November 12, 2025 • 26 mins
Eric A. Rose, MD is a world leader in cardiac surgery and cardiovascular research who performed the first successful pediatric heart transplant.
Gerald Imber, MD is a plastic surgeon and author whose medical history books include Genius on the Edge: The Bizarre Double Life of Dr. William Halsted and Cardiac Cowboys: The Heroic Invention of Heart Surgery.
They join host Jamie Napoli to discuss the challenges facing medical innovators today, and their hopes for the future of heart medicine.
Thoughts or suggestions? You can reach us at cardiaccowboys@13thlakemedia.com.
Executive Producers: Cristina Everett for iHeartPodcasts; Dub Cornett and Jason Ross for OSO Studios; Gerald Imber; Eric A. Rose, M.D.; John Mankiewicz; Joshua Paul Johnson; and Jamie Napoli
Supervising Producer: James A. Smith
Editing and Sound Design by: Joshua Paul Johnson
Composer: David Mansfield
Cover Artwork by: Alexander Smith
Production Companies: iHeartPodcasts, OSO Studios, and 13th Lake Media
Production Legal Services: Jacqueline Eckhouse & Mel Pudig, Sloss Eckhouse Dasti Haynes LawCo; and Lincoln Bandlow, Lincoln Bandlow Law
Copyright 2025, TTB, LLC. All rights reserved.
See omnystudio.com/listener for privacy information.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
What future innovations might offer an answer to heart disease, which,
in twenty twenty five, six decades since the era of
the Cardiac Cowboys, remains the number one cause of death
in the world. Why is it essential that medical professionals
and lay people alike learn about the history of medicine.
Is there a connection between surgery and music? These are
(00:26):
just some of the topics I discuss with two world
renowned surgeons who also happen to be executive producers of
this podcast from OsO Studios. I'm Jamie Appley and this
is a special bonus episode of Cardiac Cowboys, a podcast
about life, death and innovation in the American Heartland. Doctor
(00:56):
Eric Rose is a world leader in cardiac surgery and
cardiovascular research. He was Surgeon in chief at the Columbia
Presbyterian Medical Center and Chairman of the Department of Surgery
at Columbia University. Eric performed the first pediatric heart transplant
and he is the main reason every surgeon I reached
out to leapt at the chance to work with us
on this podcast.
Speaker 2 (01:17):
Eric, Welcome, Sure, thank you.
Speaker 1 (01:20):
Doctor Gerald Limber is a plastic surgeon and author. He's
an attending surgeon at New York Presbyterian Hospital and assistant
Clinical Professor of Surgery at WYLD Cornell Medical College. He
wrote the medical history books Genius on the Edge about
William Halstead, the father of American surgery, as well as
Cardiac Cowboys The Heroic Convention of Heart Surgery, which was
(01:40):
published in February of twenty twenty four. Welcome Jerry, Thank
you now. Jerry. Before I met you, the only cardiac
surgeon I'd ever heard of was Christian Barnard, the South
African doctor who performed the world's first human heart transplant.
You're the one that introduced me to the cardiot Cowboys,
(02:00):
surgeons like Walt Lillahi, Michael DeBakey, Danton Cooley. How were
you first introduced to these figures?
Speaker 3 (02:07):
I was a classic surgery resident at Cornell at New
York it was then called New York Hospital, not New
York Presbyterian in the seventies, and at that time, the
recently deposed chief of Surgery and still head of cardiovascular
surgery was Walt lille High, and he was wandering around
(02:28):
the halls terrorizing everybody. Not really, I mean, they all
just kind of afraid to approach him. But he terrorized me,
and I just kept my distance because the stories about
him were legion and it was kind of a lot
of fun to sit around the coffee room waiting for
your case and hearing stories about the things that Lilie
(02:49):
had done. That was my introduction to this.
Speaker 1 (02:52):
What brought you years later to writing the story?
Speaker 3 (02:56):
Well, the decades later. Indeed, I had written a Genius
on the Edge, the story about William Stewart Halsted, and
it was a relatively successful book, and speaking to her
in the whole business, and then someone suggested that I
do another book. I think it was my agent, and
(03:18):
I was thinking about the very famous feud between Cooley
and DeBakey. It was the longest standing feud in medicine,
and very few feuds in the medical world are covered
in the New York Times on a regular basis or
on the cover of Life magazine. So I thought that
was really great, and I had written that, and my
(03:41):
agent probably said, this is terrific if you're writing a
magazine article. But there has to be more to it.
And so in my research kind of the other three
names popped up, Shumway and the Little High of course,
who I knew, and Christian Alila.
Speaker 1 (04:01):
High emerges as a undersung hero both in your book
and in the podcast. He's certainly not a household name,
at least for lay people. Eric, how common would you
say it is for surgeons or medical professionals to be
aware of the history of their field and how important
do you think it is.
Speaker 2 (04:19):
One, I think it's very important. Two, I think Kodiac
surgeons of my generation were already losing the chain of
thought recognizing Lilahi, and I was lucky enough to go.
I was invited toath birthday party in Minnesota and everybody
(04:40):
was anybody was there, including cooling into Baky and it
was clear that this at this point, you know, his
genius had been recognized in the field again and as
role the more you look into it, there is no
operation as far as I know that it's called a
Lili High procedure because you've basically invented all of them.
(05:02):
Closure of VSD, repair of tetralogy, maybe a mustard operation.
