him as,
and called him, “Mike.” Shortly after beginning his training at Baylor,
however, Oscar Creech and another staff surgeon, John Overstreet, took
him aside during lunch at the Doctor’s Club.
“We brought you here to give you some words of advice: Forget ‘Mike.’ He’s Dr. DeBakey. And
never make an excuse. And never talk back. Never. Ever.” And so I made a really solid desire to
do that. And so the only thing I ever told Dr. DeBakey the whole time I was on his service was
“Yes, sir” and “No, sir.” Unless he said tell me more. Always, “Yes, sir.” “No, sir.”117
When the time came for his three months with DeBakey, John found that
the fearsome legends about the rotation, which had already begun to
emerge, were true.
I was on his service one time for three months—never left the hospital. Never went home.
Worked my ass off. At that time they had only one resident. Later on they had one take care of
the ICU, one take care of the hospital, one would be in the OR. I did all three. My wife said I
was nuts when I got out—said I couldn’t do anything but run around and do something. I was so
used to running. One time he grabbed me by the coat and said, “Goddammit, can’t you say
anything but ‘Yes, sir’ and ‘No, sir’?” And I said, “No, sir.” 118
John soon found out that the overwhelming load of work to be done did
not allow him even to eat. In fact, he even forgot about being hungry.
I lost 35 pounds. . . . I had to give up eating, is what I had to do, and I would get my
nourishment usually when I’d hit every floor. All the nurses knew and they’d have some orange
juice for me, or some milk or something.119
In the years to come DeBakey’s habit of avoiding the hospital elevators

and bounding up or down stairs on rounds became legendary. The trailing
team of residents, medical students, and other staff struggled to keep up—
no one wanted to be left behind or appear to be slow or weak. On one
occasion John’s efforts to maintain close quarters with the Chief during a
stairwell sprint led to an unexpected and awkward collision.
We were running. Two at a time. Take two stairs at a time—you wanted to be sure you could
keep up with him. And he just stopped abruptly. He stopped, and Boom! I knocked his ass
straight on the ground!120
To John Ochsner’s great relief DeBakey simply rose and continued

onward, saying nothing then or at any time afterward.
In addition to the General Surgery and traditional specialty residencies,
from July 1954 onward, there was a dedicated training program in Thoracic
Surgery at the Baylor College of Medicine. This was also an Affiliated
Residency after July 1955, with the trainees spending time learning about
the different aspects of chest surgery in the several Baylor-aligned hospitals.
Cardiovascular cases were most prevalent at Methodist and Texas
Children’s Hospitals, while tuberculosis led the way at the VA. Jefferson
Davis Hospital provided a good exposure to the treatment of thoracic
trauma. Most of the thoracic residents had already finished general surgery
programs at Baylor or elsewhere and received a junior faculty
appointment.121
7.9 Hypertension
By the middle part of the twentieth century, the relationship between high
blood pressure and cardiovascular mortality—atherosclerosis, heart attacks,
strokes—was well-recognized. The enormous toll these disease entities took
on the population was also generally appreciated. In fact, for many years
heart disease and stroke ranked number one and number three on the list of
most common causes of death in the United States, and atherosclerosis
typically made the top 10 as a separate category. Hypertension—high blood
pressure—was and is considered a major contributor to the development of
each of these killers.
Most of the time the cause of high blood pressure cannot be readily
identified. In these cases, it is called “essential hypertension,” which is
simply cloaking terminology for the fact that the reason for the disease is
unknown. While the elevated pressure can be managed, actual cure is
elusive because the source of the derangement in physiology is likewise
obscure. In some situations, however, an identifiable cause can, in fact, be
found, and legitimate cures are attainable. One example of such a clinical
scenario is known as renovascular hypertension.
The kidney is well known, even among the lay population, as a kind of
filter of the blood—removing impurities and waste products in the form of
urine. Less appreciated are the multitude of physiologic effects this organ
exerts. One of these effects relates to blood pressure and the arterial blood
supply of the kidney.
In a sense, the kidney is capable of acting as a kind of thermostat of the
blood pressure, through a convoluted pathway involving multiple organs
and hormones. When the kidney is subjected to lower perfusion pressures, it
releases a substance called renin into the blood stream, which acts indirectly
through enzymatic processes to induce vasoconstriction and elevate the
blood pressure. So long as the “measured” pressure is accurate, this
physiologic function of the kidney is in keeping with the health and
protection of the organism. If, on the other hand, the artery to the kidney is
narrowed by some process—atherosclerosis, dissection, etc.—the organ
may “see” a diminished blood pressure and release renin into a circulation
that is already at an optimum dynamic state. This then causes inappropriate
vasoconstriction and the kidney induces hypertension through its “well-
intentioned” normal function.
Classic studies in the mid-1930s had put this understanding of
renovascular hypertension on firm footing. Naturally, scientists and
clinicians endeavored to find a way of interrupting the pathologic processes,
either through medical or surgical means. For a time the extreme solution of
nephrectomy—removal of the affected kidney—was advocated. This could
be effective, naturally, but it was a major operation fraught with dangers. In
addition, the disease process often affected both kidneys, and such a radical
recommendation was then not an option. Moreover, probably due to
limitations in diagnostic technology (and therefore accuracy) even
unilateral nephrectomy often led to disappointing results. It was not until
vascular surgical techniques had advanced in the 1950s that a direct surgical
approach to the anatomic arm of the problem—improving the blood flow to
the kidney to disrupt the improper release of renin—was subject to
consideration. The Baylor Department of Surgery turned its attention to this
issue in 1958.
The surgery of arterial reconstruction comprised three key techniques at
this point: resection with grafting, bypass, and endarterectomy. The
surgeons at Baylor applied all three to flow-restricting lesions of the renal
arteries. These were the days when the group was in its first, rapturous
embrace of Dacron as an arterial substitute, and the material was used in
every manner and configuration imaginable. When the occlusive disease
encompassed the entire renal artery, the vessel was resected and replaced
with a graft. If the problem was extensive but not global, bypasses were
used. Very focal lesions were found to be amenable to endarterectomy. The
surgeons performed unilateral and bilateral bypasses, endarterectomies, and
resections.122
The group encountered an unforeseen problem when endarterectomy was
the chosen surgical modality. As we have seen, in this technique, an artery
harboring atherosclerotic disease is opened, and the occlusive plaque
dissected out and extruded. The issue that arose involved the closure of the
incision in the artery wall, known as the arteriotomy. For optimal access to
the disease, an incision along the axis of the artery, a longitudinal
arteriotomy, was favored. When the endartectomy had been completed and
this incision was sutured, however, it was noted that the very act of closing
it narrowed the vessel. Regardless of the skill or the technique involved—
interrupted sutures or a running over-and-over stitch—the closure inevitably
consumed some of the circumference of the artery wall. Since the whole
goal of the procedure was maximizing the caliber of the vessel, this was
manifestly self-defeating. Attempts were made at transverse arteriotomy—
incising perpendicular to the axis of the vessel—but these made the
endarterectomy more difficult and still constricted the arterial lumen, albeit
to a lesser degree.
For the answer to this vexing problem DeBakey turned—not for the first
or last time—to his knowledge of the past. Back in 1906, Alexis Carrel and
Charles Guthrie had published an article in which they described a method
of closing an experimental arteriotomy not by simple suturing, but by
placing a patch over the opening and sewing the edges of the arterial wound
to the patch. This kept the closure from narrowing the artery. The authors
did not anticipate that their ingenious innovation would be of much use
outside the laboratory, observing that “excepting for experimental purpose,
it will probably be rarely employed.”123 They were correct in this prediction
for more than half a century, but the new clinical problems involved with
expansion of vascular surgery to the realm of smaller arteries, such as the
renals and carotids, resurrected Carrel and Guthrie’s brilliant concept.
DeBakey dubbed the approach “patch graft angioplasty,” and, although it
could be employed as a solitary surgical treatment, it was the ideal
complement to endarterectomy.*
The early results of renal artery surgery for hypertension at Baylor were
exceptional, with reports citing more than 80% of patients returning to
normal blood pressures.125 Stimulated by this success, and the funding that
emanated from it, the Baylor surgical laboratories undertook extensive
studies on the many aspects of renal physiology and their relationship to
arterial blood flow. George Morris, buoyed by his Markle Foundation grant,
performed much of this work. DeBakey also initiated studies into the
application of patch graft angioplasty to disease in other arterial segments.
The first paper focusing entirely on the patch graft methodology, “A
Technique Permitting Operation upon Small Arteries,” was delivered at the
American College of Surgeons Clinical Congress in San Francisco in
1960.126
The bulk of the clinical and laboratory results unveiled in this paper were
related to application of the new method to the peripheral vasculature, but
data were also included regarding its use in the coronary arteries of
experimental animals. This was part of the first wave of direct, meaningful
surgical assault on that prolific and dreaded killer, the cause of “heart
attacks”: coronary artery disease.
7.10 Instruments
In the early days of clinical vascular surgery the innovative impulse of the
surgeon was rarely enough to achieve success. Operations could be devised
that made perfect sense “on paper,” but presented daunting challenges when
actually attempted. To be sure, many of these difficulties related to
anatomic exposure or the disruptive physiologic effects of the procedures
themselves, but another common problem involved the inadequacies of the
old surgical instruments when applied to these new scenarios.
For example, as we have seen, surgeons realized at once that safely
opening arteries for endarterectomy or anastomosis necessitated the
interruption of blood flow within the vessels. One issue that arose was how
to accomplish this without damaging the delicate vascular structures.
Existing surgical tissue clamps in the mid-twentieth century were far too
destructive: they controlled the bleeding, all right, but they also crushed the
artery wall. Charles Guthrie had recognized the problem as early as 1912,
and it was one of the reasons why the surgeons of World War II had
accomplished very little in the way of arterial repair work.127 A pediatric
surgeon with special interests and talents in cardiovascular surgery, Willis
Potts of Chicago, made a momentous advance in the late 1940s with the
invention of a clamp with fine, interdigitating teeth and relatively light grip
strength. The teeth grabbed the tough, fibrous outer wall of the artery,
holding the instrument in place by this manner rather than by the ratchet
effect of the clamping mechanism.128 This insight, which Potts gained
somehow from watching the application of an ACE bandage, allowed for
secure occlusion of an artery without injuring the tissue. Potts clamps,
which remain a mainstay in vascular surgery to this day, were credited with
allowing many of the successful arterial reconstruction procedures on the
battlefields of Korea.*
Clamps were not the only surgical instruments that needed revision for
the new purposes of vascular surgery. Scissors, forceps, retractors, and other
tools of the trade were simply too bulky and cumbersome for the delicate
new work being done. As was the case with prosthetic arterial replacements,
the necessary new equipment was, for the most part, not on the market.
In response to this inconvenient but unavoidable fact, DeBakey
established a machine shop in the Baylor Department of Surgery in 1957.130
From this point on, he and the other surgeons worked closely with the
machinists to develop and perfect surgical instruments and devices, mainly
for cardiovascular endeavors. The symbiotic, productive relationship got a
big boost in skill and energy when a special talent joined the shop in the
person of machinist Louis Feldman in 1959.
Feldman was a 35-year-old New Yorker who had grown up on the Lower
East Side and attended Brooklyn College.131 He served in the Army in
World War II and moved with his wife and two young daughters to the
boomtown of Houston in the 1950s. Feldman brought to Baylor a rare
combination of mechanical ability, innovative spirit, and a resolute
conviction that nothing was impossible. These attributes meshed
wonderfully with those of the ambitious Baylor surgeons. Soon, with
Feldman taking over, the Baylor machine shop was producing custom
surgical instruments of consummate precision and craftsmanship. These
underwent immediate practical testing in the operating room, and Feldman
made adjustments as necessary to meet the evolving needs of the surgeons,
sketching out the changes on the blackboard in the shop. He did not stop
there, however. He took over the work of perfecting the Baylor heart-lung
machine and even designed and built custom operating room tables, for
both the patients and the array of new instruments he was creating.
Before Feldman’s first year at Baylor was over, George Pilling and Son
Company was marketing—in addition to the DeBakey Dacron grafts—an
entire line based on the Baylor cardiothoracic and vascular surgical
instruments. Pilling’s engineers and technicians helped in the design as
well, including the famous DeBakey atraumatic tissue forceps, which
continue to be used to the present time across a wide spectrum of surgical
specialties. The Pilling cardiothoracic and vascular instruments all bore the
DeBakey label, but Feldman, who ended up owning a number of patents
from his work at Baylor over the years, recognized that the Chairman’s
name carried with it a cache—in Houston and elsewhere—that few others
possessed: “The mere fact that I was working for Dr. DeBakey gave me sort
of credibility with the rest of the school.”132
Over the years to come DeBakey, so renowned for his authoritarian and
even severe treatment of subordinates (especially the surgery residents)
maintained a friendly and warm relationship with Feldman. During every
holiday season he gave the machinist a gift certificate to Foley’s
Department Store in downtown Houston. Since Mrs. Feldman had a
January birthday, she could always expect a nice gift from her husband and
the landmark emporium.133
Patients coming out of the operating room after the extensive thoracic
and cardiovascular operations were often desperately ill. Blood loss could
be extensive, pulmonary function was frequently compromised, and most of
the patients were in poor shape to begin with. As was the case with recovery
rooms, over the years several isolated examples of prototypical intensive
care units (ICUs) had cropped up here and there, but it was not until the
1950s and 1960s that the concept began to sweep over hospitals and
medical centers across the country. The first ICU to appear at the Texas
Medical Center was in the Methodist Hospital. The year was 1958, and
DeBakey spearheaded the effort.
The Methodist Intensive Care Unit was conceived as part of a three-
phase approach to the care of surgical patients in the perioperative period.
The first phase, Self Care, consisted of a 35-bed unit earmarked for
preoperative patients admitted for workup before surgery. These patients
took care of their own personal needs, and the ward was something akin to
a preoperative hotel. The second phase, Intermediate Care, was the standard
sort of postoperative general floor nursing care to which everyone was
accustomed. Then there was the new ICU.134
There were just six beds at first. Nurses were specially hired for the unit
and trained in electrocardiography as well as other state-of-the-art
monitoring techniques. Some of the more reactionary surgical specialists
initially scoffed at the whole idea, but as the clinical results began to
demonstrate the value of the unit they were soon singing a different tune.
Only a few months after the ICU opened, Ted Bowen, the Methodist
Hospital administrator, began receiving pointed complaints: some of the
same surgeons who had mocked the idea of an intensive care area now
grumbled that DeBakey’s patients were taking up all of the unit beds!
Bowen approached DeBakey about the issue and was met with an
enthusiastic but conditional recommendation to expand: “Let’s get some
more beds in there. But don’t use my beds. I am having a hard time as it is.
By Friday I can’t operate because all the beds are full.”135
By November 1958, the new surgical ICU, comprising 24 beds, was
completed. In order to create the space Bowen had had to subsume the
doctor’s lounge and medical staff suite adjacent to the second-floor
operating rooms, but no one was complaining. Only a few months later the
envious internists got their own medical ICU, too.
More individuals whose names would be synonymous with excellence in
surgery came aboard the Baylor faculty in the late 1950s. These men were
all at least partially trained under DeBakey in Houston, so they were known
commodities. One of these was Walter S. “Sam” Henly, a native Texan who
had graduated from Johns Hopkins School of Medicine and, after being
drafted into the Navy for the Korean War, finished the General and Thoracic
Surgery residencies at Baylor in July 1958. In addition to his clinical
responsibilities, Henly was interested in the physiology of blood flow to the
heart muscle—the myocardium—and had even earned a grant from the
American Heart Association to study this.136 Another familiar newcomer
was Arthur Beall, Jr., who originally hailed from Georgia and had been
educated at Emory University School of Medicine. Beall had done his
internship at Washington University in St. Louis before also serving a stint
in the Navy. He had been among the one-year residents at Methodist
Hospital before joining the Baylor Affiliated Hospitals general surgery
residency. Beall had also finished the thoracic surgery training program.137
One more who signed up was the Floridian H. Edward Garrett. Another
graduate of the Emory medical school, Garrett had served two and a half
years of surgical residency at Vanderbilt University in Nashville, Tennessee,
before being sent overseas. In Korea, Garrett worked in a MASH unit. He
subsequently finished his training in general and thoracic surgery at Baylor
before joining the faculty along with the other young surgeon-scientists.138
It was well that the Baylor surgery faculty was expanding to include
members who could function independently of the Chairman: DeBakey’s
travel schedule only grew busier as the years passed. Of course, one of his
most frequent destinations had always been Washington, D.C.
Toward the latter part of the decade the amount of time DeBakey spent in
the capital city did not diminish, but the nature of many of his visits
changed. While he continued to serve in important capacities on the
National Research Council and Board of Regents of the National Library of
Medicine, he also began applying his energies in new directions. Many of
these were related to fund-raising and governmental lobbying on behalf of
healthcare and related research interests.
Financial support for medical (and all scientific) research in the United
States after World War II had expanded enormously, primarily due to a shift
in its source. Prewar research in America had depended on endowments,
private foundations, and the like and had thus been limited for the most part
to a few well-heeled universities and institutions. After the war, however,
the federal government had taken over the lion’s share of this all-important
function. Thereafter, funds for research in medicine and the other sciences
were spread much more widely and evenly. Grants from the NIH totaled $4
million in value in 1947. A decade later, that figure had swollen to $100
million (by 1974, it would be $1 billion).*139
DeBakey was as aware of the new research-funding paradigm as anyone,
and—given his years in Washington—far nimbler in negotiating the official
labyrinths of the capital city than the great majority of his peers in academic
surgery. Using these skills and an ever-expanding network of contacts great
and small he became devoted to securing as many of the federal grants as
possible for Baylor, while advocating for increased funding of medical
research in general.
One of the most important contacts DeBakey made at this time was the
philanthropist Mary Lasker, the beginning of a relationship that would last
the rest of their lives—and even beyond. Mary and her husband, the
wealthy Chicago advertising wizard Albert Lasker, had created a foundation
for the purpose of furthering medical research in 1942. Annual prizes were
awarded by the foundation for clinical or basic medical science research, as
well as medical journalism. Eventually these became the most prestigious
of such awards in the United States. In addition, the Laskers began raising
public awareness about such issues as mental health, birth control, and—in
particular—cancer (from which Albert died in 1952).† Along the way, Mary
became a kind of fixture—and sometimes irritant—on Capitol Hill and at
the White House, devoting the majority of her time to lobbying for
increased funding of medical research initiatives of every sort. She was
especially vocal—and successful—in her advocacy for the NIH.
That organization’s name was once singular—the National Institute of
Health—and Mary Lasker was a main reason for its becoming plural. In
1948, through her own efforts as well as those of other interested parties, a
new National Heart Institute was established, and soon placed under the
NIH (other subordinate organizations founded around this time included the
National Institute of Diabetes and Digestive and Kidney Diseases, the
National Institute of Mental Health, and the National Institute of Allergy
and Infectious Diseases). Mary assumed a practically permanent position on
the governing board of the National Heart Institute—the National Advisory
Heart Council—and it was in this capacity that she first met DeBakey,
while he was serving on the same committee in 1957.141
Given DeBakey’s well-practiced skills at approaching interested
philanthropists—and their shared goal of advancing medical research—it
was probably inevitable that he and Mary Lasker would emerge as allies
once their paths had crossed: “We became very close friends . . . and I
became more and more closely associated with her in a number of
endeavors.”142
Once she had decided to focus on the NIH, Lasker conceived a formula
for ensuring ongoing (and, in fact, escalating) funding for the institution.
She was a lifelong Democrat and well-acquainted with a number of political
figures from that party. Among these were the influential Senator Lister Hill
and Representative John Fogarty of Rhode Island, who was the long-time
Chairman of the House subcommittee on health appropriations. During the
annual budget debates in Congress, Fogarty and Hill made a regular ritual
of haranguing against phantom NIH budget cuts, as well as producing
expert scientist and physician witnesses to buttress their subsequent pleas
for more money. DeBakey became a full-time member of this troupe, along
with such stalwart luminaries as the chemotherapy pioneer Sidney Farber,
neuropsychiatrist Karl Menninger, and rehabilitation champion Howard
Rusk (who had been on the “Short Snorter” plane with DeBakey back in
1945). Together these witnesses were sometimes referred to as “Mary’s
Little Lambs;” not always with affection.143 Their testimony was
invaluable, though—and highly effective: the NIH budget expanded by an
astronomical 150-fold between 1945 and 1961.144 DeBakey’s busy calendar
from this point on included annual treks to Washington for the budget
hearings, as well as various ad hoc lobbying trips, at the behest of Mary
Lasker.145
In the late 1950s, DeBakey’s role in Washington shifted from guiding
research efforts and shepherding the National Library of Medicine into
existence (in 1959, he became Chairman of the Board of Regents) to
influencing public policy. Back in Houston, meanwhile, the honors and
accolades continued to pour in.
In March of 1958, he was asked to return to New Orleans to give the
Rudolph Matas Lecture at the Tulane University School of Medicine.
During this year he also served as Visiting Professor of Surgery at the
University of Virginia and the University of California in San Francisco. In
1959, he accepted a similar invitation at Mt. Sinai Hospital in Miami,
Florida, and also served as President of the American Association of
Thoracic Surgery and the International Society of Cardiology.146
He also visited India for two weeks in 1959. Diana came along, and,
between his lectures, the two took in many of the familiar sights (he
proclaimed the Taj Mahal “the most beautiful edifice in the world,” and by
now he had seen enough for that to mean something).*147
In 1956, Ben Taub provided funding in the name of his parents, Mr. and
Mrs. J. N. Taub, for the Baylor Surgery Department to have a Visiting
Professorship of its own. Surgical leaders from the United States and abroad
were delighted to come to Houston for this distinction. The first luminary to
receive an invitation to the Taub Visiting Professorship was Alfred Blalock,
the Johns Hopkins Chair of Surgery who had trained Cooley and weighed in
so influentially on the planning of the Texas Medical Center a decade
before. Sir Russell Brock, who had trained Cooley for nine months in
London, followed in 1957, Owen Wangensteen of the University of
Minnesota in 1958, and John Gibbon in 1959.149
Perhaps the most signal honor DeBakey received during the entire
decade was the Distinguished Service Award of the AMA. This was given at
the opening ceremony of the organization’s Annual Meeting, attended by
President Dwight D. Eisenhower, in Atlantic City, in June 1959. This
distinction, which was first awarded back in 1938 (the initial recipient was
Rudolph Matas), is conferred for “meritorious service in the science and art
of medicine.”150 DeBakey saw it accurately as clear recognition on the part
of the largest medical association in the country of the remarkable
contributions he and the Baylor Department of Surgery had made in the
field of cardiovascular surgery during the decade of the 1950s.
During this decadus mirabilis, Michael DeBakey and his team had
conquered a succession of vascular diseases long thought to be incurable.
They had performed one of the first successful abdominal aortic aneurysm
repairs by resection and homograft replacement in the world. They had then
gone on to perform the first successful such surgery on a descending
thoracic aortic aneurysm, the first successful carotid endarterectomy, the
first successful repair of an aneurysm of the distal aortic arch, the first
successful repair of aortic dissection in the thoracic aorta, the first
successful repair of a thoracoabdominal aortic aneurysm, the first
successful repair of an aneurysm of the ascending aorta, and the first
successful repair of an aneurysm of the entire aortic arch. These were not
merely academic or even technical achievements. Each represented a new
hope for thousands of individuals who were hitherto condemned to death,
stroke, limb loss, or intractable pain. Along the way, the Baylor team had
also spearheaded the development of a legitimate, effective synthetic
replacement for diseased arteries, brought to reality or perfected essential
and novel instruments for the performance of delicate vascular procedures,
and devised important new surgical techniques such as patch angioplasty
and eversion endarterectomy, all of which continue to be in clinical use to
the present day. This was arguably the most outstanding period of sustained
surgical innovation by a single group in the history of medicine; its impact
was both global and lasting.
There was much more yet to come.
Notes
1. Miller CA. The Big Z: The Life of Robert M. Zollinger, M. D. Chicago: The American College
of Surgeons, 2014: 31.
2. Gross RE, Pomeranz AA, Watkins E Jr, Goldsmith EI. Surgical Closure of Defects of the
Interauricular Septum by Use of an Atrial Well. New England Journal of Medicine
1952;247:455. Gross followed the suggestion of a medical student named Elton Watkins.
3. Miller CA. The Big Z: The Life of Robert M. Zollinger, M. D., 31.
4. Lillehei CW, Cohen M, Warden HE, Varco RL. The Direct Vision Intracardiac Correction of
Congenital Anomalies by Controlled Cross Circulation: Results in 32 Patients with Ventricular
Septal Defects, Tetralogy of Fallot, and Atrioventricular Communis Defects. Surgery
1955;38:11–29.
5. Stoney WS. Evolution of Cardiopulmonary Bypass. Circulation 2009;119:2844–2853.
6. Lillehei CW, Cohen M, Warden HE, Read RC, Aust JB, DeWall RA. Direct Vision
Intracardiac Surgical Correction of the Tetralogy of Fallot, Pentalogy of Fallot, and Pulmonary
Atresia Defects: Report of First Ten Cases. Annals of Surgery 1955;142:418–445.
7. Miller GW. King of Hearts: The True Story of the Maverick Who Pioneered Open Heart
Surgery. New York: Crown Publishers, 2000: 156.
8. Gott VL. Lillehei, Lewis, and Wangensteen: The Right Mix for Giant Achievements in
Cardiac Surgery. Annals of Thoracic Surgery 2005;79:S2210–3. Hill JD. John H. Gibbon, Jr.
Part I. The Development of the First Successful Heart-Lung Machine. Annals of Thoracic
Surgery 1982;34:337–341.
9. Lim MW. The History of Extracorporeal Oxygenators. Anaesthesia 2006;61:984–985.
10. Lillehei CW, DeWall RA, Read RC, et al. Direct Vision Intracardiac Surgery in man Using a
Simple, Disposable Artificial Oxygenator. Diseases of the Chest 1956:29;1:1–8.
11. Gibbon JH. Application of Mechanical Heart and Lung Apparatus to Cardiac Surgery.
Minnesota Medicine 1954;37:171–180.
12. Stoney WS. Evolution of Cardiopulmonary Bypass. Circulation 2009;119:2844–2853.
13. DeWall RA. Origin of the Helical Reservoir Bubble Oxygenator Heart-Lung Machine.
Perfusion 2003;18:163–169.
2:107:11.
15. Ibid.
16. Miller GW. King of Hearts, 181.
2:107:11.
20. Cooley, D. A., Belmonte, B. A., Zeis LB, et al. Surgical Repair of Ruptured Interventricular
Septum Following Acute Myocardial Infarction. Surgery 1957;41:6:930–937.
2:107:11.
22. Ibid.
23. Ibid.
24. Ibid.
25. Ibid.
27. Cooley DA, DeBakey ME. Resection of Entire Ascending Aorta in Fusiform Aneurysm Using
Cardiac Bypass. JAMA 1956;162:1158–1159.
28. Cordell AR. Milestones in the Development of Cardioplegia. Annals of Thoracic Surgery
1995;60:793–796.
29. Cooley DA, DeBakey ME. Resection of Entire Ascending Aorta in Fusiform Aneurysm.
30. Cooper DKC. Open Heart: The Surgeons Who Revolutionized Medicine. New York: Kaplan
31. Cooley DA, DeBakey ME. Resection of Entire Ascending Aorta in Fusiform Aneurysm.
32. Michael M. DeBakey, personal communication, November 12, 2018.
33. Ibid.
35. Ibid.
36. Ibid.
37. Ibid.
39. Ibid.
2:107:11.
41. Ibid.
2:107:11.
43. Ibid.
2:107:11.
2:107:11.
47. Ibid.
48. DeBakey ME, Crawford ES, Cooley DA, et al. Successful Resection of Fusiform Aneurysm of
Aortic Arch with Replacement by Homograft. Surgery, Gynecology and Obstetrics
1957;105(6):657–664.
American College of Surgeons 2016:101:4:43–44.
50. “Michael E. DeBakey, M.D.” Speech of JL Ochsner, given to author January 20, 2017.
51. Smith KA. Laws, Leaders, and Legends of the Modern National Library of Medicine. Journal
of the Medical Library Association 2008;96:121–133.
53. Letter, M. E. DeBakey to W. G. Reidy, November 7, 1955. MS C 47, National Library of
Medicine (US) Papers relating to the construction of a new medical library, 1874–1959,
Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine
(USA).
54. Letter, M. E. DeBakey to W. G. Reidy, December 20, 1955. Reidy letters MS C 47, National
Library of Medicine (US) Papers relating to the construction of a new medical library, 1874–
1959, Modern Manuscripts Collection, History of Medicine Division, National Library of
Medicine (USA).
55. Ibid.
56. Letter, M. E. DeBakey to W. G. Reidy, January 19, 1956. MS C 47, National Library of
Medicine (US) Papers relating to the construction of a new medical library, 1874–1959,
Modern Manuscripts Collection, History of Medicine Division, National Library of Medicine
(USA).
57. DeBakey ME. The National Library of Medicine: Evolution of a Premiere Information Center.
JAMA 1991;266:1252–1258.
58. Smith KA. Laws, Leaders, and Legends.
59. The Old Supreme Court Chamber. United States Senate Pub. 113–3.
60. Smith KA. Laws, Leaders, and Legends.
61. A Medical Treasure Threatened (April 1, 1956). Chicago Daily Tribune, 16.
62. Daley Names 19 to Medical Library Group (May 25, 1956). Chicago Daily Tribune, B3.
63. Dodd P. Rayburn Gives Chicago Boost on Medical Library (June 14, 1956), Chicago Daily
Tribune, 3.
65. Ibid.
66. DeBakey ME. The National Library of Medicine.
67. Board of Regents National Library of Medicine. Agenda. First Meeting, March 20, 1957.
68. Dalton ML. Champ Lyons: An Incomplete Life. Annals of Surgery 2003:237(5):694–703.
69. Board of Regents National Library of Medicine. Agenda. First Meeting, March 20, 1957.
70. Ibid.
71. Ibid.
72. Ibid.
73. Ibid.
74. Board of Regents of the National Library of Medicine. Minutes of second meeting, FY 1957,
Washington, April 29, 1957.
75. Ibid.
76. DeBakey ME. A Conversation with the Editor. American Journal of Cardiology 1991;79:938.
77. Board of Regents of the National Library of Medicine. Minutes of the second meeting, FY
1957, Washington, April 29, 1957.
78. Creech O, Delerling RA, Edwards S, et al. Vascular Prostheses: Report of the Committee for
the Study of Vascular Prostheses of the Society for Vascular Surgery, Surgery 1957;41:62.
79. Ibid.
81. Edman TE. Tubing for Arterial Surgery Knit on V-Bed Flat Unit. Knitted Outerwear Times
1958;26(5):7–9.
83. Ibid.
84. The Institute was founded in the 1880s as the Philadelphia Textile School. When the school
was granted the right to award baccalaureate degrees in 1942, the name was changed to the
Philadelphia Textile Institute. After more growth and name changes, the school merged with
Thomas Jefferson University and was subsumed under that name in 2017.
85. Edman TE. Tubing for Arterial Surgery.
86. Ibid.
87. Ibid.
88. Edwards WS. Arterial Grafts: Past, Present, and Future. Archives of Surgery
1978;113(11):1225–1233.
89. Edman TE. Tubing for Arterial Surgery.
2:107:11.
91. Ibid.
92. Ibid.
93. DeBakey ME, Cooley DA, Crawford ES, et al. Clinical Application of a New Flexible Knitted
Dacron Arterial Substitute. Archives of Surgery 1958;77(5):713–724.
2:107:11.
95. Ibid.
96. Alexi-Meshkishvili VV, Konstantinov IE. Pioneering Contributions of Alexander A.
Vishnesky and His Team to Cardiac Surgery. Journal of Cardiac Surgery 2005;20:569–573.
97. Launius RD. Sputnik and the Origins of the Space Age.
https://history.nasa.gov/sputnik/sputorig.html (accessed October 15, 2018).
98. DeBakey ME. Diary of My Trip to the USSR. Bulletin of the American College of Surgeons
1959:44:521–526.
99. Ibid.
100. Ibid.
101. Rudolph Nureyev—Biography—Three Years in the Kirov Theatre.
http://www.nureyev.org/biographie_kirov.php (accessed November 3, 2018).
102. DeBakey ME. Diary of My Trip.
103. Ibid.
104. Ibid.
105. Ibid.
106. Soviet Visitor Lauds Local Doctor’s Work (January 20, 1959). Houston Chronicle.
107. DeBakey ME. Diary of My Trip.
108. Soviet Visitor Lauds Local Doctor’s Work (January 20, 1959). Houston Chronicle.
2:107:11.
110. Ibid.
111. Ibid.
112. Ibid.
Patient Care at Baylor College of Medicine. Houston: Baylor College of Medicine, 2011: 43–
44.
116. Ibid.
117. Ibid.
118. Ibid.
119. Ibid.
120. Ibid.
2:107:11. Annual Report of the Department of Surgery, Baylor University College of
Medicine, Houston, Texas, 1957. DeBakey Collection. Baylor College of Medicine Archives.
Houston, TX. 2:107:11.
2:107:11.
123. Carrel A. The Surgery of Blood Vessels. Bulletin of Johns Hopkins Hospital 1907;18:18.
124. DeBakey ME, Crawford ES, Cooley DA, et al. Surgical Considerations of Occlusive Disease
of Innominate, Carotid, Subclavian, and Vertebral Arteries. Annals of Surgery
1959;149(5):690–710.
2:107:11.
126. Crawford ES, Beall AC, Ellis PR, et al. A Technic Permitting Operation Upon Small Arteries.
Surgical Forum 1960;10:671–675.
127. Guthrie GC. Blood-Vessel Surgery and Its Application. London: Longmans, Green and
Company, 1912.
128. Baffes TG. Willis J. Potts: His Contributions to Cardiovascular Surgery. Annals of Thoracic
Surgery 1987;44(1):92–96.
129. Jacobson JH. Classical Music Experience: Discover the Music of the World’s Greatest
Composers. Naperville, IL: Sourcebooks, Inc., 2008: 133.
2:107:11.
131. Maker of Devices for Houston Surgeons Dead at 88 (May 8, 2012). Houston Chronicle.
https://www.chron.com/news/houston-texas/article/Feldman-maker-of-devices-for-Houston-
surgeons-3567023.php. Accessed November, 2018.
132. Ibid.
133. Claudia Feldman, personal communication. November 11, 2018.
2:107:11.
135. Roberts WC. Michael Ellis DeBakey: A Conversation with the Editor. American Journal of
Cardiology 1997;79(7):929–950.
2:107:11.
137. Arthur C. Beall, Jr. https://www.bcm.edu/departments/surgery/about-us/legacy-
leadership/beall-arthur (accessed October 24, 2018).
138. Ochsner JL. H. Edward Garrett, MD 1926–1996. Journal of Vascular Surgery
1996;24:6:1064–1065.
139. The Mary Lasker Papers: Mary Lasker and the Growth of the National Institutes of Health.
https://profiles.nlm.nih.gov/ps/retrieve/Narrative/TL/p-nid/200 (accessed October 30, 2018).
140. Bush V. Science: The Endless Frontier. Washington, DC: US Government Printing Office,
1945.
142. Ibid.
143. The Mary Lasker Papers: Mary Lasker and the Growth of the National Institutes of Health.
https://profiles.nlm.nih.gov/ps/retrieve/Narrative/TL/p-nid/200 (accessed October 30, 2018).
144. Ibid.
2:107:11.
146. Ibid.
148. Ibid.
2:107:11.
150. The American Medical Association Awards Program Criteria. https://www.ama-
assn.org/content/american-medical-association-ama-awards-program-criteria (accessed
October 7, 2018).
*
Elliott Cutler, the Chief Consultant in Surgery for the European Theater of Operations in World
War II, was noted for this work in his early career. The procedure was a blind cut of the mitral valve
through the wall of the beating heart.3
*
The surgeon actually impaled his finger intentionally with the suture needle in order to identify
where the stitch was going.
*
This never occurred during the year-and-a-half that the cross-circulation technique was used by
Lillehei, but one mother did suffer severe central nervous system injury from an air embolism. That
family had been evaluated at Baylor, too, but no treatment was then available in Houston.7
†
Gibbon did not report the four cases in the literature immediately, and they were only published
after he gave a symposium lecture in Minnesota in the fall of 1954.11 The results were not superior to
those of the other, more primitive techniques (as Cooley remarked, “One success with three deaths
did not seem to be that great”12). It was later that the significance of Gibbon’s work was widely
recognized.
*
Cooley and DeBakey had heard Lillehei speak on the topic of cross-circulation at the Society of
University Surgeons meeting, hosted by Baylor, in February 1955.15
*
Accompanying Cooley on the Minnesota trip was the pediatric cardiologist Don McNamara.
Although he observed the same cases, McNamara came away from the trip swayed by the Gibbon-
Mayo concept, and it took Cooley some time to convince him that the bubble oxygenator was the
better choice. This was important because many of the patients Cooley operated on were referred to
him by McNamara.19
*
Texas Children’s Hospital, as well as St. Luke’s Episcopal Hospital adjoining it, had opened in
1954 at the Texas Medical Center, just a few hundred feet from Methodist Hospital. At this point
Baylor surgery residents at the junior level rotated at Texas Children’s for three months at a time.22
*
In the early days of open heart surgery, even though the field could be made mostly bloodless by
the heart-lung bypass machines, the heart itself typically continued to beat during the pump period.
Early work was already being done at this time on methods of stopping motion of the heart muscle,
the myocardium, in order to permit more precise open-heart surgery. Hand-in-hand with these
studies, investigations were under way into diminishing cellular metabolism in the myocardium in
order to minimize the chances of ischemic injury. Local hypothermia and perfusion of the heart with
ionic solutions such as potassium were showing promise in accomplishing these goals.28
*
While in Korea Howard had done important work on arterial repair of battlefield injuries. He
went on to a distinguished career and developed an international reputation in pancreatic surgery.
*
Kennedy was also chairman of the Reorganization Subcommittee of Government Operations,
which officially considered the recommendations of the Hoover Commission.
*
Lyons was one of Churchill’s men at the Massachusetts General Hospital before the war. After
enlisting, he performed valuable clinical experiments with penicillin.72 Lyons became gravely sick
with hepatitis, which he contracted from the wayward scalpel of a junior assistant, but recovered to
take a faculty position at Tulane with Ochsner in 1945. DeBakey had recommended Lyons to
Ochsner during the war, and the two junior faculty members became friendly rivals at the university
and the Ochsner Clinic before they left to lead their own departments.68 Lyons become Chair of
Surgery at his home state university in 1950.
*
A sobering aspect of the site consideration, emblematic of the era, was conscious concern of
placing the library close to a center that might be targeted for atomic bombing.
*
This idea reportedly came from observing the design of bendable children’s “silly straws.”
*
The term “Sputnik Crisis” was coined by President Eisenhower himself. The specter of a
“technology gap” between the West and the USSR. was an impetus to a series of massive funding
projects that emerged from Congress in short order, aimed at eliminating any such deficit. Among the
agencies and programs that arose from the Sputnik aftermath was the National Aeronautics and Space
Administration (NASA).97
*
The lead in this production was an unknown 20-year-old dancer named Rudolph Nureyev.102
*
Various designs of this sort had been proposed and advocated in the years before anastomotic
suturing became standardized—and they continue to crop up from time to time even to the present—
but these have given way to the more precise and careful manual techniques.
*
All three of Ochsner’s sons: Alton, Jr. (“Akky”), John, and Mims Gage, became surgeons.
*
The first report of this new technique appears to have occurred in a presentation not on renal
artery surgery, but on procedures involving arterial disease in the brachiocephalic arteries. This paper,
given at the Southern Surgical Association meeting in Boca Raton, Florida, in December 1958, also
described, evidently for the first time, the technique of eversion endarterectomy. This alternate
method of extruding arterial plaque involves folding the normal vessel wall over the diseased
segment to deliver it for removal and is still utilized, particularly in the carotid surgery setting.124
*
The first of these clamps was built by Burton Richter, Potts’s neighbor in the Chicago suburb of
Oak Park, who worked for a local medical instrument manufacturer. The clamp was patented, and
Richter built them all himself. When the US Army ordered more than Richter could deliver during
the Korean War, other manufacturers slightly modified the design to fill the need, effectively
breaking the patent.129
*
One of the main reasons for this sea change in research funding was a July 1945 report to the
President entitled, “Science: The Endless Frontier.” This was authored by Vannevar Bush, a brilliant
scientist and administrator who had led the mammoth Office of Scientific Research and Development
during the war (among a vast array of responsibilities, this office oversaw the Manhattan Project). He
specifically identified the problem of private funding as a shackle on the progress of scientific
research and recommended this be superseded by governmental support, both to foster the
advancement of knowledge and ensure the economic health of the nation into the future. Bush’s
report singled out federal funding of research at medical schools as particularly important.140
†
Albert Lasker, who pioneered the use of slogans and logos in the promotion of brands, is
sometimes referred to as the “Father of Modern Advertising.” He owned the Chicago agency Lord
and Thomas, which still exists as one of the world’s largest advertising conglomerates, FCB.
*
Through a colleague, DeBakey met Prime Minister Nehru on this trip. The great Indian leader
exhibited moments of apparent disconnection, which DeBakey thought might be neurologic events.
Four years later, Nehru died after a series of strokes.148
8
Houston: 1960–1969
’Th’ applause of list’ning senates to command.
8.1 “You Can’t Build a Good House for That”

In May 1960, DeBakey was named Chair of the Democratic Advisory
Council’s Advisory Committee on Health Policy.1 This panel was
assembled to formulate the health care plank of the Democratic Party’s
platform for that Presidential election year. The committee comprised 21
members. Not coincidentally, the vice chair was Mary Lasker. Naturally,
DeBakey’s help—and success—in lobbying Congress for healthcare
funding made him an attractive leader for this group, as did his evident
medical expertise and increasing national profile. When the final policy
statement emerged, along with the rest of the party’s platform on July 11, it
called, rather innocuously, for increased funding for medical schools and
research. It was another provision, however, that drew the most attention.
The language struck notes that sound remarkably similar to some heard 60
years later:
The right to adequate medical care and the opportunity to achieve and enjoy good health.
Illness is expensive. Many Americans have neither incomes nor insurance protection to enable
them to pay for modern health care. The problem is particularly acute with our older citizens,
among whom serious illness strikes most often.
We shall provide medical care benefits for the aged as part of the time-tested Social Security
insurance system.2
DeBakey considered this concept of government-subsidized health care

for the elderly, already dubbed “Medicare,” so obviously appropriate as to
be barely worthy of debate and was shocked when some of his colleagues
erupted with vitriol against him:
Dear Mike:
I was indeed disturbed to learn that you headed the Democratic Party’s Committee on Health
Policy which endorsed Kennedy’s plan for care of the aged, under Social Security. Doctors have
always taken care of those in need, or favored means of taking care of them. This proposal of
placing medical care of the aged, whether over or under 65 or any other age under Social
Security, is of course, nothing but Socialized Medicine; and would indeed be a disaster for the
quality of medical care which the United States has become used to. There is only one thing that
would be more disastrous for the citizens of this country, and that would be the atomic bomb
itself. Nothing else would change and degrade it more.3
Nearly the entirety of the American medical establishment mobilized

against the concept of Medicare and its purported move toward socialism.
As a highly visible member of that community and the apparent standard-
bearer of the cause, DeBakey felt the wrath of his peers. Even the American
Medical Association (AMA), which had so recently given him its highest
award, “virtually ostracized” him.4
They branded me as being for “socialistic medicine.” And, of course, I never was. This was a
way to get older people medical care when they couldn’t. I’ve tried to point this out time and
time again—that I was strongly opposed to government control of medicine.5
DeBakey’s reasons for opposing government control of medicine did

differ from those of the AMA. From his time in the Army, he felt that the
quality of medicine, in both clinical and research endeavors, would
diminish under federal control: “It would become mediocre. Because
there’s no way you can run an organization of that magnitude without it
becoming mediocre.”6
He continued to support what became the first, ill-fated Medicare bill
throughout the early part of the Kennedy Administration. DeBakey traveled
to Washington for a television and newspaper “photo op” with the President
in the Rose Garden, along with several other like-minded physicians—
although many others he approached to join him for the gesture refused.
The bill was unsuccessful in Congress, however, and the Medicare program
would have to await the next President for passage.*
In that same month of May 1960, when DeBakey was asked to lead the
development of the Democratic Party’s Advisory Committee on Health
Policy, he also testified before the Senate Appropriations Committee on the
topic of federal funding for research into cardiovascular disease. After
recounting the many advances that had been made in this field during the
postwar period, he advocated eloquently for the institution of specialized
Cardiovascular Research Centers across the country. In such places, he
asserted, the familiar academic triad of patient care, education, and
scientific investigation could work hand in hand to eradicate the specter of
these maladies.7
Once again, and in the most visible manner yet, DeBakey’s familiarity
with the machinations of Washington paid big dividends for Baylor and the
Houston Methodist Hospital.
On October 2, it was announced that, with a grant of more than a quarter
million dollars from the National Heart Institute, the nation’s first
Cardiovascular Research Center would open at Methodist under the aegis of
the College of Medicine. Nearly $400,000 was earmarked for the second
year, with almost half a million per year for the next eight. DeBakey and the
new Chair of Medicine Raymond Pruitt, a cardiologist, were set to be the
Principal Investigators of what would obviously be a well-funded facility.8
Methodist Hospital Administrator Ted Bowen had barely digested this
news, which would require him to find a way of integrating the new
research center into the rapidly changing fabric of his physical plant, when
an even bigger change—and challenge—arose.*
This was an era of enormous structural growth for the Baylor University
College of Medicine and its affiliated facilities. Three new buildings were
under construction for the medical school: the M. D. Anderson wing, the
Jesse Jones wing, and the Jewish Medical Research Institute. Ground had
finally broken for the new city-county hospital, at long last to be located in
the Texas Medical Center, adjacent to the Cullen building. Methodist was
also planning construction of a new west wing, which would double the
hospital’s capacity at completion in 1963.9
The source of Bowen’s pleasant discomfiture, however, was none of
these. It was, instead, Methodist’s 80-year old matriarch, Ella Fondren, who
spent much of 1960 as an inpatient in her beloved hospital. She had fallen
while on a visit to Dallas early in the year and fractured her hip. This injury
was treated by Methodist’s Chief of Orthopedics, Joseph King. During her
recuperation, Mrs. Fondren settled into “her favorite room,” 807, which
overlooked the mostly vacant fields immediately north of the hospital.10
Even in the midst of this frenzy of construction, she could envision more.
As the weeks‘passed, Mrs. Fondren became fixated on the empty land
below her room as the ideal site for still-greater growth of the hospital:
“We’ve got to build something on that property over there and right
away.”11
Mrs. Fondren had numerous visitors during her seven-month
hospitalization, of course. Three of the regulars were Bowen, DeBakey, and
King. These three all heard her grandiose plans for further expansion.
Because Mrs. Fondren actually had the capacity to make these plans come
to fruition, she captured their attention. King and DeBakey lobbied for
space for their respective Departments, and Bowen listened to her ambitious
ideas with an eager and sympathetic ear.
Since this sort of planning typically moves forward at a measured pace
(if at all) the three regular visitors had limited expectations. Mrs. Fondren,
however, was on a mission. Just days after her discharge, she asked for a
formal proposal from DeBakey, King, and Bowen as to what they needed to
make their plans a reality in the form of her new building on the vacant site.
Invited to attend a meeting of the Fondren Foundation to make their individual presentations
within a matter of days, the three gentleman “frantically conferred,” recalled Mr. Bowen, noting
their coming to a hasty decision to request the lofty total of $1 million. “We soon found out that
we shot too low when one member the foundation spoke up and said, “Well, you can’t build a
good house for that these days.”12
When all was said and done, what became the Fondren-Brown
Cardiovascular and Orthopedic Research Center cost $9 million to build.
The Fondren Foundation contributed $2.75 million to the Ella F. Fondren
Building, the Brown Foundation $1 million for the Herman Brown
Building, and the NIH $1.96 million.13 There were other major donors,
including a new entity known as the DeBakey Medical Foundation.
DeBakey had established this foundation in 1961, in order to assist in the
never-ending process of funding medical research. The DeBakey Medical
Foundation was a nonprofit organization with, at first, just a three-person
Board of Trustees. DeBakey was, naturally, the Chairman. Ben Taub’s
nephew Henry Taub, Jr., and Baylor University College of Medicine Dean
Stanley Olson were the other two members. The Foundation’s assets were
rather meager at first and derived mainly from the man himself (it was, at
least, a tax relief). In time, however, the fund became a popular target for
the philanthropic efforts of DeBakey’s many grateful patients and well-
wishers and represented an impressive sum.
8.2 Princess Lilian
DeBakey identified five areas of cardiovascular investigation that would be
the focus of the Department of Surgery and the new research facilities in the
early part of the 1960s. These were (1) further development of
extracorporeal circulation methods for cardiac and other procedures—in
other words, tweaking of the heart-lung machines; (2) improvement in the
surgical approach to aneurysmal and occlusive arterial disease; (3) more
work on arterial substitutes; (4) study of the physiology of the heart and
arteries in health and disease; and (5) identification of the cause(s) of
atherosclerosis.14
Across the world, studies were under way to find methods of improving
the pump oxygenators that had revolutionized surgery and permitted both
open-heart operations and repair of complex proximal aortic lesions such as
ascending aortic aneurysms. One of the more expensive and inconvenient
aspects of the heart-lung machines was the need to prime them with fresh,
cross-matched blood. The priming blood was collected immediately before
the operation and pooled from numerous donors. This made it difficult to
perform very many surgeries in a short time. Even worse, despite proper
cross-matching, there were frequent reactions indicative of immunologic
transfusion issues not yet characterized. The need for multiple donors also
made emergency use of the cardiopulmonary bypass devices impractical.
Many centers were working on the problem. Some looked at diluted
blood, and others at dextrose in water, generally employing hypothermia.
Cooley and his team achieved an important advance by showing that it was
possible to prime the pump successfully utilizing 5% dextrose in water, the
disposable oxygenator, and the patient at normal temperature.15
By about 1960, Cooley was working almost exclusively at St. Luke’s and
Texas Children’s Hospitals, although he remained a member of the Baylor
Department of Surgery faculty (St. Luke’s became a Baylor affiliated
hospital in September 1961). In 1962, he formally ceased operating at
Methodist Hospital entirely, with the approval of DeBakey. The stated
reason was an inability to schedule surgical cases or get beds for his
patients. In truth, their practices had grown so large that there was literally
not enough room for both of them, although this was clearly the case in the
figurative sense, too.
DeBakey and Cooley had spent a decade together by this time. They had
written many seminal articles in tandem, and their shared operative cases
were the stuff of legend. They had never been close friends, though. The
two men were separated by 12 years in age and an immense gulf in
background and life experiences. More than enough was to be made of this
in the years to come, but these were drastically different personalities that
happened to be majestically ambitious in the same field, at the same time, in
the same place. Neither was built to play second fiddle, and it was an
unstable brew.
Cooley decided to create a cardiovascular center of his own. Closely
aligned with the two hospitals at which he practiced and funded by
philanthropy, it would be Cooley’s version of the cardiovascular facilities
under planning or construction at Methodist. This center was chartered in
August 1962, as the Texas Heart Institute.16
In late November 1960, DeBakey traveled to Belgium for a week. Visits
to foreign countries for conferences were nothing new, of course, but since
the late 1950s DeBakey (and sometimes his OR team) had been traveling
overseas to demonstrate surgical procedures in person with increasing
frequency. In this case, he had been invited by no less a figure than Her
Royal Highness, Princess Lillian, through one of the country’s professors of
surgery. The Princess had developed a keen interest in cardiovascular
surgery when her son was diagnosed with coarctation of the aorta in 1957.
The surgical expertise to tackle such a problem did not exist in Belgium at
the time, and the royal family had to travel to the United States for the
necessary operation (the procedure was performed successfully in Boston
by Robert Gross).17 When the dust had settled and her son was recovering,
Princess Lillian decided to do what she could to help others in a similar
predicament obtain necessary surgical consultation with Gross and others in
the United States. She soon established a foundation to help with
transporting cardiac patients from Belgium and elsewhere to America for
treatment, the Fondation Cardiologique Princesse Lilian. She also hoped to
render this work unnecessary by improving the standards at home. While in
Boston, the Princess had heard Gross refer to DeBakey as a surgical
“acrobat.” Some time later, while at a social event in New York, she met
DeBakey in person, introduced by Mary Lasker.18
The Princess asked DeBakey to come to Belgium to hold a colloquium
on cardiovascular disease at the Royal Palace, as well as to present
conferences and lectures on this field of surgery at the Belgian medical
schools. Notified by Lasker that the request was forthcoming, DeBakey
happily responded in the affirmative.
On his arrival in Brussels on the morning of November 27, DeBakey was
driven immediately to the Royal Palace, Chateau de Laeken (“My
apartment is at the end of the hallway and consists of a bedroom, sitting
room, dressing room, and bathroom”19). That evening at dinner, he met the
royal family for the first time, including King Baudouin, his father ex-King
Leopold, and Leopold’s wife, Princess Lilian. From the first, DeBakey was
utterly charmed by the Princess.
She actually sparkles with a highly engaging personality. She is obviously well read with a keen
intelligence and is both widely and deeply knowledgeable. Socially conscious and highly
motivated, she spoke of the various needs of her country, particularly in matters of health.
I came away from this dinner with the feeling that this was one of the most pleasant
experiences I have had, owing primarily to the engaging personality and sincerity of purpose of
Princess Lilian, who is truly a wonderfully charming and gracious lady. I find myself wishing so
much that I could offer some real help to this lady who is given so much toward helping her
people.20
On the following day, DeBakey was engaged in conferences and lectures

at Hospital Brugmann and Hospital St. Pierre in Brussels, and on Tuesday
he traveled to the University Hospital in Ghent to tour the facilities and give
a lecture on renal hypertension. He had arranged for the soundtrack of the
film that accompanied this talk to be dubbed into French, but the provided
projector did not have sound, and so he had to narrate in English (“actually,
this may have been better”).21
Princess Lilian accompanied DeBakey and the Belgian medical team on
their rounds at the University Hospital, and then joined her guest for lunch.
Later that day, DeBakey went to Bruges where he saw some of the cultural
highlights, as well as 900-year-old St. John’s Hospital.
On Wednesday, DeBakey performed resection and grafting of a thoracic
aortic aneurysm in a 67-year-old local woman, with good results.
He was welcomed back to the University Hospital the next day to tour
the new Institute of Cardiology, which was under construction. Afterward
he had lunch alone with Princess Lillian at the Palace, where she once again
impressed him with her charisma and zeal: “She is truly a remarkable
person who deserves an honored place among her people.”*22
DeBakey gave a final presentation at the Palace Theater on Friday,
December 2. The audience was composed exclusively of the Deans and
faculties of the four Belgian medical schools. The formal Colloquium
roundtable was held in the afternoon. DeBakey dined with the royal family
one last time, then was off to Houston in the morning. This weeklong visit
to Belgium was the beginning of an enduring friendship between DeBakey
and the Belgian royal family, particularly Princess Lillian. The relationship
bore tangible fruit, too: over the years to come, many Belgian surgeons
trained as fellows at Baylor, subsequently returning to their homeland to
help initiate and nurture the field of cardiovascular surgery there. Things
did not start so easily, though.
The older generation of surgeons in Belgium were as reactionary as their
contemporaries elsewhere tended to be and harbored both a skepticism of
the new techniques and a reluctance to learn and use them. Princess Lillian,
who quickly developed an understanding and appreciation of the value of
the new procedures, defended them vehemently to the naysayers.
There was one professor, for example, who was head of one of the services in Brussels, and he
refused to do any of this work himself and would sort of justify it on the basis that first there
wasn’t much of this that existed in Belgium. They didn’t see any aneurysms, and patients with
occlusive disease really could be treated by sympathectomy. They had done that for years and
they knew that was good. They didn’t know what these grafts would do and whether they’d hold
up and all that sort of thing. And I remember one time the Princess got a little upset and told one
of them off. She said, ‘‘Now look, you don’t know anything about it and yet you’re criticizing it.
You’ve had no experience in this field so how do you know when you say this shouldn’t be done
or it can’t be done?”23
DeBakey consoled the Princess with a plan: they would leave the older
generation to pass along and instead train the eager young Belgian surgeons
in the new methods of cardiovascular surgery. DeBakey himself would
accept them at Baylor for the year-long fellowship. In this way, over the
next decade, a dozen or more Belgian surgeons trained at Houston, and,
before long, four of them would lead cardiovascular surgery programs at
their country’s medical schools.
In the years to come Lilian served as a passionate apostle for DeBakey’s
gospel of cardiovascular surgery across the world. Due to her abundant
connections at high levels of society and government on several continents,
she was able to arrange for invitations to be sent to DeBakey and his team
for demonstrations and didactics in the new techniques. On two occasions,
in Santiago, Chile, in 1964, and in Budapest in 1973, she came along as part
of the team (Figure 8.1).24
Figure 8.1 Princess Lilian of Belgium observes DeBakey at work in the operating room at Methodist
Hospital.
8.3 Patterns
By the late 1950s, DeBakey and others were beginning to notice patterns in
the nature and location of arterial disease. Of course, for decades physicians
had labored under the misconception that occlusive disease, especially, was
diffusely distributed throughout the bodies of the afflicted. This mistaken
impression gravely inhibited the consideration, much less the development,
of applicable surgical techniques: What point was there in fixing one
arterial blockage if all the other arteries either were, or soon would be,
similarly affected? In the postwar era, though—as intrepid souls such as dos
Santos and Kunlin demonstrated that surgical approaches could be effective
in diseased vessels—some of the more thoughtful clinicians began to
question the old dogma. DeBakey no longer assembled poster-sized
spreadsheets of data as he had back at Tulane, but those days were not that
far off, and the penchant for order and systematization remained. As the
data on arterial disease accumulated, his thoughts crystallized into form,
and the patterns, in terms of pathology, anatomy, and treatment, were
gradually codified.
The two broadest categories of pathology were clearly aneurysms and
occlusive disease. Within these lay characteristic anatomic patterns.
With regard to aneurysms of the aorta, DeBakey recognized four
locations—or patterns of involvement, more correctly—that were most
commonly affected: (1) the aortic arch, (2) the descending thoracic aorta,
(3) the thoracoabdominal segment, and (4) the aorta below the renal
arteries.
Analogously, five categories of occlusive disease were apparent; namely,
that occurring in (1) the coronary arteries of the heart; (2) the major
branches of the aortic arch; (3) the visceral branches of the aorta; (4) the
termination of the aorta in the pelvis, along with its major ramifications;
and (5) combinations of the other four. DeBakey subdivided Categories 2
and 4 into proximal and distal forms, since occlusive disease was often
found at the origins of the carotid, iliac, and femoral arteries, but also
distally, especially where these vessels divided into smaller branches.
The location and nature of these pathologies dictated the forms of
treatment: bypass, interposition grafting, endarterectomy, patch angioplasty,
or combinations of these techniques.
DeBakey began lecturing on this synthesis of the existing knowledge
regarding arterial disease in the late 1950s, usually in a talk entitled,
“Changing Concepts in Vascular Disease,” which he gave in several venues
(including at his receipt of the Leriche Award from the International Society
of Surgery in Munich in September, 1959).25 In the early 1960s, he began to
publish articles on the subject, as well. A few years later DeBakey and his
group also published a seminal article classifying aortic dissections. These
efforts all helped to establish a sort of taxonomy of vascular pathology and
eventually standardization of its surgical treatment.*
The Annual Report of the Baylor Department of Surgery for 1959–1961
(the “annual” designation was liberally interpreted over the years) contained
a furtive sentence under the heading of “Cardiovascular Surgical
Investigations.” It read, “Experiments toward the development of an
artificial heart are in progress.”26 Despite the momentous implications of
this, no further information was provided. In fact, there was not much to
add—yet.
Not long after cardiopulmonary bypass machines were first used, it was
found that some patients could not be “weaned” off them at the conclusion
of the procedure. In some cases the heart, most frequently the left ventricle
(which pumps oxygenated blood into the systemic circulation), was simply
too weak to do its job independently—either chronically or as an acute
response to the stress of the operation or, most often, both. In the mercifully
infrequent situations where this was the case, the surgeons were faced with
the devastating scenario of having to witness the patient die on the
operating table, the ineffective heart puttering to a stop. Sometimes the
weaning process was prolonged for hours in a quixotic gesture to forestall
this catastrophe, but the best hopes, prayers, and “tincture of time” simply
could not save some patients. Such nightmare situations were important
motivators to the efforts at developing an artificial heart. The hope was that
such a device could substitute for the function of the patient’s own heart
until the native organ recovered sufficiently to resume its life-sustaining
activity at adequate strength, which might take hours or weeks. Somewhat
more fantastically, the idea that a failing heart might simply be replaced
with a machine someday was never far from the imaginations of the
investigators.
In July of 1961, an Argentine named Domino Liotta was hired as a
Cardiovascular Surgery Fellow at Baylor.*27,28 He had worked in a research
lab at the Cleveland Clinic with the famous Willem Kolff, a pioneer of
kidney dialysis and leader in the development of artificial organs. Liotta’s
own research interest was in building an artificial heart, and at Baylor he
ultimately spent much more time in the lab in this capacity than he did on
the wards.
A year later DeBakey also hired a trained surgeon and researcher from
the University of Kansas, C. William Hall, for the artificial heart program.
His job was to lead the little, minimally funded team that would pursue this
goal. They went about their task with conviction, but they needed more
financial support.
In May 1963, DeBakey testified before a Senate Subcommittee of the
Committee on Appropriations, focused on funding for the following year
for the Departments of Labor and Health, Education, and Welfare—
including the National Institutes of Health (NIH). His long-time confrere,
Lister Hill, chaired the Committee (he publicly addressed DeBakey as “an
old friend”). Among a number of other remarks and requests related to
funding for research, DeBakey made a plea for increased support of the
artificial heart investigations.
The program for developing an artificial heart is being intensively studied in a number of
laboratories, including our own, where it has been clearly demonstrated that it is feasible to
replace the heart with an artificial pump. Animals have been able to survive with an artificial
heart for as long as 36 hours. Fundamentally, the concept is workable, but what remains to be
done is in the field of bioengineering and what is needed obviously is support of research in
this area. We need the skills and talents of bioengineers who have been able to achieve such
dramatic results in other areas of science, such as space exploration. This program could
undoubtedly be greatly accelerated and hastened to its full fruition were there enough funds
available to push it along and to obtain these highly skilled individuals to attack the problem.
This is a very real example of how adequate funds could pave the road to achieving success in a
special area, and the National Advisory Heart Council has recently asked that an expert
committee be formed to approach the problem of developing an artificial heart.29
Congress ultimately appropriated $581,000 for the nation’s artificial heart

programs from the 1964 budget, with the stated goal of developing a
workable model within five years. It was not much money, but it was a
start. The program at Baylor naturally received its share of the allocation,
and this was also the beginning of a joint effort with Rice University, which
could provide the needed expertise in bioengineering that DeBakey had
mentioned in his testimony before Lister Hill’s Senate Subcommittee.
On Monday, April 23, 1962, DeBakey appeared in a special one-hour
television program, broadcast coast to coast on NBC. The show, entitled
“Breakthrough,” was a demonstration of the dramatic new cardiovascular
surgical techniques that were revolutionizing medicine. Live feeds were
transmitted from Washington, D.C., Minneapolis, and Chicago, as well as
from the operating room at Houston Methodist Hospital. DeBakey
performed a carotid endartectomy for the program—still a somewhat
controversial procedure at the time.30
In anticipation of trouble from the Harris County Medical Society, Dean
Stanley Olson sent the curmudgeonly group a preemptive letter announcing
the program in advance, hoping to forestall yet another charge of publicity-
seeking. The Society was evidently assuaged.
As experiments unfolded at Baylor it became obvious before long that
the total replacement of a heart entailed technical difficulties that were
beyond the lab’s capacity, perhaps even outside the limits of existing
technology. DeBakey then directed that work proceed on developing a
device to substitute for the function of a failing left ventricle alone.
What then emerged from the lab was essentially a double-walled tube
made of Dacron and the silicon plastic Silastic. In animal experiments it
was sutured to the left atrium and the descending thoracic aorta.
Compressed air forced between the surfaces caused the inner wall to
collapse, which thrust blood out of the pump. Ball valves were placed at
either end of the tube to ensure that the blood flowed in one direction only.
The design was tested successfully in more than 100 dogs before
circumstance delivered a human experimental subject.31
On July 18, 1963, Stanley Crawford operated on a 42-year-old man
suffering from congestive heart failure caused by dysfunction of the aortic
valve. Crawford successfully replaced this valve with a mechanical one, but
18 hours later the patient went into cardiac arrest. He was successfully
resuscitated but had evidence of injury to the brain and kidneys from the
period of arrest. He also went into left heart failure, manifested by
pulmonary edema: since the left side of his heart was now pumping at a
greatly diminished level, fluid built up in the lungs. According to the article
that was subsequently written, “Because of the hopelessness of the
situation, the patient was considered to be an ideal candidate for left
ventricular bypass.”32 Hall later said, “Dr. DeBakey was called in as a
consultant on the case, and he suggested trying the left ventricular bypass
pump that had been developed in the laboratory.”33
Crawford and Liotta implanted the experimental pump in the patient’s
chest on July 19. In short order x-rays showed significant improvement in
the pulmonary edema, with nearly complete clearing in 48 hours. The
outcome of the case was never in question, and the patient died on July 22,
but the pump was still functional at the time of death and the clinical
performance was still justifiably considered a success.
DeBakey announced the achievement at a meeting of the American Heart
Association in Los Angeles in October 1963.34
One week later, DeBakey was in New York City to receive the Albert
Lasker Clinical Medical Research Award. As noted earlier, this set of
awards was established by Albert and Mary Lasker to honor and promote
medical research. Over the years it has attained high prestige and is
colloquially known as “America’s Nobel.” Indeed, as of this writing, 86
Lasker awardees have gone on to win a Nobel Prize.
DeBakey’s citation was justifiably broad, listing his many achievements
in advancing the cause of surgical treatment in diseases of the circulatory
system. It was read by the Chair of the Nominating Committee, the noted
pioneer in chemotherapy, Sidney Farber. The closing paragraph was
eloquent in its salute.
His laboratory investigations, translated with extraordinary courage and unprecedented technical
skill to the patient, have resulted in the correction and cure of previously incurable
cardiovascular disease, replacing what would have been lingering, chronic disease and
disability, or sudden death, by vigorous, happy and productive life.35
It must have been especially gratifying for Mary Lasker to recognize her
good friend and brother-in-arms in the ongoing fight for medical research
funding in this manner (Figure 8.2).*
Figure 8.2 DeBakey with the Lasker Award.
In addition to the appropriations for artificial heart research that came out
of the May 1963 hearings, lawmakers also recommended that the National
Advisory Heart Council adopt a sense of “urgency” with regard to the work.
Accepting this, the Council looked to ways to ramp up its support.
DeBakey, of course, was a long-time member of the Council, and he
suggested that an individual with knowledge in the rarefied field be
appointed to come to Bethesda and organize the national effort. Naturally
he had his own man, C. William Hall, in mind for the job. The Council
approved this, and Hall took a six-month leave from the Baylor lab for the
position, along with the invaluable insight and experience, not to mention
the high profile, that came with it.36
8.4 Starving Vultures
In 1963, two major additions were made to the Baylor College of Medicine
and the Texas Medical Center. On May 26, 1963, after a seemingly endless
series of political roadblocks and frustrations, the new city-county hospital
finally opened. It was a stone’s throw from the Cullen building, and it was
named after the chair of the hospital’s Board of Managers for nearly 30
years, Mr. Ben Taub.
The structure of the new hospital is a true delight to those who previously worked in the
Jefferson Davis. The wards are light and airy and, in contradistinction to most hospitals, both
private and charity, there is an excellent lighting system so that an accurate visual examination
of the patient is possible at all times. The institution is totally air-conditioned, which is unusual
for a charity hospital.37
Just two weeks later, the new west wing of Methodist Hospital opened.
The most visible addition was a multicolored mural composed of 1.5
million tiles, “The Extending Arms of Christ,” which overlooked the new
entrance, complete with approach promenade. Inside, however, 375
additional beds had been added to the facility, bringing the total to more
than 800. A new intensive care unit (ICU) was also opened.38
The expansion of facilities and clinical expertise, particularly in
cardiovascular medicine, was now attracting visitors of all sorts to the Texas
Medical Center. In addition to individual patients and their families, many
physicians, trainees, and researchers were finding their way to Houston.
Medical organizations began holding meetings in the city with increasing
regularity. In August 1961, the Alton Ochsner Surgical Society convened at
Baylor, and, as a reverential protégé of the great Tulane professor, DeBakey
made sure that the Baylor contribution to the program was exemplary
(Alton Ochsner also served as Ben Taub Visiting Professor at Baylor in
1966).*39
Later, another conference caused chaos on Cherokee Street, when
DeBakey innocently overextended his reach as the gracious host. As Diana
later remembered,
Sometimes he will be forgetful, or go overboard with his enthusiasm, or both at the same time.
Michel never learned in all these years that only the hostess can extend an invitation. We will
plan a small dinner party for four guests, which means 6 at the table. I prepare for it. Then,
without telling me, he thinks of other people he’d like to have. I am expecting four, but they
keep coming in . . . 8, 10, 12, 14. You know, you can put a little water in the soup, or may be a
little more lettuce to stretch the salad, but if you are having lamb chops—two apiece—there is
nothing you can do to stretch them.
Once there was a meeting in Houston of the American Cardiology Society and Michel wanted
to invite about a dozen officers of the Society and their wives, plus a few local people, to meet
Dr. Paul Dudley White, the famous Boston heart specialist. I had the names of the local people,
so I invited them, but I did not have the names of the Society’s officers and their wives. “Don’t
worry about that,” Michel told me. “They are checking in a day early. I’ll have the girls at the
registration desk tell them they are invited to dinner with us the next night at 7:30. So I plan to
cocktail buffet for about 50.
I still don’t know whether it was Michel’s fault or someone else’s, but somehow the invitation
was passed along to everyone who registered for the meeting–the whole Cardiology Society, not
just the officers. On top of that, Michel thought it would be nice to have all the residents of Ben
Taub General Hospital in the Medical Center come to meet Dr. White, so he invited them, too,
without telling me. It was pouring rain and cold. Cabs were lined up outside the house. People
could not park. After they got in, they couldn’t get out. The house was jammed—the living
room, the terrace, the sunroom, the dining room—like the black hole of Calcutta. If someone
was over by the fireplace, he had to stay there, he could not move.
The residents from Ben Taub stood four deep around the buffet table and ate like starving
vultures. They have to eat hospital food most of the time and hardly ever get any home cooking.
They wouldn’t move, and the other guests couldn’t get to the table. Of course, I ran out of
everything. But I hardly even knew it. I was stuck at the front door greeting guests and
introducing them. Luckily some of the Baylor faculty wives realized what had happened and
scooted out or phoned home and had someone bring something. One got a Kentucky ham. One
of my sons borrowed the biggest roast beef my next door neighbor ever cooked. One friend
went home and got 300 turkey balls out of her freezer. Our bartender got on the phone without
even asking and called in another bartender and ordered an extra case of scotch and this and
that. I did not know until the next day what I owed to whom.
Then, when it was all over and the last guest was gone, Michel came into the kitchen cheerful
as he could be and said, “I think everything went along very well. It was a lovely party. Don’t
you think everything was fine?” That infuriated me. “No I don’t,” I said. “I was just panicky. We
ran out of food and liquor and everything. Why didn’t you tell me we are going to have more
than 50?” “What difference does it make?” he asked. “It went along very well.”
“From now on if we get one—just one—more than you say you are going to invite, we’re
going to the club!” He has been pretty good about it since then.41
By the 1960s, the DeBakey’s son Michael—who was no longer called

