September 29, 2025 • 41 mins
A devastating turn of events forces Walt Lillehei to re-think his approach to open heart surgery. In Houston, Denton Cooley’s swift rise plunges him into a battle of egos with his boss and mentor, Michael DeBakey.
Presented by: Chris Pine
Written and Narrated by: Jamie Napoli
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
Archival Materials Courtesy of: The University of Minnesota Archives, University of Minnesota - Twin Cities; Special Collections, University of Rhode Island Library; and G. Wayne Miller, author of "King of Hearts: The True Story of the Maverick Who Pioneered Open Heart Surgery"
Additional Archival Materials Courtesy of: "Nova" (WGBH Boston & PBS 1988 & 1999); Minnesota Historical Society; Vanderbilt University; and Medtronic
Additional Music & Stock Media Provided by: Music Bed; Premium Beat; Storyblocks; Artlist; APM; Envato Market; Incompetech; and Podcast Music
This podcast was recorded under a SAG-AFTRA collective bargaining agreement.
For more information on the history of open heart surgery, check out Dr. Gerald Imber's book "CARDIAC COWBOYS: The Heroic invention of Heart Surgery."
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 (00:00):
Welcome to the wild West of American medicine. I'm Chris
Pine in This is Cardiac Cowboys, the gripping true story
behind the birth of open heart surgery and the Maverick surgeons.
Speaker 2 (00:12):
Who made it happen.
Speaker 3 (00:17):
The person.
Speaker 1 (00:21):
It's April twenty seventh, nineteen fifty five. Walt lilla High
waits to be called on stage. He's at one of
the countless medical conferences to which he's been invited to
speak since his breakthrough. It's been a little over a
year since Lillahi used cross circulation to repair a whole
in Gregory Gliddon's heart, and it's been five years since
(00:42):
he was diagnosed with terminal cancer. Despite the bleak prognosis,
Lillahi refuses to undergo a second look operation. He doesn't
need another doctor to tell him how much time he
has left. Lelehigh already lives each day like it could
be his last. He takes the stage and begins to
(01:08):
describe his controversial technique, a child and parent sharing blood
while the child undergoes open heart surgery. Since he operated
on Gregory Glidden, lilla High has performed over three dozen
of these cross circulation procedures toward the end of the presentation,
he makes his big announcement. Lilla High has successfully repaired
(01:29):
six cases of tetrology of Fallow, one of the deadliest
and most complex heart defects to cardiac surgeons in the
nineteen fifties. This is the holy Grail. In spite of
his unprecedented success, Lila Hi has come to expect criticism,
and he gets his fair share of it today. Here's
an archival recording of Walt Lillahi.
Speaker 3 (01:51):
I could understand the skeptician because of that. Every new
idea is good, but it didn't bother us because we
knew we were on the right track.
Speaker 1 (02:00):
Today in the audience sits Alfred Blaylock and Helen Tausig
at JOHNS Hopkins. A decade earlier, doctor Blaylock, doctor Tausig,
and a lab technician named Vivian Thomas pioneered an ingenious
blue baby operation that allowed children born with tetrology of
(02:20):
Fillow to survive past infancy. Lilahi has taken their work
one bounding step forward, but they don't see it that way.
In a shocking scene detailed by Lilahi's former resident, doctor
daniel A. Gore, Helen Tausig stands from her seat during
the Q and A in shouts this criminal must be stopped.
(02:46):
This reaction isn't completely unexpected. After losing a string of
patients last autumn, Lillahi overheard his own nurses whispering about
him in the halls, calling him a murderer. And then
there was the case of the Thompson family. On the
(03:07):
morning of October fifth, nineteen fifty four, an eight year
old girl named Leslieann Thompson was wheeled into an oar
at the University of Minnesota Hospital. Leslie Anne was born
with a VSD, a hole between the ventricles in her heart.
Her parents, an Air Force officer named Dan Thompson, and
(03:27):
his wife, Geraldine, had brought Leslie Anne to specialists all
over the country, including pioneering vascular surgeons Michael de Bakey
and Denton Cooley down in Houston, But wherever they went,
the prognosis remained the same. Leslie Anne would not survive
unless the hole in her heart could be sown shut.
This brought the Thompsons to the operating room of Walt
(03:50):
Lella High.
Speaker 4 (03:53):
Doctor Varsall and I were opening the cheff of the styled,
exposing to heart and to make twheeled the mother into
the main room.
Speaker 1 (04:04):
Geraldine was a blood match for her daughter. She happily
volunteered to lend her heart and lungs to keep leslie
and alive during surgery. As Lilahi prepared to cut into
the eight year old girl's heart, two of his assistants
tended to Geraldine, who lay just six feet away. An
anesthesiologist entered the oar and approached Geraldine's table.
Speaker 5 (04:26):
Because she had an IVY get one of the armed
veins to give dan a see it. He saw it
was a dripping.
Speaker 4 (04:33):
He thought the vein it plugged up, so he put
a sixty big squeezes on that stump.
Speaker 5 (04:40):
And loan behold IV was not dripping because the bottle
was empty.
Speaker 1 (04:45):
The anesthesiologist had just squeezed a massive air embulace into
Geraldine's bloodstream. A bubble of air was surging straight toward
her heart.
Speaker 5 (04:57):
All of a sudden they yelled something wrong, be wrong,
And when they screamed, I dropped my instrument and turning
through the blood turned black.
Speaker 1 (05:11):
Lila High aborted the operation immediately as his assistants injected
Geraldine with adrenaline and brought her blood pressure back to normal.
Lila High closed Leslianne's chest without repairing her heart, and
then went out to give her father the news. Geraldine,
a lively mother of four who enjoyed dancing, swimming, and
(05:33):
playing golf, had just suffered permanent brain damage. For the
rest of her life, she'd be unable to care for
her children or herself. This was the horrific realization of
every critic's worst fear. With cross circulation, it could end
(05:54):
Lilla High's career, and it could bring the hospital to
champion his work crashing down with him. The situation needed
to be handled delicately, but Lilahi was not a delicate man.
He was blunt and empathetic to a fault. Dan, you
have to sue us, he told the grieving husband. Lilahai
(06:17):
knew that the cost of Geraldine's care would quickly outpace
Dan's modest Air Force income. A malpractice settlement would allow
Dan to continue to provide for his family.
Speaker 2 (06:27):
It would also put.
Speaker 1 (06:28):
Lilahi and his colleagues through hell, but that was a
problem for another day. For the time being, Lilahi was
focused on the work ahead of him. The tragedy of
Geraldine Thompson offered irrefutable proof that cross circulation was not
a permanent solution. There had to be another way to
(06:50):
oxygenate a patient's blood during open heart surgery, a safer way,
one that didn't endanger the life of a parent. Well,
Lilahi just had to find it. Formoso's Studios, This is
Cardiac Cowboys, a podcast about life, death and innovation in
(07:15):
the American Heartlandic episode three, the can Opener. Here's writer
and executive producer Jamie Napley.
Speaker 6 (07:33):
Back in March of nineteen fifty four, Lillihigh had hired
a twenty seven year old general practitioner named Richard Dwall.
Though he graduated from the u of M Medical School,
Dwall's grades didn't quite meet the standards of a typical
resident under Chief Owen Wangenstein, wiry with glasses and close
cropped hair.
Speaker 2 (07:54):
Duwall was a born tinkerer.
Speaker 6 (07:57):
Lila High took an instant liking to him, and he
offer for him the only job the department could afford.
The Wall left behind his GP work and started as
an animal attendant in Lilla High's lab. Months later, when
the need for an alternative to cross circulation became apparent,
Lilla High brought the problem to Richard Dwall.
Speaker 7 (08:18):
After a case one day of cross circulation. I was
just talking to Walt and he was saying, well, it's
obvious that we need a replacement for the donor.
Speaker 2 (08:28):
That's an archival recording of doctor de Wall.
Speaker 7 (08:31):
He said, now, if that interests you, that would be
a big project for you to work on in the lab.
He gave it to me as an option, but this
is a walstonerosity. He didn't force anything anyway. Neither did
doctor Wangenstein. He said, here's an opportunity. Take it, run
with it if you want, if you don't fail.
Speaker 6 (08:51):
The idea of a heart lung bypass machine was not
a new one. As far back as the nineteen thirties.