I guess he didn't do stuff like that, but that's esoterica.
His contributions be it, you know, coss circulation, then the
hard lung machine, which you simplified and made available to
(05:24):
the masses. At a reasonable price, as you depict in
the story here is is he bought the can open
to the picnic.
Speaker 1 (05:33):
Yeah, I'm interested in that because I know that I
can't remember. I think it was you, Eric who was
saying that a lot of medical students aren't aware of
some of this history and some of these figures. I mean, Jerry,
as a medical historian, can you speak to the importance
of medical history, why people should know these stories, not
just how to use these tools and how these procedures work,
(05:56):
but who created them in the stories behind them.
Speaker 3 (05:59):
Well, I think it's important for a number of reasons.
It's always important to know where you came from. But
we all think of ourselves as normal people. And when
you think of the people who are historically important in
our field, I don't really know our fields. They were
just regular people too, and they happened to be at
(06:20):
a certain time in the history of medicine when things
were just wide open, and it was kind of a
time when people would take a chance because nobody knew
the answer to things. And I'm sure exactly the same
thing is going on now. But we're just regular people
and we can't see it. And if somebody says something
(06:42):
wildly far fetched, we just laugh it off and go
about our daily business. It was the same thing with
Little High as it was with Halstead. The things that
they did, most people will say this kind of wackle,
but they were in the right place at the right time,
and they were courageous and they taught us that if,
(07:03):
as Lilla High said, something has to be done, it
has to be done. And they they they hate to
use analogies of ball playing analogies, but they brought the
ball down the field. You know, they just did it.
And it's important to know how it happened. It didn't
just materialize. Somebody had to have the audacity and the
(07:25):
and the the insight to do these things, and we
all benefit from them. And you know, the next step
is up to us. I mean when you said that
Eric did the first pediatric art transplant, but he was
their progeny, you know, it just he wouldn't have done
it if they hadn't done this first. And so it's
really important to know that. And I think that it
(07:47):
was very important that that Eric sent them royalties all
the time every time.
Speaker 1 (07:51):
You know, it's something that that fascinates me about the
characters in this in these stories that the doctors that
we call the cardiac cowboys is just how willing to
fail they all were. Walt Lillahigh using a dog's lung
as an early heart lung machine, Denton Cooley trying out
(08:12):
a total artificial heart that had really limited success, if
you'd call that in the lab. So, Eric, how do
you square that that risk taking culture of the nineteen fifties,
the nineteen sixties and into the seventies with the work
of surgeons today. How has that changed?
Speaker 2 (08:30):
Well, the morbidity and mortality underlying diseases is obviously improved,
but in an era, especially with the initial patients being kids,
you know, the risks that you'd take to get a
living patient that had the potential for decades is not
more of life versus certain death. It was a different
(08:51):
ballgame now. Congeneral heart disease now is no death sentence
anymore for the best majority of the kids. That was
not the case. The same thing with pediatric oncology and
things like that. Leukemia was a uniformly fatal disease in
young children in the past, and a similar story evolved
(09:14):
in chemotherapy and the like that now leukemia in childhood
is a curable disease. So I think I said at
one point that now being a heart surge is a
lot more like being the pilot for United Airlines or
whereas the original surgeons and more like fire pilots, and
(09:38):
my generation was kind of between. But that's the evolution
of progress.
Speaker 1 (09:50):
Eric, What areas within the field of heart medicine do
you see real innovation taking place today?
Speaker 2 (09:56):
Pediatric surgery is just an exacting feel Now the quality
of the work is just spectacular. You know, these walnut
sized hearts that are fixed by these guys and women.
Now that's the other big change in cardiac are There's
a lot of women doing it, but in other areas
(10:16):
are still I think more sex appeal than progress. Cooley's
use of an artificial heart sounds really sexy. It still
hasn't happened, and arguably it won't because there have been
parallel technologies that made so much progress that dying from
cardiogenic shock, for example, from a heart attack. Just recently,
(10:40):
a randomized trial of a temporary ELVAD show reduction in
mortality from like fifty percent to twenty percent.
Speaker 1 (10:51):
All that being a left centricular assist device.
Speaker 2 (10:53):
Yeah, I would predict, you know, ten years, it will
get down to five or maybe even one device, and
you keep your own heart too. A total heart sounds easy.
The heart seems like it's simple. It's just a pump,
but it's a lot more than that. It's a conduit,
it doesn't clot and regulates itself. It's also an endocrine organ.
(11:18):
It's secretes some hormones. So a lot of things about
the normal heart that are just not duplicable. I think,
long term, by a machine, maybe I'll be putting long
in my lifetime. I just don't think it's gonna happen.
Speaker 1 (11:32):
You're optimistic about a total artificial heart, Well, then let
me ask you this, Eric, because I'm curious about your
thoughts on the future. One of my favorite moments in
the show is from our episode about the first total
artificial heart. Doctor Billy Cohne quotes doctor Lynn Warner Stevenson
her famous line that a heart transplant is the answer
(11:53):
to heart failure the way the lottery is the answer
to poverty. I know where Billy Cone stands on this.
He's been working on the Bible core total artificial heart.
What do you see as the answer to this problem
where do you think the future of heart medicine lives.