“Mickey” except by his parents, aunts, and grandfather, none of whom ever
did stop—had been out of the house for a number of years. He had finished
his secondary education at the Fountain Valley boarding school in Colorado
in 1958, then moved on to Tulane, where his father, uncle, and two of his
aunts had been educated. There he discovered that being the son of a world-
famous surgeon could have its drawbacks. Many of the professors at Tulane
either remembered the great Dr. DeBakey from his time there or learned of
him from the news media. However unfair, comparisons of the son and
namesake to his illustrious father were inevitable. On top of that, young
Michael found that he had no ambition to be a physician, despite—or
because of—his family’s conspicuous presence in the field and even several
summers working as an orderly at Methodist Hospital. After his freshman
year Michael transferred to the small, private liberal arts University of the
South in Sewanee, Tennessee. When he graduated from there he went on to
obtain a master’s degree at the American Institute for Foreign Trade in
Phoenix, Arizona, and got a job with Texaco. It was while working for this
company that he was sent to Lima, Peru, a place that would turn out, in
time, to be a new home.*
In their own turn Michael’s brothers Ernest, Barry, and Denis would
carry on the family’s tradition of higher education. Ernest attended Arizona
State University and the Baylor College of Law, while both Barry and
Denis went to the University of Texas in Austin (Figure 8.3).
The Ben Taub Visiting Professorship that had been inaugurated at Baylor
in the late 1950s continued to attract leaders in the American surgical
community into the new decade. Warren Cole of the University of Illinois
received the honor in 1960, and Francis Moore from the Peter Bent
Brigham Hospital at Harvard the following year. It was during this visit that
Moore became the unknowing foil for Stanley Crawford and his
mischievous sense of humor.42
Moore evidently harbored skepticism regarding some of the new
revascularization procedures that were being performed in such enormous
volume at Baylor by this time. One of these operations, devised to address
the very common problem of occlusion of the superficial femoral artery in
the thigh, was known as femoropopliteal arterial bypass (this was the
operation pioneered by Jean Kunlin in Paris a decade before). DeBakey had
arranged for Moore to observe one of these relatively new procedures. In
addition to DeBakey, Crawford and John Ochsner were scrubbed in. At the
end of the case, after the bypass had been completed and a new pathway for
arterial blood to reach the lower leg was open, DeBakey triumphantly asked
Moore to reach under the sterile drapes and feel the now-bounding pulse in
the patient’s foot: “Frannie, come feel this. Now you’ll know what a great
operation this is.”
Moore checked for the pulse but found none. “Mike, I can’t feel
anything.”
Annoyed, DeBakey felt for the pulse and again pronounced it strong.
“Check again, right here.” But Moore still said he could not feel it.
This cycle repeated several more times, with DeBakey getting
increasingly frustrated. Finally, he broke scrub and stalked out of the
operating room.
What Debakey and his distinguished visitor did not know was that every
time Moore felt for the pulse, Crawford surreptitiously clamped the graft
shut with his hand.
Hours later, on rounds, DeBakey stopped in his tracks and stared at
Ochsner. “You know, that damned Frannie Moore,” he said. The Brigham
chief was mainly renowned as a scientific investigator; not so much as a
particularly talented surgical technician. “No wonder he can’t operate. He
can’t even feel a pulse!”43
Figure 8.3 DeBakey in his office at Baylor, early 1960s.
The following year, 1962, the Taub Professor was Robert M. Zollinger
from the Ohio State University. DeBakey had known Zollinger since World
War II, when the latter had been the Chief Consultant in General Surgery in
the European Theater of Operations. In this period, Zollinger was in the
midst of a clean sweep of leadership positions in the most important
surgical organizations: in a five-year span he served as Chairman of the
American Board of Surgery, and President of the American College of
Surgeons, the American Surgical Association, and the Society of University
Surgeons. The comfort of long friendship allowed both DeBakey and
Zollinger to express their regards freely in correspondence over the years,
and this included a healthy dose of humor that would have shocked both of
their resident staffs.
May 9, 1964
Dear Zolly,
My congratulations on your election to the presidency of the American Surgical Association. It
is a good thing that we are making such rapid progress in extending our boundaries into outer
space. Inasmuch as there are no more surgical organizations here for you to head . . .
May 13, 1964

Dear Mike,
As a super politician heading the super-duper committees for you-know-who, I was pleased you
took the time to share your thoughts with such a dimlight as myself.
We want you to know, however, that our carotids are remaining clear and the current is
strong.
Yours sincerely,
Zolly
May 25, 1964

Dear Mike,
I was glad to see you standing at parade rest in the rose garden in the recent “Medical Tribune.”
The next time you meet with the President, start telling him rather than standing there
completely hypnotized while he tells you what to do. DeBakey is a man of action—at least he
keeps telling me he is.
Zolly
December 24, 1964

Dear Mike,
I have looked at your wrinkled brow in my morning paper every day, and it occurs to me that
you might need some new glasses. One of my friends has been working with a series of
magnifying lenses of the Benjamin Franklin type which can be clipped on over a regular pair of
glasses. It also occurs to me that this can be useful to you for a great deal of your close-up work.
Who knows, you may see what you are doing for a change!! We need to know the
measurements of your peculiarly shaped head from your optician. I just found out, to my horror,
that my ears are set far too low.
Bob
February 25, 1965
Dear Zolly,
I am enclosing my prescription which you requested. I am not sure that I want to see any more
than I am seeing now. If I see more clearly than I do now, it might be too painful.
November 23, 1965

Dear Bob:
I certainly appreciate your good advice, and since I have great respect for my elders I shall give
it serious consideration.
So much that I delegate to others is not done up to my standards, and I simply have to do it
myself. Since you have this problem, too, you can understand . . . tell me, how does one learn to
accept a lower standard?
Dear Zolly,
Thanks for your thoughtful note. I was pleased to know that you read this kind of literature
(or did your secretary call it to your attention?)
I have missed seeing you.
Give your charming wife, for whom I have increasing admiration, my best wishes.
Sincerely yours,
Michael E. DeBakey44
In June 1964, DeBakey was featured in a cover story for the wide-
circulation folio format magazine, Look. The article, entitled “Medicine’s
Frontier: Rebuilding the Human Body,” was one of the first in what would
be, before long, a veritable host of “on the front line”-type reports
documenting the day-to-day life of the Methodist cardiovascular surgery
team and its hard-driving leader. DeBakey’s sister Lois was ebullient: “I am
bursting—bursting with pride after having read the exciting article about
you in Look!”45
Zollinger ‘s congratulatory letter was, unsurprisingly, more cynically
humorous.
June 24, 1964
Dear Mike:
I congratulate the newspaper reporter of “Look” who found that you really do sleep in the
dressing room while the boys open and close the cases. We all got a good chuckle out of the
report and it was nicely done. If I had known cardiovascular surgery was so easy and exciting, I
would have taken it up myself!
Love and kisses,
Bob46
DeBakey and Zollinger shared a number of characteristics, besides being

chairs of university surgery departments, serving as Surgical Consultants
during the war, and nurturing surprisingly well-developed senses of humor.
Both were known as fierce taskmasters and driven perfectionists, as well.
They also swapped practical ideas (Zollinger had a circular desk built at his
home that was a near duplicate of DeBakey’s). In addition, each recognized
the great value of high-quality images in conveying sometimes complex
surgical concepts. Zollinger, who authored what he coyly called a “picture
book” of surgery, the Atlas of Surgical Operations, had inaugurated a
Department of Medical Illustration at Ohio State all the way back in the late
1940s.*47 DeBakey followed suit at Baylor, and, in late 1963, he hired away
from the NIH a gifted young medical illustrator named Herbert Smith, Jr.
Baylor already had a Department of Visual Education, but Smith’s
Medical Communications division in the Department of Surgery soon
outstripped the central organization’s capacities, hiring other talented
illustrators and embracing advanced technologies for the time, including
silk-screening techniques and acetate cells for slides. Motion picture
capability was essential, of course.
Under DeBakey, the Baylor Department of Surgery had been producing
operative motion pictures for years and had garnered numerous awards for
them. The effort to produce them was sometimes prodigious. Since
DeBakey wanted the films to provide their audiences the perspective of the
surgeon, in the early days the cinematographers had to improvise precarious
arrangements. The most successful of these was an actual diving board,
cantilevered over the operating field above the surgeon to allow the desired
view. Wire mesh baskets were suspended beneath the board, to catch any
rolls of film that might slip out of the photographers’ hands as they were
changed.
After Smith arrived, and his Communications outfit blossomed, an actual
Surgical Filming Stand was constructed. This stainless steel behemoth,
which vaguely resembled Robby the Robot from the science fiction film
Forbidden Planet, could be moved in and out of the operating field and
draped as necessary to maintain sterility. At first the stand required the
photographer to assume an uncomfortable crouching position during use,
but it was later modified to allow a more ergonomical prone positioning.
Subsequent versions incorporated powerful lights and a hydraulic system to
allow the photographer some limited motility to get just the right shot, as
well.
Since these movies required narration, Smith also set up a sound booth
complete with sophisticated microphones and recording equipment. Film
editing facilities were also established.
8.5 President and Duke
When the DeBakey-chaired government committee on cardiovascular
disease and cancer had its report short-circuited by the Bay of Pigs fiasco in
1961, one of the more annoyed of the involved individuals was Mary
Lasker (Figure 8.4). She had bided her time, though, and when her good
friend Lyndon Johnson came to occupy the Oval Office, she did not hesitate
to resurrect the idea. DeBakey agreed to chair another attempt, and, on
March 7, 1964, Johnson announced the endeavor, a Presidential
Commission on Heart Disease, Cancer, and Stroke, at a press conference.
The leading causes of death in the United States are heart disease, cancer, and stroke. They have
a greater impact than all other major causes of death in this country. Fifteen million Americans
are today suffering from these diseases. . . . Two-thirds of all Americans now living will
ultimately suffer or die from one of these diseases. I have therefore asked the distinguished
panel of laymen and doctors to recommend steps that can be taken to reduce the burden and
incidence of these diseases. This panel will be chaired by Michael E. DeBakey of Baylor
University College of Medicine in Houston, Texas.48
Figure 8.4 DeBakey with Mary Lasker.
In a sense, this very prestigious position was the culmination of

DeBakey’s many years of service in Washington, D.C., contributing to the
positive influence of the federal government on medicine and research.
Johnson laid the matter bare at the first Commission meeting in April,
stating that, “Somehow, some way, sometime, you are going to find the
answers, and I hope it will be soon.”49 He also ratcheted up the pressure by
setting a deadline of October so that he could include the analyzed
recommendations in his State of the Union address for the following year.
DeBakey was given space at the Executive Office Building and a staff of
more than a dozen to help him complete the Commission’s report.
As a consequence, in the months to come, DeBakey would be spending
even more than his usual amount of time in the nation’s capital. There was
much work to be done in compiling information, sorting it, and then
drawing conclusions. Johnson’s panel consisted of 27 individuals. DeBakey
was already acquainted with a number of them, including R. Lee Clark
from the M. D. Anderson Hospital, Sidney Farber, his own patient Arthur
Hanisch, Howard Rusk, and Helen Taussig of the “blue baby” operation.50
DeBakey divided his forces into eight subcommittees, covering Heart
Disease, Cancer, Stroke, Research, Manpower, Communications, Facilities,
and Rehabilitation. Information was collected from “agencies, groups, and
institutions . . . through letters, staff visits, surveys, etc.” The Commission
also held hearings at which a variety of experts in the various fields
contributed their knowledge and opinions. During the approximately six
months of the DeBakey Commission’s operation, more than 100 individuals
were interviewed.51
Despite the enormous amount of background data that were gathered and
the time and work that was necessary to digest it and generate
recommendations, the report was completed on time. It was published in
two volumes.
After reviewing the magnitude of the problems associated with the three
diseases, the Commission’s report provided 35 specific recommendations.
These were grouped in the areas of (1) a National Network for Patient Care,
(2) Research and Teaching, (3) Application of Medical Knowledge in the
Community, (4) Development of New Knowledge, (5) Education and
Training of Health Manpower, and (6) Additional Facilities and Resources.
The report also provided estimates of the funds necessary to implement
these recommendations, projected out over the following five years (the
Commission was not shy; the estimate for Year One was $357 million,
which grew by Year Five to $739 million).52
The artificial heart found its way into the discussion. A very optimistic
projection asserted that “an effective model is within the range of
possibility by 1970 or even earlier.”53
If the hand of DeBakey was evident in this observation, it was even more
obvious in the recommendation for Regional Medical Centers. These were
envisioned as large hospital complexes spread strategically across the
country, serving broad areas by providing clinical expertise in the setting of
teaching and research. Fundamentally, they would be academic medical
centers, and, indeed, assurance was made that existing university facilities
would be incorporated into the model whenever possible. The plan called
for establishing 25 centers for heart disease, 20 for cancer, and 15 for stroke
over the ensuing five-year period.54 In a sense, these regional centers were
indirect descendants of the military general hospitals and specialty centers
that DeBakey helped bring about during the course of World War II.
Although the report was completed in October 1964, it was not officially
delivered to President Johnson until December.* During the intervening
period, DeBakey happened to be in Washington fine-tuning the final version
when one of the watershed events in the history of cardiovascular surgery
occurred at Baylor in his absence. Not only was this at the Methodist
Hospital, it was on his own service and involved one of his own patients
(Figure 8.5).
Figure 8.5 DeBakey delivers final report of the Presidential Commission on Heart Attack, Cancer,
and Stroke to President Johnson, December 1964.
At this time Ed Garrett, the Floridian who had completed his training in
General and Thoracic Surgery at Baylor and joined the faculty in 1961, was
in charge of DeBakey’s large clinical service in the Professor’s absence.
This was the scenario when a 42-year-old truck driver with severe coronary
artery disease named Heriberto Hernandez was admitted on November 16,
1964.55
Hernandez had suffered a heart attack in December 1963. He had been
enduring incapacitating angina pectoris ever since. In August 1964, he was
admitted to Methodist and underwent a full cardiac evaluation, including
coronary angiography. This showed a severe, localized narrowing of the left
main coronary artery, along with diffuse disease of other branches.
DeBakey considered that this pattern of disease was not amenable to any
accepted surgical options and recommended medical therapy only. He sent
Hernandez home.
Unfortunately, the angina symptoms only worsened, and Hernandez was
admitted again on November 16. At this point, he could not even walk
without shortness of breath and devastating chest pain. The cardiologists
had no more cards to play and referred him back to surgery. With DeBakey
at work in Washington, Hernandez’s care devolved on Garrett. The only
surgery that could be offered was coronary endarterectomy and patch
angioplasty. On November 23, Garrett, along with a newly graduated
Instructor named Jimmy Howell, took Hernandez to the OR.56 The
surgeons’ plan for endarterectomy was thwarted when they realized that the
plaque on the left main coronary artery involved the bifurcation of the
vessel. The technique would not work at a spot like this. With nothing to
lose, they decided to attempt a bypass graft.
Garrett had done a sizable number of operations bypassing arterial
occlusions in many locations in the body, using segments of the saphenous
vein from the leg as a conduit. He saw no reason why the same technique
should not work here. After the vein had been obtained and prepared,
Garrett and Howell placed cardiopulmonary bypass cannulas and
anticoagulated Hernandez with heparin. Then they placed a partial
occlusion clamp on the ascending aorta and sewed the vein on. Next, they
doubly clamped the left anterior descending artery and opened it
longitudinally. They expected their patient to go into ventricular fibrillation
with this maneuver and were prepared to go on bypass, but the arrhythmia
did not arise and they sewed the second anastomosis in 23 minutes.57
Hernandez did have another myocardial infarction, either during or after
the operation, but it did not produce any symptoms and was only identified
on EKG. A heart catheterization was done postoperatively, too, but the
operator failed to actually cannulate the graft (he may not have realized
such a thing was present) and as a result did not provide proof of its
functionality. Although that was a shame for posterity—and, later, all-
important issues of primacy—it was not of much consequence for
Hernandez: except for a few episodes of extreme effort, his angina was
gone for good.
This operation was not the first aortocoronary bypass known to have
been performed. Ownership of that particular distinction is nebulous,
however, and there are several competing candidates. Garrett and Howell’s
procedure appears, though, to have been the first done—successfully—with
saphenous vein.*
As was the case with the initial carotid endarterectomy in 1953, this
operation was not reported in the literature at the time it happened. The
reasons are, similarly, open to speculation. The most likely explanation is
that, again—in the absence of definitive follow-up—any publication of the
procedure was deemed premature. This was DeBakey’s later assertion, and
there does not seem to be any cause to doubt it. Whatever the reason, no
more coronary bypass operations were performed at Baylor until the
procedure began to enter the mainstream of cardiac surgery several years
later. It was nine years before the Hernandez coronary bypass case was
finally published in 1973.59 One happy circumstance of this late report
arose from the fact that, since the patient was alive, the article represented
the longest postoperative follow-up of such a patient in the world.†
Back in Washington, DeBakey delivered the final report of the
Commission on Heart Disease, Cancer, and Stroke to President Johnson on
December 9, 1964.60 The last time he had tried to deliver a similar
document, the Bay of Pigs invasion had prevented his even seeing President
Kennedy. This time, there was another interruption—albeit only temporary.
When I got to the White House, [Presidential special assistant Jack] Valenti was there and he
met me and said, “The President’s got someone with him right now and he isn’t through yet so I
want you to wait a few minutes.’’ So I was sitting there waiting when suddenly Valenti came in
and said, “You’ve got a long-distance urgent call from New York! You can take it over here.” So
I went into this room to take it and it was the doctor calling me about the Duke of Windsor.61
The Duke’s personal physician in New York had tracked down DeBakey
because his famous patient had been found to be harboring an abdominal
aortic aneurysm. He wanted to arrange an immediate transfer to Baylor so
that DeBakey could evaluate the Duke for possible surgery.62
The President completed his meeting before DeBakey finished making
arrangements over the phone for the Duke’s transfer to Houston, so, for one
of the rare times in his high-profile public life, Lyndon Baines Johnson was
kept waiting.
Five days later, the Duke of Windsor and his American wife, the former
Wallis Simpson—as well as their substantial entourage—arrived by train in
Houston. They were met by the British Consul General and taken by Rolls-
Royce limousine directly to Methodist Hospital, where a six-room suite had
been arranged for them on the fourth floor (according to a spokesman, the
facility’s census was down due to the holiday season, otherwise such lavish
arrangements would not have been possible). The Duchess’s room was
specially furnished and decorated in the French Provincial style and flowers
ordered by Queen Elizabeth awaited the royal couple.63
The press, then as now, was nothing less than infatuated with British
royalty, and multitudes of the Fourth Estate descended on Houston from all
over the world. The Duke, of course, had once been King Edward VIII, and
his 1936 abdication in order to be with “the woman he loved” was one of
the major news stories of the twentieth century. The Methodist Hospital
staff struggled with an onslaught of inquiries and other fact-finding
endeavors driven by reporters seeking a unique story but endured them with
mostly good graces.
After confirming the diagnosis and assessing (along with the
cardiologists) Edward’s candidacy for such a major surgical procedure,
DeBakey scheduled the operation of aneurysm resection for December 16.
At surgery, DeBakey found the aneurysm to be the size of a cantaloupe
(preoperatively, it was thought to be smaller—about the diameter of an
orange).64 He resected the aneurysm and replaced it with a tube of Dacron.
“Skin-to-skin” (and this was the sort of operation where DeBakey would
close the incision himself) the procedure took 67 minutes.65
The Duke recovered from the operation without difficulty, and news of
the success was soon circling the globe. The fame of DeBakey and the
Texas Medical Center had long since reached international proportions, but
it was propelled into the stratosphere by the publicity of this event.
Contributing to a large degree was a New Year’s statement from the Duke
of Windsor himself that he was recovering well from “vascular surgery
performed by Dr. Michael DeBakey, the greatest expert in this field today
(Figure 8.6).”66
Figure 8.6 The Duke and Duchess of Windsor with DeBakey, 1965.
During the Duke’s recovery at Methodist, and then at the Warwick Hotel
in Houston—where the entourage stayed for a few days afterward—he and
his wife spent a considerable amount of time with the philanthropic
matriarch of Methodist Hospital, Mrs. Fondren. They had lunch and tea,
and shared biscuits and anecdotes. The Royals even took the time to visit
the lavish Fondren house in Houston’s ritzy River Oaks neighborhood.
Afterward, the Duke was quoted as saying he was appreciative of the
opportunity to see an “average American home.”67
Edward and Wallis soon returned to their American residence at the
Waldorf-Astoria Hotel in New York City, but the cachet of their visit to
Houston lingered long after their train had pulled away from Houston. The
majority of the many news items regarding DeBakey, over many years to
come, would mention this memorable episode, referring to him as “the
surgeon who operated on the Duke of Windsor” or similar epithets.
Although the operation was, for the Methodist surgical team, rather prosaic,
it became among the most famous they would ever do.
Just a few months later, one more encounter with the mass media spread
word even further of the goings-on in Houston. On May 2, 1965, another
DeBakey operation—an aortic valve replacement—was broadcast on live
television. There was a significant difference this time, however. A new
telecommunications satellite called Early Bird was employed for the
twofold purpose of delivering the proceedings live to audiences across
Europe and North America, as well as allowing DeBakey to interact in
“real-time” with the medical faculty at Geneva University. The number of
viewers who watched the broadcast was estimated at 300 million at the
time, making it the largest audience ever to watch a television program to
that point.68
8.6 Texas Tornado

By now DeBakey’s name was becoming a household word in the United
States. Just a few weeks after the ground-breaking satellite broadcast, he
took another big step in this direction.
For much of the twentieth century, the pinnacle of notoriety for a public
figure in America was to be pictured on the cover of Time magazine.
DeBakey joined the long list of the famous (and infamous) to receive this
recognition when a somewhat abstract-looking painting of him in profile
appeared on the front of the May 28, 1965 issue.*70
The article itself, entitled “The Texas Tornado” in reference to a supposed
epithet of DeBakey’s, described the cardiovascular diseases that comprised
the bulk of the work being done at Baylor, as well as the operative
procedures that he and his team had devised or modified to correct them. It
then went on to give some background life details before describing a
typical day for the Baylor Chief Surgeon.
His 20-hour day begins before dawn, when he tackles his paper work in his den at home . . .
writing scientific papers in longhand. He finds that the time it takes to write makes him use
words with the precision that is so precious to him. . . . The huge, horseshoe-shaped desk is
crammed with stacked lantern slides of diseased arteries, patients’ histories, statistical analyses
of the results of thousands of operations, reprints of reports by other surgeons, masses of
correspondence, and a tiny portable TV. If DeBakey switches it on, it is only to remind him
when it is 6:30 and time to head for the hospital.
Houston’s normally seething traffic is mercifully light when DeBakey takes off for Methodist
Hospital in his Alfa Romeo Sprint (a gift from a grateful Italian patient) at an unpredictable
speed and in no particular gear.
His first chore at the hospital starts at 7 AM, when he checks three adjoining operating rooms
to make sure they have all been set up in accordance with orders worked out with his two chief
assistants, Dr. H. Edward Garrett, 39, and Dr. Jimmy Frank Howell, 32.
Professor DeBakey has a handsome, spacious, blue-carpeted office in Baylor’s College of
Medicine, and rarely uses it. In Methodist Hospital, Surgeon DeBakey has a tiny office, as
cluttered as his den, and runs it like an Army command post. . . . He keeps an administrative
assistant and three secretaries frantically busy.71
In addition to this “slice of life” human interest material, the Time article
discussed, in a general way, the experimental work being done on the
artificial heart. In fact, much of the piece focused on this, complete with a
discussion of the left ventricular bypass case from 1963, in addition to the
current work being done. Hopeful reports of successful total artificial heart
experiments in dogs and calves were carefully presented. In case anyone
missed the point, a diagonal white banner adorned the magazine’s cover,
with the words “Toward an Artificial Heart” emblazoned on it.72
The writers also touched on DeBakey’s squabbles with the AMA,
focusing on that powerful group’s opposition to his Commission’s recent
recommendation for the establishment of Regional Medical Centers. The
AMA, it was reported, saw this as “a plot to reorganize US medicine under
Federal control.”73
Of course, this kind of language hearkened back to similar protests
against recommendations made by the DeBakey-chaired Democratic
Advisory Committee on Health Policy prior to the 1960 election. The most
sweeping of those plans had been the idea of providing government-
sponsored medical care for the elderly. Although the initial effort at passing
a bill for Medicare during the Kennedy Administration had failed, even as
the Time magazine article on DeBakey appeared on newsstands another
such bill was being debated in the Senate. This second attempt was
ultimately successful, and Johnson signed Medicare into law on July 30,
1965.
During that same summer the congressional appropriations committees,
acting on the DeBakey Commission’s recommendations, granted
considerable funds for the artificial heart projects. Rhode Island
Representative John Fogarty, one of Mary Lasker’s “little lambs,” pitched a
softball to the NIH delegation, quite literally simply asking them how much
money they would need “to start a real planning program to develop an
artificial heart.”74 DeBakey and his confederates returned with the
astronomical figure of $40 million over the next four years—and it was
approved. The NIH Director, James Shannon, actually opposed the funding
of the artificial heart research because he doubted the science behind it.
This high-level opposition would eventually lead to problems.*
Back in Houston, DeBakey now pushed C. William Hall to apply for a
grant from this suddenly swollen resource. From his time in Bethesda
organizing the national effort in artificial heart research, Hall quite
reasonably considered that he was about as well-qualified as anyone to
write up an appropriate grant proposal, although he had somehow never
actually done such a thing before. He carefully considered all the work that
he expected the lab to do, calculated the costs involved—materials,
equipment, personnel—and came up with what he thought was a reasonable
total: $25,000. Hall proudly presented his frugal estimates to DeBakey and
was taken aback by the response.
He almost threw them at me. In fact, I think he actually did. For Dr. DeBakey was thinking on a
much bigger plane. He was considering a whole range of problems that might be studied in
connection with the development of the artificial heart. He had decided to solve the whole
problem, and not just build a little pump. When Dr. DeBakey got finished with the grant
proposal, it totaled 4.5 million, which was awarded.75
The Baylor-Rice artificial heart program, now as well-funded as its

participants could ever hope to be, pressed forward with research into the
left ventricle replacement pump.
8.7 The Heart Man
In 1965, the Baylor surgical faculty consisted of 13 full-time faculty
members with the rank of Assistant Professor or higher. DeBakey, of
course, was Professor and Chairman. Other full Professors were Denton
Cooley and the general (primarily gastrointestinal) surgeons George L.
Jordan, Jr., and Paul Jordan. The Associate Professors were Stanley
Crawford and George Morris. The Assistant Professors were Arthur Beall,
Jr., Ed Garrett, Grady L. Hallman, Walter Henly, Jimmy Howell, and the
laboratory men C. William Hall and Domingo Liotta.76
DeBakey’s honors and awards from this period included Doctor Honoris
Causa, or honorary doctorate, degrees from the Universities of Turin,
Athens, and Ghent, as well as an honorary Doctor of Laws degree from his
alma mater, Tulane University. He also received, among many others, the
St. Vincent Prize for Medical Sciences from Turin (which carried with it
several thousand dollars in prize money), the Golden Eagle Award for
“Scientific Didactic” films in Padua, the Wisdom Award of Honor in
Beverly Hills, California, and something called the Great Collar with
Golden Medal from the Prix International Dag Hammarskjoeld
organization, which was surprisingly based in Milan, Italy.77
A BBC-TV crew, undoubtedly intrigued by the dramatic events
surrounding the operation on the Duke of Windsor, descended on the Texas
Medical Center in October 1966. Their goal was to profile DeBakey, and
their final product, which was broadcast in the United Kingdom on
November 5 as “The Heart Man,” accomplished this decisively (with the
exception of the reporter’s difficulty with the name of the city, which she
pronounced “hoo-stun”). To the producer’s enormous good fortune, Edward
happened to be at Methodist in person during the filming, having returned
for routine follow-up examinations. The very private Duke somewhat
surprisingly agreed to be interviewed, and when asked why he had come all
the way to Texas for his operation, paid the ultimate tribute: “Well, I came
direct to the maestro.”78
The British crew captured DeBakey in his most commanding air,
sweeping into operating rooms with a flourish and leading a kite-tail retinue
of junior associates and trainees through the labyrinthine hallways of
Methodist Hospital. They also documented his more acerbic side as the
stern Professor, hinting at the biting criticisms and fearsome dressing-
downs that were, by now, legendary among the tight-knit community of
American Surgery. These slings and arrows were typically reserved for
surgery residents and fellows, as well as office staff—medical students and
ancillary personnel went relatively unscathed.
The tales of colorful belittling and abrupt termination are legion. On
more than one occasion DeBakey demanded that a resident drape and
repeatedly redrape a surgical patient, insisting that the procedure had been
done incorrectly, although the trainee could discern no difference in the
failures and the ultimately approved technique. He was famous for
lamenting, hands spread above the surgical field in supplication to the
universe, that he was surrounded by incompetents and saboteurs. A favorite
remark was that all he needed was a third hand and he could do every
operation by himself. If DeBakey fired a resident, though, they would often
be as quickly reinstated after a cooling-off period of indeterminate length.
This was not, however, always the case.
There was one guy that was a great resident. A young girl had a post-traumatic thoracic
aneurysm. She was in an automobile accident. Postoperatively he had written an order for saline
at so many drops per minute, but they kept going and going and she got congestive heart failure.
He didn’t say to stop it at two liters or something. And [Dr. DeBakey] fired that boy right there
and he was out—done—now.79
Eventually the residents came to recognize and define a hierarchy of

termination. There was “fired”—meaning the individual in question needed
to remove themselves from the Professor’s sight immediately, but they
might return in a few hours or the next day; “fired-fired”—an obviously
more serious state in which a longer time could be expected before
reinstatement; and “fired-fired-fired”—which was permanent and
irrevocable.
DeBakey’s personality in adulthood was defined by an essential
dichotomy. There was the “public” persona—the charming, witty
intellectual with a quick, beaming smile and the extraordinary ability to
converse comfortably on virtually any topic. This was the DeBakey seen by
most surgical peers, interviewers, patients, and philanthropists. The other
was “Black Mike”: the fierce taskmaster quick to criticize and slow, if ever,
to praise. This was the DeBakey that was, all too often, most familiar to his
trainees.
For some who had known this complex man the longest, the two sides
were sometimes difficult to reconcile. Alton Ochsner struggled to
understand his protégé.
I’ve been in the Clinic over there several times when he’s been very curt. This is very foreign to
the Mike I know. When he was here I never saw this. He was the sweetest character. When I saw
him in the operating room over there, when he would speak curtly, this was not Mike.80
Ochsner believed that the tension of the complex cardiovascular

procedures, as well as professional competition with his clearly threatening
junior colleague Denton Cooley, drove the change he observed in DeBakey.
In fairness, many of the leaders of academic surgery throughout the
twentieth century were famous for their dominating and authoritarian
personalities, in the United States and elsewhere. This phenomenon only
became more florid in America when the mid-century generation of such
leaders returned from military service, and the discipline this entailed, in
World War II.
For his part, DeBakey did not pretend not to know what was said about
him, but he attributed these perceptions to his unwillingness to compromise
his high standards.
Most people are mediocre. That’s the whole definition of mediocre. It’s very difficult for me to
put up with mediocrity. The most difficult thing I have to deal with is to put up with mediocrity.
I still can’t get adjusted to it, and what happens is that I’m turned off to these people, I don’t
want to associate with them. I don’t want to teach them, I don’t do anything to them. I just want
to leave them alone, just not worth fooling with. And, of course, this affects my personality in
my relations with other people and it’s part of the criticisms that I have to put up with, because a
great majority of the people don’t find me very warm and it’s because I’m turned off to them. I
don’t want to have a relationship with them and I’m not willing to be a good guy, you see, I
can’t pay that price to do it.81
His explanation of his sometimes-harsh behavior toward his trainees was

consistent over the years.
You’re dealing with the life and death of people. The necessity to meet all of the standards
becomes critical in many of the patients that I have to deal with, who are physically ill. So that
when they don’t meet those standards in that relation, I’m upset about it. And I say to them very
often, don’t you see all you’re doing is getting me upset and this creates a bad relationship
because you’re not paying attention to your job? I’ve given you instructions about this time and
time again. I say to you now do this, do that, do you understand the reason for it? You tell me
you do and yet you don’t do it. I have to come up here and check you constantly. I have no
confidence in your ability to do what I tell you to do. That’s why I’m constantly checking you
and finding these deficiencies. I can’t help insisting upon these standards in that environment
because I know how important it is to the life of the patient, and I have had many experiences in
which the patient died because someone was careless, time and time again. How do you explain
that, how can you explain that to the family?82
It bears noting, however, that despite the harrowing experience of
suffering through training under DeBakey, nearly all of his former students
later expressed affection for their hard-nosed teacher and his draconian
instruction. He had strengthened them for any eventuality they might face
in their careers, and if they could handle training under DeBakey, they
could handle anything. Besides, they all recalled, if you actually did the
work, he treated you fairly. This affection did not quite rise to the level of
nostalgia, though. None ever expressed a desire to relive the experience. As
one who went on to great achievement himself put it, “He was able to
stimulate his help to peak performance. And if he didn’t get that peak
performance, he would re-stimulate you until he did.”83
Perhaps not coincidentally, DeBakey suffered from frequent headaches,
which affected him from boyhood on. He believed these to be familial and
not associated with the stress of his profession, but the contribution of the
nature and immense volume of his workload cannot have been salutary.
I just tolerate the headache. It goes away after a while. There’s not a damn thing you can do
about it. I can be absolutely relaxed in every possible way and wake up in the middle of the
night with a headache. I just disregard it. I never stop working or anything. I operate and do
everything. I find that’s the best way to deal with it. Occasionally it gets to be kind of severe and
I have to take a little aspirin. My mother had them, and my brother has them. Three of my sisters
have them. I can remember when I was a little boy I had them.84
8.8 Left Ventricular Bypass

The rapid growth of Methodist Hospital’s facilities in the first half of the
1960s could still not keep up with the overwhelming influx of patients that
came to Houston to be treated by DeBakey and his team. All the magazine
stories, operation broadcasts, and television profiles added to the lustre of
the man and his facilities and, with it, the draw. Many more patients came
from afar than from Houston. They traveled from every state and dozens of
foreign countries (which was one of the reasons DeBakey did not
particularly care about the grumblings of the Harris County Medical
Society). With Methodist full to capacity, dozens of patients had to be
turned away by the admitting office every day. Many would-be patients
took rooms in nearby hotels.
By the fall of 1965, the problem had reached dire proportions. Desperate
for a solution—and more bed space—Ted Bowen, the Methodist
Administrator, opted to lease the Glen Eagle Convalescent Home, about a
mile south of the Medical Center. This became the Methodist Hospital
Annex. It filled every bed on the day of its opening in November.85
During the time of its operation, the Annex housed patients who were
admitted for preoperative testing (the usual surgical patient’s course was to
the Annex preoperatively, then to Methodist—or the Fondren-Brown
complex after it opened in 1968—for surgery and postoperative ICU care,
then to the sixth floor for Intermediate Care, followed by ordinary nursing
care and discharge). DeBakey did daily rounds on the Annex patients when
possible, and this was one of the few times in his routine when he could
indulge his enthusiasm for fast driving. Tales abound of his racing to the
Annex down Fannin Street at breakneck speed, and—like Gertude Forshag
20 years before—the residents who sometimes accompanied him often had
cause to doubt their imminent life spans.
DeBakey could perhaps be forgiven his open-throttle approach to the
Annex trip in light of the vehicles he drove. In addition to the Alfa Romeo
mentioned by the Time writers, he owned a succession of extraordinary
automobiles—usually foreign sports cars—over the years. He drove a
Maserati Bora, a Ferrari Dino, and a 12-cylinder Lamborghini. These were
mainly gifts from well-to-do patients who, understanding that he would not
accept a traditional fee and instead direct them toward philanthropic
contributions, wanted to bestow something he could not transfer to the
Baylor Surgery Department or the DeBakey Medical Foundation. However,
the most magnificent of his automobiles from this era was a 1967 Ferrari
330 GTC Speciale, which he purchased while on a visit with Princess
Lillian and King Leopold to the Ferrari headquarters in Maranello, Italy.
Only a handful of this model were ever built (the Princess got the first).86
DeBakey’s example was made in the closest Ferrari could come to his
favorite color, powder blue.*
In the fall of 1966, DeBakey’s old friend Arthur Hanisch decided to buy
him a Cadillac Eldorado. The two men had stayed close over the years,
including their stint together on the Presidential Commission on Heart
Disease, Cancer, and Stroke. When Hanisch developed arterial occlusive
disease in the legs in the early 1960s, he even underwent successful bypass
surgery using one of the Dacron grafts he had been instrumental in
developing. Hanisch gave DeBakey carte blanche to select any options on
the luxury car, and he did not hesitate: air conditioning, tinted glass, and
cruise control all made the list, as well as power windows, headlights, and
door locks. The Eldorado was, of course, to be delivered in General Motors’
Atlantis Blue—with a blue leather interior.87
Sadly, Hanisch passed away shortly before New Year’s, at the age of 71,
and did not live to see his friend receive the extravagant gift.88
In February 1966, DeBakey and his team were on national television
again, this time on the CBS network with the venerable “Most Trusted Man
in America,” Walter Cronkite. The program was entitled, “The Twentieth
Century,” and DeBakey was designated by the series as its “Man of the
Month.” He was shown in his element once more, in the now-familiar OR
scenes and images of perioperative care. Time was also provided for
DeBakey to assert his belief that the next generation of a left ventricle-
supporting artificial heart was nearing readiness for clinical application.89
In the interim since its semi-successful use more than two years before,
the single-ventricle pump had undergone significant revision and redesign.
The old tube with ball valves at the ends had been replaced, over the course
of hundreds of animal experiments, with a hemispherical design. The actual
pump was not intended to be placed in the patient’s chest, but would sit
directly outside: a location described as “paracorporeal.” This model had
two chambers: one for the blood and one for carbon dioxide (CO2) gas. A
diaphragm separated the chambers. When CO2 from an external source was
pumped into the gas chamber, the blood in the other compartment was
forced out, into the arterial circulation. Pumping could be performed
manually or triggered by the EKG. The whole thing was made of Silastic,
which was lined with Dacron because years of experiments and clinical use
suggested this might minimize trauma to the blood.*90
In addition to his remarks on the “Man of the Month” broadcast,
DeBakey had also somewhat injudiciously made public mention of the
imminence of clinical use of this pump in two important venues: a
conference in New York City in January and another in New Orleans in
April. Based on the latter, especially, members of the national and
international press again descended on Houston in mid-April, eager to be on
hand for this promised breakthrough.91
Marcel DeRudder was a 65-year-old retired miner from Illinois with
severe disease of the mitral valve of the heart due to rheumatic fever. He
had not been able to work for more than two decades and, by the spring of
1966, was in grave condition. DeBakey recommended replacement of the
bad valve with a prosthetic model, but was concerned that in its chronically
weakened state, DeRudder’s heart might not be strong enough to be weaned
from the cardiopulmonary bypass machine. He explained this to his
debilitated patient and indicated that a temporary mechanical assist device,
experimental but with literally hundreds of successful animal tests under its
belt, was available for use in such an event. DeRudder agreed to proceed
with the operation without reservation, with or without the left ventricular
assist pump. He indicated a conspicuously noble desire to assist in the
progress of science, even if he himself did not survive the operation.
DeBakey ran the case by the university’s committee on human research,
which gave him the go-ahead.92
When the press descended on Houston, Methodist administration had
organized a special news conference to sate, in effect, the media beast.
Instead, it only served to feed the frenzy. At this setting, on April 19,
DeBakey and the hospital spokespeople outlined the entire organization of
the imminent implantation. They named the operative and support teams,
indicated the arrangements for photographic documentation, and shared the
plans for dissemination of the necessary information. As of that time no
recipient had yet been determined, and, in fact, it was pointed out that that
could only be done at the time of operation. The implication was clear to
the newsmen, though: it would not be long—if you want the story, don’t go
anywhere.93
On the morning of Thursday, April 21, 1966, DeBakey took DeRudder to
the operating room to attempt mitral valve replacement. The procedure
itself turned out to be relatively straightforward. After this had been
accomplished successfully, though, DeRudder could not be weaned from
the heart-lung machine—just as had been feared. His own heart was simply
too damaged to go back online fully so soon. The newsmen were given this
information. DeBakey placed the tubes for the hemispherical left
ventricular bypass pump into DeRudder’s chest. There were some
frightening moments after its activation, when DeRudder’s heart stopped
completely, but manual massage coaxed the organ back to work, and the
operation was completed (Figure 8.7).94
Figure 8.7 Anxious moments for the Methodist OR team during the Marcel DeRudder operation,
April 21, 1966.
Immediately after the procedure, DeBakey conducted a news conference

wherein he expressed hope but cautioned against unrealistic expectations.
He also credited any success in the endeavor to teamwork. He did mention
that, to the best of his knowledge, this was the first time such a device had
been implanted in a human being.95
The surgical team and, in fact, the whole medical center were aglow with
the successful left ventricular pump placement. However, for one of the few
times in his career, Michael DeBakey had made a serious miscalculation.
The response of the public and, especially, his colleagues, to the highly
publicized announcement of the DeRudder operation was light-years from
his expectations.
Although they had consumed the event voraciously, the lay press—or at
least some of its elements—broadly questioned the publicizing of
something so clearly experimental. Some, including the New York Times,
wondered about false hope that might be given to thousands suffering from
cardiac disease.96
Worse still, it came out almost immediately that a similar pump had been
implanted in a patient some two months before, by Adrian Kantrowitz at
Maimonides Medical Center in Brooklyn. Kantrowitz was another surgeon-
scientist whose lab was funded for artificial heart research by the NHI. His
patient had not survived, but Kantrowitz made a point in interviews to
emphasize that his group—unlike DeBakey’s—had made no
announcements: “We chose to study our attempt carefully and analyze the
results before making any public statement.”97
The reaction of the community of surgeons was well encapsulated in a
letter to DeBakey from Eugene Bricker, then Professor of Surgery at
Washington University in St. Louis and known by DeBakey since his
service as Consultant in Plastic Surgery in the European Theater of
Operations in World War II:
April 26, 1966
Dear Mike
I am sorry I feel compelled to write this letter, but I must do so. I have talked to quite a few of
our colleagues since the advent of your last splurge of publicity and I find that the reaction is
pretty much the same. . . . No one doubts your ability, your sincerity, your energy or your
dedication. In view of all this it is hard to understand why you will participate in the promotion
of a public spectacle that, in my opinion, is an exhibition of extreme poor taste, is not in the best
interest of surgery, and does not serve the best interest of your patient or his family.
As one of your friends who has known and admired you for years I am taking the liberty of
saying that this incident was handled in a way that I consider to be unethical and a discredit to
the profession of surgery. These are strong words and I regret feeling forced to say them.
I . . . urge you to desist from this type of publicity promoting activity before you lose your
friends and the admiration and respect of the rest of the profession.98
This was not some provincial grumbling from the Harris County Medical
Society, but a chorus of voices composed of leaders such as Bricker who
represented the cream, as well as the rank-and-file, of the surgical
community. DeBakey would take notice, and, although he defended himself
through such channels as a dramatic Life magazine article about the case
(“DeBakey felt the public was entitled to know what had been achieved by
a research program financed by $4.5 million in federal grants”99) he would
nonetheless alter his future behavior accordingly.
In the meantime, DeRudder was faring poorly. He did not regain
consciousness after the operation. DeBakey stayed at the bedside and even
slept on a cot in his patient’s ICU room. After the press conference he was
oblivious to the maelstrom of media that swirled around the case.
Nevertheless, the hands-on attention did not change the clinical outcome.
On April 26, DeRudder died, apparently from a pulmonary issue unrelated
to the left ventricular bypass pump. The machine, like its antecedent from
1963, had continued working right up until the end.100
In the next week, before the wave of negative feedback from his
colleagues had struck, DeBakey was featured in both the Life magazine
article and as a guest on the television news program “Meet the Press.” He
paid tribute to DeRudder for his sacrifice in the interest of advancing
medicine and expressed unbridled optimism for the future of temporary,
implantable cardiac replacements.
Only three weeks later, another attempt was made at implanting the left
ventricular bypass pump. This time no announcement was made about the
operation, although the national press got wind of it anyway and again
flocked to Houston. DeBakey gave no press conferences or interviews.
After three days this patient, unfortunately, also succumbed.
The third attempt came on August 8. It was not announced until after the
operation had been complete, and the patient’s name was not released.
There was no press conference, and Methodist Hospital representatives
explicitly indicated that DeBakey would not communicate with the media
about the case.
This patient was Esperanza Del Valle Vasquez, a 37-year-old beautician
from Mexico City who had suffered from valvular rheumatic heart disease
most of her life. Her aortic valve regurgitated badly, and her mitral valve
was stenotic (she had actually undergone the old closed mitral valve
operation of commisurotomy about 12 years earlier). Esperanza’s activity
was severely restricted by these derangements. In some respects, she was in
even worse condition than DeRudder had been. Measurements at heart
catheterization indicated that her cardiac output was only about half of
normal, and pressures on the side of venous return were greatly elevated.
All four of her cardiac chambers were dilated due to the increased work
they were forced to perform.
DeBakey and his team knew that patients of this sort were notoriously
difficult to wean from the cardiopulmonary bypass machine, so they were
well prepared to place Esperanza on the left ventricular bypass pump. As it
happened, in this case they actually inserted the pump tubing into the left
atrium and the axillary artery before attempting to wean. Then the surgeons,
technicians, and pump operators gradually turned their respective dials until
the left ventricle bypass pump was doing all the work not being done by
Esperanza’s heart.
In the days to come there would be some tense moments, when urine
output fell or, most frighteningly, when an episode of near-fatal pulmonary
edema arose (but was swiftly—and effectively—treated). On the tenth day,
however, the numbers indicated that Esperanza’s heart had recovered well
enough to function on its own, and the bypass pump was removed in the
operating room. On September 6, 1966, she was discharged from Methodist
and returned to her home in Mexico City, where she went back to working
eight-hour days in her salon.*101
Esperanza Del Valle Vasquez made medical history as the first patient to
survive placement of an artificial heart. Despite the magnitude of the news,
Methodist Hospital and DeBakey continued with their new and wise policy
of releasing simple printed statements to the media, carefully avoiding
“circus-like” press conferences or interviews. Three other patients
underwent placement of the device during the remaining months of 1966,
but none survived. Information regarding these patients was not released.102
8.9 Transplant
Also in 1966, three new members who would make their presence known
joined the Baylor surgical faculty at the Instructor level. These were
Edward B. Dietrich, Charles H. McCollum, and George P. Noon.
Dietrich had completed his general surgery training in Michigan, then
come to Houston for the Thoracic Surgery Fellowship. Although he initially
suffered from DeBakey’s wrath, Dietrich eventually won the Professor’s
confidence and trust and was offered the opportunity to join the
Department.
McCollum and Noon had both completed the Baylor General and
Thoracic Surgery residencies. McCollum was a native Texan who had
graduated from the University of Texas at Austin and the University of
Texas Medical School at Galveston. After an internship at the University of
Pennsylvania, in which he realized his passion lay in surgery, McCollum
returned to his home state for training under DeBakey. In DeBakey’s words,
McCollum demonstrated “Excellent performance in patient care, surgical
judgment, surgical technical capability, and biologic knowledge.”104
Noon hailed from the border town of Nogales, Arizona, and attended the
University of Arizona in Tucson. He subsequently matriculated for medical
school at Baylor in 1956, where he remained for a career stretching well
into the twenty-first century. DeBakey recognized his talents early on.
He is an extraordinarily able young man. Superior in every way, since he was a student. I picked
him up as a student. He was a top notch student. He was a leader of his class—dedicated. Very
hard worker. Has the desire to constantly improve himself, to do superior work, [he is] devoted
to his work, gives the time.105
In October 1966, NIH head James Shannon acted on his disapproval of

the artificial heart research programs by changing the name of the program
to the “Artificial Heart and Myocardial Infarction Program.” In effect, this
bit of administrative derring-do shifted some $10 million away from
artificial heart research and into general basic science research regarding
heart attacks.106
In December 1967, one of Debakey’s first faculty members, the gifted
Oscar Creech, passed away at the tragically young age of 51 from
lymphoma. As noted, he had left Baylor in 1956, to succeed Alton Ochsner
as Chief of Surgery at Tulane. Creech continued to excel in New Orleans,
doing pioneering work in regional perfusion chemotherapy and, just two
years before, describing a simple and brilliant improvement of the
technique of aortic aneurysm surgery.* Lois DeBakey wrote Creech’s
moving obituary for the Archives of Surgery.107
At this time Lois was still in New Orleans with her sister, Selma. Lois
was on the Surgery faculty at Tulane, and Selma was communications
director at the Ochsner Clinic. Within two years DeBakey would bring them
both to the Texas Medical Center to join the faculty of Baylor (he would
also move his father Shiker and sister Selena from Lake Charles to
Houston; Figure 8.8).
Figure 8.8 The DeBakey family in Lake Charles, 1960s. Left to right: Lois, Michael, Shiker, Selma,
Selena.
In that same month that closed out 1967, the community of

cardiovascular surgery was upended with the announcement of the first
successful human-to-human heart transplant. Indeed, the news that South
African surgeon Christiaan Barnard had performed the feat on December 3,
in Cape Town, electrified the entire world.†
Besides the startling nature of the procedure itself, the fact that it had
been done in such an odd place and by a relatively unknown surgeon
intrigued the lay populace as much as it confused the cognoscenti. It was
well known by those in the field that clinical application of heart
transplantation was in the offing, but most expected the news to come from
the clinics of Norman Shumway at Stanford or Kantrowitz at Maimonides,
both of whom had done far more research into the subject—and far more
presentations of their work at conferences and in articles—than had
Barnard.
The South African patient died from pneumonia after 18 days, an
infection thought to have been related to the immune suppression drugs that
were necessary to prevent rejection. This grim outcome did not dissuade
Barnard and others from moving forward, however. Kantrowitz attempted
the operation on an infant a few days after Barnard’s initial case, but the
small patient only survived a few hours. Shumway entered the fray, too, on
January 9, 1968, but his patient only survived two weeks.109
Barnard’s second case, performed on January 3, 1968, was the
breakthrough. This patient was the first to survive the initial postoperative
period (he eventually lived for 20 months after the transplantation). After
this, the floodgates opened.
For skilled cardiac surgeons, the operation was not particularly
technically challenging (John Ochsner remembered Cooley calling him
after his first of the procedures to say, “ ‘You’ve got to go do a heart
transplant—they’re fun!’ And they were”110). Other potential pitfalls, such
as how a heart that had been separated from its nerve supply would
function, had turned out not to be troublesome as anticipated. The real
bugaboos, as things became clearer, were donor supply and immunologic
rejection.
Rejection was a well-recognized phenomenon, but its very complex
mechanisms were incompletely characterized at the time. As a result,
pharmacologic methods of inhibiting it were primitive and only imperfectly
effective. Much more research would be necessary before this response—
really a mosaic of intricate interactions—could be tamed.
The issue of suitable donor hearts was equally challenging. By necessity,
the availability of a donor heart would always be unpredictable. A precise
set of circumstances was necessary, usually a young accident victim in
whom the heart was uninjured but the central nervous system was destroyed
(this was the beginning of the clinical importance of the concept of “brain
death”). Any would-be recipient was faced with an indefinite wait until the
right criteria of misfortune affected some stranger. In the meantime, of
course, the cardiac disease that had rendered them in need of transplantation
—obviously dire—might well take their life.
In March of 1968, as the rush of heart transplantations was beginning
worldwide, DeBakey composed an insightful editorial for the Journal of
Thoracic and Cardiovascular Surgery. In addition to covering the scientific
and practical hurdles involved in the dramatic new procedure (including
identifying the two main problems noted earlier), DeBakey recognized
deeper cultural and even philosophical issues about to come into play.
The moral, ethical, legal, and psychologic implications of human cardiac transplantation will
undoubtedly be much more far-reaching than anticipated from present brief experience. The
issues must be thoroughly analyzed, human values reconsidered, and satisfactory answers
sought in the light of reason rather than in the heat of emotions. Clichés, irrelevancies, and
capricious injunctions must not be allowed to thwart sane judgment. Should medical scientists
abrogate their responsibility to their patients and to society to resolve such issues when they
arise, they can expect restrictions to be prescribed from without.111
Elsewhere in the editorial, DeBakey saw the advent of cardiac

transplantation as an impetus to develop the artificial heart. Such a device
could provide a temporary substitute during the wait for a donor heart or be
useful in rejection episodes the way dialysis was sometimes of value in
similar instances involving kidney transplants.
On May 2, 1968, Cooley performed a heart transplant in Houston, at St.
Luke’s Hospital. This patient survived the one-month span after surgery that
is traditionally defined as the postoperative period and, as such, was the
first “successful” heart transplant recipient in the United States.* By the end
of August 1968, Cooley had done nine more and was rapidly accruing the
world’s largest series.112
In that same month of August, DeBakey’s team at Methodist threw their
hat in the cardiac transplant ring, as well—in the most spectacular of
circumstances.
While the Cooley team at St. Luke’s had been piling up heart transplant
cases like trophies, some of DeBakey’s junior colleagues—especially
Dietrich and Noon—were practicing the operation on dogs. Before long,
they were technically adept. Then Dietrich came up with an audacious plan.
It occurred to him that the right donor with an isolated, acute central
nervous system injury might well be able to provide multiple organs at the
same “harvest” setting. He put out feelers to the other Houston hospitals in
hopes of being contacted if such a particular set of circumstances should
arise. Hope it was, too; with Cooley constantly in the news, St. Luke’s
gobbled up all the potential donors. Dietrich considered the necessary
logistics and quietly assembled teams on paper.
It would require five coordinated operating rooms functioning
simultaneously—one for the harvesting and the other four for the
implantations. Therefore he would need five teams of surgeons,
anesthesiologists, technicians, and ancillary staff—Dietrich even enlisted
photographers to document the prospective proceedings. These individuals
were essentially on call for whenever—if ever—the right set of
circumstances might arise.
On the night of August 30, Dietrich’s elaborate plans paid off. He
received a call from St. Joseph’s Hospital in downtown Houston, where the
20-year-old victim of a self-inflicted gunshot wound to the head lay
unresponsive on a ventilator. Her brain waves were flat on the
electroencephalogram. Ostensibly she had shot herself in front of her
husband. Since there were no other witnesses this could have posed
problems—maybe he had done it—but the police were not interested in
pursuing that possibility, and Dietrich was able to obtain consent from the
distraught spouse, as well as the rest of the family, for the complicated
transplant procedures. He called Methodist and activated the notification
plan. Soon the team members—some 75 strong—were on their way in.
At the time, there were four suitable patients on the wards at Methodist
Hospital in need of new organs. William Carroll, a 50-year-old factory
worker from Arizona, was suffering from serious coronary artery disease
and, after finding out that he was not a candidate for revascularization
surgery, was hoping for a heart transplant. William Whaley, a 39-year-old
gentleman from Fort Lauderdale, had chronic emphysema and was awaiting
pulmonary transplantation. William Kaiser, 41, of Odessa, Texas, had
previously undergone kidney transplantation, but this organ had failed and
he was waiting for another. Finally, 24-year-old Thomas Stevenson of
Houston was also awaiting renal transplantation.113
After she was transferred from St. Joseph, the potential donor underwent
blood typing and a repeat of her EEG, which confirmed the absence of
brain activity. Dietrich then called DeBakey, who was home for once at
11:30 PM, and—for the first time—informed him of his elaborate plans (it
was a minor miracle that no one from the on-call teams had spilled the
beans).
The teams went to work setting up their rooms while the recipients were
prepared. DeBakey appeared at 1 AM, now August 31. He had some
misgivings about the whole thing and briefly considered that only the heart
transplant ought to be done, but his observation of the overwhelming energy
and excitement in the operating suite, not to mention the precision and
intricacy of the planning, convinced him to proceed with the whole
grandiose scheme.
The layout of the operating rooms to be used was already set. The donor
room was centrally located, with the two kidney recipient rooms to one side
and the heart and lung rooms to the other. There was, by necessity, a fair
amount of bouncing from OR to OR, but the head surgeons in each room
were assigned in this fashion: DeBakey was in the heart recipient room,
assisted by Dietrich; Arthur Beall was in the lung room; George Noon was
in the donor room; and George Morris and Russell Scott were in the kidney
rooms.114
Miraculously, everything went off without a hitch. The organ harvesting
began at 1:45 AM. The heart was implanted first, then the lung, followed by
the two kidneys. By 6:30 AM the operations were all done, and the four
recipients were all recovering.
The Houston papers on Sunday, September 1, announced the news:
“DeBakey Team in Multi-Transplant,” “4 Transplants From One
Woman.”115
The Baylor/Methodist surgery team had jumped into the cardiac
transplant pool with the biggest possible splash.
Unfortunately, Whaley and Kaiser died about a month later, but young
Stevenson survived with his new kidney and even married one of his
nurses. Carroll was also discharged from the hospital, returning to live in
Phoenix.
By the year’s end, DeBakey and his team had done nine more heart
transplants, and Cooley with his St. Luke’s contingent had accomplished
seven more.116 The projected shortage of donors was not yet a rate-limiting
factor. The other overarching concern, however—rejection—was turning
out to be a problem of devastating proportions.
A month after the mega-transplant the new operating room suite formally
opened in the Herman Brown Building, along with the adjacent new 50-bed
ICU in the Fondren structure. There were eight gleaming new rooms,
complete with observation decks in the classic style of the operating theater.
They were divided into two ranks surrounding a sterile Central Core.
Rooms 1 through 4 were designated for DeBakey and his junior colleagues
Noon and Dietrich. The other set was the operative domain of Jimmy
Howell, George Morris, and Stanley Crawford.117
These rooms would see countless thousands of operative procedures—
including pioneering and landmark work—in the next 50 years.*
Indeed, the sheer volume of surgical cases at Baylor was reaching its
zenith in this era. Fully 10% of the open heart operations in the United
States happened at either Methodist, St. Luke’s, or Texas Children’s
Hospital. The two physicians with the highest rate of reimbursement in the
United States from the still-new Medicare program in 1968 were DeBakey,
with $202,959 for 604 operations, and Cooley, with $193,124 for 408
operations.118 Since these numbers were available to the public—and,
predictably, made headlines in the newspapers—they generated a certain
amount of chagrin at the Texas Medical Center. In response, Baylor offered
the timely clarification that the surgeons’ fees were deposited in a medical
school account, rather than the pockets of the physicians. This quashed the
op-ed protests for the time being, but the ever-present hobgoblin of money
was soon to arise in a very different concern. The Department of Surgery’s
role in generating voluminous revenue for both the hospitals involved and
the Baylor University College of Medicine would prove to be paramount in
the most significant administrative upheaval at the school since the move
from Dallas in 1943.
One summer in the late 1960s, a 10-year-old girl named Patty Bride was
flying by herself from Hartford to Houston with a stop in Washington. As
an unattended minor, when she reached the capital city, Patty was escorted
by a stewardess to the Pan Am VIP suite behind the ticket counter. She was
told sternly not to bother the gentleman who was already there. The well-
dressed man seemed to be reading some very important papers.
She sat terrified, still and quiet, afraid even to go to the restroom. Within
minutes, the man gently asked her, “Where are you going?” She replied,
“To Houston, so my parents can pick me up.”
The man nodded, then continued, “Where are you from that they have to
go to Houston and get you?” She nervously answered “Lake Charles,
Louisiana.” The man laughed heartily, which brought the attendant running
in to fuss about Patty’s “disturbing Dr. DeBakey.”
Didn’t I know who he was?? No. I was 10, and besides we hadn’t been introduced. He promptly
told her that we were old neighbors and that he’d be responsible for me since we were both
headed to Houston. He had me sit next to him on the plane, asked a hundred questions about
Lake Charles, where my dad worked, if I knew the high school (I did, it was our neighborhood
public high) and WHEN I TOLD HIM WHERE WE LIVED, HE KNEW THE HOUSE! Lake
Charles was smaller then, and if you went to Lake Charles High, you lived in our neighborhood.
He said he used to pass by it almost every day. When we got off the plane, we were holding
hands. He literally ‘handed’ me over to my awe-struck daddy. I didn’t know how renowned he
was at the time, but listening to my dad on the trip home I started to get the idea that he was one
up on Babe Ruth.119
8.10 The Baylor College of Medicine

