Family and student life
This special surgeon was born on 17th September 1908 and died, aged 99, on Friday 11th July 2008. His hundredth birthday celebrations were being considered; it is a matter of some regret that we could celebrate in September 2008. DeBakey, born in Louisiana, one of five children of Lebanese immigrants who spoke French at home. He described himself as the of a family who was expected to achieve greatly. His father was a pharmacist and his mother a seamstress. He told me personally how much he appreciated meeting the doctors coming into the pharmacy for prescriptions. He found them extremely impressive people and himself wished to become a doctor at a very early age. There were no precedents in the family – he was the first. This man was, in my opinion, by some distance, the most outstanding surgeon of any generation. During his lifetime, particularly American people had difficulty accepting the enormity of his achievement and it is my personal opinion that time will need to elapse before his enormous contribution is properly appreciated.
He studied science in Tulane University, New Orleans, and told me the story of becoming involved with research while still a medical student. He started to read all of the articles in the various books, and then periodicals, which were available in the medical school library. Once he wanted to read a particular journal but found that it was exclusively available for the chairman of surgery. DeBakey asked whether he could possibly see the journal and they explained to him that permission would need to be sought from Dr Ochsner. DeBakey had no concerns about that and thought that Dr Oschner wouldn’t find him seeing these journals. It was agreed that DeBakey would go to the office of the chairman of surgery and read the articles there in the outer office and not take them out. DeBakey did so and regularly read the articles in that particular journal. On one occasion Dr Oschner asked the secretariat if the young man was still coming to see this special medical journal. He asked that when DeBakey visited the outer office, he be informed so that he could meet him. Thus it was that DeBakey met Anton Oschner and it became plain that DeBakey was interested in innovation already at this stage.
A man of innovation
He became aware of the struggle, particularly among physiologists, to develop a facility to stop the circulation and mimic the circulation with a pump and oxygenate the blood. This was, of course, the struggle to achieve what was later known as a Heart Lung machine. Physicians had already mastered the concept of oxygenation; that was not the problem. They put to DeBakey that a pump was required to circulate the blood whilst the heart and the lungs were taken out of circuit. DeBakey accepted the challenge and explained to me how he went off and researched all manner of pumps and considered all of the possibilities. He was not an engineer but a man who was comfortable in libraries, seeking information. He came across the concept of a pump in which a flexible rubber tube was used and stroked from the outside by pressure, which led to movement of the contents along the tube. DeBakey decided that this could be achieved using a roller and thickened materials on the roller, which would press upon the plastic tube and thus make the contents of the tube move in one direction. He realised that this would not be pulsatile but argued that pulsatility was not necessarily required. DeBakey developed the concept of the roller pump whilst he was a medical student working with physiologists and Oschner became aware of DeBakey’s remarkable innovation while he was a medical student. This took place in approximately 1932.
By 1935 DeBakey went to Strasbourg and Heidelberg. Strasbourg was chosen particularly because he was a native French speaker but he was also fluent in German. He was able to read in these various languages and extend his knowledge. Thus he came under the influence of Professor Leriche and met some leading surgeons of the time such as Kunlin, who subsequently described the first vein bypass. DeBakey was a man of innovation all of his life. He developed new scissors and was active during the Second World War in the medical corps. After the war he was involved in developing the mobile army surgical hospitals (MASH), so well known as in the film and television series.
The first use of Dacron
In 1948 he became Chairman of the Baylor University College of Medicine in Houston, Texas. It should be appreciated that Houston was completely non-medical centre at the time. It was like taking a post in the desert. DeBakey was in doubt whether he should accept the post and said to Oschner that he wanted to stay with him because he had more to learn. But Oschner recognised that DeBakey had reached the time where he should lead his own group, and this is what he did.
In 1953, DeBakey was to use Dacron for the first time. He told me the story about how this happened. He was aware that it was necessary to find a suitable synthetic material to be used for bypass in arteries. He took himself off to a ladies’ wear shop, in which he felt very uncomfortable. He asked what sort of material they had and particularly if they had nylon, which they didn’t. He was looking for sheets of Pearlon – they didn’t have that either. And suggested to him that he should consider Dacron. Thus, he explained to me, by serendipity, Dacron was the only one available and he took it home. Using the skills his mother had taught him, he sewed the Dacron into a tube. In his inimitable style, he described to me how this Dacron tube was tried in dogs and it worked, so he was ready to use it in humans. Thus, in 1953, five years after taking up his chair in Baylor, he used Dacron for the first time to bypass an artery, and spare parts surgery as a concept was born.
