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- [00:00]
Narrator/Host
This is an iHeart podcast.
- [00:04]
Jasper AI Advertiser
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.
- [00:36]
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. Lyman Glidden is still conscious when they wheel him into the operating room. He's 39 years old, rugged and strong from years spent working in the iron mines of northern Minnesota. He's as healthy as they come. But Lyman's health isn't the reason he's here today. A few feet away from Lyman's operating table is a scrawny 13 month old boy who lies unconscious on a second operating table. This is Gregory, the youngest of Lyman's 10 children. Gregory was born with a hole in his heart the likes of which no child has ever survived. He's about to have open heart surgery. The problem is this is 1954 and outside of these walls, the field of open heart surgery doesn't exist. The anesthesiologist begins hand pumping cyclopropane gas into Lyman's lungs. As he feels himself slipping out of consciousness, his eyes drift to the small machine that sits between him and his son, Gregory. It's a prototype built with scavenged parts from a dairy pump and plastic beer tubes, and never before tested on a human patient. The machine was designed to circulate blood between a parent and child during open heart surgery. If it works, it might just save Gregory from a slow and agonizing death. If it doesn't, it could kill not just Gregory, but his father too.
- [02:34]
Dr. Gerald Imber
There really were no medicines, no devices, and no procedures that could help a patient more than minimally in the 50s.
- [02:42]
Chris Pine
That's cardiologist Dr. J. Phillip Saul.
- [02:45]
Dr. Gerald Imber
All a cardiologist could do was take a picture and diagnose. They couldn't treat anything.
- [02:52]
Chris Pine
In the early 1950s, young families around the world faced a medical crisis. Thanks to the baby boom, infants were being born in higher numbers than ever before in history. Millions of them suffered from congenital heart defects. Children's wards were filled with kids who'd never lived to see adulthood. Just like Gregory Glidden, these children gasped for breath, their tiny chests pounding with heart murmurs you could feel through their ribs. Their desperate parents drove them back and forth to local hospitals for bouts of pneumonia and heart failure. But there was nothing the doctors could do for them. The solution lay in a new field of medicine. Before 1950, surgeons considered the living heart off limits. Less than 20 years later, doctors weren't just transplanting hearts, they were building artificial ones. The maverick surgeons who blazed this trail wouldn't come from the Ivy League or the great European medical institutions. They were a motley crew of doctors scattered across the Midwest and Texas, forged in the crucible of World War II. Commanders of the earliest MASH units, they came back ready to take on the next great fight of their lives. For the next two decades, these heart surgeons competed and feuded, racing to be the first, the best, the most prolific. Some appeared on the covers of Time and Life magazine, operated on kings and advised presidents. Others ended up disgraced, penniless, convicted on felony charges. Together, they ignited a revolution in medicine.
- [04:38]
Dr. Eric Rose
He removed the heart from a 25 year old girl and transplanted it into the chest of a 55 year old man.
- [04:43]
Dr. Gerald Imber
Some of the men waging the battle are DeBakey and Cooley. In Houston, Dr. C.W. lilleheim, the surgeon who captained the research.
- [04:50]
Jamie Napoli
Team and performed the operation.
- [04:51]
Dr. Gerald Imber
Thomas Edison, Walter Reed and Jonas Salk.
- [04:54]
Dr. Eric Rose
Today we gather to recognize that Michael.
- [04:56]
Dr. Gerald Imber
DeBakey's name belongs among them.
- [04:58]
Dr. Eric Rose
Will you welcome Dr. Christian Barnard?
- [05:05]
Chris Pine
Who were these daring surgeons who willed an entire medical field into existence? How did they achieve so much in such a short span of time? And why his history left them behind. From Oso Studios, this is Cardiac Cowboys, a podcast about life, death and innovation in the American Heartland. Episode 1 the Starting Gun.
- [05:47]
Jamie Napoli
For the.
- [05:48]
Chris Pine
Last two years, writer and executive producer Jamie Napoli has tracked down what remains of the Cardiac Cowboys. He interviewed the living surgeons, their patients and their families to bring you this story. Here's Jamie Napoli.
