Heart Beat Maurice Neligan "I love fool's experiments. I am always making them."- Charles Darwin
The quotation was prompted by a published report on a particularly vacuous piece of "research", something that everyone knew anyway. These researchers from Barcelona found that the tallest and most handsome male medical students were most likely to become surgeons.
Conversely the shorter, uglier men tended to become physicians. That is a bit hard on physicians, I am sure there must be some exceptions.
In my earliest medical days and with increasing frequency following my exposure to cardiac surgery, I began to hear the names of the two lions of Texas and world cardiac surgery. Michael DeBakey and Denton Cooley were colossi as doctors and surgeons. Initially working together in Baylor University, they pioneered new techniques, refined existing ones, published and taught prodigiously.
They were among the first to perform coronary artery bypass and heart transplantation. Each developed an artificial heart valve and, in co-operation with Dr Domingo Liotta, were involved in the development of the first realistic artificial heart.
It was apparently this latter development that led to a cooling of the relationship between them. It appears that while Dr DeBakey was absent in Washington DC giving presidential advice, Dr Cooley, back on the ranch in Houston, became the first person to actually implant the device.
This story concerns one of them, Michael DeBakey, man of teak and spirit. He was of Lebanese extraction and graduated in medicine from Tulane University in New Orleans. He became a professor there and at the outbreak of the second World War he volunteered for military service. In this he became the director of the surgical consultants division.
Among countless other achievements, he pioneered the development of the Mobile Army Surgical Hospitals (MASH), now known to all. This single development alone would have guaranteed his place in medical history.
Post war, he went to Texas where he began his long association with Baylor University and Methodist Hospital. It was here that he performed the first successful surgical repair of a dissecting thoracic aortic aneurysm.
This remains one of the most difficult and dangerous operations in the cardiac surgeon's repertoire and one never approached with equanimity. DeBakey's classification, eponymously, is used worldwide today.
New Year's Eve 2005, DeBakey (97) was sitting in his study, preparing a lecture. He was alone in the house. Suddenly, the classical searing pain of dissecting aneurysm came. He was in agony but slowly, rationally, he made the correct self diagnosis.
In classical medical fashion, he then became a bad patient. His wife and daughter, returning home, were not fooled for an instant by his story of a pulled muscle and summoned help. The doctors agreed with his diagnosis and arranged urgent admission.
DeBakey declined hospitalisation, let alone surgery, and lingered on at home, gradually becoming weaker. He actually lectured to a large audience on January 6th, 2006.
Finally, in decline, he was admitted to Methodist Hospital on January 23rd. His long- term colleagues Drs Pool and Noon showed him the test results and recommended surgery.
DeBakey, knowing all the risks, said he would think about it. He gradually became unresponsive and death was imminent. Surgery now posed enormous risks and many of the doctors expressed misgivings.
Such operations had never been successful in patients of that age and his physical condition was getting worse by the hour. The anaesthetic staff adamantly refused to put him asleep for the procedure on the reasonable prognostication that he might never wake up.
The hospital ethics committee mulled over the problem, particularly in view of the patient's expressed reluctance to undergo surgery and his written "do not resuscitate" fiat.
Mrs DeBakey and the family were insistent that he be given the chance and even organised an anaesthetist from another hospital who said she was prepared to try.
Finally after hours of debate, the ethics committee finally gave its consent to the surgery taking place. Much precious time had been lost in debate and the patient's condition had been deteriorating all the while, but the issues being debated were not trivial. Near midnight on February 9th, DeBakey was wheeled into his own operating theatre and the operation began.
The classical Type 2 DeBakey dissecting aortic aneurysm was repaired using an arterial Dacron graft as developed by the surgeon himself. The operation took seven hours.
The tough old surgical lion came through and he is now 99.
He is the oldest patient to survive this operation and in so doing asked us all many ethical questions. I salute Drs Noon, Pool and Shenaq for their bravery and integrity. In medical parlance, DeBakey would not have been a good patient to lose and they would have been much criticised. They stood firm. The questions posed for the rest of us remain.
Maurice Neligan is a cardiac surgeon.