Cardiac Cowboys – Episode 3: "The Can Opener"

Podcast: Cardiac Cowboys
Host: Chris Pine
Date: September 29, 2025
Summary by: [Podcast Summarizer AI]

Overview

In this gripping episode, "The Can Opener," Cardiac Cowboys tells the revolutionary and perilous story behind the invention of open heart surgery in mid-20th century America. Through the trials and missteps of Minnesota surgeon Walt Lillehei and his colleagues, listeners hear how resourcefulness, risk-taking, and relentless innovation in makeshift labs led to medical devices—literally crafted from scavenged parts and beer tubes—that gave rise to the field of heart surgery. The episode explores the dangerous early procedures, the birth of the bubble oxygenator, the lines between heroism and tragedy, and the eventual creation of the pacemaker, changing medicine—and countless lives—forever.

Key Discussion Points

1. Walt Lillehei and the Dawn of Open Heart Surgery

• Setting the Stage (00:35):
  • April 1955. Walt Lillehei, having survived terminal cancer for five years, presents his controversial "cross circulation" procedure—where a child's parent provides heart-lung support during surgery—at a major medical conference.
  • Quote: "He takes the stage and begins to describe his controversial technique. A child and parent sharing blood while the child undergoes open heart surgery." (01:40)
• Milestone Achievement:
  • Successfully repaired six cases of tetralogy of Fallot, a previously inoperable congenital heart defect.

2. Medical Backlash and Tragedy

• Controversy and Criticism (02:26):
  • Despite his success, Lillehei faces severe skepticism. Archival voices capture the tense hostility.
  • Quote: Helen Taussig shouts during Q&A: "This criminal must be stopped." (03:09)
  • Even nurses dub him a "murderer" after a series of patient deaths.
• The Thompson Case: Human Cost of Innovation (04:28-07:20):
  • During surgery on young Leslie Ann Thompson, her mother Geraldine, the donor, suffers an air embolism due to an anesthesiologist’s error, causing permanent brain damage.
  • Lillehei’s blunt, compassionate response:

    "Dan, you have to sue us." (07:04)

  • The tragedy cements that cross circulation is unsustainable—prompting the search for a safer technique.

3. Inventing the Bubble Oxygenator

• Recruiting the Tinkerer (08:08):
  • Lillehei enlists Richard DeWall, a creative but academically average GP, to develop a bypass machine.
• Simplicity Over Complexity (11:53):
  • Lillehei’s design philosophy:

    "We needed a simple oxygenator. Heat, sterilizable, disposable." (11:53)

  • Bubble Oxygenation: Eschewing established engineering wisdom, Lillehei and DeWall use oxygen bubbles to oxygenate blood and gravity to clear bubbles—a method all experts consider deadly.
• Prototype Success and Failure (14:31-17:51):
  • Lab tests on dogs are successful, but the early human trials with children result in deaths due to undiagnosed conditions—not device failure.
  • Quote: "We operated on one patient a day and often by Friday night all five patients were dead."
    – Dr. Christian Barnard (17:20)
  • Despite devastating losses, Lillehei persists.

4. Widespread Adoption and Professional Rivalry

• Breakthrough Success (17:51-19:21):
  • By July 1955, first successful operations in children—proof the bubble oxygenator works.
  • Quote: "The children on either side of my operation both passed away, so I felt very lucky."
    – Dr. Pamela Evans, former patient (19:16)
• Medical Skepticism vs. Validation (19:38-21:24):
  • Ongoing criticism at conferences, but Texas surgeon Denton Cooley stands to validate the technique:

    "Now I have 100 patients that have done well with it. That was the end of the discussion." (21:06)

  • Cooley's modifications, called "Cooley's Coffee Pot," further improve the device and increase its adoption.