- [06:03]
Jamie Napoli
Throughout history, the heart has been thought of as the seat of the soul, the source of romantic love. A heart can be heavy or hard, melted or broken. But all the heart does really is pump blood. Dark, rust colored blood, starved of oxygen, flows into the right side of the heart. From there, it's pumped to the lungs. When the blood returns, it's bright crimson and oxygen rich. The left side of the heart then pumps it through the aorta and out to the rest of the body. And it does this over and over again. 100,000 times a day. But for the one in every hundred children born with the defect, it doesn't work that way. Holes in the atria, the upper chambers, or the ventricles, the lower chambers allow the oxygenated and deoxygenated blood to mix, forcing the heart and lungs to work harder. Imagine trying to drink water through a straw with a hole in it. Surgeons hypothesized that some of these holes could be sewn shut with a few carefully placed sutures. But there's a problem.
- [07:24]
Dr. Gerald Imber
The heart is pumping blood at five liters a minute, and you open it up and it is still working. It's a bloodbath.
- [07:30]
Jamie Napoli
That's medical historian and plastic surgeon Dr. Gerald Imber.
- [07:34]
Dr. Gerald Imber
For 2,000 years, since the time of Hippocrates, the rule has been you don't mess with the heart, because if you touch the heart, you kill the patient.
- [07:45]
Jamie Napoli
In the 1940s, when C. Walton Lillehy and F. John Lewis were starting out at the University of Minnesota, no surgeon dared to cut into the living heart. Every year, thousands of newborn infants were condemned to live short, excruciating lives. All that was about to change. In less than a decade, Lillehy and Lewis would overturn thousands of years of convention and open the door to a dangerous new frontier of medicine.
- [08:30]
Archival Recordings
We have witnessed this morning the severe bombing of Pearl harbor by enemy planes, undoubtedly Japanese.
- [08:41]
Jamie Napoli
December 7, 1941. Like many American boys after the boy bombing of Pearl Harbor, U. Of M medical school classmates Walt Lillehei and John Lewis signed up together for the Army Reserve. They were activated on the same day. After the war, they returned to their alma mater to begin their surgical residencies.
- [09:04]
Archival Recordings
It was a special time in the history of surgery.
- [09:07]
Jamie Napoli
That's an archival recording of John Lewis.
- [09:10]
Archival Recordings
Due to the army experience, blood transfusions became much safer than they were. Anesthesiology became much better than it was. Things became possible, never been possible before.
- [09:23]
Jamie Napoli
As friends, Lillehy and Lewis made for an odd pair. Lewis was tall and lanky with warm features, horn rimmed glasses and a bow tie permanently fixed to his collar. Lillehy, stocky with slicked back hair, had a gaze so piercing it would stop people in their tracks. Lewis was witty and intellectual. He spent his time outside of the hospital writing poems, painting still lifes and playing classical music. Lillehai preferred drinking at an all night jazz club. If Lewis was Butch Cassidy, verbose and funny, Lillehy, reserved and chillingly intense, was the Sundance Kid.
- [10:07]
Narrator/Host
He had the most beautiful color of stilly blue eyes so intense that you were just mesmerized immediately I was always.
- [10:18]
Kay Lillehei
Just totally smitten by him.
- [10:21]
Jamie Napoli
That's Sia Bowman, a nurse who worked with Walt Lillehei.
- [10:25]
Narrator/Host
He absolutely was fascinated about how things fit together and how things actually worked.
- [10:35]
Jamie Napoli
Lillehy was a born tinkerer. As a child, when his parents refused to help him buy a motorcycle, Lillehy started building his own from spare parts. By 14, he had at least three different bikes that he'd zip around on through the Minneapolis suburbs. He met his future wife, Kay Lindbergh, when she was working as a new at the Minneapolis General Hospital. Kay found him intense and very much a loner. But she was attracted to how this strong, silent type could show so much empathy for his patients.
- [11:11]
Archival Recordings
It's really what drew my mother to him.
- [11:13]
Jamie Napoli
That's Walt and Kay's son, Dr. Craig Lillehei.
- [11:17]
Archival Recordings
Dad was a compassionate man and not in an outwardly or a showy sort of way. She remembers him as an intern and resident, sitting down at the bedside and talking with families.
