The Can Opener

Summary

Cardiac Cowboys – Episode 3: "The Can Opener"

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

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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.

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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.

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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)

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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.

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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.

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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.

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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.

Transcript

[Walt Lillehei]

This is an iHeart podcast.

[Podcast Narrator / Jasper AI Advertiser]

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[Chris Pine]

Welcome to the Wild west of American Medicine. I'm Chris Pine and this is Cardiac Cowboys, the gripping true story behind the birth of open heart surgery and the maverick surgeons who made it happen. The first surgical anatomical operation it's April 27, 1955. Walt Lillehei waits to be called on stage. He's at one of the countless medical conferences to which he's been invited to speak since his breakthrough. It's been a little over a year since Lillehai used cross circulation to repair a hole in Gregory Glidden's heart, and it's been five years since he was diagnosed with terminal cancer. Despite the bleak prognosis, Lillehei refuses to undergo a second look operation. He doesn't need another doctor to tell him how much time he has left. Lillehai already lives each day like it could be his last.

[Podcast Narrator / Jasper AI Advertiser]

Dr. Seawald Lillahy.

[Chris Pine]

He takes the stage and begins to describe his controversial technique. A child and parent sharing blood while the child undergoes open heart surgery. Since he operated on Gregory Glidden, Lillehgh has performed over three dozen of these cross circulation procedures. Toward the end of the presentation, he makes his big announcement. Lillehy has successfully repaired six cases of tetralogy of Fallot, one of the deadliest and most complex heart defects to cardiac surgeons in the 1950s. This is the Holy Grail. In spite of his unprecedented success, Lillehai has come to expect criticism, and he gets his fair share of it today. Here's an archival recording of Walt Lillehei.

[Walt Lillehei]

I could understand the skeptics because not every new idea is good. But it didn't bother us because we knew we were on the right track. Just as certain as she could be.

[Chris Pine]

In the audience sits Alfred Blalock and Helen Taussig at Johns Hopkins A decade earlier, Dr. Blaylock, Dr. Taussig and a lab technician named Vivian Thomas pioneered an ingenious blue baby operation that allowed children born with tetralogy of Fallot to survive past infancy. Lillehy has taken their work one bounding step Forward. But they don't see it that way. In a shocking scene detailed by Lillehei's former resident, Dr. Daniel A. Gore, Helen Taussig stands from her seat during the Q and A and shouts, this criminal must be stopped. This reaction isn't completely unexpected. After losing a string of patients last autumn, Lillehei overheard his own nurses whispering about him in the halls, calling him a murderer. And then there was the case of the Thompson family. On the morning of October 5, 1954, an eight year old girl named Leslie Ann Thompson was wheeled into an OR at the University of Minnesota Hospital. Leslie Ann was born with a vsd, a hole between the ventricles in her heart. Her parents, an Air Force officer named Dan Thompson and his wife Geraldine, had brought Leslie Ann to specialists all over the country, including pioneering vascular surgeons Michael DeBakey and Denton Cooley down in Houston. But wherever they went, the prognosis remained the same. Leslie Ann would not survive unless the hole in her heart could be sewn shut. This brought the Thompsons to the operating room of Walt Lillehei.

[Walt Lillehei]

Dr. Varso and I were opening the chest of the child, exposing the heart, and they just wheeled the mother into the main room.

[Chris Pine]

Geraldine was a blood match for her daughter. She happily volunteered to lend her heart and lungs to keep Leslie Ann alive during surgery. As Lillehei prepared to cut into the eight year old girl's heart, two of his assistants tended to Geraldine, who lay just six feet away. An anesthesiologist entered the Oregon and approached Geraldine's table.

[Walt Lillehei]

He saw that she had an IV in one of the arm veins to give anesthesia. He saw it wasn't dripping. He thought the vein had plugged up. So he put about six or eight big squeezes on that puff and lo and behold, the IV was not dripping because the bottle was empty.

[Chris Pine]

The anesthesiologist had just squeezed a massive air embolus into Geraldine's bloodstream. A bubble of air was surging straight toward her heart.

