The Fates of the Cowboys

Summary

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".

Transcript

[Walt Lillehei]

This is an iHeart podcast.

[Jasper AI Narrator]

This podcast is about bold moves, the kind that change everything. At Jasper, we bring that same energy to the way marketing teams work. Jasper is the agentic content automation platform used by thousands of marketers to streamline how content gets created, reviewed and shipped. From global campaign launches to SEO and GEO to multi language localization, Jasper helps teams create better content faster and at scale. It's not just AI for writing, it's an engine for modern marketing execution. Start building scaled content pipelines lines at Jasper AI. That's Jasper AI.

[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. It's February 16, 1973. An icy wind cuts through the concrete and stone buildings of downtown St. Paul, Minnesota. Reporters bundled in heavy coats are gathered at the US Courthouse. After a day of deliberation, the jury has reached a verdict in the case of the United States v. Lillehei. The courtroom is packed. Everyone is waiting for the defendant to arrive.

[Walt Lillehei]

They wanted to indict me as a felony. I committed a felony.

[Chris Pine]

That's Dr. Walt, Lili.

[Walt Lillehei]

There's two things I could do. Plead guilty completely or resist it and go to trial.

[Chris Pine]

Over the previous four and a half weeks, Lillehai has spent nearly every weekday in this very courtroom as the U.S. attorney for the District of Minnesota argued for his conviction on five counts of tax fraud. For each count, Lillehai faces up to five years in prison and $10,000 in fines, in addition to $125,000 in back taxes.

[Walt Lillehei]

I couldn't work other than make me write something at all hours, but I had to be there. It was one of the most difficult periods of my life.

[Chris Pine]

The prosecution has introduced more than 6,000 exhibits into evidence and produced 164 witnesses. These include members of Lillehai's staff, his former patients, and women who claim to have had intimate relationships with him, one of them while working as a sex worker. Lillehai's wife, Kay, has avoided the trial, taking an extended trip away from the Twin Cities for much of the previous month. But it did her little good. Newspapers, from the Honolulu Star Bulletin to the New York Times, have printed all the sensational and humiliating details that have emerged in trial. Over an hour after the jury reached its decision, Lillehy arrives at the courthouse. He's 54 years old. The fact that he is still breathing is a miracle. Two decades have passed since he was handed a death sentence in the form of a lymphosarcoma diagnosis. In the intervening years, his neck has grown increasingly crooked. Just keeping his head upright has become a feat of strength and focus. He looks older, worn down by long hours and little sleep, but his deep set blue eyes remain as piercing as ever. He stands at the defense table and stares straight ahead, inscrutable, waiting for the court clerk to announce the jury's decision. Walt Lillehei is the father of open heart surgery, a doctor whose contributions to humanity are incalculable. Whatever the verdict, those present in the courthouse can't help but wonder how this could have happened, how such a great man could have been brought so low, and how much farther he has left to fall. From OSO Studios, this is Cardiac Cowboys, a podcast about life, death and innovation in the American Heartland. Episode 6 the Fates of the Cowboys here's writer and executive producer Jamie Napoli.

[Narrator / Documentary Voice]

BEFORE the 1950s came to a close, Walt Lillehy had revolutionized cardiac surgery several times over. Doctors across the country were using modified versions of his and Richard de Waal's bubble Oxygenator to save the lives of children born with deadly heart defects. Life threatening conditions like Tetralogy of Fallot were now treatable with surgical procedures Lillehei invented. Thanks to Lillehy and Medtronic founder Earl Bakken, the deadly condition of heart block could now be corrected with a portable pacemaker. And Lillehy was just getting warmed up. By the end of 1957, he and his team at the University of Minnesota had performed over 400 open heart operations, more than any other surgical team at that time. By September 1960, they'd passed 1,000. On top of his breakneck surgery schedule, Lillehy was constantly on the road, introducing his cutting edge ideas to heart surgeons around the world. And as his reputation grew, the world came to Lillehei.

[Walt Lillehei]

A lot of people of all colors and religions came to the University of Minnesota to learn about heart surgery.

[Narrator / Documentary Voice]

That's U of m Cardiovascular surgeon Dr. Sarah Shumway.