A Philadelphia surgeon named John Gibbon and his wife Mary
had been developing something called a screen oxygenator. In nineteen
thirty five, they used it to bypass a cat's heart
(09:11):
for half an hour, but it would take another eighteen
years and the backing of IBM before their wildly expensive,
brand piano sized machine was ready for human use. After
one successful case and five tragic failures, John and Mary
Gibbon abandoned the pursuit for good. In nineteen fifty one,
(09:38):
a Minnesota surgeon named Clarence Dennis experimented with his own
bypass machine based on John Gibbons blueprints. A thirty two
year old Walt Lillehigh was in the room when Dennis
attempted to fix the damaged heart of two year old
Cheryl Judge. Lillehigh could see how cumbersome Dennis's machine was.
(09:58):
It required a team of of sixteen surgeons, technicians, and
nurses just to function.
Speaker 3 (10:05):
His heart lung machine was very complicated that it weighed
about one thousand pounds and it would fill a one
car garage with the pumps and the elaborage system you
need to auctionate blood.
Speaker 6 (10:18):
In lilla High's estimation, the more moving parts, the more
room for error. But Lilihaigh was a lowly junior surgeon
at the time, so his opinions didn't count for much.
Lilihaigh watched as a technician's error caused the machine to
pump air into Cheryl's bloodstream, similarly to what would happen
(10:38):
to Geraldine Thompson three years later. The air bubbles blocked
the flow of blood to the girl's vital organs. Within hours,
Cheryl Judge was dead. It was Clarence Dennis's second attempt
at open heart surgery, and his second dead patient be
(11:00):
years before he tried again. So as Lilahei met with
his young protege, Richard d Wall, making plans for a
new kind of bypass machine, he emphasized simplicity above all else.
Lilihi wanted his machine to be foolproof, so.
Speaker 3 (11:18):
I told Dick we needed a simple auctionator. Each sterilizable, disposable.
Speaker 6 (11:27):
Every heart lung bypass machine works in essentially the same way.
Dark oxygen depleted blood is taken out of the patient.
Speaker 2 (11:36):
Before it enters the heart.
Speaker 6 (11:38):
The bypass machine then, through any number of methods, oxygenates
the blood and then returns it to the patient's arteries.
Both Gibbons and Dennis's machines used rotating disks or cylinders
to spread the blood out into a thin film, exposing
it to as much oxygen as possible. As a result,
(11:58):
their machines needed to be massive for simplicity's sake, Lillihigh
opted for a different approach, bubbles.
Speaker 7 (12:10):
Doctor Lillie had a couple of admonitions for me. Said, well,
if you're going to work on this project. I suggest
you avoid libraries, avoidant literature search, because who wants you
to be prejudiced by the mistakes of others.
Speaker 6 (12:27):
Lillehi may have advised Dwall against library research to help
him keep an open mind, but there was another reason
as well.
Speaker 2 (12:35):
Here's doctor Lillie High.
Speaker 3 (12:36):
Again bumbling oxygen into blood to oxygenate. It was the
one method that every single authority said would not work.
Speaker 8 (12:44):
Chill everybody with air embolism.
Speaker 9 (12:47):
Well, I knew this, of course, but I didn't tell
if t well.
Speaker 6 (12:53):
Oxygen bubbles in the bloodstream had killed two year old
Cheryl Judge and caused permanent brain damage for Gerald Thompson.
Many experts believed a bypass machine that introduced bubbles into
the bloodstream on purpose was a terrible idea, But the
Wall didn't know all that, so he threw himself headlong
into the task assigned to him. The prototype that he
(13:15):
wheeled into Lillahi's lab in early nineteen fifty five was
a lot smaller than any bypass machine in history, but
it didn't exactly inspire confidence.
Speaker 8 (13:26):
It was Goldberg type of apparatus.
Speaker 6 (13:30):
That's University of Minnesota cardiologist doctor James Moeller.
Speaker 8 (13:34):
There's a ship of austin from an usher attack would
go into the blood and it bubble up to the top.
And then there was a he Bubbweiser chamber which had
steel wool air, then go down a tube of our
forty five degree angle, then to a spiral tube and
go into the patient. And all that was to auctionate
this blood.
Speaker 6 (13:56):
The Wall's prototype may have looked complicated, but it was
actually quite simple. It created bubbles to oxygenate the blood
and then relied on gravity to eliminate those bubbles before
returning the blood to the patient's body. It was cheap,
easily cleaned, and it didn't require a massive team to function.
It was this machine that so impressed the hot shot
(14:18):
Houston surgeon Denton Cooley when he paid a visit to
lilli High's lab. First to Wall and then Lillihigh tested
the bubble oxygenator on groups of lab dogs. When all
of the dogs were covered with perfect health, lili High
(14:39):
was confident he'd finally found his replacement for cross circulation.
By April of nineteen fifty five, he was ready to
put the oxygenator to use on a human patient.
Speaker 2 (14:51):
He found an.
Speaker 6 (14:52):
Ideal candidate in a three year old boy from a
small coal mining village in New Brunswick, Canada, James Robshaw,
like many of Lillihigh's patients, was born with a ventricular
septle defect of VSD. James's parents lacked the means to
cover his travel and medical expenses. Fortunately, a charity drive
(15:15):
covered the cost of the boy's thousand mile journey from
New Brunswick to Minneapolis. Walt Lillihigh offered to operate pro
bono on the morning of May thirteenth. Lillihigh used his
and Richard D. Wall's bubble oxygenator to bypass James's heart.
(15:39):
Just like all of their test operations in the animal lab,
the surgery went off without a hitch. Lilihi successfully patched
the whole in James's heart. After months of rushed hospital
visits and health scares, James's parents could finally rest easy.
Late that evening, the boy's health took a shocking turn.
Speaker 2 (16:04):
For Lillihigh. It felt like Gregory Gliddon all over again.
Speaker 6 (16:08):
When James's heart stopped beating, Lillihigh and a Wall spent
hours trying to resuscitate him.
Speaker 2 (16:14):
By four point thirty in the morning. There was nothing
more they could do.
Speaker 6 (16:20):
Lillihai made a second attempt with the bubble oxygenator.
Speaker 2 (16:23):
At the end of May.
Speaker 6 (16:25):
This time the young patient was healthy enough to be
discharged after surgery, only to die four days later at home.
For many surgeons trying out experimental procedures, failure of this
severity might signify the end of the road.
Speaker 9 (16:43):
We lost patients in those days, and we operated it
on one pacient a day, and often by Friday night
all five patients were dead.
Speaker 6 (16:51):
That's pioneering heart surgeon doctor Christian Barnard, who trained under
Lilla High in the nineteen fifties.
Speaker 9 (16:58):
It took a lot of guts to go back the
next week and tie again and start over it again.
And as one of doctor Lillahi's porteeses that ability to
go back after so much punishment and start again and
believe in.
Speaker 7 (17:11):
What he did.
Speaker 6 (17:16):
Lilihigh was convinced that the bubble oxygenator was not at
fault for the loss of these children. An autopsy revealed
that James Robshaw's death was caused by another undiagnosed heart condition,
and Lila High's second patient had blood vessels that had
grown out of position, so in July, Lillahigh tried yet again.
(17:38):
This time he operated on Jesse Weddell, a twenty two
month old boy from Bayard, Iowa, who was born with
tetrology of filoh. The surgery lasted two hours and required
donations of blood from sixteen of Jesse's family members and friends.
Speaker 2 (17:54):
But it succeeded. The bubble oxygenator.
Speaker 6 (17:58):
Allowed Lillahigh to save Jesse Weddle's life and the life
of the patient after him, and the one after that.
Speaker 10 (18:06):
I just feel I feel blessed that I survived.
Speaker 6 (18:10):
Doctor Pamela Evans was six years old when Walt lilla
High repaired her VSD using the bubble oxygenator. She says
he waited to introduce himself to her family until after
the operation.
Speaker 10 (18:23):
My parents never met him before my surgery, and I
have no memories of him except after my surgery. I
see that as maybe protecting his own soul and in
some ways protecting my parents as well. The children on
either side of my operation both passed away, so I
(18:43):
felt very lucky.
Speaker 6 (18:46):
Before long lilla High had abandoned cross circulation forever. Never
again would he need to endanger the life of a
parent to save their child. As always, litla High's success
evoked mixed reactions from the medical community.
Speaker 5 (19:03):
Most people are enamored good complexity.
Speaker 3 (19:06):
Look is one of the things.
Speaker 11 (19:08):
That I've trought all my life.
Speaker 5 (19:10):
Nobody could take some idiots but divide the lebble oxygen.
Speaker 2 (19:16):
Here's Richard Dwall again.