- [11:30]
Jamie Napoli
The U of M hospital wasn't particularly well regarded in the early 50s, but for those in the know, this was where all of the most exciting cardiovascular developments in the world were taking place. Lillehy and Lewis boss, Dr. Owen Wongenstein, had spent the last two decades revamping the surgical department. According to his own wildly ambitious vision, Wangenstein aimed for nothing less than the Nobel Prize. To that end, he recruited an eclectic team of brilliant young surgeons from all over the country. Tinkerers, outside the box thinkers and rule breakers. Here's Dr. Gerald Imber again.
- [12:16]
Dr. Gerald Imber
Owen Weinstein was the chief of surgery at Minnesota, and in 1949 he established a department of cardiac surgery when there was no such thing as cardiac surgery.
- [12:29]
Jamie Napoli
Wangenstein wanted his surgeons to define the future of medicine. In his mind, that future lay in the living heart. All of the early attempts at open heart surgery ended with patients dead on the operating table. In 1952, Wongenstein asked 35 year old John Lewis to take up the gauntlet. Lewis would lead the department's pioneering attempt at open heart surgery. But first he'd need to find a way to keep his young patients from bleeding out. Mid operation. He became fascinated by by a technique called hypothermia.
- [13:10]
Archival Recordings
I was sitting beside him actually at that meeting. The presentation was by Dr. William Biglow from Toronto, Canada.
- [13:18]
Jamie Napoli
That's an archival recording of Walt Lillehei.
- [13:21]
Archival Recordings
He had pointed out that the limit the brain could go without blood safely was four minutes, but you could double that time if you reduced the body temperature, including the brain. He felt that that was ample time for the simple defects inside the heart. Dr. Lewis and I both in the audience were very impressed. We said, that's the place to begin.
- [13:46]
Jamie Napoli
On a chilly morning in September 1952, Lewis brought five year old Jacqueline Johnson into the operating room. To lower her body temperature, Lewis wrapped Jacqueline in a rubber cooling blanket. For two hours, nurses monitored her temperature closely. If it dropped too low, her heart could fibrillate, its rhythm growing fast and out of sync. In the time before clinically available defibrillators, this would be a death sentence for young Jacqueline Johnson. When the thermometer hit 28 degrees degrees centigrade, Jacqueline was laid out on the operating table. At this temperature, Lewis estimated her brain needed about 50% less oxygen than normal. Flanked by his assistants, Richard Varco and Walt Lillehei, Lewis raised his scalpel and sliced into her chest.
- [14:46]
Dr. Eric Rose
The incisions used for those early operations were all horizontal.
- [14:50]
Jamie Napoli
That's cardiac surgeon Dr. Eric Rose.
- [14:53]
Dr. Eric Rose
They required division of multiple muscles to get through division of arteries, which now are very important to leave for later use and painful. These were primitive incisions.
- [15:04]
Jamie Napoli
Jacqueline had been tentatively diagnosed with an asd, an atrial septal defect, the simplest kind to repair. But the surgeons wouldn't be able to confirm the diagnosis until they saw for themselves.
- [15:20]
Dr. Eric Rose
After spreading the ribs and exposing the pericardium, surgeons need to do an incision in order to see the actual heart. The heart itself is completely exposed at that point.
- [15:32]
Jamie Napoli
Lewis conjectured that hypothermia bought him about eight minutes before Jacqueline suffered permanent brain damage. Eight minutes to enter the heart, locate the hole, sew it shut, and then resuscitate her. The surgeons clamped off the blood vessels leading into and out of Jacqueline's heart. When it stopped beating, Lewis made his first incision. As he spread open the heart wall, he could see immediately that the diagnosis was correct. There was a small hole in the heart's upper chamber. He quickly and carefully sewed it shut. And then Lillehy and Varco rushed to restart Jacqueline's heart. But after the clamps were removed from her blood vessels, her heart still refused to pump blood. Lewis began massaging it with his hands. And then it started to beat on its own. Here's Walt Lillehei again.
- [16:34]
Archival Recordings
I remember looking up at the clock. It was about 10 minutes to 10 when the heart took over. I said, this is it, John. We're into the heart to stay.
- [16:44]
Jamie Napoli
John Lewis had just performed the first successful open heart operation in history. He was thrust into the spotlight, and over the next year, he performed a series of ASD repairs using hypothermia Lillehei was happy for his friend. By all accounts, the man didn't have a jealous bone in his body. But he saw a problem.