[Walt Lillehei]

Walt had learned a lot during the war about integration, and he really took it to heart. Surgeons from England and India and throughout Europe would come and spend a year at the University of Minnesota. In those days you had to get your BIA been in America.

[Narrator / Documentary Voice]

In 1957, Lillehgh was named Minnesota's man of the Year by the United Press. Former President Harry S. Truman personally congratulated Lillehgh and his team when they were honored with the Lasker Award, often referred to as the American Nobel Prize for Achievement in Medical Research. Despite his practice of donating all of the patents for his inventions to the University Lillehgh was making money more than he'd ever imagined. He and Kay moved their family of six into a beautiful stone house designed by an acclaimed St Paul architect. Lillehy drove to the university hospital in a Jaguar xke, and on weekends, the family would ride up and down the Mississippi river river in one of their new power boats.

[Walt Lillehei]

He would speed in it. I mean, you know, who does that, right?

[Narrator / Documentary Voice]

That's G. Wayne Miller, author of the Lillehai biography, King of Hearts.

[Walt Lillehei]

I mean, could you imagine a chief of surgery today, you know, like at Mass General or the Cleveland Clinic, driving around a speedboat, partying, drinking, driving, you know, up a major river?

[Narrator / Documentary Voice]

While many surgeons slowed down on their drinking and partying as they settled into middle ages, Lillehei remained as voracious as ever.

[Walt Lillehei]

Walt liked to have a good time. He liked to laugh. He liked to drink. He liked women. He liked music. He liked thrills, you know, because by rights, he had no, no right to even be alive.

[Narrator / Documentary Voice]

As always, Lillehei lived like there was no tomorrow. And thanks to his continued success and the watchful presence of surgical chief Owen Wongenstein, Lillehy rarely faced consequences for his questionable behavior. In 1966, at a meeting of the American College of Cardiology, Lillehei was elected as the organization's president.

[Walt Lillehei]

Dr. Seawald Milahi.

[Narrator / Documentary Voice]

The old generation that had once called him a cowboy and a criminal had finally aged out. After years of working on the margins, fighting for legitimacy within the nascent field of cardiac surgery, Lillehal wasn't just accepted by his peers. He was chosen as their leader. That same year, surgical chief Owen Wongenstein made an announcement that would mark a seismic shift at the University of Minnesota and in the life of Walt Lillehyde.

[Walt Lillehei]

As Wong and seen approached 70, he was no longer able to do actual surgery. And he decided it's time to retire. And for Lillehai, that was unthinkable.

[Narrator / Documentary Voice]

That's medical historian and plastic surgeon Dr. Gerald Ember.

[Walt Lillehei]

Walt Ilahi never knew anyone as chief of surgery other than Owen Wangenstein. The North Star was was always Wongenstein. He brought something to surgery that was very rare. He was a scientific surgeon.

[Narrator / Documentary Voice]

Wangenstein had run the department for nearly four decades. In that time, the U. Of M Had been transformed from a largely unknown medical institution to the cardiac center of the world, rivaled only by the Baylor College of medicine, where Michael DeBakey and Denton Cooley reigned in Houston.

[Walt Lillehei]

We sort of changed the nature of the training of surgeons.

[Narrator / Documentary Voice]

That's an archival recording of Dr. Owen Wongenstein.

[Walt Lillehei]

Most people have learned surgery on the operating room. We taught our surgeons in the experimental laboratories.

[Narrator / Documentary Voice]

Walt Lillehei embodied Wangenstein's ideal, equal parts inventor and technical surgeon.

[Walt Lillehei]

When Wangenstein decided to retire, he was going to pass the mantle to Walt Lillehei. Walt put the University of Minnesota on the map. It seemed natural. But the only person who thought it was natural was Wangenstein.

[Narrator / Documentary Voice]

Here's Walt Lillehei again.

[Walt Lillehei]

The search committee was loaded against Wallenstein. They didn't want somebody that's so aggressive and forceful, independent. They said they didn't want another wellness team.

