Well-Being//

Why the Artificial Heart Is Essential for Inclusive Healthcare

Plus, its fascinating origin story.

Courtesy of bygermina/Shutterstock
Courtesy of bygermina/Shutterstock

Since the late 1980s, the public and politicians had been trying to wash their hands of the whole idea of a totally implantable artificial heart. Everyone from members of the Reagan administration to prominent academic bioethicists was losing faith. There were several reasons for this. First, society at large didn’t seem as enthralled with the miracles of the medical profession anymore; the Barney Clark media pile-on had certainly given that viewpoint a boost. So too did the so-called Baby Fae case, in which a doctor successfully transplanted a baboon heart into a human infant who lived for two weeks in 1984, setting off another ethical furor. Much closer to home but no less controversial was the death of the “Bubble Boy,” David Vetter, that same year; he was more or less incarcerated with a rare autoimmune disease in a Texas Medical Center hospital from his birth in 1971 until he died at the age of thirteen. Were doctors trying to heal the sick or just experimenting on defenseless people for the most narcissistic of reasons? Or, maybe, both? 

Then there was the issue of cost. The deep recession of 1980–82 was followed by deep cuts in social spending and general belt tightening for everyone. Stanford historian Bernstein took up the charge again. “Can America afford to develop a workable artificial heart?” he asked in an article in The Nation, suggesting that the cost of serving the “16,000–66,000 potential recipients”—a pretty broad spectrum—would range from $1.6 billion to $6.6 billion at a time when the federal deficit was approaching $200 billion. And given the ongoing but less than successful experiments with the Jarvik heart—the misery played out in public with five more patients over the next few years—people began to wonder how much better life with an artificial heart was than simply living out whatever time they had left with the faulty heart they’d been born with. 

Then too, enough had been learned about heart disease by that time to suggest that preventive medicine—Stop smoking! Start jogging! Eat less meat, more vegetables!—was a much better option than heroic, Hail Mary measures once a crisis set in. Bernstein noted in his article that the artificial heart “represents a triumph of skilled physicians and technology over illness and nature. But such triumphs can be costly and shortsighted.” 

On the other hand, people continued to die in record numbers from heart disease. And the number of available hearts for transplants remained stuck at twenty-five hundred per year, while tens of thousands waited in desperation for a rescue that wasn’t coming. These were the facts that troubled Bud a lot more than the cost of implants or the bioethicists who thought he was in league with Dr. Frankenstein. 

Bud believed his patients needed something new; he just wasn’t sure what that would be. All he knew was that he was ready to abandon air-powered pumps, not just for LVADs but for any future total artificial hearts he might devise. Yes, air-powered pumps paid the bills in his lab, and could keep a patient alive for a few years. But once the machine started to falter, those patients would wind up either back in surgery for replacement parts or back on the transplant list; so far, no air-powered device could equal the natural heart’s ability to beat 115,000 times a day. 

In addition, the current pumps were too big. No one had come anywhere close to inventing a device that could fit inside a woman’s chest, much less that of a child. To Bud, the answer seemed obvious: someone had to come up with something different. A machine that kept the blood flowing through the body but didn’t have a pump that wore out. Something that would flow continuously, without a break, for who knew how long. Maybe longer than the life of the patient it was implanted in. 

Bud began talking about the issue with friends and colleagues, but also in public, at medical conferences, and in papers he wrote for medical journals. There were researchers and engineers who were abandoning air-powered pumps for centrifugal pumps, which forced blood through the body with a spinning instead of a pulsing action. But spinning blood at high speeds was well known to create one dangerous side effect, a condition known as hemolysis, in which red blood cells fall apart, leading to anemia and then more serious problems, like kidney and heart failure. Once again, blood destruction was looking like a barrier to success. 

Another side effect of a centrifugal device would be that the patient wouldn’t have a pulse, something no human being had done without since emerging from the primordial ooze. Bud’s attitude was, so what? Who said you really needed it? 

The answer was: the entire medical profession. Or, at least, that segment of the medical profession that studied such things, which included many of Bud’s esteemed colleagues. They had tolerated all of his mumbling and grumbling, the rotating library of Penguin classics in his coat pocket, and the Boys’ Life stories about his childhood in West Texas because Bud was a world-class surgeon. He was the one you wanted in the OR, whether you were transplanting, implanting, or just trying to keep some unlucky soul from dying in your very hands. But now, it seemed, Bud’s colorful imagination had gotten the better of him. Now he was going on and on with all this pulsatile-versus-nonpulsatile nonsense. It was ridiculous. No self-respecting surgeon was going to waste time on a scheme that probably ensured his or her signature on a patient’s death certificate. 

What followed was a personal trial for Bud. Now forty-eight, he was keeping pace with Cooley to maintain the Heart Institute’s backbreaking surgical schedule. And it was Bud, not Cooley, who was running the ever-expanding research lab down in the basement. 

He had worked tirelessly to get himself to the pinnacle of his profession. The perks weren’t what they had been in DeBakey’s or Cooley’s heyday—even in those pre-Kardashian days, magazine editors were rapidly losing interest in putting doctors on their covers unless, like the bearded, avuncular, Harvard-trained Andrew Weil, they were sporting some new, natural, organic, life-extending cure for who knew what. Still, Bud was doing pretty well: he traveled around the world, sometimes with Cooley and sometimes without, performing surgery and lecturing on the latest techniques. He knew the best restaurants in Paris, Riyadh, and God knows where else, and he had a whole entourage of minders who allowed him to focus exclusively on saving lives. The best medical journals clamored for his papers. He lived just a few blocks from Denton Cooley in a more modest but elegantly appointed home in River Oaks, and his son and daughter went to the best private school in Houston. As with so many doctors of this time, home life was something Bud mostly did without. There is a story that Rachel Frazier tells about this period that is illustrative: for some unfathomable reason, Bud had to make a run to his home in the middle of the day. Colleagues at THI would have been surprised that he found the place at all, but he managed to unlock the front door with his key and headed upstairs. There he ran into the family maid of many years, who took one look at the shambling, shaggy-haired intruder and screamed in terror. She had never seen Bud before. Still, to most small-town Texas boys—and a lot of big-city Texas boys—Dr. Bud Frazier looked like he had it made. 

Until he boarded that pulseless heart train. Then, as Bud put it to a writer for Popular Mechanics many years later, “I was like Robinson Crusoe doing magic tricks for the goats.” The man who had once won virtually all medical debates using the latest scientific data suddenly found himself trying to score points with—a feeling in his gut. This was not a good spot for a man of medicine. Oh, he argued that all the other organs operated with continuous flow; that was one point. And blood flowed continuously at the capillary level—it didn’t need a pulse to keep moving there. But that was all he had. He just believed you could make a heart with continuous flow instead of a pulse. Bud had no scientific proof that humans could do without a pulse or a heartbeat, while the opposition had the entirety of medical history on its side.

Excerpted from TICKER. Copyright © 2019 by Mimi Swartz. Published by Broadway Books, an imprint of Penguin Random House LLC.

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