Speaker 7 (19:18):
Every bend and every curve, every piece had a purpose
in it. But if you didn't know what the purpose was,
it looked rather strange and peculiar. So you have a
lot of people coming in there. They'd look at this
and say, well, this is stupid. I can do better
than that. They'd have a change by the time they
got on the plane on the way home, And of
course they had disasters in their laboratories.
Speaker 6 (19:42):
Just like with cross circulation, Lilla High was again struggling
to garner validation for a procedure that was saving lives.
In nineteen fifty seven, he found himself at yet another
medical conference listening to criticism of his and d Wall's
bubble oxygenator.
Speaker 7 (20:00):
A surge no one mentioned his name had tried this
in a laboratory and had disaster after disaster with it.
He obviously didn't know what he was doing, and he
presented this at a national meeting of very distinguished people,
condemning work which was rather hurtful in its own way.
Speaker 6 (20:19):
In the conference audience sat a tall, thirty six year
old Texan. During the comments section, the Texan got up
and addressed the skeptical crowd with his confident Buckwheat Cooley smile.
Speaker 7 (20:32):
I still laugh at it, Dent Cooley responded, how is
it Minnesota? I studied what they did there, I took
it home to Texas and now have one hundred and
twenty five patients that have done well with it. That
was the end of the discussion.
Speaker 6 (20:49):
Two years earlier, during his visit to Lillahi's lab, Denton
Cooley had recognized the ingenious simplicity of the bubble oxygenator.
After leaving Minneapolis, he and Baylor cardiologist Dan McNamara had
traveled ninety miles south to the Mayo Clinic, the only
other hospital performing open heart operations. There, a surgeon by
(21:14):
the name of John Kirkland had a bypass machine of
his own based on the work of John and Mary Gibbon.
Speaker 11 (21:20):
John Kirplin had this big apparatus. This is about the
fat at the table you know.
Speaker 2 (21:25):
That's an archival recording of Denton Cooley.
Speaker 11 (21:28):
And he had a group of cardiologists and physiologists and
bio engineers in the operating room and very complicated a
cordless setup. And on the way back to Houston, doctor
McNamara said, I'm not going to list your operator on
any of my patients until you can duplicate John Kirkplin's
program there at the Mayo Clinic with no way to
duplicate that.
Speaker 6 (21:49):
Kirkland's machine cost upwards of fifty thousand dollars. Lila High
and walls cost about thirty dollars adjusted for inflation. That's
the difference between half a million and a little over
three hundred.
Speaker 2 (22:04):
Since Cooley would.
Speaker 6 (22:05):
Be financing this project himself, he went for the cheaper option.
He enlisted the help of two Baylor medical students and
got to work.
Speaker 11 (22:15):
But within a few months after I got back to Houston,
I had my own Bobo oxygenator and we took both.
Speaker 6 (22:25):
Cooley's motto was simplify, modify, apply. He began tweaking the
dwall Lilla High bubble oxygenator to make it even more
cost effective. Most notably, he swapped out its plastic tubing
with easily sterilizable stainless steel, earning his machine the nickname
Cooley's Coffee Pot. The coffee Pot was a stunning success,
(22:49):
and Cooley's caseload grew rapidly. It wouldn't be long before
it caught the attention of his ambitious and demanding boss,
doctor Michael DeBakey. In addition to running the surgical department
at Baylor, DeBakey had spent the last several years jetting
back and forth to Washington, d C. To lobby for
(23:10):
medical research funding.
Speaker 2 (23:12):
I think the goal was to do what he can
to make the world a better place.
Speaker 12 (23:17):
Part of this he could do it in the operating room,
and part of it he could do it in Washington.
Speaker 6 (23:22):
That's cardiologist doctor Antonio Gatto, who worked under DeBakey at Baylor.
Speaker 12 (23:27):
He knew where the hower fulcrims were that turned the engines,
that he could accomplish more for medicine overall by getting
more funding for research or setting up different types of
research centers. We had a lot of politicians we saw.
Speaker 6 (23:43):
This was a golden age for medical research funding. Between
nineteen forty five and nineteen sixty one, the National Institutes
of Health budget grew from under four million dollars to
four hundred and sixty million dollars. The more Debaky elevated
his public image, the more of a say he had,
and where that money went. Cooley's daughter, doctor Louise Cooley Davis,
(24:11):
tells a story about the day her father learned DeBakey
had scheduled a VSD operation of his own using Cooley's
coffee pot.
Speaker 13 (24:19):
DeBakey wanted to use it in a case and hadn't
asked my father, So it kind of touched my father's
ego that the baker would have said, I'm going to
use your oxygenator when he had been so unsupportive of
it all along.
Speaker 6 (24:33):
Cooley drove straight to DeBakey's house to confront him. Despite
the fact that Cooley worked for DeBakey, he didn't feel
it was right for the surgical chief to confiscate his machine.
Speaker 13 (24:47):
My father had developed this on his own, not paid
for it all by Debaky, and had not gotten any
support from Debatey, so my father said, no, you can't
use my coffee pot.
Speaker 6 (24:59):
It was the first real crack in the two men's relationship.
In the coming years, that crack would grow until it
left its mark on the entire field of cardiac medicine.
After blocking de Bakey's attempt to use the bubble oxygenator,
Cooley continued to do what he did best. He fixed hearts.
(25:20):
In nineteen fifty seven alone, he performed one hundred and
seven open heart operations, about three times more than Walt
lilla High and John Kirkland combined. So when Cooley stood
up at a medical conference to defend Lillihigh and announce
his own unprecedented success, he gave the Dwal Lillehide bubble
oxygenator all the validation it needed. Soon it was being
(25:43):
mass produced, bringing open heart surgery to hospitals all across
the world. That was thanks in part to another of
lilla High's trainees, doctor Vincent L. Gott, who worked with
Dwal to simplify the design even further.
Speaker 3 (25:58):
They've developed the wall bubble auctionator into a sheet of plastic,
which is the same principle, but it could be manufactured commercially,
ship sterile and hung up and prime and ready to go.
And we patented that it would patten the University of Minnesota.
Speaker 6 (26:17):
If heart surgery were a picnic. Denton Cooley would later
say Walt Lilla High brought the can opener. No matter
(26:39):
how great his achievements or how many lives he saved,
Little High was haunted by the ones he couldn't and
no failure was more excruciating to him than the tragedy
of Geraldine Thompson. At the US Courthouse in Minneapolis, Lila
(27:03):
High watched from the defense table as.
Speaker 2 (27:05):
The thirty three year old mother of four approached the
witness stand. She'd lost weight.
Speaker 6 (27:13):
Her sister testified that in the year since the failed
VSD operation that resulted in Geraldine's permanent brain damage, she'd
dropped from one hundred ten pounds to just seventy nine pounds.
She couldn't walk without dragging her left foot, she'd lost
most of the use of her left hand, and she
(27:33):
struggled to answer basic questions like what were the ages
of her four children. Geraldine required around the clock care,
and her husband said that the bills had exhausted their savings.
Lilahi wanted the Thompsons to be made whole, but the
hospital was offering less than a tenth of the family's demands,
(27:54):
so a settlement was out of the question.
Speaker 14 (27:58):
He really did feel like Bunny doesn't solve proms, but
to try to give some compensates.
Speaker 4 (28:02):
That.
Speaker 2 (28:02):
Yeah, he was all fourth.
Speaker 6 (28:04):
That's Walt Lilahi's son, doctor Craig Lilihigh.
Speaker 14 (28:07):
He really did feel like, yes, sue and win.
Speaker 8 (28:11):
You deserve those moneys.
Speaker 6 (28:14):
But the Thompson's lawyers struggled to win over the jury.
They were taking on a world famous doctor in his
home city. Worst of all, according to Walt Lillahigh, they
didn't correctly identify the anesthesiologist who was responsible.
Speaker 2 (28:29):
For the error. Here's doctor Walt Lillahigh. Again, he was
a real.
Speaker 5 (28:34):
Culprit, but he never was even named in the suit.
I don't think they ever understood what happened.
Speaker 6 (28:45):
After hearing two weeks of testimony, the jury was deadlocked
nine to three in favor of Lilahi's team. The judge
dismissed the case. It was the worst possible outcome for
all parties. The Thompsons were left without a dime to
cover the lifetime of medical care Geraldine would require. The
(29:07):
hospital's reputation was sullied by the damning front page press coverage,
and lilli High would never rest easy knowing that a
family that had suffered under his watch would be taken
care of. Now that his bubble oxygenator was being mass produced,
Lila High hoped that tragedies like that of Geraldine Thompson
were behind him, But even as he performed open heart
(29:29):
operations at an unprecedented rate, a troubling pattern emerged.