[Narrator / Documentary Voice]

Lilleheim may not have been a natural fit for the administrative role. He didn't enjoy his academic duties at the U of M Medical school. He was notoriously bad with paperwork, and he could barely manage his own office, let alone an entire department. But he was the undeniable star of the university hospital, according to Lillehei, Although he expressed interest in Wangenstein's job, even writing a letter to the dean laying out his plans for the department, he wasn't even granted any interview.

[Walt Lillehei]

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.

[Dr. Craig Lillehei]

It's.

[Walt Lillehei]

It's crazy. The dean of the medical school had gone on record as saying, walt Lilly is uncontrollable. He's a drunk and a womanizer, a scare chaser, and he'll become chairman of department over my dead body.

[Narrator / Documentary Voice]

Instead of promoting a surgeon from within the department, the selection committee looked elsewhere. In early 1967, they settled on a young surgeon from the University of California, San Francisco, who specialized in transplants of the abdominal organs. Dr. John Najarian may have lacked Walt Lillehy's fame and experience, but he was imposing in his own Way. At 6 foot 4, 250 pounds, Najarian had once turned down an offer to play pro football for the Chicago Bears. On June 1, 1967, Najarian arrived at the U of M for his first day on the job.

[Walt Lillehei]

When he got here and became chief, he was horrible.

[Dr. Craig Lillehei]

That's Walt Lucas.

[Walt Lillehei]

He took credit for everything, for all of the cardiac surgery. He would always make the announcement to the newspaper, but anything went wrong. Then there was a spokesman for the hospital, exact opposite of Augustine, that was very obnoxious, very distasteful.

[Narrator / Documentary Voice]

According to cardiac surgeon Dr. Chip Bowman, it's possible that Lillehy didn't give Najarian a fair shake.

[Chris Pine]

I think those probably are two of.

[Walt Lillehei]

The biggest egos I've ever seen in my life.

[Narrator / Documentary Voice]

Najarian was doing groundbreaking work, too.

[Walt Lillehei]

I think they just were envious of one another.

[Narrator / Documentary Voice]

Lillehy was devastated at being passed over. He didn't lash out or explode. True to form, he ignored the blow to his ego and pressed on with his work. But Lillehai had spent a lifetime damning up his disappointments and frustrations. Now the dam was beginning to burst.

[Walt Lillehei]

I think the wild part of Walt at that point became uncontained.

[Narrator / Documentary Voice]

That's author G. Wayne Miller again.

[Walt Lillehei]

The thrill seeking and the not caring and the having fun and the calamities exemplified the wildness going uncontained.

[Narrator / Documentary Voice]

That summer, Walt Lillehai and his wife Kay, were driving their power boat back from dinner with friends.

[Dr. Craig Lillehei]

Coming back on the St. Croix river, driving at night and driving fast.

[Narrator / Documentary Voice]

That's Walt and Kay's son, Dr. Craig Little.

[Dr. Craig Lillehei]

High mom, who knew the river, she spent much more time on it, had just stood up and said, walt, I think there's a sandbar up here. He hit it full tilt, and mom was launched into the dashboard. She had multiple facial injuries. Dad and a boat. That wasn't a great combination.

[Narrator / Documentary Voice]

Kaye remained in the University Hospital for 10 days as doctors performed reconstructive surgery on her face. On another day that summer, the Lilleha's beautiful new house caught fire. No one was injured, and the house was saved from destruction. But many of the family's possessions, including Walt Lillehy's slides and financial records, were damaged or destroyed. Years later, Kay would look back on that summer as a series of painful memories. Here's an archival recording of Kay Lillehyde.

[Walt Lillehei]

It was not a pleasant time. That was the year I had my accident and our house burned. It's funny, somebody gave me a Christmas pipe that year. I think I dropped it or something. But I keep it. And it's shipped. It's the one that's got the date out of it, 1967.

[Narrator / Documentary Voice]

Not long after Najarian took over at the U of M, Lillehy announced that he would be leaving his alma mater to run a surgical department of his own at the New York Hospital Cornell Medical Center. Cornell was precisely the kind of conservative Ivy League establishment Lillehy had spent his career squaring off against. This new job would bring him the prestige and the paycheck that he deserved. In turn, he'd bring Cornell into the new frontier of cardiac surgery.