[Walt Lillehei]

All of a sudden they yelled, something's wrong, something's wrong. And when they screamed, I dropped my instruments and turned and see. The blood turned black.

[Chris Pine]

Lillehia boarded the operation immediately as his assistants injected Geraldine with adrenaline and brought her blood pressure back to normal. Lillehy closed Leslie Ann's chest without repairing her heart and then went out to give her father the news. Geraldine, a lively mother of four who enjoyed dancing, swimming and playing golf, had just suffered permanent brain damage. For the rest of her life, she'd be unable to care for her children or herself. This was the horrific realization of every critic's worst fear. With cross circulation, it could end Lillehai's career. And it could bring the hospital that championed his work crashing down with him. The situation needed to be handled delicately. But Lillehai was not a delicate man. He was blunt and empathetic to a fault. Dan, you have to sue us, he told the grieving husband. Lillehai knew that the cost of Geraldine's care would quickly outpace Dan's modest Air Force income. A malpractice settlement would allow Dan to continue to provide for his family. It would also put Lillehai and his colleagues through hell. But that was a problem for another day. For the time being, Lillehy was focused on the work ahead of him. The tragedy of Geraldine Thompson offered irrefutable proof that cross circulation was not a permanent solution. There had to be another way to oxygenate a patient's blood during open heart surgery. A safer way. One that didn't endanger the life of a parent. Walt Lillehei just had to find it. From OSO Studios, this is Cardiac Cowboys, a podcast about life, death and innovation in the American Heartland. Episode 3 the Can Opener here's writer and executive producer Jamie Napoli.

[Jamie Napoli]

Back In March of 1954, Lillehy had hired a 27 year old general practitioner named Richard De Waal. Though he graduated from the U of M Medical School, De Waal's grades didn't quite meet the standards of a typical resident under Chief Owen Wongenstein. Wiry, with glasses and close cropped hair, Dewal was a born tinkerer. Lillehy took an instant liking to him, and he offered him the only job the department could afford. De Waal left behind his GP work and started as an animal attendant in Lillehei's lab. Months later, when the need for an alternative to cross circulation became apparent, Lillehei brought the problem to Richard de Waal.

[Walt Lillehei]

After a case one day of cross circulation, just talking Dewalt, and he was saying, well, it's obvious that we need a replacement for the donor.

[Jamie Napoli]

That's an archival recording of Dr. De Wall.

[Walt Lillehei]

He said, now if that interests you, then that would be a good project for you to work on in the lab. He gave it to me as an option, but this is Walt's generosity. He didn't force anything on anybody. Neither did Dr. Longenstein. Said, here's an opportunity. Take it. Run with it if you want. If you don't fail.

[Jamie Napoli]

The idea of a heart lung bypass machine was not a new one. As far back as the 1930s, a Philadelphia surgeon named John Gibbon and his wife Mary had been Developing something called a screen oxygenator. In 1935 they used it to bypass a cat's heart for half an hour. But it would take another 18 years and the backing of IBM before their wildly expensive grand piano sized machine was ready for human use. After one successful case and five tragic failures, John and Mary Gibbon abandoned the pursuit for for good. In 1951, a Minnesota surgeon named Clarence Dennis experimented with his own bypass machine based on John gibbons blueprints. A 32 year old Walt Lillehei was in the room when Dennis attempted to fix the damaged heart of two year old Cheryl Judge. Lillehei could see how cumbersome Dennis machine was. It required a team of 16 surgeons, technicians and nurses just to function his heart.

[Walt Lillehei]

Lung machine was very complicated. It weighed about 1,000 pounds and it would fill a one car garage with the pumps and the elaborate system you need to oxygenate blood.

[Jamie Napoli]

In Lillehei's estimation, the more moving parts, the more room for error. But Lillehy was a lowly junior surgeon at the time, so his opinions didn't count for much. Lillehy watched as the technician's error caused the machine to pump air into Cheryl's bloodstream. Similarly to what would happen to Geraldine Thompson three years later. The air bubbles blocked the flow of blood to the girl's vital organs. Within hours, Cheryl Judge was dead. It was Clarence Dennis second attempt at open heart surgery and his second dead patient. It would be years before he tried again. So as Lillehy met with his young protege Richard de Waal, making plans for a new kind of bypass machine, he emphasized simplicity above all else. Lillehgh wanted his machine to be foolproof.