Speaker 3 (29:36):
Ten percent of the ventricular defect closures developed heartbluck, and
the first seventy cases we had seven heartblucks. All of
those seven died and that was a devastating complication to us.
Speaker 6 (29:53):
Heart Block is a disruption in the heart's electrical system
after a VSD repair. Lilla High found that some of
patient's hearts refused to return to their normal rhythms or
to beat it all. The only options available in nineteen
fifty seven were to administer a shot of adrenaline or
to manually massage the heart. Neither of them was particularly effective.
Speaker 3 (30:18):
I knew nothing about it, and very if you cardiologists
knew anything about it, and you just sudd their shoulders
and hope for the best. Patients were give them to
death in those early days.
Speaker 6 (30:31):
In the nineteen fifties, heart surgeons experienced the death of
a patient on a weekly, sometimes daily basis, but that
didn't make it any easier to cope with. Here's doctor
Craig Lilihaigh Again.
Speaker 14 (30:46):
In those days, you know, them mortalities were astronomical, but
as you were pushing the frontier, that's the baggage that
you took on. Dad didn't really share his disappointments with
his kids.
Speaker 2 (31:00):
He never bared his soul about how that hurt. But
I know it hurt.
Speaker 6 (31:07):
Walt lilla High often didn't want or didn't know how
to talk about his failures to his wife Kay. He
could be a locked fault. For Lilla High, the only
way to talk about problems was in the context of
solving them.
Speaker 3 (31:24):
Well, we used to have Saturday morning conferences in this hospital,
but patient outcomes as you learn from your mistakes better
than you learn from your accomplishments. And one day we
were discussing an incant a diet of heart block, and
the physiology chief suggested, you know, we have an instrument
in our laboratory called a grass physiological stimulator. He said,
(31:48):
one of our student sessions is stimulating the arts of
frogs and saw it takes only one or two worlds. Well,
was a revelation, at least in my head.
Speaker 6 (32:01):
Lillahi was familiar with the work of cardiologist Paul Zohl,
who resuscitated a patient's heart by delivering high voltage electrical
shocks using metal paddles and leaving terrible burns on the
patient's skin. With that in mind, Lilihigh tasked the young
doctor Got with studying the low voltage grass stimulator for
(32:21):
human use. If Lila Hig's theory was correct, the small
electrical pulses the machine put out might just make it
possible to pace a patient's heart back into rhythm. Here's
an archival recording of doctor Got.
Speaker 2 (32:36):
And January Naction fifty seven.
Speaker 6 (32:37):
Doctor Hi Paul down to lab said, I've got a
patient here in heart block.
Speaker 2 (32:41):
Did you bring up the grass stimulator?
Speaker 6 (32:46):
The stimulator was about the size of a small microwave,
and with its many knobs and switches, it looked like
something you might see in an old submarine control room.
With the patient's chest still open from surgery, Lillahigh could
run the leads directly into her heart. There were a
(33:06):
thousand ways for this to go wrong, but as Lili
High liked to say, ready.
Speaker 13 (33:11):
Fire aim, Dark Little High put in the wire into
mycardium and his skin and sure enough.
Speaker 2 (33:20):
That patient did fine.
Speaker 6 (33:22):
And just like that, the modern pacemaker was born. Lilla
High continued to use the grass stimulator to pace patients
with heart block, but the machine could be cumbersome.
Speaker 3 (33:37):
That'd be plugged into the one ten bullies and the
patient and art block couldn't go for any time at
all without stimulation, So they couldn't go down to X ray,
they couldn't go to the lab unless you strung a wire.
Speaker 6 (33:51):
When patients needed to be moved around the hospital, nurses
would run numerous extension cords end to end down the halls.
Here's nurse a.
Speaker 15 (34:00):
Bowman moving a child with the temporary pacemaker to another
bed or to the sunroom to sit in the sun.
They would have a group of about ten people moving
this plug down the hall space by space. That was
suggested by one of the nurses, and it became sort
(34:21):
of a routine. It was just this whole thought that
ran this together, and we're going to find a solution
to help these children.
Speaker 6 (34:41):
On Halloween nineteen fifty seven, there was an explosion at
the main plant of the Northern States Power Company. It
triggered a massive blackout across the the Twin Cities of
Minneapolis and Saint Paul for two and a half hours.
(35:09):
The University hospital and the lives of its young patients
whose hearts required constant electrical stimulation were dependent on emergency power. Thankfully,
all of those patients survived, But for Walt Lillehigh, the
urgent need for a battery powered pacemaker had become clear.
(35:29):
In nineteen fifty seven, there was a young and ambitious
electrical repair man working at the hospital by the name
of Earl Bachan. Just like Lillahih, Bachin was fascinated by
the way things work as a kid. He built a
taser to fend off schoolyard bullies and a multimeter device
to measure the passion of a kiss, which he called
(35:51):
the kissometer. Naturally, Lillehigh felt a close kinship to Bachan.
Speaker 3 (35:57):
But electricians absolutely refused to come in the operation room
what an operation was in progress. They said it was
not part of their contract. Came over for every open
heart operation, and he was that first and last person
as far as I was concerning.
Speaker 6 (36:17):
After the blackout, Lillahigh assigned Bachan the task of building
the first battery powered pacemaker. Bachan worked on the problem
during his off time from the hospital, testing various designs
in the garage where he and his brother in law
ran their electronics repair business.
Speaker 16 (36:35):
It was an unheeded rage in Minnesota. That is quite
an achievement, as you can imagine.
Speaker 6 (36:41):
That's Adrian Fisher, curator of Exhibits and Collections at the
Bachan Museum.
Speaker 17 (36:46):
Did torres I think was a coffee can? In the
very early days, they were repairing radios and TVs just
to make ends meet. The big client for them was
the Heart hospital at the University of Minnesota.
Speaker 6 (37:00):
And drew his first sketch of a working pacemaker on
the back of a memo from a medical device company.
His inspiration came from a popular electronics magazine article.
Speaker 16 (37:10):
He remembered seeing in a magazine from fifty six a
transistorized circuit sketch of a metronome. The transistor was invented
shorty before that, and so he pretty much used a
circuit sketch and put it in a box.
Speaker 6 (37:25):
Less than two months after getting his assignment, Bachin returned
to Lila High's office with a four and a half
inch square box, and Lila High wasted no time in
putting it to use. He tested the device on a
dog for only a few hours before implanting it in
a young patient with heart block. The portable pacemaker was
an immediate success. Bachen began selling the device to surgeons
(37:51):
outside of the U of M, some of whom had
previously denied the existence of heart block.
Speaker 18 (37:57):
Well name any names back McCall feral, oh no insurgents
telling me that they've ever had hard book, seen it,
and I find out that they're not only ordering that
supply of pacemakers, but a number of electrodes.
Speaker 6 (38:10):
The pacemaker would continue to be refined in the coming decades,
becoming smaller, fully implanted, empowered by long lasting lithium batteries. Today,
more than a million pacemakers are implanted every year. Earl
Bachen and his brother in law's garage repair company kept
the patent on their invention. They called themselves Medtronic. Metronic
(38:35):
is now one of the largest medical device companies in
the world, worth over one hundred billion dollars. Walt Lillehigh,
who'd never been very good with money, was one of
their first investors. As the nineteen fifties neared its end,
Lillihigh was at the apex of his creative genius and
(38:58):
his career.
Speaker 2 (39:00):
He'd already outlived his.
Speaker 6 (39:01):
Prognosis, and his no Tomorrow approach to life had paid off.
He was living and working at full tilt. It wouldn't
be long before he lost control.
Speaker 1 (39:17):
On our next episode, surgeons across the country raced to
transplant the human heart. The stakes are unimaginably high, rivalries
turned vicious, and the first surgeon to cross the finish
line chucks the world next time on Cardiac Cowboys.
Speaker 6 (39:43):
Cardiac Cowboys is a production of iHeart Podcasts, OsO Studios
and Thirteenth Lake Media. Were presented by Chris Pine and
written and narrated by me Jamie Appley.
Speaker 2 (39:57):
Our executive producers.
Speaker 6 (39:58):
Are Christina ev for iHeart Podcasts, Dub Cornette and Jason
Ross for OsO Studios. Doctor Gerald Imber, author of Cardiac Cowboys,
The Heroic Invention of Heart Surgery, Doctor Eric A. Rose,
John Mankowitz, Joshua Paul Johnson, and myself.
Speaker 2 (40:19):
James A.