Speaker 2 (12:09):
I think there's no question that invasive procedures with sternotomies
and the like are being replaced by much less invasive
procedures by definition, and plantation of a total artificial heart
that's permanent or semi permanent has got to be an
invasive procedure and arguably a very sick patient. Now, when
(12:33):
you can put a temporarial AD into a human through
the femeral artery or even in some instance maybe even
a redial artery without a sternotomy, a device that has
a diameter of a pencil can pump fively use a
blood and be put in it in the field instead
(12:54):
of waiting for the patient to get to the hospital.
That to me is much more progress.
Speaker 3 (13:00):
That's interesting that you say that, Eric, because as you
was talking about the LVAD, the new LVADs, they are
temporary and temporary to watch. So even though they're wonderful,
what's the end point if a quarter million people are
waiting for a heart transplant and they're only thirty two
hundred a year being done, and you have an LVAD
and you're still waiting for art transplant, Unless there's a thah,
(13:23):
total artificial art is that not so?
Speaker 2 (13:26):
I think there are two kinds of patients, the cute
ones in whom the heart muscle itself is quite recoverable,
and that's where there's been a lot of progress. By
getting these devices in early and resting the heart muscle,
it comes back, and the degree to which it does
is generally enough that they don't need another mechanical device
(13:49):
long term and long term bads are also improving, but
they still have these drive lines that come out of
the body, and until that kind of problem is solved,
it's a very unappealing way to live your life, even
if it's pumping for you with a garden hose coming
out of your abdomen. I think that's solved a solvable problem.
(14:12):
You know, there's room for both, but right now the
acute heart failure issue is really at the forefront. I
think of problems, they're being solved, not fully, but he
a lot better than dying.
Speaker 1 (14:27):
So another question directed to you, Eric is about funding
for this government funding. You know, looking back at the
Cardiac Cowboys, a number of those surgeons, Michael Debake most
famously owed a lot of their accomplishments to funding from
the National Institutes of Health. Over the last year, the
nih has faced thousands of layoffs, billions of dollars in
(14:49):
funding cut threatened with forty percent cut to its budget.
I'm interested how you think the ramifications of that, the
atmosphere of uncertainty impact that would be Michael Debke's and
Walt Little highs of today.
Speaker 2 (15:01):
It's concerning, and I hope it's temporary. But cardiac re
placement with parts and parts of entricals in the light
now is a viable industry, which it wasn't even ten
twenty years ago. So there are lvad companies now that
can capitalize progress in this space. Jane j just bought
(15:23):
a company that I was on the board of for
a lot of money, with a lot of investment that
already has about a billion a year of revenue because
of its effectiveness and a qute harfare. So I think
it's less important because when you get a therapy that
makes it, capitalism works. It's earlier stage therapies that I'm
(15:46):
concerned about. And I'll give you an example. I'm on
the board of a company called Corvion, which is trying
to make alvads for kids. They're tiny they're about the
size of a quarter. It's a very elegant device. We
had a board call last week saying that DOE had
not funded the NIH grant that was sustaining this company.
(16:11):
Now it turns out the doge as is it's spent
reversed this decision, but you know, the company was scrambling
and that was that. I think is a luster of
you know, what can go wrong and shouldn't right.
Speaker 1 (16:27):
I mean, I have to imagine that's multiplied by a
tremendous number of early innovations that are facing those same
kinds of chaos.
Speaker 2 (16:33):
No question most of what you'll fail. But that's the
nature of this work.
Speaker 1 (16:37):
To begin with, Jerry, you've written two books that one
might describe as being about the wild men of medicine.
Doctor William Halstead, the subject of Genius on the Edge
was in addition to being a genius and revolutionizing surgery,
(16:58):
he was famous addicted to cocaine and morphine. He was
the inspiration for the show The Nick with Clive Owen.
Is that a theme that you are consciously pursuing in
your work? What do you look for when you're approaching
a new topic for medical history.
Speaker 3 (17:12):
Something that's interesting and important, and if it's not a
little I guess if the topic or the way the
topic is pursued by the heroic personnel is not a
little bit wild, people aren't interested in wasting their time
reading it. They're not interested in progress in evolution. They're
interested in revolution and in medicine. Revolution comes at a price,
(17:36):
and part of the price is having that personality willing
to take a dive off the highboard without looking to
see if there's water in the pool. You know, it's
just that they're different. They're different kinds of people than
we are. So through history there are a number of
people like that. You know, semilwise, you can just go
through medical history and find people who took a chance
(17:58):
and who were astigated or lost their careers because they
but they believed in and what they've believed in was right.
But there are so few people that have done more
than one thing and just taken that leap into the
pool so many times and changed so many things. There's
a limited pool of stories. They're all very interesting, but
(18:20):
there has to be something beyond what interests just the
doctor in that field. There has to be something that
the public at large can understand be be excited by,
or thrilled by, or repelled by, or frightened by.
Speaker 1 (18:34):
Yeah, I mean I'm curious. You had brought up parallels
between Hostead and Walt Lilla High earlier in this conversation.
I'm curious about that. If you think there is a
relationship between perhaps their their success as an outlier and
also their personal failings.