Earl Hankamer resigned as Chairman of the Baylor University College of
Medicine Board of Trustees in 1965. His had always been a steady—and
steadying—hand in the tumult of explosive growth the school had seen
during the postwar era. Hankamer’s place was taken by another wealthy
Houstonian named Joseph Allbritton, whose devotion to Baylor perhaps
exceeded his capacity at managing the complex retinue of physicians at its
College of Medicine.
At this point in time, despite the medical school’s conspicuous success,
the finances of the institution were not in good order. A major reason for
this was its affiliation with the parent university in Waco and, in turn, the
Baptist General Convention. These sectarian connections eliminated the
possibility of state or federal financial support, which was why the pursuit
of philanthropists was always of overriding importance. Moreover, those
potential benefactors who were not Baptists tended to bestow their gifts on
other causes or institutions, reasoning that “the Baptists will take care of
that.”120
Inheriting this difficult fiscal situation, Allbritton looked for other
solutions. It would not have taken him long to recognize that the Houston
Methodist Hospital represented a possible source of funds to help the
school. After all, he reasoned, were it not for the Baylor University College
of Medicine (especially the Department of Surgery), Methodist would not
have become world-famous. Moreover, the hospital would not have enjoyed
the financial rewards it was now reaping.
Allbritton focused his attention in this matter on two individuals: the new
Dean of the College, Raymond Pruitt, and DeBakey. Pruitt, who was Chair
of the Department of Internal Medicine, had taken over as Dean when
Stanley Olson left after 14 years at the post—due, by some accounts, to
difficulties getting along with Allbritton. A cardiologist by trade, Pruitt was
close with DeBakey, who had helped recruit him to Baylor from the Mayo
Clinic. As noted earlier, the two had been the Principal Investigators at the
Cardiovascular Research Center.
In one particular instance, Allbritton summoned Pruitt and DeBakey to
meet him at Houston’s Hobby Airport before his early morning flight to
parts unknown. The topic of conversation was the Baylor budget deficit.
I asked [Pruitt], “Why does he want me?” He replied, “He’d like you to join me.” I said, “He
lives right over at the Warwick. Why can’t we go see him there before he goes to the airport?
Why do we have to go to the airport to meet him?” “Well, Mike, I promised him you would go.”
So I agreed to go because of Ray’s promise, “But I think it’s demeaning to do what he did.”
So Ray and I went to the airport. I wasn’t in a very good mood. We met him there. He said,
“We’ve got a shortfall of $500,000 in the budget. We’re going to have to make it up, and I want
you to go to Methodist and tell them that they’ve got to make that up.” My response to him was,
“Mr. Allbritton, I don’t have the authority to do that, nor will I do it. That’s your responsibility,
not mine. I’m responsible for the Department of Surgery.”121
DeBakey offered to make up half of the shortfall from the Department of

Surgery coffers, with Allbritton having to come up with the rest from
somewhere.
He looked at his watch, and he said, “I’ve got to go now to my flight. I’ll talk to you when I get
back.” That’s how we left it. He never did talk with me when he got back.122
The Methodist Hospital administration was not going to be sympathetic

to this appeal regardless of the messenger. From their perspective, they
already contributed to the costs of the teaching programs and laboratories
(and it was through Methodist that the NIH funds to complete the Fondren-
Brown buildings were possible, due to Baylor’s sectarian status).
Meanwhile, the situation at the medical school was growing dire.
Between the financial difficulties and the leadership of Allbritton, esprit de
corps was at a low. Dean Pruitt left, finding much greener pastures back at
the Mayo Clinic, where a new medical school was being launched. Seven
other Department Chairs had also resigned, and there was even talk
amongst the faculty about abandoning the school entirely and starting a new
one: the University of Texas had made noise about establishing a medical
school in Houston for as long as anyone could remember. Rice University
was also a possibility.
With Pruitt’s departure, Allbritton was forced to convene a faculty
committee to search for a replacement. What he did not anticipate was their
nomination of DeBakey.
They met with me. We had dinner one evening, and the committee members told me that they
were going to recommend me for Deanship because they believed that I was the only one on the
faculty who really had the strength and the independence to hold the faculty together and to
work toward trying to get out of this morass we were in. I told them I would be willing to accept
it provided I retained my Chairmanship in Surgery and I could call on them for administrative
help.123
The committee forwarded its recommendation to Allbritton, who must

have recognized his miscalculation immediately. An appropriate action that
would have corresponded to his own wishes was not possible, so he chose
not to act at all, apparently hoping that such a “pocket veto” might make all
his troubles simply go away. He then incautiously told the Board that the
committee had not made a report, so he could not nominate a suitable
candidate.
Allbritton called for another committee. One of the members was the
virologist Joseph Melnick, a friend of DeBakey’s.
Joe Melnick came to see me shortly after that, and he said, “Mike, I don’t like what’s going on.
This new committee seems to be appointed to do a kind of character assassination on you.
They’re bringing in people in to tell them that you’re dishonest, that you’re running around with
some nurse, that your reports and articles you’ve written are not only faulty but dishonest.”124
DeBakey’s response was to telephone his friend and attorney, Leon

Jaworski. After obtaining confirmation that none of the allegations was true,
Jaworski talked DeBakey out of a lawsuit for defamation, pointing out that
Baylor would suffer greatly from the negative publicity. He asked DeBakey
if a copy of the original committee report could be obtained and was
assured it could.
Then Mr. Jaworski called Joe Allbritton and told him what was going on. He said, “DeBakey’s
threatening a suit. I think the best thing for you to do is just resign. You’ve obviously not been
truthful with your board members, and I’ve consulted them. You’ve told them that you hadn’t
gotten this report, and you had gotten it. I have a copy of it, and you’ve had it for two months.”
That forced his resignation.125
The way was now clear, and, in May 1968, the Board of Trustees
appointed DeBakey Vice President for Medical Affairs and Chief Executive
Officer of the College of Medicine (attorney Carloss Morris, CEO of the
nationwide Stewart Title Company and a long-time trustee, replaced
Allbritton as Chairman of the Board). DeBakey further delegated four
Associate Deans who would report to him on their various jurisdictions:
Hebbel Hoff for Faculty and Clinical Affairs, Joseph Merrill for Scientific
Affairs, James Schofield for Medical Student Affairs, and Joseph Melnick
for Graduate Studies.126
DeBakey’s obvious and immediate goal was to stop the financial
bleeding. He was well aware of the limitations that the school’s Baptist
affiliation engendered, both in terms of government money and access to
some of the city’s high rollers, “I soon realized that we needed a new Board
of Trustees whose membership would include the most influential and
leading citizens of Houston and thus could raise money to support the
College.”127
On September 1, 1968 (the day after the epic quadruple transplant),
DeBakey put the finishing touches on a manifesto of sorts entitled, “Current
Status of the Baylor University College of Medicine.”128 In this document,
he recalled the original recommendations regarding the establishment of an
academic medical center made to the Board of Trustees more than 20 years
before by Alfred Blalock, Henricus Stander, and Basil MacLean. He also
pointed out his own memo to Judge Townes from 1951, which echoed the
counsel of those three experts. The point of this, of course, was to
demonstrate how the advice had not been taken and how many of the
present problems were the inevitable result.
At this time, the endowment of the Baylor University College of
Medicine was barely more than $4 million, far less than that of comparable
Southern medical schools (for example, Tulane University’s was $13
million) and not in the same discussion as the major Northeast institutions
(Harvard, $73 million). The annual expenditures of the College were in
excess of $21 million, and the annual budget deficit was close to $1
million.129 This was an untenable situation, exacerbated by the constant rise
in operating costs. Moreover, Baylor simply could not compete financially
with other institutions when it came to recruiting faculty, the lifeblood of
any academic enterprise.
The solution, DeBakey asserted, was to separate the medical school from
its sectarian ties. This, however, would entail considerable political acumen:
there were many powerful figures whose response was likely to be
unpredictable. Luckily, Debakey had a strong ally in the person of his friend
Judge Abner McCall, the President of Baylor University in Waco.
McCall took DeBakey to see E. Hermond Westmoreland, one of four
ministers on the Board. Earl Hankamer went along.
He turned to Earl and said,” I thought we had a Baylor Medical Foundation?” He responded,
“Well, we have.” Earl had started it; I had helped him start it. “But we are still unable to get
enough money. We tried to build this up, and we don’t have that many wealthy Baptist friends.
Other foundations think we are able to take care of ourselves, and so we do not get support from
them. I am in complete accord with Mike’s idea, and Judge McCall told me the same thing.
Mike’s idea is to get the trustees—the best people in Houston—who represent the financial
community and who will represent, very often, the various foundations.”
Abner, Westmoreland, and a few other ministers who agreed went to the Baptist General
Convention. They had worked out a deal so that the proposal went through.130
In a sense, Baylor University deprived itself of its own medical school so

that that institution might survive and, as events bore out, thrive. The
separation was not complete, though: the University retained the right to
select one-fourth of the 32 members of the Board of Trustees of the College
of Medicine. Although this created some trouble with state legislators and
others who did not immediately recognize that the medical school was now
free of sectarian entanglements, the Baptist-appointed contingent was a
“solid minority” of the Board and held no special sway.
The organizational meeting of the new Baylor College of Medicine, née
the Baylor University College of Medicine, was held on January 23, 1969,
at the Ramada Club in Houston. The official nondenominational nature of
the College was put into the record, and DeBakey was named President.
The Chairman of the new Board of Trustees was Conoco Oil head Leonard
F. McCollum (whose wife was a DeBakey patient).131
In the next few years, this reorganization of the medical school paid
handsome dividends. Funds from a multitude of new sources poured in,
along with the sterling new faculty that followed (a $30 million endowment
campaign was launched in March, 1970—almost half the goal was achieved
in the first month). A mandate from the Texas legislature to increase the
number of new physicians in the state led to a doubling of the medical
school class size, also, and with it a marked increase in state financial
support.
In January 1969, though, these propitious events were still in the future.
In another part of the Texas Medical Center that same month, however,
events were unfolding that would soon put Baylor in the brightest glare of
the national spotlight and in far from flattering terms. The fallout from these
events would give rise to one of the greatest controversies—and most
acrimonious disputes—in all of medical history.
Notes
2. The American Presidency Project. https://www.presidency.ucsb.edu/documents/1960-
democratic-party-platform (accessed February 6, 2019).
3. Letter to T. D. Cronin to M. E. DeBakey. DeBakey, Michael E. Michael E. DeBakey Archives.
1903–2010. Located in: Archives and Modern Manuscripts Collection, History of Medicine
Division, National Library of Medicine, Bethesda, MD; MS C 582. Series 2:4.
6. Ibid.
7. Federal Support of Medical Research: Report of the Committee of Consultants on Medical
Research to the Subcommittee on Departments of Labor and Health, Education and Welfare of
the Committee on Appropriations, United States Senate, 86th Congress, Second Session, May,
1960. Washington, D.C.: US Government Printing Office, 1960.
2:107:11.
11. Sibley MM. The Methodist Hospital of Houston, Serving the World. Austin, TX: Texas State
Historical Association, 1989: 170.
13. Ibid., 81.
2:107:11.
15. Cooley DA, Beall AC, Jr., Grondin P. Open-Heart Operations with Disposable Oxygenators, 5
Per Cent Dextrose Prime, and Normothermia. Surgery 1962;52(5): 713–719
16. Cooley DA. A Brief History of the Texas Heart Institute. Texas Heart Institute Journal
2008;35(3): 235–239.
18. The Foundation eventually sent more than 2,000 patients to the United States for advanced
cardiovascular surgery. Interview, Don Schanche with Princess Lilian of Belgium, Houston,
Texas, November 10, 1972. DeBakey Archives, National Library of Medicine, Bethesda, MD;
MS C 582. Series 1:2:26.
19. Diary of Trip to Belgium November 26-December 3, 1960. DeBakey Archives, National
20. Ibid.
21. Ibid.
22. Ibid.
24. Letter M. E. DeBakey to C. V. Ypersele, August 22, 2003. DeBakey Archives, National
2:107:11.
26. Ibid.
27. Ibid.
29. US Congress, Senate Subcommittee of the Committee of Appropriations for 1964, Hearings on
Department of Health, Education and Welfare Appropriations. Washington D.C.: Government
Printing Office, 1963: 1402.
30. “Breakthrough.” April 23, 1962. Michael E. DeBakey Library and Museum. Baylor College of
Medicine, Houston, Texas.
31. Liotta D, Hall CW, Henly WS, et al. Prolonged Assisted Circulation During and After Heart or
Aortic Surgery. Transactions of the American Society of Internal Organs 1963; 9:182–185.
32. Hall CW, Liotta D, Henly WS, et al. Development of Artificial Intrathoracic Circulatory
Pumps. American Journal of Surgery 1964;108:685–692.
33. Ibid.
35. Farber S, Lasker M. Citation—The 1963 Albert Lasker Award for Clinical Research Presented
to Michael E. DeBakey. Bulletin of the New York Academy of Medicine 1963;39(11):704–705.
2:107:12.
38. New Addition Officially Opens 6 June 1963 with Laying of the Cornerstone and Dedication of
Mural. The Journal: A Publication of the Methodist Hospital, the Texas Medical Center. June
6, 1963.
2:107:12.
40. Letter M. E. DeBakey to A. Ochsner, January 16, 1961. Copy obtained from JL Ochsner,
January 20, 2017.
2:107:12.
43. John L. Ochsner, personal interview, January 20, 2017.
44. Letters between M. E. DeBakey and R. M. Zollinger. DeBakey Collection. Baylor College of
45. Letter L. DeBakey to M. E. DeBakey, June 16, 1964. DeBakey Archives, National Library of
46. Letters between M. E. DeBakey and R. M. Zollinger. DeBakey Collection. Baylor College of
47. Miller CA. The Big Z: The Life of Robert M. Zollinger, MD. Chicago: The American College
of Surgeons, 2015: 217.
48. President’s Commission on Heart Disease, Cancer, and Stroke. A National Program to
Conquer Heart Disease, Cancer, and Stroke. Washington D.C.: Government Printing Office,
1964: 87.
49. Ibid., 89.
50. Ibid., 84–85.
51. Ibid., 89–101.
52. Ibid., 78.
53. Ibid., 7.
54. DeBakey ME. Reviewing the Recommendations of the President’s Commission on Heart
Disease, Cancer, and Stroke. Bulletin of the New York Academy of Medicine
1965;41(12):1333–1337.
55. Garrett HE, Dennis EW, DeBakey ME. Aortocoronary Bypass with Saphenous Vein Graft,
Seven Year Follow Up. JAMA 1973;223(7):792–794. DeBakey Collection. Baylor College of
Medicine Archives. Houston, TX. 9:140:1
56. Garrett HE, Dennis EW, DeBakey ME. Aortocoronary Bypass with Saphenous Vein Graft.
57. Ibid.
Publishing, 2016: 208–209. Favoloro RG. Saphenous Vein Autograft Replacement of Severe
Segmental Coronary Artery Occlusion: Operative Technique. Annals of Thoracic Surgery
1968;5:334–339.
59. Ibid.
62. Ibid.
63. Windsor Is Ready to Face Surgery (December 15, 1964). New York Times.
64. Repairing the Royal Aorta (December 25, 1964). Time.
65. Duke of Windsor Leaving Hospital (December 31, 1964). Associated Press.
67. Ibid.
68. Satellite May 2, 1965: Early Bird. Michael E. DeBakey Library and Museum. Baylor College
of Medicine, Houston, Texas.
69. Ibid., 19.
70. Cover (May 28, 1965). Time.
71. The Texas Tornado (May 28, 1965). Time, 53–54.
72. Time. May 28, 1965.
73. The Texas Tornado (May 28, 1965). Time, 54.
75. Fox RC, Swazey JP. The Courage to Fail. Chicago: The University of Chicago Press, 1974:
157–158.
2:107:12.
77. Ibid.
78. Duke Praises DeBakey (November 2, 1965). Associated Press.
80. Interview, Don Schanche with Alton Ochsner (n.d.). DeBakey Archives, National Library of
82. Ibid.
86. Goodfellow W. Ferrari: Road and Racing. Lincolnwood, IL: Publications International, Ltd.,
2005: 89. Some sources indicate that four examples of the Speciale built on a 330 chassis were
made, while others indicate three. After a few years DeBakey gave this car to his brother
Ernest, who also had it for a short period of time before selling it. The Ferrari has passed
between collectors in the time since and was sold at auction in 2018 for more than $3 million.
87. Letter M. E. DeBakey to A. Hanisch, November 5, 1966. DeBakey Collection. Baylor College
of Medicine Archives. Houston, TX. 9:121:9
88. Arthur Hanisch, PMA Board Member, Dies (January 16, 1967). Pharmaceutical
Manufacturers Association Bulletin, 1.
90. DeBakey ME. Left Ventricular Bypass Pump for Cardiac Assistance: Clinical Experience.
American Journal of Cardiology 1971;27(1):3–11.
94. Surgery: A Better Half-Heart (April 29, 1966). Time.
http://content.time.com/time/magazine/article/0,9171,835432,00.html. Accessed September 6,
2019.
95. Implanted “Heart” Pumps Life into Doomed Patient (April 22, 1966). St. Petersburg Times, 1.
96. Science and Publicity (April 22, 1966). The New York Times, 40
97. Schmeck HM, Jr. A Successful Artificial Heart Could Be a Boon to Mankind (April 22, 1966).
The New York Times, 22.
98. Letter E. Bricker to M. E. DeBakey, April 26, 1966. DeBakey Archives, National Library of
99. A Patient’s Gift to the Future of Heart Repair (May 6, 1966). Life, 84.
101. DeBakey ME. Left Ventricular Bypass Pump for Cardiac Assistance: Clinical Experience.
American Journal of Cardiology 1971;27(1):3–11.
103. The Left Ventricular Bypass. Michael E. DeBakey Library and Museum. Baylor College of
104. Letter ME DeBakey to NS Searle, October 25, 2004. DeBakey Collection. Baylor College of
Medicine Archives. Houston, TX. Series 2.
105. Don Schanche with Michael DeBakey, Houston, January 3, 1972. DeBakey Archives,
106. Shannon, J. A. Artificial heart program. Memorandum to the Secretary, Department of Health,
Education, and Welfare. October 4, 1966.
107. DeBakey L. A Tribute: Oscar Creech Jr., MD. Archives of Surgery 1968;96(3):483–484.
108. Fox RC, Swazey JP. The Courage to Fail, 157–158, 124.
2:107:12.
111. DeBakey ME. Human Cardiac Transplantation. Journal of Thoracic and Cardiovascular
Surgery 1968;55(3):447–451.
113. Transplants: Multiple Organs. Michael E. DeBakey Library and Museum. Baylor College of
114. DeBakey Team in Multi-Transplant (September 1, 1969). Houston Post.
115. Ibid.; 4 Transplants from One Woman (September 1, 1969). Houston Chronicle.
117. Charles H. McCollum, Personal communication, June 6, 2018.
118. Winters WL, Parish B. Houston Hearts, 133–134.
119. Patricia Byrd (née Bride), personal communication, September 29, 2017.
120. Baylor College of Medicine Oral History Project. Michael E. DeBakey interview. December
17, 1988. DeBakey Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series
3:9:7.
121. Ibid.
122. Ibid.
123. Ibid.
124. Ibid
125. Ibid.
126. Memorandum M. E. DeBakey to Members of the Salaried Faculty, Heads of Service
Departments, July 23, 1968. DeBakey Archives, National Library of Medicine, Bethesda, MD;
MS C 582. Series 3:9:18.
3:9:7.
128. DeBakey ME. Current Status of the Baylor University College of Medicine. DeBakey
129. Ibid.
3:9:7
131. Minutes of the Organizational Meeting of Baylor College of Medicine (BCM), formerly
Baylor University College of Medicine (BUCM), January 23, 1969; 3(7):13.
*
DeBakey was also asked by the Administration to chair a committee on cancer and heart disease.
This committee appeared at the White House to present its report on April 17, 1961. Unfortunately,
this was the day of the Bay of Pigs invasion of Cuba. As DeBakey recalled, “We left the report at the
White House, and never heard another word about it.”8
*
The National Institutes of Health (NIH) grant was realized in the form of the Goldston
Cardiovascular Research Unit, complete with a six-bed research ward, on Methodist’s ninth floor. In
1964, this was folded into the Moody Unit, a “General Clinical Research Center.”
*
Princess Lillian’s place among her people was, for many years, a tenuous one. A brilliant,
athletic, and strikingly attractive young woman, she was King Leopold’s second wife (his first,
Queen Astrid, had been killed in an automobile accident). Although her father was a government
official, she was not nobility by birth. Her marriage to Leopold occurred six years after Astrid’s
death, which was considered by some to be inappropriately soon. Complicating matters, Leopold was
a prisoner at the time, his country having surrendered to the Germans. For all these reasons (none
especially fair) Lillian was long a controversial figure in Belgium. Leopold himself was unpopular
for his actions during the war (although he was exonerated of any crimes), and this was why his son,
Baudouin, was already King.
*
In the DeBakey classification of aortic dissections, three types are identified. Type I dissections
arise in the ascending aorta, extending to the arch and, frequently, beyond. Type II lesions are
confined to the ascending aorta. Type III arise in the descending thoracic aorta, although they may
extend more proximally into the arch or ascending aorta. The DeBakey classification remains in use.
*
DeBakey recalled later that Liotta was not accepted as a resident due to an “inadequate”
education.28 The Cardiovascular Fellowship, in distinction to the General and Thoracic Surgery
residencies, was mainly intended for foreign physicians and such conditions did not apply.
*
DeBakey was visiting Princess Lilian and King Leopold in Belgium when he learned of the
honor. There were two Clinical Awards in 1963. The other was given to Charles Huggins, for his
work in endocrine therapy for malignancy. Huggins subsequently won the 1966 Nobel Prize in
Medicine.
*
John Ochsner finished training under DeBakey in 1960 and then completed a year of cardiac
surgery with Denton Cooley. After this, John decided to return to join his father at the Ochsner Clinic
in New Orleans. On this occasion DeBakey wrote a heartfelt letter to his old “Chief,” praising John’s
qualities as a surgeon and human being in the highest terms and remarking that, “nothing would have
given me greater pleasure than to have John remain a permanent member of my staff.”40 John
Ochsner went on to a legendary career of his own, including—not least—duplicating his father’s role
as Rex of Mardi Gras. He passed away during the writing of this book, for which he provided many
important contributions.
*
In 1962, Michael married a Peruvian girl whose father had been a patient of DeBakey’s.
*
Zollinger’s Atlas of Surgical Operations is still in print, in its 10th edition at the time of this
writing.
*
The Fondren-Brown complex was formally dedicated during this same month. Princess Lilian
and King Leopold happened to be visiting from Belgium at the time and attended the ceremony.
*
In a later interview, Howell stated that he and Garrett had performed saphenous vein grafts in
several patients prior to this, without success. However, these cases were never reported. Rene
Favoloro of the Cleveland Clinic is generally credited with introducing the concept of the coronary
artery-saphenous vein bypass. He published his first report in 1968.58
†
The last follow-up of Hernandez reported in the paper was from 1971, so the documented length
was seven years.
*
The portrait was done in four sittings in Houston by the painter Henry Koerner. When Koerner
asked him to turn his head to the side, DeBakey protested, “Not my profile!”69
*
In 1956, he had also opposed placing the National Library of Medicine at the NIH.
*
The Ferrari paint color was called “Aurora Blue.” DeBakey’s scrubs were also powder blue,
which he usually offset with white cowboy boots. All the other scrubs at Methodist were green.
*
Another of the salutary characteristics of Dacron was its ability to engender development of a
pseudo-intima: a smooth “false lining” that mimicked the physical characteristics, if not the biologic
activity, of the blood vessels’ natural inner layer, the endothelium (or intima). When Dacron was used
as an artificial heart lining, however, the compression of the pumps caused the pseudointima to crack,
which could induce thrombosis and embolization. In response, Edman developed a “plush” velour
lining for the project, which was effective in preventing the fracturing of the pseudo-intima and was
soon also applied to tube grafts.
*
When Esperanza was seen at subsequent follow-up appointments in Houston, she was doing
well clinically, and testing indicated good cardiac function. Tragically, she was killed in an
automobile accident six years after her valve replacement surgery.103
*
Since Dubost’s first description back in 1951, surgeons had resected the aneurysm, which was
difficult and dangerous. Creech took a page from Rudolph Matas’s operation of
endoaneurysmorrhaphy and suggested opening the aneurysm sac, ligating any back-bleeding
branches, suturing the graft to the normal vessel above and below the lesion, then closing the
aneurysm sac back over the completed graft. This immediately became the new standard technique.
†
Barnard’s brother Marius was a Fellow in Cardiovascular Surgery at Baylor during the 1966–
1967 academic year.108
*
This patient underwent a second heart transplant after the first heart was rejected about six
months later, but died a few days afterward.
*
In 2018, the Fondren-Brown operating rooms were razed so that the space could be repurposed
as part of a Methodist Hospital renovation.
9
Houston: 1969
The Artificial Heart
The struggling pangs of conscious truth to hide
9.1 Haskell Karp

The names of patients involved in momentous medical events are
frequently lost to history. This is often purposeful, done to protect the
individual’s privacy. When an operation is performed for the first time, or a
medical therapy given its initial testing, the identity of the first human
subject is only rarely revealed, or even of interest. But the comfortable
anonymity that surrounded the life of the first total artificial heart recipient,
Haskell Karp, was shattered forever by the spectacular publicity that
surrounded his decidedly unnatural death.
By early April 1969, Karp had been an inpatient on Denton Cooley’s
service at St. Luke’s Episcopal Hospital for a full month. He hailed from the
Chicago suburb of Skokie, Illinois, where he made his living as an
estimator at Crewdson Printing on Clark Street.1 He was 47 years old, and
had been married for 23 of those years to his wife, Shirley. The couple had
three sons, ranging in age from 11 to 22.2 The Karps had come to Houston,
like so many others, because he was suffering from severe heart disease.
Haskell had endured four known heart attacks over the previous 10 years,
and these had damaged so much of his myocardium that he dwelt in a sort
of constant unstable congestive heart failure, liable to drift over the edge at
the slightest provocation. As a consequence, Karp’s level of activity was
extremely curtailed. He had driven a bread truck before his heart problems
forced him to find a different way to make a living. Even then, he had been
one of the most energetic employees at Crewdson. But those times were
long past. Now he could scarcely get out of bed; simply brushing his teeth
was exhausting. This profound fatigability was a source of immense
frustration for Karp, beyond the obvious threat to his life.
Karp’s physicians in Chicago had done all they could, including putting
in a pacemaker in 1968, but medical therapy was no match for this degree
of heart failure. He came to Houston for the slim hope of a surgical
intervention that might help.
X-rays and catheterization studies had made it clear that Karp’s heart was
not just pumping poorly: the left ventricle had actually dilated to
aneurysmal dimensions. It barely moved with his heartbeat. He also had,
unsurprisingly, severe coronary artery disease.3 Cooley recommended a
heart transplant, but Karp had fundamental reservations about the operation
and refused. There was an alternative, however. The Karps had heard
through news stories about ventricular aneurysmectomy, in which a wedge
of the aneurysm was removed and the surrounding, relatively normal heart
muscle sewn back together.4 Ideally this might remove enough of the
noncontractile heart muscle to allow the remainder to function at some
reasonably adequate level. Cooley responded that he was familiar with the
operation, but he could not be sure if it would be feasible in Karp’s case—
there was a substantial chance that his heart would be too damaged from
scar tissue for the operation to be performed. It was also possible that the
procedure could be done, but Karp’s weakened heart might not work well
enough for him to be weaned off the cardiopulmonary bypass machine
afterward. In either event it would be necessary to have a donor heart
available so a transplant could be performed or Karp would not make it out
of the operating room (OR) alive. From his experience Cooley estimated a
70% chance that the wedge resection would work, but the only way to
know was to try it.5 Karp’s alternatives were clearly limited, but he
considered the ventricular aneurysm surgery—with a backup plan of heart
transplant if need be—the best.
So the wait for a donor began. Despite his ambivalence toward the idea
of a heart transplant, Karp knew that Cooley had the most experience in that
operation of anyone in the world, having performed 18 of them by this time.
The bespectacled Illinois printing estimator languished on St. Luke’s wards
throughout March 1969, waiting for a backup donor heart he was not even
sure he really wanted, should it come to that.
At this point in time there were always at least several individuals on the
wards at St. Luke’s who, like Haskell Karp, were awaiting heart transplants.
During the first great rush of excitement after Barnard’s operation in Cape
Town, and then the successes in America and elsewhere, finding donors was
not much of a problem. By this time, though, the bloom had come off the
rose. Not only was the novelty of the whole thing wearing off—and with it
the widespread, sensational media coverage—but the results of the
operation were turning out not to be so good—of Cooley’s 18 recipients,
only three were still alive by this time. Donors were drying up.
On the evening of Wednesday, April 2, Cooley came to Karp’s hospital
room, where his patient was resting alone, with a new idea. Instead of
waiting for a donor heart, which might well never come, there was another
option. They could proceed with the ventricular wedge procedure, and, if
this turned out badly, Cooley could place a temporary, implantable pump to
bridge the gap in time until a donor heart became available for
transplantation. The temporary pump was new, but it was ready. Cooley was
prepared to operate any time Karp wanted—the sooner, the better.6
This was news indeed. Karp asked Cooley to return the following day,
when his wife would be present to hear the brash proposal. It was near 7 PM
on Thursday when Cooley reappeared, with a consent form in hand. He
wanted to operate the next day. After a full month at St. Luke’s Hospital,
Shirley was stunned to hear that surgery was suddenly on the tentative
schedule.
Mrs. Karp tried to absorb the details of the plan as Cooley presented
them. In her startled state, they registered poorly. She thought the backup
plan was the heart-lung machine, although a “newer model” that had not
been used before. The timing of surgery was also confusing and upsetting.
Why the rush to the OR if no donor heart had surfaced? Cooley said that her
husband’s condition had deteriorated and that the aneurysm could rupture at
any time. Haskell had no complaints of pain and seemed to Shirley to be in
the same condition as he had been since their arrival in Houston. But, Mrs.
Karp reflected, she was no doctor.7
Convinced by Cooley of the necessity to proceed and to do so with
urgency, the Karps signed the consent form. They were not sure what the
hurry was all about and were far from clear as to what Cooley’s
contingency plan was, beyond the fact that the form said it was a
“mechanical device.”8
They were not alone.
Less than four months previously, in late December 1968, Cooley had
contacted Domingo Liotta, the Argentinian research fellow working in
DeBakey’s lab on the total artificial heart project. Cooley wanted a meeting,
and he had a purpose in mind.
As Baylor Surgery Department faculty members, Cooley and Liotta were
acquainted, but, given their disparate ranks, they moved in very different
circles. Liotta hoped to be a clinical cardiac surgeon someday but was
relegated at this point to the laboratory and animal surgery. Cooley, on the
other hand, was at the very top of the profession: one of the most famous
and successful surgeons in the world. Liotta frankly idolized Cooley and
was overjoyed at the meeting invitation. Superstar and dilettante convened
in Cooley’s St. Luke’s Hospital basement office on the morning of
Saturday, December 21, 1968.9
Cooley wanted to know how the work on the artificial heart was coming.
Liotta expressed his view that the research was making insufficient progress
—telling Cooley, in fact, that he was “not doing anything.”10 He also
intimated that DeBakey was paying little attention to the project. Liotta
despaired of the work—what he considered his work—ever coming to its
natural culmination: human implantation. Cooley listened to this tale of
woe, then—in what must have seemed to Liotta the angelic voice of divine
intervention—asked a pointed question. Did Liotta want to work on his
mechanical heart at St. Luke’s with Cooley? The goal would be
implantation in a patient, as soon as possible.
Although the offer was like a brilliant beacon to Liotta, with any
consideration at all came several immediate and serious implications.
Liotta’s entire salary was paid by the National Heart Institute (NHI)
artificial heart grant, HE-05435.11 DeBakey was, of course, the principal
investigator on the grant. Consequently, Liotta was obligated—by both
ethical standards and, since it was a federal grant, the law—to notify
DeBakey of any work he did on the artificial heart and, likewise, required to
do such work in the specified lab at Baylor. If he accepted the offer, Liotta
would have to violate the terms of his contract and the grant itself and so,
with extraordinary likelihood, place himself in harm’s way. Such violations
could destroy an academic career.
The song of the sirens was angelic, too: a star-struck Liotta accepted
Cooley’s offer. He told no one but his wife.12
9.2 HE-05435
By the end of 1968, the combined artificial heart research project at the
Baylor Department of Surgery and the Rice Biomedical Engineering Labs
had been under way for more than four years. Its shining success, the left
ventricular bypass pump first implanted in 1966, had given rise to great
optimism about the feasibility of a biventricular version: a complete
replacement for the failing heart. Indeed, this had been the initial focus of
the work, but when technical difficulties arose, the effort had shifted
towards the single-ventricle model that met with such success. In mid-1968,
at DeBakey’s direction, the lab focused again on a double-ventricle
version.13 As before, technical obstacles proved to be considerable.
Nonetheless, despite Liotta’s statements to Cooley, significant progress was
being made, and DeBakey was involved at every step.
Throughout 1968, the Professor had several meetings regarding the
project with C. William Hall, who continued to lead the laboratory team, as
well as with Liotta and others. DeBakey reviewed progress reports from the
group about every month in the second half of 1968, as well. Hall and
Liotta composed these in the form of memoranda, discussing general lab
considerations, as well as specific issues regarding the dual-ventricle pump,
as they came up.*
By September designs for a proposed model of a double-ventricle pump
had evolved far enough for the Baylor Surgery Department illustrator, Ben
Baker, to produce a schematic drawing of the device in preparation for its
construction.14
This illustration depicted the pump as a semicircle in cross-section, with
two equally sized ventricles divided by a substantial septum. Diaphragms
were incorporated into the walls of the ventricles. Carbon dioxide gas
injected into these would compress the spaces and move the blood. External
controls would regulate the volume of gas, as well as the rate and proper
sequence of compression to mimic actual cardiac pumping. In Baker’s
drawing, gas conduit tubes extended from the pump out through the ribcage
to the external power source and control mechanism (Figure 9.1).15
Figure 9.1 Ben Baker’s drawing of the dual ventricle artificial heart model from September 1968.
Not long after, prototypes of this pump were built by Louis Feldman and
the other technicians. The lab had both a plastics and a machine shop, each
supervised by Feldman. The machinists created aluminum molds, which the
plastics technicians used to fabricate the pumps. The pumps were composed
of three separate plastic parts—the body, dome, and diaphragm—which
were put together by hand.16 The valves were sewn to the assembled
pumps, then the blood and soft tissue interfaces were covered in Thomas
Edman’s Dacron velour. DeBakey suggested this himself, as a means of
minimizing trauma to the blood cells, the same old problem he had been
battling since the sleeve valve transfusion syringe 36 years before.17 The
assembled pumps were tested on the bench, using devices that measured
flows, pressures, and the like.18
While the Baylor surgery lab was making this major progress on the
actual pump in late 1968, the Rice biomedical engineers were at work
building power and control units for the dual ventricle device. The
technology of the time did not permit the sort of miniaturization that would
allow these elements to be contained within the mechanical heart itself, so
external machines were necessary to pump the carbon dioxide gas, as well
as to monitor and control the systems. The Rice team built a large console
for the purpose, as big as a meat freezer. The wide, stainless steel bottom
contained two pneumatic, motor-driven pump systems for each of the dual
ventricles, one to generate pressure and one to create a vacuum. This
allowed gas to be pumped into and out of the twin prostheses. On top of this
unit was the smaller control system, consisting of a display oscilloscope,
four rectangular preamplifier units, and a pulse generator. At the discretion
of the technicians, these machines could control the artificial heart rate—
ranging from 20 to 120 pulses per minute—and the duration of both systole
and diastole. The control unit could automatically synchronize the right and
left heart pumping action, which was obviously an essential feature.
Overall, the console functioned remarkably well.19
Given this buzz of activity related to the total artificial heart, it is not
clear why Liotta told Cooley in December 1968 that nothing was being
done in the lab. For his part, DeBakey did not have a high opinion of Liotta
and his contributions to the effort.
He really had no innovative concept at all. He was really quite a dull person . . . I felt sorry for
him, even when Dr. Hall would come to me and say, we’ve got to do something about him, I
can’t continue to work with him.20
One example of the approach to research that frustrated Liotta’s superiors

arose from consideration of valves for the new artificial heart. In the fall of
1968, Liotta became enthusiastic about the use of animal heart valves for
the device. He either did not realize or did not care that these had been tried
before and been shown to perform poorly. They could not be autoclaved, for
example, which called into question their sterility. Attaching the valves to
the pump proved troublesome, as well. In general, as Feldman noted,
“nobody trusted them.”21
DeBakey recalled:
I told him that we’d been through that and knew that that wouldn’t work, it’s not satisfactory.
What is more, if you’re going to build an artificial heart, you’ve got to build an artificial heart
with artificial valves. So I said, well, this is silly to do something like this which leads nowhere,
and besides I’m certain that they wouldn’t work satisfactorily, but he insisted upon doing it and
went ahead and did it. These are the kind of things that used to irritate Hall. And, of course, it
didn’t work.22
At the end of 1968, C. William Hall left to take a position at the

Southwest Research Institute in San Antonio. Although DeBakey
immediately considered a replacement for Hall, in the meantime this left
Liotta essentially unsupervised in the lab.23
Since the pumps had passed their bench tests and the control and power
mechanisms were ready, DeBakey authorized animal experimentations for
the artificial heart shortly after the first of the year. These trials were
intended “to test the technical feasibility of replacing the entire heart with
this device, to learn what modifications in design were needed for proper
anatomic attachment, and to obtain physiologic data for use in determining
proper control of the driving mechanism of the pump.”24
Before the first animal test was performed, however, there occurred one
of the more peculiar and inexplicable events in what would soon be a litany
of them.
On January 29, 1969, Liotta submitted an abstract for the upcoming
annual meeting of the American Society for Artificial Internal Organs,
scheduled for late April in Atlantic City. The abstract was entitled,
“Orthotopic Cardiac Prosthesis,” and the listed authors were Liotta, Rice
engineers William O’Bannon and Hardy Bourland, Baylor electronics
engineer Sam Calvin, and DeBakey. Liotta reported data from several sets
of experiments, concluding with the remarkable observation that “in 10
calves, total replacement of both ventricles was carried out for 24–44 hours
with the animals standing normally.”25 The reported results of the dual
pump were especially notable, of course, because not one of these
experiments had actually taken place yet!
The glib reporting of results from observations that had not yet been
carried out was obviously far beyond the pale for any conscientious
scientist. It would be several months before this example of Liotta’s
questionable character was revealed, by which time much more earth-
shattering evidence had accumulated.
9.3 The Calf Experiments
In the meantime, the first animal tests of the artificial heart began. Liotta’s
preferred animal valves were used initially, either because DeBakey
allowed it or was unaware. On January 30, February 3, and February 13,
Liotta implanted double-ventricle pumps with homograft valves in calves.
None of the animals made it off the operating table alive.26
The fourth calf also died on the table when a ventricular diaphragm
ruptured, but there was an important difference in this February 20
experiment. The homograft valves in this pump had been replaced with
prosthetic ones that went by the brand name of “Wada-Cutter.”27
The brainchild of Japanese surgeon Juro Wada, and manufactured by the
Cutter Biomedical Corporation, these new artificial valves consisted of a
tilting disk of Teflon circumscribed by a titanium ring. Struts from the ring
acted as hinges on the tilting disk, and the entire mechanism was embedded
in a Teflon cloth circle that allowed for suturing to the valve annulus of a
patient’s heart. The sophisticated design was intended to minimize
thromboembolic events. At this time, the Wada-Cutter valves were
undergoing clinical trials at the Texas Medical Center.28
The chief investigator on the project was Denton Cooley.
The technicians and engineers in the lab wondered where Liotta had
gotten the new prosthetic valves but asked no questions.29 They also were
silent when he subtly altered the technique of suturing the valves onto the
pump. The first of the Wada valve experiments (the fourth overall) was
performed on February 20, and another followed on February 24.30
The second of these experiments went by far the best to that point: the
animal lived almost 12.5 hours. Since it was the first even to make it off the
table this was cause for celebration, but not all was good news. The calf
never stood and stopped producing urine after about four hours on the
pump. Pulmonary congestion developed as well. All of these were ominous
signs that the pump was causing drastic and deleterious changes to the
organs of the calf.31 A ruptured ventricular diaphragm again ended the
proceedings, but not before Baylor surgery department photographers
documented the event, including the presence of Cooley.32 He was
apparently summoned from St. Luke’s Hospital when the animal did not
immediately die.
On the next day, Cooley sent a letter to the business office at Baylor
College of Medicine authorizing Liotta to charge the expenses for these two
Wada valve calf experiments to small, private grants he controlled (Liotta
did not actually do this until mid-March).33
Although he had never been an enthusiastic laboratory researcher, Cooley
was fully cognizant of the responsibilities and obligations that come hand-
in-hand with extramural—especially government—research grants. He
knew that if Liotta were discovered to be working on the artificial heart
outside the auspices of the DeBakey grant, there would be hell to pay for
the Argentinian. Cooley’s own furtive insinuation into the process with the
provision of the Wada valves and modification of their attachment—which
were, in fact, his ideas—was also a serious breech of scientific ethics.
Cooley tried to dance around this by having the costs of the first two Wada-
valve calf experiments diverted to his own accounts. These payments,
however, came after the experiments were already completed (and the
animals were dead).
Following the fifth experiment the team decided to construct three
different sizes of the pumps.34 Since each was made from three molds this
meant that Feldman and his machine shop team had to create nine separate
aluminum molds. Around this time visitors from the NHI, the source of
funding for the project, toured the facilities. Ted Cooper, head of the NHI,
was among them. DeBakey himself showed them the new pumps and
described the experiments that were under way.35
Two more calf experiments were performed in March. Again, the animals
were unable to stand after the procedure and remained on ventilators for the
brief remainder of their lives. Renal and pulmonary failure also occurred.
The seventh calf—the final experiment, as it turned out—lived for 44 hours
after implantation, but this was not as encouraging as it might seem.36 The
animal suffered all the organ system dysfunction the others had, but—in
order to test the longevity of the pump mechanisms, and the effect on the
blood cells—on DeBakey’s orders the calf was fully anticoagulated with
heparin.37 This kept the pump running, but the animal was essentially a
“perfused cadaver.”38 That was March 20.
9.4 Stratagem
While the pumps themselves were functioning at something less than an
ideal level, the power and control mechanisms devised by the Rice
engineers worked well. On January 17, even before the first calf
experiment, Domingo Liotta contacted one of the Rice engineers, William
O’Bannon, about constructing another such console.
I was asked if I could build a power unit. I said I could but I did not know whether it would be
proper. Dr. Liotta approached me. He was speaking for Dr. Cooley. He said it was Dr. Cooley’s
idea.39
Liotta asked O’Bannon to keep the offer secret and, in particular, not
disclose that Cooley was behind it. He said that $20,000 was available to
pay for the machine, but that it should not be constructed at Rice. As a side
job, O’Bannon was one of the directors of a small electronics concern
called Texas Medical Instruments. He decided that in this capacity he could
build a new power unit in his garage.40
Still, O’Bannon had qualms and went to his superior at Rice, J. David
Hellums, a Professor of Chemical Engineering and leader of the Rice side
of the artificial heart research program. Although O’Bannon did not tell
him, Hellums suspected that the anonymous purchaser was Cooley.
Nevertheless, as long as it did not interfere with his work at Rice, Hellums
had no reason to forbid O’Bannon from working on another power console
on his own time.41
O’Bannon was intrigued by the opportunity to work with the famous
Denton Cooley and by the challenge of building another power unit for just
$20,000—far less than had been spent on the unit at Rice. He went to work
in his garage, making some minor modifications to the previous design.
Over the next several weeks, while the artificial heart calf experiments
proceeded at Baylor, O’Bannon assembled a new console. Later he said that
if he had known it were for use in a human being, “I am not sure I would
have built it.”42
In mid-March 1969, the lab workers began noticing some strange
behavior on the part of Liotta. He began storing the Dacron velour fabrics
as well as the pieces of silicon plastic known as Silastic in his own secure
refrigerator. He also asked one of the plastics technicians, Suzanne
Anderson, to extend the velour lining of the pumps onto the connecting
tubes, which—for anatomic reasons—made no sense if they were to be
used in calves. When she did not do this to his liking, he angrily told her
that she “was going to kill someone.”43 After the final calf experiment on
March 20, Liotta asked the technicians to fabricate three “perfect” pumps—
one of each size—according to the new specifications, also extending the
length of the tubing. When the component parts were finished Liotta
assembled them into the complete pumps himself, a job typically performed
by the plastics team. That was on March 29. As far as anyone in the lab
knew, no further calf experiments were on the schedule.44
The lab technicians noted all of this activity with concern. After the fact,
Anderson stated that she suspected Liotta was planning implantation of the
pumps in humans. She said nothing, however. From her perspective, Liotta
was in charge of the lab, he was a physician, and it was not her place to
question him.45 No one informed DeBakey, either.
By Wednesday, April 2, the artificial heart pumps were ostensibly ready,
and O’Bannon had completed and delivered his 400-pound garage-built
power console to St. Luke’s.46 The only thing missing, from Cooley’s
standpoint, was the right patient candidate or, more accurately, the proper
scenario. That evening he visited Haskell Karp’s hospital room to spell out
the new plan.
The next morning Cooley telephoned Herb Smith, the head of Medical
Communications for the Baylor Department of Surgery. He requested that
still and motion picture cameras and photographers be present at Karp’s
surgery the following day. Smith assigned the head photographer, Joachim
Zwer, to film the procedure and Gregory Stone, an assistant, to shoot the
stills.47
Cooley assigned one of his junior colleagues, Robert Bloodwell, the task
of inspecting O’Bannon’s control console as well as supervising its testing.
Bloodwell found a spot for the big machine in the St. Luke’s urodynamics
lab.48 After delivering the unit on Wednesday night, O’Bannon had more or
less fled the scene, recognizing that plans were well under way for human
implantation. On Thursday he went to his superior, Professor Hellums.
Mr. O’Bannon came to me and said Dr. Cooley and Dr. Liotta were planning a total replacement
on a person the next day. Mr. O’Bannon was obviously extremely upset. He said he had told
them he could not participate unless it was cleared with me. He further asked me to say no.49
Since O’Bannon had made himself unavailable, on Wednesday night
Liotta called the Baylor electrical engineer Sam Calvin over to St. Luke’s to
inspect and test the console. While the two men were looking over
O’Bannon’s new unit, Cooley appeared and, to Calvin’s shock, suggested
that human implantation might be imminent.
I was surprised because I didn’t think we were ready for application of the artificial heart on the
human level. I was reluctant to get involved, but Dr. Liotta told me it was my responsibility to
check the pump unit, and I thought he was speaking as my chief.50
Calvin spent eight hours testing O’Bannon’s garage-built machine. It

worked flawlessly. Still, he had misgivings about what was about to occur.
I assumed that, since Dr. Liotta had been the director, it was legitimate; at the last I was not sure
because I was told not to reveal it to anyone. I was told that it should be kept secret.51
At the surgery laboratory the newly assembled pumps were sterilized by

gas autoclave on the evening of Thursday, April 3. The following morning
the technicians noticed that they were missing from the lab. Liotta had
taken them to St. Luke’s in their sterile pouches, tucked into his briefcase.52
April 4, 1969, was Good Friday. Denton Cooley had scheduled five open
heart surgery cases for the day. Karp was the fifth.
In the anteroom to DeBakey’s office, where his secretary welcomed
visitors, two of the more important and well-perused documents in the
Medical Center were on full display. These were DeBakey’s large “three-
months-at-a-glance” travel calendars, and they revealed—in exquisite detail
and in plain sight—all of the Professor’s comings and goings. Every
conference, committee meeting, visiting professorship, or other official
reason DeBakey had for leaving Houston was documented in advance here.
The residents scoured these calendars with obvious interest: if they knew
DeBakey would be away while they were on his service, they could stand
down to some degree—perhaps even take a day or two off.
Because of these semi-public calendars, most of the members of the
Department of Surgery were well aware that the Professor was leaving town
on Friday, April 4, 1969. He was flying to the nation’s capital for a meeting
of the NHI at Bethesda, Maryland.
The topic of the meeting was progress on the artificial heart.53
9.5 The Operation
The presence of strange equipment and personnel in the St. Luke’s OR suite
that Friday did not escape the notice of the “pump techs” who ran the
cardiopulmonary bypass machines for Cooley’s cases. Some wondered if a
heart transplant was planned, but, in that event, there should have been a
donor ready, and no such unfortunate was apparent.
In the morning, Cooley telephoned Hellums over at Rice, still hoping to
have O’Bannon present to operate his power/control console. Hellums
stood firm, though. He had three solid reasons why he would not permit it.
In the first place, DeBakey was not involved in the endeavor, and Hellums
was well aware that the artificial heart was his show. Second, the whole
plan was ripe for catastrophe since he and O’Bannon felt strongly that the
unit had not been adequately tested, especially for use in a human being.
Finally, even though O’Bannon had built the thing on his own time, he still
was a Rice employee and Hellums would not have his own institution
dragged into the matter.54
Cooley’s charm could not overcome these well-considered protests, and
O’Bannon did not appear. Instead, however, another member of the small
Texas Medical Instruments Company—in fact, the President—John
Maness, who was not then affiliated with Rice (or Baylor) came to St.
Luke’s to run the control console.*55 Since there was no automatic setting
and the mechanism had to be operated manually, this was no small
commitment.
Cooley calmly and deliberately performed the first four of the day’s
operative cases, in St. Luke’s Operating Room No. 1. When he had finished
these, it was mid-afternoon. The stage was now set for the main event:
Liotta stood by with the artificial heart pumps, Manness and two other
technicians were prepared with the control console, the still and motion
picture photographers were on hand, and Cooley’s surgical assistants—
Bloodwell and Grady Hallman—as well as the anesthesia and pump teams,
were all at the ready. Several other fellows and trainees, essentially
bystanders, filled the room.
Haskell Karp was rolled into the OR and quickly anesthetized. His chest
was shaved, slathered with iodine prep, and draped with sterile cloths and
sheets in the time-honored fashion. The persona of the Skokie printing
estimator vanished—replaced by a rectangular expanse of orange-tinted
skin framed by blue drapes. The operation commenced. At almost the same
moment, DeBakey’s plane was departing Houston’s Hobby Airport for
Washington, D.C.
After opening the chest and initiating cardiopulmonary bypass, Cooley
examined the aneurysmal left ventricle. The scar tissue encompassed more
than two-thirds of the left ventricle myocardium and extended into the
interventricular septum. As experienced with ventriculoplasty as anyone in
the world, Cooley recognized at this point that the procedure was probably
hopeless but he felt “obligated” to try.56 When the wedge resection was
accomplished, and the healthy edges sutured back together, the all-
important step of weaning from the bypass machine began. Within minutes
it was obvious that it was impossible: there simply was not enough
functioning heart muscle left to do the job. Cooley did not hesitate: he
swiftly removed Karp’s heart, the ultimate crossing of the Rubicon.
He left enough native atrial tissue to attach the prosthetic pump, just as if
he were doing a transplant. One of the artificial hearts—the medium-sized
one—was brought onto the operative field, tailored to fit the remnants of
Karp’s heart, and sutured into place with continuous, “running” stitches: the
left atrium first, then the right, followed by the pulmonary artery and,
finally, the ascending aorta. This suturing took Cooley longer than for a
heart transplant because the prosthetic material was stiffer and, besides, it
was the first time he had ever implanted such a thing. The surgeons then
passed the control tubes through the ribcage out to the console beyond the
sterile field. They activated the pump and, seeing it function apparently as
designed, removed the bypass cannulae and closed the chest.57
Only the surgeons and the control technicians knew that a functional
artificial heart even existed, much less that one might be implanted in this
operation. The rest of the team and the onlookers sat or stood in open-
mouthed astonishment at what they had witnessed.
Because the large control mechanism was essentially immobile, Karp
was not taken to the intensive care unit but remained in OR No. 1 for
recovery.
Within minutes Cooley was in front of reporters for an impromptu press
conference. A dreamy-eyed Liotta flanked him. The Houston journalists had
gotten used to these spur-of-the-moment presentations, especially after the
onslaught of heart transplants, but even the most jaded of the
correspondents—and the wire service colleagues who joined them—were
unprepared for a story like this.
Cooley described the cardiac prosthesis, emphasizing that it had been
built by Liotta and that the two men had been collaborating on the project
for four months. He discussed the decision-making process and
intraoperative findings that had led to the use of the artificial heart,
emphasizing that the plan was ventriculoplasty and that the use of the
artificial heart was an emergency life-saving measure. The patient and his
family had been made aware of the possibility that a prosthetic heart might
be necessary, though, and had consented to its use. It was only intended to
keep Karp alive until a donor could be found for transplantation, and no one
knew how long it would work, possibly up to a week—maybe longer.
During the improvised presentation Cooley got word that Karp was awake
and responsive, and he seemed to tear up (Figure 9.2).58
Figure 9.2 Liotta and Cooley with Haskell Karp following implantation of the artificial heart. Note
large external power and control mechanism.
Back in the ersatz intensive care unit (ICU) of OR No. 1, Karp was still
on a ventilator, but clearly alert. The surgical team decided to remove the
endotracheal tube and let him breathe on his own and, perhaps, speak. The
assigned photographers dutifully recorded it all. Shirley Karp later said that
Haskell whispered that his chest was sore, and, as soon as the documentary
pictures had been obtained, he was reintubated.59
Meanwhile, in Washington, DeBakey checked into his old haunt, the
Hays-Adams Hotel, and prepared for his meeting in Bethesda the next
morning. A call from Houston shattered his quiet solitude.
I did get the word that night, but I didn’t know the facts about it. So the next morning on the
television news they had a picture of the artificial heart and Liotta and Cooley there, and there
was the pump, the one we made in the laboratory. They had been using it on their own. It was
obvious. You could look at the pictures and see. It was just incredible.60
On that Saturday morning newspapers across the world were also

emblazoned with banner headlines, trumpeting the first implantation of an
artificial heart. At the NHI meeting DeBakey was fairly swamped with
questions, nearly none of which he could answer. The committee members,
including Ted Cooper, were well aware of the work in the Baylor lab from
previous publications and the recent site visit. They were curious about
Liotta’s role in this surprise implantation: they all knew that he was
employed on the NHI grant in DeBakey’s lab. Even more than this, though,
the committee wondered about Cooley’s involvement. He was not known to
have any interest in prosthetic heart research and had even made headlines
at a meeting eight months before when he compared such a device to
“science fiction.”61
While DeBakey grappled with a roomful of unanswerable questions in
Bethesda, back in Houston the euphoric enthusiasm of the previous day’s
events was fading, replaced by more ominous developments as the reality
of the situation began to emerge.
The Houston newspaper headlines were as big as those anywhere, with
the added dimension of civic pride. Reading the accounts with a concerned
fascination, Hebbel Hoff, a physiologist and Associate Dean for Faculty and
Clinical Affairs, called for an emergency meeting of Baylor’s Committee on
Research Involving Human Beings to consider what had occurred.62
On that same Saturday morning, the St. Luke’s administration was
making arrangements for another press conference, this time lacking the
barely concealed jubilation.
Karp had survived the night, although his condition was certainly
tenuous: urinary output had been poor from the beginning of the
postoperative period, and, ominously, it was getting worse. Keeping his
blood oxygen levels up also became challenging just a few hours after the
operation was complete: something dire was happening to his lungs.63
Anyone familiar with the calf experiments would have recognized this
pattern. Cardiac output measurements suggested that there might be a
technical error with the implantation, as well: data were consistent with a
“partial occlusion or compression” of the superior vena cava. This seemed
to be caused by the outflow tract of the right ventricular portion of the
prosthesis, “which was somewhat improperly oriented.”64 The need for a
donor heart was becoming acute, and a certain controlled panic was
beginning to creep into the medical team.
Consequently, Cooley convinced Shirley Karp to go before the television
cameras and radio microphones and, standing alongside him, make an
impassioned nationwide plea for a donor heart.
I cry without tears. I wait hopefully. Our children wait hopefully and we pray. Someone—
somewhere—please hear my plea. A plea for a heart for my husband. I see him lying there
breathing and knowing that within his chest there is a man-made implement where there should
be a God-given heart. How long he can survive, one can only guess.
If I myself could give up my heart to my husband I would do it. My husband is a young man.
He wants to live. My son Michael, 22 is going to be married in September. He wants to be there.
He wants to see his other children. I have a 19-year-old boy and an 11-year-old boy. He wants to
see them grow. He wants to enjoy some of the good things in life. He suffered for ten years
already. I think it’s time something good happens.65
Cooley added that, “The reason we have agreed to publicize this is to try
to get a donor.” Although the previous day’s press conference began before
Karp had even emerged from anesthesia, Cooley added that, “otherwise
we’d be inclined to keep this quiet until it is proven.” He then pointedly
remarked that, “I’m disappointed and somewhat alarmed that we haven’t
had a donor.”*66
The emergency Saturday meeting of the Committee on Research
Involving Human Beings immediately identified one of the most salient
issues of the coming controversy just from the newspaper articles. Liotta’s
reported provision of the biventricular pump was instantly recognized as a
possible conflict with the NHI rules, which stipulated that any human
experiments stemming from grant HE-05435 had to be cleared by this very
committee. In fact, this was the case for any scientific investigation
performed at Baylor that made use of human subjects. Hoff made sure that a
November 4, 1968, memorandum to this effect from the Committee’s
Chairman, Harold Brown, was read into the record.
If human beings are to be used in any study, an application for approval by the above committee
should be submitted to Dr. Harold Brown, Chairman, Committee on Research Involving Human
Beings, Room 6-4, Ben Taub General Hospital.67
Notes from this informal meeting were referred to an official reconvening

for Monday morning.
The paradox of frantic waiting for a new, natural heart continued through
Sunday. Two planes “stood ready at a Houston airport to fly to any section
of the country and pick up a donor.”69 Moved by Shirley Karp’s emotional
plea, several apparently healthy individuals called St. Luke’s Hospital
offering to donate their own hearts. A spokesman was quoted as saying, “we
explained to them that there is no way in the world we could accept.”70
That night a heart which they could accept became available. It belonged
to a 40-year-old woman from Lawrence, Massachusetts, named Barbara
Ewan. Mrs. Ewan, who was a widow, had been in a coma at the local
hospital for more than two weeks. On Saturday, April 5, she had
experienced a brief period of cardiac arrest and tests indicated that she had
suffered irreversible brain damage. After seeing Shirley Karp’s tearful
televised appeal, Mrs. Ewan’s children had decided to donate her heart. The
necessary telephone consultations ensued, and arrangements were made for
her to be flown to Houston.71
Once Mrs. Ewan was at St. Luke’s, which was Monday morning, April 7,
blood and tissue compatibility tests were run quickly. They confirmed a
match. She was declared dead 90 minutes after arriving at the Texas
Medical Center. Mrs. Ewan was then moved into an OR adjoining Karp’s,
and Denton Cooley proceeded with his 19th human heart transplant. By the
time of its removal, the artificial heart had been pumping in Karp for 64
hours.72
Although the prosthetic pump was no longer in use, Karp was kept in the
OR rather than being transported to the ICU. It was here that the Methodist
nephrologist Robert Morgen saw him at about 3 PM on Monday afternoon
and recorded a grim description.
I found the patient semi-comatose with pupils in mid position, poorly responsive to light
stimulation; the ocular fundi showed slight retinal venous distention. The face was dusky,
suffused, and puffy. The neck was thick and puffy and I could not evaluate the external jugular
veins. There was mild edema of the entire anterior and lateral chest wall and moderate edema of
the flanks and hip region . . . the abdomen was moderately distended and tense; I heard no
bowel sounds . . . the blood pressure was ranging from 80–90 mmHg systolic; the diastolic
pressure was not easy to determine. There was a graded decrease of skin temperature from the
hips to the feet, the latter being clearly cold due to poor perfusion.73
Karp was on full mechanical ventilatory support, as well as circulatory

support from constant intravenous infusion of the medication Isuprel.
Morgen was informed that Karp had been “virtually anuric” since the time
of the prosthetic implantation.74 The filtering function of the kidneys was
rapidly deteriorating, with elevated—and worsening—blood urea nitrogen
and creatinine concentrations. Karp was also dangerously acidemic. A chest
x-ray showed pulmonary congestion, with fluid in the right chest
compressing the lung.75
Morgen’s overall impression was of “cardiogenic circulatory
insufficiency,” with consequent multiple organ system dysfunction. He
initiated treatment with bicarbonate infusions to improve the acidemia and
prepared for dialysis in case it became necessary.76
9.6 Investigations
A few hundred yards away, at the Baylor College of Medicine, the
Committee on Research Involving Human Beings was meeting formally to
discuss what they knew of the case. After a tumultuous weekend in
Washington, DeBakey also was returning to Houston that day, and Hebbel
Hoff wanted Liotta to explain himself before his Principal Investigator.
Joseph Merrill also attended what must have been a particularly
uncomfortable interview.77
Liotta admitted that the pump implanted in Karp had been developed in
the surgical lab at Baylor under the auspices of the Cardiovascular Research
and Training Center grant. He confessed to working furtively with Cooley
for several months and asserted that Cooley had told him not to inform
DeBakey about the collaboration. He admitted that he knew he should
inform DeBakey but decided not to do so because he believed that the
Professor would not approve the clinical use of the dual-ventricle pump.
Liotta said that he “had no knowledge of the requirements of the Baylor
Committee on Research Involving Human Beings nor of any obligation
devolving on him because of his support by a NHI Grant to follow
guidelines laid down by the National Institutes of Health.” He had not
discussed these issues with Cooley. The meeting closed with DeBakey
directing Liotta to bring the protocols of the animal experiments to him and
to provide a written account of the entire episode.78
On the following day, Liotta’s responses at this interview were
documented and discussed at another meeting of a committee, the second of
three that would take place at Baylor in the wake of the events of April 4.
This was a gathering of the Advisory Committee of NIH grant HE-05435.
Hoff and Merrill were on this council, as well as Ted Bowen and four other
faculty members. They reviewed Liotta’s answers and interviewed David
Hellums from Rice on this Tuesday, April 8. They moved swiftly and
drafted a letter for DeBakey in his role as Principal Investigator on the
grant, as well as President of the College.
In the face of this information, the Advisory Committee recommends that you notify the
National Heart Institute that Dr. Domingo Liotta, without your knowledge or that of any
member of the Advisory Committee, took action described above, purposely withheld all
information pertaining to the plans to use this device in a human subject, and did not seek
approval of Baylor’s properly constituted Committee on Research Involving Human Beings.
The Committee further recommends that Dr. Liotta’s employment on this grant be terminated
immediately and that the National Heart Institute be apprised of this action.79
Even as this recommendation was being composed, Ted Cooper from the
NHI was finishing up another letter to DeBakey. The two had discussed this
in Washington.
Cooper was anxious to get all the details. I said, “Now you write me a letter and tell me
specifically what you want, and I’ll get it for you when I get back.” So he wrote me as President
of the College to get the facts.80
In the April 8 letter, Cooper expressly asked DeBakey if the artificial

heart that the news outlets said Cooley had implanted had been developed,
in fact, under the NHI grant. He also asked for a summary of the animal
experimental data and inquired as to whether the Baylor committee on
human experimentation had approved the implantation, as required by the
grant.81
Across the way at St. Luke’s Hospital, Haskell Karp’s spectacular four
days in the public eye came to a relatively quiet end. He died at 3:15 PM on
April 8, 1969. A postmortem exam was performed, and this demonstrated a
number of findings of importance. Most of the organs and tissues had
evidence of circulatory congestion, a confirmation of the nephrologist
Morgen’s impression of cardiogenic circulatory insufficiency. Some of
these changes were undoubtedly chronic. The immediate cause of death was
felt to be pneumonia caused by the bacterium Pseudomonas aeruginosa.
The pathologists observed that the tiny blood vessels of the kidneys known
as the glomeruli were clogged with “fibrin thrombi,” small blood clots.82
The reports of the committees on human research and the NHI grant were
essentially preliminary. The real Baylor inquiry began on Thursday, April
10. By this point, the news of Cooper’s letter to DeBakey had made it to the
papers, and the tenor of the media coverage was shifting as it became public
that something was amiss in the Karp case. For the Baylor administrators
and spokesmen, answers would be needed to the inevitable questions sure
to arise.
DeBakey appeared that morning before an emergency meeting of the
Executive Committee of the Board of Trustees. He briefly described what
was known to that point about the events surrounding the Karp case,
emphasizing the impact that implantation outside the boundaries of the
grant could have on both the present and future status of federally funded
research at Baylor. He recommended an independent group be established
to conduct a thorough investigation.
There are specific things we need to determine. We need to define our specific responsibility as
to whether or not this was a violation of the National Institutes of Health, whether or not a
member of the faculty has violated certain ethical rules of the college. These things must be
determined. What I propose is a committee of some objective group, and assure them we have
established guilt anonymously.83
Board Chairman Leonard F. McCollum officially established such a

