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1

The Wizard, 2015

Bud Frazier sometimes wandered through St. Luke’s Hospital like a large wraith in a white coat. For decades he had traveled from his office in the Texas Heart Institute through the maze of attached hallways that was St. Luke’s, a worn paperback perpetually open in his hand, often something by Shakespeare, rarely anything that could remotely be considered popular. At seventy-five, Bud had earned certain privileges: The right to walk and read, which kept a lot of people out of his way. The right to leave towels in swirls and eddies on the floor of the private bathroom in his office. The right to check his cellphone at society galas, because people assumed he was checking on patients, and sometimes he was. A few years back, Bud had had to give up his black cowboy boots for running shoes, because surgery, especially lengthy surgeries, could be as hard on your legs and your back as it was on your hands. He’d had two brand-new titanium knees put in last summer and had been glad when he was able to give up the fancy cane he’d had to use. It made pretty women solicitous, which made him grouchy.

Bud’s wife, Rachel, liked to describe her husband, generously, as an absentminded professor, but like many people at the top of their fields, Bud had lots of folks looking after the mundane details of his life so that he could focus on his work. Bud often forgot his wallet; he did not balance his checkbook; he did not “do” email. Once, when he could not find a parking place for a gala, he parked his old Jaguar XKE—a gift from a grateful patient—on the front patio of the Houston Museum of Natural Science, barely missing the fountains. Everyone forgave him his trespasses: Bud could list, among a very long list of friends and associates and patients and their family members, everyone from Mehmet Oz to the memoirist Mary Karr, from Dick Cheney to Bono, from Olivia de Havilland to various Middle Eastern and European royalty. He had a long-suffering assistant named Libby Schwenke who was charged with getting him from point A to point B, whether it was from Houston to Kazakhstan or just across the Texas Medical Center, which, unfortunately for her, was the largest in the world. Even so, Bud was perennially late, famous for slipping into a party or a lecture long after it was in progress, which allowed him to be simultaneously unobtrusive and a center of attention. Time for Bud was negotiable after so many years operating on the very sick, who didn’t follow schedules either.

So here he was, at the crack of dawn, alone. Docs a lot younger than Bud, with better knees but slower hands, were still at home next to their sleeping wives at five-thirty in the morning. Whether he could admit it or not, Bud preferred his office to his home, surrounded by the books that were always in danger of tumbling off the shelves—valuable first editions and ratty paperbacks; Plutarch, Dickens, Dostoyevsky, a few nods to the likes of Hilary Mantel and Larry McMurtry. His literary tastes were a lot more high minded than those of the average medical student rotating through the Texas Heart Institute, a fact he sometimes couldn’t resist noting—to his med students. (When it came to literature, Bud was an equal-opportunity snob: introduced to U2 frontman Bono by a wealthy friend, Bud was appalled when the Irish rock star didn’t immediately recognize some lines Bud recited from Yeats.)

Bud opened the door and stepped into the outer office, with the bank of secretarial cubicles on one side and a wall of framed photos and clippings on the other. Because there wasn’t any natural light here, the pictures were as fresh as the day they had been taken: photos of Bud with his mentors, Dr. Michael DeBakey and Dr. Denton Cooley, who had been among the most famous heart surgeons of their day in the years from 1960 to 1980 or so. In another photo, Bud posed with Christiaan Barnard, the South African surgeon who had shocked the world—and set off major envy attacks among his colleagues—by performing the first human heart transplant in 1969. There was a photo of Bud with the longest-living heart transplant patient in the world—his patient—and next to it a twenty-year-old story from the New York Times about the success of the left ventricular assist device. Bud had an impressive collection of medals, and on the highest shelf above his assistant’s desk, a tenuously crowded collection of crystal vases and plaques etched with his name. There was a framed portrait with a quote from Teddy Roosevelt—a favorite of many aggrieved surgeons—about the man in the arena who, “if he fails, fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” Close to that was another maxim: “No one gets in to see the Wizard, not nobody, not no how,” a former student had written, quoting the Wizard of Oz. It was an inside joke. Everyone got in; Bud Frazier was incapable of telling anyone no.