[Walt Lillehei]

So I told Dick we needed a simple oxygenator. Heat, sterilizable, disposable.

[Jamie Napoli]

Every heart lung bypass machine works in essentially the same way. Dark oxygen depleted blood is taken out of the patient before it enters the heart. The bypass machine then, through any number of methods, oxygenates the blood and then returns it to the patient's arteries. Both Gibbons and Dennis machines used rotating discs or cylinders to spread the blood out into a thin film, exposing it to as much oxygen as possible. As a result, their machines needed to be massive. For simplicity's sake, Lillehy opted for a different approach. Bubbles.

[Walt Lillehei]

Dr. Lillehei had a couple of admonitions for me, said well if you're going to work on this project, I suggest you avoid libraries, avoid literature search, because I don't want you to be prejudiced by the mistakes of others.

[Jamie Napoli]

Lillehei may have advised de Waal against library research to help him keep an open mind. But there was another reason as well. Here's Dr. Lillehei again.

[Walt Lillehei]

Bubbling oxygen into blood to oxygenate. It was the one method that every single authority said would not work. Kill everybody with air embolism. Well, I knew this of course, but I didn't tell Dick D Wall.

[Jamie Napoli]

Oxygen bubbles in the bloodstream had killed two year old Cheryl Judge and caused permanent brain damage for Geraldine Thompson. Many experts believed a bypass machine that introduced bubbles into the bloodstream on purpose was a terrible idea. But Dewalt didn't know all that. So he threw himself headlong into the task assigned to him. The prototype that he wheeled into Lillehy's lab early 1955 was a lot smaller than any bypass machine in history. But it didn't exactly inspire confidence.

[Walt Lillehei]

It was kind of a Rube Goldberg type of apparatus.

[Jamie Napoli]

That's University of Minnesota cardiologist Dr. James Moeller.

[Walt Lillehei]

There's a shed of oxygen from an oxygen tank would go into the blood and it bubble up to the top and then there is on debubbilizer chamber which had steel wall there. Then it would go down a tube at about a 45 degree angle, then to a spiral tube and go into the patient. And all that was to oxygenate this blood.

[Jamie Napoli]

De Waal's prototype may have looked complicated, but it was actually quite simple. It created bubbles to oxygenate the blood and then relied on gravity to eliminate those bubbles before returning the blood to the patient's body. It was cheap, easily cleaned and it didn't require a massive team to function. It was this machine that so impressed the hotshot Houston surgeon Denton Cooley, when he paid a visit to Lillehy's lab. First de Waal and then Lillehei tested the bubble oxygenator on groups of lab dogs. When all of the dogs recovered with perfect health, Lillehy was confident he'd finally found his replacement for cross circulation. By April of 1955, he was ready to put the oxygenator to use on a human patient. He found an ideal candidate in a three year old boy from a small coal mining village in New Brunswick, Canada. Little James Robichaw, like many of Lillehei's patients, was born with a ventricular septal defect, a vsd. James parents lacked the means to cover his travel and medical expenses. Fortunately, a charity drive covered the cost of the boy's thousand mile journey from New Brunswick to Minneapolis. Walt Lillehei offered to operate pro bono. On the morning of May 13, Lillehai used his and Richard de Waal's bubble oxygenator to bypass James's heart. Just like all of Their test operations in the animal lab, the surgery went off without a hitch. Lillehei successfully patched the hole in James's heart. After months of rushed hospital visits and health scares, James parents could finally rest easy. Late that evening, the boy's health took a shocking turn. For Lillehei, it felt like Gregory Glidden all over again. When James heart stopped beating, Lillehai and de Waal spent hours trying to resuscitate him. By 4:30 in the morning, there was nothing more they could do. Lillehei made a second attempt with the bubble oxygenator at the end of May. This time the young patient was healthy enough to be discharged after surgery, only to die four days later at home. For many surgeons trying out experimental procedures, failure of this severity might signify the end of the road.