[Walt Lillehei]

We went to New York, we ducked his houses out a long ways, and I had just been in a very bad accident, so I really wasn't kind of worth it. Anyhow, I didn't want to go.

[Narrator / Documentary Voice]

It had been a hell of a summer for Kay a hell of a marriage. In fact, her husband may have been a genius, but he was not an easy man to be married to.

[Walt Lillehei]

I did spend a lot of time in clinical and research, so it wasn't much time. I don't know why my wife stuck with me.

[Narrator / Documentary Voice]

In the end, Kay decided that she and the kids would stay behind in St. Paul. As Lillehei's final day at the U of M approached, a dispute arose regarding the equipment that filled his laboratory. Lillehei wanted to bring his lab resources with him to New York.

[Dr. Craig Lillehei]

Dad felt they were his. They were bought on his grants.

[Narrator / Documentary Voice]

That's Dr. Craig Lillehei again.

[Dr. Craig Lillehei]

Well, the university felt otherwise.

[Narrator / Documentary Voice]

To prevent him from taking anything out of the lab unnoticed, Najarian had the equipment inventoried. Before he left Minnesota, Lillehy and his team rented moving vans and under cover of darkness, drove them to the university.

[Dr. Craig Lillehei]

What they did is they loaded all the stuff into the U Haul trucks and drove them to New York. Clearly, this was done off hours because no one was around.

[Narrator / Documentary Voice]

When Najarian arrived at work the following day, he'd be enraged to find Lillehy's lab completely empty, except for one thing.

[Dr. Craig Lillehei]

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, Lillehy.

[Narrator / Documentary Voice]

Hadn'T lost his flair for the dramatic.

[Jasper AI Narrator]

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.

[Narrator / Documentary Voice]

You arrived in New York in the fall of 1967. Striding through the hospital with his entourage of cowboy surgeons, Lillehei turned heads from the start.

[Walt Lillehei]

He brought with him 17 people on his staff and they included whites, blacks, Jews, Hindus, Japanese, everybody.

[Narrator / Documentary Voice]

That's Dr. Gerald Ember again, because they're.

[Walt Lillehei]

All people that Walt and Weinstein thought was smart or had good ideas and they stood out like a sore thumb. In New York Hospital in, you know, in 1967, which was an exceedingly WASPy enclave at the time.

[Narrator / Documentary Voice]

Early in his tenure at New York Hospital, Cornell Medical Center, Lillehei did exactly what he was hired to do. He worked on the cutting edge, making history and headlines along the way. In December, the world's first successful human heart transplant was performed in Cape Town, South Africa. The procedure had been pioneered by two of Lillehy's trainees, Christian Barnard and Norm Shamway. In June of the following year, Lillehy himself entered the heart transplant arena. His fourth transplant in February of 1969, was a landmark operation in its own right. Lillehy's team removed not just the heart, but also the liver, kidneys and corneas from a single donor and transplanted them into six different recipients, extending the lives of four patients and giving sight to two others. On Christmas Day 1969, he transplanted a new heart and lungs into a 43 year old new Jersey man who was dying of emphysema. This was only the second heart lung transplant in Denton. Cooley, down in Houston, had gotten there first. But try as he might to stay out ahead in the heart race, Lillehy had lost a step.

[Walt Lillehei]

He at that time, was losing his vision.

[Narrator / Documentary Voice]

That's an archival recording of cardiothoracic surgeon and Lillehei trainee, Dr. Richard de Waal.

[Walt Lillehei]

I think the radiation that he had had and cataracts and so on, so that he really couldn't see to operate.

[Narrator / Documentary Voice]

In yet another way. Lillehy found himself debilitated by the aggressive cancer treatment he'd undergone two decades earlier. His ability to operate was under threat. And yet operating was the only thing Lillehei enjoyed about his new job. He viewed his administrative duties with disdain.

[Walt Lillehei]

Being chairman of the department is terrible job.

[Narrator / Documentary Voice]

That's Dr. Lillehai again.

[Walt Lillehei]

Committee meetings are endless. All these little problems that take up your time. So and so is not getting along with so and so and would you speak to this person or that person?

[Dr. Craig Lillehei]

And it's terrible.

