HOUSTON — The surgeon's steady hands clamp off a throbbing artery below the jaw of a 78-year-old stroke patient. The vessel flexes gently but perceptibly, like a high-tension wire in the crosswinds of a storm.
The target is a red artery pocketed in ribbons of muscle. The surgeon guides a razor's edge along its length. The vessel is one of the carotids, through which blood reaches the brain. When these become clogged by atherosclerosis, people die.
The incision exposes the blockage. The tissue is removed. The surgeon closes the wound, weaving strands of silk-like gut into a thin black line of sutures, his hands plunging and rising with the rhythmic intensity of a symphony conductor. This music takes less than an hour to perform, and there is no sound, save the muffle of pumps and the chanting of life-support machines.
The chairman of surgery at Baylor College of Medicine, Michael Ellis DeBakey, knows what he is doing. Decades ago, he pioneered the technique known as carotid endarterectomy--the surgical removal of arterial blockage. Before this, stroke cases were considered nearly hopeless.
"My reward?" says DeBakey, 78, pulling elastic gloves from his large hands as he hurries to another operation. "My reward is that the patient is going to do well, and is going to have a lot more life in front of him."
DeBakey knows about life. He has touched thousands of hearts, figuratively and literally, and mended most of them by grafting or replacing nonfunctional pieces of what only 30 years ago was an untouchable netherworld of human anatomy.
He has also transplanted scores of whole hearts, and has written more than 1,300 articles and essays as well as several books. He has trained more than 500 surgeons, an accomplishment that he considers his most lasting.
His inventions and techniques, including Dacron grafts and a heart-lung pump, both revolutionized and standardized the art of cardiovascular surgery.
He also knows death, the unremitting constant that eventually mocks his finest labors. Death swept off the patient he most wanted to save--his first wife, mother of four sons. She died of a massive heart attack.
DeBakey was in the operating room when he heard she had been stricken. He was helpless to save her, and cried at the foot of her hospital bed. That was in February, 1972. His brown eyes still mirror the pain of that day--and the pain of all the other souls lost in his war against heart disease.
"You fight (death) all the time, and you never really can accept it," he said. His velvet-edged voice rises now and then for emphasis. "You know in reality that everybody is going to die, but you try to fight it, to push it away, hold it away, with your hands."
This morning DeBakey rushes from the carotid operation to Baylor's animal lab, where he is to put an experimental valve in the heart of a calf.
He arrives as the animal is being prepared, its chest clamped open, the acrid smell of smoke from the cauterizing knives hangs heavy in the air. There under the blue-white glare of surgical lights is a beating heart.
DeBakey pauses. He is enraptured. After 54 years, he still finds the heart, any heart, an item of inexpressible beauty.
DeBakey first saw a living heart in 1933, when he was a young intern-resident at New Orleans Charity Hospital. The victim of a knifing had been brought into the emergency ward. The organ lay palpitating, exposed.
"I could see it there even though we didn't open the chest. I saw it beating and it was beautiful, a work of art, an awe-inspiring sight. I still have an almost religious sense when I work on the heart. It is something God makes, and we have yet to duplicate."
There have been many attempts, of course. DeBakey himself is credited with paving the way to the first artificial heart with the implantation of an assistance device 20 years ago. The patient was a 37-year-old Mexican woman. The device was a left ventricular bypass pump. It supplemented the function of the ventricular, or lower, chambers of the heart.
She lived with the pump for 10 days, and was weaned from it after her own diseased valves had been surgically repaired. She survived for six more years of normal life, until her heart was stilled in a car accident.
A number of years later, in 1971, DeBakey consulted with the designers of the famous Jarvik-7 mechanical heart. After long thought, he opposed its permanent use.
"They spent hours with me--(William) DeVries and (Robert) Jarvik--and I told them right from the start I could never, never use (the heart) as a permanent implant."
The reason: All the animal data suggested that implant patients faced a future of unbroken misery in a tangle of medical complications. "What sort of world are you condemning a man to, tethered to this big machine? In one sense you might be prolonging his life, but in another sense, you are prolonging his death, making it an agony.