Special Committee, charged with the task “to investigate compliance by the
College with the guidelines established by the NHI for the development and
use of the artificial heart.”84 This group met for the first time later that day.
Hoff was the Chairman, and there were 12 faculty members, including
Merrill and Brown, as well as the virologist Joseph Melnick and
pediatrician Russell Blattner.85 Even though he was both Chairman of the
Department of Surgery and President of the College, DeBakey chose not to
serve on the committee because he did not wish to fuel any concerns that
the findings might be compromised by his influence.
I immediately recognized that it would be best for me to just pull out of the whole thing because
I knew that there would be . . . that DeBakey is trying to persecute Cooley, you see. So I got out
of it completely and had nothing to do with the investigation in any way.86
Over the next three days, the committee spoke with most of the figures of
note in the development of the artificial heart, as well as its implantation in
Haskell Karp. Statements were transcribed. Liotta was interviewed on that
first day, April 10. On Friday, April 11, the committee interviewed Louis
Feldman, C. William Hall, the plastics technician Suzanne Anderson,
Surgery Department financial officer Gerald Maley, and Surgery Lab
Supervisor Polk Smith. The next day saw statements taken from Calvin,
Hellums, O’Bannon, Cooley’s surgical assistants Robert Bloodwell and
Grady Hallman, Chairman of the St. Luke’s Committee on Research
Involving Human Beings Brantley Scott, and Denton Cooley himself.87
Liotta’s statements were largely a repeat of his interview from three days
before, with two major exceptions. Now he indicated that Cooley had not
asked him to keep DeBakey in the dark, only that he did not inform the
Professor because he “did not feel Dr. DeBakey would allow me this
collaboration.” He also made the rather remarkable statement that “we were
not prepared to go to clinical application.” This, however, was made in the
context of supporting the notion of the Karp implantation as being
unexpected and an emergency decision. The committee’s follow-up
questioning revealed their incredulity: “But it was all conveniently
ready?”88
On Friday—one full week after the implantation of the artificial heart—
the collection of testimony continued. Feldman’s remarks were somewhat
technical, emphasizing the painstaking efforts involved in the laboratory
work. He did give Liotta credit for his contributions in developing the dual-
ventricle artificial heart, but emphasized the role of “4 machinists, 3 plastics
technicians, plus lab technicians, totaling over 20 people.” He indicated that
it would take an independent company “four to five months” to duplicate
the work—essentially eliminating the possibility that such a thing had
occurred under Cooley’s direction. When shown a photo of the Karp heart,
Feldman said, “This is ours. This is the Baylor pump.”89
Hall echoed Feldman’s comments, stating that, “If anyone asked me, I
would say yes, this is the Baylor-Rice artificial heart.”90
Anderson concentrated on describing Liotta’s suspicious behavior in the
weeks leading up to the Karp implantation. Maley confirmed that the sole
source of Liotta’s salary was the NHI grant and reported Cooley’s attempts
to pay for the two calf experiments with the Wada-Cutter valves. Polk
Smith described all of these experiments in some detail, offering that, “In
my opinion, none of the operations could be considered a success.” She
added that, “to my knowledge no one in the laboratory had any idea that the
pump was to be used in a human being.”91
The final interview session was on Saturday, April 12. Calvin, Hellums,
and O’Bannon all recounted the roles they played in the events leading up
to the implantation.92
Cooley’s men Hallman and Bloodwell defended the use of the artificial
heart as an alternative to death on the OR table and expressed ambivalence
about the process of consent and approval for human experimentation.
Neither was exactly sure about the sequence of events that had resulted in
the pump and control mechanism appearing at St. Luke’s for the Karp
procedure.93
Brantley Scott simply observed that Cooley had submitted no protocol
for human experimentation to his committee.94
Cooley also came before the Baylor committee on Saturday. By now,
word of the investigation had reached the media, and he was worried that
something “sinister” was afoot. He had spoken in Baltimore two days
before at a previously scheduled meeting and had taken the opportunity to
address a press conference. At that time he was quoted as saying, “It is not
time for a witch-hunt but to see what we have gained from this experience.”
Firing a pre-emptive strike, Cooley had also proclaimed, “I have done more
heart surgery than anyone in the world. Based on my experience I feel I am
qualified to judge what is right and proper for my patients.”95 Sitting before
the committee, he wondered aloud at their motives. The drama-within-a-
drama commenced with Hoff reassuring the surgeon that the committee was
merely “colleagues trying to find out what the facts are.”*96
Cooley began by observing that he had known Liotta for a number of
years and was aware of his experience in the field of cardiovascular pump
research. He thought that this knowledge might prove helpful in a vexing
clinical problem. The number of heart transplant donors was simply not
enough, and too many people were dying on the operating table or while
waiting for a transplant. Cooley had an idea for a temporary mechanical
heart. This was not intended as a permanent total heart replacement, he said,
but what he called a “resuscitative pump,” one that could be used to buy
time until a donor could be found.
I drew the design. I asked him if he was working on a total heart and he said no, that nothing
was going on in the lab at that time. I told him he could work outside of the Medical Center and
if he were sure this work had nothing to do with the work budgeted by the National Heart
Institute I thought it would be acceptable. I assured him we had funds to develop this pump. I
told him that if an internal device was to be built it must not be developed at Baylor or Rice.97
Cooley went on to describe O’Bannon as being “anxious to cooperate”

on the control mechanism for the project and to note that Hellums had
okayed it.99
When asked to clarify why he had not just come forward with the idea
and discussed it with DeBakey, Cooley revealed some of the friction that
had existed between the two over the preceding years:
Let me remind you that my position is rather awkward in the surgical research labs. Apparently
my abilities more or less have been overlooked in the medical school dating back to the pump
oxygenator.100
Cooley specifically denied that the Karp pump bore any relationship to
the one developed under the NHI grant, but admitted that it had been built
in the Baylor laboratory: “I have never felt I should be denied access to the
surgical lab since I have contributed to it in so many ways.” Moreover, he
asserted that “the materials were all purchased by me.” With regard to the
calf experiments, he went on to note that, “Dr. Liotta said he had used nine
[sic] calves, and that all have been paid for. If not we stand ready to pay for
them.”101
As to the actual results of those experiments, “in my opinion, enough
laboratory work was done to put this thing on in this manner and I would do
it again.” Not content to leave it at that, Cooley then blithely observed, “I
have done equally bizarre things.”* He indicated that he was aware of the
November 4, 1968, Baylor memo regarding human experimentation, but he
asserted that it was not applicable to the case in question since it “was not
an elective operation.”
This came about in this way. Everything was delivered at once. Everything, and the patient was
there. It was all there so we decided to try it. The whole thing. We were trying to use a
resuscitative pump. Had the donor we had hoped for come in two hours later, we would have
removed the pump and put the heart in, but to our great dismay, this did not happen.103
As to the problem of Liotta’s responsibility to inform DeBakey, Cooley

reflected that “no formal issue” was made of keeping the outside work
secret. When asked if it had occurred to him to make a statement to
DeBakey that a new Liotta-Cooley collaboration was beginning, he
demurred.
Yes, it occurred to me, but having met with nothing but negative replies to anything of this
nature, and being determined to develop this device, we did not make a formal report.104
Pressed on this fundamental point, Cooley admitted: “I could have

written him a note.”105
All of the interviewees signed notarized transcriptions of their statements
except Liotta and Cooley. The committee prepared a one-page summary of
Liotta’s participation in the affair—which essentially duplicated his own
testimony—and he did sign this with Hoff and Merrill as witnesses.106
Cooley, however, evidently thought better of it and signed nothing.
Instead, nine days later, he sent a letter to Hoff “refusing to acknowledge
the statements alleged to be mine made before the special committee on
April 12, 1969.” He then went on to make a “simple statement” which
nonetheless mostly reiterated his comments from the interview. He added
two important clarifications, however. Having apparently considered that
his previous answers were inadequate, Cooley addressed his reasons for not
contacting Baylor’s Committees on Research Involving Human Beings and
for ignoring the tenets of the NHI grant. He wrote, “I did not consult the
committee on human experimentation at Baylor since I had never consulted
them in the past with use of new devices in surgery and since none of the
other surgeons in the department had to my knowledge consulted them.”107
“You must deduce that I feel no obligation to the National Institutes of
Health grants since I was not funded by them,” Cooley continued. “Thus, I
am responsible primarily to the Department of Surgery and to myself.”108
He concluded the letter by citing a perceived wound and leveling a
threat: “The Baylor Medical College has done me harm by unnecessarily
announcing to the news media its formal investigation with an assumed
purpose of determining my guilt. The subsequent effect upon my
professional reputation will influence my future actions in this matter.”109
By then Liotta had been terminated from the NHI grant—the axe falling
officially on April 16.110 At nearly the same time DeBakey got word of the
phony calf experiment abstract that Liotta had submitted to the American
Society for Artificial Internal Organs back in January. Aghast, he
immediately withdrew it.111 He also learned that Liotta, Cooley, and
Hallman were preparing a manuscript for publication which detailed the
Karp case. Somehow, DeBakey got hold of this. As Department Chairman
any proposed paper should have been cleared by him, anyway, but such
niceties were not the order of the day at Baylor during that eventful spring.
Included in the article draft was a sketch of the Karp artificial heart
pump, sent to Herb Smith for conversion to a printable version. Incredibly,
it was just the Ben Baker drawing from September of 1968, with a few
changes penciled in by Liotta. DeBakey sent these items to Hebbel Hoff on
April 18 (Figure 9.3).112
Figure 9.3 Schematic drawing of the Karp artificial heart submitted by Liotta to Herb Smith in April
1969. Compare to Baker’s original drawing (Figure 9.1).
On that same day, the Special Committee wrapped up its work and
submitted it to Chairman of the Board McCollum. They had been charged
with a thorough but expeditious investigation, and had certainly delivered
on both accounts. The report contained these documents:
I. Statement of Special Committee, incorporating:
a. Membership and charge.
b. Ted Cooper’s letter from the NHI dated April 8, 1968.
c. The Public Health Service’s guidelines for grants.
d. Baylor’s memo from November 4, 1968, requiring all human experimentation to be
cleared by the Committee on Research Involving Human Beings.
e. Hoff’s account of the preliminary investigation, up to and including the first
interview of Liotta.
f. The April 7, 1968, report of the Baylor Committee on Research Involving Human
Beings.
g. The April 8, 1968, memorandum from the Advisory Committee for grant HE-
05435.
II. A summary of Liotta’s participation in the events leading up to and including the Karp
implantation, as gleaned from his interviews.
III. The four progress reports sent by Liotta to DeBakey on August 29, 1968; September 17,
1968; October 28, 1968; and December 18, 1968; including a summary of their contents.
IV. A St. Luke’s Hospital Medical Research Committee policy statement.
V. The abstract Liotta sent to the American Society of Internal Organs on January 29, 1969.
VI. DeBakey’s memo to Hoff containing the article manuscript on the Karp case by Liotta,
Cooley, and Hallman. This included the drawing of the pump that Liotta barely amended
from Ben Baker’s version, which DeBakey also appended.
VII. A summary sheet with the results of the seven calf experiments.
VIII. The statements of the witnesses (Cooley’s was initially included, but subsequently
deleted, presumably because of his refusal to sign off on it. Maley’s statement was
accompanied by the vivarium data and correspondence from Cooley’s attempt to pay for
the two calves that had Wada valve pumps implanted).113
Based on all this accumulated information, the Committee came to two

official conclusions. They determined that, “Funds from the National Heart
Institute were used in the development of the artificial heart used in the
recent operation involving the patient Karp” and that “Guidelines for
projects involving human beings were not followed.”*114
9.7 Consequences
As if the Cooley-Liotta-Karp case were not enough, another nearly
incomprehensible breech of standard, ethical medical care took place at
Baylor less than three weeks after the Karp fiasco. Again, it was ballyhooed
in the press. On April 22, a faculty ophthalmologist named Conrad Moore
performed a total eye transplant.115 This was a preposterous, hopeless
operation that could not possibly succeed (Moore did not even bother
attempting to connect the donor and recipient optic nerves—not that it
would have worked). When questioned by reporters, Moore said that he had
done similar experiments in cats while a resident at New York Hospital.
However, the head of ophthalmology at that institution said that Moore had
never been a resident there, although he had done some postgraduate work
that did not involve live animals. It was another public relations disaster for
Baylor, and DeBakey was nonplussed at these back-to-back events.
It’s hard to believe that a professional man with any sense of ethics and any sense of knowledge
about the field would do things like this. It’s hard to explain, very hard to explain. It shook my
faith in human beings, I must say. It was very depressing. The medical profession is like any
other group of people; they have the same bell curve, with a very small percentage who are
really top notch in quality. Now unfortunately the general impression is that all doctors are top
notch in quality. The truth of the matter is that they’re made up of people like the people they
come from in that society, and in that society you’ve got people of all qualities and all characters
and all spectrum of ethics. Those that are very high in ethical character to those that are really
little or none, actually to the criminal areas. So in among the medical profession you have this
too . . . there still remains that segment that is very flexible, and whose avarice and greed bends
their ethics easily.117
On April 29, McCollum responded to Ted Cooper’s letter to DeBakey

from April 8. He stated that the Special Committee investigation had
confirmed that “Dr. Liotta’s salary, and to a substantial degree his research,
is supported by grant HE 05435.”118 McCollum also indicated that “The
protocol for the clinical application of this device was not reviewed by the
appropriate committee of this college because the clinical implantation was
performed without the knowledge of the Principal Investigator for the
above described grant, or any member of any pertinent committee, or any
executive, of this College.”119 The Chairman went on to note that his Board
was taking “stringent steps” to ensure that all protocols of Baylor and the
NHI would be followed in the future. As Cooper had requested, McCollum
attached the animal experimental data.120
Cooper answered on May 1, stating that it was his “interpretation” that an
artificial heart developed under the NHI grant had been used clinically at
Baylor without review by the appropriate committees. He then asked what
McCollum meant by “stringent steps” to keep something like this from
happening in the future.121
On May 9, McCollum replied, confirming that Cooper’s interpretation
was correct and outlining the steps the President and Board of Trustees had
in mind to prevent further cases such as the Karp artificial heart and Moore
eye transplant operations.
Faculty has recommended, and it is expected that the Board will approve, as a condition for
membership on the faculty of the Baylor College of Medicine that every new appointee and
every present faculty member must sign a statement agreeing to abide by the regulations and
bylaws of the College, including adherence to the guidelines for human experimentation
formulated by the National Institutes of Health.122
Every faculty member would receive a copy of these guidelines. The

procedure for performance of human experimentation would continue to
include submission of a protocol to the Committee on Research Involving
Human Beings for review and approval. “Failure of a faculty member to
observe either of these regulations for human experimentation will occasion
a consideration of disciplinary proceedings.”123 McCollum also noted that
Liotta had been suspended from all activities related to the artificial heart
research program as of April 16.
On May 14, Cooper responded, thanking McCollum for clarifying the
steps that Baylor had taken in ensuring compliance with human
experimentation guidelines. He also somewhat innocently asked for a copy
of the complete record of the full Special Committee investigation.124 He
was probably not expecting the answer he received, dated May 29.
Dear Dr. Cooper:
In reply to your letter of May 14, the Board of Trustees of Baylor College of Medicine has
directed me to advise you that the investigation of the Faculty Committee and its report, as well
as supporting documents, constitute confidential and privileged communications and were so
marked by that committee. For this reason, the board would not be authorized to release the
“complete record of the investigation” as requested by you.125
This, then, shut the outside door on the official Baylor investigation:
except for the inevitable leak or two, the findings were to be kept secret.
The only way for third-party observers to divine the committee’s
determinations would be by the school’s subsequent actions. Liotta, of
course, had already been separated from the artificial heart research project
and would soon be relieved of all duties at Baylor. In the big picture,
though, the obscure Liotta’s fate was not of much consequence. The
question of repercussions for the world-famous Denton Cooley was another
matter.
After the announcement of the investigation, which had so upset Cooley,
there was a noticeable shift in the tenor of the press coverage of the Karp
case and its aftermath. The initial media reception had been entirely
positive, focusing on the technological achievement. This was, after all,
only a few weeks before the Apollo 11 moon landing, and, in the popular
consciousness, it must have seemed at that moment that nothing was
beyond the capabilities of modern science. The prosthetic cardiac
replacement was touted as the third movement in a symphony of dramatic
breakthroughs in the treatment of heart disease: first came DeBakey’s left
ventricular assist device in 1966, then Barnard’s first transplant, and now
the total artificial heart. When it came to light that Baylor was investigating
the whole thing, under the prodding of the NHI, the press pivoted to this
new and dramatic angle. Headlines shifted from breathless trumpeting of an
enormous breakthrough (“Man Given Mechanical Heart in First Total
Replacement,” “Skokie Man Given First Artificial Heart”) to the terse
language of investigatory reporting (“Engineer Thought Heart for Animals,”
“More Facts Sought on Cooley Heart Case’’).126
Even as the media scrutiny shifted in tone from admiration to suspicion,
Cooley stood his ground. In public and private forums he consistently
emphasized his pre-eminence as a cardiac surgeon and the special status
this gave him to make decisions regarding his patient’s best interests,
independent of review boards. In a sense his peers’ input was of minimal
importance because, to Cooley, he had no peers. He also continued to
promote the idea that the Karp artificial heart was developed separately
from the Baylor model and that he was under no obligation to follow NIH
rules since he received no funding from the organization. In the controversy
that was to follow—for decades—these would remain the cornerstones of
his defense. At some settings Cooley tugged on the patriotic heartstrings, as
well, including saying that he was “distressed” that Barnard had performed
the first heart transplant in South Africa and that he wanted to make sure
that the first artificial heart was implanted in the United States (the thoughts
of the Argentine Liotta on the subject were not recorded).127
Although DeBakey had retracted Liotta’s original falsified abstract from
the meeting of the American Society for Artificial Internal Organs, Cooley
nevertheless went to the conference in Atlantic City to give a short
presentation on the Karp implantation. It was just two weeks after the case.
The full article was subsequently published in the November 1969 issue of
the American Journal of Cardiology.128 Meanwhile, DeBakey himself
wrote an article, “Orthotopic Cardiac Prosthesis: Preliminary Experiments
in Animals with Biventricular Artificial Heart,” which described the
legitimate development of the pump and control mechanisms under the HE-
05435 grant.129 This paper was published in the April–June 1969 issue of
the Cardiovascular Research Center Bulletin. After it appeared, DeBakey
took the extraordinary measure of having all nine co-authors sign a
statement on the title page, “This is a true and accurate account of the
development and testing of the orthotopic cardiac prosthesis.”130
There was, of course, much poisoned water already under the bridge by
mid-May, when Cooley composed an uncharacteristically plaintive
handwritten letter to DeBakey after the Special Committee’s two
conclusions were released to the public.
Sunday, May 18, 1969
10:00 PM
Dear Mike:
After returning from Waco tonight I had the opportunity to read the Trustees statement and
official verdict in the Sunday papers as related to the artificial heart. Until now I have not had
the opportunity to speak before anyone except the investigating committee (which did not even
keep a record of my testimony).* Previously and just after the Karp incident I requested
permission to discuss the situation with you before the newspapers made a “Roman Holiday” of
the controversy. Now that the report of the board has been delivered to the press again I ask that
we have a talk to determine what may yet be salvaged from the ruins of our relationship. This
becomes increasingly urgent each day since I must make some decisions regarding my own
future. Please ask your secretary to let me know what evening (preferably) you would be
available.
Yours truly,
Denton131
No reply was forthcoming, and, indeed, DeBakey’s next communication

with Cooley would not occur until September and then only in relation to
the latter’s resignation from the Baylor faculty.
In accordance with the promise made to Ted Cooper, on July 9,
McCollum and the Board of Trustees approved a new version of the
appointment form for faculty of the Baylor College of Medicine. By signing
this form, any new or retained faculty member agreed to abide by the rules
of the Committee on Research Involving Human Beings. These had been
revised to state unequivocally that all research at Baylor—whatever the
funding source—must adhere to the rules of the May 1, 1969, Public Health
Service document, “Protection of the Individual as a Research Subject.”132
A copy of the form was sent to Cooper, who in turn expressed his
ultimate satisfaction with the Baylor responses to all his inquiries. From an
NIH perspective, the matter was essentially closed, and most of the Texas
Medical Center breathed a collective sigh of relief: the main source of
research funds would continue unabated.
In the end, every member of the Baylor College of Medicine full-time
and clinical faculty, more than 1,350 individuals (including Liotta, before
he was dismissed) signed the form, except one: Denton Cooley.133
In June, Cooley submitted a research protocol to continue work on the
two-stage cardiac replacement. Although this had been approved by the St.
Luke’s and Texas Heart Institute research committees, Baylor’s Committee
on Research Involving Human Beings rejected it on June 25. DeBakey was
a member of this Committee.
In a remarkable twist to a story replete with them, DeBakey noted that
Cooley and Liotta also approached him about joining forces to continue
with the artificial heart project together: “(Liotta) came to see me after I had
dismissed him. He came to see me twice. Cooley sent him. He said that
Cooley had asked him to come and see me—wanted to meet with me. And
on this occasion what he proposed—what Cooley proposed—was that the
three of us join together in a clinical research program on the artificial
heart.”134 Obviously nothing of this sort was remotely possible at this point
in time.
The rejection of his protocol was the impetus for Cooley to decline his
reappointment to Baylor on September 2. In a formal letter to DeBakey, he
wrote,
The directive from the Board of Trustees requiring that all members of the faculty must agree to
accept the action of the committee on human experimentation at Baylor before proceeding with
clinical investigation places some members of the clinical faculty in an untenable position. For
those whose research is neither funded by the College of Medicine or by federal grants, this
responsibility should reside solely with the research committee of the hospital in which the
investigation will be done. The refusal of the committee at Baylor to accept or even consider the
protocol for continuation of research with the orthotopic cardiac prosthesis after acceptance by
the research committee of the St. Luke’s Episcopal Hospital and the Texas Heart Institute serves
as an example of the obstacles which in my opinion will prevent optimal inpatient care and
furtherance of clinical research.135
Cooley felt that he could not function under those rules and declined
reappointment. DeBakey’s September 11 reply was as well-considered as it
was crafted.
As a highly esteemed institution dedicated to medical education, research, and health care,
Baylor College of Medicine must discharge its responsibilities not only to science and the
scientific community, but to patients who come under the care of its faculty members and to
society at large. In so doing, it must establish and enforce standards of ethics and criteria for
medical research for all members of its faculty, whether full-time or clinical. To have dual
standards, one for full-time faculty and another, more relaxed, for clinical faculty, would
compromise not only the clinical faculty, but the College as well.
Nor can standards of human experimentation be altered, depending on the source of
supporting funds, as you suggest. Such inflexibility would grant a degree of autonomy to every
investigator who receives private research funds, which might render the school vulnerable to
criticism for conduct for which it has abdicated responsibility.136
DeBakey went on to skewer Cooley’s research protocol, noting that if his

proposal (as it appeared) was for a pump related to the Baylor artificial
heart, then the seven calf experiments had shown it was not ready for
human experimentation. Conversely, if a new pump were being considered,
then Cooley had included no animal experimental data from which to
justify clinical implementation.
It did not matter, DeBakey said, if affiliated hospital committees
approved research protocols. It was the parent institution’s ultimate
responsibility to the individual patient and to society at large to ensure
ethical and conscientious clinical investigations—Baylor’s human research
committee would never be a rubber stamp.
DeBakey then closed the letter, his last contact with Cooley for nearly
four decades.
It is regrettable that you find it impossible to comply with the requirements for human research
and medical ethics recommended by the faculty of the Baylor College of Medicine and accepted
by all similar creditable institutions.137
With Cooley’s departure from Baylor the saga of the artificial heart
seemed to have come to an end, but there were yet a few acts to be played
before the final curtain fell.
9.8 Aftermath
The public’s appetite for information about the case and the two superstar
surgeons whose enormous personas defined it was insatiable. Newspaper
stories fueled by strategic leaks of portions of the Special Committee’s
report continued to appear into the fall of 1969 and beyond. Nearly a year
after the Karp operation a talented Life magazine writer named Tommy
Thompson descended on the Texas Medical Center to compose what would
become a cover story—and the beginning of another controversy. His
article, which appeared in the April 1970 issue of the magazine, was a nuts-
and-bolts depiction of the day-to-day work lives of the two surgeons and
their evident rivalry. Thompson also covered the Karp case briefly,
managing to elicit from Cooley a remarkable confession:
Q: Did you use Dr. DeBakey’s heart?
A: Well, I guess, in effect, I took it.138
The aspect of Thompson’s article that stood the test of time even more
than Cooley’s confession, though, was the magazine’s cover: close-up
photos of the eyes of DeBakey and Cooley, peering above surgical masks.
The accompanying headline read, “A Bitter Feud: Two Great Surgeons at
War over the Human Heart.”139
Over the years that word, “feud,” became a source of consternation for
those in the DeBakey camp. To their way of thinking, such a word implied a
mutual and active enmity, and DeBakey was above such things. He had no
ill will toward Cooley because he did not think about him at all and only
rarely discussed the artificial heart case.
I didn’t pay much attention to the so-called competition on his part, because I thought he could
only gain from it, become a better surgeon by challenging himself. I’ve always had my own
competition that overshadows everything else; it’s not a competition with any other individual
and certainly not with Dr. Cooley—it’s a competition with myself. I am a perfectionist and I
must respond to and match up to my own challenges and my own demands upon myself. My
fight is and has always been within me.140
For his part, Cooley did not make an effort to hide his antipathy toward
his former Chief over the next decades. He rarely missed a chance to deflect
credit for an innovation away from DeBakey, and even popular press
profiles of the Texas Heart Institute star usually included references by him
or his underlings to attempts at outdoing DeBakey and his team. One
surgeon who visited the Institute remembered
It was almost incredible to see Cooley at work because he moved with such assurance and
speed. But it bothered me and others to listen to him, because he was constantly making
unfavorable comparisons—unnecessary ones—to DeBakey. Once he moved amazingly fast with
a continuous suture around the perimeter of an artificial valve that he was implanting in a child’s
heart. When he finished he looked up at the clock as if he had been running against some
personal deadline, and then he laughed and said, “the old man across the way can do this, too,
but it takes him three times as long.” I had watched DeBakey do the same operation, and it did
take longer, but it took longer because he was far more exacting and careful. He sewed the valve
in with interrupted sutures—40 separate sutures, each tied individually, so that if one or two
give way the valve will still hold firmly. Cooley’s continuous suture was much faster, but if it
gives way at any point, the whole thing will unravel and the patient will die. Remarks like
Cooley’s didn’t earn him any respect in my book.141
By the spring of 1969, the concept of in-house hospital committees with

oversight on human experimentation was certainly afoot in American
medicine—Baylor’s Committee on Research Involving Human Beings
being an early example. Such “Institutional Review Boards” are now
ubiquitous. The influence of the Karp case (with its widespread media
coverage) on their proliferation is debatable, but there can be no question
that the rationale for these committees—the avoidance of ad hoc human
research with questionable informed consent—is to avoid just such events.
In April 1971, Shirley Karp filed a law suit against Cooley, Liotta, Sam
Calvin, and St. Luke’s Episcopal Hospital.142 The complaint made several
allegations. Shirley claimed that she and her husband had not been
informed of the true nature of the artificial heart pump and that it had not
been adequately tested in animals. In effect, Haskell had been the subject of
human experimentation without his knowledge. Furthermore, it was alleged
that the Karps had been tricked into thinking that there was a human donor
available nearby and that Cooley had actually intended to implant the
artificial heart all along—the ventriculoplasty being a charade.
Cooley and members of his team defended their actions and described the
particulars of the case—albeit without shedding much light on Karp’s actual
clinical course. It was in this setting that Shirley described her husband as
having had his life-supporting tubes removed just long enough for
photographs to be taken.
By far the most remarkable aspect of this litigation involved the
subpoenaing of DeBakey as a witness for the plaintiff.
On the surface, as one of the world’s leading experts on artificial hearts
and a widely publicized rival of Cooley’s, DeBakey must have seemed the
perfect expert witness for the Karps’ case. At deposition, however, DeBakey
stated that he would render no medical opinion on the case or on
hypothetical questions arising from it. When the actual trial came, in June
1972, DeBakey’s testimony was taken in the judge’s chambers, with the
court reporter and all counsels present. The defendants argued that his
testimony in the courtroom “would be highly inflammatory and serve no
purpose except to introduce issues into the case before the jury that were
not properly before the court.”143 They need not have worried, as it turned
out: DeBakey simply refused to express any opinion about the case or the
artificial heart in general. The apparently relieved judge accepted this
without question and decided that DeBakey “had no evidence of any
probative value to present to the jury.”144 DeBakey was excused from
testifying in court, and his testimony in chambers was sealed. Shortly
afterward, the judge gave a directed verdict in favor of the defendants—in
essence stating that there was not enough evidence to consider trying the
case. The jury never heard it (Mrs. Karp lost on appeal, too).
Cooley retreated to the friendly confines of St. Luke’s and Texas
Children’s Hospitals, as well as his own Texas Heart Institute. No one
doubted that he regretted having to leave the Baylor College of Medicine
after more than 18 years on the faculty, but now he could pursue his own
best interests unfettered. In particular, the salary tithing to the Department
of Surgery was a thing of the past for Cooley, and he could keep as much of
the enormous income generated by his vast practice as he (and the
government) saw fit. In the months to come he would be censured by the
Harris County Medical Society, but that was for the old issue of publicity-
seeking and Cooley paid it little attention.145 Another censuring by the
American College of Surgeons was not as easy to ignore, but all it
ultimately amounted to was an embargo of his presentation of work at the
group’s annual Clinical Congress for a year. In reality, these were no more
than slaps on the wrist, and, in the public eye, Cooley’s reputation had
suffered very little. In the ensuing years he piloted the Texas Heart Institute
to dizzying heights in terms of clinical volume and prestige.*
The case of Haskell Karp and the artificial heart has by now generated
half a century’s worth of conflicting narrative, confused speculation, and
fanciful flummery. Much of the tale will remain forever cloaked in the fog
of time. Were the Karps really aware of what they were agreeing to? How
long and to what degree was Haskell conscious after the prosthetic pump
implantation? Why was DeBakey not compelled to testify in the
malpractice case? Perhaps most mysteriously, why did no member of the
artificial heart research team contact DeBakey about the impending human
implantation?
Some facts, however, are beyond dispute. In late December 1968, Denton
Cooley and Domingo Liotta entered into a relationship to finalize and
implant a prosthetic heart in a human being. Despite Cooley’s sometime
denials, the pump implanted in Haskell Karp on April 4, 1969, was, in fact,
built in the Baylor surgery research labs under the auspices of NHI grant
HE-05435. Wada prosthetic valves and a modified outflow tract were
incorporated at the suggestion of Cooley, but these were relatively minor
changes (and, since the attachment apparently compressed Karp’s superior
vena cava in a significantly deleterious fashion, this modification could not
have been much of an improvement). Michael DeBakey was the Principal
Investigator on the grant, but neither he nor the appropriate committees
were notified of these plans or their implementation. Karp lived 64 hours
with the artificial heart in place, but suffered organ system dysfunction
similar to that which plagued the calf experiments. He lived 33 hours with
Barbara Ewan’s heart before succumbing from bacterial pneumonia.
Aspects of the behavior of both Cooley and Liotta during this episode
defy understanding.
Liotta could not have failed to see that his work with Cooley on the
prosthetic heart pump outside the NHI grant was unethical and possibly
illegal. His submission of research that had not been performed was an
unforgivable breach of academic standards, and his removal of the pumps
from the Baylor lab was simple theft. Cooley’s assertion that the artificial
heart was developed separately from the NHI grant was demonstrably and
obviously false. His feigned ignorance of proper protocols for human
experimentation, and wholly unconvincing posture that the prosthetic pump
implantation was a spur-of-the-moment decision are equally unbecoming.
The careful arrangements that were made to have all of the pump
equipment and personnel on hand, not to mention the planned presence of
photographers and even the signing of specific consent forms, puncture that
artifice. His implanting the pump without a donor heart on the horizon,
given the results of the animal experiments, was reckless and almost
certainly doomed Karp. The notion that a donor organ was close by merely
deepens the intrigue: Why not wait to operate until it was at hand? It has so
far proved impossible to identify documentary evidence that Karp’s
condition had drastically worsened just prior to the attempted
ventriculoplasty, which was Cooley’s justification for proceeding with
surgery. When it was obvious that the artificial heart could only last a short
time, and since his stated purpose was to utilize such a device as a
“resuscitative pump” in bridging to transplant, why did Cooley wait until
the morning after the artificial heart surgery to make a national appeal for a
human heart donor?
After the Karp fiasco DeBakey removed his travel calendars from public
view. Never again would the whole Texas Medical Center know when he
was going out of town.
The pump itself now resides in the Smithsonian’s Museum of American
History, floating in a formalin-filled Lucite box on the shelf of a glass
cabinet. It rests in a locked room containing other artifacts of medical
history that are interesting enough to preserve but not to display. Its official
designation is “The Liotta-Cooley Artificial Heart.” The name is at once
both accurate and entirely wrong, which seems eminently fitting.
Notes
1. Boyer BD. Hope New Heart Corrects 10 Recent Cardiac Attacks. Chicago Sun-Times,
Saturday, April 5, 1969, 1.
2. Artificial Heart in Skokie Man (April 5, 1969). Chicago Sun-Times, 1.
3. Cooley DA, Liotta D, Hallman GL, Bloodwell RD, Leachman RD, Milam JD. Orthotopic
Cardiac Prosthesis for Two-Staged Cardiac Replacement. American Journal of Cardiology
1969;24(5):723–730.
4. Ibid.
5. Texas Plea Made for Heart Donor. (April 6, 1969). New York Times, 56.
6. Shirley Karp, Individually, Etc., v. Denton A. Cooley and Domingo S. Liotta, 493 F.2nd 408
(5th Cir. 1974).
7. Ibid.
8. Ibid.
9. Minetree H. Denton Cooley: The Career of a Great Heart Surgeon. New York: Harper Collins,
1973: 20.
10. Statement of Denton A. Cooley before Special Committee of Baylor College of Medicine,
April 12, 1969. DeBakey, Michael E. Michael E. DeBakey Archives. 1903–2010. Located in:
Archives and Modern Manuscripts Collection, History of Medicine Division, National Library
11. Statement of Gerald Maley before Special Committee of Baylor College of Medicine, April
11, 1969. DeBakey, Michael E. Michael E. DeBakey Archives. 1903–2010. Located in:
12. Statement of Domingo Liotta before Special Committee of Baylor College of Medicine, April
13. Statement of Louis Feldman before Special Committee of Baylor College of Medicine, April
14. Memo, M. E. DeBakey to H. Hoff, April 18, 1969. DeBakey, Michael E. Michael E. DeBakey
Archives. 1903–2010. Located in: Archives and Modern Manuscripts Collection, History of
Medicine Division, National Library of Medicine, Bethesda, MD; MS C 582. Series 3:7:39.
15. Ibid.
17. Interview, Don Schanche with Michael DeBakey, Houston, Texas, August 13, 1972. DeBakey,
18. Confidential and Privileged Report of Special Committee to the Board of Trustees of Baylor
College of Medicine, April 18, 1969. DeBakey, Michael E. Michael E. DeBakey Archives.
Division, National Library of Medicine, Bethesda, MD; MS C 582. Series 3:7:56.
19. DeBakey ME, Hall CW, Hellums JD, et al. Orthotopic Cardiac Prosthesis: Preliminary
Experiments in Animals with Biventricular Artificial Heart. Cardiovascular Research Center
Bulletin 1969;7(4):127–142.
23. Ibid.
Experiments.
26. Ibid.
28. Hallman GL, Messmer BJ, Elkadi A, et al. Clinical Experience with the Wada-Cutter Cardiac
Valve Prosthesis. Annals of Thoracic Surgery 1970;10(1):9–19.
29. Fox RC, Swazey JP. The Courage to Fail. Chicago: The University of Chicago Press, 1974:
163.
Experiments.
31. Ibid.
32. Letter H. R. Smith to M. E. DeBakey, April 8, 1969. DeBakey, Michael E. Michael E.
DeBakey Archives. 1903–2010. Located in: Archives and Modern Manuscripts Collection,
History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C 582.
Series 3:7:39.
Experiments.
39. Statement of William O’Bannon before Special Committee of Baylor College of Medicine,
40. Ibid.
41. Statement of J. David Hellums before Special Committee of Baylor College of Medicine,
43. Statement of Suzanne Anderson before Special Committee of Baylor College of Medicine,
44. Ibid.
45. Fox RC, Swazey JP. The Courage to Fail, 163.
47. Letter H. R. Smith to M. E. DeBakey, April 8, 1969. DeBakey, Michael E. Michael E.
Series 3:7:39.
48. Statement of Robert Bloodwell before Special Committee of Baylor College of Medicine,
50. Statement of Sam Calvin before Special Committee of Baylor College of Medicine, April 12,
1969. DeBakey, Michael E. Michael E. DeBakey Archives. 1903–2010. Located in: Archives
and Modern Manuscripts Collection, History of Medicine Division, National Library of
51. Ibid.
56. Shirley Karp. Cooley used the word “obligated” in his Statement.
Cardiac Prosthesis for Two-Staged Cardiac Replacement.
58. Kass M. Pioneer Surgery Only a Stopgap (April 5, 1969). Houston Post.
59. Shirley Karp. Cooley used the word “obligated” in his statement.
Cooley’s remarks, which were made at a seminar in Long Beach, California, on August 3,
1968, were widely quoted in the press.
64. Ibid.
65. Plea for a Heart – God-Given Heart. (April 5, 1969). Houston Chronicle, 1.
66. Ibid.
67. Preliminary Investigation—Committee on Human Research and Advisory Committee of NIH
Grant HE-05435, April 7–8, 1969. DeBakey, Michael E. Michael E. DeBakey Archives. 1903–
2010. Located in: Archives and Modern Manuscripts Collection, History of Medicine
68. Kass M. Pioneer Surgery Only a Stopgap (April 5, 1969). Houston Post.
69. Skokie’s Heart Patient Gets Many Offers of New One (April 7, 1969). Chicago Sun-Times, 66.
70. Ibid.
71. Fox RC, Swazey JP. The Courage to Fail, 152–153.
73. Letter R. O. Morgen to H. E. Hoff (n.d.). DeBakey, Michael E. Michael E. DeBakey Archives.
74. Ibid.
75. Ibid.
76. Ibid.
77. Account of Preliminary Investigation of Application of Baylor Heart Pump in Man. DeBakey,
78. Ibid.
79. Memorandum from Advisory Committee of NIH Grant HE-05435 to M. E. DeBakey, April 8,
81. T. Cooper letter to M. E. DeBakey, April 8, 1969. DeBakey, Michael E. Michael E. DeBakey
83. Full Transcript of DeBakey’s April 10 Report to Executive Committee of the Board of
Trustees, June 17, 1969. DeBakey, Michael E. Michael E. DeBakey Archives. 1903–2010.
Located in: Archives and Modern Manuscripts Collection, History of Medicine Division,
85. Ibid.
90. Statement of C. William Hall before Special Committee of Baylor College of Medicine, April
91. Statement of Polk Smith before Special Committee of Baylor College of Medicine, April 11,
93. Ibid.
94. Statement of Brantley Scott before Special Committee of Baylor College of Medicine, April
95. Cooley Fears “Witch-Hunt” in Mechanical-Heart Probe (April 11, 1969). The Baltimore Sun,
A1.
96. Statement of Denton Cooley before Special Committee of Baylor College of Medicine, April
97. Ibid.
98. Ibid.
99. Ibid.
100. Ibid.
101. Thompson T. The Year They Changed Hearts (September 17, 1971). Life.
102. Statement of Denton Cooley before Special Committee of Baylor College of Medicine, April
103. Ibid.
104. Ibid.
106. Letter D. A. Cooley to H. E. Hoff, April 21, 1969. DeBakey, Michael E. Michael E. DeBakey
107. Ibid.
108. Ibid.
109. Letter L. F. McCollum to T. Cooper, May 9, 1969. DeBakey, Michael E. Michael E. DeBakey
110. Telegram M. E. DeBakey to E. F. Bernstein and V. L. Gott, April 17, 1969. DeBakey, Michael
E. Michael E. DeBakey Archives. 1903–2010. Located in: Archives and Modern Manuscripts
Collection, History of Medicine Division, National Library of Medicine, Bethesda, MD; MS C
582. Series 3:7:59.
111. Memorandum M. E. DeBakey to H. E. Hoff, April 18, 1969.DeBakey, Michael E. Michael E.
Series 3:7:59.
113. Ibid.
114. Fox RC, Swazey JP. The Courage to Fail, 348–349.
115. Letter W. G. Spencer to H. E. Hoff, April 19, 1969. DeBakey, Michael E. Michael E. DeBakey
117. Letter L. F. McCollum to T. Cooper, April 29, 1969. DeBakey, Michael E. Michael E.
Series 3:7:38.
118. Ibid.
119. Ibid.
120. Letter T. Cooper to L. F. McCollum, May 1, 1969. DeBakey, Michael E. Michael E. DeBakey
121. Letter L. F. McCollum to T. Cooper, May 9, 1969. DeBakey, Michael E. Michael E. DeBakey
122. Ibid.
123. Letter T. Cooper to L. F. McCollum, May 14, 1969. DeBakey, Michael E. Michael E.
Series 3:7:38.
124. Letter L. F. McCollum to T. Cooper, May 29, 1969. DeBakey, Michael E. Michael E.
Series 3:7:38.
125. Man Given Mechanical Heart in First Total Replacement (April 5, 1969). Houston Post.
Skokie Man Given First Artificial Heart (April 5, 1969). Chicago Tribune. Engineer Thought
Heart for Animals (April 9, 1969). Houston Chronicle. More Facts Sought on Cooley Heart
Case (May 7, 1969). Houston Chronicle.
126. Cooley Sees a Permanent “Built-In” Heart (April 25, 1969). New York Post.
128. DeBakey ME, Hall CW, Hellums JD, et al. ##Orthotopic Cardiac Prosthesis: Preliminary
Experiments.
130. Letter D. A. Cooley to M. E. DeBakey, May 18, 1969. DeBakey, Michael E. Michael E.
Series 3:7:39.
132. Letter M. E. DeBakey to D. A. Cooley, September 11, 1969. DeBakey, Michael E. Michael E.
Series 3:7:39.
133. Letter D. A. Cooley to M. E. DeBakey, September 2, 1969. DeBakey, Michael E. Michael E.
Series 3:7:39.
134. Letter M. E. DeBakey to D. A. Cooley, September 11, 1969. DeBakey, Michael E. Michael E.
Series 3:7:39.
135. Ibid.
136. Thompson T. The Texas Tornado vs. Dr. Wonderful (April 10, 1970). Life, 74.
137. Life. April 10, 1970.
139. Ibid.
140. Shirley Karp.
142. Ibid.
143. Dr. Denton Cooley Censured, Honored (December 9, 1969). Houston Chronicle. The honor
was a Samuel L. Seigler Foundation Award given in New York City for Cooley’s “courage,
integrity, and compassion for human life.”
*
Liotta and Hall sent memos to DeBakey on August 29 and September 17. Liotta sent two more,
on October 28 and December 18. These covered such issues as the type of pump to be used, studies
on valves, and methods of attaching the artificial heart to the stumps of blood vessels remaining after
removal of the native organ.18
*
Maness had previously been in the Rice Bioengineering Department along with O’Bannon
before leaving to lead this company.
*
A possible donor had reportedly been available on Friday. This was a woman from Cleveland,
Texas, who had suffered central nervous system injury during a stillbirth. Evidently she had gone into
irreversible cardiac arrest before she could reach St. Luke’s and her heart could not be utilized.68
*
Arnold Schwartz, who was interviewed for this book, stated that Cooley was interviewed by a
three-person subcommittee consisting of Joseph Merrill, Hebbel Hoff, and Schwartz. Furthermore,
Schwartz indicated that he wrote up the transcript himself and delivered it to DeBakey.98
*
In one stranger-than-fiction instance Cooley replaced a patient’s heart with one from a ram.
When this immediately failed, a Keystone Cops tableau ensued as an attempt was made to harvest
another heart from an understandably reluctant pig. Needless to say, these efforts were
unsuccessful.102 In another instance of some renown, Cooley was consulted on a case of presumed
aortic aneurysm. He doubted the provisional diagnosis and offered that “if that is an aneurysm I will
eat it.” DeBakey subsequently operated on the patient, confirming the diagnosis. The aneurysm was
resected and stored in saline solution, rather than the usual—but toxic—formalin. Cooley then made
a production of eating the aneurysm, including a candlelit dining table set up in the operating suite,
complete with a scrub nurse as waitress. Whether what he ate was actually the aneurysm was
debated.
*
William Spencer, Professor and Chairman of the Department of Rehabilitation and a member of
the Special Committee, sent a separate letter to Hoff on April 19, which was added to the
documentation. It was Spencer’s contention that a third basic finding should have been included in
the Committee’s report: that DeBakey was unaware of the intent to use the artificial heart clinically
and should bear no responsibility for the failure to follow guidelines.116
*
Of course the Special Committee had recorded and transcribed Colley’s interview, and DeBakey
was in possession of the transcript.
*
Cooley hired Liotta after his dismissal from Baylor, but this only lasted until 1971. DeBakey
later related, “I’m told all of this, because I don’t know except through second-hand accounts . . .
they couldn’t find anything he could do, so they finally had to get rid of him.”146
10
Houston: 1970–1989
The place of fame and elegy supply,

Th’ applause of list’ning senates to command.
10.1 Super Center

With the arrival of the new decade, the exuberant but scientifically callow
wave of heart transplants that began with Barnard’s bang in Cape Town
ended with a worldwide whimper. The overall mortality figures were
already in the 80% range and only getting worse. Just 2 of the 30 patients
transplanted in Houston were still alive by early 1970 (both were
DeBakey’s patients—his first heart transplant, William Carroll, and a
vivacious young Yugoslavian named Duson Vlaco*).1 Although the
operation itself was not a technical obstacle, the problems of rejection and
donor availability were far thornier. As Stanford’s Shumway noted, “It’s not
a surgical business, primarily. If it were merely a surgical exercise, they all
would have survived . . . Cooley said, ‘The prescription for success in heart
transplants is cut well, tie well, get well.’ That’s naïveté. The problems
come after surgery. They’re not surgical problems.”2 Shumway’s group
continued working on the issues, but nearly every other heart transplant
program came to a standstill.
The writer Tommy Thompson, who had penned the Life magazine cover
story on the purported rivalry between Cooley and DeBakey, reappeared on
the scene at the Texas Medical Center not long afterward. He was
researching an article for the magazine on the spectacular rise and fall of the
heart transplant operation. Along the way this idea turned into a full-fledged
book, and the topic expanded. Thompson contacted DeBakey by letter to
announce this and try to arrange an interview. If there had been any mystery
as to how DeBakey felt about the previous “Feud” article, Thompson’s
letter clarified the issue, closing with “I regret deeply the ill feelings you
had over the Life article. I hope this book can in some way make it up to
you.”3
It is unlikely that the book that emerged late the following year, Hearts:
Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac
Frontier, did much to reverse those ill feelings. Thompson’s transom had
widened to include the entirety of the cardiac surgery services of Methodist,
St. Luke’s, and Texas Children’s Hospitals as a backdrop for the interplay of
the dueling DeBakey and Cooley. Although both were depicted as larger-
than-life, modern-day Titans, neither surgeon emerged as especially heroic.
The writing was skillful, however, and Hearts found a fairly wide audience
on its release. Just before the book was published, Thompson contacted
DeBakey again.
I want you to read it carefully and absorb the entire book before making any quick judgments. It
is a very carefully constructed book and I believe—in fact, I am positive—that you emerge as a
powerful, distinguished figure. . . . There may be individual sentences or ideas which you do not
like, but if you take the book’s cumulative effect, I believe you will realize it is a heartfelt
document.
I like you very much, Mike; in fact, in an age of no heroes, you appeal to my sense of drama
and accomplishment. I wish you many more years of good work and fine health. We need you
around.4
If DeBakey responded to this missive, a copy of his answer has not

survived.
Two other talented writers, Selma and Lois DeBakey, left their jobs in
New Orleans at the Ochsner Clinic and Tulane University to come to
Houston in 1968. Lois, who had a master’s degree as well as a PhD in
English from Tulane, was given a faculty position at Baylor (Professor of
Scientific Communications). Selma, with only a bachelor’s degree, suffered
through a protracted period without a similar title. This was especially
irksome since she had been Director of the Department of Medical
Communications at the Ochsner Clinic. DeBakey rectified this in 1972
(Selma’s title, also Professor of Scientific Communications, was backdated
to 1968).6
The DeBakey sisters were well on their way to a particular fame of their
own—as unofficial final arbiters of taste and style in the language of
medical communication. They especially railed against the unnecessary use
of obfuscating jargon and byzantine grammar—what they called
“Medicant.”7 Their symposium on this topic would become one of the most
popular conferences at the annual Clinical Congress of the American
College of Surgeons. The highlights of these presentations were
entertaining examples of this imprecise and awkward language (“The
patient’s pelvis was fractured by being thrown from an automobile,” “The
group was composed of half men, half women”8) often depicted in
humorous cartoons. The assembled surgeons laughed heartily, but all lived
in fear of becoming a part of the presentation (although it would not have
mattered much: Lois and Selma kept the identities of the language offenders
secret).
The sisters’ office was near DeBakey’s at Methodist Hospital, and they
“worked with him daily, supporting his vast and varied professional
activities across a broad range.”9 They became well known as fierce
defenders of their brother in print, and their command of language made
them formidable adversaries for any who offered criticism of him,
particularly if it came in a form that was not grammatically pristine.
Shiker DeBakey (who later in life sometimes spelled his first name
Shaker) moved to Houston at around the same time as the sisters. He lived
with Selena on Travis Street, even closer to the Texas Medical Center than
his famous son.10 Mr. DeBakey died there while occupied with his beloved
gardening on June 2, 1970. He was 85. Shiker was buried alongside
Raheeja in the Hope Mausoleum in New Orleans.11
The total artificial heart research at Baylor continued, now under the
laboratory leadership of a researcher named John H. Kennedy. The same
issues remained, of course—damage to the blood cells, end-organ injury,
etc. All the publicity of the Karp case and its spectacular fallout did nothing
to diminish these. Further modifications seemed not to change the
experimental outcomes significantly. The team summarized its frustrating
lack of progress in 1973.
As one reviews out two years’ observation of the fate of animals following implantation of an
artificial heart device, it is, of course, disheartening that previously healthy animals are rendered
moribund by one or another variation of a pneumatically powered orthotopic cardiac prosthesis,
an experience shared by all investigators to date.12
On the other hand, the time invested in the program was paying
dividends, especially in the field of temporary support—the left ventricular
assist device (LVAD).
It’s going to take time to finally resolve all of these problems, but you’ve got to keep working at
it. You will never resolve them otherwise. It’s the only way to do it. In the meantime, there are a
number of spin-offs from it. We also are better equipped to do mechanical assistance. We
understand that better, we have better techniques for that. So that that’s doing a lot better.13
For many patients, replacement of their ailing heart was no longer the
best option, anyway. Those with segmental occlusion or narrowing of their
coronary arteries were being recommended in mounting numbers to
undergo the new coronary bypass operation, and the early returns were
extremely promising. As a result, cardiac surgery—until recently devoted
primarily to congenital lesions or acquired disorders of the valves—was
now pivoting dramatically toward the treatment of coronary artery disease.
By 1975, in fact, surgeons at the Methodist Hospital had performed 10,000
instances of the new procedure, with excellent results (the report of the first
successful coronary bypass, performed by Edward Garrett and Jimmy
Howell, was published in the Journal of the American Medical Association
in 1973).14 There was some resistance from the more conservative
cardiologists, just as there had been from other internists when the now
well-established operations of aortic aneurysm repair and carotid
endarterectomy had been introduced, but this was diminishing with each
newly asymptomatic angina patient.*
Naturally, this new operation was also being embraced with gusto by
Cooley and the other denizens of the Texas Heart Institute. Combined with
their already-busy practices in congenital and acquired open-heart surgery,
the surgeons’ case volumes skyrocketed. As a result, the demand for the
cardiopulmonary bypass teams reached a new zenith: the Baylor pump team
performed 303 cases in 1961, 203 of these at St. Luke’s and Texas
Children’s Hospitals. By 1968, this number had increased to 1,295 in total,
899 at St. Luke’s and Texas Children’s.†15
There was only one problem: the pump technicians were employees of
Baylor.
St. Luke’s owned its own pumps and provided the necessary supplies, but
the technicians themselves came from the College of Medicine, with which
Cooley and his compatriots were now most emphatically (and publicly) not
affiliated. In the initial chaos and confusion after the resignations, no
onehad paid much attention to this fact, but, by October 1969, DeBakey
was aware. At the time, he was in the midst of attempting to make the pump
teams financially self-sufficient, and the fact that Cooley’s team was still
drawing on this Baylor resource without compensation certainly stuck in his
craw. On October 6, 1969, DeBakey sent a letter to the St. Luke’s
administrator, Newell France.
Dear Mr. France:
For the past several years, Baylor College of Medicine has supplied a vital service to St. Luke’s
-Texas Children’s Hospitals by providing the services of the Baylor Pump Team for use in
cardiovascular surgery . . . enabling St. Luke’s Hospital to realize approximately $300,000
expense free income over the past several years.
At the present time, the Pump Team is supplying it services to four of the Houston area
hospitals. It is the desire of Baylor College of Medicine to continue . . . with the exception that
each of the hospitals will be charged a specific amount per case.
Baylor College of Medicine has not received any income from the staff in cardiovascular
surgery at St. Luke’s-Texas Children’s Hospitals since July 1, 1969. In considering this, our
proposal . . . for immediate continuing services of the pump team is as follows: St. Luke’s-Texas
Children’s Hospital pay to Baylor College of Medicine retroactive to July 1, 1969 and on a
continuing basis, the sum of $100 per pump case . . .17
The retroactive aspect of DeBakey’s proposal meant that St. Luke’s-

Texas Children’s owed Baylor $22,500.18
Despite this letter, nothing happened. St. Luke’s-Texas Children’s
Hospitals did not pay the fee, retroactively or going forward, and Baylor
continued to supply the pump team. This strange situation persisted until
November 1970, when Cooley telephoned the veteran pump team leader
Mary Martin at home to say that her services would no longer be needed;
presumably his hospitals had hired their own crews. St. Luke’s-Texas
Children’s Hospitals never reimbursed Baylor College of Medicine for use
of the cardiopulmonary bypass personnel, paying only $1650 for unrelated
equipment.19
The fundamental underlying cause of coronary artery disease—and all
arterial occlusive disease—was atherosclerosis, a topic never far from the
conscious thoughts of the President of the Baylor College of Medicine. The
Cardiovascular Research and the Lipid Research Centers at Baylor had
been founded (and funded) in the early 1960s with the acknowledgment that
elucidation of the causes of this great scourge were their primary raisons
d’être. DeBakey and the other physician-scientists at the school were
always on the lookout for talented researchers to pursue this goal.
One of the rising stars in research of this kind in the late 1960s was
Antonio Gotto, Jr. A former Rhodes Scholar, Gotto was a graduate of the
Vanderbilt University School of Medicine and the Massachusetts General
Hospital Internal Medicine residency program.20 At this time, he was
making his name as a young researcher doing outstanding investigative
work into cholesterol and lipoproteins at the National Institutes of Health
(NIH). Baylor had been pursuing Gotto since 1968, mainly in the person of
Joseph Merrill, the Associate Dean for Scientific Affairs (subsequently
Executive Vice President of the College) whom DeBakey had also recruited
from the NIH. Gotto and Merrill had been acquainted when the two had
both been at Vanderbilt. This connection was enough to spark interest but
not a commitment; when Gotto actually visited Baylor in 1969, it was
during the tumultuous period when Internal Medicine, along with several
other departments, had no chair.*
By mid-1970, though, things had changed. Under DeBakey, Baylor was
in much better shape by any measurable criteria. The school’s financial
status was stabilizing, and the academic Department Chairs were filling up
with talented and ambitious individuals. DeBakey had a philosophy for
building a first-rate academic medical school, and he applied it with vigor:
“I think you should put your money where the track record shows that it
works best—in people who pursue excellence in the field, can innovate, and
do good research. Concentrate on excellence. Concentrate on innovation.
Concentrate on making advances and you will get recognition, and you will
get patients, no matter what.”21 During this period, DeBakey brought in an
old friend, Eugene Stead of Duke University, to spend a sabbatical year in
Houston as Visiting Professor in the Internal Medicine Department. The
underlying reason for Stead’s presence was to recruit faculty and help build
the department. In this respect, DeBakey later said, he “did a tremendous
job.”22
After an impromptu hotel room interview with DeBakey in Washington,
D.C., Gotto accepted a position in the Department of Internal Medicine. He
then turned his focus to obtaining grants for his proposed research projects.*
These efforts proved successful, allowing Gotto to establish new research
centers at Baylor in atherosclerosis and lipids. A year later, the old
Cardiovascular Research Center application was up for renewal, and,
impressed at his facile handling of both the grant processes and the research
itself, DeBakey put Gotto in charge of the ultimately successful effort. This
was just the beginning.
In 1974, the NIH announced a competition for National Research and
Demonstration Centers. There would be three in total, one to be focused on
the heart and blood vessels, one on blood itself, and the third on pulmonary
diseases. Under Gotto and DeBakey’s leadership, Baylor was awarded the
Center for Heart and Blood Vessel Research. Together with the existing
research centers, this comprised what the investigators termed a “Super
Center.” As Gotto observed,
The National Research and Demonstration Center combined, within one center, groups of
investigators studying basic and clinical aspects of cardiovascular disease and groups carrying
out educational projects geared toward physicians and the public. The demonstration projects
allowed us to study the translation of cardiovascular knowledge into community applications.†24
10.2 Reformation
Another individual DeBakey helped recruit to Baylor from the NIH a few
years earlier also had lasting impact on the school. William T. Butler came
on board in 1966, to lead a new Microbiology and Immunology
Department. He quickly became known as a capable and affable member of
the faculty. When the heart transplant program was initiated, Butler’s
expertise in immunologic matters came into prominence. In 1973, when
Merrill failed to see eye-to-eye with Methodist Hospital on several matters,
Butler assumed his administrative role and soon displayed a particular
aptitude for the work. In a few years he would rise to full leadership
positions.
Other significant administrative changes were afoot at the new school,
also. At long last, the recommendation from the days of the Blalock and
Stander consultations actually came to fruition, at least at Methodist
Hospital. In 1970, the chairs of the academic departments of the clinical
specialties at Baylor became (for the most part) officially the chiefs of the
corresponding services at Methodist also.*
The medical school also truncated the curriculum significantly, to 34
months. DeBakey had long advocated for a contraction of the period of
education and training for doctors. In fact, he even had a plan for
prospective physicians to begin their medical—and, in some cases, even
specialty—instruction immediately out of high school. This would entail a
sort of combination of college and medical school. The intent was to
achieve a broad-based liberal arts education that also incorporated the
“basic sciences” that generally occupied the first two years of medical
school. In this plan, the typical 12 years of instruction required to produce,
for example, a competent surgeon (four years of college, four of medical
school, and four of residency) could be compressed into eight (four years of
undergraduate/medical school and four years of residency). Unsurprisingly,
DeBakey generally encountered stiff resistance to this plan, despite the
obvious advantages it promised of increasing the number of trained
physicians while decreasing the cost of their training. The education
establishment at every one of these levels balked at the idea; DeBakey
described them as “reactionary.”26
On the other hand, the response of the Texas state legislature to this new
entity, the Baylor College of Medicine, turned out to be a positive one—in
due time. There were some challenges at first, mainly from senior
lawmakers who found it difficult to conceive that the Baylor medical school
was somehow no longer under the control, or at least influence, of the
Baptists. Even if it were independent and nonsectarian, it was still a private
institution, so why should the school receive public funds?
The answer to this question was that Baylor could help alleviate the
shortage of physicians in Texas and in the quickest and least expensive
manner. By doubling the number of medical students per class, which
actually occurred at Baylor in 1972, it was as if an entire new medical
school had appeared in Texas, conjured out of the ether.
By March 1973, when DeBakey appeared before the legislature to solicit
further funding, the benefits of supporting Baylor College of Medicine were
abundantly clear to the legislators. Some of the representatives offered such
ebullient observations as, “This program has probably saved the state 10
times what it would have cost to build a new medical school,” and “You
have far exceeded anything you have promised and done more than any
other medical school. You have converted me.”27
Hand in hand with DeBakey’s concept of updating the undergraduate and
medical school experience was a long-considered plan to increase the
number of minorities in the medical profession. At this point in time,
several medical schools, including Johns Hopkins and Duke, were
attempting to accomplish this by including minority students in their
medical school classes. These efforts met with mixed results, however.
DeBakey believed that to be successful, the emphasis on recruiting
minorities should begin earlier in their academic lives.
As far as minorities are concerned, I think the basic problem there is not opportunities of
minorities, it’s to start earlier: preparing minorities for the medical schools by getting, them, in
grammar school and high school, to be interested in health activities and interested in careers in
medicine and working towards it.28
Beginning in 1969, several dozen college students, mostly women and

minorities, spent the summer at the Baylor College of Medicine in a Work
and Study Program. They observed and, to a limited degree, took part in
medical research and clinical activities. The stated goal of this program was
“to increase the number of ethnic minorities and women in medicine and
thereby to improve the quality of health care available to America’s
disadvantaged.”29 (A DeBakey summer program continues at Baylor to this
day).
From interacting with these students, DeBakey began to formulate the
idea for an entire high school focused on premedical education, with a
particular emphasis on (although not exclusively for) minorities.
There’s where to get them. I talked to them and urged them. I said, “Here’s a great opportunity
for you. You’ve got a wonderful opportunity for a career in medicine and I hope you go on now
and plan to study medicine.” And it really is a good response for me because they are telling me
that as a consequence of this experience they are going to study medicine.30
The idea crystallized in 1972, in the form of the High School for Health
Professions, a joint venture between the Baylor College of Medicine and
the Houston Independent School District. The first class was comprised of
45 students, all entering in the 10th grade. Classes were held at Baylor until
a dedicated building was completed. This was the first institution of its kind
—a “magnet” school for the health sciences—in the nation.31
10.3 A Raindrop Hits the Ocean

In January 1972, DeBakey travelled to Acapulco for a medical conference.
Diana accompanied him. As was frequently the custom on such junkets, in
the evenings the couple enjoyed lengthy meals and much conversation late
into the night. As they were returning to Houston, Diana complained of an
upset stomach. Although he suspected she was suffering from a
gastrointestinal virus, DeBakey had her admitted to Methodist Hospital for
observation and testing. DeBakey also knew that she was harboring
coronary artery disease and had even had a small myocardial infarction in
Bogota while traveling to visit her son Michael in Peru.32 This condition
was not considered amenable to surgical intervention, however.
At 8:30 on the morning of Friday, February 11, DeBakey was summoned
from the operating room to Diana’s bed on the 7th floor. This was a stat—
emergency—call and, for once, the operation in which he was engaged
would have to wait.
DeBakey ran up the five flights of stairs to Diana’s floor and sped into
her room. She was surrounded by physicians who had responded to the
Code Blue call over Methodist’s public address system. Soon George Noon
arrived, with the cardiologist Ed Dennis. They all knew that it was too late;
there was nothing any of them could do—Diana was gone. She was 62.33
The other physicians and caregivers shuffled silently out of the room.
DeBakey stood motionless at the foot of the bed, clad in his powder blue
surgical scrubs and cap, weeping unabashedly.
In the days to come, the Houston papers published numerous glowing
stories about Diana DeBakey, tracing her life through 35 years of marriage
to her illustrious husband. The focus of these articles, though, was
invariably on Diana’s many kindnesses toward her husband’s patients and
their families, particularly those from foreign countries who had the anxiety
of their often-desperate conditions heightened by language and cultural
barriers.
His patients came to the Texas Medical Center from all parts of the world, and Diana DeBakey
became their Houston friend. She always visited her husband’s heart patients in the hospital,
taking to those from abroad delicacies from their home countries and inviting their worried
relatives to her home for tea. Traditionally on Thanksgiving she had new medical students at
Baylor to dinner. She liked to say her only talent was for Creole cooking. Once, when she had
had several foreign doctors and students to dinner, each privately thanked her for having served
his national dish—rice. Diana DeBakey was warm, charming, generous and a delightful
raconteuse. Although she had entertained and been entertained by presidents, movie stars, and
kings, she was always available to the children on her block. Her death last week came as a
great loss to her family and friends, but she will be missed by friends and neighbors in a
worldwide community of her own making.34
After a ceremony at Palmer Memorial Episcopal Church, Diana was
buried in Houston’s Memorial Oaks Cemetery.35
Several months later, when he was asked to give his thoughts on his late
wife, DeBakey remembered a trip they had made together to India, many
years before.
Once I went to Bombay as visiting professor and Diana went with me. We met Santha Rama
Rau, the India-born writer who lives in New Orleans, at a garden party. Diana had been reading
about the Hindu religion and so had I, but I had trouble understanding the subtle spiritual
nuances of it. So I asked Santha Rama Rau to help me understand. “There is only one way to
understand,” she said. “You have to be a Hindu.” But I wanted at least some understanding, so I
asked her about a fundamental concept, the question of mortality and immortality. It is not
difficult to understand the life-after-death concept of Christianity and the concepts of heaven
and hell, I said to her. They follow death. What is the Hindu concept?
“The closest I can come to answering you is to ask you this question,” she said to us. “What
happens to a drop of water, a raindrop, when it hits the ocean?”
I’m afraid I still don’t understand.
I think Diana did.36
A few days after the funeral, a distraught DeBakey contacted Princess