[Walt Lillehei]

We lost patients in those days.

[Podcast Narrator / Jasper AI Advertiser]

We operated on one patient a day and often by Friday night all five patients were dead.

[Jamie Napoli]

That's pioneering heart surgeon Dr. Christian Barnard, who trained under Lillehei in the 1950s.

[Walt Lillehei]

It really took a lot of guts to go back the next week and try again and start over again.

[Podcast Narrator / Jasper AI Advertiser]

And that's one of Dr. Lillehy's fortes.

[Walt Lillehei]

Was the ability to go back after.

[Podcast Narrator / Jasper AI Advertiser]

So much punishment and start again and.

[Walt Lillehei]

Believe in what he did.

[Jamie Napoli]

Lillehy was convinced that the bubble oxygenator was not at fault for the loss of these children. An autopsy revealed that James Robichaw's death was caused by another undiagnosed heart condition. And Lillehy's second patient had blood vessels that had grown out of position. So in July, Lillehy tried yet again. This time he operated on Jesse Weddell, a 22 month old boy from Bayard, Iowa who was born with tetralogy of Fallot. The surgery lasted two hours and required donations of blood from 16 of Jesse's family members and friends. But it succeeded. The bubble oxygenator allowed Lillehei to save Jesse Weddle's life and the life of the patient after him and the one after that.

[Podcast Narrator / Jasper AI Advertiser]

I just feel, I feel blessed that I survived.

[Jamie Napoli]

Dr. Pamela Evans was six years old when Walt Lillehei repaired her VSD using the bubble oxygenator. She says he waited to introduce himself to her family until after the operation.

[Podcast Narrator / Jasper AI Advertiser]

My parents never met him before my surgery and I have no memories of him except after my surgery. I see that as maybe protecting his own soul and in some ways protecting my parents as well.

[Walt Lillehei]

The children on either side of my.

[Podcast Narrator / Jasper AI Advertiser]

Operation both passed away, so I felt very lucky.

[Jamie Napoli]

Before long, Lillehy had abandoned cross circulation forever. Never again would he need to endanger the life of a parent to Save their child. As always, lillehei's success evoked mixed reactions from the medical community.

[Walt Lillehei]

Most people are enamored of complexity, which is one of the things that I've taught all my life. Nobody could figure out how some idiots would devise a bubble oxygenator.

[Jamie Napoli]

Here's Richard de Waal again.

[Walt Lillehei]

Every bend and every curve, every piece had a purpose in it. But if you didn't know what the purpose was, it looked rather strange and peculiar. So you have a lot of people coming in there and they'd look at this and say, well, this is stupid. I can do better than that. They'd have it changed by the time they got on the plane on the way home. And of course, they had disasters in their laboratories.

[Jamie Napoli]

Just like with cross circulation. Lillehgh was again struggling to garner validation for a procedure that was saving lives. In 1957, he found himself at yet another medical conference listening to criticism of his and de Waal's bubble oxygenator.

[Walt Lillehei]

The surgeon, I won't mention his name, had tried this in a laboratory and had disaster after disaster with it. He obviously didn't know what he was doing. And he presented this at a national meeting of very distinguished people condemning quark, which was rather hurtful in its own way.

[Jamie Napoli]

In the conference audience sat a tall 36 year old Texan. During the comments section, the Texan got up and addressed the skeptical crowd with his confident Buckwheat Cooley smile.

[Walt Lillehei]

I still laugh at it. Then Cooley responded, I was at Minnesota. I studied what they did there. I took it home to Texas and Now I have 100 patients that have done well with it. That was the end of the discussion.

[Jamie Napoli]

Two years earlier, during his visit to Lillehei's lab, Denton Cooley had recognized the ingenious simplicity of the bubble oxygenator. After leaving Minneapolis, he and BAYLOR Cardiologist Dan McNamara had traveled 90 miles south to the Mayo Clinic, the only other hospital performing open heart operations. There, a surgeon by the name of John Kirkland had a bypass machine of his own based on the work of John and Mary Gibbon.