- [17:14]
Dr. Eric Rose
Hyperthermia requires being able to do things exceedingly fast. You could do surgery inside the heart, closing relatively simple defects. But any more complex procedure really was not doable. Reproducibly.
- [17:29]
Jamie Napoli
Across the street from the ORs where Lillehy and Lewis worked stood the brand new Variety Club Heart Hospital. At the time, it was the only medical institution in the world dedicated to the heart. And its children's ward was overflowing with sick kids suffering from more complex defects no doctor could fix. At least not using hypothermia. John Lewis had taken the first step into the new frontier of open heart surgery. But Lillehei could see that to make any more progress, a new approach was needed, and children would continue to die by the thousands. Until he found it. 200 miles north of Minneapolis, a rugged mine worker named Lyman Glidden and his wife, Frank Francis, gave birth to their tenth child, a boy. They named him Gregory. Like many parents in the 1950s, Lyman and Frances already had one child with a congenital heart defect, ladonna.
- [18:41]
Shirley Glidden Spinelli
We called her Donna. Nobody really talked a lot about her affliction, which was a hole in her heart.
- [18:48]
Jamie Napoli
That's Shirley Glidden Spinelli, the fourth of Lyman and Francis children.
- [18:53]
Shirley Glidden Spinelli
She was not able to go to school because she just didn't have the energy to go. Donna and I slept in the same bed, and we'd actually sleep with our arms around each other. We just were very, very close as sisters. One Saturday morning, my mother, she looked in our room and I don't know what she noticed, but she cried for my dad. Chick. Chick. That was his nickname. My sister Donna had died during the night. She looked so peaceful. I was not aware I was, what, 10 or 11 years old laying there next to her? And she had already died.
- [19:37]
Jamie Napoli
In the spring of 1953, when baby Gregory began showing similar symptoms to his sister, ladonna. Lyman and Francis feared the worst. It would be months before doctors confirmed what the parents already knew. Gregory had a hole in his heart. Left untreated, it would kill him, just like it did his sister. The Gliddons were lucky, they were told, in that they lived just a day's drive from the only city in the world where doctors were repairing heart defects like Gregory's. They made the trek down to the Variety Club Heart Hospital, where they heard all about the miracles being performed by the great John Lewis. But when Gregory underwent a heart Catheterization. Lyman and Francis were told that, like most of the children at the hospital, their son's defect was too complex to be fixed. There was nothing John Lewis could do for them. In his laboratory across the street, Walt Lillehei was working tirelessly on a miracle of his own. The pace of medical progress is often slow and plodding, but time was something Gregory Glidden didn't have. And neither did Walt Lillehei. Three years earlier, Lillehei had noticed a small rubbery bump by his left ear. He had another surgeon biopsy the growth and sent it to a pathologist. The results would change his and his wife Kaye's lives forever. Here's an archival recording of Kay Lillahy.
- [21:26]
Kay Lillehei
My husband was diagnosed with lymphocytoma. I remember looking it up in the dictionary. It said that the most fetal attack of cancer. I needed to be home, you know, he wasn't going to live that much longer.
- [21:41]
Jamie Napoli
Lymphosarcoma is an obsolete term for non Hodgkin lymphoma, a rare and deadly cancer that was growing in the parotid gland in Lillehei's left cheek. The prognosis was grim. Lillehy was unlikely to survive the next five years. Surgical chief Owen Wongenstein assembled a crack team of doctors to operate on his young protege. On June 1, 1950, Lillehai entered the OR at the University Hospital for the first time as a patient.
- [22:19]
Dr. Gerald Imber
Wangenstein was a particularly aggressive cancer surgeon.
- [22:23]
Jamie Napoli
That's Dr. Gerald Imber again.
- [22:25]
Dr. Gerald Imber
And it was said that Wangenstein hated cancer so much because it was the only thing that killed more patients than he did.
- [22:34]
Jamie Napoli
Lillehy was on the table for more than 10 hours. Multiple surgeons worked on him, including his good friend John Lewis.
