Cardiac Cowboys – Special Bonus Episode

Dr. Eric A. Rose & Dr. Gerald Imber on the Future of Heart Medicine
Podcast: Cardiac Cowboys
Host: Jamie Napoli (iHeartPodcasts)
Guests: Dr. Eric A. Rose, Dr. Gerald Imber
Date: November 12, 2025

Episode Overview

This special bonus episode of Cardiac Cowboys features a lively and insightful conversation with Dr. Eric A. Rose, renowned cardiac surgeon and pioneering heart transplant specialist, and Dr. Gerald Imber, plastic surgeon, medical historian, and author of Cardiac: The Heroic Invention of Heart Surgery. Together with host Jamie Napoli, they dissect the legacy of the original “cardiac cowboys”—the fearless innovators of early open-heart surgery—and examine the current landscape and future frontiers of heart medicine. The episode covers the importance of medical history, changing attitudes toward risk in surgery, innovations in heart devices, the challenge of funding early-stage medical breakthroughs, and the intersection between music, creativity, and surgical excellence.

Key Discussion Points & Insights

1. Remembering the Cardiac Cowboys

• Introduction to Key Figures: While Christian Barnard is a household name, many of the true cardiac surgery trailblazers—Walt Lillehei, Michael DeBakey, Denton Cooley—remain under-recognized outside medical circles.
  • “Before I met you, the only cardiac surgeon I’d ever heard of was Christian Barnard… You were the one that introduced me to the cardiac cowboys.” —Jamie Napoli (02:19)
• Personal Encounters: Dr. Imber recalls his encounters with Walt Lillehei as a young resident:
  • “He was wandering around the halls terrorizing everybody. Not really… But he terrorized me and I just kept my distance because the stories about him were legion.” —Dr. Gerald Imber (02:42)

2. Making History Matter

• The Vanishing Chain of Tradition: Dr. Rose states that even within the profession, memory of originators like Lillehei was fading by the time of his own career.
  • “Cardiac surgeons of my generation were already losing the chain of thought recognizing Lillehei… There is no operation, as far as I know, that’s called the Lillehei procedure because he basically invented all of them.” —Dr. Eric Rose (04:54)
• Importance of Context: Both guests emphasize why the stories and personalities behind the procedures matter.
  • “It’s always important to know where you came from… the things that they did, most people would say, ‘That’s kind of wacko,’ but they were in the right place at the right time, they were courageous… It’s important to know how it happened. It didn’t just materialize.” —Dr. Gerald Imber (06:34)

3. Culture of Risk, Then and Now

• Daring Innovation: The original cardiac surgeons took enormous risks, often with scant resources, in pursuit of saving lives where no other hope existed.
  • “Walt Lillehei using a dog’s lung as an early heart-lung machine. Denton Cooley trying out a total artificial heart… How do you square that risk-taking culture?” —Jamie Napoli (08:30)
• Modern Contrast: Dr. Rose explains the evolution from “fighter pilots” to “airline pilots”:
  • “Now being a heart surgeon is a lot more like being the pilot for United Airlines, whereas the original surgeons were more like fighter pilots and my generation was kind of between. But that’s the evolution of progress.” —Dr. Eric Rose (09:05)

4. Innovations & Limits in Heart Medicine

• Current Progress: Pediatric surgery now achieves results once thought impossible.
  • “The quality of the work is just spectacular… these walnut sized hearts that are fixed by these guys and women now.” —Dr. Eric Rose (11:31)
• Artificial Heart Hurdles: Despite decades of effort, a practical total artificial heart remains elusive.
  • “The heart seems like it’s simple—it’s just a pump—but it’s a lot more than that… There are a lot of things about the normal heart that are just not duplicable. I think long-term by a machine, maybe I’ll be proved wrong, but in my lifetime, I just don’t think it’s going to happen.” —Dr. Eric Rose (12:29)
• The Future Lies in Less Invasive Devices: Advances such as temporary left ventricular assist devices (LVADs) are changing the landscape for acute heart failure care.
  • “When you can put a temporary LVAD into a human… a device that has the diameter of a pencil can pump 5 liters of blood and be put in in the field instead of waiting for the patient to get to the hospital. That to me is much more progress.” —Dr. Eric Rose (13:45)

5. Structural and Systemic Challenges

• Bottlenecks Remain: The need for heart transplants far outstrips supply, even as devices improve. Questions remain about permanent solutions for chronic patients.
  • “What’s the end point? If a quarter of a million people are waiting for a heart transplant and there are only 3200 a year being done…” —Dr. Gerald Imber (14:35)
• Funding Threats: Dr. Rose warns of the risk to early-stage innovation posed by government funding cuts, while noting private industry can only fill gaps to an extent.
  • “It’s concerning and I hope it’s temporary… It’s earlier stage therapies that I’m concerned about… the company was scrambling when NIH didn’t fund the grant. That’s the luster of what can go wrong and shouldn’t.” —Dr. Eric Rose (16:37)