[Walt Lillehei]

John Kirkland had this big apparatus which is about the size of the table.

[Jamie Napoli]

You know, that's an archival recording of Denton Cooley.

[Walt Lillehei]

He had a group of cardiologists and physiologists and bioengineering engineers in the operating room and very complicated sort of a setup.

[Jamie Napoli]

And on the way back to Houston.

[Walt Lillehei]

Dr. McNamara said, I'm not going to let you operate on any of my patients until you can duplicate John Kirkland's program there at the Mayo Clinic. There's no way to duplicate that.

[Jamie Napoli]

Kirkland's machine cost upwards of $50,000. Lillehei and de Waal's cost about $30. Adjusted for inflation, that's the difference between half a million and a little over 300. Since Cooley would be financing this project himself, he went for the cheaper option. He enlisted the help of two Baylor medical students and got to work.

[Walt Lillehei]

Within a few months after I got back to Houston, I had my own bubble oxygenator and we took off.

[Jamie Napoli]

Cooley's motto was simplify, modify, apply. He began tweaking the Dewal Lillehai bubble Oxygenator to make it even more cost effective. Most notably, he swapped out its plastic tubing with easily sterilizable stainless steel, earning his machine the nickname Cooley's Coffee Pot. The coffee pot was a stunning success, and Cooley's caseload grew rapidly. It wouldn't be long before it caught the attention of his ambitious and demanding boss, Dr. Michael DeBakey. In addition to running the surgical department at Baylor, DeBakey had spent the last several years jetting back and forth to Washington, D.C. to lobby for medical research funding.

[Walt Lillehei]

I think the goal was to do what he can to make the world a better place. Part of this he could do it in the operating room, and part of.

[Jamie Napoli]

It he could do it in Washington. That's cardiologist Dr. Antonio Gatto, who worked under DeBakey at Baylor. He knew where the power fulcrums were.

[Walt Lillehei]

That turned the engines that he could accomplish more for medicine overall by getting more funding for research or setting up different types of research centers. We had a lot of politicians.

[Jamie Napoli]

We saw this was a golden age for medical research funding. Between 1945 and 1961, the National Institutes of Health budget grew from under $4 million to $460 million. The more DeBakey elevated his public image, the more of a say he had in where that money went. Cooley's daughter, Dr. Louise Cooley Davis, tells a story about the day her father learned DeBakey had scheduled a VSD operation of his own using Cooley's coffee pot. DeBakey wanted to use it in a.

[Podcast Narrator / Jasper AI Advertiser]

Case and hadn't asked my father. So it kind of touched my father's ego that DeBakey would have said, I'm going to use your oxygenator when he had been so unsupportive of it all along.

[Jamie Napoli]

Cooley drove straight to debakey's house to confront him. Despite the fact that Cooley worked for DeBakey, he didn't feel it was right for the surgical chief to confiscate his machine.

[Podcast Narrator / Jasper AI Advertiser]

My father had developed this on his own, not paid for at all by DeBakey, and had not gotten any support from DeBakey. So my father said, no, you can't use my coffee pot.

[Jamie Napoli]

It was the first real crack in the two men's relationship. In the coming years, that crack would grow until it left its mark on the entire field of cardiac medicine. After blocking DeBakey's attempt to use the bubble oxygenator, Cooley continued to do what he did best. He fixed hearts. In 1957 alone, he performed 177 open heart operations, about three times more than Walt Lillehei and John Kirkland combined. So when Cooley stood up at a medical conference to defend Lillehy and announce his own unprecedented success, he gave the Dewal Lillehgh bubble oxygenator all the validation it needed. Soon it was being mass produced, bringing open heart surgery to hospitals all across the world. That was thanks in part to another of Lillehgh's trainees, Dr. Vincent L. Gott, who worked with De Waal to simplify the design even further.

[Walt Lillehei]

They developed the Dewal Lillehye Bumble Oxygenator into a sheet of plastic, which is the same principle, but it could be manufactured commercially, shipped sterile, and hung up and primed and ready to go. And we patented that. He was patented. University of Minnesota.