Speaker 3 (18:53):
Well that's an interesting question because they would have hated
one another, or certainly hal said would have this spies
the lie because I mean little High just you know,
he was a cowboy. And when you think about Halstead,
you say, oh, he was addicted to cocaine and morphine
and ya YadA. But the reality was those things were
(19:14):
the result of experimenting with this new anesthetic that a
guy named Sigmund Freud had been expo exposing people to
in Vienna and using it on patients as a local
anesthetic and using it on himself first and are his
students first, So they either became addicted or most of
them died, and he became addicted, but he did not
(19:36):
have what we would call an addictive personality. He was
using enormous amounts of cocaine, testing it for medical reasons.
It was just as simple as that. He was a
morphine addict because nobody knew about cocaine addictions, so in
order to get him off the cocaine, they gave him morphine,
so he became addicted to that too. But he was
a total, rigid, straight arrow, and he knew the thing
(20:00):
that he wanted to do, and he did those things,
and he would not countenance anyone deviating from his orders
or having their own their own ideas about things. Lilla
High was exactly the opposite. Lil I live the life
of a guy having fun. Little I didn't want to
(20:20):
know what previous experiments had been done on a particular
subject because he didn't want to bias himself. He just leapt.
Speaker 1 (20:28):
So while we're on the subject of the personalities of
geniuses and drawing these parallels, Eric, I hope I'm not
embarrassing you by asking this, but I understand you were
in a band in high school. It's on your Wikipedia page,
Is that right?
Speaker 2 (20:42):
Yeah, I've worked for my father.
Speaker 1 (20:45):
In our conversations making Cardiac Cowboys, Doctor Billy Cone spoke
quite a bit about playing trombone. He's in several bands.
Doctor Ken Maddox spoke extensively about his background as a singer.
Doctor Michael DeBakey played saxophone and clarinet. Do you think
there's a connection between music and surgery.
Speaker 2 (21:03):
Oh for sure.
Speaker 3 (21:04):
Oh you're nuts absolutely.
Speaker 2 (21:09):
First of all, especially good music is a team sport.
Any good surgery gets complex or science is a team
sport too, and to be playing with other people you
know they're good, makes enthusiastic. It's very different from sports.
For example, I think I was never any good at
(21:29):
any any competitive sport, but it was pretty good at
playing pianre and it was fun, and the exposure to
people who obviously were much better than you, you could
absorb it and enjoy it and not be threatened by it.
And I think surgery is often that way too, But
(21:50):
there are sports types that view surgery more competitively than
that too, and there's room for both.
Speaker 1 (22:00):
I think it was his daughter, Louise Cooley Davis who
talked with us about his background as a basketball player,
relating so directly to his work as a surgeon. But
that high level of specialization but also working within a team,
I think is an interesting parallel.
Speaker 3 (22:15):
I had respectfully point out that as a musician, my
classical guitar teacher fired me. That's how good I was.
Speaker 2 (22:25):
Yeah, but if you joined a rock band, you might
have been in the Beatles or something.
Speaker 1 (22:32):
Well, I think it all. It all worked out the
way it was supposed to do. So, Jerry, back to
your books. You've written two riveting medical history books. Is
there a new story coming down the pike? Are there
any subjects you're interested in exploring?
Speaker 3 (22:46):
Yeah, well, I'm committed to two projects right now. One
of them is very amusing. I'm working with a writer
named Matt Leiner was pretty well known and we were
asked by Harpercollumns to write an amusing book about agent,
which I mean, what could be funnier except for people
(23:06):
who are agent? But there there are, there are a
lot of funny things. So we're just we're laving our
heads off doing that book and we haven't written three
pages yet, but it's fun. And then I'm then I
was asked by a university here to write the history
of a particular department of reconstructive surgery. And I'm doing
(23:31):
that because I was an honor to be asked. And
there that's it's for n y U and I'm from
Cornell and we were we were about two miles separated
down First Avenue in Manhattan, and they were the enemy,
and and here I am writing a book about them,
but I couldn't say no. So those are my projects now,
(23:52):
and that's the next six months of my of my
writing life. But I have a day job, so I
got to, you know, have to keep going.
Speaker 1 (24:01):
So my final question to both of you, Cardiac Cowboys.
The podcast came out a little over a month ago
at the end of September. Both of you were executive
producers on it. What are your highest hopes for the podcast?
What do you hope it achieves.
Speaker 2 (24:14):
I hope that well Little Eye becomes a household name.
I don't know if that's true or not, but I
think you, you and and the tactical people and the
storytellers and Jerry with this have done an enormous service
by pointing out his role. I hope he becomes better known,
and I hope the foibles that he had begun recognized
(24:39):
for what they were almost nothing. He was a human being.
He was a human being.
Speaker 3 (24:45):
It's interesting you say that because I had a conversation
with someone who is a generation younger than I now
at New York Presbyterian who when we talked about Lila
High thought the worst of him and said, oh, you
know the stories I heard, he was just a terrible
list and a terrible that he just knew his bad
(25:05):
reputation because he had been fired from New York Hospital
from his positions there, because he was a terrible administrator
and he was losing his eyesight, and he wasn't no longer.
Speaker 2 (25:17):
The surgeon that he was.
Speaker 3 (25:18):
Perhaps, but even someone from that institution didn't understand the
importance of Walt Dloa High in not the history of
cardiac surgery, in the history of medicine. So you I
agree with you completely.
Speaker 2 (25:31):
He was He's just in another league.
Speaker 3 (25:34):
Yep, yep, agreed.