Lilian.
He immediately came to me. I have my hunting lodge in Austria and he called me saying she
had died, and I said, “Michael, what can I do?” He said, “May I come?” which touched me very
much, because that was the greatest proof of friendship. And he came straight from there, landed
in Munich and I went to fetch him in my car and when I saw him getting out of the plane, I was
horrified. The man was broken. He had lasted a few days in his work but he was broken.
Literally broken. So I gave him what I could give: the mountains, solitude, sleep.37
DeBakey took what solace he could from the beautifully isolated and
peaceful setting, near the Tyrolean village of Hinterriss in the Austrian Alps.
After three days, he left for a conference in Japan.
The house on Cherokee was empty now—the four boys having long
since moved out—so when he was in Houston, DeBakey spent many nights
in his office. Naturally the presence of his sisters close by was a blessing,
and they—as well as his sons—did their best to ease his loneliness and
depression.* As he had done since their arrival in Houston four years before,
DeBakey stopped by the sisters’ home after hours or on the weekends to
play songs from a distant era on the piano and enjoy some of their mother’s
Lebanese and Cajun dishes.
To keep him company, his son Barry moved into the house for a short
time, along with his wife. This only created more tension, however, and did
not last long.38
The salve for all things in the life of Michael DeBakey was, of course,
work. In the wake of Diana’s death he threw himself into this with even
greater commitment, if that was possible.
A surviving OR schedule from the unremarkable date of Tuesday, March
26, 1974, gives some idea of the magnitude of surgical responsibility
DeBakey shouldered at the time. Even with the knowledge that his
assistance by this time was both numerous and expert, the workload is
prodigious.
Room 1
667 CM Right popliteal aneurysm
202 VM Insertion epicardial pacemaker
670B SP Aneurysm of abdominal aorta
665 MP Secondary wound closure
FICU MD Left above-knee amputation
Room 2
612D GM Left carotid endarterectomy
220 HS Aorto-right and left anterior descending coronary artery bypass.
645A OM Aneurysm abdominal aorta
603B AS Aneurysm abdominal aorta
Room 3
612A JS Aorto-right and left anterior descending coronary artery bypass.
646B CF Aorto-left anterior descending, and circumflex coronary artery bypass.
227A FM Aorto-right, left anterior descending, and circumflex coronary artery bypass.
Room 4
206A SB Aorto-right, left anterior descending, and circumflex coronary artery bypass.
626 SN Mitral valve replacement
629A RB Aorto-left anterior descending coronary artery bypass.
Arteriograms
217 HD Translumbar aortagram and bilateral femoral arteriograms
251A JC Bilateral carotid and bilateral subclavian and right femoral arteriograms
In addition to his never-ending clinical responsibilities and ongoing

research leadership, DeBakey took a special interest in this era in
establishing and maintaining a liaison with the leaders in medical science
among America’s Cold War adversaries, the USSR and the People’s
Republic of China. In so doing, he found a kindred spirit in the most
unlikely of places.
10.4 Strange Bedfellows
DeBakey travelled to the USSR in July 1972, to attend an international
conference and, in the parlance of a later era, “network” with his Russian
friends. This was his fifth trip to the Soviet Union. Détente was in the air:
President Nixon had just visited Soviet Premier Leonid Brezhnev in
Moscow a few weeks earlier—the first American President to venture into
that country. The historic presidential visit had yielded a number of new
agreements related to the limitation of nuclear weapons, easing restrictions
on trade, and fostering scientific cooperation. Naturally the physicians were
particularly intrigued by the latter progress—which included specific
initiatives on joint research into heart disease and cancer. Long-time
Democrat DeBakey took the bold step of congratulating Nixon after he
returned to Houston.
July 13, 1972
Dear Mr. President:
I have just returned from Russia, where I attended an international congress and had an
opportunity to meet again with some of my medical friends in the Ministry of Health. With
immense pride I heard them tell me of the highly favorable impression you made on the Russian
people during your recent visit there. You will be pleased to know that the collaborative
programs you initiated in heart and cancer research were received with great enthusiasm by the
physicians and scientists in the Ministry of Health. . . . I am convinced that they are extremely
anxious to work with us closely on a friendly and mutually productive basis. Your efforts to
encourage these relationships have been highly rewarding. I am simply writing to express again
my sincere and grateful appreciation for the inspiring leadership you are providing in these
notable endeavors for can only lead to better and more peaceful relations between the Nations.
Sincerely,
Michael E. DeBakey, M.D.39
Nixon received the letter and responded:

July 25, 1972
Dear Dr. DeBakey
Your gracious letter of July 13 recently crossed my desk. Needless to say, I was greatly
encouraged to learn from you that the future looks very bright for the joint American-Soviet
cancer and heart research programs. Nothing could have a more lasting impact on international
understanding than the success of these bilateral medical efforts, and I deeply appreciate your
thoughts on this and giving me your initial observations about these efforts.
With every good wish,
Sincerely,
Richard M. Nixon40
DeBakey and Nixon were about as strange bedfellows as politics was
likely to make (DeBakey had been on the Administrations “enemies” list,
apparently due to his criticisms of cutbacks in research funding).*41
Nevertheless, the two continued their correspondence through the
President’s second term, until the spiraling fortunes of the administration
rendered the relationship moot. DeBakey even visited Nixon at the
presidential retreat in San Clemente, California in the summer of 1973. The
main thrust of their discussions remained the exchange of medical scientific
research in the context of easing Cold War tensions.*
To this end, DeBakey’s landmark 13-day trip to China, in February 197,3
held the promise of special significance. Nixon’s own historic visit to the
People’s Republic—a watershed moment in the annals of the late twentieth
century—had been just about a year before, and the fact that the second
visit happened at all was much a product of the first. DeBakey had planned
a trip to China in the early 1960s, but the State Department had forbidden it.
In this new era, he was invited as a guest of the Minister of Health and the
China Medical Association, as well as a quasi-private group in the United
States called the China-America Relations Society.44
DeBakey made the trip to China as part of a contingent of Americans,
some of whom were also in the medical field. The Chinese government
tightly controlled their itinerary. The cities they visited were Peking
(Beijing), Nanking (Nanjing), and Shanghai.45
In this period immediately following the devastating Cultural Revolution,
Maoist China presented conflicting images for the visitors, although
nothing of the persecutions was shown them. Nevertheless, the beauty of
the Forbidden City contrasted starkly with the utilitarian drabness of the
modern architecture, as well as the uniform clothing. Their hosts were,
without exception, gracious and pleasant, if not necessarily well-informed.
This was particularly the case with regard to the healthcare system, which
naturally was a topic of great interest to DeBakey.
The Americans were taken to some communal farms in the countryside,
where the famous “barefoot doctors” practiced their unique brand of
traditional Chinese medicine combined with some Western influences.
DeBakey was surprised to learn that these practitioners, who all wore shoes
(the affectionate name came from their willingness to go into the rice
paddies to see patients), sometimes even did surgical procedures as
involved as appendectomies.46
Typically, though, the barefoot doctors referred more complex cases to
well-staffed and -equipped metropolitan hospitals. It was here that DeBakey
and the other visitors witnessed major surgeries and the anesthetic approach
for which China had become famous.
At this point in time, the practice of acupuncture had captured the
imagination of many in the west. The “Ancient Chinese Secret” exoticism
of the technique, combined with its reportedly near-miraculous results,
made for a powerful tonic to those in search of some alternative to pill- and
procedure-based medicine. DeBakey was curious as well, but he carried
along the healthy skepticism of the scientist. In actual practice, he found
acupuncture to be a very different technique from what was widely
portrayed in the popular press back home. Far from a panacea, it was
actually rarely utilized on its own, as least in the surgical procedures he
witnessed. The Chinese anesthesiologists instead employed the technique as
an adjunct to systemic sedation and local anesthetics. To them it was just
another tool in the bag. DeBakey recognized that there was no anatomic or
physiologic basis for acupuncture and reasoned that whatever efficacy it
enjoyed derived from its cultural longevity: Chinese patients knew that it
had been used for centuries, were accustomed to it, and had faith in it, so it
worked for them.47
DeBakey published his observations of China, which were generally
favorable, in a monograph entitled, “A Surgeon’s Diary of a Visit to China,”
as well as in a much more widely circulated distillation of this that appeared
in Reader’s Digest. His observations on acupuncture were among the first in
the US press to balance the sensational claims of the lay advocates.48
Before this, though, he reported his experiences to President Nixon, who,
of course, had a special consideration for matters related to China. DeBakey
reiterated his belief in the value of international medical exchange to forge
closer geopolitical relationships.
July 9, 1973
My dear Mr. President:
In my many visits to various countries of the world I have never experienced a more cordial
reception or been accorded warmer hospitality . . . There can be no question that your historic
visit to China initiated this new climate of warm friendship with America and the sincere desire
for improving and strengthening our interchange. Through your courage, vision, and initiative
you have inaugurated a new era for a generation of peace and for constructive developments for
mankind. In this connection I believe that the medical bond of interchange constitutes one of the
strongest mechanisms for improving international relations. I should like to suggest that some
effort be made to develop an arrangement for exchange or even collaboration with China, such
as you initiated with the USSR. . . .
Sincerely yours,
Michael E. DeBakey, M.D.49
In that same summer of 1973, DeBakey recommended that Nixon use the
power of his office to help move forward, with the USSR, a “cooperative
venture in three spheres of activity.”50 These three practical considerations
would be (1) the preparation of a joint manual on the most urgent aspects of
heart disease as determined by the research from both countries, (2) the
exchange of young trainees and scientists to spend months learning the
methods in the counterpart country, and (3) the establishment of a
collaborative program in the field of cardiovascular devices and
instrumentation. DeBakey also suggested a similar program be initiated
with the Chinese, who were considerably further behind the US than the
Soviets in such matters.51
DeBakey undoubtedly recognized that an exchange program of the sort
he envisioned would be significantly one-sided: with regard to modern
scientific treatment of cardiovascular disease there was not much the
Americans were likely to learn at that point from their colleagues in the
other two countries. While the politicians were acutely attuned to this fact,
it was quite beside the point to DeBakey. His goal remained what it had
been since his initial “missionary” travels back in the 1950s: spreading the
word about the enormous benefits of cardiovascular surgery and, in so
doing, creating closer relationships on an international scale.
In January of 1973, DeBakey and George Noon traveled to the USSR for
a more direct and practical reason. One of the leaders of the Soviet
scientific establishment, the mathematician and physicist Mstislav Keldysh,
was suffering from atherosclerotic occlusive disease of the lower
extremities.* He could not walk more than a few yards without having to
stop due to pain in his legs—the debilitating but usually correctable
symptomatology known as “intermittent claudication.”
Angiography had been done, and this had revealed narrowings in the
aorta and iliac arteries as well as frank occlusions in the superficial femoral
arteries of the thigh. He also had several blockages below the knees.
DeBakey recommended multiple bypass operations, to be performed at the
same setting. These were not operations that were necessarily beyond the
capabilities of the Soviet surgeons, but they were very familiar with
DeBakey by now and the Soviets were well aware of his unparalleled
experience in such cases. He and Noon arrived in Moscow shortly after
New Year’s 1973 and operated on Keldysh on January 10.52
At surgery, they performed a bypass graft from the aorta to the external
iliac arteries in the pelvis using a bifurcated Dacron graft, as well as
bypasses from the femoral to the popliteal arteries in both legs. These grafts
were saphenous veins (one of the Russian assistants accidentally tore a vein
as it was being removed from its anatomic bed; in Houston, this would have
probably led to the causative agent being “fired-fired”: in Moscow it
elicited a grunt from DeBakey). Since they were not directly addressing the
tibial artery occlusive issues, DeBakey added a lumbar sympathectomy to
the proceedings. After the vascular work was done, the surgeons removed
the gall bladder, which also had been giving Keldysh some trouble.*53
The immediate postoperative period after such major surgery was likely
to be rocky, so Noon stayed by Keldysh’s bedside. The recovery went well,
except for a moment when Noon realized the Russian doctor also in
attendance was changing the scale on the physiologic monitor to make the
pulse waveform look better whenever it dipped.
A grateful Keldysh put DeBakey and Noon in touch with surgeon Valery
Shumakov, who was in charge of the Soviet artificial heart program. This
would be one of the “cooperative ventures” in the years to come.
Since his joining the Baylor surgical faculty in 1966, George Noon
remained a stalwart and would spend his entire, illustrious career in that
capacity. In the 1970s, several other familiar names remained entrenched in
their positions, including Stanley Crawford, George Morris, and Arthur
Beall. There were other comings and goings, however. Charles McCollum,
who had briefly gone into private practice in a prominent Houston group,
returned to the university in the early 1970s. The allure and excitement of
being at one of the world’s hubs of vascular surgery was irresistible. Ted
Dietrich left to found the Arizona Heart Institute in Phoenix around the
same time.55
Kenneth Mattox, a rangy native Texan with a sonorous baritone voice
that he showed no fear of putting on display, finished his training in general
and thoracic surgery at Baylor in 1973. DeBakey brought him onto the
faculty, asking him to move over to the Ben Taub Hospital and “help out”
the general surgeon George Jordan, who was at that point nearly on his own
at the city-county facility. Once there, Mattox applied the DeBakey
standards of work and scientific inquiry to the abundant trauma caseload.
Soon some of the most important trauma research in the world was being
reported out of the Ben Taub.†
In 1974, DeBakey traveled to Sydney, Australia, to serve as Visiting
Professor. While there, he encountered an impressive trainee named Gerald
Lawrie, still in his 20s. DeBakey invited the young Australian to come to
Houston as a Cardiovascular Fellow, and, after this was completed, offered
him a faculty position at Baylor. Lawrie joined DeBakey’s personal surgery
service and assisted the Professor on a number of spectacular cases—both
in terms of the clinical scenarios and the personalities involved—in the
years to come.57
10.5 Surgeon to the Stars

The rich and famous had been flocking to Houston to see DeBakey since
the early 1960s. His savvy media presence, professorial aura, and track
record of pioneering excellence in cardiovascular surgery were the drawing
cards. Some were heads of state, captains of industry, or European nobility
like Leopold, but it was the Hollywood celebrities and other entertainers
who seemed to take a special interest in seeking out DeBakey—and being
seen doing it. Over the years he cared for such familiar names (or their
family members) as Alan Ameche, Morey Amsterdam, Leo Durocher, Curt
Jurgens, Guy Lombardo, Joe Louis, Phyllis McGuire, Edmond O’Brien,
Jeanette MacDonald, Wayne Newton, Danny Thomas, and Clifton Webb.57
The gifted and popular comic actor Danny Kaye was not a patient of
DeBakey’s, but he became a friend and visitor to the Texas Medical Center.
The two met at a New Year’s Eve party in Mary Lasker’s New York City
apartment in 1965. Over the years, Kaye made no secret of the wish that he
had become a physician rather than an entertainer, and when DeBakey
invited him to observe some operations in Houston, he leapt at the chance.
A photograph of Kaye in the operating room, in gown and gloves alongside
DeBakey, was a favorite keepsake: according to Kaye’s own physician he
kept it on his bedside table to his dying day (Figure 10.1).58
Figure 10.1 George Noon, DeBakey, and Danny Kaye in the Methodist Hospital operating room.
Courtesy George Noon.
Another celebrated comedian, Jerry Lewis, was both a patient and a special
friend. DeBakey made a number of appearances on Lewis’ famous
fundraising Muscular Dystrophy Association telethon and served as an
honorary Vice President of the organization. Like Kaye, Lewis had a special
fascination with medicine and surgery and was afforded the opportunity to
observe some operations at Methodist. His letter to DeBakey following
such an experience was effusive and touching.
March 28, 1975
Dear Mike,
It would take the likes of Salinger, Hemingway, and Faulkner to even begin to help say the
things I feel in my heart. Needless to say, watching you, your hands, and your mind save the life
of that dear man is just “one” small part of what I’d like to allude to, but the hospital, the staff,
the feeling, the dedication, and all the things I know you are directly responsible for made me
feel not only inadequate, but so totally humble by it all that I still feel the inner tremor when I
think about it . . . and suffice it to say, that’s all I’ve been thinking about since I left you. To say
thank you for sharing with me those most private and intimate moments would be ludicrous. I
would have to find something a thousand times more meaningful than just “thank you” to truly
give all of it its proper due . . .
In closing, let me say, I think God did two great things:
1. HE CREATED YOU!
2. HE ALLOWED ME TO MEET YOU AND BE YOUR FRIEND.
You have my love and deep respect.
Always,
Jerry59
In 1978, Lewis accompanied a friend to Methodist Hospital, where

DeBakey immediately recognized that there was something seriously wrong
with the actor. As it turned out, Lewis was both addicted to the painkiller
Percodan—prescribed for chronic back pain—and harboring a threatening
gastrointestinal ulcer. DeBakey had Lewis admitted to Methodist, where
successful surgery for the ulcer was performed and he was weaned from the
Percodan. Lewis later credited DeBakey with saving his life, and the two
remained in regular contact over the years to come (Figure 10.2).60
Figure 10.2 DeBakey with comedian Jerry Lewis.
One infamous celebrity of sorts also briefly appeared on the patient rolls.
In May 1975, the Chicago organized crime figure Salvatore “Sam”
Giancana was admitted to Methodist with gall bladder disease. He
underwent cholecystectomy by DeBakey and Lawrie, staying for a week
afterward to recover. At the time, Giancana was preparing to testify to
Congress regarding the potential involvement of the syndicate in a CIA plot
to assassinate Fidel Castro. Security around him was tight, reportedly
including the x-raying of a cake sent as a get-well present. According to
newspaper accounts, Giancana slipped out of the hospital undetected by the
Houston Police, who had had him under surveillance. He was murdered in
his Chicago home just a few weeks after his gall bladder procedure.61
The legendary film star Marlene Dietrich also made her way to Houston,
in January 1974. Dietrich had injured her leg several weeks earlier after
falling off a stage, and the wounds she had suffered did not heal. It turned
out that the long-term smoker was harboring significant peripheral arterial
occlusive disease. Her leg eventually healed after bypass surgery and skin
grafting, and, in gratitude, she gave DeBakey a memorably inscribed
photograph in a silver frame. Clad only in a white fur robe and heels,
Dietrich flashes a seductive look with her bare leg carefully posed like a
chorus girl: “This is the leg that you made good again—not to speak of the
hidden parts. All my love, Marlene.”62
DeBakey became long-time friends with Frank Sinatra after the famous
singer sent his father to Houston in January 1969. “Marty” Sinatra was
suffering from serious heart and lung troubles, as well as an aortic
aneurysm. Unfortunately, the senior Sinatra was gravely ill when he made it
to Methodist Hospital and never recuperated sufficiently for the surgeons
even to consider an operation. He passed away just five days after arriving
in Houston, his famous and devoted son at the bedside.63
The younger Sinatra was impressed with the Texas Medical Center and
with DeBakey, and he became a regular referrer of patients (many of whose
bills he paid) as well as contributor to the DeBakey Medical Foundation—
giving $20,000 annually by some accounts.64 DeBakey was an invited guest
at Sinatra’s wedding in 1976. By then, the singer had already made an even
more significant—albeit unintentional—impact on the surgeon’s life.
In February 1974, Sinatra gave a birthday party for the legendary comic
Jack Benny who, despite his well-worn gag of being 39 years old, was
turning 80. The celebration was held at Sinatra’s luxurious Palm Springs
“compound,” which had no fewer than nine bedrooms. At the time, one of
these was occupied by DeBakey.
Another attendee at the party, not precisely a guest, was a 32-year-old
blonde, blue-eyed German actress named Katrin Fehlhaber. She had been
vacationing in Mexico with friends—one of whom knew Sinatra. When
word of the Benny birthday bash got out, the entourage decided to shift
locales to Palm Springs. At the soiree Katrin crossed paths with DeBakey
and, despite the age difference—he was 65 at the time—in her words, “it
just clicked.”65
10.6 Katrin
A few weeks later, back in Germany, Katrin received a call from DeBakey,
who indicated that he was “around the corner” and hoped to visit.
I said, “Wow, where are you?” And he said, “In Iran.” I thought to myself while I was gone—I
was in between, in England—has something been renamed in Germany, that is called Iran?
Because this is not European standard to come from Iran. But he thought he was already near in
Europe there, and that is on that side of the Atlantic, and that is around the corner all for him.
That was the way he travelled and the way he saw the world and life. But he had this actually
rather long trip from Iran, which he thought was around the corner on the map. He came, and I
picked him up from the airport. I had only on my car three gears and a dog on my lap, and I
drove the most the car gave, and I think he was never so frightened in his life than on that trip.66
DeBakey was evidently not cowed by this taste of his own automotive
medicine, and the unlikely courtship proceeded.
Back in Houston, DeBakey’s colleagues—not to mention his sons and
siblings—were surprised at the turn of events: for any number of reasons he
was hardly a likely figure for a May-September romance. There was no
denying, though, that this was the happiest anyone had seen him in years;
certainly since Diana’s death. It seemed the surgeon and the actress had
only just met when wedding invitations began appearing in the mail all over
Houston and elsewhere.
The formal ceremony occurred in a plush hotel (that had once been a
castle) outside the city of Hamburg on August 9, 1975. Although the guest
list was a long one and featured many notable invitees, the ceremony itself
was relatively small. DeBakey’s sons were there, along with their wives, as
was Ted Bowen, the long-time Methodist Hospital Administrator, and many
other friends and family. Curt Jurgens, the Austro-German actor who was a
patient of DeBakey’s, was an invited guest. The ceremony was covered by
People magazine, which did not spare its gossipy tone.
The German newspapers billed it as the wedding of the year. So some 2,000 citizens of the
Hamburg suburb of Bargteheide dutifully turned out in the grueling August heat to celebrity-
watch at the wedding of America’s famous heart surgeon, Dr. Michael DeBakey, 67, and 33-
year-old Katrin Fehlhaber.
The German-born Katrin, who dabbles in acting and painting, met DeBakey at a party in Los
Angeles. Impressed by the soft-spoken surgeon, who is president of the Baylor College of
Medicine in Houston, Katrin followed him to Texas to paint his portrait. She stayed to capture
the widower on canvas and off campus.
They were married last month in Houston in a civil ceremony, and then decided to stage a
spectacular summer rerun for Katrin’s relatives. Before the wedding, the German pastor—
unaware that DeBakey’s 20-hour work days have earned him the nickname “The Texas
Tornado”—asked Katrin if the sexagenarian bridegroom would prefer to be seated. “Michael
stands for hours for his operations,” she snapped, “and he’ll stand for this.”
DeBakey, who implanted the first artificial heart pump in 1966, was so hounded by reporters
when he arrived in Germany that he hired a public relations firm. A press conference was
arranged. Although he refused to answer any personal questions, DeBakey lectured benumbed
newsmen for one hour on arteriosclerosis and blood traumatization.
Two days later, spectators who turned out for the wedding with folding chairs and sausage-
and-bread snacks were as chagrined as the press. They had heard the guests would include Frank
Sinatra and the King and Queen of Belgium. All they got was familiar German actor Curt
Jurgens. “Not much,” sniffed one heartless observer. “Jurgens can be seen at any birthday party
or bar mitzvah.”67
The newlywed DeBakeys had arranged to honeymoon on a yacht, but,

due to some snafu, the boat was not ready at the appointed time. When
Princess Lilian and her husband King Leopold heard about this, they invited
the couple to join them in the South of France, where they were
vacationing. This was an easy offer to accept. When they arrived, DeBakey
noticed that Leopold did not look well. The abdicated King said that he had
been feeling poorly for some time, and his doctors had been unable to
ascertain the reason. DeBakey examined Leopold and found a large,
pulsatile abdominal mass—unquestionably a menacing aortic aneurysm.
The honeymoon had run into its second obstacle, and Katrin learned
quickly the challenges of living with an internationally famous
cardiovascular surgeon.
DeBakey announced that they all needed to arrange immediate
transportation back to Houston to get Leopold “taken care of before this
thing ruptures and kills you.”68
On August 19, 1975, DeBakey and Lawrie performed abdominal aortic
aneurysm repair on King Leopold. The procedure went well, and, after her
husband had been discharged and was recuperating at home, the Princess
sent DeBakey a heartfelt letter of thanks.
November 11, 1975
My very dear Michael,
I have tried so many times to write to you in vain. I cannot find the right words to tell you my
gratitude, my appreciation, and my admiration. The moment these words are put down on paper,
they seem so poor, so utterly meaningless, compared to what I feel! What my children and
myself owe you, is not to be spoken about. It is our lives that were at stake. . . .
You know that whenever, and wherever we can be of any help to you if ever this was needed,
there is nothing we should not be ready to do for you—
I shall hurry and finish this letter, from fear when reading it over, of tearing it to pieces like so
many others—
Thank you Michael and May God bless you
Lilian69
In gratitude for the aneurysm operation and all the many other things he
had done on behalf of the medical community in Belgium and around the
world, Lilian and Leopold commissioned a sculpture of DeBakey by the
French artist Georges Muguet.
One of the contributions DeBakey helped to make, halfway around the
world, had its origins in 1976, when an unusual partnership consisting of
the government of Saudi Arabia and representatives of the Tennessee-based
Hospital Corporation of America approached Baylor about establishing a
cardiac surgery program—to be run by the school on an ongoing basis—in
Riyadh.70
That city was the home of the King Faisal Specialist Hospital and
Research Center, a self-contained medical complex and community that had
been founded the previous year. The hospital was staffed with well-trained
physicians and other personnel from around the globe, all of whom were
required to be fluent in English.
On-site inspections and exploratory committees concluded that the idea
was feasible, and the first team from Baylor, consisting of senior surgeon
Arthur Beall, an associate surgeon, an anesthesiologist, two perfusionists,
two OR nurses, and four ICU nurses, arrived in Riyadh on May 15, 1978.
They performed their first operation one week later—closure of a patent
ductus arteriosus in a 15-year-old Saudi girl.71
By February of 1981, the Baylor cardiovascular surgery team (the
mission expanded to include vascular surgery by necessity) had completed
its 1,000th procedure.
Baylor teams generally came to Saudi Arabia for three-month tours,
although some stayed as long as two years. As Lawrie remembers, “Dr.
DeBakey was a master motivator. At first, no one was interested in going to
Riyadh, but after he talked about it to the faculty, everyone wanted to sign
up.”72
Results of the Baylor surgical teams in Saudi Arabia matched those in
Houston. In 1979, Baylor successfully applied to the Residency Review
Committee for Thoracic Surgery to have its residents spend four months of
their training year at King Faisal Specialist Hospital. Reciprocally, Saudi
surgery trainees who performed exceptionally in Riyadh were soon being
placed in the surgery residency in Houston.
10.7 The Living Heart

Although the total artificial heart research had not resulted in a workable
model, many lessons learned along the way were brought to bear in further
refinements to mechanical assistance of the failing heart. In the mid-1970s,
with George Noon now contributing to the effort, there was a renewed
focus on what was at this time called a left ventricular bypass pump. A few
designs were studied, based around a hemisphere of polyether polyurethane
and a pneumatically actuated diaphragm, incorporating either tilt-disk or
ball valves. In some cases, the old dacron-and-silastic construction was
used.73
In the meantime, another, very different new technology had appeared on
the scene, for similar indications. This was the intra-aortic balloon pump
(IABP). In this method of cardiac support, as the name implies, a balloon is
placed inside the thoracic aorta, a short distance below the origin of the left
subclavian artery. Based on pressure readings or the patient’s EKG, the
balloon automatically inflates and deflates. Inflation occurs during diastole
(the period between heartbeats) and causes aortic blood to be pushed
backwards into the coronary arteries, thereby increasing perfusion of the
myocardium. Deflation occurs during systole (the heartbeat) and a vacuum
effect decreases the resistance the left ventricle must push against, which
improves function.
If an analogy is made to electrical circuits, the IABP is essentially an
augmentation of cardiac function in series, while the left ventricular bypass
pump does something similar in parallel. Either can be effective, both as a
means of sustaining life and in allowing the heart to recover its own
capacity, as in, for example, weaning from the cardiopulmonary bypass
pump after heart surgery. At this point, the Baylor team advocated the
bypass pump on a theoretical basis by consideration of the physiologic
parameters that could be improved by the two techniques. Interestingly, in
this same time frame, DeBakey’s group considered the concept of long-term
nonpulsatile perfusion and found it to be problematic: “Prolonged,
nonpulsatile bypass may lead to impaired tissue perfusion, peripheral
pooling, and metabolic acidosis, which, in turn, diversely affects cardiac
function.” 74 In fairness, these comments represent reflections on
phenomena observed in connection with operative cardiopulmonary bypass,
but, in the years to come, DeBakey and his team would harness the power
of nonpulsatile, continuous-flow perfusion to advance the cause of
temporary—and possibly even permanent—cardiac replacement to a new
level.
After Mstisislav Keldysh had introduced his American surgeons to Valery
Shumakov in 1974, there was a measure of cooperation between the Baylor
and Soviet artificial heart teams. Noon went to Moscow in March of 1976,
where he and Shumakov each placed one of their devices in a calf.75 Three
months later the Soviets came to Houston for a repeat of the performance.
In the end these efforts did not succeed in their ultimate goal, but they were
of value in stimulating scientific cooperation between the Cold War rivals—
although the medical scientists considered themselves kindred spirits more
than adversaries. As Noon said, “We didn’t come up with an artificial heart
that was ever implanted in a human being, but we had a lot of fun
collaborating with them.”76
In 1977, Antonio Gotto took over as Chairman of the Department of
Internal Medicine at Baylor (as well as Chief of Internal Medicine at
Methodist Hospital). In that same year, he and DeBakey collaborated on a
project that was very different from what either had attempted before, but a
natural outgrowth of their prior experience.
A publisher had approached DeBakey earlier about writing a book on
cardiovascular disease for a lay audience. According to the plan, there
would be a description of normal cardiovascular function, the nature of the
disease processes, and methods of treatment and—especially—prevention.
DeBakey wisely enlisted Gotto to give his unique perspective both as an
internist—to balance the surgical viewpoint—and as a front-line researcher
in atherosclerosis with a special interest in prevention. The need for visual
supplementation to the text was obvious, and he recruited the talented
medical artist Herb Smith to provide appropriate illustrations. These came
to include pen-and-ink line drawings in the style of classic surgical atlases
(some with red ink for arteries and blue for veins) as well as a few
photographs and diagrams. The final product emerged in 1977, as The
Living Heart, which carried the subtitle: “Two famous heart specialists tell
how your cardiovascular system works, why it fails, and what can be done
about it.”77
At just under 250 pages, The Living Heart was surprisingly detailed and
in-depth. The history of cardiovascular medicine and surgery was covered,
as well as the basic sciences of anatomy, biochemistry, physiology, and
pathology as they applied to this system. DeBakey and Gotto then shifted to
a discussion of the various disease processes: congenital and acquired
maladies of the heart, hypertension, aneurysms, arterial occlusive disease,
and diseases of the veins. The treatments then in vogue were well-described
and illustrated. As one of the first books of its kind, The Living Heart met
with considerable success. Serialization and support by the popular
syndicated columnist Ann Landers was important in this regard. She called
the book “superb” and even went so far as to suggest that it “may well add
years to your life.”78
The relationship between DeBakey and Gotto grew close over the years:
“For some reason he seemed to take a liking to me . . . and I know I did
things that would have gotten other people probably kicked out—like being
late. “79
Gotto had a daughter who was, unfortunately, severely afflicted with
Type I diabetes mellitus. As a young girl she developed an affinity for the
grandfatherly DeBakey and liked to swing from his arms the way the
Ochsner children had, decades before. During her high school years, her
illness required frequent hospitalizations, which were both unpleasant and
depressing. One of the highlights for her, however, was DeBakey’s frequent
appearances. “When he was in town, Dr. DeBakey never missed a day
visiting her in her room. And some days, this was the only time that her face
would brighten up, and she would become animated.”80
On one of these visits DeBakey’s unremitting perfectionism could not be
contained, and Gotto’s wife, Anita, had a brief glimpse into the life of a
surgery resident at Baylor.
“Anita was sewing a prom dress for one of our daughter’s friends, whose mother was ill.
Dr. DeBakey said, ‘Anita, what are you doing?’ My wife told him, and he said, ‘Let me see
your stitches.’ He examined the dress and said, ‘These are your basting stitches, aren’t they?’
She said, ‘No, Dr. DeBakey, these are my finishing stitches.’ He said, ‘These are terrible, let me
have your scissors!’ He ripped out every single stitch and said, ‘Let me have your needle and
thread.’ He proceeded to resew the dress in its entirety, while my wife sat there in a state of
astonishment.”81
The incident was never discussed afterward. Fifteen or so years later, the
Gottos invited DeBakey to New Year’s Eve dinner at their home. Knowing
his preference for Louisiana-style food, Mrs. Gotto made gumbo especially
for him. The Professor sampled the spicy dish and remarked, “Anita, you
may not be able to sew, but you sure cook good gumbo.”82
Over the years, many prominent physician professors have been honored
by their trainees with the formation of a society in their honor. This tradition
is especially well established among teachers of surgery and their students.
In most cases, societies of this sort have periodic meetings that consist of
research or clinical symposia presented in tribute to the mentor. In 1977, a
former surgical fellow at Baylor, a Greek named Panagiotis Balas, who was
Professor of Surgery at Athens University Medical School, helped bring to
fruition such a group in the form of the Michael E. DeBakey International
Cardiovascular Society.83
The first meeting of this society was held as an “International Congress
of Cardiovascular Surgery” in Athens, in June 1977, under the auspices of
the Greek Ministry of Culture and Sciences and the Ministry of Social
Services. Balas was the first President, and other officers included Vice-
President Arthur Beall and Secretary George Noon.
The Congress was held at the Athens Hilton and consisted of two days of
presentations on the major topics of interest in the field at the time. One of
the more fascinating elements of the conference was a chartered trip to the
Island of Kos, home of the legendary Hippocrates. There the group partook
in a special administration of the Hippocratic Oath and listened to a lecture
on the life of its namesake under the shade of the ancient oriental plane tree
where he is said to have taught.84
Katrin, who was eight months pregnant, accompanied DeBakey to
Athens, where they stayed at the Hotel Grand Bretagne. In between
meetings of the conference and several social gatherings, DeBakey met the
President of Greece, Konstantinos Tsatsos. The first meeting of the
DeBakey International Cardiovascular Society was a success, and Balas
hoped to have it become a regular, if not annual, event in Athens. The other
members recognized, however, that moving the site around would be more
likely to maintain interest. The second meeting, the following year, was
scheduled in the home base of Houston.
On July 29, 1977, at Methodist Hospital, Katrin gave birth to a daughter,
Olga-Katarina DeBakey.85 Within days, a mountain of cards, telegrams,
flowers, and the like from all over the world arrived at the home on
Cherokee Street, offering congratulations and good wishes. More than a few
featured good-natured ribbing at the father’s relative maturity (he was 68).
The very young debutante made her first appearance soon thereafter in
photographs in her parents’ arms, taken at the house when she was just two
days old (Katrin had tried unsuccessfully to enlist the services of the noted
portraitist, Yousuf Karsh of Ottawa, for this purpose*86).
On New Year’s Eve 1977, near-tragedy struck the home on Cherokee
when fire swept through the ground floor after the family had retired for the
evening. The fire may have started from candles on the Christmas tree or
(as the newspaper reported) embers from the fireplace but, regardless of the
origin, in a short time much of the living room was engulfed.87 Barry
DeBakey, who was attending a party at the home of some friends in his old
neighborhood, saw the flames through the windows and rushed to the
house.89 Everyone, including the infant Olga, was evacuated safely, and the
Fire Department extinguished the flames. DeBakey was hospitalized for a
short time at Methodist with smoke inhalation, superficial facial burns, and
two broken ribs.90 All in all, it could have been a great deal worse.
DeBakey developed close friendships with several members of the
Baylor College of Medicine Board of Trustees over the years. One of these
was Albert Alkek, another of Houston’s seemingly inexhaustible supply of
wealthy and philanthropically inclined oilmen. Alkek was a friend of Board
Chairman Leonard McCollum, who had initially approached DeBakey
about appointing him.
One day Mr. McCollum said to me, “You know, Albert Alkek is a man of considerable wealth.
He is also a man of great good generosity. I think that he would be interested in being a member
of our board and supporting Baylor.” So I said, “Well, that’s great. Let’s have a luncheon for
him.”
I talked with Mr. Alkek and we felt an immediate report. He happens to be of Lebanese
descent, as I am. That gave us some common interest, not that we made any great point about it.
It just happened to be that way. We consider ourselves Americans of Lebanese descent. We soon
became close friends. He asked what was more important with regard to priority for funding. It
soon became apparent to me that we needed to expand, so I said, it would be great to call this
the Alkek Tower.91
The Alkek Tower was built on top of the existing Brown building, which
had been designed to allow for such an expansion. When it opened in 1978,
the four new floors and 70,000 square feet would house the National Heart
and Blood Vessel Research and Demonstration Center, along with nearly 70
new beds for cardiovascular patients and, on the ninth floor, DeBakey’s
office.*92
At nearly the same time (and not to be outdone) the Fondren Foundation
began construction of six new floors to add to its namesake structure. It was
at the dedication ceremonies for this addition in May 1978 that the
sculpture commissioned by Princess Lilian and King Leopold—a four-foot
tall, 300-pound bronze bust of DeBakey—was unveiled.93 The likeness,
which depicted DeBakey in surgical cap and scrub suit, with arms crossed,
was placed outside Methodist Hospital (it was later moved to the lobby of
the hospital’s Dunn Tower when that edifice was constructed, where it
remains today; Figure 10.3). A plaque beneath the bust reads, “Michael E.
Debakey, M.D. Surgeon, Educator, and Medical Statesman.”
Figure 10.3 Michael, Katrin, and Olga DeBakey.
Mrs. Ella Fondren, now in her mid-90s, had moved into the Methodist
Hospital in 1976. The great benefactor and matriarch enjoyed a corner room
on the luxurious 12th floor of the building that bore her name, with all the
amenities. These, as ever, included the frequent attention of DeBakey, Ted
Bowen, and other senior members of the Methodist and Baylor
administrative hierarchies.†94
Mr. Ben Taub had already been living at the hospital for a number of
years. Like Mrs. Fondren, he was not ill—beyond the infirmity of age—but
his status as one of the greatest leaders and patrons of medicine in Houston
conferred certain privileges. When his rounding team passed by Taub’s
room on the sixth floor, DeBakey would inevitably stop and spend some
time alone with his old friend (most of the team considered this a welcome
breather from the stressful haste of the rounds).95
In the years before Taub moved into Methodist, he and DeBakey would
go on their own rounds on Sunday mornings after their traditional breakfast
together. Far more than a benevolent millionaire signing checks in some far-
away mansion, Taub liked to see, first-hand, the workings of the facilities
he ran and supported. The two men would wander the wards and the
operating suites, discussing the grandiose plans and stratagems that
eventually became realities within the titanic Texas Medical Center.
On one occasion, many years earlier, their noble reverie was punctuated
in an unexpected and messy fashion by the operating residents.
We used to always see how fast we could do something, you know, and (one resident) was doing
a splenectomy and he was watching the clock. Then when he finished he said “Finished!
Vroom!” and he threw the spleen down on the floor. It went out of the door, and at that time Dr.
DeBakey and Mr. Taub were making rounds.96
The slippery organ flitted past the feet of the two startled men and
bounded away.
Figure 10.4 DeBakey at dedication of Alkek Tower and unveiling of bust commissioned by Lilian
and Leopold of Belgium, May 11, 1978.
10.8 Spilling Ink

In the late 1970s, DeBakey reprised his role from 40 years before as the
compiler of lengthy and exhaustive reviews of clinical subjects. Now,
however, he had accumulated most of the reported information himself.
One example was his article, “Patterns of Atherosclerosis and Rates of
Progression,” which appeared in Atherosclerosis Reviews in 1978.97 This
56-page paper was a sort of follow-up to the talks and articles he had put
together in the late 1950s and early 1960s under the title, “Changing
Concepts in Vascular Disease.” In the intervening years, DeBakey and his
team had accrued data from thousands of patients, which he analyzed in
terms of the stated criteria, as well as epidemiologic and biochemical
parameters. What emerged from the analyses was a clear taxonomy of
anatomic distribution of the disease process as well as a recognition of three
categories of progression: rapid, intermediate, and relatively indolent. What
remained elusive were definite causative factors and the capacity to predict
a particular patient’s clinical course.
Obviously, it would be extremely desirable to determine the susceptibility of the individual
patient to the various patterns and rates of progression at the onset of the disease or even before.
It must be admitted, however, that in our present state of knowledge, this has not been possible
to accomplish. Much emphasis in recent years has been placed on certain risk factors, including
particularly hypercholesterolemia, hypertension, and cigarette smoking as primary factors, and
heredity, sex, age, hypertriglyceridemia, obesity, diabetes mellitus, physical activity, stress, and
personality types as secondary risk factors. In our experience, it has not been possible to
establish a strong correlation between individual risk factors and the various patterns and rates
of progression of atherosclerosis that have been described and illustrated in this presentation or
even between risk factors and individual susceptibility. Indeed, perhaps one-fourth or more of
the patients observed have no identifiable risk factor.98
The lengthy article, which included diagrams of surgical reconstructions

devised to address the occlusive process (as well as the cholesterol and
triglyceride levels of the patients in question) concluded by suggesting that
atherosclerosis is, in fact, a spectrum of pathologies.
It is our firm conviction that the disease complex referred to as arteriosclerosis or atherosclerosis
represents a number of distinctively different clinical and anatomicopathologic patterns with
various rates of progression. Much of the confusion about etiology, diagnosis, treatment, and
prevention is believed to stem from the failure to recognize these widely different patterns,
which may indeed represent different entities . . . It is not inconceivable that when the precise
cause is ultimately discovered, it will be found that each of the several or more different patterns
of these arteriopathies has a specific etiologic agent or set of etiologic factors.99
DeBakey followed-up this epic paper with another for the American
Journal of Surgery in June 1979. Derived from a talk he had given in Dallas
back in 1972, “The Development of Vascular Surgery” was every bit as
comprehensive as its audience had come to expect from the author. In 42
profusely illustrated pages, DeBakey covered the evolution of angiography,
vascular suturing, thromboendarterectomy, bypass grafting, interposition
grafting, and patch-graft angioplasty. He also discussed the use of
autogenous tissue and the development of prosthetic materials as arterial
replacements. Last, he integrated these elements into an in-depth
consideration of their application to disease processes in the various arterial
beds. “The Development of Vascular Surgery” was a tour de force and
remains as complete and readable a consolidation of vascular surgery in the
pre-endovascular era as any ever published.100
During this period DeBakey also authored, along with colleagues, a
number of papers focused on individual diagnoses but with similarly
expansive databases: “Surgical Treatment of Aneurysms of the Descending
Thoracic Aorta: Long Term Results in 500 Patients,” “Dissection and
Dissecting Aneurysms of the Aorta: Twenty-Year Follow-Up of 527
Patients Treated Surgically,” “Experience with 366 St. Jude Valve
Prostheses in 346 Patients.”101
Through the 1970s, the coronary artery bypass procedure continued to be
performed with increasing frequency. Nowhere was this more evident than
in the Texas Medical Center, where both the Baylor and Texas Heart
Institute surgeons pursued the operation energetically. On a national level,
however, there remained some controversy as to whether much benefit was
being derived by patients.
One key source of this confusion was a 1977 paper emanating from a
Veterans Administration (VA) Cooperative Study.102 In this article, which
analyzed the results of 1,000 patients from 13 different VA centers, there
appeared to be no benefit from the operation unless the coronary artery
disease was extensive. There were weaknesses in the study, however. The
follow-up was brief—just 21 months—and the experience of the surgeons
involved was variable. Results in terms of survival, graft patency, and other
easily compared measurables were also bleak. Perhaps most damning was
the relatively few cases performed at each reporting institution: although
1,000 seemed like a large number of patients, the average annual number of
coronary artery bypass grafts performed at each institution was just seven
(seven such operations in a single day was not uncommon at that point at
Methodist).
Although DeBakey pointed out the failings of the VA study in speeches
and addresses, the best form of combat was, he well knew, publishing data.
Accordingly, he and Lawrie composed an article, published in the Journal
of the American Medical Association in February 1978, which assessed the
experience over 10 years with the operation at the Houston Methodist
Hospital. Their results indicated that less than 2% of patients so treated died
during their hospitalization, and more than 90% were still alive at five
years, which was comparable to “normal” cohorts matched for age and
sex.103
Sensing that the real issue was the old struggle between the internist and
the surgeon, DeBakey and Lawrie closed with a peaceful gesture.
In most centers, the cardiologist first performs the necessary studies and observations and, on
the basis of the clinical judgment he has acquired, determines whether surgical treatment should
be considered. If, in his opinion, surgical consideration is indicated, the cardiovascular surgeon
is consulted, following which the decision regarding the preferred treatment is made on the basis
of their combined clinical judgment. Under these circumstances, cardiologists and
cardiovascular surgeons do not assume adversarial roles, but rather collaborate in determining
appropriate and effective therapy. This traditional method of exercising clinical judgment has
proved effective throughout the history of medicine—and remains so today.104
10.9 Chancellor
In the summer of 1978, DeBakey was approaching his 70th birthday. With
that milestone would come an unwelcome statutory terminus: this was the
age of mandatory retirement from the office of President of the Baylor
College of Medicine.105
DeBakey did not want to step down. He had inherited a foundering ship a
decade before and in short order righted it. Now, in the late 1970s, the
school was on a sound financial footing, was doing top-notch research
thanks to a stellar faculty he had assembled, and enjoyed a far-reaching and
glittering reputation for education and patient care. Almost as a reflex, some
members of the Board of Trustees and faculty believed that DeBakey’s
retirement must be imminent due to his age. The Professor, however,
considered himself to be in excellent physical and mental condition and
capable of continuing service at a high level for many years to come
(subsequent events would prove this out, as he went on to do just that after
many of those concerned about his senectitude in this period had passed
away). Undoubtedly he was reminded of the injustices perpetrated by
mandatory retirement age on such surgical icons as Harvey Cushing of
Harvard and his own mentors Rudolph Matas and Alton Ochsner, all of
whom had been put on the shelf by their institutions while at the top of their
form.106
Powerful members of the Board were adamant in their desire to
formulate a plan of succession for the Presidency. The faculty was divided
on the issue. Everyone holding a stake moved with caution—most were in
awe of DeBakey, and not a few lived and worked in outright fear of him.
All agreed that if he were to step down as President, some gesture must be
made by the school to acknowledge his unparalleled contribution to its
success and well-being. What ensued was a remarkably complex game of
administrative political chess, complete with factional subterfuge, ethically
marginal tactics, and plenty of hurt feelings.107
The Board compromised by creating the new position of Chancellor for
DeBakey. In this capacity, he would be an advisor to the President and to
the Board. He would also remain Chairman of the Department of Surgery,
which all concurred was a sine qua non.
The search for a new President proved to be challenging. Among the
names seriously considered were Ted Cooper, the former Chair of the
National Heart Institute who was then Assistant Secretary of Health, and
Charles Sanders, General Manager of the Massachusetts General Hospital.
A unique element of the recruitment was the need for any viable candidate
to be able to interact smoothly with DeBakey, whom no one expected to
disappear from the scene. While this search was under way, DeBakey held
the title of both President and Chancellor. This arrangement lasted from
October 1978 to November 1979.108
Ultimately William T. Butler, the Executive Vice President and Dean of
the school—whom DeBakey had recruited to lead the Department of
Microbiology and Immunology back in the 1960s—became the new
President. He was possessed of all the necessary attributes: a strong track
record in teaching and research, an understanding of the “Baylor way,” and
proved success in administration. Perhaps most importantly, he was on
good terms with the Chancellor.
As the new decade of the 1980s approached, DeBakey prepared to
assume his new role at the school. In some ways, the arrangements were
another confirmation of the validity long attached to the old French maxim,
plus ça change, plus c’est la même chose.
10.10 The Shah

In early March 1980, Dr. Benjamin Kean of New York telephoned Houston
looking for DeBakey. The Professor was out sick at the time, so Gerald
Lawrie took the call.* Kean indicated that one of his patients needed to have
his spleen removed. For many years, the overwhelming majority of patients
sent to DeBakey by out-of-state physicians needed cardiovascular
operations (if, it turned out, they needed any procedure at all), but that was
not the only unusual thing about this referral.
The patient in question was Mohammad Reza Pahlavi, the 60-year-old
former Shah of Iran, who had been deposed as a consequence of the Islamic
Revolution in his country the previous year. The Shah was not in good
health. Back in 1974, he had been diagnosed with a chronic form of
lymphoma (a fact that had not been disclosed to the public—or, in fact, to
the Shah himself for some time). For five years he had done reasonably
well on a simple chemotherapeutic regime instituted by his French doctors,
including an internist named George Flandrin. Shortly after his exile,
however, the Shah had developed enlarged lymph nodes in his neck and
been placed on more aggressive chemotherapy by Flandrin. Not long
afterward, he became jaundiced while staying in Mexico and—after being
misdiagnosed, and then treated for, malaria—was transferred to New York
Hospital (at the behest of Kean) for surgery to remove his gall bladder. That
was in October 1979.
At the time of the gall bladder surgery, the Shah’s spleen was known to
be enlarged, but the surgeon involved did not think it was safe to remove
the organ due to the complexity of the operation as it unfolded, as well as
the patient’s overall fragile condition. This may well have been the correct
judgment at the time, but the decision definitely led to serious problems—
and controversy—in the months and years to come. The Shah’s
postoperative course was rocky: a gallstone was missed and had to be
retrieved by means of a new procedure. There was some good news,
though: multiple imaging studies, as well as biopsies from the liver, lymph
nodes, and bone marrow, were negative for lymphoma. One neck node was
positive, and this was treated with radiation.
In December, the Shah was transferred to Lackland Air Force Base in San
Antonio, Texas. His presence on US soil was problematic for President
Jimmy Carter and his administration. In November—while the Shah was
recovering from surgery in New York—the American Embassy was stormed
in Tehran, beginning the lengthy Iran Hostage Crisis. In the eyes of many,
these events were linked. The political climate of the moment meant that
few locations in the world were welcoming now for the former king. Any
nation that harbored him might incur the terrorist wrath of the Iranian
Revolutionary regime or its sympathizers.
The Shah ended up in Panama, a destination of necessity more than
anything else. This was where he lay languishing, in the small Centro
Medical Paitilla Hospital, when Kean contacted DeBakey.110 Since the gall
bladder surgery, the Shah had developed laboratory evidence of
hypersplenism—overaggressive activity of that organ, in which blood cells
are inappropriately captured and destroyed. This was no surprise given the
enlargement of the spleen. In the early weeks of 1980, his white blood cell
count hovered in the 2,000/mm3 range and his platelet count was
approximately 60,000/mm3. Both were less than half of normal. This put
the Shah at great risk for infection and/or hemorrhage. His chemotherapy
had to be stopped, also.
On Friday March 14, 1980, DeBakey, Lawrie, Kean, New York Hospital
Chief of Staff Hibbard Williams, the Shah’s senior advisor, an American
named Robert Armao, and the rest of the Houston team boarded a Lear Jet
for Panama.
Their arrival was distinctly different from those to which DeBakey and
his team had grown accustomed over the years. No Panamanian physicians
(or any officials) greeted the visitors, only another of the Shah’s advisors.
They had to take a taxi cab to their hotel—a Holiday Inn. When they finally
reached the hospital, armed guards at the Shah’s room announced that they
had orders not to let the American doctors in. Some phone calls from the
Shah’s advisors eventually gained DeBakey and his team entrée, and they
finally met and examined their famous patient. As usual, DeBakey’s aura of
absolute assurance and mastery—not to mention his cultivated comfort in
the presence of eminent figures—engendered the Shah’s confidence.
The Panamanian physicians in charge were Gaspar Garcia de Paredes,
Chief Surgeon of the hospital, and Carlos Garcia, surgeon to de facto
Panamanian dictator Omar Torrijos. It was not until the next day that they
“coolly” greeted the American team. No attempt was made to hide the cause
of their animosity: DeBakey’s presence was an insult—it broadcast to the
world that the Panamanian surgeons were not considered capable of
performing even so straightforward a surgical procedure as a splenectomy.
This was confusing since, just a week before, these same physicians had
agreed that DeBakey and his team would perform the operation. The
difference, the Panamanians revealed, was the publicity that had ensued.
Although this was certainly extreme, it was hardly the Americans’ fault, and
they had no control over it.
DeBakey considered his options and, regretting the necessity, elected to
withdraw his team from the scene. There was some soul-searching by de
Parades, who intimated to DeBakey that he did not wish to offend the
famous surgeon but was influenced by his colleagues, whose pride had been
bruised. This changed nothing, though. Forced to rely on the conflicting
opinions of strangers, experts though they may be (to varying degrees), the
Shah himself was unsure how to proceed.
One consideration was to move the royal patient to another site,
preferably outside of Panama (there was a US Army hospital in the country
called Gorgas that Kean was familiar with, but it was ultimately rejected).
When the Shah was still at Lackland Air Force base, the American
authorities decided that, if he needed any further specialized care, he could
return to the United States. The problem was that the Panamanian
government made it clear that if the Shah left their country to have his
operation, he would not be allowed to return.
Between the conflicts of his physicians, the geopolitical climate that
rendered him an outcast, and the serious nature of his illness, the Shah was
a figure of unique pathos as the spring of 1980 approached. His former
grandeur only added to the spectacle. The new regime in Iran—and many
other individuals in that region and elsewhere whose views aligned with it
—would have wanted it no other way, except one which culminated in his
death (while he was in New York for the gall bladder surgery, crowds of
Iranian college students in the United States on visas chanted “death to the
Shah” outside his hospital room).110
By the end of the weekend a decision had been made, such as it was:
nothing would happen for 10 days or so. The idea was that this delay, which
the physicians all agreed would be a minimal risk to the Shah, might allow
tempers to cool. Then, perhaps, a compromise could be reached. DeBakey
composed a short news release with a minimal cover story.
March 16, 1980
Report No. 1
The physicians who have been called in consultation to see the Shah together with the
Panamanian physicians who are charged with his care have carefully reviewed and analyzed all
the studies that have been performed, and on the basis of these analyses, it was their unanimous
opinion to defer surgery with the view of preparing him for the operation at a later date when his
condition is optimal. The consulting physicians will remain in contact with their Panamanian
colleagues.
The Baylor team returned home on Monday, March 17. On Thursday, the
President’s Chief of Staff, Hamilton Jordan, flew down from Washington to
discuss the situation.
DeBakey told Jordan that the hospital in Panama was subpar, and the
surgeons there hostile. He would return to do the operation if the Shah
wished him to do so, but only with his own team and complete authority.
Even then, the limited facilities would entail serious risk of postoperative
complications, and this fact needed to be acknowledged. DeBakey
suggested that moving the procedure to another venue would be the best
thing. Houston would be ideal, but since this was politically impossible,
perhaps a destination in Egypt could be arranged. DeBakey had heard that
the Egyptian President Anwar Sadat was willing to accept the Shah. He had
also been to the Cairo hospitals before and knew their capabilities.
Moreover, he had actually trained some of the surgeons there. Jordan
doubted if Egypt was a viable option, but would pass the idea along. He
then left Houston for Panama.
The Shah contacted DeBakey the next day, Friday, March 21, with the
information that he had, in fact, been invited by Sadat to Egypt. He was
headed to Cairo in 48 hours. Would DeBakey and his team come there to do
the operation? By all means, DeBakey replied.
On the next day, de Paredes called Gerald Lawrie to announce that the
Shah’s operation would go forward on March 29, in Panama, and the
Houston team could come down the day before. The call was not returned.
On Wednesday, March 26, the Baylor team left Houston for Cairo on a
private Boeing 707. The personnel consisted of DeBakey, Lawrie,
anesthesiologist Sharon Storey, Jr., blood bank specialist David Yawn,
hematologist Jochewed Werch, DeBakey’s long-time surgical nurse Ellen
Morris, and technician Betty Riley. In addition to surgical instruments,
anesthetic medications, an IBM blood separator, and frozen packed red
blood cells, the plane had room for mattresses on the floor. They were used.
The 13-hour flight landed in Cairo at 9:00 PM local time. The trip was
secret, but news reporters sniffed it out as always and were waiting at the
airport. So was Robert Armao. He and DeBakey went straight to see the
Shah at the Maadi Hospital. This was a military facility that had largely
been gutted of equipment during the 1973 war. Two Egyptian physicians,
hematologist A. M. Afifi and surgeon Mohammed Kamal Ahmed, met him
there. The reception was warm and friendly—in sharp contrast to that in
Panama. Ahmed had been a cardiovascular surgery fellow at Baylor in
1964. The Shah seemed more comfortable than he had in Panama, which
was hardly surprising. His physical appearance was unchanged.
The following morning the Baylor team left the Meridien Hotel to begin
preparations at the Maadi Hospital. Ellen Morris set about a meticulous
cleaning of the designated operating room, by hand. Lawrie descended to
the basement to collect and assemble whatever abandoned equipment could
be brought to bear.114 DeBakey joined the Egyptian physicians in closely
examining the Shah. The royal blood counts were getting worse: the
platelets were now just 30,000/mm3, the white blood cell count was
2,000/mm3, and the Shah was now anemic. Although his chest x-ray was
normal, he had a cough and a fever that waxed and waned. His spleen was
significantly larger, too. In consultation, the physicians all agreed that the
time for surgery was at hand. Once it was clear that the IBM separator was
working well (there were transient issues regarding power compatibility
with the Egyptian electrical system) and that the necessary blood products
—platelets, red cells, plasma—were at hand and ready, the operation would
proceed.
By Friday evening, March 28, everything was prepared. President Sadat
arrived at 7:15 PM to converse with the surgeons and wish the Shah well.
The operation commenced at 8 PM.
The operating room was a crowded place that night. In addition to the
surgical team—DeBakey, Lawrie, Ahmed, and a surgical oncologist named
A. Fouad Nour—Kean and Hibbard Williams were there, as well as George
Flandrin.
The operation began with a shock: when the abdomen was opened the
Shah’s liver came into immediate view. The entire organ was milk-white,
nearly completely replaced by tumor. Whatever else transpired, the Shah’s
condition was unquestionably terminal; the only issue was time. Proceeding
with removal of the spleen would give him more of that, so the team went
forward with the operation.111
The splenectomy procedure itself was not particularly complex or
challenging—although the Shah’s spleen was enormous at 1,900 mg (about
10 times the normal size). The tail of the pancreas was imbedded in the
hilum—or root—of the spleen and had to be divided and oversewn as well.
The surgeons noted that the pancreas had significant fibrosis, which
indicated prior episodes of pancreatitis; this actually made the closure of the
tissue easier since it was thicker and tougher. They then closed the
peritoneum—the thin membrane lining the abdominal cavity—over the area
where the spleen had been. There was no bleeding or leakage so, after
discussing it, they opted not to put a drain into the space left by the excised
spleen. That was the custom at Baylor. Before closing the incision, they
took a biopsy from the left lobe of the liver, and Flandrin took a bone
marrow biopsy from the left iliac crest. The whole operation took 80
minutes.
The Shah was taken from the operating room to a special, secure ICU
area for recovery. DeBakey stayed with him until he was awake and clearly
stable. Lawrie spent the night—and next day—at the bedside.* The
immediate postoperative laboratory values were most encouraging: the
hemoglobin concentration was normal, as were the platelets at
130,000/mm3 and the white blood cell count at 5,100/mm3. The hospital
sent out a press release that the operation was a success.
When DeBakey returned to the Meridien Hotel at about 2:00 AM he was
met by a massive media contingent. He had to be smuggled through a
service elevator like a mop-top Beatle in New York City to make it to his
room.
A formal news conference came the following day, after DeBakey had
examined the Shah and found him to be recuperating nicely. The lab results
continued to improve, as well.
On Sunday, the American medical team was invited to the Presidential
Palace, where Sadat gave them medals. DeBakey’s was the highest honor:
the Merit Order of the Republic, First Class.
By now the biopsy results had come back, and they were not encouraging
—though scarcely surprising to those who had been at the operation. Both
the spleen and liver showed infiltration with lymphocytes: malignant cells.
A conference of physicians was held to discuss the next moves; the
Empress attended. DeBakey advocated against restarting the chemotherapy
—it would be of little value in affecting the Shah’s prognosis and would
both compromise his quality of life and subject him to increased risk of
infection. Flandrin, who had seen the Shah respond well to chemotherapy
over a number of years, insisted that it was worth a try. The Empress sided
with the French physicians she knew. She also wished to keep the biopsy
results secret, both from the Shah and the press, but DeBakey pointed out
that doing so would be a mistake. The truth would be revealed through
some source before too long—it would be better all around if the physicians
and family were the origin of the news from the start. DeBakey again wrote
the release himself, incorporating Flandrin’s optimism about the
reintroduction of chemotherapy.
March 31, 1980
On this third postoperative day the patient has continued to progress in a most satisfactory
manner. He is now out of bed and has been moved from the intensive care unit. All vital signs
are normal and hematological examination shows that the hemoglobin, hematocrit, white blood
cell count and platelets have been restored to normal levels. He is comfortable, taking fluids by
mouth and in good spirit.
Histological studies of the bone marrow revealed normal activity. Histological studies of the
spleen and the liver revealed some lymphocytic infiltration. For this reason chemotherapy which
had to be discontinued 3 weeks ago because of the adverse effects of the hypersplenism on the
blood will now be resumed with greater confidence in light of normal bone marrow activity and
in light of the good response he had to chemotherapy during the past several years.
Over the next few days the Shah continued to recover uneventfully.
DeBakey made an overnight trip to Jordan, where he dined with King
Hussein and received another medal (he also visited the American-born
Queen Noor, who had just given birth to a baby boy—who would become
Prince Hamzah bin Hussein—and was still in the hospital). Finally, on
Wednesday, April 2, DeBakey and his Houston team took their leave of the
Shah, who expressed his thanks in gracious terms. The exiled ruler sadly
joked that, unlike Sadat and Hussein, he had no decoration to give
DeBakey. He was discharged from the hospital one week later and went to
the Koubbeh Presidential Palace north of Cairo.
Unfortunately the Shah’s subsequent clinical course was far from
uneventful. Shortly after DeBakey returned to Houston the chemotherapy
regimen was restarted. A week or so later the Shah began to feel poorly,
with nausea and vomiting, a low-grade fever, abdominal pain, and a
neurologic deficit in the leg called foot drop. The white blood cell count had
decreased to just 2,100/mm3.
DeBakey flew back to Cairo on April 26, to check on his patient. In the
meantime the chemotherapy had been discontinued. On DeBakey’s exam
there was no abdominal pain or tenderness, and the Shah was taking food
again in a day or so. Lab values also returned to normal, and the foot drop
improved. There was a slight increase in the serum concentration of
amylase—an enzyme secreted by the pancreas that can be significantly
elevated when the organ is leaking—but the value was the same as it had
been when DeBakey left Egypt the first time. All the physicians—DeBakey
and a regiment of Egyptians—were worried at the time about the possibility
of a pancreatic leak or an abscess at the prior surgery site, but they all
“agreed that there was no clinical or laboratory evidence of a subphrenic
infection and that all his symptoms were probably caused by a reaction to
the cancer chemotherapy.”113
DeBakey returned home on April 29. Before leaving, he recommended
that if any chemotherapy be administered, it be done in low doses.
From this point on DeBakey and Kean were not included in the
decisions, which were now the exclusive domain of the French physicians
who held the Empress’s confidence. The Shah’s clinical course was a
gradual and steady spiral toward death. Any delicate balance between the
quixotic attempt to treat the Shah’s cancer with chemotherapy and the
regimen’s inevitable impairment of his immune system ultimately proved
impossible to maintain. In his immunosuppressed state, he developed
several infections in the final weeks, including pneumonia, cellulitis of the
thigh, and an infected pancreatic pseudocyst with subphrenic abscess. It
bears noting that these were all treated successfully weeks before his death.
Chemotherapy was eventually discontinued in order to help treat (and
prevent further) infections, but, given the advanced status of the cancer, the
outcome was inevitable; the Shah died on July 27.*
10.11 Journal of Vascular Surgery