Speaker 6 (40:19):
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. Archival materials courtesy of
the University of Minnesota Archives, University of Minnesota Twin Cities
(40:39):
Special Collections, University of Rhode Island Library, and g Wayne Miller,
author of the Walt Lilla High biography King of Hearts,
The True story of the maverick who pioneered.
Speaker 2 (40:50):
Open heart surgery.
Speaker 6 (40:52):
For more information on the first cardiac surgeons, check out
doctor Gerald Imber's book Cardiac Cowboys, The Heroic Junction of
Heart Surgery
Speaker 1 (41:11):
Hmm.
Welcome to the wild West of American medicine. I'm Chris
Pine in This is Cardiac Cowboys, the gripping true story
behind the birth of open heart surgery and the Maverick surgeons.
Speaker 2 (00:12):
Who made it happen.
Speaker 3 (00:17):
The person.
Speaker 1 (00:21):
It's April twenty seventh, nineteen fifty five. Walt lilla High
waits to be called on stage. He's at one of
the countless medical conferences to which he's been invited to
speak since his breakthrough. It's been a little over a
year since Lillahi used cross circulation to repair a whole
in Gregory Gliddon's heart, and it's been five years since
(00:42):
he was diagnosed with terminal cancer. Despite the bleak prognosis,
Lillahi refuses to undergo a second look operation. He doesn't
need another doctor to tell him how much time he
has left. Lelehigh already lives each day like it could
be his last. He takes the stage and begins to
(01:08):
describe his controversial technique, a child and parent sharing blood
while the child undergoes open heart surgery. Since he operated
on Gregory Glidden, lilla High has performed over three dozen
of these cross circulation procedures toward the end of the presentation,
he makes his big announcement. Lilla High has successfully repaired
(01:29):
six cases of tetrology of Fallow, one of the deadliest
and most complex heart defects to cardiac surgeons in the
nineteen fifties. This is the holy Grail. In spite of
his unprecedented success, Lila Hi has come to expect criticism,
and he gets his fair share of it today. Here's
an archival recording of Walt Lillahi.
Speaker 3 (01:51):
I could understand the skeptician because of that. Every new
idea is good, but it didn't bother us because we
knew we were on the right track.
Speaker 1 (02:00):
Today in the audience sits Alfred Blaylock and Helen Tausig
at JOHNS Hopkins. A decade earlier, doctor Blaylock, doctor Tausig,
and a lab technician named Vivian Thomas pioneered an ingenious
blue baby operation that allowed children born with tetrology of
(02:20):
Fillow to survive past infancy. Lilahi has taken their work
one bounding step forward, but they don't see it that way.
In a shocking scene detailed by Lilahi's former resident, doctor
daniel A. Gore, Helen Tausig stands from her seat during
the Q and A in shouts this criminal must be stopped.
(02:46):
This reaction isn't completely unexpected. After losing a string of
patients last autumn, Lillahi overheard his own nurses whispering about
him in the halls, calling him a murderer. And then
there was the case of the Thompson family. On the
(03:07):
morning of October fifth, nineteen fifty four, an eight year
old girl named Leslieann Thompson was wheeled into an oar
at the University of Minnesota Hospital. Leslie Anne was born
with a VSD, a hole between the ventricles in her heart.
Her parents, an Air Force officer named Dan Thompson, and
(03:27):
his wife, Geraldine, had brought Leslie Anne to specialists all
over the country, including pioneering vascular surgeons Michael de Bakey
and Denton Cooley down in Houston, But wherever they went,
the prognosis remained the same. Leslie Anne would not survive
unless the hole in her heart could be sown shut.
This brought the Thompsons to the operating room of Walt
(03:50):
Lella High.
Speaker 4 (03:53):
Doctor Varsall and I were opening the cheff of the styled,
exposing to heart and to make twheeled the mother into
the main room.
Speaker 1 (04:04):
Geraldine was a blood match for her daughter. She happily
volunteered to lend her heart and lungs to keep leslie
and alive during surgery. As Lilahi prepared to cut into
the eight year old girl's heart, two of his assistants
tended to Geraldine, who lay just six feet away. An
anesthesiologist entered the oar and approached Geraldine's table.
Speaker 5 (04:26):
Because she had an IVY get one of the armed
veins to give dan a see it. He saw it
was a dripping.
Speaker 4 (04:33):
He thought the vein it plugged up, so he put
a sixty big squeezes on that stump.
Speaker 5 (04:40):
And loan behold IV was not dripping because the bottle
was empty.
Speaker 1 (04:45):
The anesthesiologist had just squeezed a massive air embulace into
Geraldine's bloodstream. A bubble of air was surging straight toward
her heart.
Speaker 5 (04:57):
All of a sudden they yelled something wrong, be wrong,
And when they screamed, I dropped my instrument and turning
through the blood turned black.
Speaker 1 (05:11):
Lila High aborted the operation immediately as his assistants injected
Geraldine with adrenaline and brought her blood pressure back to normal.
Lila High closed Leslianne's chest without repairing her heart, and
then went out to give her father the news. Geraldine,
a lively mother of four who enjoyed dancing, swimming, and
(05:33):
playing golf, had just suffered permanent brain damage. For the
rest of her life, she'd be unable to care for
her children or herself. This was the horrific realization of
every critic's worst fear. With cross circulation, it could end
(05:54):
Lilla High's career, and it could bring the hospital to
champion his work crashing down with him. The situation needed
to be handled delicately, but Lilahi was not a delicate man.
He was blunt and empathetic to a fault. Dan, you
have to sue us, he told the grieving husband. Lilahai
(06:17):
knew that the cost of Geraldine's care would quickly outpace
Dan's modest Air Force income. A malpractice settlement would allow
Dan to continue to provide for his family.
Speaker 2 (06:27):
It would also put.
Speaker 1 (06:28):
Lilahi and his colleagues through hell, but that was a
problem for another day. For the time being, Lilahi was
focused on the work ahead of him. The tragedy of
Geraldine Thompson offered irrefutable proof that cross circulation was not
a permanent solution. There had to be another way to
(06:50):
oxygenate a patient's blood during open heart surgery, a safer way,
one that didn't endanger the life of a parent. Well,
Lilahi just had to find it. Formoso's Studios, This is
Cardiac Cowboys, a podcast about life, death and innovation in
(07:15):
the American Heartlandic episode three, the can Opener. Here's writer
and executive producer Jamie Napley.
Speaker 6 (07:33):
Back in March of nineteen fifty four, Lillihigh had hired
a twenty seven year old general practitioner named Richard Dwall.
Though he graduated from the u of M Medical School,
Dwall's grades didn't quite meet the standards of a typical
resident under Chief Owen Wangenstein, wiry with glasses and close
cropped hair.
Speaker 2 (07:54):
Duwall was a born tinkerer.
Speaker 6 (07:57):
Lila High took an instant liking to him, and he
offer for him the only job the department could afford.
The Wall left behind his GP work and started as
an animal attendant in Lilla High's lab. Months later, when
the need for an alternative to cross circulation became apparent,
Lilla High brought the problem to Richard Dwall.
Speaker 7 (08:18):
After a case one day of cross circulation. I was
just talking to Walt and he was saying, well, it's
obvious that we need a replacement for the donor.
Speaker 2 (08:28):
That's an archival recording of doctor de Wall.
Speaker 7 (08:31):
He said, now, if that interests you, that would be
a big project for you to work on in the lab.
He gave it to me as an option, but this
is a walstonerosity. He didn't force anything anyway. Neither did
doctor Wangenstein. He said, here's an opportunity. Take it, run
with it if you want, if you don't fail.
Speaker 6 (08:51):
The idea of a heart lung bypass machine was not
a new one. As far back as the nineteen thirties.
A Philadelphia surgeon named John Gibbon and his wife Mary
had been developing something called a screen oxygenator. In nineteen
thirty five, they used it to bypass a cat's heart
(09:11):
for half an hour, but it would take another eighteen
years and the backing of IBM before their wildly expensive,
brand piano sized machine was ready for human use. After
one successful case and five tragic failures, John and Mary
Gibbon abandoned the pursuit for good. In nineteen fifty one,
(09:38):
a Minnesota surgeon named Clarence Dennis experimented with his own
bypass machine based on John Gibbons blueprints. A thirty two
year old Walt Lillehigh was in the room when Dennis
attempted to fix the damaged heart of two year old
Cheryl Judge. Lillehigh could see how cumbersome Dennis's machine was.
(09:58):
It required a team of of sixteen surgeons, technicians, and
nurses just to function.
