Cardiac Cowboys – Episode 2: “Ready... Fire... Aim”

Podcast by iHeartPodcasts | Hosted by Chris Pine | September 29, 2025

Overview

This episode continues the thrilling true story of how open heart surgery was born in America’s heartland, focusing on the mavericks who defied medical orthodoxy to change medicine forever. Through vivid storytelling and rich archival voices, listeners are transported to 1950s Baltimore, Houston, and Minneapolis, as ambitious and controversial figures — Vivian Thomas, Denton Cooley, Michael DeBakey, Walt Lillehei, and others — innovate, clash, and strive for greatness in a world where cutting into the heart was once considered certain death.

Main Themes

• Breaking the Rules to Build a Field: Pioneers like Vivian Thomas, Alfred Blalock, Denton Cooley, Michael DeBakey, and Walt Lillehei push the boundaries of surgery, inventing techniques and devices in makeshift labs.
• Rivalries and Egos: The professional and personal tensions between Cooley and DeBakey form the centerpiece of the episode, setting up medical history’s greatest feud.
• Racism and Recognition: The episode highlights the overlooked contributions of Black medical innovators, especially Vivian Thomas, against a backdrop of segregated America.
• Desperation and Innovation: A “wild west” spirit pervades medicine as high-stakes operations are performed with experimental methods and homemade devices.
• Legacy and Erasure: Questions arise about why some history-makers are celebrated, while others are nearly forgotten.

Key Discussion Points and Insights

Opening: Segregation and Vivian Thomas’s Genius (00:35 – 06:18)

• Vivid Description of Segregated Baltimore, 1944:

  • “Marriage between an interracial couple is punishable by up to 10 years in prison… Johns Hopkins won’t admit its first Black student for another 18 years…” (Chris Pine, 00:35)

• Vivian Thomas’s Role at Johns Hopkins:

  • Although technically a laboratory assistant, Thomas was a surgical master, developing life-saving techniques while being paid “little more than a janitor’s wages” (Pine, 01:49).
  • “Vivian Thomas was a very skillful surgeon and could carry out all of these procedures unassisted.” (Dr. Denton Cooley, 01:36)
  • Thomas develops the method for the Blalock-Taussig Shunt, the first surgical workaround for tetralogy of Fallot in “blue babies.”

• Lack of Recognition & Historical Injustice:

  • Thomas, despite his pivotal role, isn’t initially credited for his work.
  • Only Blalock and Taussig are named in the procedure; Thomas “would be an old man before he was recognized for his achievement.” (Pine, 05:41)

The First Blue Baby Operation (04:49 – 06:42)

• Operation Details:
  • “Neither Blalock nor Taussig knew how to perform the procedure. Only Vivian Thomas did.” (Pine, 03:41)
  • Thomas guides Blalock step-by-step, standing on a stool to see as he instructs.
    • “Blalock would ask Vivian questions all the time over his shoulders. Vivian, should I do it this way or that way, you know?” (Cooley, 04:49)
  • The operation is a dramatic success: Eileen Saxon's skin turns pink for the first time.
    • Quote: “You did well in there, Vivian.” – Cooley as Blalock (05:27)

Denton Cooley: The Ambitious Prodigy (06:18 – 09:04)

• Cooley’s Early Promise:

  • Trained under Thomas and Blalock at Hopkins, assisted the first Blue Baby operation at age 24.
    • “I had an obligation to carry on that Legacy.” (Cooley, 06:18)

• Move to Houston — Entering DeBakey’s Orbit:

  • Cooley joins the upstart Baylor College of Medicine under superstar surgeon Michael DeBakey.
  • Their personalities contrast:
    • “Denton would come in and he said, fix me a glass of club soda with ice. And then…pour me a little bit of Coke in there so that it looked like scotch and soda.” (Michael DeBakey Jr., 08:45)
    • DeBakey’s harshness: “He was hell on wheels in the hospital. He could look at you and melt you.” (DeBakey Jr., 09:10)

The Legendary Cooley-DeBakey Rivalry Begins (09:25 – 13:45)

• Early Friction, Surgical Bravado:

  • On Cooley’s first day, DeBakey catches sight of golf clubs in his car: “Get rid of those things, son. You’re not going to need them while you’re here.” (DeBakey to Cooley, 09:25)
  • Anecdote of DeBakey’s no-nonsense style: chastising over pressing the wrong elevator button.
    • “You’re a mistake. You being here is a mistake.” (Cooley, 11:07)

• Innovation at the Bedside:

  • Cooley suggests a radical operation (aneurysm excision) on his first day. DeBakey challenges him to do it the next morning — a sink or swim moment.