[Jamie Napoli]

If heart surgery were a picnic, Denton Cooley would later say, Walt Lillehei brought the can opener.

[Podcast Narrator / Jasper AI Advertiser]

This show is about modern mavericks, risk takers, builders and rule breakers pushing new frontiers. At Jasper, we know that spirit we're doing for marketing what these cardiac cowboys did for medicine. Throwing out the old playbook and building something radically better. Jasper is the agentic content automation platform that helps marketing teams move fast and stay in control. Whether you're launching a product, optimizing web content for LLMs, expanding campaigns into new markets, or scaling audience personalization, Jasper gives your team a repeatable, intelligent system for orchestrating content at scale. Unlike generic AI tools, Jasper doesn't just write with structured workflows, brand safe automation, and built in intelligence that understands your voice, audience and goals. Jasper replaces scatter tools and disconnected processes with one seamless content pipeline. It's already helping thousands of teams reduce production time, cut agency costs, and publish more content that's actually on brand. If you're a marketing leader looking to transform how your team works or just trying to keep up with the pace of change, check out Jasper AI. That's Jasper AI.

[Jamie Napoli]

No matter how great his achievements or how many lives he saved, Lillehy was haunted by the ones he couldn't. And no failure was more excruciating to him than the tragedy of Geraldine Thompson. At the U.S. courthouse in Minneapolis. Lillehei watched from the defense table as the 33 year old mother of four approached the witness stand. She'd lost weight. Her sister testified that in the year since the failed VSD operation that resulted in Geraldine's permanent brain damage, she'd dropped from 110 pounds to just 79 pounds. She couldn't walk without dragging her left foot. She'd lost most of the use of her left hand, and she struggled to answer basic questions like what were the ages of her four children? Geraldine required around the clock care, and her husband said that the bills had exhausted their savings. Lillehy wanted the Thompsons to be made whole, but the hospital was offering less than a tenth of the family's demands, so a settlement was out of the question.

[Walt Lillehei]

He really did feel like money doesn't solve problems, but to try to give some compensation, that, yeah, he was all for it.

[Jamie Napoli]

That's Walt Lillehei's son, Dr. Craig Lillehei.

[Walt Lillehei]

He really did feel like, yes, sue and win. You deserve those monies.

[Jamie Napoli]

But the Thompsons lawyers struck to win over the jury. They were taking on a world famous doctor in his home city. Worst of all, according to Walt Lillehei, they didn't correctly identify the anesthesiologist who was responsible for the error. Here's Dr. Walt Lillehei again.

[Walt Lillehei]

He was the real culprit, but he never was even named in the suit. I don't think they ever understood what happened.

[Jamie Napoli]

After hearing two weeks of testimony, the jury was deadlocked 9 to 3 in favor of Lillehei's team. The judge dismissed the case. It was the worst possible outcome for all parties. The Thompsons were left without a dime to cover the lifetime of medical care Geraldine would require. The hospital's reputation was sullied by the damning front page press coverage. And Lillehy would never rest easy knowing that a family that had suffered under his watch would be taken care of. Now that his bubble oxygenator was being mass produced, Lilai hoped that tragedies like that of Geraldine Thompson were behind him. But even as he performed open heart operations at an unprecedented rate, a troubling pattern emerged.

[Walt Lillehei]

10% of the ventricular defect closures developed heart block. And the first 70 cases, we had seven heart blocks. All of those seven died. And that was a devastating complication to us.

[Jamie Napoli]

Heart block is a disruption in the heart's electrical system after a VSD repair. Lillehei found that some of his his patients hearts refused to return to their normal rhythms or to beat at all. The only options available in 1957 were to administer a shot of adrenaline or to manually massage the heart. Neither of them was particularly effective.

[Walt Lillehei]

I knew nothing about it. Very few cardiologists knew anything about it. And we just shrugged our shoulders and hope for the best. Patients were doomed to death in those early days.

[Jamie Napoli]

In the 1950s, heart surgeons experienced the death of a patient on a weekly, sometimes daily basis. But that didn't make it any easier to cope with. Here's Dr. Craig Lillehei again.