Speaker 3 (10:05):
His heart lung machine was very complicated that it weighed
about one thousand pounds and it would fill a one
car garage with the pumps and the elaborage system you
need to auctionate blood.
Speaker 6 (10:18):
In lilla High's estimation, the more moving parts, the more
room for error. But Lilihaigh was a lowly junior surgeon
at the time, so his opinions didn't count for much.
Lilihaigh watched as a technician's error caused the machine to
pump air into Cheryl's bloodstream, similarly to what would happen
(10:38):
to Geraldine Thompson three years later. The air bubbles blocked
the flow of blood to the girl's vital organs. Within hours,
Cheryl Judge was dead. It was Clarence Dennis's second attempt
at open heart surgery, and his second dead patient be
(11:00):
years before he tried again. So as Lilahei met with
his young protege, Richard d Wall, making plans for a
new kind of bypass machine, he emphasized simplicity above all else.
Lilihi wanted his machine to be foolproof, so.
Speaker 3 (11:18):
I told Dick we needed a simple auctionator. Each sterilizable, disposable.
Speaker 6 (11:27):
Every heart lung bypass machine works in essentially the same way.
Dark oxygen depleted blood is taken out of the patient.
Speaker 2 (11:36):
Before it enters the heart.
Speaker 6 (11:38):
The bypass machine then, through any number of methods, oxygenates
the blood and then returns it to the patient's arteries.
Both Gibbons and Dennis's machines used rotating disks or cylinders
to spread the blood out into a thin film, exposing
it to as much oxygen as possible. As a result,
(11:58):
their machines needed to be massive for simplicity's sake, Lillihigh
opted for a different approach, bubbles.
Speaker 7 (12:10):
Doctor Lillie had a couple of admonitions for me. Said, well,
if you're going to work on this project. I suggest
you avoid libraries, avoidant literature search, because who wants you
to be prejudiced by the mistakes of others.
Speaker 6 (12:27):
Lillehi may have advised Dwall against library research to help
him keep an open mind, but there was another reason
as well.
Speaker 2 (12:35):
Here's doctor Lillie High.
Speaker 3 (12:36):
Again bumbling oxygen into blood to oxygenate. It was the
one method that every single authority said would not work.
Speaker 8 (12:44):
Chill everybody with air embolism.
Speaker 9 (12:47):
Well, I knew this, of course, but I didn't tell
if t well.
Speaker 6 (12:53):
Oxygen bubbles in the bloodstream had killed two year old
Cheryl Judge and caused permanent brain damage for Gerald Thompson.
Many experts believed a bypass machine that introduced bubbles into
the bloodstream on purpose was a terrible idea, But the
Wall didn't know all that, so he threw himself headlong
into the task assigned to him. The prototype that he
(13:15):
wheeled into Lillahi's lab in early nineteen fifty five was
a lot smaller than any bypass machine in history, but
it didn't exactly inspire confidence.
Speaker 8 (13:26):
It was Goldberg type of apparatus.
Speaker 6 (13:30):
That's University of Minnesota cardiologist doctor James Moeller.
Speaker 8 (13:34):
There's a ship of austin from an usher attack would
go into the blood and it bubble up to the top.
And then there was a he Bubbweiser chamber which had
steel wool air, then go down a tube of our
forty five degree angle, then to a spiral tube and
go into the patient. And all that was to auctionate
this blood.
Speaker 6 (13:56):
The Wall's prototype may have looked complicated, but it was
actually quite simple. It created bubbles to oxygenate the blood
and then relied on gravity to eliminate those bubbles before
returning the blood to the patient's body. It was cheap,
easily cleaned, and it didn't require a massive team to function.
It was this machine that so impressed the hot shot
(14:18):
Houston surgeon Denton Cooley when he paid a visit to
lilli High's lab. First to Wall and then Lillihigh tested
the bubble oxygenator on groups of lab dogs. When all
of the dogs were covered with perfect health, lili High
(14:39):
was confident he'd finally found his replacement for cross circulation.
By April of nineteen fifty five, he was ready to
put the oxygenator to use on a human patient.
Speaker 2 (14:51):
He found an.
Speaker 6 (14:52):
Ideal candidate in a three year old boy from a
small coal mining village in New Brunswick, Canada, James Robshaw,
like many of Lillihigh's patients, was born with a ventricular
septle defect of VSD. James's parents lacked the means to
cover his travel and medical expenses. Fortunately, a charity drive
(15:15):
covered the cost of the boy's thousand mile journey from
New Brunswick to Minneapolis. Walt Lillihigh offered to operate pro
bono on the morning of May thirteenth. Lillihigh used his
and Richard D. Wall's bubble oxygenator to bypass James's heart.
(15:39):
Just like all of their test operations in the animal lab,
the surgery went off without a hitch. Lilihi successfully patched
the whole in James's heart. After months of rushed hospital
visits and health scares, James's parents could finally rest easy.
Late that evening, the boy's health took a shocking turn.
Speaker 2 (16:04):
For Lillihigh. It felt like Gregory Gliddon all over again.
Speaker 6 (16:08):
When James's heart stopped beating, Lillihigh and a Wall spent
hours trying to resuscitate him.
Speaker 2 (16:14):
By four point thirty in the morning. There was nothing
more they could do.
Speaker 6 (16:20):
Lillihai made a second attempt with the bubble oxygenator.
Speaker 2 (16:23):
At the end of May.
Speaker 6 (16:25):
This time the young patient was healthy enough to be
discharged after surgery, only to die four days later at home.
For many surgeons trying out experimental procedures, failure of this
severity might signify the end of the road.
Speaker 9 (16:43):
We lost patients in those days, and we operated it
on one pacient a day, and often by Friday night
all five patients were dead.
Speaker 6 (16:51):
That's pioneering heart surgeon doctor Christian Barnard, who trained under
Lilla High in the nineteen fifties.
Speaker 9 (16:58):
It took a lot of guts to go back the
next week and tie again and start over it again.
And as one of doctor Lillahi's porteeses that ability to
go back after so much punishment and start again and
believe in.
Speaker 7 (17:11):
What he did.
Speaker 6 (17:16):
Lilihigh was convinced that the bubble oxygenator was not at
fault for the loss of these children. An autopsy revealed
that James Robshaw's death was caused by another undiagnosed heart condition,
and Lila High's second patient had blood vessels that had
grown out of position, so in July, Lillahigh tried yet again.
(17:38):
This time he operated on Jesse Weddell, a twenty two
month old boy from Bayard, Iowa, who was born with
tetrology of filoh. The surgery lasted two hours and required
donations of blood from sixteen of Jesse's family members and friends.
Speaker 2 (17:54):
But it succeeded. The bubble oxygenator.
Speaker 6 (17:58):
Allowed Lillahigh to save Jesse Weddle's life and the life
of the patient after him, and the one after that.
Speaker 10 (18:06):
I just feel I feel blessed that I survived.
Speaker 6 (18:10):
Doctor Pamela Evans was six years old when Walt lilla
High repaired her VSD using the bubble oxygenator. She says
he waited to introduce himself to her family until after
the operation.
Speaker 10 (18:23):
My parents never met him before my surgery, and I
have no memories of him except after my surgery. I
see that as maybe protecting his own soul and in
some ways protecting my parents as well. The children on
either side of my operation both passed away, so I
(18:43):
felt very lucky.
Speaker 6 (18:46):
Before long lilla High had abandoned cross circulation forever. Never
again would he need to endanger the life of a
parent to save their child. As always, litla High's success
evoked mixed reactions from the medical community.
Speaker 5 (19:03):
Most people are enamored good complexity.
Speaker 3 (19:06):
Look is one of the things.
Speaker 11 (19:08):
That I've trought all my life.
Speaker 5 (19:10):
Nobody could take some idiots but divide the lebble oxygen.
Speaker 2 (19:16):
Here's Richard Dwall again.
Speaker 7 (19:18):
Every bend and every curve, every piece had a purpose
in it. But if you didn't know what the purpose was,
it looked rather strange and peculiar. So you have a
lot of people coming in there. They'd look at this
and say, well, this is stupid. I can do better
than that. They'd have a change by the time they
got on the plane on the way home, And of
course they had disasters in their laboratories.
Speaker 6 (19:42):
Just like with cross circulation, Lilla High was again struggling
to garner validation for a procedure that was saving lives.
In nineteen fifty seven, he found himself at yet another
medical conference listening to criticism of his and d Wall's
bubble oxygenator.
Speaker 7 (20:00):
A surge no one mentioned his name had tried this
in a laboratory and had disaster after disaster with it.