The 1980 meeting of the DeBakey International Cardiovascular Society was
scheduled for late November in Baghdad, Iraq, an interesting and ironic
twist in light of the role of its namesake in the terminal care of the former
Shah of Iran just a few months earlier. Yousif Al-Naaman, who had trained
in Houston in the 1950s and was a leading academic surgeon in Iraq, as
well as President of the Society at the time, was in charge of local
arrangements. Most of the members had never been to this ancient Middle-
Eastern nation and were looking forward to the experience, but after many
plans had been finalized, fate took a hand. Iraqi ruler Saddam Hussein
inaugurated one of the bloodiest wars of the twentieth century by sending
his armed forces into full-scale attack against the neighboring new Islamic
Republic of Iran on September 22. There was obviously no hope of staging
the conference in Baghdad in the midst of such a crisis (or even in the
following year, which Al-Naaman also tried to arrange). Instead, the Society
rescheduled the next meeting for April 1981 in the familiar, albeit less
exotic environs of Houston. That meeting featured a “grand finale”
barbeque at George Morris’ sprawling “Lazy M” ranch about 60 miles north
of Houston, which may have been more mundane than the original locale
but entailed considerably less risk.114
A special guest at this 1981 meeting was Alton Ochsner, who was also
given the Michael E. DeBakey Award, embodied in a small, tabletop
version of the bust commissioned by Princess Lilian and King Leopold.115
After returning home, Ochsner sent DeBakey a heartfelt letter thanking his
protégé for the distinction, as well as the opportunity to spend some time
with three-and-a-half year old Olga.
April 7, 1981
Dear Katrin and Mike:
I cannot tell you how much Jane and I enjoyed being in Houston. We were greatly honored that I
should be asked by your society Mike, to be the principal speaker and to receive the award. This
is something that I cherish more than anything else, because of our close relationship and great
affection and admiration that I have for you and your family. It is something I will never forget
and I will always cherish.
We enjoyed the brunch with you Sunday morning. It was such a nice affair and such a thrill to
see Olga. How she has grown and what a doll she is. I know what a great joy she is to both of
you. . . .
Thanking you again and with much love and affection to all of you from both Jane and me, I
am
Yours very sincerely
Alton Ochsner, M.D.115
Just five months later Ochsner died, after a brief illness. He was 85 years
old. DeBakey wrote a lengthy obituary for his great mentor that was
published in the journal Surgery, which Ochsner had founded along with
Owen Wangensteen back in 1937.
I recall my first impression of Dr. Ochsner when I was a medical student—a vibrant, dynamic,
energetic, and charismatic man. His eyes sparkled and his face beamed as he bustled through his
long, overfilled days. But when he attended to a specific task, whether it was teaching a class,
operating on a patient, writing a paper, or directing research, his attention was riveted on that
task and that task alone. I was transfixed by his words when he lectured and by his surgical
dexterity in the operating room. To the very end his mind was exquisitely keen, fertile, and
active, always analyzing, conceiving, and developing ideas and devising ways to improve
surgical techniques. He had the personality of the legendary surgeon: a decisive man—a man of
wisdom and of action. Is it any wonder that after he asked me to work with him, I never gave
further thought to any specialty but surgery?116
In 1981, the Baylor Department of Surgery faculty consisted of DeBakey,
Professor and Chairman, along with seven full professors: George Jordan,
Paul Jordan, Arthur Beall, George Morris, Stanley Crawford, Jimmy
Howell, and George Noon. Kenneth Mattox, Gene Guinn, Charles
McCollum, and Gerald Lawrie were the Associate Professors, with five
Assistant Professors and three Instructors. With this team of veteran,
talented surgeons and their corps of residents and medical students, the
operating rooms at Methodist Hospital, as well as Ben Taub and the VA,
were consistently running at full capacity from dawn to night.117
One student who spent three months on DeBakey’s service during the
summer of 1982 was a young Berliner named Matthias Loebe. When
DeBakey found out where Loebe was from, he reminisced aloud to his
young charge about the far-off days with Martin Kirschner in Heidelberg.
Memories of touring the countryside with Ernst Schanz during the spring
wine festival were particularly vivid. DeBakey wondered what had ever
happened to his old friend, from whom he had heard nothing since before
World War II. Probably, he had lost his life in the terrible conflict; after all,
DeBakey had personally witnessed a devastated Germany in the spring of
1945. On his return to Berlin, Loebe decided to try and find out.118
He contacted Professor Zenker in Munich, who had also been in
Heidelberg during DeBakey’s tenure and might remember the German
resident who spoke excellent English and drove his own car. Loebe’s
instincts were correct: Zenker not only knew who Schanz was and what had
happened to him—he was very much alive—but he knew where he could
be found.
As it happened, Ernst Schanz had been an army surgeon during the war
and had eventually become Chief of Staff at the Wehrmacht hospital in
Linden/Westfalen. He had survived the conflict and, after its conclusion,
remained in this town, opening up his own hospital/clinic. After many years
caring for the local populace, Schanz had retired and built a home in Porta
Westfalica.
DeBakey contacted Schanz in July 1983 and informed him that he would
be visiting Germany later that summer. In September, DeBakey and Schanz
renewed their friendship in Hamburg, almost exactly 47 years after they had
last parted ways in Heidelberg.119
In April 1981, DeBakey was given the Distinguished Service Award by
the oldest and most prestigious surgical organization in North America, the
American Surgical Association. The award, also called the Medallion for
Scientific Achievement, is the highest honor given by the Association and is
not an annual event (it was not given out again until six years later).
DeBakey was the seventh surgeon to receive this distinction—the six prior
winners were Lester Dragstedt, Robert Gross, Owen Wangensteen, Robert
Zollinger, Francis Moore, and Jonathan Rhoads.120
Five of these illustrious individuals were, primarily, gastrointestinal
surgeons. Gross was a pediatric surgeon who, as we have seen, made his
name with ground-breaking early work in congenital heart disease.
DeBakey, though, was the first honoree whose primary field of endeavor
was surgery in acquired diseases of the cardiovascular system. In a sense,
this represented a coming of age.
The discipline of vascular surgery had, by the early 1980s, undergone
significant evolution from its humble beginnings. This change was not
limited to technical aspects, but was also reflected in educational,
certifying, and practice patterns. From its earliest days, surgery of the blood
vessels was perceived as an extension of the techniques and clinical practice
of general surgery. This fact was reflected in the very name of the first
American vascular surgical association, the Society for—rather than of—
Vascular Surgery. More than three decades had passed since then, however,
and there were now a number of postgraduate fellowships in the specialty,
as well as a defined, special certification from the American Board of
Surgery. In addition, all across the country there were numerous
practitioners who identified themselves as vascular surgeons and were
considered the same in their communities. One thing that was missing,
however, was an official periodical dedicated to vascular surgery.
Abortive efforts had been made at instituting just such a thing in both the
1960s and 1970s, but the very surgeons most likely to embrace (and, not
coincidentally, subscribe to) a vascular surgery journal chose not to support
the idea. When canvassed during those decades, members of both the
International Society for Cardiovascular Surgery (ISCVS) and the Society
for Vascular Surgery (SVS), the most important organizations devoted to
such work, voted against a new specialty journal. There were reasonable
concerns that sufficient research material to support such an independent
venture was not available and that such existing periodicals as Surgery and
the American Medical Association’s Archives of Surgery did a pretty good
job of publishing vascular surgical papers, anyway. Moreover, these
journals were well-established and comfortable, and the surgeons who did
vascular procedures in those decades still mainly identified themselves as
general surgeons.121
By the 1980s, though, all that was changing.
In the fall of 1981, the American agents of a French medical publishing
house called Masson approached DeBakey about establishing a “major
journal concerning vascular surgery.” In Masson’s vision this would be a
mainly Baylor affair, DeBakey acting as Editor with Stanley Crawford and
George Morris as Associate Editors.122
After reflecting on the idea, though, DeBakey decided to bring it up
before the ISCVS and the SVS, who happened to be holding a joint
conference in Boston the following June. At a combined business meeting
of the councils of these two organizations, on June 16, DeBakey asked the
board members to consider the idea of supporting a new vascular surgery
journal.*123
This was the sort of thing that called for study by a committee, and a
four-member ad hoc one was appointed, with John L. Ochsner as the chair.
By October this committee had reached its conclusion and recommended
creation of a new independent journal to be sponsored by the two societies.
An editorial staff was recommended, too, composed of DeBakey as editor-
in-chief and senior editors D. Emerick Szilagyi of Detroit’s Henry Ford
Hospital as well as Jesse Thompson of Dallas.
The SVS and ISCVS councils were more comfortable working with the
familiar C. V. Mosby Publishing Company out of St. Louis, and Masson,
who had been an instigator of the idea, was left out in the cold.
One of the primary duties of the editor-in-chief was to review articles for
publication. Of course, DeBakey had been on the editorial board of many
publications over the years, along with extensive experience doing much
the same thing in the Army during the war. As matters evolved, the senior
editors and an editorial board of 26 prominent vascular surgeons did a great
deal of the reviewing, but DeBakey made the final decisions regarding
publication. Since it was owned by the SVS and ISCVS, papers from the
annual meetings of these organizations were published in the new journal.
At first, in fact, these were nearly all that were published, but in time
articles from other, regional vascular societies and unsolicited papers
became more abundant.
DeBakey suggested a name for the new publication: the Journal of
Vascular Surgery. The editors agreed that this title was succinct and
accurate. Crucially, a library search determined that no such name existed
among the rest of the world’s literature. In the summer of 1983, however,
Mosby was contacted by an attorney for an organization called, “The
Angiology Research Foundation.” No one on the editorial board had ever
heard of this group or their alleged quarterly magazine called Vascular
Surgery. Nevertheless, the attorney indicated that the new Journal of
Vascular Surgery sounded too much like his client’s publication, the literary
value of which would be diminished amid what surely must be widespread
public confusion. He was preparing litigation.125
Mosby’s attorney reasoned that “Vascular Surgery” was not a
copyrightable name but the designation of a discipline, and advised
inaction. The threat vanished before long.
The first issue of the Journal of Vascular Surgery appeared in January
1984. As DeBakey had anticipated, and the joint council of the SVS and
ISCVA had endorsed by their action, the journal became the primary outlet
for clinical and research work in the field. He remained editor–in-chief of
what has come to be known colloquially as “JVS” until 1988, by which
time the readership had grown to more than 7,000.126
10.12 CMV
The most important reason that vascular surgery existed as a specialty at all
was atherosclerosis, of course, yet—despite years of intense research
funded at the highest levels—the fundamental underlying cause of the
disease remained controversial and, in the minds of many, elusive. Certain
risk factors had been identified—hypertension, diabetes, smoking,
hyperlipidemia, obesity—and these were already so well established that
they were ingrained in the public consciousness. Indeed, these risk factors
became so synonymous with the pervasive disease that they came to be
identified in the population at large as the causes. In the labs and on the
wards, though, the understanding was different.
DeBakey’s friend and colleague Antonio Gotto was one of the main
proponents of the theory that elevated cholesterol and lipid levels are
responsible for atherosclerosis. DeBakey himself was not so sure.
In 1987, reviewing the massive Baylor experience and its associated
database—information from some 15,000 patients—DeBakey and his
colleagues reported that cholesterol levels were unrelated to the rate at
which atherosclerosis developed in major arteries. Moreover, in 1,400 other
patients, all of whom had undergone coronary artery bypass surgery, the
rate of recurrent disease was unrelated to their cholesterol levels. To
DeBakey and others, it seemed that—although cholesterol and its related
compounds might play a role in the development of atherosclerosis—
something else had to be at work.127
After a time, the many sensible but eventually blind alleys that research
efforts had explored led the investigators to consider more exotic
possibilities.
In 1983, DeBakey and the Baylor virologist Joseph Melnick published an
article in the high-profile British journal Lancet that demonstrated the
presence of portions of the common cytomegalovirus (CMV) in the walls of
arteries in patients with atherosclerosis.128
CMV is a virus that infects the majority of the population. From 50% to
80% of the US is infected by age 40. Typically, CMV infection is—at worst
—accompanied by a mild viral syndrome similar to mononucleosis. It is
often entirely asymptomatic. Thereafter the virus lays dormant, ostensibly
never making its presence known again in the course of its host’s life. One
of the regions where it can reside in this permanent or temporary quiescent
stage is the endothelial cells lining blood vessels.
A few years after the initial report, in 1987, the Baylor group reported a
follow-up study in which it was reported that patients with atherosclerosis
who came to require vascular surgery had abnormally high levels of
antibodies to CMV.129
The implication was that this virus might be the elusive cause of
atherosclerosis, possibly through a cycle of latency and active infection
leading to a sustained inflammatory state in the artery. The ubiquity of
CMV certainly conformed to the known near-universality of the arterial
disease, and the concept of chronic inflammation as a source of many
prominent disease entities was well afoot.
This was not, in fact, even the first time it was theorized that
atherosclerosis was caused by an infectious agent. As far back as 1908, the
legendary Chief of Medicine at Johns Hopkins, Sir William Osler, had
considered such a possibility.130 Over the years other possible pathogens
had been brought up for consideration, but, for the most part, the concept
had fallen into disfavor before DeBakey and Melnick resurrected it in 1983.
The field remains an active one, with still more microbial suspects under
scrutiny—including CMV.
While the fundamental underlying cause of the disease was being sought,
those on the metaphorical front lines in the fight against it recognized that
there was benefit from practical observations of the process. In a 1985
follow-up to the paper on “Patterns of Atherosclerosis and Rates of
Progression” from seven years before, DeBakey, Lawrie, and Donald
Glaeser, who was Director of the Sakowitz Cardiovascular Computer
Monitoring Research Lab at Baylor, analyzed the data from no fewer than
13,827 patients. They published their findings in the Annals of Surgery as
“Patterns of Atherosclerosis and Their Surgical Significance.”
What the authors found largely confirmed their previous reports as to the
anatomic distribution of the disease. They identified five areas where
atherosclerosis most commonly arose: (1) the coronary arteries, (2) the
major branches of the aortic arch, (3) the visceral branches of the abdominal
aorta, (4) the terminal abdominal aorta and its major branches, and (5) a
combination of two or more of these areas occurring simultaneously.
Patterns of progression and recurrence were complex but identifiable.
Perhaps the most important take-home message for vascular specialists, and
all physicians, was that even after successful treatment, patients with
significant atherosclerotic disease required close follow-up for the course of
their lives.131
10.13 NASA
After the disastrous results of cardiac transplantation in the late 1960s, most
medical centers that had tried the operation gave it up, including the Baylor
College of Medicine and Methodist Hospital. Some soldiered on, in the
research labs for the most part, trying to combat the seemingly
insurmountable obstacle of rejection. A breakthrough came with the
introduction of the drug Cyclosporine A, which was isolated from a fungal
source in the mid-1970s.132 It was found to have significant
immunosuppressive effects, and, by 1984, the Food and Drug
Administration had approved the new wonder drug for clinical use.
Transplants of all sorts reaped immediate benefit.
Buoyed by this turn of events, DeBakey—along with George Noon—
approached the Methodist Hospital administration about restarting the heart
transplantation program.* There was some hesitation, which was certainly
understandable given the previous experience, but nothing approaching
genuine opposition. Once the decision had been made in the affirmative, a
huge new transplant team, 35 members strong, was established.133
By October 15, 1984, the team was performing its fourth heart transplant
of the new Cyclosporine era. This patient happened to be an engineer at the
nearby NASA Johnson Space Center, David Saucier, a circumstance that
would turn out to be propitious.134
Saucier’s operation and postoperative course went smoothly, and, during
his convalescence, the engineer conversed freely and at length with his
surgeon. The issue of organ donor scarcity arose on one occasion. This was
a vexation with which DeBakey was well familiar, but Saucier was only
now coming to understand. Just as he had felt in the 1960s, DeBakey
continued to be convinced that the best solution to this shortage of organs
was a workable artificial heart. Saucier listened and, in his status as a
transplant recipient, soon found a new purpose that intertwined with his
talents: “Since my own transplant, I have spent a lot of time visiting people
waiting for a donor heart,” he said. “Sometimes they don’t make it and it’s
very tough to watch people struggle so valiantly and then lose the battle. I
feel a real sense of urgency to come up with a practical alternative to
transplant surgery.”135
One of Saucier’s areas of expertise at NASA was fuel pump technology
for the space shuttle. Six months after the operation he was back at work
and infused with a desire to solve this new problem, which he had not even
known existed before. Saucier arranged for a handful of fellow NASA
engineers to meet with DeBakey, Noon, and the other Baylor staff to
discuss ideas. One of these was Jim Akkerman.
It was interesting. The day they showed up, two great big limousines came, and there were six
doctors in each of the limousines, and they had on their pinstriped suits, and there was the
doctor of hematology and the doctor of hemodynamics and the doctor of hemo-this and hemo-
that. And they brought a big box full of blood pumps that they had worked on, all of them had
gears and electric motors, and I’m a mechanical engineer and it just made my heart go pitter pat
to see all of this machinery.136
The meetings were initially informal and even off-hours. The NASA
group tried to grasp the bioengineering lessons that had been learned over
more than 20 years of artificial heart research, dating back to the early days
of Domingo Liotta and C. William Hall. They studied the old devices and
data, bringing a wealth of knowledge of their own to the table with regard
to fluid pumping.
Of course, others had been working on the problem, too. In 1982, a
dentist named Barney Clark underwent implantation of a total artificial
heart built by University of Utah physician Robert Jarvik. Clark lived 112
days with the “Jarvik 7” heart, tethered to a 400-pound pneumatic
compressor—not unlike Haskell Karp had been—before dying of
multisystem organ failure. The case made headlines around the world.
What DeBakey was after was not a total artificial heart, however. From
his perspective that idea was now shelved, possibly for good. He was
looking to harness the explosion in technology of the late twentieth century,
especially miniaturization, to perfect the LVAD as a bridge to
transplantation, a support for the failing heart until it could recover, or even
as a permanent augmentation. In their spare time, the NASA engineers went
to work.
The National Heart and Blood Vessel Research and Demonstration
Center at Baylor and Methodist Hospital, which had been founded on the
basis of a competitive grant in 1974 and moved to the Alkek Tower four
years later, ceased to be funded by federal sources at the beginning of 1985.
This might have been a devastating event for the institutions involved, and
particularly for the individuals working and conducting research in the
facility, but private resources—with the appropriate nudge—came to the
rescue. In March, Baylor College of Medicine President William Butler
announced, along with a fund raising campaign for the purpose, that the
Research and Demonstration Center would now become the DeBakey Heart
Center. The Center’s namesake—who established a foundation to help
support the project—would be the overall Director, with Antonio Gotto
serving as Scientific Director. Soon thereafter, the new transplantation
group would be folded into the endeavor.*137
This was not the only new project DeBakey and Gotto collaborated on in
1985. In a follow-up to their successful book The Living Heart, the authors
this time turned their attention to practical nutritional aspects of minimizing
the risk of developing cardiovascular disease (in 1980, Gotto had been
instrumental in the opening of a heart-healthy restaurant called Chez Eddy
in the new Scurlock Tower across the street from Methodist Hospital).
Written along with a dietitian and clinical psychologist, The Living Heart
Diet would become a New York Times bestseller.139
A bestseller of a different kind sprung from the pen of E. Stanley
Crawford and his son, John L. Crawford II, in that same year. Over the
previous two and a half decades the elder Crawford, who had been one of
DeBakey’s first recruits to Baylor out of Edward Churchill’s Massachusetts
General Hospital residency back in 1954, had become the doyen of aortic
surgery. Expanding on the first operations done for complex aortic
pathology at Baylor in the 1950s, he had polished and perfected the
techniques over the years and amassed a tremendous number of successful
outcomes in some of the most daunting surgical scenarios. In his 362-page
book, Diseases of the Aorta: An Atlas of Angiographic Pathology and
Surgical Technique, Crawford discussed aortic problems in surpassing
detail.140 He discussed the pathologic characteristics, demonstrated the
usual findings on imaging studies, especially arteriography, and—the piece
de resistance—demonstrated his surgical approaches in a clear line drawing
format, accompanied by concise text descriptions. The book became an
instant classic (the following year Crawford and his colleagues published an
article containing an anatomic classification of thoracoabdominal aortic
aneurysms that remains the standard).141
In many ways, Crawford was reminiscent of DeBakey’s late friend and
colleague, Idys Mims Gage. Both were superb clinicians and outstanding
technical surgeons. Although committed academics, both men were happy
in their situation and eschewed political scheming for high place: Gage was
content to be Ochsner’s second-in-command, and Crawford understood that
Baylor would always be DeBakey’s show.† Neither sought greener pastures.
Both were well-known purveyors—masters even—of a brand of humor that
might best be characterized as earthy. Unfortunately, both were also heavy
smokers of Picayune cigarettes—a brand of legendary strength
manufactured in New Orleans. Outside the hospital, the native Alabamian
Crawford was also a devoted fisherman and hunter, memorably leading
annual white-winged dove hunts in Mexico.142
As Director of Baylor’s Vascular Surgery Fellowship training program,
Stanley Crawford became particularly well known for his Wednesday
morning conferences, which were clinicopathologic seminars in the classic
fashion—not entirely different from Alton Ochsner’s old “Bullpen.”
Physicians and trainees of every stripe and training level attended them.
Crawford led the conferences with élan, and invited specialists from across
the spectrum to participate in the analysis of the presented cases. Anyone
who showed up was fair game for a question—and all who attended
benefitted from the combined experience and expertise.
Tales of Crawford’s unique personality are countless, and recalled by his
trainees and co-workers with affection. Reportedly, on at least one occasion
when the extent of the aortic aneurysm was difficult to gauge in the
operating room, he simply slipped off his surgical glove and reached into
the patient’s chest with his bare hand, remarking in a matter-of-fact manner
that he could feel things better that way.143 Crawford’s smoking habit was
pervasive, and he would sometimes bring a lit Picayune into the operating
room itself while a patient was being prepped, hiding the cigarette behind
his back and cupping his hand over his mouth in a makeshift mask. When
an inspector noticed the burn marks from cigarettes on a wooden shelf
above the scrub sunk and inquired what they might be, Crawford’s residents
coolly responded that the OR might have termites.144
Sadly, Crawford and Gage had another thing in common—both suffered
debilitating strokes. One day in January 1991, Crawford was relaxing
between cases in the surgeons lounge at Methodist Hospital (as usual,
smoking a cigarette) when his colleagues noticed him slump over. Jimmy
Howell asked if he was having a headache—Crawford, like DeBakey—
suffered from migraines—but there was no reply as the cigarette fell to the
floor. At first he seemed to be only mildly affected, and he was admitted to
the ICU for observation, but before long the symptoms were profound.
Crawford’s carotid artery was completely occluded, which eliminated the
possibility of surgical intervention.145
The disability from this stroke prevented any further clinical activities
and, sadly, Crawford was also unable to deliver two important named
lectures he had been scheduled to give that year, the John Gibbon and John
Homans talks for the American College of Surgeons and Society of
Vascular Surgery, respectively. Instead, his young trainee and colleague
Joseph Coselli, who would carry on his legacy as a master of
thoracoabdominal aortic aneurysm surgery, gave the Gibbon speech in
Crawford’s absence, and his son John presented the Homans lecture.
Stanley Crawford was in attendance, confined to a wheelchair.146
On the other hand, Crawford was not about to let his misfortune keep
him from his beloved hunting, and, according to reports, he had a special
rig made for his “snake-charmer” shotgun to permit this continued
indulgence.147
Crawford died of lung cancer on October 27, 1992, at the age of 70. He
was universally mourned as a master of surgery, as well as a researcher and
educator par excellence.
Through the first 76 years of his life, DeBakey had no significant health
problems. Despite caring for thousands of patients with cardiovascular
disease, he had never had an EKG—he never felt the need. Although he
always took the stairs—considering the open doors of an elevator, in the
words of one writer, “an unthinkable invitation to lethargy and sloth”—
DeBakey never intentionally exercised for its own sake.148 Profiles in the
lay press described his Spartan meals: coffee and a banana for breakfast,
half-eaten sandwiches in his office. He was known to favor Tabasco sauce
on everything and to carry peanuts or pistachios around to snack on during
the day. Ben Taub always had candy in his hospital room, and DeBakey
would quietly take a piece or two at his visits while gently checking his old
friend’s pulse. He had burgers brought in on a frequent basis, both for
himself and, when cases ran late, for the OR staff.149
On Wednesday, November 21, 1984, DeBakey was admitted to
Methodist Hospital with a hemorrhaging duodenal ulcer. This required an
emergency operation, which was performed by George Jordan. In the two-
hour procedure the ulcer was oversewn to stop the bleeding, then Jordan
performed a “vagotomy and pyloroplasty.”150 This was a standard anti-ulcer
operation of the time in which the autonomic nerve to the viscera (called the
vagus: Latin for “wanderer,” which describes the nerve’s meanderings
through the neck, chest, and abdomen) is severed. Interrupting the nerve
diminishes acid secretion by the stomach—which was for many years
thought to be the main cause of ulcers. The other part of the procedure
—“pyloroplasty”—is a widening of the gastric outlet intended to make sure
that disruption of the vagus nerve does not prohibit passage of food.
DeBakey stayed in Methodist for 13 days before being discharged to
home. Awaiting him there were scores of letters, notes, and telegrams
wishing his good health and speedy recovery.
Robert Zollinger, the retired Chair of Surgery at Ohio State University
Medical Center and DeBakey’s friend since the Washington days in World
War II, sent warm regards in his inimitable style.
Dear Mike,
I read in the paper where, like the great Cushing, you are having difficulty with an ulcer. This is
easy to understand when I recall the hot sauce you put on scrambled eggs in the Hays-Adams
one morning in Washington years ago.
I made you promise one time to give an hour lecture to the students once a year. Now I am
asking you to take Wednesdays and Saturdays off—you would be surprised how much you
enjoy it! Both Dick Meiling and myself wish you a speedy recovery on Ranitidine since we are
afraid of the possible effects on your virility if you take too much Tagamet! I presume you pay
absolutely no attention to your physician.
Last night I tried to reach you by telephone but the hospital operator said you were
incommunicative and completely “incognito”! Please be nice to yourself for a few days and
years—we need you.
Zolly*151
At a special ceremony in the Rose Garden of the White House, on June

25, 1987, President Ronald Reagan presented DeBakey, along with 19
others, the National Medal of Science. Reagan called the winners, “the
heroes of the modern age.”152 DeBakey’s specific citation read, “For his
pioneering medical innovations throughout his medical career and his
unique ability to bring his vast professional knowledge to bear on public
policy as a national and international medical statesman.”153 Despite these
official accolades, however, not everyone considered DeBakey and his
colleagues heroes.
At intermittent periods since the mid-nineteenth century, individuals and
groups opposed to the use of animals in scientific research have risen up to
make their views known, often vociferously and sometimes violently. In the
Victorian era these people were known as anti-vivisectionists, an ad hoc
portmanteau of the Latin word for life and the well-known term for surgical
exploration of tissue, dissection. In the 1980s, there was one such
blossoming of the movement, manifested by a groundswell of support for
the idea of eliminating animal experimentation, both in medical research
and commercial industry. To those in favor of this, and some of their
supporters lacking sophistication in regards to the matter, advances in
technology by this time should have supplanted the need for such primitive
means of acquiring biologic knowledge as animal surgery.
The role of this kind of research in the heroic advancement of
cardiovascular surgery was, on the other hand, enormous—dating to the
efforts of Alexis Carrell and Charles Guthrie in the early years of the
twentieth century. Indeed, scarcely any of the groundbreaking advances in
surgery (or medicine, for that matter) during the scientific era up to that
time could have been accomplished by any other means. With his grasp of
these salient facts, as well as his own epoch-making contributions in the
field, DeBakey was an ideal spokesman for the contrary view to the
passionate animal rights activists and their fringe element, the anti-
vivisectionists.
In 1987, Democratic congressman Robert Mrazek of New York
introduced a bill to eliminate NIH funding to institutions that used pound
animals for research. This was a bill that was backed by a coalition of 11
humane and anti-vivisection societies called ProPet, which mustered
considerable lobbying expertise and financial resources.154 DeBakey
composed compelling op-ed pieces for the New York Times and Washington
Post in opposition to the bill.
As a patient advocate, both in and out of the operating room, I feel a responsibility to protect the
rights of patients to medical advances resulting from animal research. Had the animal legislation
now pending in Congress been enacted when I began my career, it would have prevented me
from developing a number of life saving procedures in my research laboratory.
Are we now to hold human health hostage to the right of abandoned animals to be killed in
pounds? Would animal rights activists have objected to the first kidney, heart or liver transplant?
Would they forego the protection humanity enjoys today against poliomyelitis, tetanus,
diphtheria, and whooping cough or the treatment for strep throat, ear infections, bronchitis and
pneumonia–all products of animal research? Would they have denied the 11 million diabetics the
right to life that insulin has given them–or victims of cancer the help they have received from
radiation and chemotherapy?
The American public must decide: Show we tell hundreds of thousands victims of heart
attacks, cancer, AIDS, and numerous other dread diseases that the right of abandoned animals to
die in a pound supersedes the patient’s right to relief from suffering and premature death? In
making that decision, let us use not anger and hatred but reason and Goodwill.155
The Mrazek bill was defeated in Congress.

In the late 1980s, DeBakey also began to leverage his name and
international reputation in an endeavor conceived to assist in the
development of American-style hospitals, as well as cardiovascular centers,
in various underserved parts of the world. The first of these efforts on the
part of what was known as the DeBakey Consulting Group occurred in
1990, in Turkey.156
After DeBakey performed successful surgery on a Turkish businessman
in the 1970s, a steadily increasing number of patients began to come to
Houston from that country for medical care. One of these was the Prime
Minister Turgut Özal, who underwent coronary bypass surgery in 1987.
Two years later, he was elected President of Turkey. From this point, a
veritable flood of Turkish patients—more than 200 per year—began to
inundate Methodist Hospital.157
Özal soon decided that his own country needed such facilities and
expertise in the health care field, too. Contracts were signed for Methodist
to affiliate with a hospital in Turkey, and help establish laboratories there.
But Özal wanted a new institution to be built, modeled on the academic
facilities he had seen at the Texas Medical Center, in his hometown of
Malatya, in eastern Anatolia.158
In conjunction with Turkish architects and engineers, DeBakey, along
with an American architectural firm and an international financial and
logistics consultants company, planned out what emerged as the Inonu
University hospital, an 880-bed acute care facility with high-tech critical
care capability.159
After this, further projects were developed in Saudi Arabia, Spain,
Russia, Uzbekistan, and the United Arab Emirates. For various reasons
these did not come to fruition.160
As this extramural effort proceeded, DeBakey was also instrumental in
developing a cooperative teaching and research exchange relationship for
the Baylor College of Medicine with Sweden’s famous Karolinska
Institutet. He and his counterparts in Stockholm, particularly Bertil
Hamberger, worked to establish a Research Fellowship at Baylor, as well as
a teaching exchange program, which saw prominent faculty from each
institution travel to their newly allied facility. These programs extended to
the mid-1990s.161
Back in the United States, DeBakey’s trips to Washington, D.C. on
matters of public policy and federal funding of medical research were less
frequent in his later years, but one exception would always be the National
Library of Medicine. His love of libraries from Lake Charles on was
undiminished, and he remained as devoted to the national medical
institution as he had been since his first forays into the stacks of the “Old
Red Brick.” Having been instrumental in the library’s transformation from
an Army facility to a national, civilian one, DeBakey was intimately
involved in its subsequent development over the next decades as a member
of the Board of Regents. As the century drew toward a close and the
enormous power of information technology began to be realized, the very
mission of the library shifted. No longer would its sole purpose be the
provision of biomedical information to professionals. In the era of the
internet, the National Library of Medicine would be a resource for health
information serving the entire population.*162
A key figure in this transformation was Donald A. B. Lindberg. A pioneer
in medical information technology, Lindberg became Director of the
Library in 1984, and he skillfully shepherded its evolution into the
electronic wonder it became over the ensuing years. The old Index Medicus
was converted into a computerized system in the 1960s, subsequently
becoming the library-based, searchable Medline in the following decade.164
Then, under Lindberg’s leadership—with DeBakey, as Chair of the Board
of Regents, prominently backing the effort—the library successfully
achieved one goal in 1997 with the well-publicized introduction of
PubMed. This is a free access portal to the National Library of Medicine’s
catalog, with hyperlinks to actual articles on publisher’s websites, allowing
browsers to not only find but actually read desired articles. Within some
remaining practical limitations, the introduction of PubMed permitted
everyone with a computer (or, later, hand-held device) to access the latest
medical information and research instantly.165
Notes
1. McKellar S. Artificial Hearts: The Allure and Ambivalence of a Controversial Medical
Technology. Baltimore: Johns Hopkins University Press, 2018: 72.
2. Thompson T. Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac
Frontier. Electronic edition. New York: Open Road Integrated Media, Inc., 2016: 262.
3. Letter, T. Thompson to M. E. DeBakey, July 13, 1970. DeBakey, Michael E. Michael E.
Series 2:4.
4. Letter, T. Thompson to M. E. DeBakey, September 14, 1971. DeBakey, Michael E. Michael E.
Series 2:4.
5. McKellar S. Artificial Hearts, 72.
6. Baylor College of Medicine personnel files, Selma and Lois DeBakey. DeBakey Collection.
Baylor College of Medicine Archives. Houston, TX. 2:55:10–11. Letters, Selma DeBakey to
ME DeBakey. DeBakey, Michael E. Michael E. DeBakey Archives. 1903–2010. Located in:
7. Winters WL. Selma and Lois DeBakey: Icons of Medical Communication. Methodist DeBakey
Cardiovascular Journal 2016;12(3):188–189.
8. Wendler R. DeBakey Sisters Teach Logic and Language of Medicine. Texas Medical Center
May 1, 2008.
9. DeBakey L, DeBakey S. Michael E. DeBakey, M.D.: Beloved Brother, Master Mentor,
Compatible Colleague, Professional Paragon. Methodist DeBakey Cardiovascular Journal
2009;5(3):49–56.
10. Death Certificate for Shakir Morris DeBakey [sic], June 2, 1970, File No. 41948. Texas
Department of State Health Services; Austin Texas.
11. Ibid.
12. Kennedy JH, DeBakey ME, Akers WW, et al. Development of an Orthotopic Prosthesis.
Thoracic and Cardiovascular Surgery 1973;65:673–683.
15. Memorandum, I Harrison to ME DeBakey, August 9, 1969. DeBakey Collection. Baylor
16. DeBakey ME. Successful Carotid Endarterectomy for Cerebrovascular Insufficiency:
Nineteen-Year Follow-Up. JAMA 1975;233:1083–1085.
17. Letter ME DeBakey to N France, October 6, 1969. DeBakey Collection. Baylor College of
18. Ibid.
22. Ibid.
23. Antonio Gotto, Jr. personal communication, March 5, 2019.
24. Gotto AM. Profiles in Cardiology: Michael E. DeBakey. Clinical Cardiology 1991;14:1007–
1010.
27. Brogan MR. DeBakey Fund Request Gets a Warm Reception. Periodical and date unknown.
28. Interview, Don Schanche with Michael DeBakey, Houston, August 8, 1972. DeBakey, Michael
582. Series 1:2:16.
29. Baylor College of Medicine Summer Work and Study Program. DeBakey Collection. Baylor
30. Interview, Don Schanche with Michael DeBakey, Houston, August 8, 1972. DeBakey, Michael
582. Series 1:2:16.
31. High School for Health Professions 1986 Fact Sheet. DeBakey Collection. Baylor College of
32. Michael M. DeBakey, personal communication, March 29, 2019.
33. George P. Noon, personal communication, March 28, 2019.
35. Ibid.
37. Interview, Don Schanche with Princess Lilian of Belgium, Houston, Texas, November 10,
39. Letter M. E. DeBakey to R. M. Nixon, July 13, 1972. DeBakey, Michael E. Michael E.
Series 3:10:19.
40. Letter R. M. Nixon to M. E. DeBakey, July 25, 1972. DeBakey, Michael E. Michael E.
Series 3:10:19.
41. Talking with the Enemy (August 3, 1973). Medical World News.
43. Ibid.
44. Strickland SP. The History of Regional Medical Programs. Lanham, MD: University Press of
America, 2000: Introduction.
Series 3:10:19.
47. Ibid.
48. DeBakey ME. A Surgeon’s Diary of a Visit to China. Phoenix, AZ: Phoenix Newspapers, Inc.,
1974.
Series 3:10:19.
50. Ibid.
51. Ibid.
52. George P. Noon, personal communication, June 21, 2017.
53. Ibid.
54. Ibid.
56. Gerald M. Lawrie, personal communication, March 4, 2019.
57. Kenneth L. Mattox, personal communication, March 15, 2019.
58. Notable patients of Dr. DeBakey. DeBakey Collection. Baylor College of Medicine Archives.
60. Letter J Lewis to ME DeBakey, March 28, 1975. DeBakey, Michael E. Michael E. DeBakey
Medicine Division, National Library of Medicine, Bethesda, MD; MS C 582. Series 2:4.
64. Sinatra N. Frank Sinatra: An American Legend. New York: Reader’s Digest Association,
1998.
65. Texas Monthly, April, 1979, 126.
66. A Conversation Remembering Michael E. DeBakey with Dr. Donald A. B. Lindberg and
Katrin DeBakey. https://profiles2.nlm.nih.gov/s/nlm/i/FJBBQN (accessed February 23, 2019).
67. For Dr. DeBakey and His Bride, It Was All Hearts and Flowers (August 25, 1975). People.
69. Letter Princess Lilian to M. E. DeBakey, November 11, 1975. DeBakey, Michael E. Michael
E. DeBakey Archives. 1903–2010. Located in: Archives and Modern Manuscripts Collection,
Series 2:5:18.
70. Beall AC, Guinn GA, Mattox KL, et al. Cardiovascular Surgery in Saudi Arabia. American
Journal of Surgery 1981;142:646–648.
71. Ibid.
72. Gerald Lawrie, personal communication, March 20, 2019.
73. “History of the DeBakey Artificial Heart at Baylor College of Medicine.” DeBakey, Michael
582. Series 3:8:23.
74. Noon GP, DeBakey ME, Normann NA. Left Heart Bypass as Practiced at Baylor College of
Medicine. Surgical Team 1976;5:36–38.
75. Wren C. US and Russian Doctors Implant Artificial Hearts (March 13, 1976). New York Times.
76. Bhimaraj A, Loebe M. Editorial: An Interview with Dr. George P. Noon. Methodist DeBakey
Cardiovascular Journal 2015;11(1):45–47.
77. DeBakey ME, Gotto AM. The Living Heart. New York: The David McKay Co., Inc., 1977.
78. Landers A. Keep a Check on Hypertension (October 18, 1977). St. Petersburg Times.
80. Gotto AM. Tribute to Dr. Michael E. DeBakey. Heart Views 2009;10:52–53.
81. Ibid.
82. Antonio Gotto, Jr., personal communication, March 5, 2019.
83. Kenneth L. Mattox, personal communication, March 15, 2019.
84. Program, International Congress of Cardiovascular Surgery, Athens, Greece, June, 1977.
DeBakey Collection. Baylor College of Medicine Archives. Houston, TX. 10:110:1.
85. Birth certificate for Olga Katarina DeBakey, July 29, 1977. DeBakey Collection. Baylor
86. Letter, Katrin DeBakey to Yousuf Karsh (n.d.). DeBakey Collection. Baylor College of
87. DeBakey Recovering “Very Well” (January 6, 1978). Houston Post.
88. Yousuf Karsh, master photographer off the twentieth century. Sitting 12973, February 16,
1969. Dr. Michael DeBakey, The Methodist Hospital, Houston.
https://karsh.org/sittings/debakey/.
90. DeBakey Recovering “Very Well” (January 6, 1978). Houston Post.
93. Ibid.,193.
94. Ibid., 246–247.
95. Charles H. McCollum, personal communication, March 22, 2019.
97. DeBakey ME. Patterns of Atherosclerosis and Rates of Progression. In: Paoletti R, Gotto AM
Jr., eds. Atherosclerosis Reviews, Vol. 3. New York: Raven Press, 1978: 1–56.
98. Ibid.
99. Ibid.
100. DeBakey ME. The Development of Vascular Surgery. American Journal of Surgery
1979;137(6):697–738.
101. DeBakey ME, McCollum CH, Graham JM. Surgical Treatment of Aneurysms of the
Descending Thoracic Aorta: Long-Term Results in 500 Patients. Journal of Cardiovascular
Surgery 1978;19(6):571–76. DeBakey ME, McCollum CH,Crawford ES, et al. Dissection and
Dissecting Aneurysms of the Aorta: Twenty-Year Follow-Up of 527 Patients Treated
Surgically. Surgery 1982;92(6):1118–1134. Lawrie GM, DeBakey ME, Morris GC Jr., et al.
Experience with 366 St. Jude Valve Prostheses in 346 Patients at Baylor College of Medicine.
In DeBakey ME, ed.: Advances in Cardiac Valves: Clinical Perspectives. New York: Yorke
Medical Books, 1983: 14–21.
102. Murphy ML, Hultgren HN, Detre K, et al. Treatment of Chronic Stable Angina: A Preliminary
Report of Survival Data of the Randomized Veteran’s Administration Cooperative Study. New
England Journal of Medicine 1977;297:621.
103. DeBakey ME, Lawrie GM. Aortocoronary-Artery Bypass: Assessment After 13 Years. JAMA
1978;239(9):837–839.
104. Ibid.
105. Butler WT, Ware DL. Arming for Battle Against Disease, 827.
107. Butler WT, Ware DL. Arming for Battle Against Disease, 826–880.
108. Ibid.
109. Diary of Trip to Panama: To Attend Shah Mohammed Reza Pahlavi. March 14–17, 1980;
Diary of Trip to Egypt: To Attend Shah Mohammed Reza Pahlavi. March 25–April l3, 1980.
110. Altman LK. Shah’s Surgeons Unblock Bile Duct and Also Remove His Gallbladder (October
25, 1979). New York Times.
111. Gerald Lawrie, personal communication, March 20, 2019.
112. Ibid.
113. Letter M. E. DeBakey to G. Flandrin, September 2, 1980. DeBakey, Michael E. Michael E.
Series 3:9:36.
114. 1981 DeBakey Society program. DeBakey Collection. Baylor College of Medicine Archives.
Houston, TX.
115. Letter A. Ochsner to M. E. DeBakey, April 7, 1981. Historic New Orleans Collection. Alton
Ochsner papers 262(8).
116. DeBakey ME. Edward William Alton Ochsner. 1895–1981. Surgery 1982;91(1):3–5.
117. 1981 Baylor faculty. DeBakey Collection. Baylor College of Medicine Archives. Houston,
TX.
118. Letter M. Loebe to M. E. DeBakey, July 17, 1983. DeBakey Collection. Baylor College of
Medicine Archives. Houston, TX.1:3:2.
119. Letter M. E. DeBakey to F. E. Schanz, July 25, 1983. DeBakey Collection. Baylor College of
Medicine Archives. Houston, TX.1:3:2.
120. http://americansurgical.org/awards_Medallion.cgi (accessed April 7, 2019).
121. Szilagyi DE. The Journal of Vascular Surgery: 1982 to 1990. Journal of Vascular Surgery
1995;23:1069–1075.
122. Letter, A. W. Frankenfeld to M. E. DeBakey, September 25, 1981. DeBakey Collection.
Baylor College of Medicine Archives. Houston, TX.1:3:2.
123. Szilagyi DE. The Journal of Vascular Surgery.
124. DeBakey ME, McCollum CH, Crawford ES, et al. Dissection and Dissecting Aneurysms of
the Aorta: Twenty-Year Follow-Up.
125. Szilagyi DE. The Journal of Vascular Surgery.
126. Ibid.
127. Surgeon Questions Cholesterol Role (April 9, 1987). New York Times.
128. Melnick JL, Petrie BL, Dreesman GR, et al. Cytomegalovirus Antigen Within Human Arterial
Smooth Muscle Cells. Lancet 1983;2:644–647.
129. Adam E, Melnick JL, Probtsfield JL, et al. High Levels of Cytomegalovirus Antibody in
Patients Requiring Vascular Surgery for Atherosclerosis. Lancet. 1987;2:291–293.
130. Osler W. Diseases of the Arteries. In: Osler W (ed.), Modern Medicine: Its Practice and
Theory. Philadelphia: Lea & Febiger, 1908: 429–447.
131. DeBakey ME, Lawrie GM, Glaeser DH. Patterns of Atherosclerosis and Their Surgical
Significance. Annals of Surgery 1985;201:115–131.
132. Borel JF. Comparative Study of in Vitro and in Vivo Drug Effects on Cell Mediated
Cytotoxicity. Immunological Communications 1976;31(4):631–641.
134. Ibid., 322.
135. https://www.nasa.gov/centers/johnson/news/releases/1999_2001/j00-39.html (accessed April
3, 2019).
136. Electric Heart. PBS. Aired December 21, 1999.
https://www.pbs.org/wgbh/nova/transcripts/2617eheart.html (accessed March 22, 2019).
138. DeBakey ME, Gotto AM, Scott LW, et al. The Living Heart Diet. New York: Simon and
Schuster, 1985.
139. Crawford ES, Crawford JL. Diseases of the Aorta: An Atlas of Angiographic Pathology and
Surgical Technique. New York: Williams and Wilkins, 1985.
140. Crawford ES, Crawford JL, Safi HJ, et al. Thoracoabdominal Aortic Aneurysms: Preoperative
and Intraoperative Factors Determining Immediate and Long-Term Results of Operations in
605 Patients. Journal of Vascular Surgery 1986;3:389–404.
142. Charles McCollum, personal communication, April 21, 2019.
143. Michael Reardon, personal communication, April 25, 2019.
144. Ibid.
145. Charles McCollum, personal communication, April 21, 2019.
147. Ernst CB. In Memoriam: E. Stanley Crawford, 1922–1992. Journal of Vascular Surgery
1992;17(3):618–619.
149. Michael M. DeBakey, personal communication, February 21, 2019.
150. Letter M. E. DeBakey to R. M. Zollinger, December 14, 1984. Robert M. Zollinger, MD
Collection, Spec.199301. Zollinger, Medical Heritage Center, Health Sciences Library, The
Ohio State University. 2:10:120.
151. Letter R. M. Zollinger to M. E. DeBakey, November 28, 1984. Robert M. Zollinger, MD
Collection, Spec.199301. Zollinger, Medical Heritage Center, Health Sciences Library, The
Ohio State University.
152. Scientists Receive Medals From Reagan (June 26, 1987). The New York Times.
153. https://www.nsf.gov/od/nms/recip_details.jsp?recip_id=100 (accessed April 29, 2019).
154. Orlans FB. In the Name of Science: Issues in Responsible Animal Experimentation. New York:
Oxford University Press, 1993: 214.
155. DeBakey ME. Medicine Needs These Animals (June 4, 1987). The Washington Post.
156. DeBakey Consulting Group—Turkey. DeBakey Collection. Baylor College of Medicine
Archives. Houston, TX.1:3:2.
158. Hamilton DK, Shepley MM. Design for Critical Care: An Evidence-Based Approach. Oxford,
Architectural Press/Elsevier 2010, 51.
159. Ibid.
160. DeBakey Collection. Baylor College of Medicine Archives. Houston, TX.
161. Karolinska. DeBakey Collection. Baylor College of Medicine Archives. Houston, TX.
162. DeBakey ME. The National Library of Medicine. Evolution of a premier information center.
JAMA 1991;266(9):1252–58.
163. Reznick JS, Koyle KM. Images of America: National Library of Medicine. Charleston,
Arcadia Publishing 2017, 89.
164. https://nnlm.gov/about (accessed April 11, 2019).
165. Reznick JS, Koyle KM. Images of America, 120.
*
Carroll lived three years and nine months with his transplant; Vlaco six years and two months.5
*
The case report of the first carotid endarterectomy, performed by DeBakey in 1953, was
published in 1975.16
†
In the months after the Haskell Karp operation several of the Baylor faculty members who had
contributed their efforts to the proceedings, including Robert Bloodwell and Grady Hallman, jumped
ship. As in the case of Domingo Liotta they landed, to no one’s surprise, at the Texas Heart Institute.
*
At this point Merrill was recruiting Gotto for the vacant Chair in Biochemistry, but Gotto wanted
to be in the Department of Internal Medicine—performing research but also taking part in patient
care.
*
Gotto recalls that he first met DeBakey when the Professor came to Vanderbilt to give a lecture
to the school’s Alpha Omega Alpha medical student honor society.23
†
The National Research and Demonstration Centers were created as part of the National Heart,
Blood Vessel, Lung, and Blood Act of 1972. In turn, this had been enacted largely through the efforts
of the Lasker Foundation’s Citizens for the Treatment of High Blood Pressure (which was chaired by
DeBakey).25
*
One exception was the Department of Surgery. Although DeBakey was, of course, chair of the
department at Baylor he was never Chief of Surgery at Methodist.
*
At the time of their mother’s death, Michael lived in Peru; Ernest in Tempe, Arizona; and Denis
in Austin, Texas. Only Barry was living in Houston.
*
The Nixon Administration hastened the demise of the Regional Medical Program by cutting it
completely out of the fiscal 1974 budget. The program—which had received $140 million in
appropriations the previous year—was a prime recommendation from the “DeBakey Committee”
report of December, 1964.42
*
In addition to the conversation, DeBakey received a “beautiful” pin and cufflinks.43
*
Keldysh was deeply involved in most of the early, spectacular successes of the Soviet space
program such as Sputnick and the flight of Yuri Gagarin. He was recipient of many honors and
awards from the Soviet government and scientific community, including serving as President of the
Russian Academy of Sciences.
*
One of the OR nurses, who was actually no such thing but had trained for several weeks as one
in order to accompany her husband to the then-restricted Soviet Union, was Noon’s wife, Bonnie.54
†
Mattox improvised a spectacular method of exposing the retroperitoneal structures—the aorta,
inferior vena cava, part of the duodenum, the kidneys, etc.—by rotating the abdominal viscera out of
the way. The method became known as the “Mattox maneuver.” When he mentioned this new
exposure to DeBakey, the Professor merely said, “That’s a good approach.”56
*
Karsh formally photographed DeBakey at Methodist Hospital in February 1969.88
*
This new office was a long way from the operating room suite on the second floor, and, as the
story goes, a wealthy well-wisher offered to build an elevator for DeBakey that would connect the
two. Costs and engineering challenges were considered too great, however. Instead, DeBakey was
given a special key that allowed him to override the ordinary public elevator operation and go
between floors without stopping. He only rarely used this, however: although DeBakey said that he
never intentionally exercised, he made a point of always using the stairs in the hospital.
†
Mrs. Fondren lived here until her death at age 102, in 1982.
*
Unless otherwise noted, all information in this section derives from DeBakey’s “Diary of Trip to
Panama: To Attend Shah Mohammed Reza Pahlavi. March 14–17, 1980,” or “Diary of Trip to Egypt:
To Attend Shah Mohammed Reza Pahlavi. March 25–April 3, 1980.”109
*
He was required to address the Shah only as “Imperial Majesty.”112
*
A minor industry of second-guessing and finger-pointing books and articles sprang up in the
aftermath of the events. Most of these sources have relied on incomplete, faulty, or hearsay
information to draw their questionable conclusions. Some have suggested that DeBakey was not the
proper surgeon for the case due to the mistaken impression that he was a “cardiovascular” or
“cardiothoracic” surgeon and not an abdominal or oncologic specialist. In fact, he had been a general
surgeon for many years before those specialties—which he helped establish—even existed, and he
had continued to perform general surgical procedures on his patients over the years as a matter of
course. Moreover, the Egyptian Nour was a surgical oncologist and he was scrubbed in the case. The
exact cause of the pancreatic cyst and the abscess it created is impossible to know in hindsight. It is
worth recalling that DeBakey had published the world’s largest series on subphrenic abscesses back
at Tulane—and this was the same diagnosis of his memorable practical exam for the American Board
of Surgery given by Fred Rankin in 1939. The likelihood of his missing the diagnosis at the time of
his examination in late April is, by all odds, low.
*
Two days later, DeBakey gave the prestigious Homans Lecture at the meeting of the Society for
Vascular Surgery. Rather than present a historical address or retrospective, nostalgic discourse, he
presented an unrivalled clinical series of one of the pathologies of the aorta with which he would
remain closely associated for a number of reasons, “Dissection and Dissecting Aneurysms of the
Aorta: Twenty-Year Follow Up of 527 Patients Treated Surgically.”124 This paper is a classic in the
field.
*
The long-time Methodist administrator Ted Bowen had stepped down in 1982, after suffering
several heart attacks. The CEO at this time was Larry Mathis.
*
The Demonstration Center was subsequently funded again by the NIH in 1987.138
†
It is noteworthy that Crawford did become President of a number of local, regional, and national
surgical organizations, including the Society of Vascular Surgery.
*
Harvey Cushing was one of the giants of American surgery and a pioneer of neurosurgery.
Zollinger was an intern under Cushing at Harvard’s Peter Bent Brigham Hospital in 1927. Tagamet,
or cimetidine, is a histamine-2 (H2) receptor blocker, which inhibits release of gastric acid. A
relatively new medication in 1984, cimetidine can cause diminishment in testosterone levels with
prolonged administration, sometimes resulting in sexual dysfunction in men. The effect is rare but
much was made of it in the early years after its introduction. Ranitidine, another H2 receptor blocker,
does not have such effects. Richard Meiling was Dean of the Ohio State University College of
Medicine and a long-time friend of DeBakey’s; he had been on the “short snorter” transatlantic flight
in 1945.
*
Although the concept of the Regional Medical Centers, which sprang from DeBakey’s
Presidential Commission on Heart Disease, Cancer, and Stroke, faded into unfunded oblivion in the
1970s, one related recommendation endured. A Regional Medical Library system was created
pursuant to the 1965 Medical Libraries Assistance Act, sponsored by Lister Hill, John Fogarty, and
others. This exists now as the National Network of Medical Libraries, comprised of eight regional
institutions, more than 100 resource libraries, and about 5,000 other medical libraries.163
11
Houston: 1990–2008
Now fades the glimm’ring landscape on the sight,

And all the air a solemn stillness holds.
11.1 MicroMed
The informal liaison between the Baylor Department of Surgery and the
team of David Saucier, the NASA engineer and heart transplant recipient,
went on for several years before it became an official partnership with a
Memorandum of Understanding in 1988.1 Even then, progress seemed
glacial to the surgeons, who were used to moving fast in all things. At one
point George Noon remarked to the NASA men, “I don’t know how this is
taking you so long when you are the guys who got a man to the moon.”
Their reply was, “We got a lot more money to put those men on the
moon!”2
In the first few years of the collaboration most of the money came from
Baylor, more than $1 million by 1993. NASA did not even keep track of its
contribution before 1991; in 1993—when a more formal contract was
signed—the agency began investing hundreds of thousands of dollars in the
project on an annual basis.3
The goal could be succinctly stated: a completely internal left ventricular
assist pump that minimized thrombosis (clotting) and hemolysis
(destruction of blood cells). As usual for concepts and projects so simply
expressed, the devil was in the details.
NASA used bench and animal experiments, as well as computer
simulations in sophisticated test matrices, to optimize the various
dimensions and materials of the components, eventually constructing more
than 50 different pumps along the way. The pump that emerged from the
first years of collaboration between NASA and the DeBakey team was a
cylinder not much larger than a AA battery. It had three components. The
blood entered through a flow straightener which, as the name denotes,
directed the stream in an axial orientation—straight down the cylinder—by
means of fins. Next came the impeller, the pump’s only moving part. The
impeller was comprised of six blades imbedded with rare earth magnets.
Surrounding this was a stator. When the stator was energized to produce a
magnetic field the impeller functioned as a brushless motor, spinning at
10,000–12,000 revolutions per minute. Next came the third component, the
diffuser, which redirected any tangential flow emanating from the impeller
in an axial direction.*,4
Although this model functioned reasonably well, it still caused more
hemolysis than was desirable. The NASA engineers at the Ames Research
Center in California recognized why, identifying a similarity between the
rapid pumping of blood and rocket fuel. If pressure falls too low in the
pump, the red cells can be disrupted. In similar pump conditions rocket fuel
can easily vaporize, causing cavitations that disrupt the function of the
device, possibly fatally. One of the means utilized in the space shuttle fuel
pump to combat this problem was a device known as an inducer, which was
placed just in front of the impeller in the flow stream. The inducer
eliminated low-pressure regions, and the problems they caused, at that
point.
Incorporating this design feature reduced the hemolysis sixfold, to
perfectly acceptable levels. The fact that the pump did not, by its nature,
require valves was also helpful in this regard and in preventing clot
formation. The completed device, with its combined inducer-impeller, could
pump up to 6 liters per minute against blood pressures of 100 mm Hg.
Unlike other devices that relied on calculations, this design incorporated a
flow meter to measure that important parameter. After trying polyurethane
and polycarbonate, the engineers identified titanium as the best pump
material for purposes of function, reduced thrombogenicity, and
biocompatability.6
The implantation procedure evolved over time, but in the ultimate
recommendation involved a median sternotomy, insertion of a titanium
cannula into the left ventricle for inflow into the pump, and attachment of
the outflow tract via a Dacron graft to the ascending aorta.7 The tiny pump
itself was placed in the chest wall below the edge of the ribs. Unlike the
previous artificial hearts and left ventricle assist devices (LVADs) that had
been developed in Houston and elsewhere, this pump employed continuous
flow, rather than attempting to mimic the pumping action of the heart. As a
consequence, animals—and then patients—with the device in place often
became pulseless. † This had long been thought to be so contrary to normal
physiology that it must create serious problems with end organs (a potential
issue pointed out by DeBakey and Noon themselves in the 1970s8), but that
turned out not to be the case.
By 1995, enough progress had been made for NASA to justify “seeking
an industrial partner to continue the development effort and to license the
technology for commercialization.”9
When all was said and done, this partner turned out to be a new company
formulated specifically for the purpose—with DeBakey as one of the
founders. MicroMed Systems, Limited, an LLC located in Houston, was
awarded the licensing contract. According to the agreement, any
innovations that occurred before this license were the property of NASA,
and any subsequent developments were the property of MicroMed. The
company’s three-man Board of Directors included individuals familiar with
medical device manufacturing, as well as finance and investment banking.
DeBakey was named Chairman of the Medical Advisory Board.10
The success or failure of the company depended on the commercial
applicability of what was now called the NASA/DeBakey Ventricular Assist
Device. There were many obstacles in the way, including a significant
number of competing corporations and designs and the strenuous process of
obtaining approval from the Food and Drug Administration (FDA). Animal
experiments continued apace, but it would be three more years before the
first clinical human implantation of the device.
11.2 Education
In August 1996, the Baylor College of Medicine/Houston Independent
School District’s joint effort, the High School for Health Professions, was
celebrating its 24th year of existence. The experiment had proved to be a
success by just about any criteria: it was rated at the top of the city’s schools
and was highly selective in admissions, all while maintaining its original
mission (typically, 90% of the student body was African American,
Hispanic, or Asian). That month the institution was renamed the Michael E.
DeBakey High School for Health Professions. In the years to come,
DeBakey would visit whenever his busy schedule permitted. At each of
these occasions he was invariably treated by the teenagers like “a rock
star.”11
Education was a topic that was never far from DeBakey’s conscious
thoughts. At times he was surprised and disappointed at the lack of it in
individuals with advanced degrees.
In the late 1980s, DeBakey instituted an unstructured conference for the
senior residents. He felt that their didactic conferences were sufficient, but
that they might benefit from the opportunity to discuss with him anything
that was on their minds. These meetings—entirely voluntary—were held on
Tuesday evenings from 6:00 to 7:00 PM. The residents assigned one of their
number to select a topic, which was then discussed by the attendees and
their Professor.
On a particular evening the resident whose responsibility it was to select
the agenda failed to appear, and those present found themselves staring at
each other around the conference table. DeBakey offered to select the topic,
and the trainees concurred eagerly. Their enthusiasm melted away when he
said, “Let’s talk about poetry.”12
To the Professor’s astonishment, when he asked them to identify for the
group a favorite poem, none of the residents could even name one.
I told them, “I’m really dismayed by the fact that here I have a group of so-called educated
persons who cannot think of a single poem. English literature is filled with absolutely beautiful
poetry. You represent a small percentage of the population that is supposed to be educated. You
are not just doctors; you’re a segment of the educated members of the society. Not to be able to
name a single poem indicates to me that you are certainly not well educated.”13
The residents turned the tables and asked DeBakey to name a poem.
Naturally he responded immediately with his life-long favorite, Thomas
Gray’s “Elegy Written in a Country Churchyard.”
So I said, “How many of you remember this poem ?” Not a single one remembered. I said, “I
cannot understand this. I read that poem in high school, and I read it in college many times. I
have it at home in several books of poems that I have. In any book containing a collection of
100 of the best pomes, you will find this. It concerns a philosophy of life in addition to being
beautiful poetry. That’s why I like it. I cannot understand how you could possibly not remember
it. I made them go to the library later and get it.14
Later, DeBakey’s advocacy for the humanities as an important element of
medical education found expression in a nationwide poetry contest for
medical students, administered through Baylor and named for him. The
Michael E. DeBakey Medical Student Poetry Award continues to the
present.
After 45 years at the helm, DeBakey stepped down as Chair of the
Department of Surgery at the Baylor College of Medicine in 1993. His
successor, John C. Baldwin, took over the following year. DeBakey
remained in his position as Chancellor of the College for two more years
before he transitioned to Chancellor Emeritus in January 1996.15
His senior status was manifested in other changes, too. From 1965 on,
DeBakey had served as Chair of the selection Jury for the Lasker
Foundation Awards on an annual basis (the sole exception to this was in
1972). After 30 years, he became Chair Emeritus of the Jury in 1996 and
continued to be intimately involved in the selection of honorees for the
prestigious awards through 2005.16
Despite these honorifics reflecting his advancing age, as DeBakey
approached 90 he continued to operate on a regular basis, particularly in
cases where established or former patients requested that he perform their
surgery personally. He did confess that the time constraints of clinical
patient care (especially outside of the operating room) had finally become
bothersome, keeping him away from the other tasks he wished to
accomplish.
11.3 Yeltsin
In the summer of 1996, Russia held its first-ever Presidential election as a
sovereign nation. The incumbent President, Boris Yeltsin, had been elected
to the post in 1991, when the USSR was still an entity. He had remained in
office through the collapse of the Soviet system and was now in the running
for re-election. His prospects appeared poor at first due to an economic
downturn, his perceived poor handling of the Chechen rebels, and a
resurgence of the communists. After some clever politicking, however,
Yeltsin’s fortunes turned shortly before the election, and he won the initial
round on June 16. A run-off was scheduled for two weeks later. Yeltsin
vanished from public view around this time, and speculation was rampant
that he had suffered some sort of medical catastrophe, possibly a stroke. In
the classic fashion of the former regime, false interviews with Yeltsin were
published and old speeches of his played over the radio in an effort to
convince the populace that their President was fine and poised for another
term.17
Yeltsin went on to triumph in the run-off election on July 3, defeating the
Communist Party candidate, but he was far from fine. In fact, he had
suffered a heart attack on June 26, and it was not his first.
During the election campaign Yeltsin was carefully monitored by no
fewer than 10 physicians. After the June myocardial infarction, testing at
the Moscow Cardiology Center, including cardiac catheterization, revealed
the extent of the disease. Yevgenii Chasov, head of the Center, believed that
Yeltsin would need surgery but indicated that the risks involved would be
“colossal.”18 He consulted Renat Akchurin, a cardiac surgeon who had
briefly trained with DeBakey in the mid-1980s at Baylor, who concurred.
Although the fact that Yeltsin was suffering from cardiac disease was made
known to the public, the extent and severity were not. For the Russian
physicians the personal and political ramifications of unsuccessful surgery
or a faulty recommendation were potentially grave. Consideration was
given to consultation with German surgeons known to be experts in the
field. Eventually, however, Chasov recommended that DeBakey be brought
in to render his opinion. His reputation among both the scientific
community and the population at large was so great in Russia that
DeBakey’s thoughts on the case would be unchallenged, and whatever the
outcome of the recommended therapy, acceptance would be unconditional.
As it happened, DeBakey was already scheduled to be in Moscow at the
end of September for a conference given in honor of an old friend and
counterpart in the US–USSR cardiovascular surgery collaborations,
Vladimir Bourakovsky.*
KLM Flight 662 left Houston on the afternoon of Sunday, September 22,
1996. After stopping in Amsterdam the overnight flight continued on to
Moscow, arriving at 2:15 PM on Monday.
DeBakey was met at the airport by Chasov and Ackturin, as well as an
interpreter and security guards. The entourage then took a car to the ornate
and secluded Kremlin Guest House in the woods south of Moscow.
On the way, the Russians briefed DeBakey on Yeltsin’s condition. Finally
stripped of politics and statecraft, the facts were these.
Yeltsin had actually suffered three heart attacks in the previous fourteen months. The most
recent of these was, DeBakey now learned, the cause of the President’s disappearance from
public view after the first presidential election in June. The rumors of a stroke were false,
however. Because of the elections, most of this information had been kept secret.
The Russian cardiologists had performed several tests since the last heart
attack that were very revealing, if not especially encouraging. Yeltsin’s left
ventricular ejection fraction, a measure of the contractility of that essential
chamber of the heart, was just 20% on echocardiography (the normal range
is 55–70%). The cardiac catheterization had showed severe occlusive
disease in the right, left anterior descending, diagonal, and obtuse marginal
coronary arteries. The severity of the disease meant that, in the Russians’
opinion, balloon angioplasty was not an option. Yeltsin was also anemic, for
unknown reasons.
On the other hand, the Russian President’s kidney and liver function tests
were normal, the tales of his prodigious drinking notwithstanding.
The plan was for DeBakey to meet and examine Yeltsin on Wednesday,
September 25.
After settling in at the Kremlin Guest House, DeBakey headed to a
reception at the Palace Hotel in the city, associated with the meeting in
honor of Bourakovsky. Several old friends were in attendance, including his
American colleagues and some-time competitors, the cardiovascular
surgeons Henry Bahnson, David Sabiston, and C. Walton Lillehei.
The entire next day was devoted to the Bourakovsky meeting. Media
representatives hopefully staked out the auditorium, and seldom has a
scientific conference on cardiovascular surgery been as well attended by the
members of the Fourth Estate. They waited around for nothing, though; at
the press conference that concluded the meeting none of the attendees,
including DeBakey, would field the many questions about Yeltsin.
On Wednesday, DeBakey met up with Chasov and Ackturin again and
traveled to the Special Kremlin Clinic Hospital where Yeltsin was
recuperating. There they met the internists involved in the President’s care.
The team was disconsolate; there was a pervasive fear that surgery was too
risky. Most of the laboratory data looked reasonable, with the exception of
the anemia and evidence of decreased thyroid function. Then DeBakey was
shown the coronary angiogram. As advertised, the occlusive disease was
severe: the left anterior descending, diagonal, and obtuse marginal arteries
had significant stenoses, and the right coronary was completely occluded.
The good news was that all these vessels were widely patent—open—
beyond their areas of narrowing. Bypass surgery was clearly a possibility.
Even more encouraging, a repeat of the echocardiogram showed Yeltsin’s
ejection fraction to have improved to about 35%. It was clear to DeBakey
that the lower number seen previously was a reflection of his heart being
“stunned” by the infarction in July. Everything he saw was encouraging,
and he said so: Boris Nikolayevich seemed to him to be a fine candidate for
coronary bypass surgery, and the prognosis was excellent. This optimism
was infectious, and the glum Russian team was instantly re-energized.
DeBakey was then taken to meet Yeltsin. The President’s appearance
reinforced the diagnostic information: he was already standing when his
American visitor entered, with his famous shock of debonair white hair and
a warm smile. When DeBakey had last seen him on television—which he
now knew was in the aftermath of the latest heart attack—Yeltsin had
looked “weary and haggard.” This was a sharp contrast. Yeltsin thanked
DeBakey for coming and indicated that he felt perfectly fine.
The physical examination was unremarkable: his liver was not enlarged
and his peripheral vascular system was normal.
The medical team reconvened to hear DeBakey’s report. He told them
that, in his opinion, Yeltsin should undergo coronary bypass surgery, with at
least three bypasses and probably more. However, he continued, this
operation should be delayed for approximately six weeks. The reasons for
this were several: (1) Yeltsin was currently stable and asymptomatic, so
there was no clinically evident cause for urgency; (2) the ejection fraction
had improved significantly in one month—the trend might continue in the
next few weeks; (3) the cause of the anemia needed to be identified and
addressed; (4) the thyroid function needed to be corrected, probably by
medication; and (5) he should be placed on a program of structured diet, as
well as physical rehabilitation, to gain more strength.
The Russian team reacted with enthusiasm and endorsed the plan.
Everyone then went to the President’s room to inform him. Yeltsin was
naturally pleased and indicated that he was anxious to have the procedure as
soon as possible so he could get back to his duties. He also asked DeBakey
to give his thanks and best regards to President Bill Clinton, who was
facing his own re-election challenge in a few weeks.
Later that day DeBakey gave a press conference, at Yeltsin’s suggestion,
where he revealed his thoughts and recommendations to a somewhat
confused and skeptical room of Russian reporters. Long accustomed to
disingenuous (or outright deceitful) information from the Kremlin,
especially about the health of political figures, the correspondents were
hard-pressed to accept DeBakey’s forthright optimism in the face of the
swirling rumors. Interviewers from the American news services responded
similarly the following day. Others with more at stake also had their
reactions.
I was informed by Chasov and some other members of the Russian team of physicians that the
“opposition” to the Yeltsin regime was not happy with my report, which appeared on the
Russian television and newspapers . . . It now became evident to me that President Yeltsin’s
request that I hold the press conference was a smart political move to blunt the clamoring efforts
of his opposition for his resignation because of illness.
After the usual tours and fetes, DeBakey returned to Houston on Friday,
September 27.
At DeBakey’s suggestion, Akchurin came to Houston in mid-October to
study the use of temporary cardiac support devices with George Noon.
Although the perceived likelihood of having to use one of these machines in
Yeltsin’s case was small, all involved considered it wise to have them on
hand just in case. In the actual event, Noon brought to Russia LVADs made
by Bio-Medicus and Novacor, as well as an intra-aortic balloon pump.20
DeBakey and his team left Houston on the afternoon of Saturday,
November 2, for Amsterdam. They changed planes in the Netherlands and
arrived in Moscow on KLM 287 at 2:15 PM. In addition to DeBakey, the
entourage consisted of Noon, hematologist Clarence Alfrey, blood bank
specialist David Yawn, pump technician Gary Cornelius, OR nurse Suellen
Irwin, and Novacor Chairman Peer Portner.
Chazov was at the airport to greet the team and escort them to their
temporary quarters at the plush Barvikha Sanitorium just west of Moscow.
This institution was (and remains today) a medical center for the elite,
boasting excellent facilities and lavish accommodations. Yeltsin was staying
at the Sanitorium as well.
DeBakey met with the Russian internists, who gave him the good news
that all tests were either normal or greatly improved. The ejection fraction
was now 40%, and the anemia and hypothyroidism were resolved. Akchurin
and Chasov joined the discussion, and all agreed that it was time to proceed
with the operation—the following day. The Russians asked DeBakey to go
and see Yeltsin so that he could pass on the news.
Yeltsin greeted DeBakey warmly, with an embrace and kiss in the
traditional Russian fashion. He gratefully received the good news that his
wait for surgery was over and expressed his thanks.
By the time DeBakey was driven to the Cardiology Research Institute the
next morning, the operation was already under way. He was led to a room
adjoining the OR, with a large TV monitor displaying the proceedings.
Akchurin was already sewing in a segment of saphenous vein to the obtuse
marginal artery. In succession he then connected a vein graft to the diagonal
coronary artery and another to both the right coronary artery and a posterior
descending branch of this vessel. Next, he anastomosed the left internal
mammary artery to the left anterior descending coronary artery. Akchurin
then released the occlusive aortic clamp. The heart began to contract
normally, albeit with a brief period of fibrillation that responded
appropriately to shock. The surgeons then placed a partially occlusive
clamp on the ascending aorta and sewed the vein grafts into their inflow.
Weaning from the heart-lung machine was uneventful—so the LVAD
remained safely tucked away. The whole operation took five and one-half
hours—including nearly an hour of careful observation and attentive
“hemostasis” to minimize the risk of postoperative bleeding (Figure 11.1).
Figure 11.1 Diagram showing anatomy of coronary artery bypass performed on Boris Yeltsin,
November 3, 1996.
Afterward Chazov broke out a bottle of champagne in his boardroom and

toasts were drunk to the President’s good health. Yeltsin’s wife and
daughter, accompanied by Prime Minister Chernomerdin, thanked DeBakey
for his assistance. There was a brief press conference for the Russian media
where the successful results were announced. Chasov and Ackchurin gave
the details, and DeBakey indicated that Yeltsin would be back at official
activities in a few weeks and probably full-go in several months.
On the next day, Wednesday, November 6, Yeltsin was fully awake and
alert, and his physiologic parameters were essentially normal. He expressed
a wish to be transferred right away to the Central Hospital, but it was far too
soon for this. With a lifetime of surgical experience (and then some)
DeBakey recognized the need for a highly motivated postoperative patient
to resume strenuous activity and warned the President in gentle terms that
the best way to harm himself at this stage was to try to do too much, too
soon. “He nodded and smiled in apparent agreement.”
Next up was a series of interviews for the US news outlets, who
remained nonplussed at the Russian President’s rapid change in fortune.
DeBakey patiently tried to educate them as best he could: “Since the patient
was doing so well, they all found it difficult to ask controversial or critical
questions.”
Yeltsin’s recovery was exemplary, and he was transferred to the Central
Hospital on Friday. DeBakey stayed in Moscow until Sunday, wanting to
remain close by until his patient was out of the proverbial woods, but also
enjoying the abundant hospitality of the Russian political and medical
leadership. This included a luncheon at the Kremlin Palace, held in the 11th-
century Nun Room (he noted that one of the nuns most beloved by the
Russian people was named Olga).
One evening DeBakey and Noon were enjoying dinner and cocktails at
the opulent home of the minister of health. They noticed that the Russian
physicians kept excusing themselves and disappearing, a few at a time.
Eventually it was revealed that they were sneaking off to have a smoke or
play pool on the minister’s ornate billiards table. On a tour of the home, the
Americans were shown the table and invited to play. To the Russians
astonishment, DeBakey conjured the spirit of his youth and, taking up a
cue, proceeded to—in the parlance of the game—run the table. Noon, who
was beyond being surprised by anything DeBakey did, reflected that “he
kicked their ass.”21
On Sunday, November 7, the team returned to Houston.
The impact of DeBakey’s consultation on the Yeltsin case from a purely
medical perspective is easy to gauge: he gave Chasov, Akchurin, and the
rest of the Russian team the green light and, as importantly, the confidence
that coronary bypass surgery was the proper intervention and would be
successful. In a larger sense, though, the geopolitical ramifications of his
input were likely of far greater import. Even before the operation,
DeBakey’s public pronouncement of Yeltsin’s favorable prognosis was
significant. The Russian people recognized that, unlike their own statesmen
and media, DeBakey was trustworthy: when he said Yeltsin would be OK,
they believed him. This undercut Yeltsin’s opposition, both within his own
faction and among the communists who were calling for a new election due
to the President’s purported moribund status.22
On a longer time frame the implications are more nebulous but possibly
of even greater import. Had Yeltsin died from his cardiac disease—a
distinct possibility if not for the bypass operation—or simply been too frail
to continue in leadership, it is certainly within the realm of plausibility that
he may not have had the opportunity to select and groom an obscure
bureaucrat named Vladimir Putin as his successor.
11.4 Fifty Years