Speaker 1 (25:43):
Cardiac Cowboys is a production of iHeart Podcasts, oh SOO
Studios and Thirteenth Lake Media. Our executive producers are Christina
Everett for iHeart Podcasts dubbed Cornette and Jason Ross for
OsO Studios. Doctor Gerald Imberg, author of Cardiac Cowboys, The
Heroic Invention of Heart Surgery, doctor Eric A. Rose, John Mankowitz,
(26:09):
Joshua Paul Johnson, and myself. James A. Smith is our
supervising producer, editing and sound design by Joshua Paul Johnson.
Our composer is David Mansfield. Our cover artwork is designed
by Alexander Smith. For more information on the first cardiac surgeons,
(26:29):
check out doctor Gerald Imber's book Cardiac Cowboys, The Heroic
Invention of Heart Surgery.
What future innovations might offer an answer to heart disease, which,
in twenty twenty five, six decades since the era of
the Cardiac Cowboys, remains the number one cause of death
in the world. Why is it essential that medical professionals
and lay people alike learn about the history of medicine.
Is there a connection between surgery and music? These are
(00:26):
just some of the topics I discuss with two world
renowned surgeons who also happen to be executive producers of
this podcast from OsO Studios. I'm Jamie Appley and this
is a special bonus episode of Cardiac Cowboys, a podcast
about life, death and innovation in the American Heartland. Doctor
(00:56):
Eric Rose is a world leader in cardiac surgery and
cardiovascular research. He was Surgeon in chief at the Columbia
Presbyterian Medical Center and Chairman of the Department of Surgery
at Columbia University. Eric performed the first pediatric heart transplant
and he is the main reason every surgeon I reached
out to leapt at the chance to work with us
on this podcast.
Speaker 2 (01:17):
Eric, Welcome, Sure, thank you.
Speaker 1 (01:20):
Doctor Gerald Limber is a plastic surgeon and author. He's
an attending surgeon at New York Presbyterian Hospital and assistant
Clinical Professor of Surgery at WYLD Cornell Medical College. He
wrote the medical history books Genius on the Edge about
William Halstead, the father of American surgery, as well as
Cardiac Cowboys The Heroic Convention of Heart Surgery, which was
(01:40):
published in February of twenty twenty four. Welcome Jerry, Thank
you now. Jerry. Before I met you, the only cardiac
surgeon I'd ever heard of was Christian Barnard, the South
African doctor who performed the world's first human heart transplant.
You're the one that introduced me to the cardiot Cowboys,
(02:00):
surgeons like Walt Lillahi, Michael DeBakey, Danton Cooley. How were
you first introduced to these figures?
Speaker 3 (02:07):
I was a classic surgery resident at Cornell at New
York it was then called New York Hospital, not New
York Presbyterian in the seventies, and at that time, the
recently deposed chief of Surgery and still head of cardiovascular
surgery was Walt lille High, and he was wandering around
(02:28):
the halls terrorizing everybody. Not really, I mean, they all
just kind of afraid to approach him. But he terrorized me,
and I just kept my distance because the stories about
him were legion and it was kind of a lot
of fun to sit around the coffee room waiting for
your case and hearing stories about the things that Lilie
(02:49):
had done. That was my introduction to this.
Speaker 1 (02:52):
What brought you years later to writing the story?
Speaker 3 (02:56):
Well, the decades later. Indeed, I had written a Genius
on the Edge, the story about William Stewart Halsted, and
it was a relatively successful book, and speaking to her
in the whole business, and then someone suggested that I
do another book. I think it was my agent, and
(03:18):
I was thinking about the very famous feud between Cooley
and DeBakey. It was the longest standing feud in medicine,
and very few feuds in the medical world are covered
in the New York Times on a regular basis or
on the cover of Life magazine. So I thought that
was really great, and I had written that, and my
(03:41):
agent probably said, this is terrific if you're writing a
magazine article. But there has to be more to it.
And so in my research kind of the other three
names popped up, Shumway and the Little High of course,
who I knew, and Christian Alila.
Speaker 1 (04:01):
High emerges as a undersung hero both in your book
and in the podcast. He's certainly not a household name,
at least for lay people. Eric, how common would you
say it is for surgeons or medical professionals to be
aware of the history of their field and how important
do you think it is.
Speaker 2 (04:19):
One, I think it's very important. Two, I think Kodiac
surgeons of my generation were already losing the chain of
thought recognizing Lilahi, and I was lucky enough to go.
I was invited toath birthday party in Minnesota and everybody
(04:40):
was anybody was there, including cooling into Baky and it
was clear that this at this point, you know, his
genius had been recognized in the field again and as
role the more you look into it, there is no
operation as far as I know that it's called a
Lili High procedure because you've basically invented all of them.
(05:02):
Closure of VSD, repair of tetralogy, maybe a mustard operation.
I guess he didn't do stuff like that, but that's esoterica.
His contributions be it, you know, coss circulation, then the
hard lung machine, which you simplified and made available to
(05:24):
the masses. At a reasonable price, as you depict in
the story here is is he bought the can open
to the picnic.
Speaker 1 (05:33):
Yeah, I'm interested in that because I know that I
can't remember. I think it was you, Eric who was
saying that a lot of medical students aren't aware of
some of this history and some of these figures. I mean, Jerry,
as a medical historian, can you speak to the importance
of medical history, why people should know these stories, not
just how to use these tools and how these procedures work,
(05:56):
but who created them in the stories behind them.
