Don't Save Anything: The Uncollected Writings of James Salter(39)
DeVries is a Mormon and grew up in Salt Lake City. One of nine children, his father was a naval surgeon killed in the South Pacific during World War II. His mother is a nurse. DeVries himself has five children, coaches basketball, and is the legendary Westerner, lanky, drawling, straightforward. It was Kolff who stirred in him an interest in surgery. He was already in medical school when they met and later, with Kolff’s assistance, he obtained a prestigious residency at Duke, “I probably wouldn’t have got it by myself.” When his residency was completed it was only natural that he return to Utah which, at Kolff’s suggestion, he did. He had fully expected that an artificial heart would have been tried by then. “At the time I left the field,” he says, “I felt sure one would be put in in a few years.”
DeVries has operated on literally hundreds of animals including both Tennyson and Fumi Joe. His job has been to perfect the surgical techniques. “I know that I can put that artificial heart in better than anyone in the world right now,” he says confidently. He does about 200 heart operations a year. Of these, perhaps 5 percent are high risk—patients whose chances in cardiac surgery are not good, generally someone with poor left ventricular function. If at the conclusion of surgery the patient cannot be brought off the heart-lung machine despite all efforts, if the heart cannot be made to beat again, in short if someone is to be given up for dead, then the artificial heart will be implanted, with prior consent, of course.
“Last year I had maybe three patients who would fit the criteria,” DeVries says. He adds, “and they all died.”
The final act will be his alone. He will select the potential recipient according to a carefully prepared profile, he will decide at the crucial moment if the heart will be used, he will put it in. Two consulting cardiologists will approve his decision, but apart from that, his authority will be complete.
The result, if successful, will be someone permanently tethered to an array of bulky mechanical equipment, a control box, a large compressor, backup compressor, standby tanks of compressed air for an emergency, and the rest. To many people this seems disturbing. Kolff has always said from the beginning, however, that the comfort and happiness of the patient come first. He has even said that he would give the patient a pair of scissors and not keep him from using them if that was what he wanted.
The publicity has already begun. “We do not seek it,” Kolff says, “but it is unavoidable.”
“There’s been a tremendous amount . . . too much,” DeVries agrees.
Appearances on national television, stories, interviews. Last summer Jarvik was asked to design a heart to be used in a movie with Donald Sutherland, Threshold, about a surgeon who perfects an indestructible heart. When the movie was being made Jarvik met Sutherland and Denton Cooley, probably the best-known cardiac surgeon in the world, who kept a patient alive for several days with an artificial heart while waiting for a transplant donor in 1968. Cooley had instructed Sutherland in surgical matters and even made a brief appearance in the film. They were having drinks in a hotel in Toronto and Jarvik, convinced that Cooley had never heard of him, asked how he had become involved in all this. Cooley’s cold blue stare fixed on him.
“It’s about me,” he said.
The heart that Jarvik designed for Threshold is nuclear powered and the moment when the natural heart of the young woman who receives it is removed forever is a chilling one. This aspect of the artificial heart, that it represents an irreversible step, is one of the objections put forth against clinical testing. The NIH has shifted its support to an intermediate device which is, in effect, half a heart. It is a pump that can be temporarily attached to an ailing left ventricle to ease its work and allow it to recover—the natural heart would stay in situ. This is the LVAD, left ventricular assist device, now in limited use.
The LVAD makes sense but the results of it have not been very good. Used principally in Boston and Houston, about one patient in twenty has survived. Kolff’s people feel it has its place just as transplants do, but there are hearts that the LVAD cannot help.
One of the problems has been that the LVAD is used on patients who have been on the heart-lung machine too long and on whom everything else has been tried. There is massive bleeding because the coagulating power of the blood is gone. Even the doctors who support it say that results would be better if the LVAD could be put in sooner.
This could also apply to the first use of the J-7. The patient may have been on the heart-lung machine for five or six hours before every alternative is exhausted and the artificial heart can be used. This is too long.
Jarvik is outspoken about disagreeing with the way it will be done. He would use it on a voluntary basis, straight off, someone with cardiomyopathy—progressive disease of the heart muscle. “If the patient is on bypass six or seven hours,” he says, “I don’t think he’ll live.” DeVries agrees it is a problem.
Still, everything has been practiced, everything anticipated. For a year and a half now DeVries has gone to St. Mark’s, the abandoned hospital in which the artificial heart program is housed, to do an implant every week. He has done them in cadavers as well as animals. Early in May the J-7 was tested in a woman who had been declared dead because her brainwaves were flat. The operation was done by Kolff’s son, Jack, who is a cardiac surgeon in Philadelphia. The heart was in for several hours, supported life, and worked well.
The scrub nurses have familiarized themselves with the operation, doorways have been checked to make sure the special equipment will fit through. When the FDA gives its permission, all systems will be go.