Pioneers of Cardiac Surgery (review)

In his introduction to this collection of oral histories of cardiac surgeons, William Stoney argues that “The story of heart surgery is the story of American medicine after World War II” (54). While many historians or physicians from different specialties might disagree, Pioneers of Cardiac Surgery makes a compelling case. Between 1996 and 2004, Stoney interviewed thirty-eight leading cardiac surgeons, men responsible for nearly every major development in the field. Edited and presented in this invaluable collection, the histories provide not just an intimate insiders’ history of cardiac surgery. Instead, they form a remarkable portrait of the development of American medicine in the twentieth century.

Although several of earliest pioneers had died before Stoney began his interviews, he was able to collect histories from an impressive assortment of surgeons, both celebrities (e.g., Christiaan Barnard or Michael DeBakey) and others less famous but equally important. The interviews follow a standard format, with discussions of how the surgeons came to medicine and then cardiac surgery, their training, the course of their careers, and their reflections on the state of the field. The stories span the range of cardiac surgery, from early work on congenital heart disease, through valve surgery, transplants, coronary artery surgery, and artificial hearts. Stoney also provides his own history of the field as an introduction. The resulting book is dense but rewarding.

The accounts of surgical training are particularly striking. The exigencies of World War II and the Korean conflict reshaped training in many ways. Colleges, medical schools, and residencies were accelerated. MASH units exposed young surgeons to horrendous trauma and rewarded daring innovation. Returning from military service, weary surgeons had to complete grueling residencies and fellowships. Structured as steep pyramids, elite programs forced many residents to complete their training elsewhere. Many residencies did not allow their housestaff to leave the hospital for months on end. Residents and even interns often operated without supervision. Despite this, the people interviewed almost uniformly found ways (at least in retrospect) to enjoy their training. They gained experience and confidence, though sometimes at the expense of their patients.

The narratives also provide a vivid portrait of surgical innovation. The development of pump-oxygenators, artificial valves, and important procedures are told from many perspectives. In case after case, many surgeons had similar ideas for new techniques, but only the one most daring and cavalier actually took the risk that led to a breakthrough. Although the end results have been impressive, the successes came only after a grim toll of failed operations and deaths of countless patients and laboratory animals. The surgeons, of course, did not work in isolation. Medical centers (especially Johns Hopkins), the National Institutes of Health, and the emerging medical device industry all played prominent roles. Many of the surgeons recall with nostalgia their early years of unfettered trial and error, before supervision and constraint from the Food and Drug Administration and Institutional Review Boards. Readers will have to decide for themselves whether the efficiencies of the past era of unregulated research justify the enormous cost in human lives.

While focused on surgery, death, and innovation, the stories also document the surgeons’ daily lives. Considerable egos and surprising collegiality co-existed. Academic surgery in the 1940s and 1950s was a small world. Chairs simply called their old friends at different hospitals to find residencies for their favorite students. As cardiac surgery got going in the 1950s, the pioneers traveled back and forth between Baltimore, Houston, and Rochester-Minneapolis, sharing techniques and technologies, and then trying to one-up each other. This exchange benefitted from the internationalism of the postwar period, with a steady flow of trainees and visiting professors between the United States and Canada, South America, Europe, and South Africa. Humor makes frequent cameos. Residents’ wives, for instance, who had heard terrifying stories about DeBakey from their beleaguered husbands, were astounded by his graciousness when they later met him at social events.

The collection does have limitations, but none that undermine its value. Most of the...