Don't Save Anything: The Uncollected Writings of James Salter(38)

“The government now spends through Social Security more than one billion dollars a year on end-stage renal disease, but if I want ten thousand dollars to build a better artificial kidney, I can’t get it.”

Kolff begins his days with an 8 a.m. meeting of his staff. Around a long table sit a group of men and women, some in white coats, some in plaid shirts and jeans. In a mild voice with a slight accent, Kolff begins without fanfare.

“How are the calves?” he asks.

One of the sheep, it turns out, is having ventricular fibrillation. This is discussed for a minute or two, then the subject changes to the vacuum-molding method of making hearts. A short lecture on an electric motor they are interested in is delivered by an engineer. There is mention of microcircuits, custom chips with 1,700 gates, and a new microprocessor.

“Do we have seven thousand dollars for this new computer?” Kolff asks.

“Well, we can probably find it somewhere,” Jarvik replies. “It depends where we look for it.”

If they fire the lecturer whose name is Jeff, it is suggested, they could probably get it from his salary.

“Barely,” Jeff says, unperturbed.

There is talk about a two-by-five-inch emulator card which can do everything the chip does until the chip is available. Kolff is sitting on the edge of the table in a business suit and hiking boots.

“You call it an emulator card,” he asks, making a note.

“Yes.”

“I learn a new word every day.”

Kolff is the sort of man who inspires affection. With his high forehead and face filled with confidence and humor, one feels he knows things, and not merely about the work to which he has devoted his life.

The first heart that Jarvik designed was never tried in an animal. The second was not very good, either. Developed from an idea of Kolff’s, it was flat and in fact was called the pancake heart. Jarvik had begun work on another model when Kolff summoned him.

“When is your new heart going to be ready?” he asked. “We’ve been beaten. Dr. Nosé has beaten us.”

Nosé was a former associate in Cleveland who stayed there when Kolff left. Experimenting with the idea of a flocked surface inside the heart that was meant to encourage an organic layer to form on it, he had had a calf that survived seventeen days, a record at the time. Kolff was determined to surpass it. Jarvik was by then in medical school—he had gotten in with Kolff’s help—but he was still employed at the lab. All through Christmas that year he remembers working on the new heart.

The first calf they tried it in lived six days. It died from a massive blood clot—the inside of the heart hadn’t been cleaned well enough in this case, but the formation of clots was a constant problem in the beginning. Jarvik and Kolff were using a smooth inner surface, as smooth and nonirritating to the blood as possible.

After four or five tries, just before the ASAIO (American Society for Artificial Internal Organs) meeting that year, they had a calf that went nineteen days.

“It was so exciting,” Elaine Jarvik says, “those two weeks. It was so intense. Your parents called every night.”

“Every day was a new milestone,” Jarvik agrees.

All the early hearts were made of silicon rubber. Polyurethane was thought to be a better material, more durable, very abrasion resistant, smoother and less damaging to the blood, but the hearts made of it didn’t stand up, the diaphragms broke after a few days or weeks on the tester. Then Jarvik had an idea. It was to use several layers of polyurethane with Dacron mesh between them for support. Pharmaceutical mesh cost too much so he bought some in a fabric store for $4.95 a yard.

The first calf they tried it in went three months. That was in 1974. The record had been thirty-six days.

The new heart was called the J-3.

“That was the first thing I did that was inventive,” Jarvik says. “We used that heart, in that form, for quite a long time. We got up to about four, four and a half months.”

Each animal was a journey into the unknown, a major operation, a complete medical history. Infection was coming in where the air lines that drove the heart entered the body, and there were still blood clots forming at the seam where the diaphragm joined the wall of the chamber. Kwan-Gett, who designed early hearts, had wanted to cover the inner surface with liquid polyurethane. There would be a shallow concave mold at the bottom of the heart and the polyurethane formed by it would be the diaphragm. Jarvik took this idea which had never worked for Kwan-Gett and made a heart. It was seamless, the J-5.

With it, in 1977, they got the first six-month survival, a calf named Abebe. There have been a lot of long-lived calves since—Sirius, Claudius, Romulus, Fumi Joe, among others, and Tennyson who lived 268 days, nearly nine months. There the record stands. All of the long survivors have been with J-5 hearts except Fumi Joe who had a J-7, the model designed for human implantation. One limitation has become the animal outgrowing the heart, becoming too large for it and dying of cardiac insufficiency. Sheep, though they are difficult to work with, might solve the problem. When Jarvik came to Salt Lake City no animal with an artificial heart had lived more than three days.

The next step will be in the hands of a tall (six-foot-five), whippet-lean surgeon named William DeVries. The chief of Cardiothoracic Surgery at Utah, he has had a long acquaintance with the artificial heart. “I just sort of grew up with it,” he says. He was one of Kolff’s first new employees and like Kwan-Gett built early hearts for him. When permission for clinical testing is received from the FDA, it will be DeVries who performs the actual operation.