The Houston Heart Revolution (13:45 – 29:02)

• Cooley’s Privileged Upbringing, Sporting Talent, and Ambition:

  • “Buckwheat Cooley, as his teammates called him, was blessed with movie star looks and a confident charm.” (Napoli, 14:48)

• Cooley and Blalock’s “Lucky” Relationship (Tennis Story):

  • “Instead of it turning into a disaster, it turned into a really lucky introduction.” (Dr. Louise Cooley Davis, 16:02)
  • Cooley’s technical skill: “He would tie knots inside of a matchbox with his fingers…no wasted motion…a symphony to watch.” (Dr. Kenneth Maddox, 17:10)

• Houston’s Transformation under DeBakey:

  • DeBakey turns Baylor from a medical “backwater” into an empire using fundraising, political skill, and relentless standards.
    • “He could build an empire, and he would be its sole sovereign.” (Napoli, 22:25)

• Innovation in Repairing Blood Vessels:

  • After using tissue from corpses, DeBakey shifts to synthetic materials (Dacron), reportedly first sewing grafts from his son’s Brooks Brothers boxer shorts (27:17–27:40).
    • “He literally pulled my mother’s sewing machine out…cut two Y shaped objects out of the shorts and sewed them together.” (Michael DeBakey Jr., 27:40)

The Heart Race Moves North: Walt Lillehei’s Minnesota Breakthroughs (29:02 – 36:13)

• Lillehei’s Open Heart Surgery Daring:

  • Introduced “controlled cross-circulation” for open heart repair in children, using a human (and, experimentally, animal) donor’s lungs.
    • “He couldn’t be bothered by what other people thought…Genius of this type doesn’t come in plain vanilla packages.” (Cooley, 36:13)

• The Calvin Richmond Case:

  • To save a Black child, Lillehei, after being unable to secure a human donor, uses a dog’s lung as an oxygenator in a pioneering and risky surgery.
    • “Rather than using a human donor…Lillehei connected Calvin’s blood vessels to a dog’s lung…It was a wild thing to try to do, never used on a human.” (Dr. Gilbert Campbell, 32:59)
    • “That would be very controversial now. I mean, impossible. But the boy’s alive because of it, you know.” (Dr. Chip Bowman, 35:27)
  • The operation’s success opens new possibilities but raises deeper questions about race, ethics, and medical experimentation in America.

Walt Lillehei: The Celebrity Maverick Surgeon (36:13 – 39:30)

• A Flamboyant, Driven Rule-Breaker:

  • “He was known for having flamboyant clothes…would wear a dinner jacket and everybody else would be in their sports jacket.” (Nurse Sia Bolman, 36:38)

• Personal Toll of Obsession:

  • “He developed an incredible capacity for alcohol…he never showed it.” (Dr. Richard de Waal, 37:05)
  • His son recalls, “There were times when he clearly wanted to be away…up in his office.” (Dr. Craig Lillehei, 37:57)

The Breaking Point: Cooley’s Next Step (39:30 – End)

• Cooley’s Restlessness:

  • “No one manipulated the press as effectively as DeBakey…But here is a guy named Cooley who’s a far better surgeon…And he wanted to be out of DeBakey’s shadow.” (Dr. Gerald Imber, 40:32)
  • Cooley seeks his own groundbreaking breakthrough rather than just executing DeBakey’s projects.