He padded down the dim hallway, past the open door to Billy Cohn’s office, the heart surgeon who sometimes helped Bud—who was not mechanically minded—develop devices for ailing hearts. As often happened, Billy wasn’t there; he spent weeks in other countries, testing and lecturing on his many inventions. But even when Billy was gone, his office seemed to be fully inhabited by him, by the whirs and clicks of all sorts of tiny machines that entranced him, by the perpetual motion of his screen savers on at least three computers and laptops, by the eerie blue light they projected around the room. Billy hung his oldest prototypes on the walls with regular nails and thumb tacks and sometimes, Scotch tape: a bent fork, a lariat made of thin white tubing, a kitchen spatula—all variants of things he had invented that went into people’s bodies or helped heart surgeons do their jobs. Bud’s office walls were paneled and book lined. Billy filled his space with trinkets, doodads, and gewgaws that only he fully understood. There were the books on magic piled on top of medical texts and a deck of cards on his desk—Billy performed at national conventions. There was a cover photo from a weekly tabloid of Billy playing the trombone with his band at a bar called the Boondocks, a late-night date he kept every Tuesday. This was a man whose fingers were still only when he was sleeping—if in fact Billy ever slept. Unlike Bud, Billy didn’t keep a couch in his office.

Bud left his office suite and made for the elevators. He didn’t stop on the ground floor, where he might have taken in his first exposure of the day to natural light—it poured into the three-story atrium of the Heart Institute’s Denton A. Cooley wing, as if God himself were blessing the place. Instead, Cooley officed just behind the soaring space; at ninety-two, he still came in every day, getting around the hospital on a scooter or being pushed in a wheelchair by one of his former nurses. Fortunately, he was not such a bad driver.

At an elevator, Bud punched the button for the basement.

In the old days—the sixties, seventies, the early eighties—the animal research lab had been on the third floor of St. Luke’s, adjacent to the operating rooms. Such a location would be unethical now—who would even think of it?—but back then laws on animal research were more lax, and, besides, if Cooley wanted it there so he could duck in and out between surgeries, he got whatever he wanted because he’d founded the heart institute for starters, and he brought in the most patients, meaning, of course, he brought in the most money. The biggest problem with that location was that the obstetrics ward was also on the same floor, so the moans of women in labor were accompanied by the sounds of dogs barking, cows mooing, or the screeching of baboons.

The end of that situation came with what Bud still called The Incident of the Yucatan Mini Pigs. He had been working on some experiments that involved welding blood vessels together with lasers, and it turned out the veins of the 100-pound pigs were the closest things to humans. But then someone snuck in one night and freed pigs from their cages—probably an administrator, Bud still speculated darkly—so about twenty of them went racing into the maternity ward. Bud had to round up the mini pigs himself, herding them back into the lab as they snorted and relieved themselves all over the place. Soon after that, Cooley got a new cardiac research lab in the basement.

Bud had been in charge for the last forty years or so.

The door to the lab had a window covered with a venetian blind, a nod to security along with the key card Bud swiped to let himself in. The place wasn’t much to look at, which made it camera ready for PETA membership drives. The floor was linoleum, and the tile walls were that sorry shade of prison green. The animals in metal stanchions—like modern-day stocks—raised their heads to look at Bud: one goat, one cow. At his arrival they blinked and chewed the hay at their feet, paying him little mind.

He had told his mother, a schoolteacher, that he’d decided to become a doctor one night while she was cooking him dinner. He was in from Austin and the University of Texas, back home in the small town of Stephenville. She kept stirring a pot on the stove while he explained his choice; she didn’t stop to look at him. “Well,” she said, when he finished, “I think you should do what you want, but I never knew you to much like to kill things.” Well, “killing things” wasn’t his goal as a doctor, but being an attentive son Bud intuited her meaning: with a mother’s impeccable memory, she was referencing that time he was eight years old and his friend Butch Henry had shot a rabbit in the brush. Bud raced to the site and found a mother rabbit dying, her unborn babies tumbling out of her belly where the shotgun pellets had torn her open. Bud gathered up the tiny bundle of kits, raced home and tried to save them, but he was too late.