He obviously didn't know what he was doing, and he
presented this at a national meeting of very distinguished people,
condemning work which was rather hurtful in its own way.
Speaker 6 (20:19):
In the conference audience sat a tall, thirty six year
old Texan. During the comments section, the Texan got up
and addressed the skeptical crowd with his confident Buckwheat Cooley smile.
Speaker 7 (20:32):
I still laugh at it, Dent Cooley responded, how is
it Minnesota? I studied what they did there, I took
it home to Texas and now have one hundred and
twenty five patients that have done well with it. That
was the end of the discussion.
Speaker 6 (20:49):
Two years earlier, during his visit to Lillahi's lab, Denton
Cooley had recognized the ingenious simplicity of the bubble oxygenator.
After leaving Minneapolis, he and Baylor cardiologist Dan McNamara had
traveled ninety miles south to the Mayo Clinic, the only
other hospital performing open heart operations. There, a surgeon by
(21:14):
the name of John Kirkland had a bypass machine of
his own based on the work of John and Mary Gibbon.
Speaker 11 (21:20):
John Kirplin had this big apparatus. This is about the
fat at the table you know.
Speaker 2 (21:25):
That's an archival recording of Denton Cooley.
Speaker 11 (21:28):
And he had a group of cardiologists and physiologists and
bio engineers in the operating room and very complicated a
cordless setup. And on the way back to Houston, doctor
McNamara said, I'm not going to list your operator on
any of my patients until you can duplicate John Kirkplin's
program there at the Mayo Clinic with no way to
duplicate that.
Speaker 6 (21:49):
Kirkland's machine cost upwards of fifty thousand dollars. Lila High
and walls cost about thirty dollars adjusted for inflation. That's
the difference between half a million and a little over
three hundred.
Speaker 2 (22:04):
Since Cooley would.
Speaker 6 (22:05):
Be financing this project himself, he went for the cheaper option.
He enlisted the help of two Baylor medical students and
got to work.
Speaker 11 (22:15):
But within a few months after I got back to Houston,
I had my own Bobo oxygenator and we took both.
Speaker 6 (22:25):
Cooley's motto was simplify, modify, apply. He began tweaking the
dwall Lilla High bubble oxygenator to make it even more
cost effective. Most notably, he swapped out its plastic tubing
with easily sterilizable stainless steel, earning his machine the nickname
Cooley's Coffee Pot. The coffee Pot was a stunning success,
(22:49):
and Cooley's caseload grew rapidly. It wouldn't be long before
it caught the attention of his ambitious and demanding boss,
doctor Michael DeBakey. In addition to running the surgical department
at Baylor, DeBakey had spent the last several years jetting
back and forth to Washington, d C. To lobby for
(23:10):
medical research funding.
Speaker 2 (23:12):
I think the goal was to do what he can
to make the world a better place.
Speaker 12 (23:17):
Part of this he could do it in the operating room,
and part of it he could do it in Washington.
Speaker 6 (23:22):
That's cardiologist doctor Antonio Gatto, who worked under DeBakey at Baylor.
Speaker 12 (23:27):
He knew where the hower fulcrims were that turned the engines,
that he could accomplish more for medicine overall by getting
more funding for research or setting up different types of
research centers. We had a lot of politicians we saw.
Speaker 6 (23:43):
This was a golden age for medical research funding. Between
nineteen forty five and nineteen sixty one, the National Institutes
of Health budget grew from under four million dollars to
four hundred and sixty million dollars. The more Debaky elevated
his public image, the more of a say he had,
and where that money went. Cooley's daughter, doctor Louise Cooley Davis,
(24:11):
tells a story about the day her father learned DeBakey
had scheduled a VSD operation of his own using Cooley's
coffee pot.
Speaker 13 (24:19):
DeBakey wanted to use it in a case and hadn't
asked my father, So it kind of touched my father's
ego that the baker would have said, I'm going to
use your oxygenator when he had been so unsupportive of
it all along.
Speaker 6 (24:33):
Cooley drove straight to DeBakey's house to confront him. Despite
the fact that Cooley worked for DeBakey, he didn't feel
it was right for the surgical chief to confiscate his machine.
Speaker 13 (24:47):
My father had developed this on his own, not paid
for it all by Debaky, and had not gotten any
support from Debatey, so my father said, no, you can't
use my coffee pot.
Speaker 6 (24:59):
It was the first real crack in the two men's relationship.
In the coming years, that crack would grow until it
left its mark on the entire field of cardiac medicine.
After blocking de Bakey's attempt to use the bubble oxygenator,
Cooley continued to do what he did best. He fixed hearts.
(25:20):
In nineteen fifty seven alone, he performed one hundred and
seven open heart operations, about three times more than Walt
lilla High and John Kirkland combined. So when Cooley stood
up at a medical conference to defend Lillihigh and announce
his own unprecedented success, he gave the Dwal Lillehide bubble
oxygenator all the validation it needed. Soon it was being
(25:43):
mass produced, bringing open heart surgery to hospitals all across
the world. That was thanks in part to another of
lilla High's trainees, doctor Vincent L. Gott, who worked with
Dwal to simplify the design even further.
Speaker 3 (25:58):
They've developed the wall bubble auctionator into a sheet of plastic,
which is the same principle, but it could be manufactured commercially,
ship sterile and hung up and prime and ready to go.
And we patented that it would patten the University of Minnesota.
Speaker 6 (26:17):
If heart surgery were a picnic. Denton Cooley would later
say Walt Lilla High brought the can opener. No matter
(26:39):
how great his achievements or how many lives he saved,
Little High was haunted by the ones he couldn't and
no failure was more excruciating to him than the tragedy
of Geraldine Thompson. At the US Courthouse in Minneapolis, Lila
(27:03):
High watched from the defense table as.
Speaker 2 (27:05):
The thirty three year old mother of four approached the
witness stand. She'd lost weight.
Speaker 6 (27:13):
Her sister testified that in the year since the failed
VSD operation that resulted in Geraldine's permanent brain damage, she'd
dropped from one hundred ten pounds to just seventy nine pounds.
She couldn't walk without dragging her left foot, she'd lost
most of the use of her left hand, and she
(27:33):
struggled to answer basic questions like what were the ages
of her four children. Geraldine required around the clock care,
and her husband said that the bills had exhausted their savings.
Lilahi wanted the Thompsons to be made whole, but the
hospital was offering less than a tenth of the family's demands,
(27:54):
so a settlement was out of the question.
Speaker 14 (27:58):
He really did feel like Bunny doesn't solve proms, but
to try to give some compensates.
Speaker 4 (28:02):
That.
Speaker 2 (28:02):
Yeah, he was all fourth.
Speaker 6 (28:04):
That's Walt Lilahi's son, doctor Craig Lilihigh.
Speaker 14 (28:07):
He really did feel like, yes, sue and win.
Speaker 8 (28:11):
You deserve those moneys.
Speaker 6 (28:14):
But the Thompson's lawyers struggled to win over the jury.
They were taking on a world famous doctor in his
home city. Worst of all, according to Walt Lillahigh, they
didn't correctly identify the anesthesiologist who was responsible.
Speaker 2 (28:29):
For the error. Here's doctor Walt Lillahigh. Again, he was
a real.
Speaker 5 (28:34):
Culprit, but he never was even named in the suit.
I don't think they ever understood what happened.
Speaker 6 (28:45):
After hearing two weeks of testimony, the jury was deadlocked
nine to three in favor of Lilahi's team. The judge
dismissed the case. It was the worst possible outcome for
all parties. The Thompsons were left without a dime to
cover the lifetime of medical care Geraldine would require. The
(29:07):
hospital's reputation was sullied by the damning front page press coverage,
and lilli High would never rest easy knowing that a
family that had suffered under his watch would be taken
care of. Now that his bubble oxygenator was being mass produced,
Lila High hoped that tragedies like that of Geraldine Thompson
were behind him, But even as he performed open heart
(29:29):
operations at an unprecedented rate, a troubling pattern emerged.
Speaker 3 (29:36):
Ten percent of the ventricular defect closures developed heartbluck, and
the first seventy cases we had seven heartblucks. All of
those seven died and that was a devastating complication to us.
Speaker 6 (29:53):
Heart Block is a disruption in the heart's electrical system
after a VSD repair. Lilla High found that some of
patient's hearts refused to return to their normal rhythms or
to beat it all. The only options available in nineteen
fifty seven were to administer a shot of adrenaline or
to manually massage the heart. Neither of them was particularly effective.