Speaker 3 (05:59):
Well, I think it's important for a number of reasons.
It's always important to know where you came from. But
we all think of ourselves as normal people. And when
you think of the people who are historically important in
our field, I don't really know our fields. They were
just regular people too, and they happened to be at
(06:20):
a certain time in the history of medicine when things
were just wide open, and it was kind of a
time when people would take a chance because nobody knew
the answer to things. And I'm sure exactly the same
thing is going on now. But we're just regular people
and we can't see it. And if somebody says something
(06:42):
wildly far fetched, we just laugh it off and go
about our daily business. It was the same thing with
Little High as it was with Halstead. The things that
they did, most people will say this kind of wackle,
but they were in the right place at the right time,
and they were courageous and they taught us that if,
(07:03):
as Lilla High said, something has to be done, it
has to be done. And they they they hate to
use analogies of ball playing analogies, but they brought the
ball down the field. You know, they just did it.
And it's important to know how it happened. It didn't
just materialize. Somebody had to have the audacity and the
(07:25):
and the the insight to do these things, and we
all benefit from them. And you know, the next step
is up to us. I mean when you said that
Eric did the first pediatric art transplant, but he was
their progeny, you know, it just he wouldn't have done
it if they hadn't done this first. And so it's
really important to know that. And I think that it
(07:47):
was very important that that Eric sent them royalties all
the time every time.
Speaker 1 (07:51):
You know, it's something that that fascinates me about the
characters in this in these stories that the doctors that
we call the cardiac cowboys is just how willing to
fail they all were. Walt Lillahigh using a dog's lung
as an early heart lung machine, Denton Cooley trying out
(08:12):
a total artificial heart that had really limited success, if
you'd call that in the lab. So, Eric, how do
you square that that risk taking culture of the nineteen fifties,
the nineteen sixties and into the seventies with the work
of surgeons today. How has that changed?
Speaker 2 (08:30):
Well, the morbidity and mortality underlying diseases is obviously improved,
but in an era, especially with the initial patients being kids,
you know, the risks that you'd take to get a
living patient that had the potential for decades is not
more of life versus certain death. It was a different
(08:51):
ballgame now. Congeneral heart disease now is no death sentence
anymore for the best majority of the kids. That was
not the case. The same thing with pediatric oncology and
things like that. Leukemia was a uniformly fatal disease in
young children in the past, and a similar story evolved
(09:14):
in chemotherapy and the like that now leukemia in childhood
is a curable disease. So I think I said at
one point that now being a heart surge is a
lot more like being the pilot for United Airlines or
whereas the original surgeons and more like fire pilots, and
(09:38):
my generation was kind of between. But that's the evolution
of progress.
Speaker 1 (09:50):
Eric, What areas within the field of heart medicine do
you see real innovation taking place today?
Speaker 2 (09:56):
Pediatric surgery is just an exacting feel Now the quality
of the work is just spectacular. You know, these walnut
sized hearts that are fixed by these guys and women.
Now that's the other big change in cardiac are There's
a lot of women doing it, but in other areas
(10:16):
are still I think more sex appeal than progress. Cooley's
use of an artificial heart sounds really sexy. It still
hasn't happened, and arguably it won't because there have been
parallel technologies that made so much progress that dying from
cardiogenic shock, for example, from a heart attack. Just recently,
(10:40):
a randomized trial of a temporary ELVAD show reduction in
mortality from like fifty percent to twenty percent.
Speaker 1 (10:51):
All that being a left centricular assist device.
Speaker 2 (10:53):
Yeah, I would predict, you know, ten years, it will
get down to five or maybe even one device, and
you keep your own heart too. A total heart sounds easy.
The heart seems like it's simple. It's just a pump,
but it's a lot more than that. It's a conduit,
it doesn't clot and regulates itself. It's also an endocrine organ.
(11:18):
It's secretes some hormones. So a lot of things about
the normal heart that are just not duplicable. I think,
long term, by a machine, maybe I'll be putting long
in my lifetime. I just don't think it's gonna happen.
Speaker 1 (11:32):
You're optimistic about a total artificial heart, Well, then let
me ask you this, Eric, because I'm curious about your
thoughts on the future. One of my favorite moments in
the show is from our episode about the first total
artificial heart. Doctor Billy Cohne quotes doctor Lynn Warner Stevenson
her famous line that a heart transplant is the answer
(11:53):
to heart failure the way the lottery is the answer
to poverty. I know where Billy Cone stands on this.
He's been working on the Bible core total artificial heart.
What do you see as the answer to this problem
where do you think the future of heart medicine lives.
Speaker 2 (12:09):
I think there's no question that invasive procedures with sternotomies
and the like are being replaced by much less invasive
procedures by definition, and plantation of a total artificial heart
that's permanent or semi permanent has got to be an
invasive procedure and arguably a very sick patient. Now, when
(12:33):
you can put a temporarial AD into a human through
the femeral artery or even in some instance maybe even
a redial artery without a sternotomy, a device that has
a diameter of a pencil can pump fively use a
blood and be put in it in the field instead
(12:54):
of waiting for the patient to get to the hospital.
That to me is much more progress.
Speaker 3 (13:00):
That's interesting that you say that, Eric, because as you
was talking about the LVAD, the new LVADs, they are
temporary and temporary to watch. So even though they're wonderful,
what's the end point if a quarter million people are
waiting for a heart transplant and they're only thirty two
hundred a year being done, and you have an LVAD
and you're still waiting for art transplant, Unless there's a thah,
(13:23):
total artificial art is that not so?