In 1997, DeBakey and Gotto revised their prior work for the lay audience in
the form of The New Living Heart. After the passage of 20 years, there was
much to update. A rejuvenated President Boris Yeltsin wrote the foreword
for the Russian-language version. In this, he referred to DeBakey as “a
magician of the heart” and “a man with a gift for performing miracles.”23
These words would be quoted by writers and publicists in the same way the
Duke of Windsor’s praise had been 30 years before (Figure 11.2).
Figure 11.2 DeBakey presenting Boris Yeltsin with Russian-language copy of The Living Heart.
The following year, 1998, represented the 50th anniversary of DeBakey’s

arrival in Houston to take over the Department of Surgery at the then
Baylor University College of Medicine. He had taken over a great deal
more than that in the decades that followed, but this was the Golden Jubilee
of the great sea change in Houston medicine, and a Texas-sized soiree was
called for. Both a scientific colloquium and a Black-Tie Gala in DeBakey’s
honor were arranged for November 5.24
At the conference, attendees heard erudite discussion on the future of
medical education; the past, present, and future of surgery; and the future of
biomedical research. Nobel Laureate and National Institutes of Health
Director Harold Varmus spoke, as did Donald Lindberg, Director of the
National Library of Medicine, C. Rollins Hanlon from the American
College of Surgeons, and others.25
When the serious business at the Medical Center was over, the
celebration commenced at the Westin Galleria hotel. Jerry Lewis said a few
words, and the singer Wayne Newton, whose parents were both DeBakey
patients, entertained. After a shower of glittering praise, DeBakey addressed
the well-wishers:
While hearing so many encomiums, for which, of course, I am deeply grateful, I could not help
recalling that hoary tale of the widow who had just lost her reprobate husband and was sitting
with her son listening with astonishment to eulogies being given by some of her husband’s
drinking friends, who were extravagantly lauding his character. Finally, she turned to her son,
stating: “Go up to the casket and see if that’s your father in there.”
Of course, I am most humbly and gratefully appreciative of the plaudits, and even panegyrical
statements and expressions of my activities. They warm one’s heart to hear, and I must confess,
I am beginning to persuade myself to believe them.
The goal of perfection in the pursuit of excellent seem elusive; it is the drive directed towards
its achievement, however, that is important and satisfying. This is well expressed by Samuel
Johnson in his Preface to the Dictionary: “that thus to pursue perfection, was, like the first
inhabitants of Arcadia, to chase the sun, which when they had reached the hill where he seemed
to rest, was beheld at the same distance from them.”26
Also at the Gala, William Butler, who had transitioned from President to
Chancellor of the College in January, 1996, announced that DeBakey would
present to the school his papers and memorabilia for eventual
commemoration of his legacy.27
By that same month of November 1998, the MicroMed NASA/DeBakey
continuous axial flow LVAD was ready for human trials. Due to stringent
FDA criteria, the first implantations were done in Europe. Consideration
was given to performing the initial cases in Vienna or Zurich, but eventually
the decision was made to proceed at the Deutsches Herzzentrum Berlin,
with the cooperation of the noted German cardiac surgeon Roland Hetzer.
Another German present for the Berlin implantation was Matthias Loebe,
the former visiting medical student at Baylor who had informed DeBakey
of the status and whereabouts of his friend from Heidelberg, Ernst Schanz,
back in 1982.
The patients in Berlin being considered for placement of the LVADs were
very sick indeed: candidates for heart transplantation. There was legitimate
concern on the part of Hetzer’s team that the continuous flow pump would
not provide satisfactory physiologic blood flow for these individuals and
would accelerate their deaths. One member told Loebe, “You know, when
we put that in the patient, he will die.” Loebe, who had placed the devices
in animals in Texas and Germany, replied, “Fine, if you think we shouldn’t
do it, tell Dr. DeBakey and Dr. Noon. They have a patient in Zurich and a
patient in Vienna. They are just going to move on and do it there.” As Loebe
remembered, the German team reasoned that they were placing the device
in a patient that was (virtually) dead already, so they could not be blamed
for killing him.28
The first patient to receive the device was not dead, but he was not far
from it. He was a 55-year-old man suffering from congestive heart failure,
who was intubated and on a mechanical ventilator. He also had an intra-
aortic balloon pump for cardiac support. The procedure of implantation
went smoothly, and his postoperative course was remarkably uneventful.
The patient survived for 47 days with the device, dying of unrelated causes.
The second case, also performed in Berlin, had an even more dramatic
initial result. He was able to be extubated and even got up and walked
around. His pump was exchanged for a Novacor on Thanksgiving Day.29
None of these implantations had perfect outcomes—that was scarcely
possible given the dire clinical straits the patients had to be in to earn the
intervention—but the take-home message was clear: “proof of concept” for
this axial, continuous-flow LVAD had been achieved.
In 1999, the device, as well as DeBakey, Noon, and other Baylor,
MicroMed, and NASA personnel that worked on the project were inducted
into the Space Technology Hall of Fame.30 In addition, in April 2002,
NASA awarded the MicroMed/DeBakey/Noon LVAD its Commercial
Invention of the Year honor.31 Unfortunately, the NASA engineer whose
own heart transplant helped initiate the process that resulted in this success
did not live to see it come to pass. David Saucier died of cancer in June
1996 (Figure 11.3).
Figure 11.3 DeBakey with an early artificial heart and the MicroMed LVAD.
Although the DeBakey Consulting Group of the late 1980s-early 1990s

had not succeeded in its plans to build American-style hospitals all over the
world (the Inonu University Hospital in Turkey being the exception), its
namesake did not surrender these grandiose plans entirely. A second
enterprise, known as the DeBakey-Pechersky Partners, was incorporated in
1998, with the goal of developing dedicated cardiovascular centers in
underserved foreign countries. DeBakey was Chairman of the Board, his
friend George Zakhem served as President, and the CEO was a
businesswoman of Kazakstan origin named Anna Pechersky.32
DeBakey and Zakem were also involved in a lengthy but ultimately ill-
fated attempt to build a DeBakey Medical Center at the Byblos campus of
the Lebanese American University. This effort commenced in 1994, with
exploratory work at establishing a medical school and university hospital on
the site. Four years later Baylor and the Lebanese American University
signed an agreement to proceed, but, in 2002, the whole thing unraveled. As
a representative of the Lebanese school described it, “In 2002, a visit by the
administration to Baylor College of Medicine resulted in disengagement
between LAU and Baylor. The administration felt that Baylor is far from
being enthusiastic about partnering with LAU.”33 This was not the only
separation around the millennium in which Baylor would become
entangled.
The Society of Vascular Surgery, of which DeBakey had been a founding
member shortly after the end of World War II, opted to award him its
highest honor, the Distinguished Service Award, at its annual meeting in
Washington, D.C., in June 1999.
DeBakey’s trainee and Baylor faculty colleague Charles McCollum,
himself a widely recognized academic surgeon, composed a thoughtful
salutary article for the Journal of Vascular Surgery. He closed in winsome
terms:
A short and simple phrase exemplifies the teaching of Dr DeBakey: “attention to detail.” It is the
way he has lived his life and practiced medicine. It is a principle he has never forgotten. It has
guided him in his every endeavor and initiated the “pursuit of excellence” that has been his
lifelong motto.
Perhaps, however, his greatest legacy is his example. Today, he continues to

work and contribute as he has for 7 decades of his professional life. He
continues to push the agenda of research, education, and medical care for
all. Yet he finds time for people. Patients feel they have his full attention
when he sits to talk to them. He makes special time for the students at the
high school that bears his name. “I enjoy them. I get a kick out of those
kids,” he said. “Sometimes they want to talk about their futures, and they
are a little concerned about what they are going to do. They need to talk it
out a little bit.” He makes time, he said, because “they are the future.”
That too is key to the man. Although historians reflect on what he has accomplished in the past,
he is and has always been intent on building for the future.34
McCollum was also one of the faculty members who pushed for Baylor
to move into the new era of cardiovascular interventional therapy.
Since the start of the 1990s, and in some cases even before, the same sort
of technological advances that culminated in the
MicroMed/NASA/DeBakey/Noon implantable LVAD were revolutionizing
other aspects of surgery, and not just in the cardiovascular arena. Surgeons
and patients alike across the spectrum of disease were pushing for
“minimally invasive” techniques that diminished the extent of surgical
incisions and thus resulted in more rapid recovery and less pain. In the
cardiovascular realm, manufacturing techniques had advanced to the point
that small catheters, previously only suitable for injecting x-ray contrast
material for diagnostic studies, could now carry angioplasty balloons and
metallic stents to open up narrowed or even occluded blood vessels. By the
late 1990s, there were even increasing reports of some aortic aneurysms
being repaired by means of catheter-based techniques.
As important as the improvement of the patient experience was, in the
case of cardiovascular patients—who often harbored serious comorbidities
that put them at higher risk for surgery than other patient populations—
these minimally invasive approaches were especially attractive. The time of
open cardiovascular surgery—bypass grafts, endarterectomy, patch
angioplasty—seemed to be on the wane. The new era of endovascular
surgery was at hand.
As this revolution began to gain a foothold around the medical world
near the turn of the millennium, the Baylor cardiovascular surgery clinical
and training programs were beginning to slip behind the times. In some
respects that was perfectly understandable, since many of the stars of the
faculty were in the twilight of their careers and had made their reputations
with success in some of the most maximally invasive operations ever
devised. On the other hand, Baylor had led the way in the broader field for
half a century and, in the minds of those who mattered, could not be
allowed to trail for long.
Not that the Surgery Department was afraid of bucking a trend. Since the
1970s, most of the training programs in the country had split this field into
two specialties: cardiothoracic surgery and peripheral vascular surgery.
Eventually these distinct entities would have separate training certificates
and then boards under the American Board of Surgery. For many years after
this became the norm elsewhere, however, Baylor did not divide the
disciplines. When asked why this was the case, DeBakey once remarked,
“The cardiac and vascular services are separated in many places. I object to
that for the simple reason that I consider the cardiovascular system a unified
system.”35
Pure technologic advance with demonstrable benefit to the patient—such
as the new endovascular procedures—was, of course, a different matter. In
late 1998, with McCollum helping to lead the way, Baylor and Methodist
Hospital began halting steps toward implementation of an endovascular
program. It would not be until the new century that the effort would begin
to bear fruit, but this was not from any resistance on the part of DeBakey.
Although he might have been expected to be reluctant to see the dramatic
operations he had, in many cases, devised or perfected swept away by the
new wave of catheter-based procedures, such was not the case. As George
Noon noted, “He was every enthusiastic about those changes. He didn’t feel
bad about his things becoming obsolete. He looked into the future. He never
stopped thinking about the future and what could be developed. [He was]
very, very supportive of the changes that were taking place.”36
11.5 Schism
There were, however, other changes happening at the Texas Medical Center
about which DeBakey could muster little but frustration and
disappointment.
Ever since the opening of Houston Methodist Hospital in the Texas
Medical Center in 1951, the fortunes of the institution and the Baylor
medical school had been inextricably linked. Most of the pioneering work
in cardiovascular surgery that DeBakey and his team had performed over
the years had the first clinical applications at Methodist, and, in the
collective consciousness of the city—and, in fact, the medical world—the
two were essentially synonymous. Interested observers not on the scene
naturally assumed that Methodist was Baylor’s university hospital. This was
a reasonable presumption, but it was not correct. Methodist, for one thing,
had always had a contingent of private physicians, unaffiliated with Baylor,
and, consequently, a “town-and-gown” unease that was never far from the
surface. Even during the halcyon days of the 1960s, when scarcely a week
passed without some news story or network special touting the
achievements in Houston, there was tension for this and other reasons
between the famous hospital and its affiliated medical school. The
administrative upheaval of that decade, which eventually resulted in
DeBakey’s ascension to the leadership of the Baylor College of Medicine,
was rooted in a dispute between the institutions. The point of contention, of
course, had been funds.
During the 1970s, when Ted Bowen was President of Methodist and
DeBakey held the same position at the Baylor College of Medicine, the two
friends worked in tandem to create accord and enormous prosperity that
benefited both their entities. When other leaders took on these roles,
however, friction was bound to arise, and it did.
As the turn of the twenty-first century approached, the most recent
contract between Methodist and Baylor, signed in the early 1970s, was set
to expire. Incredibly, major players from both institutions were perfectly
prepared to allow that to happen. The issue, again, was money—this time
seasoned with ample amounts of ego and maneuvering for power.
In its simplest sense, the conflict arose with remarkable similarity to the
scenario that had caused Joseph Allbritton to come to grief as President of
the Baylor University College of Medicine more than 30 years before.
Methodist was, by this point, extraordinarily well off from a financial
perspective—with assets measured in the billions. Baylor was not running
in the red, as had been the case in the 1960s, but the college administration
was hard put not to look at Methodist’s largesse and consider that much of it
could be traced to the presence of Baylor’s illustrious faculty. On the other
hand, Methodist felt the need to protect its position and its loyal,
unaffiliated private physicians, as well. At this point, unfortunately,
administration on both sides lacked the equanimity and negotiating finesse
of earlier incarnations. The stage was set for a high-stakes, high-noon face
off in classic Old West fashion, and power brokers throughout the city took
sides.
In years gone by, many contended, this would have been the point where
DeBakey stepped in and put an end to the saber-rattling. But his role was
different now: as the Grand Old Man of the Texas Medical Center,
DeBakey was revered and respected, but no longer feared—at least not as
he had been in the past. Much of the power he had once wielded was now in
the hands of the lesser souls who were the source of the squabble. The
cavalry was not coming over the hill. DeBakey was left to make poignant
remarks and classical allusions that he whimsically realized were probably
not even grasped: “I don’t understand it. I don’t think it’s in the best
interests of either institution . . . I’m hesitant to take on the role of
Cassandra. Maybe they don’t know who Cassandra was.”37
Offers and threats were made on both sides over a period that eventually
stretched to several years, but, when the dust cleared, the two institutions
were conclusively separated. Locals compared the events to a divorce
proceeding, and there were certainly plenty of hurt feelings and
disillusionment. Like children of a broken family, some Baylor faculty went
with Methodist and others stayed with the College. The custody fight was,
at times, acrimonious. The College shifted its clinical focus to St. Luke’s
Hospital, with further plans to build, finally, a dedicated University
Hospital. Methodist found a distant, if not entirely unlikely, academic
partner in the Weill Cornell Medical College (which had been under the
leadership of Antonio Gotto since 1996).
On June 7, 2002, Princess Lilian died at the age of 85 at Château
d’Argenteuil, Waterloo. The funeral was a private, family affair.
In August of the following year, though, a special conference was held in
her honor in Brussels. The topic, naturally, was cardiovascular medicine.
DeBakey attended and gave a heartfelt and gracious tribute to the memory
of his dear friend.
He recounted their warm four-decade–long relationship and described
Lilian’s dedication to what became her life’s work. In particular, DeBakey
recalled her essential role in arranging for the Houston cardiovascular
surgical team (which she sometimes accompanied) to visit remote, difficult
settings to perform and demonstrate operations. He also remembered that
the mission of the Foundation she had established in the late 1950s to allow
for Belgians to travel to the United States, either for cardiovascular surgical
care or training, had to be reconsidered by the late 1970s because such care
in Belgian had become among the world’s best.
DeBakey found room in this eulogy to tap into the words of the
philosophers Rousseau and Kant, and he closed with Alfred Lord Tennyson:
In words, like weeds, I’ll wrap me o’er,
Like coarsest clothes against the cold;
But that large grief which these enfold,
Is given in outline and no more.38
Over the years DeBakey’s name frequently came up in connection with
the Nobel Prize in Physiology or Medicine. The process of selecting the
winners of these most prestigious of scientific awards is convoluted.
Unsolicited nominations are not entertained, and the list of those whose
proposals are considered is short. Nominations are reviewed by a
Committee, comprised of members of the faculty of the Karolinska
Institutet, assisted by specially selected expert advisors, before being voted
on by the Nobel Assembly. The entire process is so secretive that the names
of nominees and details of the selection procedure are not released for 50
years.*
Despite his enormous contributions to surgery and surgical science,
DeBakey never won the Nobel Prize. Surgeons in general have fared poorly
in selection of the award over the years, but DeBakey faced another
obstacle. His 1963 Lasker Award, “America’s Nobel Prize,” was a blanket
recognition for his many pioneering efforts in vascular surgery, including
ground-breaking new operations and the development of prosthetic grafts.
The Nobel criteria are configured differently and intended to recognize a
single specific achievement in research: “The Nobel Prize for Physiology or
Medicine is awarded for discovery of major importance in life science or
medicine. Discoveries that have changed the scientific paradigm and are of
great benefit for mankind are awarded the prize, whereas life time
achievements or scientific leadership cannot be considered for the Nobel
Prize.”40
Many observers believe that had he succeeded in creating a viable total
artificial heart DeBakey would have won the Prize. As it was, if the Nobel
Committee ever considered him, they were evidently unable to isolate the
one paradigm-shifting achievement among his many undeniable
contributions of benefit to mankind that they considered worthy of their
particular recognition.
The US Veterans Administration (VA), on the other hand, could easily
identify a number of important efforts that DeBakey had made on the part
of the organization. Among these were his contributions to the
modernization of the VA medical system after World War II, his devising
the Medical Follow-Up Agency, and his long service on the Dean’s
Committees, which had been the beginning of the relationship between the
VA Hospitals and academic medical centers in the postwar era. For these
reasons and more, the Houston VA Hospital was renamed the Michael E.
DeBakey VA Medical Center in December 2003, when President George W.
Bush signed into effect Public Law 108-170.41
The actual renaming ceremony was held on June 28, 2004. Some 600
people came out in the heat of the Houston summer for the event. DeBakey
himself, at age 95, was among the speakers. He described his experiences in
World War II, as well as the immense pride he took in his service as a
repayment for the bounty the nation had provided him and his family.
DeBakey went on to express his highest praise and admiration for the US
soldiers who had served during that conflict and in all times.
May I take a moment to pay personal homage to all veterans, of highest and lowest rank, who
have given our country the honorable gift of their military services and sometimes their ultimate
gift, their lives, to ensure America’s security and to protect its liberty and its principles of
freedom. Each who serves faithfully toward that end is a hero in my eyes, and we all owe them a
great debt of gratitude.42
A few months later, on October 22, 2004, Ernest DeBakey, second son of
Michael and Diana, died at Methodist Hospital at the age of 59 from gastric
cancer. Ernest had had a tumultuous youth, and, of the four brothers, he
may have tolerated his father’s lack of attention the worst. Many years later,
he expressed his feelings in a Father’s Day letter:
June 15, 1986
Dear Dad
Despite all evidence to the contrary, my goal has always been to exercise my best efforts and to
realize my full potential. I have stumbled more than once, but I never stayed down for long. I
thank you, as inspiration for my perseverance.
You have always maintain a distance between us and I did suffer a troubled youth. As a
consequence you may have erroneously deduced your absence was a contributing factor for my
problems. This letter is designed to clarify any such potential confusion. I assure you, I am
wholly responsible for my life.
Now, I am hopeful you shall forgive my past “Wanderings in the Wilderness,” take pride in
my accomplishments, and deem me worthy of your love.
I pray I am or shall become the son you want me to be.
Happy Father’s Day with love,
Ernest.43
Despite his difficulties, Ernest had gone on to graduate from Arizona

State University and the Baylor College of Law. After some early
professional challenges (and several children from three marriages), he had
become a successful attorney in Houston.
While Ernest was hospitalized his father visited him, but, unfortunately,
there was little that could be done from a medical standpoint other than to
keep him comfortable. All three of his brothers visited Ernest at Methodist
on the day before his death, and the “DeBakey boys” posed for a poignant
photograph together.44
11.5 Katrina
On August 29, 2005, much of New Orleans flooded in the catastrophic and
deadly aftermath of Hurricane Katrina. The Tulane University School of
Medicine was not spared, of course, and suffered extensive damage.*
Within days it became apparent that classes could not resume anytime soon,
and the students, as well as the faculty and administration, began to
consider their alternatives. With their future at stake, it was certainly
reasonable for the students to consider transferring, but if enough did so, the
existence of the school would be in peril. There seemed little choice,
however.
Two hundred miles away, in Houston, Baylor College of Medicine
administrators looked on with empathy. A little more than four years before,
Tropical Storm Allison had laid waste swaths of their city, causing $5
billion in damage—$1.5 billion to the Texas Medical Center. The school
itself had not been seriously threatened, but fear of that possibility was real,
and what Tulane was experiencing was that trepidation transformed into
reality. Almost immediately, the Baylor administration began to put together
a plan to absorb the Tulane students—and as many of the faculty as might
be practicable—into the College’s facilities and curriculum. This would be
no small task: Tulane’s medical school comprised more than 600 students,
not to mention more than 500 graduate trainees (interns, residents, and
fellows). As it happened, Baylor could accommodate the nonclinical first-
and second-year students, but the school’s clinical space could not sustain
both its own trainees and those from Tulane. There was adequate room
elsewhere at the mammoth Texas Medical Center, though, and the other
hospitals and institutions did not hesitate to offer their facilities.45
By the first week in October, everything was ready—or as ready as it was
likely to be in the foreseeable future. The Tulane students, who were housed
in a catch-as-catch-can fashion throughout the city and Medical Center,
assembled at the Baylor auditorium on Saturday, October 1, for a most
unusual orientation.
DeBakey addressed the students, sharing some amusing anecdotes from
his own days at Tulane nearly 80 years before. He pointed out that the
students would feel at home in the friendly environs of Houston and gave
pointers as to where to find the best gumbo in town. DeBakey went on to
assert that, “You’ll get as good a medical education while you’re here as
you were getting at Tulane.”46 He also noted that the DeBakey Medical
Foundation had provided $100,000 toward the effort to bring the Tulane
School of Medicine to Baylor temporarily. As much for his role in securing
their futures as for his reassuring remarks, DeBakey was given a raucous
standing ovation by the Tulane students. By mid-May 2006, most were back
in New Orleans.
11.7 Type 2
On New Year’s Eve 2005, DeBakey was settling in for a quiet evening at
home, preparing a lecture for the following week. Katrin and Olga had left
to go to Galveston Beach for the holiday. Suddenly he began experiencing a
horrific, tearing pain in his chest and back, moving up into his neck.
DeBakey settled on a couch and prayed for the sensation to pass, but it did
not. Even in extremis, he remained the clinician and attempted to diagnose
what was happening to him. The only process he could envision creating
such pain was a dissection of the aorta. It was so completely isolating that it
never occurred to him to call 911 or his physicians. As the pain continued
unabated, DeBakey found himself wishing for death to end his misery.47
Katrin and Olga, frustrated by heavy traffic, returned home. There they
found him lying on the couch in obvious discomfort. Now reasonably sure
of his diagnosis, DeBakey hid the truth from his wife and daughter, saying
that he had fallen asleep and awoken with a pulled muscle. He did not want
to alarm them, and, if he was right, it would not matter.48
Katrin was not convinced and called DeBakey’s cardiologist, Mohammed
Attar, and Matthias Loebe, who was covering for George Noon. They
arrived, examined him, and agreed with the diagnosis. By this time the pain
had subsided some, and DeBakey refused to go to the hospital.
It was not until January 3 before he could be convinced to undergo a
computed tomography (CT) scan to confirm the diagnosis, at least, and
guide the physicians. The exam confirmed that he was suffering from a
Type 2 aortic dissection, according to the classification system named after
him that was first published in the mid-1960s. The dissection had caused his
aorta to become aneurysmal—5.2 cm in diameter. The likelihood of
survival without an operation was low.
DeBakey refused to be admitted to Methodist. He was afraid of never
leaving. Well aware of the magnitude of the necessary procedure—
replacement of the ascending aorta—which he himself, along with Denton
Cooley, had first performed on Warren Harrell back in August 1956—he
was appropriately fearful of the complications. Given his age—97—there
was no doubt that he was at exceptionally high risk for such outcomes even
if the operation was flawless. No one had ever attempted the procedure in a
patient that old.
He returned home to Cherokee Street, hoping the dissection would fix
itself. He hopefully reminded himself and others, such as visiting well-
wisher Roland Hetzer, “These sometimes heal.”49
On January 6, DeBakey insisted on giving the lecture he had been
working on when the symptoms began, at the Academy of Medicine,
Engineering, and Science of Texas in Houston. Although obviously weak,
he was able to deliver the speech in its entirety.
Back at home, nursing care was provided around the clock, and DeBakey
acquiesced to periodic imaging studies at Methodist. As the days passed,
however, his condition deteriorated. His appetite was poor, his blood
pressure was difficult to manage, and he became short of breath. On
January 23, DeBakey agreed to be admitted to the hospital, where tests
showed that he had developed kidney dysfunction, as well as a pericardial
effusion—fluid in the sac around his heart, which might be from the
aneurysm leaking.
A CT scan on January 28 showed that his aorta had increased in size to
6.6 cm. George Noon showed DeBakey the images and recommended they
proceed with surgery. The Professor still demurred. By February 9, the aorta
was 7.5 cm, and it was clear that, unless he had reparative surgery,
DeBakey would die. George Noon said, “If we didn’t operate on him that
day that was it, he was gone for sure.”50
Since his first symptoms on New Years Eve, there had never been an
ideal time to operate on DeBakey; now, after a month of decline, he was an
even poorer candidate for surgery. There were other obstacles as well.
DeBakey was no longer conscious, and he could provide no input as to his
own care. There was, however, a note on his chart—composed by his
internist—indicating that he did not wish to undergo an operation.
Noon and the rest of the team called for a meeting with the family:
Katrin, Olga, the sisters, and sons. They pointed out that, even if DeBakey
survived, the chances of an uncomplicated recovery were slim. It was likely
that he would need dialysis postoperatively and, because he would probably
be on a ventilator for a prolonged period, a tracheostomy. Paralysis was a
real possibility, and blood clots as well as pneumonia also posed serious
risks. Still, without an operation there was no hope: he would die soon. The
surgeons and the family all agreed that the note from DeBakey saying he
did not want surgery was only apropos of the situation when he signed it—
when nonoperative treatment was still a reasonable option, even if it was a
long shot. Now that surgery was the only hope, they were confident that he
would want to try.
When the surgeons went to prepare for the case, they found that not
everyone agreed with their interpretation of the chart note. The Methodist
anesthesiologists indicated that—in their view—the note was binding and a
true reflection of the patient’s wishes. They refused to participate. The
tenuous nature of DeBakey’s condition and the high-risk nature of the
procedure were surely factors in their decision making (Katrin later said
that the anesthesiologists told her they “did not want to become known as
the doctors who killed him”51).
In the early evening Katrin called Salwa Shenaq, a family friend and
anesthesiologist at the VA who had previously worked with DeBakey for
many years at Methodist. Shenaq drove in from home to help. There, she
encountered the head of Methodist’s Anesthesia Department who confirmed
that his group would not administer anesthesia to DeBakey. She was also
told (incorrectly) that she could not help because she had no privileges at
Methodist.
In the meantime, behind closed doors, a growing array of attorneys,
administrators, and physicians were discussing the proper course of action.
There was no consensus as to what DeBakey’s chart note meant or, for that
matter, the full implications of a “do not resuscitate” order he had also
signed. His unrecorded comments to the team were also equivocal. When
Noon had asked DeBakey how he should proceed if the Professor could no
longer speak for himself, he was told to “do the right thing” (at this point,
Noon later reflected, “We [the surgeons] thought the right thing was to
operate on him”52).
Because of the conflicting information and opinions, the hospitals ethics
committee was called in, too. The debates continued.
As the evening grew late—nearing 11:00 PM—Katrin, finally, could take
no more. She had been in contact with a nontraditional healer in Germany
whose input she valued, but from all indications, surgery was necessary and
there was no time to lose. Summoning the force of righteous indignation,
she stormed into the conference room, just yards away from DeBakey’s
hospital bed, and demanded the operation go forward.
“My husband is going to die before we even get a chance to do
anything,” she exploded. “Let’s get to work!”53
That ended the discussion. The surgeons raced for the door and quickly
moved DeBakey to the operating suite, where Shenaq administered
anesthesia. The case began around midnight and lasted all night.
Noon and his team placed DeBakey on cardiopulmonary bypass, with
profound hypothermia to protect his central nervous system. They replaced
the ascending aorta with a graft, beginning just above the coronary arteries.*
Thankfully, DeBakey’s aortic valve was functioning well and did not need
to be replaced. Noon “suspended” the valve within the graft. As he recalls,
“The operation was routine for that type of aneurysm, but it wasn’t routine
as far as who was being operated upon.”54
Despite the concerns of the Methodist anesthesiologists, DeBakey
tolerated the operation well. As the surgeons had expected—and warned—
however, the postoperative course was rocky.
DeBakey did require a tracheostomy and short-term dialysis, as well as a
feeding tube. He remained on the ventilator for six weeks. Methodist
converted a private suite into an ICU. During this time DeBakey was not
communicative. He wavered between delirium and unresponsiveness. A
watershed moment came on April 2, when pulmonologist William Lunn
was making rounds. Lunn’s eight-year-old daughter Elizabeth accompanied
her father on that Sunday morning, and when she was told that this
particular patient was feeling low, she drew a colorful picture for him,
depicting grass, trees, rainbows, and butterflies. When this was given to
DeBakey, his eyes brightened. He stirred and asked to see the artist, then
held Elizabeth’s hand and thanked her. At that point, Lunn later said, “I
knew he was going to be O.K.”55
DeBakey was discharged to home on May 16, but was readmitted less
than three weeks later, on June 2, with shortness of breath. He was found to
be suffering from hypertension, a rapid heart rate, and fluid in his lungs.
These responded to proper medications, but he was kept in the hospital, in a
well-appointed room on the luxurious 12th floor of the Fondren building,
under closer supervision. This went on for a number of weeks.
Naturally, this kind of confinement was an annoyance to DeBakey, and
he sometimes pretended to be asleep in order to avoid the examinations and
interrogations of his physicians. Several attempts were made to lure him out
of this. One of the few television programs he enjoyed watching was CNN
news, but when the set was tuned to this it had no effect. A photograph of
DeBakey purchasing his Ferrari 330 Speciale from Enzo Ferrari himself
was also met with obstinate silence. Finally, Matthias Loebe brought to his
room an old 1930s Aloe and Co. DeBakey Roller Pump that an
administrative assistant had found on eBay. When DeBakey failed to
respond to him, Loebe mentioned that he had an original DeBakey roller
pump, and what a shame it was that the Professor could not wake up to see
his 70-year-old innovation. DeBakey immediately opened his eyes and,
grabbing the machine, began an impromptu lecture on his invention of the
device, its usefulness and function, and what an improvement it had been
over prior instruments. Amazingly, he even correctly recalled what pages he
and Robert Kilduffe had devoted to the pump in his first book, The Blood
Bank and the Technique and Therapeutics of Transfusions from 1942. From
this point on, he remained awake and communicative through his
hospitalization.56
Although the immediate postoperative organ system dysfunction
DeBakey suffered was threatening, it was only temporary. More permanent
was a substantial muscle weakness that necessitated ongoing physical
therapy. Initially resistant, DeBakey became more focused and compliant as
he recognized progress. He was eventually able to walk again unassisted,
but for his remaining life he was largely dependent on a wheelchair or
motorized scooter. As anyone who had witnessed or experienced DeBakey’s
driving might have predicted, he became something of a terror in the
hallways of Methodist Hospital, pushing the scooter to its limits and taking
blind corners at top speed.
On July 17, 2006, DeBakey’s brother Ernest passed away at the age of 96
in his adopted hometown of Mobile, Alabama. Ernest had moved there in
1948 and built a successful practice of general and thoracic surgery based
on an outstanding reputation for clinical care. Although his training had
been similar to his brother’s—with residency at Tulane under Alton
Ochsner and further thoracic instruction from the highly regarded Evarts
Graham at Washington University in St. Louis—Ernest eschewed the
academic life. Rather than being involved in teaching and research, he
preferred to focus exclusively on caring for patients. Over the decades the
two brothers continued to stay in close contact, talking on the phone every
Sunday unless special circumstances prohibited it. In his later years Ernest
turned his attention to drug abuse education as well as the scarcity of rural
physicians. He established a charitable foundation to assist in recruiting and
training medical students to provide care in underserved rural areas.57
11.13 No Panacea
After the turn of the millennium the United States entered into, or perhaps
simply recognized at a national level, another “healthcare crisis” (a phrase
first used in a Presidential address by Richard Nixon in 197158). The issue
of providing healthcare insurance for all citizens (and even non-citizens)
became, once again, a political football. As one of the country’s foremost
“medical statesman” since the end of World War II, DeBakey was both
uniquely positioned and especially motivated to consider the issues, and
speak out on them. Despite being a Democrat, he was a vocal critic of the
Clinton plan of the 1990s, expressing particular concern about the impact of
the bill on academic medicine. He continued to be involved in the
discussion a decade later.
DeBakey’s speech at the Rice University President’s Lecture on April 15,
2005, “The Role of Government in Health Care,” was published as an
“editorial opinion article” in the American Journal of Surgery the following
year.59 In the text he demonstrated a firm grasp of the many-sided problems
and offered sage advice on how to address them. He did not, however,
delude himself about the challenges to be faced or that he had all the
answers.
DeBakey began by reviewing the historic role of the state in health
activities—dating as far back as Babylon—ranging from certification of
practitioners to promulgation of public health policies. He noted the first
national health insurance program, which was established by Bismarck in
Germany in 1883, both to provide for his citizens and “to coopt the
socialists.”60 The concept was not adopted quickly in the United States for a
number of possible reasons, including most prominently the opposition of
most medical practitioners. Of course Medicare came along in 1965, but it
was fought tooth and nail at, and prior to, its inception. DeBakey then
discussed both the triumphs and tribulations of this program, of which he
had been, of course, among the most vocal proponents.
Naturally the overriding issue was, and remains, expense. DeBakey
traced the exponential explosion in healthcare costs over the previous
decades, the underlying causes (almost none of which relate to actual
clinical medicine), and the impotent (and, in fact, detrimental) efforts that
had been introduced to ameliorate the problem. Medicare expenditures
increased from $7.7 billion in 1970 to $224 billion in 2000, with not only
no end in sight, but every cause to expect catastrophic worsening of the
problem. He pointed out the issue of drug prices, as well as the lack of tort
reform to rein in unnecessary testing and liability insurance expenses. Not
least was the problem of burgeoning administrative costs: from 1970 to
1995, the number of physicians in the United States increased by 25%,
while the number of administrators rose by 2000%. Some of the incomes of
the insurance and pharmaceutical company executives were in a realm only
aptly described as obscene. Medicare rules and regulations, contained in a
volume of a preposterous 132,000 pages, magnified rather than eased the
difficulties.
DeBakey went on to decry the monstrosities known as health
maintenance organizations (HMOs) and their “policies of minimal services
at higher costs.”61
Having thus laid the groundwork, any listener (or reader) might well
have expected DeBakey then to advocate for a healthcare delivery system in
the United States based on the models of the Western European nations or
Canada. Instead, he pointed up their great weaknesses.
But “free and ready access” is a far cry from the actual delivery of quality medical care. I have
travelled the globe to developed and undeveloped countries with both democratic and
communistic governments, and so have worked in the trenches abroad, and I can state
unequivocally that I have not observed any “universal health system” or other state-operated
medical system that functions in a highly satisfactory manner or provides high quality care to all
the people all the time. In all such countries, there are long delays for any form of high-
technology care—sometimes with fatal consequences. In fact, rationing of care is a prominent
feature of all these systems.
Opponents of state intervention and proponents of “privatization” contend that the deeper
government becomes involved in health care, the more bureaucratic, complex, inefficient, and
inferior the services. Advocates of state intervention, on the other hand, argue that government
participation is the best way to improve both cost-effectiveness and accessibility of health
services.62
Freely stating that he had no “panacea,” DeBakey nevertheless sounded a

clarion warning against proponents of so-called reform. If that were to
result in “improvement in the access, quality, and deficiency of healthcare
delivery, fine, but if it means more cost cutting by denial or reduction of
services, by burdensome and intrusive government regulations, shifting
funds from patient care to corporate salaries and higher administrative
costs, that it is not reform; it is abuse.”63 He went on to recognize that some
form of national coverage was likely inevitable but expressed “grave
concern about any form of total government operated system such as an
expanded version of traditional Medicare.”64
DeBakey’s recommendation was informed by his service on the Hoover
Commission and at the head of President Johnson’s Commission on Heart
Disease, Cancer, and Stroke. He believed the best means of finding a
solution to the “disarray” of the nation’s healthcare system was the
appointment of a similar commission, essentially apolitical but necessarily
endorsed and supported by the President and Congress, to address the
problems and, not incidentally, achieve the goal of universal healthcare
coverage.
On June 5, 2007, DeBakey’s son Barry was found dead in his apartment
by his younger brother, Denis. Barry, who had graduated from the
University of Texas with a degree in political science, was the long-time
owner and operator of a successful bar and grill called Blanco’s. He had
opened the cantina in the 1980s on land owned by the Taub family in the
swanky River Oaks neighborhood. Barry was a genial soul, a “friend to
everybody,” and enjoyed perhaps the closest relationship to his father of
any of the boys. He embraced his identity as a Texan, savoring the rodeo
and spending a considerable amount of time running the Round Top Ranch
his father had bought (along with his uncle Ernest) primarily as an
investment. Barry, who died of liver failure, was 61.65
None of DeBakey’s sons (or, for that matter, his daughter Olga) went into
medicine. When asked if this fact disturbed him, particularly since—as an
unavoidable example—all of his mentor Alton Ochsner’s sons had done so,
he remarked: “No. I gave them opportunities. They worked in the hospital
and had a chance to see what it was like, but I don’t find that sort of thing
necessary to my own gratification. I love them and admire them, that
they’re doing the right thing. It pleases me that they have grown up to be
good citizens [and] honest.”66
11.9 Gold Medal

On his 99th birthday, September 7, 2007, DeBakey received word, quietly,
that he was going to be awarded the Congressional Gold Medal. The call
came from Al Green, Democratic Representative from Houston, and his
Republican colleague Michael Burgess of Flower Mound, near Dallas.
These two, along with Representative John Culberson of Houston and
Senator Kay Bailey Hutchinson, had been working on securing the honor
for DeBakey for several years. By law, two-thirds of each house must
approve the recognition and that had now been achieved. Hutchinson had
secured the necessary votes in the Senate in March, and the congressmen
collected the final pledges on DeBakey’s birthday.67
The Gold Medal is one of the oldest and highest honors that the nation’s
legislature can bestow upon a citizen, having been in existence since 1776.
DeBakey would be the 135th recipient. When the award is given, an actual
commemorative gold medal is struck at the United States Mint (bronze
versions are also made). On the obverse of DeBakey’s medal was a portrait
of the surgeon in his familiar scrub suit, with an operation under way in the
background. On the reverse was depicted a human heart superimposed over
a globe, symbolizing his world-wide contributions to cardiovascular
surgery. A ribbon encircling the heart read: “THE PURSUIT OF
EXCELLENCE HAS BEEN MY OBJECTIVE IN LIFE.” Katrin did not
like the portrait of her husband, but to change the coin would have required
approval of a separate commission, which was not feasible.68
The actual citation of the Act, which was approved on October 16, 2007,
as Public Law 110-95, summarized DeBakey’s life in 15 bullet points,
which were mostly accurate (although he must have winced at the statement
that “Dr. DeBakey performed the first successful procedures to treat
patients who suffered aneurysms leading to severe strokes”69).
One afternoon after DeBakey had been discharged from Methodist, the
doorbell at the Cherokee home rang. On opening the door, Katrin was
shocked to see Denton Cooley, still regal and imposing at a white-haired 85.
He had been driving in the neighborhood, Cooley said, and wanted to drop
by and pay his respects to his former chief. He also wanted to extend his
best wishes for a speedy and complete recovery.
Katrin apologized to her husband’s old rival, but indicated that DeBakey
was not feeling well enough to see visitors.70
Although nothing came of the impromptu visit, it was indicative of
something momentous. Suddenly, across a gulf of 40 years, there had come
an olive branch.
In the years since his schism with DeBakey and Baylor, Cooley had
continued to perform cardiovascular operations at his Texas Heart Institute
at a pace that defied convention and, sometimes, credulity. His lead as the
world’s most-experienced heart surgeon only lengthened. Unlike DeBakey
and most other academicians, Cooley had embraced the shifting sands of
the American healthcare delivery landscape. He and his Institute were
among the first to offer discount, set rates for some operations (such as the
ubiquitous coronary artery bypass) and their perioperative care. Large
corporations bought into the idea and signed contracts in the HMO model
that DeBakey and most other physicians, especially academics, abhorred.
Along the way, Cooley amassed a significant personal fortune. He made
extensive investments in the local economy and real estate. All was not
unfiltered sunshine for Cooley, however.
He suffered the sudden and unexpected loss of one of his five daughters
in 1985. A few years later there came a banking, oil, and real estate crash,
and Cooley was forced to file for bankruptcy. He listed debts in excess of
$100 million.71 He was able to recover from this enormous financial
setback, but Cooley’s annual income, which approached $10 million in the
1970s, never soared to those stratospheric heights again. Despite all this, in
general, the Texas Heart Institute and its affiliated hospitals thrived, in
direct competition with the Baylor/Methodist complex in plain sight a few
hundred yards to the south. Boasting such talents as O. H. “Bud” Frazier
(who had been trained by both DeBakey and Cooley) the Institute also
participated in front-line research into heart transplantation, along with
artificial hearts and LVADs.
Over the years the junior colleagues of DeBakey and Cooley, many of
whom had been trained—like Frazier—by both, often spoke of arranging
some sort of reconciliation of the two at-odds giants. Nothing came to
fruition, though, until after DeBakey’s brush with death.
It was then that the idea was hatched to extend an invitation for DeBakey
from the Denton A. Cooley Cardiovascular Surgical Society, an association
similar to the one assembled by DeBakey’s former trainees (and which, in
fact, predated it by five years). It was determined that he would be given
honorary membership in the group as well as a lifetime achievement award
at the next annual meeting, scheduled for October 27, 2007.
The proffering of this invitation was done with a good deal of
circumspection and discretion. No one was really sure whether DeBakey
would agree to the honors, or whether, when it came down to it, he would
actually show up. For this reason, no mention was made to the press.
Cooley later indicated that he had gained inspiration for this gesture from
a book by the astronaut Gene Cernan (who had been a patient at the Texas
Heart Institute). In his memoir, Cernan described the great rivalry, and even
personal animosity, between the American astronauts and Russian
cosmonauts during the Space Race leading up to the Apollo moon landing.
When the landing had been accomplished and the contest was over, the two
groups began collaborating. To their mutual surprise, the space explorers
found that they were cut from the same cloth and soon became good friends
(Cernan reflected that the Russians were significantly more accomplished
vodka drinkers).
Cernan’s book inspired me to take the first step toward ending the “cardiac surgery race”
between Dr. DeBakey and me. By that time, both of us had retired from surgical practice, so
further developments in cardiovascular surgery were out of our hands. . . . I began to seek a
means of settling the situation, which was increasingly on my mind.72
The day of the conference arrived. Things were already under way, with
Cooley speaking at the lectern, when a side door opened into the hall. The
attendees turned as one to see a figure in a motorized scooter, silhouetted in
the bright background light of the doorway. Cooley instinctively looked up,
too, and went silent. He left the stage and walked over to DeBakey, hand
extended. The two giants exchanged pleasant greetings and warm smiles, as
some of the world’s most accomplished and famous cardiovascular
surgeons scrambled atop chairs and tables to catch a glimpse of the scene
that had seemed destined never to occur. The impossible had happened: if
only for a fleeting moment, DeBakey and Cooley were together again.73
News of DeBakey’s Congressional Gold Medal had only been made
public a few days before, and Cooley wryly observed that, “It must be a
heavy burden for one person to be honored by a Congressional Gold Medal
and membership in the Cooley Society all in one week.”74
Not missing a beat, DeBakey replied that since the Congressional medal
was pure gold he assumed the Cooley award must be the same. With a smile
Cooley replied, “14 karat.”75
The Congressional Gold Medal Award ceremony was scheduled for
11:00 AM on Wednesday, April 23, 2008, in the rotunda of the United States
Capitol building in Washington, D.C. More than 60 people made the final
invitation list, mostly friends and colleagues from the staff and Boards of
the now-distinct Baylor College of Medicine and Methodist Hospital. Other
notable guests included Bertil Hamberger from the Karolinska Institutet, C.
Rollins Hanlon from the American College of Surgeons, and the
distinguished surgeon Hiram Polk of the University of Louisville. Lawrence
Altman, the medical writer for the New York Times, received an invitation.
So did Denton Cooley.76
On April 22, 2008, the DeBakey party traveled by private jet from
Houston to Washington, D.C. Given his medical condition a number of
special considerations had to be made, including a wheelchair onsite, a
portable oxygen tank, and precautionary liaisons with the physicians at
George Washington Medical Center. A cache of his favored drink, Coca-
Cola Classic, was a priority. On arrival at Washington, the DeBakeys
checked into the Ritz-Carlton and readied themselves for the next day’s
main event.77
On Wednesday morning DeBakey and Katrin arrived at the Capitol south
entrance at 10:30 AM, where they were met by congressional officials and
taken to the office of House Speaker Nancy Pelosi. Senator Hutchinson was
there, too, soon joined by Senate Majority Leader Harry Reid, Senate
Minority Leader Mitch McConnell, House Minority Leader John Boehner,
and Representative Al Green. A few minutes later President Bush appeared,
and photographs were taken. The group then proceeded to the rotunda
entrance at 11:00 AM.
The ceremony began with music from the United States Air Force
Strings, followed by a welcome from Speaker Pelosi. The Armed Forces
Color Guard presented the flag, and the Strings played the “Star-Spangled
Banner.” After an invocation, all the politicians who had met DeBakey
before the ceremony offered their remarks on the resolution.
President Bush pointed out that few scientists had been afforded the
honor of the Gold Medal, but the ones who had were a select company—
Thomas Edison, Walter Reed, Jonas Salk. DeBakey’s name belonged with
all of them. The President went on to recount the surgeon’s life from
childhood, pointing out the spectacular accomplishments but also
highlighting the impact of his work on everyday lives: “Dr. DeBakey has an
impressive resume, but his truest legacy is not inscribed on a medal or
etched into stone. It is written on the human heart. His legacy is the unlost
hours with family and friends who are still with us because of his healing
touch. His legacy is grandparents who lived to see their grandchildren. His
legacy is holding the fragile and sacred gift of human life in his hands—and
returning it unbroken.”78
DeBakey himself spoke last, extemporaneously and without notes
(Figure 11.4).
Figure 11.4 The Congressional Gold Medal Award ceremony, April 3, 2008.
After expressing his humility and thanks, DeBakey also described his
upbringing in Lake Charles. He remembered his parents’ great lessons to
their children of pride in their adopted country, the inestimable value of
education, and compassion for their fellow man. DeBakey spoke wistfully
of the siblings’ infatuation with the Encyclopedia Britannica and the
bittersweet donation at his mother’s behest of the well-worn cap he adored.
Never one to dwell in the past, however, DeBakey then turned to a topic
very much in the moment in the capital city: “Now, I want to make a
suggestion to the Congress about health care.”79 Cascades of laughter
circled the rotunda. After this died down, he went on to point out what a
success the VA had been after it was sorted out in the years following World
War II. He did not hesitate to point out that he had played a big role in the
sorting. Surely, he insisted, there must be lessons in that model for the
provision of healthcare for every citizen in the new century.
DeBakey closed with a poignant thanks to Congress for supporting
medical research in the country, reminding them that, in his youth, the best
training and care were in Europe, but now they could be found in the United
States.
“Again, let me come back to my sense of gratitude and because of my
sense of high treasure I have for my citizenship, since receiving this ward,
my cup runneth over. Thank you very much.”80
May 2, 2008, was the date of the 17th meeting of the renamed Michael E.
DeBakey International Surgical Society. The conference was often held in
some overseas locale where the seed of cardiovascular surgery had taken
root under the care of a DeBakey trainee. Such far-flung venues as Monte
Carlo (1984); Melbourne, Australia (1986); Yokohama, Japan (1990);
Frankfurt, Germany (1992); Lisbon, Portugal (1998); and Queensland,
Australia (2002) had hosted the conference.81 This year, however, it was
held in Houston. Of greatest note, Denton Cooley was to be inducted into
the association, a notion that would have been unthinkable only a year
before. This was the setting for a reciprocal sign of goodwill and hatchet-
burying that many at the time saw as the final curtain in the near half-
century drama that had defined the relationship of these two greats.
As 400 surgeons looked on in the ballroom of the Intercontinental Hotel,
DeBakey generously complimented Cooley:“Denton, it’s a great pleasure
for me to acknowledge the pioneering contributions you made and to have
you a part of this organization. I knew from the beginning that you had the
instincts of a great surgeon.”82
DeBakey gave Cooley the organization’s lifetime achievement award, as
well as a leather-bound reprint of one of their first papers written together
back in 1952, on aortic aneurysms. The audience rose in a standing ovation,
and Cooley remarked,
“As many of you know, we’ve been friendly rivals for many years. I think our rivalry will go
down in history as one of the greatest rivalries in modern medicine. I’m relieved we’re again
together and can be colleagues and friends again.”
He continued in a lighthearted, but melancholy tone. “Unfortunately for both of us, Mike, the
end is in sight. I don’t know whether we have the time or the effort available, but I thank you for
restoring our friendship.”83
On Friday, July 11, 2008, Antonio Gotto stopped by the house on
Cherokee Street to visit DeBakey and go over some ideas about a new
edition of The Living Heart. The two men talked for about an hour and a
half before Gotto bid adieu.84 Not long after that, George Noon was at the
door.
The old master and his protégé—at 74, long-since a senior and world-
famous master in his own right—enjoyed some light conversation and
Louisiana-style gumbo. The soup was liberally spiced with okra and
peppers, fresh from the backyard garden—just as young Michel’s mother
Raheeja had made it for him back in Lake Charles more than eight decades
before. After a bowl of ice cream, Noon took his leave: he was off to see his
grandson play a baseball game, then to a well-deserved vacation in Aspen.
DeBakey waved from his bed, wished Noon a safe trip and good luck in the
game, and said goodbye.85
Some time later the Professor collapsed, unconscious. EMTs arrived and
took him, for the last time, on the short trip to Methodist Hospital. There,
Michael Ellis DeBakey, two months shy of his 100th birthday, passed into
legend.
Notes
2. Bhimaraj A, Loebe M. Editorial: An Interview with George P. Noon. Methodist DeBakey
Cardiovascular Journal 2015:11(1):45–47.
3. Mizuguchi K, Damm G, Bozeman RJ, et al. Development of the Baylor/NASA Axial Flow
Ventricular Assist Device: In Vitro Performance and Systematic Hemolysis Test Results.
Artificial Organs 1994;18(1):32–43.
4. Mizuguchi K, Damm G, Benkowsky R, et al. Development of an Axial Flow Ventricular
Assist Device: In Vitro and In Vivo Evaluation. Artificial Organs 1995;19(7):653–659.
5. Noon GP, DeBakey ME, Normann NA. Left Heart Bypass as Practiced at Baylor College of
Medicine. Surgical Team 1976;5:36–38.
6. Wieselthaler GM, Schima H, Hiesmayr M. First Clinical Experience with the DeBakey VAD
Continuous-Axial-Flow Pump for Bridge to Transplantation. Circulation 2000;101(4):356–
359.
7. DeBakey ME. Development of Mechanical Heart Devices. Annals of Thoracic Surgery
2005;79(6):S2228–2231.
8. Noon GP, DeBakey ME, Normann NA. Left Heart Bypass.
10. Ibid.
11. Falkenberg L. Let’s Thank DeBakey for School, Too (July 15, 2008). Houston Chronicle.
https://www.chron.com/news/falkenberg/article/Let-s-thank-DeBakey-for-school-too-
1770316.php, accessed May 15, 2019.
12. Baylor College of Medicine Oral History Project, Interview III. DeBakey, Michael E. Michael
E. DeBakey Archives. 1903–2010. Located in: Archives and Modern Manuscripts Collection,
Series 3:9:9–10.
13. Ibid.
14. Ibid.
16. http://www.laskerfoundation.org/awards/ (accessed April 23, 2019).
17. Kotz DM, Weir F. Russia’s Path from Gorbachev to Putin: The Demise of the Soviet System
and the New Russia. London: Routledge, 2007: 260–264.
18. Colton TJ. Yeltsin: A Life. New York: Basic Books, 2008: 375–378.
19. Yeltsin Journal I. September 22–27, 1996. Yeltsin Journal II November 2–10. DeBakey
Archives, National Library of Medicine, Bethesda, MD; MS C 582. Series 3:10:22, 23.
20. George P. Noon, personal communication, April 8, 2019.
21. Ibid.
22. Altman LK. In Moscow in 1996, a Doctor’s Visit Changed History (May 1, 2007). New York
Times. https://www.nytimes.com/2007/05/01/health/01docs.html. Accessed May 15, 2019.
23. Ibid.
25. Ibid.
26. Ibid.
27. https://www.bcm.edu/about-us/our-campus/debakey-museum/museum-history (accessed April
20, 2019).
28. Bhimaraj A, Loebe M. Editorial: An Interview with George P. Noon.
29. Matthias Loebe, personal communication, April 29, 2019.
30. https://www.spacefoundation.org/what-we-do/space-technology-hall-fame/inducted-
technologies/debakey-blood-pump (accessed April 23, 2019).
31. NASA Selects Inventions of the Year (April 4, 2002). ScienceDaily.
www.sciencedaily.com/releases/2002/04/020402074201.htm (accessed April 23, 2019).
33. https://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/FJBBFH (accessed April 23, 2019).
34. McCollum CH. The Distinguished Service Award Medal for the Society of Vascular Surgery,
1999: Michael Ellis DeBakey, MD. Journal of Vascular Surgery 2000;31(2):406–409.
35. Roberts WC. Michael Ellis DeBakey: A Conversation with the Editor. American Journal of
Cardiology 1997;79(7):929–950.
36. A Conversation Remembering Michael E. DeBakey with Dr. Donald A. B. Lindberg and
George P. Noon. https://profiles.nlm.nih.gov/ps/access/FJBBWN.pdf (accessed April 23, 2019.
37. Schwartz M. Till Death Do Us Part (March 2005). Houston Monthly.
https://www.texasmonthly.com/articles/till-death-do-us-part/. Accessed May 15, 2019.
38. The quote is from Tennyson’s In Memoriam. DeBakey Collection. Baylor College of Medicine
Archives. Houston, TX. 2:216:6.
39. Nomination and selection of Nobel Laureates.
https://www.nobelprize.org/nomination/medicine/ (accessed April 30, 2019).
40. Letter, M. E. DeBakey to C. J. Robertson, February 24, 2004. Letter M. E. DeBakey to E. G.
Toomey, February 24, 2004. DeBakey Collection. Baylor College of Medicine Archives.
41. US Department of Veterans Affairs: Michael E. DeBakey VA Medical Center—Houston,
Texas. https://www.houston.va.gov/about/history.asp (accessed April 23, 2019).
42. Ackerman T. VA Hospital Renamed for Famed Surgeon DeBakey (June 29, 2004). Houston
Chronicle. https://www.chron.com/news/houston-texas/article/Veterans-hospital-renamed-
after-DeBakey-1474244.php. Accessed April 19, 2019.
43. Letter E. O. DeBakey to M. E. DeBakey, June 15, 1986. DeBakey Archives, National Library
44. Michael M. DeBakey, personal communication, June 21, 2018.
45. Searle NS, Writing Committee. Baylor College of Medicine’s support of Tulane University
School of Medicine following Hurricane Katrina. Academic Medicine 2007;82(8):733–744.
46. Ackerman T. Emotions Run High as Tulane Starts Class (October 2, 2005). Houston
Chronicle, 1.
48. Altman LK. The Man on the Table Devised the Surgery (December 25, 2006). New York
Times. https://www.nytimes.com/2006/12/25/health/25surgeon.html. Accessed April 19, 2019.
49. Roland Hetzer, personal communication, April 29, 2019.
50. Altman LK. The Man on the Table.
51. Ibid.
52. Society for Vascular Surgery History Project Work Group. A Visit to Michael E. DeBakey
Library/Museum. Interview with George P. Noon, 2017.
54. Society for Vascular Surgery History Project Work Group. A Visit to Michael E. DeBakey
Library/Museum. Interview with George P. Noon, 2017.
56. Matthias Loebe, personal communication, April 7, 2019. The administrative assistant who
found the roller pump on eBay was Julie Glueck, who worked for Yukihiko Nosé.
57. Mobile surgeon Ernest G. DeBakey dies at age 96.
https://alt.obituaries.narkive.com/lhBRI240/surgeon-ernest-g-debakey-dies-at-age-96-michael-
debakey-s-younger-brother (accessed March 29, 2019).
58. Strickland SP. The History of Regional Medical Programs. Lanham, MD: University Press of
America, 2000: Introduction.
59. DeBakey ME. The Role of Government in Health Care: A Societal Issue. American Journal of
Surgery 2006;191(2):145–157.
60. Ibid.
61. Ibid.
62. Ibid.
63. Ibid.
64. Ibid.
65. Crowe R. Friends Raise a Glass to DeBakey’s Late Son: Gathering at His Bar After a
Memorial Service, Friends Recall His Generosity (June 7, 2007). Houston Chronicle.
https://www.chron.com/news/houston-deaths/article/Friends-raise-a-glass-to-DeBakey-s-late-
son-1807086.php. Accessed May 1, 2019.
67. Mittelstadt M. DeBakey close to receiving Congressional Gold Medal. Houston Chronicle,
September 8, 2007, 1.
68. Memo F. Trull to M. E. DeBakey, February 12, 2008. DeBakey Collection. Baylor College of
Medicine Archives. Houston, TX. 8:4:15–18.
69. S474-3. An Act, to award a congressional gold medal to Michael Ellis DeBakey, M.D. One
Hundred Tenth Congress of the United States of America. October 16, 2007.
70. Altman LK. The Feud (November 27, 2007). The New York Times.
https://www.nytimes.com/2007/11/27/health/27docs.html. Accessed April 11, 2019.
71. Dr. Denton Cooley Petitions for Bankruptcy Protection (January 6, 1988). The New York
Times, A17.
72. Cooley DA. Feuds. Texas Heart Institute Journal 2010;37(6):649–651.
73. Altman LK. The Feud.
74. Ibid.
75. Ibid.
76. Invitation List, Congressional Gold Medal Award Ceremony. DeBakey Collection. Baylor
College of Medicine Archives. Houston, TX. 8:4:15–18.
77. DeBakey Itinerary, Gold Medal Award Ceremony. DeBakey Collection. Baylor College of
Medicine Archives. Houston, TX. 8:4:15–18.
78. President Bush Attends Congressional Gold Medal Ceremony for Dr. Michael Ellis DeBakey,
April 23, 2008. https://georgewbush-
whitehouse.archives.gov/news/releases/2008/04/20080423-3.html (accessed April 19, 2019).
79. DeBakey speech at Congressional Gold Medal Ceremony, April 23, 2008. DeBakey
Collection. Baylor College of Medicine Archives. Houston, TX. 8:4:15–18.
80. Ibid.
81. DeBakey Collection. Baylor College of Medicine Archives. Houston, TX. 10:110.
82. Wendler R. DeBakey Inducts Cooley into DeBakey Surgical Society (May 15, 2008). Texas
Medical Center News, 1.
83. Ibid.
84. Antonio Gotto, Jr., personal communication, March 5, 2019.
85. George P. Noon, personal communication, April 8, 2019.
*
DeBakey liked to point out that the concept of axial flow originated with Archimedes, who
developed a “screw pump” in the 3rd century BC for use in irrigation.5
†
If the patient’s left ventricle maintained or developed sufficient contractility, a weak pulse might
be present. Several continuous flow pumps were already in existence at this time, but were only
intended for brief use.
*
Unless otherwise noted, all information in this section derives from DeBakey’s Yeltsin Journal I,
September 22–27, 1996 and Yeltsin Journal II, November 2–10, 1996.19
*
Extant documents suggest that DeBakey was nominated in 2003 and/or 2004, at the least.39
*
The school’s longtime primary teaching institution, the venerable Charity Hospital, was
shuttered and has never been reopened.
*
Due to DeBakey’s deteriorating kidney function, his coronary arteries could not be imaged with
a contrast-based technique such as cardiac catheterization; the contrast material might damage his
kidneys further, perhaps irretrievably. There was, moreover, no clinical suspicion of significant
coronary artery disease.
12
Epilogue
Large was his bounty, and his soul sincere,

