Don't Save Anything: The Uncollected Writings of James Salter(37)
Jarvik pictured a man just walking past Kolff’s window who would in a few seconds be gone, together with Jarvik’s chances. “A hundred dollars a week,” he said hastily.
Kolff told him to hold the line for a minute. In fact the administrator was sitting in an adjoining office with a glass window between him and Kolff. When he came back on the line, he said, “OK. When do you want to start?”
It was the Volvo, Jarvik is convinced. If he hadn’t had a European car he wouldn’t have gotten the job.
Willem Kolff is a unique figure in medicine. Tall, white-haired, paternal, and shrewd, he is best known as the inventor of the artificial kidney. This was in the Netherlands in 1943, during the German occupation. Kolff, who had graduated from medical school at Leyden five years earlier, was working in a small municipal hospital in Kampen, a town on the Zeider Zee, legendary, as he says, for its fools. A young patient of his slowly died of kidney failure, going blind first, and Kolff, deeply disturbed by the event, set out to try and devise something to help such cases. A man of wonderful energy and imagination, in Kolff these qualities are matched by an equally great compassion. His father was the director of a tuberculosis sanatorium with immense concern for the welfare of his patients, which Kolff feels he inherited. In his youth he didn’t want to be a doctor because he didn’t think he could bear watching people die. The example of his father’s dedication, however, finally swayed him from his original conviction to become a zookeeper.
Kolff’s first kidney machines, designed to remove waste products from the blood, were rotating drums wrapped with tubes of cellophane. The patient’s blood circulated through the tubes and impurities were drawn through the permeable cellophane into a surrounding solution. Of the first fifteen patients the artificial kidney was tried on, only one survived, and that one might have done so anyway, Kolff admits. In 1945 there was finally an indisputable success, a sixty-seven-year-old woman who was saved. It happened to be a woman who had been a Nazi sympathizer and much hated, but she was a patient and Kolff treated her.
In wartime Holland things had to be made out of whatever was available. A local enamel factory built the tanks and the permeable membrane was sausage skin. This unorthodox approach is typical of Kolff. In Cleveland where he went a few years later to join the staff of the Cleveland Clinic, he used washing machines and fruit juice cans in the construction of more advanced models. Today there are more than 50,000 patients in the U.S. and 200,000 worldwide whose lives are dependent on the artificial kidney, and the list of Kolff’s prizes and awards for this and other accomplishments fills nearly three pages, but he is still, because of his pragmatic methods, taken perhaps less seriously than he might be. Not an active surgeon, he is treated lightly by the star performers with their powerful egos. A tinkerer and an individualist, he has few champions in the bureaus of government where grant money is found. “I make gadgets,” he says, looking out over his horn-rimmed glasses. “I’m not considered scientific.”
In 1957, Kolff and an assistant named Tetsuzo Akutsu put the first artificial heart in the Western world into a dog which lived for an hour and a half. In the beginning the concept was so bizarre and outside the scientific mainstream that papers describing experiments were not even accepted by medical societies. But research continued and over the years Kolff found coworkers whom he managed to inspire and keep. The atmosphere in Cleveland was too conservative, however, and in 1967 he decided it was time to leave. He asked a friend where he could find a good, regional medical program and the answer was Utah. Encouraged by the medical school, the university, and the governor, he moved there, leaving behind everything he had built up during seventeen years, including a farm he loved.
In Cleveland, according to Dr. Clifford Kwan-Gett, who came with him to Utah, they had money but no space. Every time someone walked to the elevator, he had to move his chair. In Utah they had space but no money. “It took about three years to get going,” Kolff agrees. He now has 120 people of different disciplines, doctors, engineers, social workers, and electronic specialists and a budget of over $5,000,000. Almost all of this money comes from government grants and contracts. About 20 percent of it goes to the artificial heart. Kolff’s own salary is less than that of a mediocre shortstop: $63,000 a year. He has never made a penny from the artificial kidney—he never even bothered to take out a patent on it.
The artificial heart has come almost full circle. From obscure and dubious beginnings it advanced to a stage where, stimulated by testimony of the famous Houston surgeon, Dr. Michael DeBakey, Congress made it a national objective. For a feverish decade in the late ’60s and early ’70s, the National Institutes of Health coordinated the efforts of research centers and blue-chip technology corporations to build a device that would be as marvelous as the Apollo ship of the space program, except this would be for a voyage inward, to the center of man.
It had been estimated that up to 50,000 people a year might be recipients of artificial hearts, but delays, failures, and waning optimism in the nation at large finally caused the NIH to lower its aim and deemphasize the program. Kolff is not one to be discouraged by mere shifts in policy, however. He has gone doggedly on. More than any other man’s, the heart is his. He finds a way around delays and cautious decisions. He has recently developed, despite government indifference, a portable artificial kidney which represents a considerable advance over bulkier models. It can be worn by the patient.