Cardiac Cowboys: "The Fates of the Cowboys"

Episode 6 | September 29, 2025 | Hosted by Chris Pine

Episode Overview

This episode of Cardiac Cowboys dives into the turbulent later years of Dr. Walt Lillehei—the pioneering “father of open heart surgery”—and the fates of his fellow “Cowboys” who revolutionized cardiac care in mid-20th-century America. The narrative charts Lillehei’s professional triumphs, personal excesses, fall from grace (culminating in a tax fraud conviction and professional disgrace), and the parallel destinies of other cardiac pioneers like Michael DeBakey, Denton Cooley, Norm Shumway, and Christiaan Barnard. It’s a deeply human exploration of ambition, rivalry, invention, and the heavy toll of breaking medical frontiers.

Key Discussion Points and Insights

1. Lillehei on Trial: The Fall of a Giant

[00:35–04:55]

• Setting: February 16, 1973, St. Paul, Minnesota. Dr. Walt Lillehei stands trial for tax fraud—a shocking turn for a man regarded as a medical savior.
• The Charges: Five counts of tax fraud, each punishable by up to five years in prison and hefty fines. Sensational details (including accusations from women from his personal life) surface, humiliating Lillehei and his family.
• Quote: “They wanted to indict me as a felony. I committed a felony.” — Dr. Walt Lillehei [01:30]

2. The Rise: Lillehei’s Golden Era

[04:55–08:18]

• By the late 1950s, Lillehei had led over a thousand open heart operations. His inventions (like the bubble oxygenator) saved countless children with heart defects.
• Influence: Created revolutionary procedures for Tetralogy of Fallot; co-developed the portable pacemaker.
• Global Appeal: Surgeons worldwide, regardless of race or religion, flocked to train at the University of Minnesota under his guidance.
• Quote: “A lot of people of all colors and religions came to the University of Minnesota to learn about heart surgery.” — Dr. Walt Lillehei [06:06]

3. Maverick Lifestyle and Looming Problems

[07:29–14:42]

• Lillehei’s penchant for risk didn’t stop in the OR—he led a fast, reckless personal life, including heavy drinking, womanizing, and thrill-seeking.
• Notable Story: Crashed his speedboat at full speed, injuring his wife, Kay; their house caught fire soon after. [14:14–15:46]
• Reflection: Even as his innovations brought glory, his wild side began to spiral out of control.

4. Betrayal and Professional Displacement

[08:40–17:59]

• Passing Over: When University of Minnesota’s surgical chief retired, Lillehei (the obvious successor) was rejected by an unsympathetic administration who saw him as "uncontrollable."
• Quote: “The dean of the medical school had gone on record as saying, ‘Walt Lillehei is uncontrollable. He’s a drunk and a womanizer…he’ll become chairman over my dead body.’” — Dr. Craig Lillehei recounting university sentiment [11:41]
• Retaliation: When replaced by Dr. John Najarian, Lillehei and his team covertly moved their lab equipment to New York, leaving behind a single rose in protest. [17:40–17:59]

5. The Cornell Years: Out of Place and Out of Time

[19:23–25:46]

• New Frontier: At Cornell in NYC, Lillehei’s diverse, unorthodox team stood out in a conservative (and discriminatory) environment.
• Pioneering Surgery: Oversaw groundbreaking multi-organ transplants, but his failing eyesight—hastened by prior cancer treatments—undermined his capacity to operate at the highest level.
• Professional and Personal Unraveling: His behavior became even more erratic, and public scandals mounted. He used a Playboy centerfold in a medical lecture—a sign of disregard for norms. [22:52]
• Colleague’s View: “When you reach a point when a man is professor of surgery and the residents feel they have to send a senior resident in the room with him so he doesn’t hurt someone, things are bad.” — Dr. Daniel Gore [24:27]

6. Financial and Legal Ruin

[25:46–30:21]

• Incompetence, Not Malice: Decades of financial neglect (misfiled receipts and shoeboxes full of unsorted bills) led to federal charges and humiliation.
• Quote: “Knowing Walt as well as I did, I really don’t think he intentionally avoided paying income taxes… He just didn’t care about it. This was his mentality at the time: Live today for the important things. If you don’t think it’s important, forget about it.” — Dr. Richard de Waal [26:37]
• The Verdict: Guilty on all counts. Medical licenses revoked; career in tatters. [28:10]
• Emotional Impact: His son Craig recalls, “Dad was low… you could tell that it was a low point. He felt badly about it.” [30:03]

7. End of the Cowboy Era: Succession, Redemption, and Changing Times

[30:21–43:31]

• Lillehei’s final operation is unceremonious; he quietly retires due to worsening cataracts.
• The world of cardiac surgery evolved: transplantation almost halted in the 1970s until cyclosporine (an immunosuppressant) arrived, reviving the field.
• Shifting Paradigms: Surgery moved from solo heroics to a disciplined, team-based, and highly regulated practice.