[Walt Lillehei]

In those days, you know, the mortalities were astronomical. But as you were pushing the frontier, that's the baggage that you took along. Dad didn't really share his disappointments with his kids. He never bared his soul about how that hurt.

[Jamie Napoli]

But I know it hurt. Walt Lillehei often didn't want or didn't know how to talk about his failures to his wife, Kay. He could be a locked vault for Lillihill. The only way to talk about problems was in the context of solving them.

[Walt Lillehei]

Well, we used to have Saturday morning conferences in this hospital about patient outcomes as you learn from your mistakes better than you learn from your accomplishments. And one day we were discussing an infant had died of heart block, and the physiology chief suggested, you know, we have an instrument in our laboratory called a grass physiological stimulator. He said, one of our student sessions is stimulating the hearts of frogs and so on. Takes only one or two volts. Well, that was a revelation, at least in my head.

[Jamie Napoli]

Lillehy was familiar with the work of cardiologist Paul Zoll, who resuscitated a patient's heart by delivering high voltage electrical shocks using metal paddles and leaving terrible burns on the patient's skin. With that in mind, Lillehy tasked the young Dr. Gott with studying the low voltage grass stimulator for human use. If Lillehy's theory was correct, the small electrical pulses the machine put out might just make it possible to pace a patient's heart back into rhythm. Here's an archival recording of Dr. Gott. In January of 1957, Dr. Lillehyde called down to the lab and said, I've got a patient here in heart block. Did you bring up the grass stimulator? The stimulator was about the size of a small microwave, and with its many knobs and switches, it looked like something you might see in an old submarine control room. With the patient's chest still open from surgery, Lillehy could run the leads directly into her heart. There were a thousand for this to go wrong, but as Lillehei liked to say, ready, fire, aim. Derek Lillehei put in the wire in the myocardium in the skin, and sure enough, that patient did fine. And just like that, the modern pacemaker was born. Lillehei continued to use the grass stimulator to pace patients with heart block. But the machine could be cumbersome.

[Walt Lillehei]

They had to be plugged into the 110 voltage and the patient in heart block couldn't go for any time at all without stimulation. So they couldn't go down to X ray, they couldn't go to the lab unless you strung a wire.

[Jamie Napoli]

When patients needed to be moved around the hospital, nurses would run numerous extension cords end to end. Down the hall, here's nurse Sia Bowman.

[Podcast Narrator / Jasper AI Advertiser]

Moving a child with the temporary pacemaker to another bed or to the sun room to sit in the sun. They would have a group of about 10 people moving this plug down the hall, space by space. That was suggested by one of the nurses and it became sort of a routine. It was just this whole thought that we're in this together and we're going to find a solution to help these children. This show is about modern mavericks, risk takers, builders and rule breakers pushing new frontiers. At Jasper, we know that spirit we're doing for marketing what these cardiac cowboys did for medicine. Throwing out the old playbook and building something radically better. Jasper is the agentic content automation platform that helps marketing teams move fast and stay in control. Whether you're launching a product, optimizing web content for LLMs, expanding campaigns into new markets, or scaling audience personalization, Jasper gives your team a repeatable intelligent system for orchestrating content at scale. Unlike generic AI tools, Jasper doesn't just write. With structured workflows, brand safe automation, and built in intelligence that understands your voice, audience and goals. Jasper replaces scatter tools and disconnected processes with one one seamless content pipeline. It's already helping thousands of teams reduce production time, cut agency costs and publish more content that's actually on brand. If you're a marketing leader looking to transform how your team works or just trying to keep up with the pace of change, check out Jasper AI. That's Jasper AI.