Heav'n did a recompense as largely send.
DeBakey’s death was headline news across much of the world. Network
newscasts ran tribute pieces, a multitude of medical journals published
thoughtful in memoria, and papers near and far printed extensive obituaries.
Lawrence Altman, the physician-journalist who had chronicled much of the
last 20 years of DeBakey’s life, penned a lengthy article on the great
surgeon for the Sunday New York Times.1
A gala celebration had been planned for September 7, 2008 in honor of
DeBakey’s 100th birthday. This was to have been held at Hermann Park just
outside the Texas Medical Center. With his passing, these arrangements
were modified, and the result was a unique circumstance: for the first time
in the city’s history, an individual would lie in honor in Houston’s City Hall
rotunda.2
On Tuesday, July 15, DeBakey’s casket was brought into the dome, and
for several hours citizens passed through, paying their respects and
recording their thoughts in more than half a dozen large memorial books.
DeBakey was dressed in the operating room uniform he had worn, in later
years, almost exclusively when at the Medical Center: powder blue scrub
suit, including cap and mask, “pulled down from his face in a position
familiar to the thousands of people who conversed with the doctor after
he’d emerged from the operating room.” Over this was the familiar white
lab coat, embroidered with “MED” on the lapel. In his right hand was a
crystal crucifix.3
Over 2,000 mourners passed through the rotunda, many kneeling to pray
before the casket, others weeping silently or crossing themselves. Some
were strangers, others old friends. The cream of Houston’s society passed
through, alongside ordinary citizens—equal in their grief just as they had
been in DeBakey’s surgical practice: the first in line was a homeless man.4
The next day, a large memorial service was held at the imposing, brand
new Co-Cathedral of the Sacred Heart in downtown Houston. A tasteful
printed program featured the entirety of DeBakey’s favorite poem, Thomas
Gray’s Elegy Written in a Country Churchyard. Archbishop Emeritus
Joseph Fiorenza spoke the invocation, and, after a hymn, the famed speaker
and televangelist Robert Schuller provided a message based on the Gospel
of Matthew (“Come, you who are blessed by my Father. Inherit the
kingdom prepared for you from the foundation of the world”). A number of
DeBakey’s long-time friends and colleagues offered their reflections on his
life, including George Noon, John Ochsner, and Antonio Gotto. Baylor and
Methodist put aside any lingering antipathy as both Bobby Alford,
Chancellor of the College, and Marc Boom, Executive Vice President of the
Hospital, paid tribute to the man who had raised both their institutions to
greatness and international fame. The eulogy was given by Joanne King
Herring, one of the more gregarious, well-known, and influential members
of Houston society. The ceremony closed in classic New Orleans funeral
fashion, with the famous Young Tuxedo Brass Band providing recessional
music. As per tradition, the band transitioned from hymns and dirges to the
raucous jazz that young Tulane student Michael Debakey had savored in the
French Quarter long before. The strains of “When the Saints Go Marching
In” filled the cavernous reaches of the cathedral.
DeBakey’s service in the US Army qualified him for interment at
Arlington National Cemetery, enshrined in the nation’s lore as “America’s
Most Hallowed Ground.” The burial site, Section 34, 399-A, is just a few
miles from where he and his small family had lived during World War II. It
is also within view of the Pentagon, where he completed his monumental
work in the Surgical Consultants Division. There, in a modest ceremony
attended by members of the family, friends, and a few high-ranking officials
and government dignitaries, the body of Michael DeBakey was consigned
to the earth on July 18, 2008.
On May 14, 2010, the Michael E. DeBakey Library and Museum opened
at Baylor College of Medicine, on the ground floor of the DeBakey Center,
adjacent to the old Cullen building. The museum put on sumptuous display
a number of artifacts and documents from DeBakey’s illustrious career,
including an original Aloe and Company DeBakey roller pump, many left
ventricular assist devices (LVADs) and Dacron graft examples, and the
1963 Lasker Award. The entire impressive effort, a partial culmination of
the announcement made by William Butler at the 50th anniversary Gala in
1998, was really only the beginnings of a colossal work of processing,
certifying, and cataloguing the memorabilia from his Medical Center offices
—a task that will extend for years to come. Plans for the museum were
mostly complete before his death, and those in a position to know indicated
that, although DeBakey did not live to see it executed, the design met with
his full approval (Figure 12.1). At the ribbon-cutting ceremony, which also
included the unveiling of an impressive, eight-foot statue of DeBakey,
Denton Cooley—whose own museum graced the ground floor of the Texas
Heart Institute—remarked that “Michael was always able to outdo me, and
he’s done it again.”5
Figure 12.1 Charles McCollum, DeBakey, and George Noon at the Congressional Gold Medal
Award ceremony.
Courtesy Charles McCollum.
As daunting a task as archiving the DeBakey collection at Baylor has

proved to be, it is only half the story. Thousands more documents and
artifacts from his home office—in all, 77 archival boxes of material—were
donated by his widow, Katrin, to the National Library of Medicine in
Bethesda, Maryland, where they are now available to researchers.
Despite his self-effacing remarks at the dedication of the DeBakey
Museum, in the eyes of many Denton Cooley was to muddy the waters of
the reconciled relationship with his old chief in a 2012 autobiography
entitled, 100,000 Hearts: A Surgeon’s Memoir.6 In the book, Cooley
reverted to his previous uncharitable characterizations of DeBakey, in
particular to draw distinction to his own achievements and winning
personality—which were undeniable and required no contrasting nemesis.
Moreover, his account of the Haskell Karp artificial heart case conflicted
dramatically with the findings—and witness statements—of the Baylor
investigation. In the wake of DeBakey’s death, the generous spirit of the
mutual Society membership seemed to have dissipated in Cooley, much to
the disappointment of many who had labored toward, or simply enjoyed
witnessing, the two great surgeons’ rapprochement. Cooley died in his
hometown of Houston on November 18, 2016, at age 96.
In 2007, the Lasker Foundation changed the name of the Albert Lasker
Award for Clinical Medical Research to the Lasker-DeBakey Clinical
Medical Research Award, given, “For a major advance that improves the
lives of many thousands of people.”7
Shortly before his death DeBakey had been informed that a statue was to
be erected in his parents’ hometown of Jdeidit Marjeyoun to honor his
100th birthday. The statue, a massive white marble bust similar in design to
Georges Muguet’s at Methodist Hospital, was sponsored by Beirut’s
American University of Science and Technology. The unveiling was to be
in December 2008, and DeBakey had planned to attend and give a speech.
Katrin made the trip in his stead and planted a tree beside the statue.8
In the years after their brother’s death, Lois and Selma DeBakey—known
at Baylor and Methodist simply as “The Sisters”—continued their energetic
defense of both him and the English language against all threats. They
continued to work out of their ninth floor office at the hospital, close by
their brother’s former suite. Selma died on March 6, 2013, at age 97, and
Lois followed on June 15, 2016, two weeks shy of her 96th birthday.
Michael M. DeBakey still lives in Peru, where he has spent the majority
of his life as a successful businessman. He has been married for 26 years,
and the couple have nine children between them. They live on a farm in
Lurin, a suburb of Lima, where they raise Peruvian Paso horses. At the age
of 80, Michael is returning to the love of writing he initially embraced as a
college student.
Denis DeBakey makes his home in Houston, where he was recently
married. His wife, Susan, was a patient of his father in her childhood. Denis
is a member of a number of boards in Houston and the Texas Medical
Center that contribute to the advancement of research and patient care, and
he is an active and visible advocate of his father’s towering legacy.
Olga DeBakey lives with her family, including two young daughters, in
the Pacific Northwest. She is an art therapist, carrying on through her work
the family tradition of channeling a passion to the good of the community.
Katrin DeBakey lives in Houston. She travels frequently, especially to
her homeland of Germany, but retains an active role in the remembrance of
Michael DeBakey’s achievements at the Texas Medical Center.
That legacy does not exist only in Houston, although it is well
represented in DeBakey’s adopted hometown. There, his name adorns such
facilities as the Michael E. DeBakey Veterans Administration Medical
Center, the Michael E. DeBakey Department of Surgery at the Baylor
College of Medicine, the DeBakey Heart and Vascular Center at Houston
Methodist Hospital, and the Michael E. DeBakey High School for the
Health Professions. There are also schools and medical institutions bearing
his name in Kenosha, Wisconsin; Hays, Kansas; Texas A&M University in
College Station; and Qatar. A number of fellowships and scholarships at
Baylor and elsewhere also carry the DeBakey name.
The memory of the great surgeon-scientist lives on beyond these obvious
nominal entities, though. The operations he devised—though updated and,
in some cases, superseded—remain in the repertoire of practicing surgeons,
and no foreseeable advance of technology seems likely ever to extinguish
them fully. Indeed, the endovascular surgical techniques so prevalent today
are, in perspective, no more than variations on the themes he and his gifted
team composed in that glorious, frantic decadus mirabilis of another era.
The vascular grafts and instruments he designed or brought to their ideal
forms are still fixtures in the modern operating room. Indeed, as the years
roll by, the DeBakey name becomes incrementally more closely associated
with his eponymous surgical tools alone—at least among those too young to
recall the dominant force in modern medicine that earned the eponym and
brought those instruments to reality.
Perhaps most importantly, though, the hundreds of surgery residents he
trained—and the defining philosophy of research, education, and patient-
centered care he inculcated within them—have spread to every corner of the
globe. These priceless lessons, cherished by his grateful students, will
undoubtedly continue to propagate as they are handed down through the
professional generations of cardiovascular surgeons descended and
descending from Michael Ellis DeBakey (Figure 12.2).
Figure 12.2
Photo by author.
Notes
1. Altman LK. Michael DeBakey, Rebuilder of Hearts, Dies at 99 (July 13, 2008). The New York
Times.
2. Ackerman T. Houstonians View Debakey’s Casket at City Hall (July 15, 2008). Houston
Chronicle. Although the terms are used with increasing overlap, lying in state refers to
exhibition of a casket or remains of a government official in a national or state capital
building, lying in repose to the same occurring in a nongovernmental structure, and lying in
honor to a similar event honoring a nongovernmental figure.
3. Ibid.
4. Ibid.
5. Ackerman T. Baylor Honors Pioneer DeBakey with Library, Museum (May 14, 2010).
Houston Chronicle.
6. Cooley DA. 100,000 Hearts: A Surgeon’s Memoir. Austin, TX: Briscoe Center for American
History, University of Texas at Austin, 2012.
7. The Lasker Awards. http://www.laskerfoundation.org/awards-overview/ (accessed April 30,
2019).
8. Winters WL. Tributes. Houston: Elisha Freeman Publishing, 2017: 76.
Index
Figures are indicated by f following the page number

For the benefit of digital users, indexed terms that span two pages (e.g., 52–53) may, on occasion,
appear on only one of those pages.
“Acute Battle-Incurred Arterial Injuries” (DeBakey and Simeone), 311

Albert Lasker Clinical Medical Research Award, 398, 399f, 571
Alkek, Albert, 516–517
Alkek Tower, 516–517
Allbritton, Joseph, 433–435, 570
Allen, Eugene E., 73
Alsace, 105–107
Kirschner, Martin, 103–104
American Board of Surgery (ABS), 129–130
Amspacher, William, 240
Anderson, Suzanne, 453. See also artificial heart, total, 1969 (Liotta-Cooley)
“Aneurysms and Thrombo-Obliterative Disease of the Aorta: Surgical Considerations” (DeBakey),
300
aneurysm surgery, 264–265. See also specific types
alternatives, 264–265
endoaneurysmorrhaphy, 248–249
historical advances, 247–249
Society for Vascular Surgery, 249
animal surgery research, 127–128, 542–543
artificial heart, calf experiments, 451–452
Antyllus, 248
aorta aneurysm surgery, 264–265
abdominal aortic aneurysm, ruptured, 296–298
heterograft experimental surgeries, 275–276
homograft (see aortic aneurysm surgery, homograft)
thoracoabdominal aortic aneurysm, 316–319, 318f
aortic aneurysms, patterns of involvement, 394
aortic aneurysm surgery, homograft, 275
DeBakey’s first and second, 267–269, 274f
DuBost’s end-to-end homograft, 266–267
graft preservation issues and solutions, 275
Gross’ studies and homograft surgery, 265–266
Oudot’s aortic bifurcation homograft, 266f, 266
thoracic aorta resection, with homograft replacement, 271–279, 274f, 294–295
aortic arch aneurysm surgery, 334f, 335–339
distal, resection and homograft, 294–298
distal, resection and homograph, with induced hyperthermia, 295–296
distal, resection and homograph, with induced hyperthermia, Matas’ letter on, 199, 296
aortic arch surgery, 346–349, 348f
aortic bifurcation surgery, homograft
DeBakey’s first and second, 267–268
Oudot’s, 266f, 266
aortic dissection
classification, 395
surgical typing, 303, 304f
thoracic aorta surgery, 302–303, 304f
type 2, DeBakey’s, 574–578
aortic valve surgery
live TV broadcast (1965), 414
mechanical aortic valve, Crawford’s first, 397–398
mechanical aortic valve, DeBakey’s first, 397–398
aortocoronary bypass, Garrett and Howell’s, 409–411
Armed Forces Medical Library, 291–294, 375–376, 377
Army Medical Library, 165, 166f
“Future of the Army Medical Library, The” (DeBakey), 256
post-World War II, 203–205, 256
Army Medical Museum, 165, 256, 312
arterial bypass, Kunlin’s first, 251–253
arterial dissection surgery, thoracic aorta, 302–303
arterial grafts, prosthetic. See prosthetic arterial grafts
arterial injuries study, Baylor University College of Medicine (1948-1951), 240–241
arteriotomy, 371
artificial heart, DeBakey’s research program
1960s, Baylor-Rice, 415–416
1960s, federal funding, 396–397
Feldman’s prototype, 448–449, 464
left ventricular assist pump, first, 421–426, 553
Soviet artificial heart team collaborations, 513
artificial heart, total, 1969 (Liotta-Cooley), 444–479. See also Hall, C William
aftermath, 475–479
calf experiments, 451–452
consequences, 469–475
first recipient, Haskell Karp, 444
HE-05435, 447–450, 448f
investigations, 461–469, 468f
Liotta’s 1969 paper, 450
operation, 455–461, 457f
stratagem, 452–455
artificial heart, total, DeBakey’s, 562f
assistant, surgery, 71, 75f
Assistant Professor of Surgery, Tulane, 133–138
atherosclerosis, 493
cholesterol and, 535
risk factors, 535
athletics
childhood, 23–24
Tulane University, 39
Atlas of Surgical Operations (Zollinger), 406
atrial septal defect repair, 330
automobile repair, self-taught, 21–22
Auxiliary Surgical Groups, 173–178, 178f
Bachelor of Science degree. See also Tulane University

commencement, 53
Bahnson, Henry, 273–274, 319
Battle Casualties: Incidence, Mortality, and Logistic Considerations (DeBakey), 255
“Battle Injuries of the Arteries in World War Two: An Analysis of 2,471 Cases” (DeBakey), 198
Battle Row house, 3–5
Bayliss, L. E., 73, 74
Baylor Affiliated Hospitals Residency Program, 367
Baylor College of Medicine. See also specific topics
1965-1969, 433–437
High School for Health Professions, 496–497
medical students, doubling, 495–496
medical students, women and minorities, 496
new city-county hospital (1963), 399–498
pump team at St. Luke’s and Texas Children’s Hospital, 492–493
Thoracic Surgery residency, 369
Baylor-Rice artificial heart program, 415–416
Baylor University College of Medicine. See also Houston, 1948-1951, Baylor University College of
Medicine; specific hospitals
1956-1960 achievements, 360–366
DeBakey on dean’s duties and qualifications, 278–279
Beall, Jr., Arthur, 375
Beebe, Gilbert, 160–161
Belgium, Princess Lilian. See Lilian, Princess
Ben Taub Visiting Professorship, 400, 402
Bertner, Ernst W. “Bill,” 217, 218, 254, 269
Blakemore, Arthur
artificial graft research, 305–306
on DeBakey’s aortic aneurysm surgery, initial critique, 271
on DeBakey’s vascular surgeries, later compliments, 319
wiring method, 273–274
Blalock, Alfred
clinical facilities issues, 223–224
Cooley training and endorsement to DeBakey, 269
on dept. chair as chief of clinical service, 229
Johns Hopkins Hospital, Chairman of Dept. of Surgery, 222
on medical school and academic medical center, 253, 255, 436, 495
Taub Visiting Fellowship, 378
Blood Bank and the Techniques and Therapeutics of Transfusions, The (DeBakey), 136
Matas review, 136–137
Bowen, Ted, 247, 374–375, 388–389, 420, 461–462, 510, 517, 569
boyhood, 10–13, 15f
Bradley, J. D., 73
“Breakthrough” appearance, 397
Broad Street home, 17–27, 20f, 22f
bronchoscopy training, Chicago, 127
Brown, Warren, 205–206, 220, 221
bubble oxygenator
Baylor, earliest (1956-1960), 329–333, 334f
Baylor, stainless steel (“Cooley Oxygenator”), 334–335
DeWall-Lillihei, 331–333
improvements and priming, pump oxygenator (1960-1969), 390
Bulletin of the US Army Medical Department, 160
Bull Pen (Tulane, senior year), 58
burn treatment, tannic acid and, 162
Butler, William T., 495, 523
bypass. See also specific types
leg, Kunlin’s first, 251–253
calf experiments, artificial heart, 451–452

Calvin, Sam, 454. See also artificial heart, total, 1969 (Liotta-Cooley)
cardiopulmonary bypass
DeBakey roller pump, 116
invention, 116
cardiovascular investigation, five areas, 390
Cardiovascular Research Center
Baylor, 493
Methodist, 388–389
“Cardiovascular Surgical Investigations,” Baylor Dept. of Surgery, 1959-1961 Annual Report, 395
carotid endarterectomy, 285–290, 291f, 349
Carter, B. Noland “Nick,” 218–219
CBS, “Man of the Month,” 421–422
Center for Heart and Blood Vessel Research, 494
“Changing Concepts in Vascular Disease” (DeBakey), 395, 519
Charity Hospital, 53–55
internship, 64
new, 128–129
research lab, 125–133
charity work, childhood, 6, 8–9
Cherokee Street house (1949), 244–249
chilblains, 165–166
childhood. See also education
athletics, 23–24
Lake Charles (see Lake Charles: 1908-1926)
mathematics knowledge, 24
music, learning and playing, 23
scholarship, 24–25
sewing skills, 6–7
cholesterol, atherosclerosis and, 535
Churchill, Edward D.
Crawford’s studies under and referral, 270
European Theater of Operations, DeBakey’s visit to, 179–180, 181
Gibbon’s patient assignment by, cardiopulmonary bypass invention, 115–116, 175–176, 195
Massachusetts General Hospital Chief, DeBakey invitation for military surgery talk, 198
Massachusetts General Hospital Chief, on DeBakey’s hospital organization knowledge, 241
Medical Advisory Committee to Secretary of War, 194
Medical Follow-Up Agency committee, Chair, 195–196
Mediterranean and European Theaters of Operations, Chief Surgical Consultant, 163
North Africa and Mediterranean Theaters of Operations, Chief Surgical Consultant, 162, 175–176
stroke and DeBakey’s Massachusetts General visiting professorship, 283–285
wound care, phased, 176, 187–188
Clark, Randolph Lee, 254–255
clinical medicine studies, 53–55
“The Clinic of Professor Rene Leriche” (DeBakey), 117
Clinique Chirurgicale A, 95, 97–101, 98f
Clinton healthcare plan (1990s), criticism, 578–579
coarctation of aorta surgeries
Cooley, 332
Gross’ studies and homograft surgery, 265–266, 332
Princess Lilian’s son, DeBakey’s surgery on, 391
cold injury, World War II, 166, 167–169
“Cold Injury” (DeBakey), 198
Cole, Warren, 402
college, 25–26, 27
Committee on Federal Medical Services, Commission on Organization of the Executive Branch of
the Government, 200–202
Congressional Gold Medal, 581–587, 585f
Consultants Division, Armed Services Forces reports, 161
Cooley, Denton. See also artificial heart, total, 1969 (Liotta-Cooley)
100,000 Hearts: A Surgeon’s Memoir, 593
1960+, St. Luke’s and Texas Children’s Hospital, 390
aortic aneurysm homograft surgery, DeBakey’s second, 268–269
aortic arch repair, 346–349, 348f
artificial heart implantation and repercussions, 1969, 444–479 (see also artificial heart, total, 1969
[Liotta-Cooley])
Blalock training, 222, 269
“blue baby” operation with Longmire, 222, 269
cardiac surgery program, building Baylor’s, 332
heart-lung machine, Gibbon-Mayo, 333
Houston arrival, 1951-1956, 269–271
Mayo Clinic and University of Minnesota visits, 332
reconciliation with DeBakey, early 2000s, 582–583, 586
Texas Heart Institute, 390–391
thoracic aorta aneurysm resections with homograft replacement, 271–279, 294–295
Cooper (DeBakey), Diana
courtship, marriage, and first home, 35f, 75, 81, 93–94, 101, 113–114
death, 497–500
on marriage vs. career, Michael DeBakey’s, 340f, 342f, 342–343
coronary artery bypass surgeries
Houston (1970-1989), 491–493, 521
VA Study, 1977 paper’s failings, 521–522
Crawford, Ernest Stanley, 539
aortic arch repair, first, 348
aortic valve surgery, first mechanical, 397–398
Baylor Department of Surgery, 1956, 304f
Boston trip, 284
death, 541
Diseases of the Aorta: An Atlas of Angiographic Pathology and Surgical Technique, 539
research fellowship, Houston, 270
service and surgeries, Houston (1954-1955), 343, 344
stroke, 540
Vascular Surgery Fellowship training program director, 540
Crawford, John L., 539
Creech, Jr., Oscar
aortic dissection classification, 303
aortic graft preservation, lyophilization, 275
Assistant Professor, 343
death, 427
departure for Tulane, 345, 346
fusiform thoracoabdominal aneurysm surgery, 316–318, 318f
Hektoen Gold Medal, 300
history and arrival at Baylor, 240–241
prosthetic arterial graft committee, Society for Vascular Surgery, 356
prosthetic arterial grafts, 307, 309–310, 356
surgeries with DeBakey (1950s), 344
“Surgery of the Aorta,” 312, 313f
thoracic aortic aneurysm surgery, televised, 314, 315f
Thoracic Surgery, Head, 240–241
tuberculosis, 256
VA Hospital, head, 1950s, 276
cross-circulation, 330–331
Cullen, Hugh Roy, 218, 222, 223, 237–238, 253
Cullen building, 216, 218, 223, 224–225, 227, 236, 242, 244, 269, 399
“Current Considerations of Wounds Surgery” (DeBakey), 197–198
“Current Observations on War Wounds of the Chest” (DeBakey), 197–198
Cutler, Elliot, 156–157, 175, 179, 181, 186, 187, 195
cyclosporine A, 537
cytomegalovirus (CMV), 535–537
Dabaghi, Shiker, 7f
Battle Row home and business, 5
birth and early childhood, 3
children, 5, 9
DeBakey boys, 281
Ernest DeBakey’s Father’s Day letter to Dr. DeBakey, 572–573
immigration to U.S. and early work, 3–4, 28
internalization, Michael’s, 6
Lake Charles, 4–7
Louisiana, early visits, 4
Railroad Avenue house, 9
real estate investments, early, 9
real estate investments, rental income, 9, 12
religious devotion and charity work, 6, 8–9
temperament and child rearing, 6
wife, courtship and marriage, 4
Dacron prosthetic arterial grafts, 356–360
death, Michael DeBakey’s
burial at Arlington Cemetery, 592
final hours, 587
funeral and memorial service, 591–592
recognition, worldwide, 591
DeBakey, Barry Edward, 197
1951-1956, Houston, 291f
1960s, college education, 401–402
death, 580–581
DeBakey, Denis Alton, 236
current life, 594
DeBakey, Ernest Ochsner, 184
1951-1956, 280–285
later life and death, 572–573
DeBakey, Katrin, 509–511, 594
DeBakey, Mickey (Michael M.)
1951-1956, 280–285
1960s, high school and college education, 401–402
childhood illness, World War II, 184–185
current life, 594
earliest years, 131, 150, 158–159, 176–177, 178f
DeBakey, Olga Katarina, 515–516, 518f
current life, 594
DeBakey Consulting Group, 566–567
Turkey, 543–544, 566–567
DeBakey Dacron Vessel Prostheses, 359–360
DeBakey Medical Foundation, 389
DeBakey-Pechersky Partners, 566–567
DeBakey roller pump, 72–75, 75f
cardiopulmonary bypass, 116
manufacture, 102
royalties and use, 114–115
Democratic Advisory Council’s Advisory Committee on Health Policy, 386–388
“Development of Vascular Surgery, The” (DeBakey), 520
DeWall, Richard, bubble oxygenator, 331–332
Dietrich, Edward B., 426
Dietrich, Marlene, 508
Diseases of the Aorta: An Atlas of Angiographic Pathology and Surgical Technique (Crawford), 539
“Diseases of the Cardiovascular System” (DeBakey), 257
“Disposition in the Forward Area” (DeBakey and Beebe), 188
“Dissection and Dissecting Aneurysms of the Aorta: Twenty-Year Follow-Up of 527 Patients Treated
Surgically,” 520–521
Distinguished Service Award
American Medical Association, 378
American Surgical Association, 532–533
Society for Vascular Surgery, 567–568
Division of Medical Sciences, National Research Council, 161
Dos Santos, João Cid, 98f, 98–99, 106, 249–253, 286–287, 393–394
DuBost, Claude, 266–267
Dudley, Ray, 230–231
Duke of Windsor, 412–414, 413f
duodenal ulcer surgery, 541–542
Eastcott, H. H. G., 289

Echols, Dean, 129, 172
Edman, Thomas, 357–359
education
grammar school, 10
high school, 10, 18, 23–26
high school, valedictorian speech, 26–27
humanities, DeBakey on, 556–567
middle school, 10
scholarship, 24–25
Tulane University, 25–26, 27
Edwards, Sterling, 358
“Elegy Written in a Country Churchyard”(Gray), 18–19, 556
Ella F. Fondren Building, 389
endarterectomy
bypass with, for arterial occlusive disease, 249–253
carotid, 285–290, 291f, 349
Dos Santos, 249–250, 252–253, 286–287
for occlusive disease, 252–253
endoscopy training, Chicago, 127
endovascular surgery, 568–569
end-to-end anastomosis, 251
end-to-side anastomosis, Kunlin’s, 251–253
“Experience with 366 St. Jude Valve Prostheses in 346 Patients,” 520–521
father, DeBakey’s. See Dabaghi, Shiker

Fehlhaber, Katrin (second marriage), 509–511, 594
Feldman, Louis
artificial heart prototype, 448–449
calf experiment pumps, 452
Cooley’s artificial heart surgery investigations, 464
double-ventricle pump (late 1960s), 448f, 448–449
instruments and devices manufactured, 373–374
femoropopliteal arterial bypass, 402
filming, operative procedures, 406–407
Fogarty, John, 416
Follow-Up Agency, Medical (VA), 191, 195–197, 572
Fondren, Ella, 388–389, 517
Fondren-Brown Cardiovascular and Orthopedic Research Center, 389
Fondren Foundation, 517
Forshag, Gertrude, 118, 128–129, 151, 152, 420
frostbite, World War II, 166, 167–169
“Future of the Army Medical Library, The” (DeBakey), 256
Gage, (Idys) Mims, 539–540
abdominal aortic aneurysm surgery on, DeBakey’s, 311
carotid endarterectomy, 349
marriage, 128
military service, World War II, 137, 138
post-World War II, 198–199
Raheeja DeBakey care, 310
stroke, 540
Tulane University, 54–55, 58
World War II, 24th General Hospital, Fort Benning, 151–152
gardening, childhood competitive, 20–21, 22f
Garrett, H. Edward, 375, 409–411
General Hospitals, World War II, 170–172
George P. Pilling and Son Company, 359–360
Germany
with American university students, 110–111
Kirschner, Martin, 78, 104, 105, 107, 113–114, 115, 532
Odom, Vada, 110–111, 111f
Sauerbruch, Ferdinand, 112–113
Schanz, Ernst, 109f, 109–111, 113–114, 129, 532
Giancana, Salvatore (“Sam”), 507–508
Gibbon, John Heysham, 115–116
heart-lung machine, 282–283, 330–331
on vascular surgeries, DeBakey’s, 318–319
Gibbon-Mayo heart-lung machine, 333
Gillentine, William (Bill), 64, 65, 67–69, 70, 129, 152
Ginzberg, Eli, 170–171
Golden Jubilee, 563–569
Gotto, Jr. Antonio, 493–494
Chair, Baylor Dept. of Internal Medicine, 513
DeBakey friendship, 513–515
Living Heart, The, 513–514
Living Heart Diet, The, 539
New Living Heart, The, 563
Weill Cornell Medical College, 570
government
control of medicine (1960), 386–388
in healthcare (2005), 578–580
grafts. See homograft; prosthetic arterial grafts; specific surgeries
Graham, Evarts, 121, 123, 124
Gray, Thomas, “Elegy Written in a Country Churchyard,” 18–19, 556
Gross, Robert, 265
aortic homograft surgeries, 267
atrial septal defect repair, 330
cadaveric aorta graft, harvesting and preservation, 265–266, 275
coarctation of the aorta repair, 265–266, 332
graft preservation, 275
Gulfport, Mississippi, World War II, 150
Guthrie, Charles, 372–373
Hall, C. William, 396, 416
departure (1969), 475
Liotta in lab of, 449, 457
Halsted, William Stewart, 64
Hanisch, Arthur, 356–357, 359–360, 421
Hankamer, Earl, 433, 436–437
Hathaway, Edward S., 41, 43–44, 45
Hawley, Paul, 239
HE-05435, 447–450, 448f
headaches, frequent, 420
healthcare crisis (1971), 578–579
Health of the Army, 160, 161
heart-lung machine, 330–331
Baylor, 333–334
Gibbon-Mayo, 333
Gibbon’s invention, 282–283, 330–331
Russian, 1950s, 362
Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier
(Thompson), 489–490
heart transplantations
1960s, 426–433
1980s, restarting, 537
Heidelberg, with Martin Kirschner, 78, 104, 105, 107, 113–114, 115, 532
Hektoen Gold Medal, 300
Hellums, J. David, 453, 454, 455. See also artificial heart, total, 1969 (Liotta-Cooley)
hemometakinesia, 199–200
Henly, Water S. “Sam,” 375
Herman Brown Building, 389, 432
Hermann Hospital, 221, 224–225, 228–230, 231, 232, 236, 246–247
High School for Health Professions, 496–497, 555
Hill, J. Lister, 350–351, 352, 355–356, 396
History of the Army Medical Department, World War II, 192, 255, 311
homograft, 264–269. See also specific surgeries
donor supply issues, 275, 276
harvesting and preservation, 265–266, 275
prosthetic, 303–312
Hook, Captain Frederick, 148–149
Hoover Commission, second, 291–294
Houston, 1948-1951, Baylor University College of Medicine, 216–257
arterial injuries study, 240–241
Cherokee Street house (1949), 244–249
construction, 218, 219f
DeBakey’s acceptance and arrival, 223–232
DeBakey’s recruitment and negotiations, 205–206, 220–223
endarterectomy and bypass, for arterial occlusive disease, 249–253
funding and move to Houston, 218
Houston VA affiliation, 238–239
Jefferson Davis Hospital, 221, 224–225, 228, 231–232
Jefferson Davis Hospital, Ben Taub, 232–238, 233f
Jefferson Davis Hospital, improving organization and surgical care, 241–243
Jefferson Davis Hospital, new surgery residency, 243
Methodist Hospital, affiliation, 243–247
Methodist Hospital, new, 247
move from Dallas, 218
outpatient clinic, 253–257
residents’ training, improved, 244
surgeries performed (1949), Methodist Hospital, 245–248
Houston, 1951-1956, 264–319
aortic arch aneurysms, distal, resection and homograft, 294–298
aortic dissections, surgical typing, 303, 304f
carotid endarterectomy, 285–290, 291f
Cooley, Denton, 269–271
DeBakey boys, 280–285
homograft, 264–269
Hoover Commission, 291–292
hyperthermia, induced, 295
National Library of Medicine (Armed Forces Medical Library), 291–294, 375–376, 377
prosthetic grafts, 303–312
recognition, vascular surgery work, 299–303
surgical research faculty and labs, 276–277
surgical research faculty and labs, Mading funding, 276–277
“The March of Medicine” TV program, 313f, 313–319, 315f, 318f
thoracic aorta aneurysm resection, Robert Allman, 271–279, 294–295
Houston, 1956-1960, 329–379
aortic arch aneurysm repair, 334f, 335–339
aortic arch repair, 346–349, 348f
Baylor achievements, 360–366
bubble oxygenator, Baylor, 329–332, 334f
faculty and staff, funding, and research, 343–346
family photo, 342f
financial support, government, 376
financial support, Lasker, 376–377
Hawaii trip, 346, 347f
home, family life, and home office, 339–343, 340f, 342f
hypertension, 369–372
instruments, 372–374
Methodist Intensive Care Unit, 374–375
National Library of Medicine, 349–356
Ochsner, John Lockwood, Baylor residency, 367–369
open heart surgery, 329–335
operative procedures, increased, 366
prosthetic arterial grafts, Dacron, 356–360
research, 366
Soviet Union, 360–366, 363f
Texas Children’s Hospital work, 367
Houston, 1960-1969, 386–437
aortic valve replacement, live TV broadcast (1965), 414
aortocoronary bypass, 409–411
arterial disease patterns, 393–399
artificial heart program, Baylor-Rice, 415–416
artificial heart program, federal funding, 396–397
automobiles, gifted, 420–421
Baylor College of Medicine, 433–437
BBC’s “The Heart Man,” 417
Ben Taub Visiting Professorship, 400, 402
“Breakthrough” appearance, 397
cardiovascular investigation, five areas, 390
Cardiovascular Research Center, Methodist, 388–389
CBS, “Man of the Month,” 421–422
Cooley’s Texas Heart Institute, 390–391
DeBakey dinner parties, overinviting guests, 400–401
DeBakey Medical Foundation, 388–389
Democratic Advisory Council’s Advisory Committee on Health Policy, 386–388
Duke of Windsor, 412–414, 413f
filming, operative procedures, 406–407
Fondren-Brown Cardiovascular and Orthopedic Research Center, 389
harsh behavior toward staff, 417–419
headaches, frequent, 420
heart transplants, 426–433
Herman Brown Building, opening, 432
honors, awards, and public recognition, 416–420
left ventricular assist pump (artificial heart), 421–426, 553
left ventricular bypass, 420–426
Lilian, Princess, 391–393, 394f
Look article (1964), 406–407
mechanical aortic valve surgery, DeBakey’s first, 397–398
Medicare and government control of medicine, 386–388
Methodist Hospital and Texas Medical Center expansions, 399–400
Methodist Hospital Annex (1965+), 420–421
office, Baylor, 403f
organ transplants, simultaneous multiple, 390–431
Presidential Commission on Heart Disease, Cancer, and Stroke, 407–412, 408f, 410f
pump oxygenator improvement, 390
Time magazine cover, 414–415
Houston, 1969, artificial heart, 444–479. See also artificial heart, total, 1969; Hall, C William
Houston, 1970-1989, 489–545
atherosclerosis, 493
Baylor pump team at St. Luke’s and Texas Children’s Hospital, 492–493
Cardiovascular Research Center, Baylor, 493
Center for Heart and Blood Vessel Research, 494
Chancellor, 522–523
coronary bypass surgery, 491–493
cytomegalovirus, 535–537
Diana DeBakey’s death, 497–500
Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier, 489–
490
High School for Health Professions, 496–497
intra-aortic balloon pump, 512–513
Journal of Vascular Surgery, 533–535
Katrin Fehlhaber (second marriage), 509–511
Kaye, Danny, 506, 507f
left ventricular assist device, 491
Lipids Research Center, Baylor, 493
Living Heart, The and Gotto friendship, 513–514
medical students, doubling, 495–496
medical students, women and minorities, 496
NASA, 537–545
Nixon, Richard and Russia/China trips, 500–506
reforms, administrative, 495–497
review articles, 519–522
Riyadh, Saudi Arabia, 511–512
Shah of Iran, 523–530
Soviet artificial heart team collaborations, 513
surgeon to the stars, 506–509, 507f, 508f
Houston, 1990-2008, 553, 557–560
50th anniversary, Houston arrival, 563–569, 564f, 566f
aortic dissection type 2, DeBakey’s, 574–578
Chair of Baylor Dept. of Surgery, stepping down, 556
Clinton healthcare plan (1990s) criticism, 578–579
Congressional Gold Medal, 581–587, 585f
education, humanities, 556–567
endovascular surgery, 568–569
on government in healthcare, 578–580
healthcare crisis, 1971, 578–579
High School for Health Professions, 555
Hurricane Katrina, 573–574
Michael E. DeBakey VA Medical Center, 572
MicroMed Systems, 553–555
NASA affiliation, 553–554
Princess Lilian death and remembrance, 570–571
schism, Houston Methodist Hospital–Texas Medical Center, 569–570
Yeltsin, Boris, 1–2, 557–563, 562f, 564f
Houston Methodist Hospital–Texas Medical Center schism, 1990s, 569–570
Houston Veteran’s Administration, 238–244
Howell, Jimmy, aortocoronary bypass, 409–411
Hufnagle, Charles
aortic homograft surgeries, 267
cadaveric aorta graft, harvesting and preservation, 265–266, 275
prosthetic grafts, 306–307
humanities education, 556–567
Hunter, John, 248
Hurricane Katrina, 573–574
hypertension, 369–372
renal artery surgery for, 371–372
renovascular, 370–371
hyperthermia, induced
distal aortic arch aneurysm resection and homograft (1954), 295–296
distal aortic arch aneurysm resection and homograft (1954), Matas’ letter on, 264, 296
Index Medicus, 544–545
inducer, 554
Inonu University hospital, 543–544, 566–567
instructor in surgery, Tulane University, 117–121
instruments, vascular surgery
1956-1960, 372–374
machine shop and Louis Feldman, Baylor, 373–374
Potts clamps, 372–373
intensive care unit, Methodist, 374–375
interne (internship), 64, 66f
intra-aortic balloon pump (IABP), 512–513
Jeep disease, 172–173

Jefferson Davis Hospital
1948-1951, 221, 224–225, 228, 231–232
organization and surgical care improvements, 241–243
surgery residency, new, 243
Taub, Ben, 232–238, 233f
Journal of Vascular Surgery, 533–535
Distinguished Service Award, Society for Vascular Surgery, recognition, 567–568
Karolinska Institutet, 544

Karp, Haskell, 444
Kaye, Danny, 506, 507f
Keldysh, Mstislav, Russia surgery, 504–505
Kennedy, John F., 351
King, Joseph, 388, 389
Kirschner, Martin, 78, 103–104, 105, 107, 113–114, 115, 532
Kolff, Willem, 396
Kunlin, Jean
1940s, surgical breakthroughs, 250–255
femoropopliteal arterial bypass, 402
Leriche’s service, 98f, 98–99, 106
Lake Charles: 1908-1926, 1–27

Battle Row house, 3–5
boyhood, 10–13, 15f
Broad Street house, 17–27, 20f, 22f
DeBakey Real Estate Company, 14
early childhood, 6–10, 8f
family, 391, 427
family trip to Europe and Lebanon (1921), 14–17, 15f
geography and setting, 2–3
odyssey, 14–17
parents, 6, 7f
reading, passion for, 11–12
real estate investments and business ventures, 14
work, family business, 12
work, pharmacy and boss’ death, 12–13
Larrey, Dominique-Jean, 166
LaSalle Hall, 34, 35f, 40f, 45
Lasker, Mary
Fogarty introduction, artificial heart funding, 416
relationship beginnings, 376–377
Lasker-DeBakey Clinical Medical Research Award, 593–594
Lawrie, Gerald, 505–506
left ventricular assist device (LVAD), 491
bridge to transplantation, 538
continuous flow, 554
new, NASA affiliation, 553–555
left ventricular assist pump
1960s, 421–426
Kantrowitz at Maimonides Medical Center, 424
left ventricular bypass, 1960s, 420–426
left ventricular bypass pump, 512
leg vein research, 129
Leriche, René, Strasbourg studies with, 77–78, 80, 95–97, 98f
Leriche Award, 395
Leriche syndrome, 92
Lewis, Jerry, 506–507, 508f, 564
Lilian, Princess (Belgium), 391–393, 394f
after Diana’s death, support, 498–499
death, 570–571
DeBakey sculpture, 517, 518f
DeBakey second honeymoon, 511
Lillehei, C. Walton, 330–331
bubble oxygenator, 331–332, 333
tetralogy of Fallot repair, 330–331, 332
Lilly, George, 75, 107, 114, 129
Lindberg, Donald A. B., 544–545
Liotta, Domingo
at Baylor, hiring, 396
Cooley recruitment, artificial heart, 446–447
on DeBakey lab artificial heart research, 449–450
“Orthotopic Cardiac Prosthesis,” 450
Liotta-Cooley artificial heart, 444–479. See also artificial heart, total, 1969 (Liotta-Cooley)
Lipids Research Center, Baylor, 493
“Liver Abscess, Part 1: Amebic Abscesses. Analysis of 73 Cases” (Ochsner and DeBakey), 120
Living Heart, The (DeBakey and Gotto), 513–514
Living Heart Diet, The (DeBakey and Gotto), 539
Loebe, Matthias, 532
Longmire, William, 220–221, 222–223, 224–225, 229
Look article (1964), 406–407
lung cancer
pneumonectomy for, 122
tobacco and, research with Ochsner, 59, 121–124
MacLean, Basil, 237–238, 253, 292, 436

Mading, Webb, 277
Maes, Urban, 66
“Management of Chest Wounds, The,” DeBakey, 148
“Man of the Month,” CBS, 421–422
“March of Medicine, The,” 313f, 313–319, 315f, 318f
marriage, 113–114
Matas, Rudolph, 61f
Base Hospital 24, World War II, 135
Blood Bank and the Techniques and Therapeutics of Transfusions, The (DeBakey) review, 136–
137
death, 349
on DeBakey’s transfusion pumps, 136–198
Distinguished Service Award, American Medical Association, 378
Gage training under, 54–55
Leriche friendship and introduction, 77, 106
letter from DeBakey, on bifurcated homograft repair of abdominal aortic aneurysm, 268–269
letters of introduction, to European surgeons, 77, 106, 112
letter to DeBakey, on distal aortic arch resection and homograft, 271, 296
Ochsner friendship, 368
post-World War II, 198–199
retirement, mandatory, 522
Rudolph Matas Award, to DeBakey, 299
teaching clinics, visiting surgeon, 50
Tulane Medical School studies, 59
university retirement, 49–50
university retirement, private practice after, 51–52
Matas Award, 299
mathematics
childhood studies and love, 24
Tulane University, 38–39
Mattox, Kenneth, 505
McCollum, Charles H.
Baylor surgical faculty, joining, 426
on DeBakey’s Distinguished Service Award, Society for Vascular Surgery, 567–568
endovascular surgery program, 568–569
medical training, pre-Baylor, 426–427
M. D. Anderson Foundation
Baylor medical school move to Houston, funding, 218
M. D. Anderson Hospital for Cancer Research, 217
origins, 216–217
outpatient clinic, support, 253
Medallion for Scientific Achievement, 532–533
Medical Advisory Committee to the Secretary of Defense, 239–240, 256
Medical Advisory Committee to the Secretary of War, 194, 197, 239–240
Medical Department of the United States Army in the World War, The, 164–165, 167
medical examinations, 53
Medical Follow-Up Agency, 191, 195–197, 572
Medical History of World War II, 192, 255, 311
Medical Regulating Office, 171
Medicare, 386–388
Melnick, Joseph, 535
Mercy Hospital, 57
Merrill, Joseph, 493
Methodist Hospital
black patient exclusion, DeBakey confronting, 301–302
Cardiovascular Research Center, 388–389
Methodist Hospital, 1948-1951
Baylor affiliation, 243–247
new, construction, 247
surgeries at (1949), DeBakey’s, 245–248
Methodist Hospital, 1960-1969
expansions, 399–400
expansions, Annex (1965+), 420–421
Methodist Intensive Care Unit, 374–375
Michael E. DeBakey International Cardiovascular Society, 515
Michael E. DeBakey International Surgical Society, 586
Michael E. DeBakey Library and Museum, 562f, 592–593
Michael E. DeBakey VA Medical Center, 572
MicroMed, 553–555
NASA/DeBakey continuous axial flow LVAD, 555, 562f, 565
NASA/DeBakey/Noon continuous axial flow LVAD, 565–566, 568
military service, World War II, 135–136, 137–138. See also specific topics and research papers
“Military Surgery in World War Two: A Backward Glance and a Forward Look” (DeBakey), 198
Mobile Army Surgical Hospital (MASH) debate, 189–191
Mobile Hospitals, 173
Moore, Francis, 402–404
Morris, George, 372
mother, DeBakey’s. See Zorba, Raheeja
Moursund, Walter, Baylor School of Medicine
Dean (1940s-1952), 220
DeBakey recruitment, 225–227
DeBakey’s clinical services, providing, 228
Department of Surgery (1940s), 221
Houston Naval Hospital, 239
keeping DeBakey at Baylor, Dudley meeting, 230–231
Mueller, E., 73, 74
Mueller, V., 81
multiple organ transplants, simultaneous, 390–431
music
high school band, 5
Tulane University band, 39
NASA affiliation
1980s, beginnings, 537–545
1990s+, 553–554
left ventricular assist device, 553–555
MicroMed NASA/DeBakey continuous axial flow LVAD, 555, 562f, 565
MicroMed NASA/DeBakey/Noon continuous axial flow LVAD, 565–566, 568
National Heart and Blood Vessel Research and Demonstration Center, 516–517, 538
National Library of Medicine, 292–294, 375–376, 377, 544
1955-1960, 349–356
National Medal of Science, 542
National Research Council (NRC), 161–162
Division of Medical Sciences, 161–184
security issues on care, 162
security issues on care, sulfonamide for wound care, 163
security issues on care, tannic acid for burn treatment, 162
security issues on care, whole blood vs. plasma for traumatic shock, 163–164
Netter, Frank B., 312, 313f
New Living Heart, The (DeBakey and Gotto), 563
New Orleans return (1936), 113–116
“New Syringe Method for Blood Transfusion, A” (DeBakey and Gillentine), 66
Newton, Wayne, 506, 564
Nixon, Richard, 500–506
Nobel Prize, 571–572
Noon, George P.
Australia trip and Lawrie, 505–506
Baylor faculty, 426
medical education and recruitment, 426–427
Russia, Mstislav Keldysh surgery, 504–505
“Notes on the Care of Battle Casualties” (Churchill), 176
O’Bannon, William, 450, 452–454, 455. See also artificial heart, total, 1969 (Liotta-Cooley)
occlusive disease
bypass, 251–253
categories, 394–395
endarterectomy, 252–253
Ochsner, Alton, 51f
assistant in surgery under, 71
Diagnostic Clinic (Bull Pen), 58–59
European training impetus, DeBakey’s, 77
friendship with, DeBakey’s letter to father on, 80–81
Huey Long’s campaign against, 55–56
on Leriche’s view of DeBakey, 103–104
Raheeja DeBakey care, 311
reputation, 1930s, 133
research papers with DeBakey, 117–121
retirement, 345, 522
surgical seminar, 58–59
tobacco research with DeBakey, 59, 121–124
Tulane School of Medicine, DeBakey’s studies, 48, 51f, 55–56, 58–59, 71
Tulane University Hospital, 133–135
Ochsner, John Lockwood, 367–369
Ochsner Clinic, 133–135, 198–200
Odom, Charlie, 46–47, 47f, 64, 65, 78–79
Odom, Guy, 46–47, 78–79
Odom, Vada, 79, 110–111, 111f
Olson, Stanley, 279
100,000 Hearts: A Surgeon’s Memoir (Cooley), 593
open heart surgery (1956-1960), 329–335
“Organization of Surgical Services in the Zone of the Interior, The” (DeBakey), 198
organ transplants, simultaneous multiple, 390–431
“Orthotopic Cardiac Prosthesis” (Liotta), 450
“Orthotopic Cardiac Prosthesis: Preliminary Experiments in Animals with Biventricular Artificial
Heart” (DeBakey), 472
Osler, William, 64
Oudot, Jacques, aortic bifurcation homograft, 266, 267f
outpatient clinic, Baylor University College of Medicine, 253–257
oxygenator, bubble. See bubble oxygenator
parents. See Dabaghi, Shiker; Zorba, Raheeja

patch graft angioplasty, 371–372
“Patterns of Atherosclerosis and Rates of Progression” (DeBakey), 519–520, 536
“Patterns of Atherosclerosis and Their Surgical Significance” (DeBakey), 536
Patton, General
meeting, 185–186
plane ride, 186–187
penicillin, World War II, 170
“Peptic Ulceration: An Evaluation of the Relative Protective Value of Alkaline Duodenal Juices”
(DeBakey), 72
phlebothrombosis research, 127
pilonidal disease, 172–173
“Plasma Bank, The,” DeBakey, 148
phlegmasia disease research, 129
Pontius, Robert, 240, 275
Portable Surgical Hospital, 175
Porter, Rufus, 73
Potts, Willis, 372–373
Potts clamps, 372–373
pre-medical studies, 36
“Problem of Carcinoma of the Lung, The” (DeBakey), 278
prosthetic arterial grafts
Dacron, 356–360
early, 303–312
Society for Vascular Surgery committee on, 356
Voorhees’s research and trials, 306–307
Pruitt, Raymond, 388, 433–434
PubMed, 544–545
pump oxygenator. See also bubble oxygenator
improvements, 1960s, 390
“Pyogenic Abscess of the Liver: II. An Analysis of Forty-Seven Cases with Review of the Literature”
(Ochsner, DeBakey, and Murray), 120

Rankin, Fred
American Board of Surgery examiner, 131, 150
Chief Surgical Consultant, Army Surgeon General, 150
Micahel M. “Mickey” DeBakey’s childhood illness, 184–185
President, American Medical Association, 152–153
Surgical Consultants Division, head, 153
Rayburn, Sam, 351–353
renal artery surgery, for hypertension, 371–372
renovascular hypertension, 370–371
“Resection of Entire Ascending Aorta in Fusiform Aneurysm Using Cardiac Bypass” (DeBakey and
Cooley), 339
residency programs
Baylor College of Medicine, Thoracic Surgery residency, 369
DeBakey’s medical training, 71
improved (1948-1951), 244
Jefferson Davis Hospital, new, 243
review articles, 519–522
Richardson Hall, 45, 47f
rigid bronchoscopy training, Chicago, 127
Riyadh, Saudi Arabia, 511–512
“Role of Government in Healthcare, The” (DeBakey), 579
roller pump, DeBakey
cardiopulmonary bypass, 116
manufacture, 102
royalties and use, 114–115
Tulane Medical School, 72–75, 75f
Rudolph Matas Award, 299
“Ruptured Aneurysms of Abdominal Aorta: Excision and Homograft Replacement,” 298
Russia. See also Soviet Union; specific individuals
artificial heart team collaborations, 513
heart-lung machine (1950s), 362
Keldysh, Mstislav, 504–505
Nixon trips, 500–506
Yeltsin surgery, Moscow (1996), 1–2, 557–563, 562f, 564f
Saldarriaga, Alberto, 95, 97–98, 117, 256

Saucier, David, 537–538, 553, 566
Saudi Arabia, 511–512
Sauerbruch, Ferdinand, 112–113
Schanz, Friedrich “Fritz” Ernst
1983 reunion, 532
DeBakey’s Germany studies, 109f, 109–111, 113–114, 129
Schmidt, Charles Ernest, 73, 129
sculpture, Methodist Hospital, Lilian commission, 511, 517, 518f
Service Commands, 155–156
Shah of Iran, 523–530
short snorter, 179
Sinatra, Frank and Marty, 509
sleeve valve, auto engine, first introduction, 21–22
sleeve-valve transfusion apparatus
Europe, introduction to, 102
invention, 62–63, 65–70, 68f
Snoke, Albert W., 237, 253
Society for Vascular Surgery (SVS), 199, 200f, 249, 301
Soviet Union. See also Russia; specific individuals
first visit, 360–366, 363f
Nixon trip, 1972, 500–502
Vishnevsky, Alexander, 360–362, 364, 365, 366
sports
childhood, 23–24
Tulane University, 39
“Standards of Military Practice in the Army, The” (DeBakey), 198
Stander, Henricus Johannes, 221–223, 495
Starks, Ernest, 359
statues, 592, 594, 595f
Storck, Ambrose, 177
Strasbourg
Clinique Chirurgicale A, 95, 97–101, 98f
with Leriche, René, 77–78, 80, 95–97, 98f, 106
Strong, Robert A., 150
“Successful Resection of Aneurysm of Thoracic Aorta and Replacement by Graft” (DeBakey and
Cooley), 273
“Successful Resection of Fusiform Aneurysm of Aortic Arch with Replacement by Homograft”
(DeBakey, Crawford, Cooley, and Morris), 348
sulfonamide, for wound care, 163
“Surgeon’s Diary of a Visit to China, A” (DeBakey), 503
Surgery
launch, 117
research articles, DeBakey & Ochsner, 117–121
Surgery in World War Two: Vascular Surgery, 311
“Surgery of the Aorta” (DeBakey and Netter), 312, 313f
Surgical Consultants Division, 158–164
Armed Services Forces reports, 161
Bulletin of the US Army Medical Department, 160
concept and function, 153
Field Army assignments, 156–157
Health of the Army, 160, 161
lessons of past and Army Medical Library, 164–169, 166f
lessons of present, 170–173
medical and surgical equipment, 157–158
National Research Council manuals, 161–162
papers written and presented, DeBakey’s, 159–160
Rankin, Fred, 153–154, 155
surgical exam, American Board of Surgery, 130–131
“Surgical Management of the Wounded in the Mediterranean Theater in the Time of the Fall of
Rome, The” (Churchill), 176
“Surgical Treatment of Aneurysm of the Abdominal Aorta by Resection and Restoration of
Continuity with Homograft” (DeBakey and Cooley), 273
“Surgical Treatment of Aneurysms of the Descending Thoracic Aorta: Long Term Results in 500
Patients” (DeBakey), 520–521
“Surgical Treatment of Coronary Disease, The” (DeBakey), 119–120
“Surgical Treatment of Scleroderma: Rationale of Sympathectomy and Parathyroidectomy, The”
(Leriche and DeBakey), 117
“Syringe-Sleeve-Valve Transfusion Instrument: A New Method of Transfusion of Unmodified Blood,
A” (DeBakey and Gillentine), 66
tannic acid, for burn treatment, 162

Taub, Ben, 232–238, 233f
Baylor Visiting Professorship funding, 378
later life, 517–518
Mading friendship, 277
“Technique Permitting Operation upon Small Arteries, A” (Crawford, Beall, Ellis, et al.), 372
tetralogy of Fallot repair, 222, 330–331, 332
Texas Children’s Hospital
1956-1960, 367
Cooley, Denton (1960+), 390
heart pump team, 492–493
Texas Heart Institute
Cooley’s artificial heart, 1960, 473–474 (see also artificial heart, total, 1969 [Liotta-Cooley])
Cooley’s founding, 391
Texas Medical Center
idea and founding, 218
Ochsner’s friends at, 220
Textbook of Surgery, DeBakey’s chapter, 106
Theaters of Operation, World War II
DeBakey’s visits, 178–188, 182f
European Theater of Operation, Churchill, DeBakey’s visit to, 179–180, 181
Field Army assignments, 156–157
Mediterranean and European Theaters of Operation, Churchill, 163
North Africa and Mediterranean Theaters of Operation, Churchill, 162, 175–176
Thompson, Tommy
Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier, 489–
490
Life cover story (April 1970), 475–476
thoracic aorta aneurysms
resections with homograft replacement, earliest, 271–279, 274f, 294–295
“Successful Resection of Aneurysm of Thoracic Aorta and Replacement by Graft” (DeBakey and
Cooley), 273
“Surgical Treatment of Aneurysms of the Descending Thoracic Aorta: Long Term Results in 500
Patients” (DeBakey), 520–521
televised surgery, 314, 315f
thoracic aorta dissection surgery, 302–303, 304f
thoracoabdominal aortic aneurysm, 316–319, 318f
thrombophlebitis research, 127
Time magazine cover, 414–416
tobacco research, 59, 121–124
transfusion, blood
introduction to, 62
research, DeBakey’s early, 128
sleeve-valve transfusion apparatus, 62–63, 65–70, 68f
traumatic shock, whole blood vs. plasma for, 163–164
trench foot, World War II, 165–169
Tuffier, Marin-Theodore, 236
Tulane University, 1926-1935, 25–26, 27, 34–82. See also specific individuals
assistant in surgery, 71, 75f
Bachelor of Science commencement, 53
Bull Pen (senior year), 58
Charity Hospital, 53–55
clinical medicine studies, 53–55
college acceptance, 26
Cooper, Diana, 75
father’s financial support, 34
freshman year, athletics, orchestra, and band, 39–41
freshman year, classes, 36–37
freshman year, classmates, 37–38
freshman year, LaSalle Hall, 34, 35f, 40f, 45
freshman year, social life, 37–38, 39–40
freshman year, zoology and Hathaway’s tutelage, 41
Gage, Idys Mims, 54–55, 58
instructor, 77
interne (internship), 64, 66f
Matas, Rudolph, 49–50, 51–52, 59, 61f
mathematics, 38–39
medical examinations, 53
Mercy Hospital, 57
neighborhood and academic dormitory, 34–35, 35f
Ochsner, Alton, 48, 51f, 55–56, 58–59, 71
pre-medical studies, 36
Richardson Hall, medical education begins, 45, 47f
roller pump, DeBakey, 62, 72–75, 75f
sleeve-valve transfusion apparatus, 62–63, 65–70, 68f
sophomore year, 43
surgery studies, start, 48
transfusion, blood, 62
tuition and fees, 36
Tulane University, 1936-1942, 113–138
Assistant Professor of Surgery, 133–138
homecoming, 113–116
Instructor in Surgery, 117–121
lab, 125–133
tobacco and lung cancer research, 121–124
Turkey, Inonu University hospital, 543–544, 566–567
Uglov, Fedor, 362

university education, Tulane. See Tulane University
valedictorian speech, high school, 26–27

Van Allen, C. M., 73
venous blood clots research, 129–130
ventricular aneurysmectomy, 445
ventricular septal defect repair, 330–331
Vidrine, Arthur, 55–56, 103
Vishnevsky, Alexander, 360–362, 364, 365, 366
Visiting Professor, 299
Massachusetts General Hospital, Boston, 283–285
Uglov, Fedor, 362
Voorhees, Tracy
Armed Service Forces reports, 161
Hoover Commission and National Library of Medicine, 225, 292–294
Medical Advisory Committee to the Secretary of War, 194
prosthetic grafts research and trials, 305–307
retaining surgical specialists after World War II, 193–194
Wada, Juro, 451

Wada-Cutter valves, 451
“War Sessions,” 148–149
Washington, DC, World War II. See also specific topics
1818 H Street, 152–158
Surgical Consultants Division, 158–164, 170–173
Surgical Consultants Division, lessons on past and Army Medical Library, 164–169, 166f
Weill Cornell Medical College, 570
wife, DeBakey’s. See Cooper (DeBakey), Diana
World War II, 135–136, 137–138. See also specific topics and articles
Army discharge, 197–206, 200f
Auxiliary Surgical Groups, 173–178, 178f
General Hospitals, 170–172
Gulfport, Mississippi, 150
herniated discs, 172
History of the Army Medical Department, 192, 255, 311
Medical Advisory Committee to the Secretary of War, 193–195
Medical Follow-Up Agency, 191, 195–197, 572
Medical Regulating Office, 171
Mobile Army Surgical Hospital (MASH) debate, 189–191
Mobile Hospitals, 173
penicillin, 170
pilonidal disease, 172–173
Portable Surgical Hospital, 175
recording, wartime Medical Department History, 192
Surgical Hospitals, 173
Theaters of Operation visit, 178–188, 182f
trench foot and cold injury, 165–169
Washington, DC, 152–173, 166f (see also Washington, DC, World War II)
wound care
phased, Churchill’s, 176, 187–188
sulfonamides for, 163
Wylie, Edwin “Jack,” 286–287
Yeltsin, Boris, 1–2, 557–563, 562f, 564f
Zollinger, Robert M., 404–405, 406

Zorba (DeBakey), Raheeja, 7f
Battle Row home and business, 5
birth and immigration to U.S., 4, 28
children, 5, 9
courtship and marriage, 4
death, 310
internalization, Michael’s, 6
Lake Charles, 4–7
religious devotion and charity work, 6, 8–9
seamstress work and teaching Michael to sew, 6–7
temperament and child rearing, 6

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Craig Alan Miller - A Time For All Things - The Life of Michael E. DeBakey-Oxford University Press (2019)

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Praise for A Time for All Things

CRAIG ALAN MILLER, MD, FSVS, FACS

Published in the United States of America by Oxford University Press

© Oxford University Press 2020

CIP data is on file at the Library of Congress

1. Lake Charles: 1908–1926

The story of Michael E. DeBakey parallels the most potent century in

Roger T. Gregory, MD, RVT, FACS

In the spring of 2014, I was deeply involved in the research and

Along the cool sequester’d vale of life,

1.1 November 2, 1996

1.2 Mise en Scene

1.3 Battle Row

Balanced between these defining characteristics of his parents, Michael

Figure 1.1 Shiker and Raheeja DeBakey, circa 1910.

Before Shiker’s business success provided enough wherewithal to buy a

The theatre was completed in the fall of 1920.

One of the different languages he encountered was, of course, Arabic.

Michael celebrated his 13th birthday in Lebanon on September 7, 1921.

After arriving in New York the family took an overnight train to

1.7 Broad Street

Michael was particularly fascinated by the sleeve valve, a design found

As the DeBakey children came up through the Lake Charles schools

“We have not wings, we cannot soar,

“Oh, pause not then—nor falter

Knowledge to their eyes her ample page,

2.1 LaSalle Hall

In his freshman year Michael lived in room 13 in LaSalle Hall.7 Settling

Michael found the gratuitous live shows to be more repulsive than

Michael found these diversions entertaining at the time. Although he

Michael’s athletic exploits were confined to the intramural leagues at

Michael’s more constructive extracurricular outlets—such as the bands—

Hathaway noticed the quality of Michael’s drawings and dissections and

The extended study hours Michael instituted for himself—early morning

2.3 Richardson Hall

Figure 2.5 Alton Ochsner.

Ochsner was, at this point, 34 years of age. He stood five-and-a-half feet

At Mercy Hospital Michael also helped to staff the little emergency

2.8 Bull Pen

Drawing on his brief prior experience, Michael—just 23 at this time—

Figure 2.7 DeBakey as an intern at Charity Hospital, 1932.

On receipt of this very encouraging letter DeBakey and Gillentine

Among the firms DeBakey and Gillentine targeted were George B.

Ochsner was not the only department chair to recognize DeBakey’s

2.12 Assistant in Surgery

Figure 2.9 The DeBakey roller pump. Note tubing flange.

Almost immediately, DeBakey realized that this new device would be

Diana also had her own defining characteristics. As Michael began to

If DeBakey had a response to his father’s Polonius-like message it has

In that summer of 1935, Michael rented an apartment that he shared with

DeBakey took advantage of an invitation to tour the nearby Becton-

A youth to Fortune and to Fame unknown.

3.3 Clinique Chirurgicale A

In this period, Leriche typically had a dozen or so trainees at the Clinique

3.4 Le Sang Pur

The big news from home concerned the spectacular assassination of

Kirschner eventually warmed up to DeBakey and even invited him to his

3.8 Instructor in Surgery