8. The Other Cowboys: Triumph, Feuds, and Legacies

[33:33–42:03]

• Norm Shumway: Persevered through transplantation’s dark period, credited for heart transplant’s modern legitimacy.

• Christiaan Barnard: Achieved global fame but ended bitter, dogged by sensational media coverage and personal missteps.

• Denton Cooley: Set records for open-heart operations; awarded highest civilian honors; enjoyed a long, celebrated career.

• Michael DeBakey: “Maestro" and “Texas Tornado,” an architect of American healthcare, personal physician to presidents. Famously feuded with Cooley, reconciled only in their late nineties.

  • Memorable Moment: “I'm glad our feud is over,” Denton Cooley said. DeBakey replied: “Denton, we never had a feud.” [40:00–40:31]

9. Recognition and Reflection

[40:31–42:59]

• Lillehei is shunned at a major professional conference before Dr. John Kirkland, a respected peer, publicly credits him as “one of the great pioneers,” inviting a standing ovation and belated redemption.

• Quote: “He was viewed very much as a pariah in cardiac surgery, and boy, that had been his life.” — Dr. Craig Lillehei [40:50]

• The episode closes with ruminations on the mortality, sacrifice, and courage—not only of the surgeons but also of the patients and their families, whose willingness to risk everything was as crucial as any invention.

  • Quote: “The history of open heart surgery is written on death certificates and headstones. It is the history of dying patients and their desperate families… So when we tell the story of the Cardiac Cowboys, we're speaking not only of the bold surgeons who pioneered a new field. We're talking about… the thousands of other families who signed up to be first, who took on all the risk, knowing that even if they did not survive, their hearts would change the world.” — Narrator [43:57]

10. Curtain Call: The End of an Era

[42:59–end]

• Surgeons today are likened to commercial airline pilots—skilled, but supported by a system, not flying solo as “fighter pilots.” The era of cowboy genius is over, replaced with teamwork and oversight.
• Quote: “There's no way you could experiment this way in any hospital and get away with it… this was in the mid 20th century and medicine was truly marching forward. People took chances and people died. But in the long run, lots of people lived.” — Dr. Gerald Imber [43:33]

Notable Quotes & Memorable Moments (with Timestamps)

• Lillehei acceptance of risk and his own mortality:
  “He liked thrills, you know, because by rights, he had no right to even be alive.” — G. Wayne Miller [07:59]

• On his downfall:
  “It's as if you're saying Joe DiMaggio wanted to be a batting coach, but we're not going to give him the job.” — Walt Lillehei [11:33]

• Professional sabotage and defiance:
  “They left a vase with a single rose in the center of the lab and the rest of the place was cleared out. Some might characterize it as thievery, but whatever it was that did happen, Lillehei… hadn’t lost his flair for the dramatic.” — Dr. Craig Lillehei / Narrator [17:59]

• On Lillehei’s failed attempts at administration:
  “Committee meetings are endless. All these little problems… so and so is not getting along with so and so and would you speak to this person or that person?” — Walt Lillehei [22:05]

• On the evolution of heart surgery:
  “I think being a heart surgeon is more like being an airplane pilot in a commercial airline… heart surgery now is a team sport.” — Dr. Eric Rose [43:05]

• The closing tribute to patients and families:
  “The history of open heart surgery is written on death certificates and headstones… when we tell the story of the Cardiac Cowboys, we're speaking not only of the bold surgeons who pioneered a new field. We're talking about… the thousands of other families who signed up to be first...” — Narrator [43:57]

Timestamps for Key Segments

• 00:35–04:55: Lillehei’s trial and the start of his public downfall
• 04:55–07:59: Lillehei’s medical breakthroughs and celebrity status
• 08:18–14:42: Recklessness and personal crisis escalate
• 11:01–17:59: Professional setbacks and departure from Minnesota
• 19:23–25:46: New York years, transplant milestones, personal decline
• 25:46–30:21: Trial, conviction, consequences
• 30:21–33:33: End of Lillehei’s surgical career
• 33:33–42:03: The destinies of other ‘Cowboys’ and the transformation of medicine
• 42:59–end: Reflections on legacy and the unsung patient pioneers

Final Thoughts

This episode blends archival audio, candid interviews, and evocative narration to illuminate not only the monumental achievements—and tragedies—of revolutionary surgeons, but also the overlooked sacrifices of patients and families whose courage made history. The “Cowboys” changed cardiology forever, but their human stories—of rivalry, excess, struggle, and, ultimately, gratitude—resonate far beyond the operating room.

For more insight, read Dr. Gerald Imber's "Cardiac: The Heroic Invention of Heart Surgery".