[Jamie Napoli]

On Halloween 1957, there was an explosion at the main plant of the Northern States Power Company. It triggered a massive blackout across the twin cities of Minneapolis and St. Paul. For two and a half hours, the University hospital and the lives of its young patients whose hearts required constant electrical stimulation were dependent on emergency power. Thankfully, all of those patients survived. But for Walt Lillehei, the urgent need for a battery powered pacemaker had become clear. In 1957, there was a young and ambitious electrical repairman working at the hospital by the name of Earl Bakken. Just like Lillehei, Bakken was fascinated by the way things were as a kid. He built a Taser to fend off schoolyard bullies and a multimeter device to measure the passion of a kiss, which he called the Kiss O meter. Naturally, Lillehei felt a close kinship to Bakken.

[Walt Lillehei]

Electricians absolutely refused to come in the operating room when an operation was in progress. They said it was not part of their contract. Earl Bakken came over for every open heart operation. He was that first and last person as far as I was concerned.

[Jamie Napoli]

After the blackout, Lillehgh assigned Bakken the task of building the first battery powered pacemaker. Bakken worked on the problem during his off time from the hospital, testing various designs in the garage where he and his brother in law ran their electronics repair business. It was an unheated garage in Minnesota. That is quite an achievement as you can imagine. That's Adrian Fisher, curator of exhibits and collections at the Bakken Museum. The toilet, I think was a coffee can. In the very early days they were repairing radios and TVs just to make ends meet.

[Walt Lillehei]

A big client for them was the.

[Jamie Napoli]

Heart hospital at the University of Minnesota. Bakken drew his first sketch of a working pacemaker on the back of a memo from a medical device company. His inspiration came from a Popular Electronics magazine article. He remembered seeing in a magazine from 56 a transistorized circuit sketch of a metronome. The transistor was invented shortly before that. And so he pretty much used that circuit sketch and put it in a box. Less than two months after getting his assignment, Bakken returned to Lillehy's office with a four and a half inch square box. And Lillehei wasted no time in putting it to use. He tested the device on a dog for only a few hours before implanting it in a young patient with heart block. The portable pacemaker was an immediate success. Bakken began selling the device to surgeons outside of the U of M, some of whom had previously denied the existence of heart block.

[Walt Lillehei]

I won't name any names, but I can recall several well known surgeons telling me that they never had heart block. I'd seen it and I find out that they were not only ordering a good supply of pacemakers, but a number of electrodes.

[Jamie Napoli]

The pacemaker would continue to be refined in the coming decades, becoming smaller, fully implanted and powered by long lasting lithium batteries. Today, more than a million pacemakers are implanted every year. Earl Bachelor Hawkin and his brother in law's garage repair company kept the patent on their invention. They called themselves Medtronic. Medtronic is now one of the largest medical device companies in the world, worth over $100 billion. Walt Lillehei, who'd never been very good with money, was one of their first Invest. As the 1950s neared its end, Lillehy was at the apex of his creative genius and his career. He'd already outlived his prognosis and his no tomorrow approach to life had paid off. He was living and working at full tilt. It wouldn't be long before he lost control.

[Chris Pine]

On our next episode, surgeons across the country raced to transition transplant the human heart. The stakes are unimaginably high. Rivalries turn vicious, and the first surgeon to cross the finish line shocks the world. Next time on Cardiac Cowboys.

[Jamie Napoli]

Cardiac Cowboys is a production of I Heart Podcasts, oso Studios and 13th Lake Media. We're presented by Chris Pine and written and narrated by me, Jamie Napoli. Our executive producers are Christina Everett for iHeart Podcasts, Dub Cornette and Jason Ross for OSO Studios. Dr. Gerald Imber, author of Cardiac the Heroic Invention of heart surgery Dr. Dr. Eric A. Rose, John Mankiewicz, Joshua Paul Johnson, and myself. James A. Smith is our supervising producer. Editing and sound design by Joshua Paul Johnson. Our composer is David Mansfield. Our cover artwork is designed by Alexander Smith. Archival materials courtesy of the University of Minnesota Archives, University of Minnesota, Twin Cities Special Collections, University of Rhode Island Library and G. Wayne Miller, author of the Walt Lillehei biography King of the True Story of the Maverick who Pioneered Open Heart Surgery. For more information on the first cardiac surgeons, check out Dr. Gerald Imber's book, Cardiac the Heroic Invention of Heart Surgery.

[Chris Pine]

SA.