5. Patent, Legacy, and the "Can Opener"

• Mass Production (26:33-26:52):
  • The simplified bubble oxygenator, co-invented by Vincent Gott, is mass-produced and patented by the University of Minnesota, transforming cardiac surgery practice worldwide.
• Naming the Revolution:
  • "If heart surgery were a picnic, Walt Lillehei brought the can opener." – Quoted from Denton Cooley (26:52)

6. Legal Aftermath and Ethical Toll

• The Thompson Lawsuit (28:14-30:20):
  • Geraldine Thompson’s malpractice trial results in a hung jury. The family is left uncompensated, deeply affecting Lillehei.
  • Quote: "He really did feel like yes, sue and win. You deserve those monies."
    — Dr. Craig Lillehei, son (29:43)

7. Relentless Risk and the Birth of the Pacemaker

• Ongoing Deadly Setbacks (31:11-32:07):
  • Heart block, a lethal post-surgery complication, claims many patients. Options are scant.
  • Quote: "We shrugged our shoulders and hoped for the best. Patients were doomed to death in those early days." (31:54)
• Innovation from Failure (33:00-34:00):
  • Inspired by a physiology lab instrument, Walt Lillehei and Dr. Vincent Gott develop a crude but effective pacemaker using a "grass stimulator," saving patients with electrical heart block.
• Battery Pacemaker (37:17-39:30):
  • After an area-wide blackout exposes the danger of tethered devices, Earl Bakken, a hospital repairman, invents the world's first portable, battery-powered pacemaker—creating Medtronic.
  • Quote: "Bakken drew his first sketch of a working pacemaker on the back of a memo from a medical device company...he pretty much used that circuit sketch and put it in a box." (39:30)

8. The Human Cost and End of an Era

• Unspoken Burdens (32:22-32:38):
  • Emotional toll: "Dad didn't really share his disappointments with his kids. He never bared his soul about how that hurt." — Dr. Craig Lillehei
• Legacy and Next Frontier (41:52):
  • By the end of the 1950s, Lillehei is at his creative peak, but the relentless pace foreshadows new challenges—and the coming competition to transplant the human heart.

Notable Quotes & Moments (with Timestamps)

• "This criminal must be stopped." – Helen Taussig (03:09)
• "Dan, you have to sue us." – Walt Lillehei (07:04)
• "It was kind of a Rube Goldberg type of apparatus." – Dr. James Moeller (14:01)
• "We operated on one patient a day, and often by Friday night all five patients were dead." – Dr. Christian Barnard (17:20)
• "Most people are enamored of complexity...Nobody could figure out how some idiots would devise a bubble oxygenator." – Walt Lillehei (19:38)
• "Now I have 100 patients that have done well with it. That was the end of the discussion." – Denton Cooley (21:06)
• "If heart surgery were a picnic, Walt Lillehei brought the can opener." – Denton Cooley (26:52)
• "We shrugged our shoulders and hoped for the best. Patients were doomed to death in those early days." – Walt Lillehei (31:54)
• "Bakken drew his first sketch of a working pacemaker on the back of a memo from a medical device company...he pretty much used that circuit sketch and put it in a box." – Jamie Napoli (39:30)

Timeline of Major Developments (with Timestamps)

• 00:35–03:09: Lillehei unveils cross circulation technique, faces harsh medical criticism.
• 04:28–07:20: The Thompson surgery—Geraldine suffers permanent brain damage.
• 08:08–14:31: Invention, prototyping, and early failures of the bubble oxygenator.
• 17:51–19:21: Bubble oxygenator achieves first human success.
• 21:06–22:24: Denton Cooley validates the bubble oxygenator technique in Texas.
• 26:33–26:52: Commercial production and patenting of simplified oxygenator.
• 28:14–30:20: The legal aftermath of the Thompson case.
• 31:11–34:00: The heartbreak of heart block and the creation of external pacemakers.
• 37:17–39:30: The blackout and the invention of the portable, battery-powered pacemaker.
• 41:52–42:19: Next episode preview—race to transplant a human heart.

Themes & Takeaways

• Pioneering medical innovation is fraught with loss, risk, and unexpected consequences.
• The path from dangerous experiment to lifesaving standard often winds through tragedy.
• Personal rivalries, resourcefulness, and a willingness to ignore authority fueled progress.
• Lasting medical revolutions—open-heart surgery, the pacemaker—often began in crude, makeshift settings outside of mainstream science.

Listener Value

Whether you’re a history buff, a medical professional, or just love stories of human ingenuity, this episode offers acutely personal stories and vivid detail about the mavericks who broke all the rules to make modern cardiac surgery possible. The blend of archival moments, first-person reminiscence, and technical insight—along with moments of intense ethical questioning—brings the heart (and heartbreak) of medical progress to life.

Next Episode Preview:
The coming chapter chronicles the high-stakes national race to deliver the world’s first human heart transplant, setting the stage for new rivalries and unimaginable risks.