[Narrator / Documentary Voice]

The rapid deterioration of his vision and his new title weren't the only ways in which Lillehai had changed. Without the structure of his home life with Kay and their four kids, and without the mentorship of his old boss, Owen Wongenstein, Lillehai was unmoored.

[Walt Lillehei]

The wildness became uncontrollable.

[Narrator / Documentary Voice]

In his biography of lillehei, G. Wayne Miller describes him projecting a slide of a topless woman in his first lecture to Cornell medical students.

[Walt Lillehei]

His opening presentation, using a Playboy centerfold. You know, like, this is not what you do when you go anywhere, but certainly not to an Ivy League facility. He didn't care. He was into a place in his life where he just wanted to do what he wanted to do to, you know, the emotional harm of people around him who were close, who he loved and who loved him.

[Narrator / Documentary Voice]

Lillehei was known to frequent a bar and restaurant on East 70th called the Recovery Room. There he surrounded himself with eager young residents and attractive nurses. He had affairs. He threw frequent Parks parties in his lavish four bedroom apartment.

[Walt Lillehei]

There were nights when he was the last person in the bar.

[Narrator / Documentary Voice]

That's Dr. Gerald Imber again.

[Walt Lillehei]

And there were nights when neighbors heard fights between Walt and Kay when she was there visiting. One night in particular, he was banging on the door, three o' clock in the morning. She wouldn't let him in.

[Narrator / Documentary Voice]

At the hospital, he developed a reputation for avoiding meetings. He was on the road much more than ever before in his career, lecturing in medical schools all over the world, often to the detriment of his own work. Lillehei was rapidly wearing out his welcome in New York. According to former resident Dr. Daniel A. Gore, just months into Lillehei's tenure at Cornell, doctors were already discussing the certainty of his early departure.

[Walt Lillehei]

The handwriting was already on the wall. I don't know if Walt was aware of his failing eyesight as much as everyone around him was, but 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.

[Narrator / Documentary Voice]

In the spring of 1970, a little over two years since he'd arrived in New York, to much excitement and fanfare, Lillehy was notified that he would be relieved of his duties as the surgical chief and the chairman of the department. To those who worked with him, the news came as no surprise. The only person who felt blindsided was Walt Lillehei. This time around, he didn't seek a position at another hospital or abscond with his lab equipment. Stripped of his titles, Lillehy continued to operate and lecture at Cornell for as long as they'd have him, because there was another, more dire problem looming on the horizon. Lillehai had always lacked for organizational skills. Back at the U of M. His financial record keeping comprised hand scrawled note cards, crammed into shoeboxes. It's been an absolutely impossible problem to.

[Walt Lillehei]

Keep my desk cleaned. It's something like trying to keep a clearing, I think, in the Amazon jungle.

[Narrator / Documentary Voice]

Or the Zambezi River. This harmless quirk took on grave significance in 1969, when he learned he might face legal action for years of unpaid taxes. Lillehei was offered a plea deal, but he turned it down. On April 13, 1972, he was charged with filing false and fraudulent income tax returns over the course of five years in Minnesota.

[Dr. Craig Lillehei]

I remember going through these bills, and, dad, you know These are from 10 years ago.

[Narrator / Documentary Voice]

That's Dr. Craig Lillehei again.

[Dr. Craig Lillehei]

He says, yeah, yeah, well, I haven't filed that yet. So he was always way behind his taxes. Other things took priority.

[Narrator / Documentary Voice]

And here's Dr. Richard de Waal again.

[Walt Lillehei]

Knowing Walt as well as I did, I really don't think he intentionally avoided paying income taxes. He. 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.

[Narrator / Documentary Voice]

In early January of the following year, the government's case against Lillehei went to trial. Lillehei commuted to court from his home in St. Paul. He'd sit in silence as the prosecution presented hundreds of instances of his poor judgment. He had deducted home television repair costs as office supplies, boat storage charges as attorney's fees, and veterinary treatment for the family cat as pharmaceutical supplies. But what made headlines were the payments to women who alleged that they'd had intimate relationships with. With Lillai. The most egregious of these was the $100 deducted as typing expenses paid to a sex worker during a Las Vegas medical convention.