- [22:43]
Kay Lillehei
They did drastic surgery. They took out the clinomastoid, the big muscle of the neck, and then down into the chest until there were no more cancer cells. He ended up with a ry neck, you know.
- [23:02]
Jamie Napoli
Over the next four months, Lillehy remained bedridden in the duplex he shared with Kay and their daughter Kimberly, just a short drive from the university. But even as he struggled to recover from the operation, Lillehein knew there was no cure for lymphosarcoma. How much time could he have left?
- [23:22]
Kay Lillehei
We always lived with that threat. Remember our first house that we bought? He said, ah, better not spend too much money. I'll leave something for you. That was the threat always.
- [23:33]
Archival Recordings
He really believed that he was living on borrowed time.
- [23:36]
Jamie Napoli
That's Dr. Craig Lillehy again.
- [23:38]
Archival Recordings
That certainly had an impact on him. And realizing that the time was it was limited. Life was a gift.
- [23:47]
Jamie Napoli
Lillehy returned to work a changed man. He was noticeably thinner, he'd lost muscle mass during his recovery, his head and neck were forever tilted to the side, and at age 32, he didn't think he'd live to see the end of the decade if he was intensely focused on his work before now, post op, Lillehei's drive was preternatural. So as the world celebrated John Lewis for curing one very particular type of heart defect, Lillehgh was using every precious waking moment to do his friend one better to find a way to buy surgeons more time inside the heart to cure more and more complicated defects to save the lives of more dying kids. Kids like Gregory Glidden.
- [24:46]
Jasper AI Advertiser
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- [25:48]
Jamie Napoli
Lillehy was having a drink with his lab assistants Herb Warden and Morley Cohen, after another late night in the lab when the men arrive at a simple but revolutionary idea.
- [26:00]
Dr. Gerald Imber
One of his assistants mentioned that his wife was pregnant and they were talking about the fact that in pregnancy the placenta was providing oxygenated blood to the brain of the fetus and then lungs didn't have to do anything and all of a sudden little hi just zones out. Just why don't we use another animal's circulation to bypass the heart so that oxygenated blood would go to the brain and you would have time to do what you needed to do.
- [26:32]
Jamie Napoli
They called it controlled cross circulation. A human heart lung machine. Someone with a matching blood type, ideally a parent whose heart and lungs could oxygenate the child's blood While the surgeon operated, just like in pregnancy, a parent would act as a sort of temporary life support for their child. Lillehy and his assistants began scavenging for spare parts to assemble their prototype beer hose and a Sigma pump utilized by the dairy industry. These men were tinkerers. They used whatever did the job.
- [27:10]
Narrator/Host
People of Lohai's generation, especially the cold weather states in the Midwest, made do with what they had. And if they didn't have something, they made it themselves. They didn't look for someone else to solve the problem.
- [27:22]
Jamie Napoli
That's Roberta Beach, a coordinator at the Variety Club Research Center.
- [27:26]
Narrator/Host
Here you have a man who survived war and he survived cancer. And that made him willing to do things that other people perhaps would not do.
- [27:38]
Jamie Napoli
After a successful round of tests in the animal lab, Lillehy and his team began looking for their first human candidate. In order to prove the advantage of cross circulation over hypothermia, Lillehy needed a patient with a more complex defect than anything his friend John Lewis had ever attempted to fix.
- [27:59]
Dr. Gerald Imber
He went around the hospital, tried to identify a child with a serious ventricular septal defect, and he identified a boy named Gregory Glidden. The couple had already lost a child and they were certainly loath to have the child operated upon.
- [28:19]
Jamie Napoli
Lillehy spent time with the Gliddons, working to earn their trust. He listened to their concerns and talked through the risks. Lyman, who was a blood match for his son, would need to act as Gregory's heart lung donor. There was a chance the operation could result in the deaths of both father and son. It was a leap of faith.
- [28:46]
Dr. Gerald Imber
They finally agreed to leave Gregory at the hospital for care and allow him to have surgery if they thought he was a suitable candidate.
- [28:58]
Jamie Napoli
Getting the approval of hospital administrators proved to be the far greater challenge. Wongenstein and Lillehei shared a close bond, made closer by the disfiguring cancer operation Wongenstein had performed on him. Wongenstein would do anything to see Lillehy succeed. But there was a system in place. John Lewis had made history a year earlier, earning the hospital publicity and a fortune in donations. If anyone was going to attempt the much more complicated ventricular septal defect, or VSD repair, it would have to be Lewis.
