Free The Heart Healers by James Forrester Page B

mistakes.
    Wanting to be convinced while retaining his reluctance, Harken demurred. “Well, I do not think any respectable physician would send me a patient.”
    Brewster Ellis countered, “I’m generally considered respectable. I’m the president of the New England Cardiac Society; I’d certainly send you another patient. I’ve never sent you a patient who wasn’t dying and, if you would be willing to try again, I’d be willing to send you patients.” And so Harken agreed to try a seventh time. This time he succeeded, less than a week after Bailey’s success. Harken soon proved that he had indeed learned from his failures: after his initial success “only” two of his next fifteen patients died.
    After ten successive deaths between them, Bailey and Harken each had a survivor. Like me, some readers may feel queasy at how it came about, when surgeons offered unproven, potentially lethal treatments to vulnerable, desperate patients. Nonetheless that was the accepted ethical norm of the time. But the most critical part of this story is the part that remains true about medical research today: innovators cannot do things perfectly the first time—they learn from their mistakes. The stunning, unspoken consequence is that for great medical advances to occur, patients will be injured and some will die. Later in our story I will confront this wrenching conundrum as a leader of a large research program in a lethal disease, CAD.
    With Bailey’s success just days earlier, Dwight Harken chafed with the realization that he was destined to be the bridesmaid instead of the bride. “Unless … what if…?” Harken pondered. Didn’t it really depend on the meaning of “first”? Some might think first meant, “first to perform cardiac surgery successfully,” but couldn’t it just as easily mean, “first to publish a description of successful cardiac surgery”? Fifty years from now, historians would not know the precise date of the original surgery, but they would certainly have the journal in which its first description was published. Harken was in Boston, home of the world’s most prestigious medical journal, The New England Journal of Medicine, whose editor was his good friend Dr. Joe Garland. As chance would have it, a cynic might say, Harken’s manuscript was published that year whereas feisty Charles Bailey’s manuscript was not published until the following year. As Harken later lamely suggested, “Whether one gives priority to the first operation or the first publication is a matter of personal opinion.”
    Time magazine, however, suffered no semantic confusion. On March 25, 1957, Charles Bailey’s face appeared alone on its cover. As Harken later admitted to many of us, “He beat me to the punch.” Harken’s technical knockout defeat in cardiac surgical fisticuffs was to foreshadow an even more sensational and controversial defeat for the world’s most talented cardiac transplant surgeon two decades hence.
    Harken’s shrapnel extraction and Bailey’s crude repair of the narrowed mitral valve (mitral stenosis) established the first two signposts in the emergence of cardiac surgery after World War II. It would be nineteen years until the final jewel, coronary artery bypass surgery for CAD, would be inserted in cardiac surgery’s crown. In those two decades CAD blossomed and mitral stenosis withered. Today the only mitral stenosis patients I see are immigrants from underdeveloped countries. The reason is penicillin: it effectively prevents acute rheumatic fever in children with streptococcal sore throat. Preventing rheumatic fever has in turn eliminated mitral stenosis among residents of the developed world.
    Very early in my career in the 1960s in Philadelphia and much later as a visiting professor in underdeveloped countries, however, I saw my share of mitral stenosis patients. One was a very thin once-athletic twentysomething auburn-haired young woman about the same age as me, now approaching the end