Speaker 3 (30:18):
I knew nothing about it, and very if you cardiologists
knew anything about it, and you just sudd their shoulders
and hope for the best. Patients were give them to
death in those early days.
Speaker 6 (30:31):
In the nineteen fifties, heart surgeons experienced the death of
a patient on a weekly, sometimes daily basis, but that
didn't make it any easier to cope with. Here's doctor
Craig Lilihaigh Again.
Speaker 14 (30:46):
In those days, you know, them mortalities were astronomical, but
as you were pushing the frontier, that's the baggage that
you took on. Dad didn't really share his disappointments with
his kids.
Speaker 2 (31:00):
He never bared his soul about how that hurt. But
I know it hurt.
Speaker 6 (31:07):
Walt lilla High often didn't want or didn't know how
to talk about his failures to his wife Kay. He
could be a locked fault. For Lilla High, the only
way to talk about problems was in the context of
solving them.
Speaker 3 (31:24):
Well, we used to have Saturday morning conferences in this hospital,
but patient outcomes as you learn from your mistakes better
than you learn from your accomplishments. And one day we
were discussing an incant a diet of heart block, and
the physiology chief suggested, you know, we have an instrument
in our laboratory called a grass physiological stimulator. He said,
(31:48):
one of our student sessions is stimulating the arts of
frogs and saw it takes only one or two worlds. Well,
was a revelation, at least in my head.
Speaker 6 (32:01):
Lillahi was familiar with the work of cardiologist Paul Zohl,
who resuscitated a patient's heart by delivering high voltage electrical
shocks using metal paddles and leaving terrible burns on the
patient's skin. With that in mind, Lilihigh tasked the young
doctor Got with studying the low voltage grass stimulator for
(32:21):
human use. If Lila Hig's theory was correct, the small
electrical pulses the machine put out might just make it
possible to pace a patient's heart back into rhythm. Here's
an archival recording of doctor Got.
Speaker 2 (32:36):
And January Naction fifty seven.
Speaker 6 (32:37):
Doctor Hi Paul down to lab said, I've got a
patient here in heart block.
Speaker 2 (32:41):
Did you bring up the grass stimulator?
Speaker 6 (32:46):
The stimulator was about the size of a small microwave,
and with its many knobs and switches, it looked like
something you might see in an old submarine control room.
With the patient's chest still open from surgery, Lillahigh could
run the leads directly into her heart. There were a
(33:06):
thousand ways for this to go wrong, but as Lili
High liked to say, ready.
Speaker 13 (33:11):
Fire aim, Dark Little High put in the wire into
mycardium and his skin and sure enough.
Speaker 2 (33:20):
That patient did fine.
Speaker 6 (33:22):
And just like that, the modern pacemaker was born. Lilla
High continued to use the grass stimulator to pace patients
with heart block, but the machine could be cumbersome.
Speaker 3 (33:37):
That'd be plugged into the one ten bullies and the
patient and art block couldn't go for any time at
all without stimulation, So they couldn't go down to X ray,
they couldn't go to the lab unless you strung a wire.
Speaker 6 (33:51):
When patients needed to be moved around the hospital, nurses
would run numerous extension cords end to end down the halls.
Here's nurse a.
Speaker 15 (34:00):
Bowman moving a child with the temporary pacemaker to another
bed or to the sunroom to sit in the sun.
They would have a group of about ten people moving
this plug down the hall space by space. That was
suggested by one of the nurses, and it became sort
(34:21):
of a routine. It was just this whole thought that
ran this together, and we're going to find a solution
to help these children.
Speaker 6 (34:41):
On Halloween nineteen fifty seven, there was an explosion at
the main plant of the Northern States Power Company. It
triggered a massive blackout across the the Twin Cities of
Minneapolis and Saint Paul for two and a half hours.
(35:09):
The University hospital and the lives of its young patients
whose hearts required constant electrical stimulation were dependent on emergency power. Thankfully,
all of those patients survived, But for Walt Lillehigh, the
urgent need for a battery powered pacemaker had become clear.
(35:29):
In nineteen fifty seven, there was a young and ambitious
electrical repair man working at the hospital by the name
of Earl Bachan. Just like Lillahih, Bachin was fascinated by
the way things work as a kid. He built a
taser to fend off schoolyard bullies and a multimeter device
to measure the passion of a kiss, which he called
(35:51):
the kissometer. Naturally, Lillehigh felt a close kinship to Bachan.
Speaker 3 (35:57):
But electricians absolutely refused to come in the operation room
what an operation was in progress. They said it was
not part of their contract. Came over for every open
heart operation, and he was that first and last person
as far as I was concerning.
Speaker 6 (36:17):
After the blackout, Lillahigh assigned Bachan the task of building
the first battery powered pacemaker. Bachan worked on the problem
during his off time from the hospital, testing various designs
in the garage where he and his brother in law
ran their electronics repair business.
Speaker 16 (36:35):
It was an unheeded rage in Minnesota. That is quite
an achievement, as you can imagine.
Speaker 6 (36:41):
That's Adrian Fisher, curator of Exhibits and Collections at the
Bachan Museum.
Speaker 17 (36:46):
Did torres I think was a coffee can? In the
very early days, they were repairing radios and TVs just
to make ends meet. The big client for them was
the Heart hospital at the University of Minnesota.
Speaker 6 (37:00):
And drew his first sketch of a working pacemaker on
the back of a memo from a medical device company.
His inspiration came from a popular electronics magazine article.
Speaker 16 (37:10):
He remembered seeing in a magazine from fifty six a
transistorized circuit sketch of a metronome. The transistor was invented
shorty before that, and so he pretty much used a
circuit sketch and put it in a box.
Speaker 6 (37:25):
Less than two months after getting his assignment, Bachin returned
to Lila High's office with a four and a half
inch square box, and Lila High wasted no time in
putting it to use. He tested the device on a
dog for only a few hours before implanting it in
a young patient with heart block. The portable pacemaker was
an immediate success. Bachen began selling the device to surgeons
(37:51):
outside of the U of M, some of whom had
previously denied the existence of heart block.
Speaker 18 (37:57):
Well name any names back McCall feral, oh no insurgents
telling me that they've ever had hard book, seen it,
and I find out that they're not only ordering that
supply of pacemakers, but a number of electrodes.
Speaker 6 (38:10):
The pacemaker would continue to be refined in the coming decades,
becoming smaller, fully implanted, empowered by long lasting lithium batteries. Today,
more than a million pacemakers are implanted every year. Earl
Bachen and his brother in law's garage repair company kept
the patent on their invention. They called themselves Medtronic. Metronic
(38:35):
is now one of the largest medical device companies in
the world, worth over one hundred billion dollars. Walt Lillehigh,
who'd never been very good with money, was one of
their first investors. As the nineteen fifties neared its end,
Lillihigh was at the apex of his creative genius and
(38:58):
his career.
Speaker 2 (39:00):
He'd already outlived his.
Speaker 6 (39:01):
Prognosis, and his no Tomorrow approach to life had paid off.
He was living and working at full tilt. It wouldn't
be long before he lost control.
Speaker 1 (39:17):
On our next episode, surgeons across the country raced to
transplant the human heart. The stakes are unimaginably high, rivalries
turned vicious, and the first surgeon to cross the finish
line chucks the world next time on Cardiac Cowboys.
Speaker 6 (39:43):
Cardiac Cowboys is a production of iHeart Podcasts, OsO Studios
and Thirteenth Lake Media. Were presented by Chris Pine and
written and narrated by me Jamie Appley.
Speaker 2 (39:57):
Our executive producers.
Speaker 6 (39:58):
Are Christina ev for iHeart Podcasts, Dub Cornette and Jason
Ross for OsO Studios. Doctor Gerald Imber, author of Cardiac Cowboys,
The Heroic Invention of Heart Surgery, Doctor Eric A. Rose,
John Mankowitz, Joshua Paul Johnson, and myself.
Speaker 2 (40:19):
James A.
Speaker 6 (40:19):
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. Archival materials courtesy of
the University of Minnesota Archives, University of Minnesota Twin Cities
(40:39):
Special Collections, University of Rhode Island Library, and g Wayne Miller,
author of the Walt Lilla High biography King of Hearts,
The True story of the maverick who pioneered.
Speaker 2 (40:50):
Open heart surgery.
Speaker 6 (40:52):
For more information on the first cardiac surgeons, check out
doctor Gerald Imber's book Cardiac Cowboys, The Heroic Junction of
Heart Surgery
Speaker 1 (41:11):
Hmm.
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