[Dr. Craig Lillehei]

That was some of the other behaviors that. That were uncovered with other women. And. And that was obviously very disheartening for my mom. I was away at school, and in fact, I remember they had a little kiosk in. In Harvard Square where they get the paper to be able to read about it because mom wasn't very happy to talk about it. Dad wasn't going to talk about it much either.

[Narrator / Documentary Voice]

Lillehy's lawyer argued that rather than owing the government hundreds of thousands of dollars, Lillehei was in fact owed money for the royalties for medical patents he donated to the U of M. This may have been accurate, but coming after weeks of damning testimony and evidence that showed flagrant instances of tax fraud, it'd be a difficult pill for the jury to swallow. On February 16, Lillehei arrived in court to hear the verdict. Though Kay had been absent throughout the trial. She was with him now. Lillehy stood as the court clerk read out the jury's decision on each of the five counts. Guilty. Guilty. Guilty. Guilty. Guilty. In the weeks that followed, the medical establishment would rush to cast Lillehgh from its ranks. In March, his license to practice medicine was suspended by the Minnesota Board of Medical Examiners. Members of the New York Board and the American College of Surgeons attempted to suspend Lillehei from these bodies as well. It didn't matter. Lillehei's eyesight was compromised and though he was just 54 years old, it was no longer safe for him to operate. He served six months of court mandated charitable medical service at a VA hospital in Brooklyn. Rather than leading operations, Lillehei would assist the VA surgeons.

[Dr. Craig Lillehei]

Dad was low. I remember visiting him in New York during that time and he never shared his downs with me. But you could tell that it was a low point. He felt badly about it.

[Narrator / Documentary Voice]

As the end of the year approached, Lillehy scrubbed up one final time.

[Jasper AI Narrator]

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 with these cardiac cowboys down 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 scattered 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.

[Narrator / Documentary Voice]

Just as he had many times over the six months prior, Lillehei checked his ego at the OR door and assisted his junior colleagues. He already had a cataract operation on the books. Lillehei knew his days as a surgeon were at an end. When the operation was over, Lillehei announced his retirement quietly to the young surgeon standing beside him.

[Walt Lillehei]

I told the resident, I said going to be the last operation because I'm going to have this cataract removed and eminent to try sort of set. That was my last operation.

[Narrator / Documentary Voice]

Lillehei moved back home to St. Paul, Minnesota. His legacy was tarnished, if not destroyed completely. But as he stepped out of the limelight and into a life of relative obscurity, he found that a new opportunity lay out before him. His family, whom he'd so often overlooked through the years, was somehow still standing strong at his side. Perhaps now he could do right by them. Throughout the 1970s, the practice of heart transplantation had stopped nearly altogether. At Stanford University, one surgeon persisted. Dr. Norm Shamway, the man who pioneered the human heart transplant, continued to practice and refine the procedure in the face of legal conflicts and controversy. In the late 1970s, the discovery of an immunosuppressant called cyclosporine changed everything.

[Walt Lillehei]

In December of 1980, the FDA permitted us to use it in clinical heart transplantation. And then the results immediately were getting something like 80 to 90% one year survival.

[Narrator / Documentary Voice]

That's an archival recording of Dr. Shumway.

[Walt Lillehei]

Then all of the other programs in heart transplantation began to come to life.

[Narrator / Documentary Voice]

Today, more than 4,500 heart transplants are performed every year in the US alone and the average life expectancy for recipients is well over 10 years. The long term success of heart transplant is in large part thanks to the radical perseverance of Norm Shumway. The life of the man who won the transplant race took a different course entirely.

[Walt Lillehei]

Have you ever regretted this? At the times when you have been attacked by people and gotten mail where they've said that this was an unfortunate thing, this heart transplanting and all, have you ever been sorry about it? I have regretted. I regretted the whole affair when I saw how much my children suffered as a result of the press taking up really intimate family life. I regret it when I realized how much my family suffered as a result of this.