His life’s through line became saving the unsavable. This made Bud not just famous and respected, but beloved, and not just in Houston but anywhere he had taken care of sick people around the world. But he still had one goal to accomplish before he hung it up: Bud wanted to see a working artificial heart become a reality, a total replacement that could be implanted and then forgotten, as his frenemy, another famous heart surgeon, Robert Jarvik liked to say. And, finally, Bud felt that he was close.

In the next room, Bud found the calf. He was a Corriente, a smallish breed descended from the Spanish. His coat was a reddish brown, soft and thick; in a different life he would have spent his youth avoiding cowboys in a roping competition at a rodeo. Instead, he was standing up in his small stall, wires and tubes running in and out of his chest every which way, hooked up to enough monitors better suited to a moon shot. Bud scratched the calf’s forehead and thought, as he often did, that they were such sweet animals.

Nearby, on a pile of old hospital blankets, was Dr. Daniel Timms, who had been sleeping there all night. A youthful-looking thirty-five-year-old biomedical engineer from Brisbane, Australia, Timms was a slight, tightly wound man with piercing blue eyes and a snaggletooth that, depending on which nurse you asked, made him more or less movie-star handsome. His short brown hair was often tousled, and he always seemed in need of a shave. Daniel wasn’t known around the THI for his sense of humor, but the rumors of his genius gave him a pass.

The calf shifted its weight and Daniel’s eyes followed, watching the animal’s chest move in and out. Then, reflexively, Daniel’s eyes moved to the monitor. It registered the calf’s vital signs as completely normal.

Or rather, completely normal considering that yesterday, in an eight-hour operation, Drs. Frazier and Cohn had sliced out the calf’s heart and replaced it with Daniel Timms’ invention, a device smaller than a tennis ball, that, once stitched in place, took over all the functions of a normal heart. Except, that is, for one thing: the calf had no detectable pulse. One small titanium disc spinning in its housing—at four thousand times a minute—was the only thing keeping this calf alive.

2

How Hard Could It Be?

Deep in the bowels of the Smithsonian Institution’s National Museum of American History is a section of a storeroom with a particular set of drawers. If you go through the proper channels, a friendly curator will let you in and, donning a pair of gloves, open the drawers to reveal some very strange and pretty unappealing-looking devices. Some are made of plastic faded to the color of old chicken broth—though that’s a nice way of putting it. Others contain discolored tubes and fabric stained the color of rust, or, more precisely, old blood. Virtually all of them have two parts stuck together—one heart is connected with Velcro. Most have large holes on each side, giving them the look of cockeyed binoculars.

They do not look like anything a sane person would want stuck inside him- or herself. But in fact these devices represent what has been, for a very long time, the holy grail of medicine: a dependable artificial heart that works on its own inside the body, just like an artificial hip or knee. The cure for cancer runs a very close second to this pursuit, but the fact is, heart disease kills more people around the world than all cancers combined: 17.9 million people or 32 percent of all deaths in 2015. (Three million women in the United States had breast cancer last year, while 12 million had heart disease.) And while these numbers are declining in the developed world, about 26 million Americans currently have heart disease; 2,150 of them die of it each day, an average of one death every forty seconds, or one out of every six deaths in the United States. The number of people who die from heart attacks may have also fallen significantly over the years, thanks to better care and better technology, but now a greater problem is heart failure, a chronic, progressive illness interrupted with life-threatening crises. The American Heart Association’s figures show that 5.7 million people suffered from heart failure in the period from 2009 to 2012, but that number jumped to 6.5 million, a 14 percent increase, from 2012 to 2014. Heart transplants have become the solution of choice for disease that is beyond treatment with diet, lifestyle, and medication, but surgeons and their desperate patients know the truth: in any given year there were only 2,500 hearts available for transplant, with about 50,000 people on the waiting list. In other words, there are twenty times more losers than winners.