Speaker 2 (13:26):
I think there are two kinds of patients, the cute
ones in whom the heart muscle itself is quite recoverable,
and that's where there's been a lot of progress. By
getting these devices in early and resting the heart muscle,
it comes back, and the degree to which it does
is generally enough that they don't need another mechanical device
(13:49):
long term and long term bads are also improving, but
they still have these drive lines that come out of
the body, and until that kind of problem is solved,
it's a very unappealing way to live your life, even
if it's pumping for you with a garden hose coming
out of your abdomen. I think that's solved a solvable problem.
(14:12):
You know, there's room for both, but right now the
acute heart failure issue is really at the forefront. I
think of problems, they're being solved, not fully, but he
a lot better than dying.
Speaker 1 (14:27):
So another question directed to you, Eric is about funding
for this government funding. You know, looking back at the
Cardiac Cowboys, a number of those surgeons, Michael Debake most
famously owed a lot of their accomplishments to funding from
the National Institutes of Health. Over the last year, the
nih has faced thousands of layoffs, billions of dollars in
(14:49):
funding cut threatened with forty percent cut to its budget.
I'm interested how you think the ramifications of that, the
atmosphere of uncertainty impact that would be Michael Debke's and
Walt Little highs of today.
Speaker 2 (15:01):
It's concerning, and I hope it's temporary. But cardiac re
placement with parts and parts of entricals in the light
now is a viable industry, which it wasn't even ten
twenty years ago. So there are lvad companies now that
can capitalize progress in this space. Jane j just bought
(15:23):
a company that I was on the board of for
a lot of money, with a lot of investment that
already has about a billion a year of revenue because
of its effectiveness and a qute harfare. So I think
it's less important because when you get a therapy that
makes it, capitalism works. It's earlier stage therapies that I'm
(15:46):
concerned about. And I'll give you an example. I'm on
the board of a company called Corvion, which is trying
to make alvads for kids. They're tiny they're about the
size of a quarter. It's a very elegant device. We
had a board call last week saying that DOE had
not funded the NIH grant that was sustaining this company.
(16:11):
Now it turns out the doge as is it's spent
reversed this decision, but you know, the company was scrambling
and that was that. I think is a luster of
you know, what can go wrong and shouldn't right.
Speaker 1 (16:27):
I mean, I have to imagine that's multiplied by a
tremendous number of early innovations that are facing those same
kinds of chaos.
Speaker 2 (16:33):
No question most of what you'll fail. But that's the
nature of this work.
Speaker 1 (16:37):
To begin with, Jerry, you've written two books that one
might describe as being about the wild men of medicine.
Doctor William Halstead, the subject of Genius on the Edge
was in addition to being a genius and revolutionizing surgery,
(16:58):
he was famous addicted to cocaine and morphine. He was
the inspiration for the show The Nick with Clive Owen.
Is that a theme that you are consciously pursuing in
your work? What do you look for when you're approaching
a new topic for medical history.
Speaker 3 (17:12):
Something that's interesting and important, and if it's not a
little I guess if the topic or the way the
topic is pursued by the heroic personnel is not a
little bit wild, people aren't interested in wasting their time
reading it. They're not interested in progress in evolution. They're
interested in revolution and in medicine. Revolution comes at a price,
(17:36):
and part of the price is having that personality willing
to take a dive off the highboard without looking to
see if there's water in the pool. You know, it's
just that they're different. They're different kinds of people than
we are. So through history there are a number of
people like that. You know, semilwise, you can just go
through medical history and find people who took a chance
(17:58):
and who were astigated or lost their careers because they
but they believed in and what they've believed in was right.
But there are so few people that have done more
than one thing and just taken that leap into the
pool so many times and changed so many things. There's
a limited pool of stories. They're all very interesting, but
(18:20):
there has to be something beyond what interests just the
doctor in that field. There has to be something that
the public at large can understand be be excited by,
or thrilled by, or repelled by, or frightened by.
Speaker 1 (18:34):
Yeah, I mean I'm curious. You had brought up parallels
between Hostead and Walt Lilla High earlier in this conversation.
I'm curious about that. If you think there is a
relationship between perhaps their their success as an outlier and
also their personal failings.
Speaker 3 (18:53):
Well that's an interesting question because they would have hated
one another, or certainly hal said would have this spies
the lie because I mean little High just you know,
he was a cowboy. And when you think about Halstead,
you say, oh, he was addicted to cocaine and morphine
and ya YadA. But the reality was those things were
(19:14):
the result of experimenting with this new anesthetic that a
guy named Sigmund Freud had been expo exposing people to
in Vienna and using it on patients as a local
anesthetic and using it on himself first and are his
students first, So they either became addicted or most of
them died, and he became addicted, but he did not
(19:36):
have what we would call an addictive personality. He was
using enormous amounts of cocaine, testing it for medical reasons.
It was just as simple as that. He was a
morphine addict because nobody knew about cocaine addictions, so in
order to get him off the cocaine, they gave him morphine,
so he became addicted to that too. But he was
a total, rigid, straight arrow, and he knew the thing
(20:00):
that he wanted to do, and he did those things,
and he would not countenance anyone deviating from his orders
or having their own their own ideas about things. Lilla
High was exactly the opposite. Lil I live the life
of a guy having fun. Little I didn't want to
(20:20):
know what previous experiments had been done on a particular
subject because he didn't want to bias himself. He just leapt.