• A Fateful Visit to Lillehei’s Minnesota Lab:

  • Cooley and Dr. Dan McNamara, after a “wild” night out with Lillehei, witness not just elite surgery but a prototype DIY heart-lung machine constructed from “a tangle of coiled hose, a Sigma motor pump, plastic tubes, and a blood reservoir…cost about $30.” (Napoli, 42:53)
  • To McNamara, it looks mad; to Cooley, it looks like the future.

• Cliffhanger Ending:

  • “This radical heart lung bypass machine represented everything Cooley had been waiting for…Denton Cooley and the city of Houston were about to enter the heart race.” (Napoli, 44:02)

Memorable Quotes & Moments (with Timestamps)

• Vivian Thomas’s Genius and Invisibility:
  “Vivian Thomas was a very skillful surgeon and could carry out all of these procedures unassisted.”
  — Dr. Denton Cooley (01:36)

  “Vivian should I do it this way or that way, you know?”
  — Dr. Denton Cooley, recalling Blalock’s dependence on Thomas in surgery (04:49)

• On DeBakey’s Intensity:
  “He was hell on wheels in the hospital. He could look at you and melt you.”
  — Michael DeBakey Jr. (09:10)

  “You’re a mistake. You being here is a mistake.”
  — Dr. Denton Cooley, quoting DeBakey’s tongue-lashing (11:07)

• On Cooley’s Skill:
  “He would tie knots inside of a matchbox with his fingers…a symphony to watch.”
  — Dr. Kenneth Maddox (17:10)

• On Building a Medical Empire:
  “In Houston, DeBakey could build an empire, and he would be its sole sovereign.”
  — Jamie Napoli (22:25)

• On Innovation Born of Scarcity:
  “I looked at the material, you know, and felt it…when you do that, you got a tube.”
  — Dr. Denton Cooley, on sewing Dacron grafts from synthetic fabric (26:43)

  “He literally pulled my mother’s sewing machine out…cut two Y shaped objects out of the shorts and sewed them together…”
  — Michael DeBakey Jr. (27:40)

• On Medical Experimentation and Risk:
  “It was a wild thing to try to do. I’d never used it on a human…Don’t expect to find an interstate in the wilderness. You know we’re plowing new ground.”
  — Dr. Gilbert Campbell on the dog-lung oxygenator surgery (32:59)

• On Medical Mavericks:
  “Genius of this type doesn’t come in plain vanilla packages.”
  — Dr. Denton Cooley (36:13)

• Looking to the Future:
  “This radical heart lung bypass machine represented everything Cooley had been waiting for…Denton Cooley and the city of Houston were about to enter the heart race.”
  — Jamie Napoli (44:02)

Section Timestamps

| Segment | Description | Timestamp | |---------------------------|--------------------------------------------------------------------------------------|------------| | Segregation & Vivian Thomas| Setting the racial context, Thomas’s work at Hopkins | 00:35–06:18| | Blue Baby Operation | Operation on Eileen Saxon, Thomas guiding Blalock | 04:49–06:42| | Cooley’s Rise | Early life, move to Houston, relationships with Blalock & DeBakey | 06:18–13:45| | DeBakey’s Houston Empire | Baylor’s transformation, synthetic graft innovation | 13:45–29:02| | Minneapolis & Lillehei | Open heart breakthroughs, Calvin Richmond case, medical mavericks | 29:02–36:13| | Dazzling, Wild Surgeons | Lillehei’s personality, personal cost, conference in Houston | 36:13–39:30| | Cooley’s Determination | Frustration with DeBakey, visit to Lillehei, heart-lung machine | 39:30–44:21| | Next Time | Preview of coming feuds and showdowns | 44:21–44:49|

Conclusion

“Ready... Fire... Aim” captures the wild ambition and fierce rivalries that drove the birth of open heart surgery—from the unheralded brilliance of Vivian Thomas to the larger-than-life duel between Cooley and DeBakey, and the reckless genius of Walt Lillehei. The episode is a gripping reminder that medical progress is not only built from intellect and perseverance, but also from deeply human drives: ego, competition, and the willingness to risk everything when the stakes are life and death.