- [29:40]
Dr. Gerald Imber
John Lewis was very successful fixing ASD atrial septal defects. In fact, he was the only person in the world who was doing it for a year. The ventricular septal defect is larger, it's more difficult to get to, and it was more time consuming. The issue became much more complex when they attempted to fix a vsd.
- [30:04]
Jamie Napoli
Lewis First VSD patient turned out to be a misdiagnosis. The defect was even more complicated than anyone realized. Lewis ran out of time trying to repair it, and the young patient died on the table. Lewis made a second attempt with Lillehei assisting. The diagnosis was correct, and yet Lewis again found himself running out of time.
- [30:29]
Dr. Gerald Imber
Lillehy was by his side and trying to help him, and Lewis began to perspire and began to panic. He realized he was losing his patience and it just drove him to despair. The child died and the idea of repairing VSDs under hypothermia died with him.
- [30:54]
Jamie Napoli
In short order, Lewis's research funding was cut and Lillehy's was increased the following year. In Lewis's words, he'd be booted out by Wangenstein. For Lewis, it was a swift and painful coup. He told one of his residents, it is difficult to tolerate the success of a friend. Lillehy now had the full backing of his mentor and he got to work.
- [31:22]
Dr. Gerald Imber
His team would go on Saturdays down to Mayo.
- [31:25]
Jamie Napoli
That's Dr. Paul Eisio, a professor at the U of M's Visible Heart Laboratories. They'd watch surgery and then they would.
- [31:32]
Dr. Gerald Imber
Visit Jesse Edwards, who had a heart library there. They'd studied congenital specimens.
- [31:38]
Jamie Napoli
Lillehy and his team spent hours in the pungent, formaldehyde suffused lab at the Mayo clinic, just a 90 mile drive south of Minneapolis. The cardiac pathologist there, Jesse Edwards, kept thousands of preserved human hearts in barrels and Lillehy dug through them, studying every type of heart defect for which there existed a specimen. Whatever he'd find beating in Gregory Glynn's chest, he wanted to be ready for. Back in Minneapolis, news of Lillehy's procedure was causing a growing panic among the hospital administrators. Lillehei saw his chance to save Gregory's life disappearing before his eyes.
- [32:25]
Dr. Gerald Imber
There was enormous pressure on Wangenstein not to allow him to do it. Wangassin had a visitor from Chicago. Willis Potts, a very famous pediatric surgeon, said, congratulations, you're about to be the first surgeon to have a 200% mortality. It was meant, of course, as the ultimate insult. So the administrators of the hospital, hearing some famous surgeon say, oh my God, how can you do this? Tried to stop them from doing it.
- [32:59]
Jamie Napoli
The administrator's concerns were not unjustified. With its beer tubes carrying blood around the OR its potential for 200% mortality, cross circulation seemed more carnival sideshow than modern medicine. Not only could it fail, it could discredit the university. March 25, 1954. The day before Lillehei was scheduled to operate on Gregory Glidden administrators stormed into the office of hospital director Ray Amberg. They wanted to shut Lillehai down, and Wongenstein was called in to defend his protege. Lillehy's future and Gregory Glidden's life hung in the balance.
- [33:46]
Archival Recordings
I'll confess, cross circulation was very much viewed as heresy.
- [33:51]
Jamie Napoli
That's Dr. Craig Lillehei again.
- [33:53]
Archival Recordings
It was an idea that even today feels a little radical.
- [33:58]
Jamie Napoli
As Wongenstein was arguing Lillehei's case to the hospital director, Lillehei went about his other work. If he was anxious in the hours leading up to the operation, nobody could tell. When Lillehei returned to his office after performing an abdominal surgery, he found an note on his desk from Wongenstein. Dear Walt, it read, by all means, go ahead. By Now, Gregory was 13 months old, and he'd spent three of those months in the Variety Club Heart Hospital. To help shed light on Gregory's experience at the hospital, here's Dr. Pamela Evans. Lillehei repaired a defect in Dr. Evans heart. Not long after Gregory's operation, my pediatrician.