Speaker 1 (20:28):
So while we're on the subject of the personalities of
geniuses and drawing these parallels, Eric, I hope I'm not
embarrassing you by asking this, but I understand you were
in a band in high school. It's on your Wikipedia page,
Is that right?
Speaker 2 (20:42):
Yeah, I've worked for my father.
Speaker 1 (20:45):
In our conversations making Cardiac Cowboys, Doctor Billy Cone spoke
quite a bit about playing trombone. He's in several bands.
Doctor Ken Maddox spoke extensively about his background as a singer.
Doctor Michael DeBakey played saxophone and clarinet. Do you think
there's a connection between music and surgery.
Speaker 2 (21:03):
Oh for sure.
Speaker 3 (21:04):
Oh you're nuts absolutely.
Speaker 2 (21:09):
First of all, especially good music is a team sport.
Any good surgery gets complex or science is a team
sport too, and to be playing with other people you
know they're good, makes enthusiastic. It's very different from sports.
For example, I think I was never any good at
(21:29):
any any competitive sport, but it was pretty good at
playing pianre and it was fun, and the exposure to
people who obviously were much better than you, you could
absorb it and enjoy it and not be threatened by it.
And I think surgery is often that way too, But
(21:50):
there are sports types that view surgery more competitively than
that too, and there's room for both.
Speaker 1 (22:00):
I think it was his daughter, Louise Cooley Davis who
talked with us about his background as a basketball player,
relating so directly to his work as a surgeon. But
that high level of specialization but also working within a team,
I think is an interesting parallel.
Speaker 3 (22:15):
I had respectfully point out that as a musician, my
classical guitar teacher fired me. That's how good I was.
Speaker 2 (22:25):
Yeah, but if you joined a rock band, you might
have been in the Beatles or something.
Speaker 1 (22:32):
Well, I think it all. It all worked out the
way it was supposed to do. So, Jerry, back to
your books. You've written two riveting medical history books. Is
there a new story coming down the pike? Are there
any subjects you're interested in exploring?
Speaker 3 (22:46):
Yeah, well, I'm committed to two projects right now. One
of them is very amusing. I'm working with a writer
named Matt Leiner was pretty well known and we were
asked by Harpercollumns to write an amusing book about agent,
which I mean, what could be funnier except for people
(23:06):
who are agent? But there there are, there are a
lot of funny things. So we're just we're laving our
heads off doing that book and we haven't written three
pages yet, but it's fun. And then I'm then I
was asked by a university here to write the history
of a particular department of reconstructive surgery. And I'm doing
(23:31):
that because I was an honor to be asked. And
there that's it's for n y U and I'm from
Cornell and we were we were about two miles separated
down First Avenue in Manhattan, and they were the enemy,
and and here I am writing a book about them,
but I couldn't say no. So those are my projects now,
(23:52):
and that's the next six months of my of my
writing life. But I have a day job, so I
got to, you know, have to keep going.
Speaker 1 (24:01):
So my final question to both of you, Cardiac Cowboys.
The podcast came out a little over a month ago
at the end of September. Both of you were executive
producers on it. What are your highest hopes for the podcast?
What do you hope it achieves.
Speaker 2 (24:14):
I hope that well Little Eye becomes a household name.
I don't know if that's true or not, but I
think you, you and and the tactical people and the
storytellers and Jerry with this have done an enormous service
by pointing out his role. I hope he becomes better known,
and I hope the foibles that he had begun recognized
(24:39):
for what they were almost nothing. He was a human being.
He was a human being.
Speaker 3 (24:45):
It's interesting you say that because I had a conversation
with someone who is a generation younger than I now
at New York Presbyterian who when we talked about Lila
High thought the worst of him and said, oh, you
know the stories I heard, he was just a terrible
list and a terrible that he just knew his bad
(25:05):
reputation because he had been fired from New York Hospital
from his positions there, because he was a terrible administrator
and he was losing his eyesight, and he wasn't no longer.
Speaker 2 (25:17):
The surgeon that he was.
Speaker 3 (25:18):
Perhaps, but even someone from that institution didn't understand the
importance of Walt Dloa High in not the history of
cardiac surgery, in the history of medicine. So you I
agree with you completely.
Speaker 2 (25:31):
He was He's just in another league.
Speaker 3 (25:34):
Yep, yep, agreed.
Speaker 1 (25:43):
Cardiac Cowboys is a production of iHeart Podcasts, oh SOO
Studios and Thirteenth Lake Media. Our executive producers are Christina
Everett for iHeart Podcasts dubbed Cornette and Jason Ross for
OsO Studios. Doctor Gerald Imberg, author of Cardiac Cowboys, The
Heroic Invention of Heart Surgery, doctor Eric A. Rose, John Mankowitz,
(26:09):
Joshua Paul Johnson, and myself. James A. Smith is our
supervising producer, editing and sound design by Joshua Paul Johnson.
Our composer is David Mansfield. Our cover artwork is designed
by Alexander Smith. For more information on the first cardiac surgeons,
(26:29):
check out doctor Gerald Imber's book Cardiac Cowboys, The Heroic
Invention of Heart Surgery.
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