[Narrator / Documentary Voice]

After his divorce, Christian Barnard was married twice more. To a 19 year old Johannesburg heiress in 1970 and to a 24 year old model in 1988. Rheumatoid arthritis wreaked havoc on his hands until he stopped operating altogether in 1983. While his younger brother Marius developed the first critical illness insurance program in the world and fought apartheid as a member of the South African Parliament, Christian Barnard continued to bask in his celebrity, publishing health books and not novels and drawing criticism for his endorsement of a face cream that promised to reverse aging. Here's Norm Shumway again.

[Walt Lillehei]

It's too bad because I think Bernard was a very capable cardiac surgeon in his later practice, but I think his contribution was awakening the neurosurgical community into the concept of brain deaf. I think we can say he was, in that sense, a true pioneer.

[Narrator / Documentary Voice]

At the rapidly growing Texas Heart Institute in Houston, Denton Cooley continued to perform more heart operations than any surgeon alive. In 2001, he and his team hit the unprecedented milestone of 100,000 open heart surgeries. He was awarded the Presidential Medal of Freedom by President Ronald Reagan and the National Medal of Technology by President Bill Clinton. He continued operating until his 87th birthday.

[Walt Lillehei]

Nearly 100 years, our country has been blessed with the endless talents and dedication of Dr. Michael DeBakey.

[Narrator / Documentary Voice]

That's President George W. Bush presenting DeBakey with the congressional Gold Medal.

[Walt Lillehei]

He has dedicated his career to a truly noble ambition, bettering the life of his fellow men.

[Narrator / Documentary Voice]

So, Dr. DeBakey, on behalf of all.

[Walt Lillehei]

Those you've healed and those you've inspired, we thank you. May God bless you.

[Narrator / Documentary Voice]

In addition to the congressional gold medal, DeBakey was honored with the National Medal of Science, the Presidential Medal of Freedom, and Alaska Award. From the development of the MASH unit to the birth of Medicare, DeBakey's influence extended to all facets of American healthcare in the 20th century and into the present day. Nicknamed the Texas tornado, DeBakey was one of the most trusted doctors in modern history, consulting in the personal medical care of Presidents Lyndon Johnson and Richard Nixon, as well as President President Boris Yeltsin of Russia. After saving the life of the Duke of Windsor, the former King Edward VIII of England, debakey was bestowed with yet another fitting nickname. Maestro. And while he worked down the street from his protege, Denton Cooley, the two men did not talk for the better part of four decades. And yet, to this day, DeBakey's son Michael and many of his friends and family insist there never was a feud.

[Walt Lillehei]

Feud is not the word I would have used.

[Dr. Craig Lillehei]

I think that's a bad description of the problem.

[Narrator / Documentary Voice]

On the last day of 2005, DeBakey was preparing a speech when he suffered a dissection of the aorta. Well aware of the abysmal odds of surviving serious vascular surgery, at age 97, he told his family. Family he'd simply pulled a muscle and ignored the pain. For the next month, he refused to undergo surgery. By February 9, DeBakey was in critical condition. As he lay unresponsive at Methodist Hospital, his family and surgical team, led by lifelong Baylor surgeon Dr. George P. Noone, made the decision to operate replacement replacing DeBakey's ascending aorta with a Dacron graft. It's a procedure pioneered decades earlier by debakey and Denton Cooley and It saved debakey's life. After he was discharged and recovering at home, debakey received a visit from an unexpected guest.

[Walt Lillehei]

Daddy really did want to make amends.

[Narrator / Documentary Voice]

That's Dr. Louise Cooley Davis, a daughter of Denton Cooley.

[Walt Lillehei]

He wanted to apologize and give his respect to DeBakey. When Dr. DeBakey recovered from all this, it was as if he had been.

[Jasper AI Narrator]

Born again and forgot that he was mad at my father.

[Narrator / Documentary Voice]

In October of 2007, at a meeting of the Denton A. Cooley Cardiovascular surgical Society, a 99 year old Michael DeBakey entered the auditorium in a motorized scooter and rolled to the stage to accept a lifetime achievement award. Here's trauma and cardiovascular surgeon Dr. Kenneth Maddox.

[Walt Lillehei]

There was not a dry eye in the room. Everybody was standing on the tables and chairs and there must have been 20, 30 minutes of ovation. When the ovation stopped, Denton had a prepared script and could not finish it. That's when Denton said, I'm glad our feud is over. And Dr. DeBakey said, at that point, Denton, we never had a feud.