- [34:49]
Narrator/Host
Told my parents about the heart hospital in Minnesota. There was a playroom that we could play in. I remember the children having wheelchair races.
- [35:04]
Jamie Napoli
Early on the morning of March 26th. Gregory was wheelchair to OR number two in his crib, surrounded by his stuffed animals.
- [35:13]
Narrator/Host
To this day, when I'm in a hospital or I have to have, like, a procedure or something, if I'm on the gurney, I still recall watching the lights flash by as they were wheeling me to the operating room. It's very, very vivid, you know, boom, boom, boom.
- [35:34]
Jamie Napoli
In the or, Gregory was moved to an operating table as the anesthesiologist prepared the cyclopropane gas to put him under.
- [35:43]
Narrator/Host
I know I was really, really cold. I kept saying, mommy, Mommy, I'm so cold. I'm so cold. And I mean, I had nothing on no sheets or anything.
- [35:55]
Jamie Napoli
Once Gregory was unconscious, Lillehei began the operation. Operation. He cut open the boy's chest and spread his ribs. The surgeons inserted narrow tubular cannulas into Gregory's aorta as well as the superior and inferior vena cava in his neck. Through these cannulas, Gregory's blood would be diverted from his heart through plastic beer tubes into the small Sigma pump and then into Lyman's blood vessels through an incision in the inner thigh. Lillehy gave the command. Pump on. At the flip of a switch, the machine hummed to life. Blood began to flow between father and son. Gregory's tiny heart stopped, and Lyman's picked up the slack, pumping blood for both of them. Lillehy sliced into Gregory's heart. A 2 1/2 centimeter cut into the right ventricle. Surgeon Richard Varco pulled apart the sides of the incision, but it was too dark to see inside. Shortly before the operation, Lillehy had the idea to borrow a headlamp from an ear, nose and throat doctor at the hospital. Without the support of the sternocleidomastoid muscle in his neck, just keeping the lamp upright was a struggle for Lillehy. He aimed its dim beam of light into the lower chamber of Gregory's heart.
- [37:22]
Dr. Gerald Imber
Lillehy actually manually stuck his finger in and found the hole.
- [37:26]
Jamie Napoli
That's Dr. Gerald Imber. Again.
- [37:28]
Dr. Gerald Imber
The diagnosis, which is not always correct, was correct this time. The child did have a ventricular septal defect. He was able to run a series of silk sutures through it.
- [37:40]
Jamie Napoli
And here's cardiac surgeon Dr. Eric Rose again.
- [37:43]
Dr. Eric Rose
It's remarkable that he was able to get them closed with relatively primitive needles and primitive suture material that now we take for granted entirely.
- [37:54]
Jamie Napoli
At 12 minutes and 15 seconds past zero time, Lillehy had sewn shut the hole between Gregory's ventricles. As the boy lay there unconscious, Lillehy could feel his heart beating more powerfully than it ever had in his 13 months of life.
- [38:13]
Dr. Gerald Imber
He closed the defect and then he closed the heart. And then they closed the chest and they reached over to shake one another's hands. They had detached the father from the son. They had a living child who was crying, a normal post operative cry. At the end of surgery.
- [38:31]
Jamie Napoli
When Lyman regained consciousness, his wife Frances gave him the good news. Every doctor they'd spoken to over the last year had told them Gregory's defect would kill him. Walt Lillehei had just saved the boy's life. Over the next few days, Gregory's condition steadily improved. Lillehy was cautiously optimistic for a quick recovery. But his optimism soon faded.
- [39:04]
Dr. Gerald Imber
Everything was wonderful. Until it wasn't. He became ill twice. He ran a fever. The child Gregory needed to have a tracheostomy performed so that they could suck the mucus out of his lungs.
- [39:19]
Jamie Napoli
Gregory's health took agonizing swings. Over the next week, he grew dangerously ill with pneumonia. Some days, his breathing and heartbeat appeared normal. Other days he gasped for breath and didn't recognize his own parents. Lillehy was unflagging, checking in at all hours of the night and performing an emergency tracheostomy to help Gregory breathe. But nothing he did seemed to improve the boy's condition. On April 6, Gregory took one more turn for the worse. By 9:15 in the morning, the boy was dead. Walt Lillehei had to do the hardest part of any surgeon's job. He had to break the news to the family.