The early days of endarterectomy
In the same year, he became aware that carotid endarterectomy should be a possibility. This was because, in 1948, Dos Santos had performed a thrombindarterectomy of the femoral artery in Lisbon and, in 1951, Miller Fisher in Montreal, a neurologist, had provoked the vascular surgeons into attempting to overcome the fleeting symptoms of stroke by anastomosing the patent branches of the external carotid artery to the distal internal carotid artery. Certainly this procedure was performed in 1951 by Carrea Murphy and Molins and reported in 1955, but DeBakey performed carotid endarterectomy on 8th August 1953. He didn’t publish the results for a long time. The first published results on a carotid endarterectomy were by Felix Eastcott in London in 1954. The procedure was performed at St Mary’s Hospital in early 1954 and published in the Lancet in autumn 1954.
DeBakey was, therefore, at the root at two whole new ways of performing reconstructive surgery and, by 1960, he was instrumental in developing coronary artery bypass grafting around the coronary circulation of the heart.
The dispute with Denton Cooley
By 1962, he had been awarded a large grant to develop an artificial heart, which was first implanted controversially by Denton Cooley in 1969. The feud which followed between these two surgeons became legendary. DeBakey never spoke to me about it because it was obviously too painful for him but Stanley Crawford was aware of this story and knew both men extremely well. Stanley told me quite clearly that the two were outstanding achievers and it was simply over-difficult that they should both exist in the same hospital at the same time. Cooley argued that the mechanical heart should be used in a particular patient and DeBakey was embarrassed that against his wishes Cooley had implanted the heart even whilst DeBakey was in Washington in a meeting with the President of the United States.
DeBakey received congratulations on the first use of the mechanical heart but was actually furious at what Denton Cooley had done. This led to Cooley separating from DeBakey and setting up his own establishment across the parking lot, in the Texas Heart Institute. The two giants peered at each other across the parking lot for decades but it wasn’t until 2007 that they were reconciled and DeBakey accepted an honour in Cooley’s hospital.
Medals and awards
DeBakey was married and had five children with his first wife, who died in 1972. He then married Katrin Fehlhaber, a German film actress, in 1975. Shortly afterwards they had a daughter, Olga. She has a distinctive appearance, unmistakably the daughter of this man. He was so pleased to have another child at that stage and adored his daughter Olga.
In 1969, DeBakey received the presidential Medal of Freedom by Lyndon B Johnson, and in April 2008 the Congressional Gold Medal. He explained to me on one occasion that the president had asked him to be minister of health. I recognise that this was something he had never done and he was receiving substantial income for research from Washington, and I wondered how he has managed to handle that invitation and not offend the president. DeBakey explained to me that he just persuaded him he was not the right man for the job. "Anyone could do that work as minister of health. That wasn’t why I was on God’s Earth. What I had to do no one else could do. I had to reserve my talents and gifts for what only I could do and set aside something that others could do just as well."
No one could say DeBakey was arrogant. Certainly he had a black side to him and was a man of considerable focus and achievement. He would rise at four in the morning and write for a couple of hours. He was a practising Episcopalian and a Democrat and a very hard taskmaster. He never suffered fools gladly. I personally noticed a marked difference in the relationship of his juniors to him and to Denton Colley. Cooley was very much more open, affable and the typical charming Texan aristocrat that he was, and yet the popularity of DeBakey for many of the staff around him was much greater. It was very difficult to analyse what was special about DeBakey. Apparently curt with so many of the people around him and yet my only conclusion is that the majority will have decided that the result of interaction with him left them stronger and better people than they otherwise would have been.
A powerful healer of patients
I enjoyed watching DeBakey decide how to plan his operations. I had the pleasure of sitting with him while physicians, radiologists and anaesthetists stood behind him and presented to us the details of patients for considered of surgery. DeBakey would just sit there, look straight ahead, take in the information and at the end of this he would make rounds.
On one occasion he asked me to make rounds with him. His method was most interesting. He had a private nurse who had attended this meeting of presentation of material and she, in the company of DeBakey, usually just the two of them, went from room to room to see the patients. Outside the room the nurse would repeat and summarise all of the crucial clinical information that DeBakey had heard plus an update of when he operated (if he did), when he’d last seen the patient and a summary of everything that had taken place. Without holding notes DeBakey would then enter the room and his impact upon his patient was quite remarkable. This man had a personality and a healing power for patients, who gave them such enormous confidence and certainty that he was the man who would get them better. DeBakey was the most powerful healer of patients in this regard that I ever witnessed. He was dedicated. Interaction with his patients was an object lesson to me that I shall never forget.
Surgeon to presidents and royals
It is therefore unsurprising that this man who was such an innovator but also a great doctor sho