[Narrator / Documentary Voice]

In April of 1979, Walt Kay and their son Craig Lillehei attended an annual meeting of the American association for Thoracic Surgery. Hundreds of heart surgeons were present, some of whom confessed to feeling uncomfortable seeing Lillehy in the audience.

[Dr. Craig Lillehei]

He was viewed very much as a pariah in cardiac surgery, and boy, that had been his life.

[Narrator / Documentary Voice]

That's Dr. Craig Lillehy again.

[Dr. Craig Lillehei]

I remember the darkness of the room, the lights, the big crowd in there, and it was the presidential address that Dr. Kirkland was giving.

[Narrator / Documentary Voice]

Dr. John Kirkland was an eminent cardiac surgeon at the Mayo Clinic and a former colleague and competitor of Lillehy's. For a time in 1955 and 1956, he was the only other surgeon in the world performing open heart operations.

[Dr. Craig Lillehei]

And he started to tell a story about the beginnings of cardiac surgery and use that opportunity to credit dad as one of the great pioneers of Walt Lillehei.

[Narrator / Documentary Voice]

Kirkland said he always was and still is a great hero of mine because of his enormous ability and warm friendship.

[Dr. Craig Lillehei]

This is a giant. Kirkland was the president of the society at the time, and it was a giant saying, here's our pioneer and recognizing him and. And he said, please stand up, Dr. Lillehy.

[Narrator / Documentary Voice]

Lillehei got to his feet as the crowd of former colleagues and rivals, trainees and enemies delivered a thunderous applause, welcoming the disgraced surgeon back into their ranks. By then, the heyday of the cowboy cardiac surgeon was already over, consigned to history and myth with greater oversight and the rise of interventional cardiology. The nature of the job has changed. And while patients are safer today than ever before before, the world may never again see the likes of Walt Lillehy, Michael DeBakey, Danton Cooley, Norm Shumway and Christian Barnard.

[Walt Lillehei]

When I entered the training program, you were a heart surgeon. You were like a fighter pilot.

[Narrator / Documentary Voice]

That's cardiac surgeon Dr. Eric Rose.

[Walt Lillehei]

Every mission that you went on required enormous skill and it really was centered in, in you. What's evolved now, though, I think being a heart surgeon is more like being an airplane pilot in a commercial airline. There are systems of support and there's so much experience with doing it. And heart surgery now is a team Sport.

[Narrator / Documentary Voice]

And here's Dr. Gerald Imber again.

[Walt Lillehei]

There's no way you could experiment this way in any hospital and get away with it. But this was in the mid 20th century and medicine was truly marching forward. And people took chances and people died. But in the long run, lots of people lived.

[Narrator / Documentary Voice]

Edward Darvall had just lost his wife and daughter in a horrific car accident when he was asked to make the most difficult decision of his life. After a moment's reflection, he agreed to donate his daughter Denise's heart to extend the life of Louis Wishkansky. Marcel Deruder lay dying when he told his wife that he was happy to serve as a guinea pig for Michael DeBakey's experimental LVAD so that the doctor might learn something that would save someone else. After losing their 13 month old son, Gregory Lyman and Francis Glidden did not hesitate to let Walt Lillehy reopen the boy's chest and examine the sutures in his heart because it might prevent other young parents from having to say goodbye to their child. The history of open heart surgery is written on death certificates and headstones. It is the history of dying patients and their desperate families. Unfathomably courageous men and women who faced impossible choices and chose to act not just to save themselves, but to save those who would come after them. 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 Gliddens, the Richmonds, the Thompsons, the Darvals, the Washkanskis, the Deruders and the Karps, and 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. Cardiac Cowboys is a production of Iheart 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. 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 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. Special thanks to Edie Belasco, Hannah Comstock, Lisa Edelstein, Antonia DeBaros, Ian Gottler, Clark Harris, John Josh Littman, G. Wayne Miller, David Strathearn, and Saxon Traynor. For more information on the first cardiac surgeons, check out Dr. Gerald Imber's book Cardiac the Heroic Invention of Heart Surgery.