- [40:05]
Dr. Eric Rose
I would say that there are many, many surgeons of that era who just didn't view it as part of their job to explain things and to mourn with families when they lost kids. Whether that empathy originates with his own illness or I think it's impossible to say, but it's just an incredible gift, being able to communicate and being present, just being present with those families.
- [40:33]
Jamie Napoli
Lillehy's experimental procedure had ended in failure. If the career of John Lewis were any indication, Lillehy's fight to cure heart defects in children would soon be at an end.
- [40:51]
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- [41:53]
Dr. Gerald Imber
The administrators and the heads of medicine and pediatrics now really had ammunition. They didn't want the university to be open to criticism, and they didn't want more people to die. They thought this was a terrible idea.
- [42:07]
Jamie Napoli
But Lillehei was determined to figure out where he'd gone wrong. After Gregory's death, he took an unusual extra step. He asked Lyman and Francis for consent to perform an autopsy. Lillehy looked on as the pathologist opened Gregory's chest and removed his tiny heart. Once again, Lilleheim made an incision in Gregory's right ventricle.
- [42:40]
Dr. Gerald Imber
He looked and he saw that his repair, his VSD repair, had completely healed. He didn't know whether to laugh or cry because there was a dead baby on the table. But he knew he had cured his problem and the child had died from pneumonia.
- [43:02]
Jamie Napoli
Lillehy may have failed to save Gregory. But the boy's death would not be in vain. Lillehy's procedure had worked, and it could work again, if only he were given another chance. The door to open heart surgery had just been blown wide open. But no one outside of Walt Lillehei knew it.
- [43:29]
Narrator/Host
I see him as this genius in some ways, like a Vincent Van Doe or something. You know, they're troubled souls, but they're trying to do the best that they can.
- [43:42]
Jamie Napoli
68 years after Gregory Glidden's death, Pamela Evans reflects on what his family's sacrifice has meant for her and for the world.
- [43:52]
Narrator/Host
I'm 72 years old. I should be dead. The loss of that child's life led me to 44 years in academia, where I impacted thousands of young adults. I would thank them and I would say, that child not only saved me, but it saved other children as well.
- [44:29]
Jamie Napoli
At the Maple Hill Cemetery in Hibbing, Minnesota, a small headstone marks the burial site shared by Gregory Glidden and his sister Ladonna. Under Gregory's name is an epitaph which reads, his little heart changed the world. That change wouldn't come without a fight. Lillehein knew that he'd face a sharp backlash after Gregory's death. To move forward, he'd need to take matters into his own hands.
- [45:03]
Dr. Gerald Imber
Walt did the kind of thing that Walt always did. He waited until the administrators were out of town. He scheduled two more surgeries. Because when something's got to be done, it's got to be done.
- [45:13]
Jamie Napoli
These next two operations would determine the future of open heart surgery. Once news of cross circulation spread outside of Minnesota, Walt Lillehei, a man with no experience in the spotlight, would find himself in the crosshairs of some of the most powerful figures in medicine.
- [45:32]
Dr. Eric Rose
It's very, very easy to criticize an effort that results in a dead child. Very easy. But part of Walt's genius was his persistence.
- [45:42]
Jamie Napoli
Lillehy's radical cross circulation procedure was the spark that ignited a revolution in heart medicine. He'd fired the starting gun. And soon surgeons all across the world would join the race. In Houston, New York, Halifax, Palo Alto, and Cape Town, South Africa. This is the story of the brilliant, fearless and deeply flawed men and women who looked past the accepted medical wisdom of their age and reached into the future. The doctors and nurses who risked their careers, the patients who gave their lives. The towering achievements and unimaginable sacrifices. The rise and fall of the heart surgeon as God. And the brutal, bloody, and ultimately triumphant road to medical progress.
- [46:41]
Chris Pine
On our next episode, two of the country's most ambitious surgeons join forces to make Houston, Texas, the new cardiovascular capital of the world. But a friendly competition turns them from close colleagues to fierce rivals. Next time on Cardiac Cowboys.
- [47:11]
Jamie Napoli
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, Twins 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.