6. Genius, Risk, and Personality in Medical History

• The Wild Men of Medicine: Dr. Imber’s biographies highlight the rebels who make revolutionary leaps, sometimes at great personal cost.
  • “People aren’t interested in… evolution. They’re interested in revolution. And in medicine, revolution comes at a price… part of the price is having that personality willing to take a dive off the high board without looking to see if there’s water in the pool.” —Dr. Gerald Imber (19:48)
• Halstead vs. Lillehei: Imber draws psychological and philosophical contrasts between two pioneers:
  • “Halstead was a total rigid, straight arrow… Lil High was exactly the opposite. Lil… didn’t want to know what previous experiments had been done because he didn’t want to bias himself.” —Dr. Gerald Imber (21:29)

7. Surgery, Music, and the Nature of Teamwork

• Creativity and Collaboration: Dr. Rose sees clear connections between music and surgery:
  • “Especially good music is a team sport. Any good surgery, it gets complex—or science is a team sport, too. And to be playing with other people that are good makes you enthusiastic… and I think surgery is often that way, too.” —Dr. Eric Rose (23:43)
• Humor and Humility: Dr. Imber jokes about his musical limitations.
  • “My classical guitar teacher fired me. That’s how good I was.” —Dr. Gerald Imber (24:51)

8. Looking Forward, Telling Stories

• Imber’s New Projects: He is co-authoring a humorous book on aging and writing an institutional history of NYU’s reconstructive surgery department.
  • “We’re laughing our heads off doing that book, and we haven’t written three pages yet, but it’s fun.” —Dr. Gerald Imber (25:22)
• Hopes for the Podcast’s Impact: Both guests passionately wish for greater recognition of Walt Lillehei’s achievements.
  • “I hope that Walt Lillyhei becomes a household name. I think you and… Jerry with this, have done an enormous service by pointing out his role. I hope he becomes better known…” —Dr. Eric Rose (26:51)
  • “Even someone from that institution didn’t understand the importance of Walt Dillahai in not just the history of cardiac surgery, [but] in the history of medicine.” —Dr. Gerald Imber (27:21)

Notable Quotes & Memorable Moments

• On courage in medicine:
  “If something has to be done, it has to be done.” —Dr. Gerald Imber, paraphrasing Walt Lillehei (06:34)
• On how surgery evolved:
  “Now being a heart surgeon is a lot more like being the pilot for United Airlines, whereas the original surgeons were more like fighter pilots…and my generation was kind of between.” —Dr. Eric Rose (09:05)
• On the risks and rewards of innovation:
  “Part of the price is having that personality willing to take a dive off the high board without looking to see if there’s water in the pool.” —Dr. Gerald Imber (19:48)
• On the complexity of the heart versus machines:
  “The heart seems like it’s simple—it's just a pump—but it's a lot more than that… It's also an endocrine organ.” —Dr. Eric Rose (12:29)
• On teamwork in surgery and music:
  “Any good surgery, it gets complex—or science is a team sport, too. And to be playing with other people, you know, that are good makes you enthusiastic...” —Dr. Eric Rose (23:43)

Timestamps for Key Segments

| Segment | Timestamp | |------------------------------------------------|:-------------:| | Meet the Guests & Cardiac Cowboys Intro | 00:37–02:19 | | Early Encounters with Walt Lillehei | 02:42–03:27 | | Value of Medical History/Lillehei’s Legacy | 04:34–06:34 | | Risk-taking Then vs. Now | 08:30–10:24 | | Frontiers in Heart Medicine/LVAD Discussion | 11:25–13:45 | | Transplants, Artificial Hearts, & Limitations | 13:45–16:03 | | Funding, Innovation & the Role of NIH | 16:03–18:08 | | The Wild Men of Medicine & Genius | 19:21–21:29 | | Parallels between Music and Surgery | 23:04–24:35 | | Imber’s Writing Projects & Medical Storytelling| 25:08–26:37 | | Hopes for the Podcast’s Legacy | 26:37–28:10 |

Conclusion

This episode delivers a deep dive into both the historical spirit and the modern crossroads of heart medicine, blending sharp insights into surgical innovation with candid reflections on the human stories behind the scalpel. Drs. Rose and Imber call for a renewed respect for the field’s pioneers, urging both medical professionals and the public to appreciate the boldness of the cardiac cowboys—and to recognize that progress always begins with audacity and risk. The conversation ends with a hope: that history will finally match innovation with memory, and that the legacies of great yet often overlooked figures like Walt Lillehei are properly enshrined for a new generation.