Teamwork

blalock-thomas1

These two men did pioneer work on blood loss and shock. They developed heart surgery procedures that are still in use. Odds are, you have only heard of one of them.

Vivien Theodore Thomas was born on August 29, 1910 in Lake Providence, Louisiana. After graduating high school in 1929, he planned to attend Tennessee Agricultural and Industrial State Normal School, (Now known as Tennessee State University) with hopes of becoming a doctor.

He had been in school two months when the stock market crashed, causing him to lose his part-time carpentry job. Forced to drop out of college, Thomas still found work as a Lab Assistant at Vanderbilt University Medical School, working for surgeon Dr. Alfred Blalock. Although hired to sweep floors and clean out cages, Vivien Thomas impressed Dr. Blalock with his intelligence. Blalock was so impressed that he trained Thomas to be his Surgical Technician.

Thomas began assisting Blalock in the study of shock during surgery. Shock is caused by a sudden drop in blood flow through the body, and can be fatal. Working together, Blalock and Thomas developed ways to prevent shock from occurring during an operation. By World War II most of their theories were in use, saving the lives of countless injured soldiers.

In 1941, Dr. Blalock was hired by Johns Hopkins Hospital in Baltimore, Maryland, to serve as the hospital’s Chief Surgeon and as a Surgical Professor in the Hopkins Medical School. The doctor asked his trusted assistant to go with him, and Thomas agreed. But while Blalock was responsible for training every surgeon in the school, Thomas had to enter the building through the service entrance. He was also listed on the hospital payroll as a handyman.

The two men respected and trusted each other, but were hardly equal. At one time, Blalock was paid ten times more than Thomas. Often the doctor hired Thomas to serve drinks in his home during a social event. And never was Thomas allowed in the Operating Room.

It was at Johns Hopkins that the two men met Dr. Helen Taussig. Taussig had been hired in 1930 to oversee the Cardiac Clinic of the Harriet Lane Home, (Hopkins’ children’s hospital) and quickly grew interested in “Blue-Baby” diseases.

Usually, blood coming into the heart is routed first to the lungs, where it absorbs oxygen. The oxygen rich blood then goes back to the heart, where it is pumped throughout the body. Blue Babies are born with a badly formed heart or blood vessels that cannot provide enough oxygen to the blood. Their skin has a distinctive blueish tinge, especially in the fingertips. At that time Blue Baby diseases were incurable, and almost all of the patients died very young.

Dr. Taussig approached Dr. Blalock with an idea: if a Blue Baby’s heart couldn’t provide  oxygen to the blood naturally , then why couldn’t a surgeon re-route the major blood vessels? Taussig’s plan was interesting but extremely dangerous. The operation would have to take place near the heart, and heart surgery was so risky it was almost never recommended. Any accidental damage to the heart would have to be repaired within 4 minutes, or the patient died.

Busy with his teaching duties, Blalock asked Vivien Thomas to work out the details of how such an operation could be done. Thomas began by studying medical textbooks, drawings and diagrams of hearts, and even real hearts taken from dead bodies. Then he operated on dogs, intentionally creating Blue Baby hearts in them. Later he would operate again, repairing the heart and making careful notes of everything he did. It was a slow process, learning exactly what had to be done.  Many dogs died, and several of the surgical tools he needed didn’t even exist. Quite often, Thomas would invent them.

X-rays of the patient were another problem. X-ray films provide a good still photograph of the workings of the body. But Taussig preferred to use a fluoroscope. A fluoroscope image is best described as “X-ray TV”– It provided moving images of the interior of the body. If the patient accidentally moved, so did the picture. There was no way to record the fluoroscope image, so the three doctors would have to study their patient’s fluoroscope scans carefully and commit them to memory.

At last they felt they were ready, and Taussig began to search for a proper patient. On November 29, 1944, they operated on a little girl named Eileen. Although fifteen months old, Eileen only weighed nine pounds.

Thomas had planned to be in the observation room, watching the operation. Blalock said no – he felt more comfortable with Thomas close enough to give him advice. In preparation for the operation, Thomas had performed the procedure over 100 times on animals. Blalock had been taught the procedure by Thomas, but had actually done it only once. Breaking all the rules of the time, Thomas entered the operating room and guided  Blalock through the operation.

Eileen’s heart never stopped beating and her blood vessels were only as thick as a  matchstick. After about 90 minutes, Blalock was finished. Everyone held their breath as he removed the last clamp from a blood vessel. After a long pause, Helen Taussig said “Al, the baby’s lips are a glorious pink color.”

Proven to be a success, Blalock’s team performed nearly 300 operations in less than a year. Surgeons came from around the world to study Blalock’s new surgical procedures, only to learn that Thomas was the expert, not Blalock or Taussig. Still, the operation was known as the “Blalock-Taussig Shunt,” named for the surgeon who performed it and the doctor who suggested it.

Blalock retired in 1964 and died four months later. For six years, Thomas continued to teach but took on no major project – almost as if  he were in mourning. But as the 1970’s began, more and more African-Americans were entering the Hopkins Medical School. To them, Vivien Thomas was not just one of their teachers, he became their mentor. And just as he had guided Blalock so many years before, Thomas’ advice and support guided a new generation of doctors through medical school.

Thomas died in 1985, just a few days before his autobiography was published.* Today, Vivien Thomas is almost unknown to the general public. But Dr. Alfred Blalock never forgot him. If someone stood too close to his right shoulder during an operation, Blalock would tell them to back away. “Only Vivien may stand there.”**

* Thomas’ autobiography has been reissued with a new title: Partners of the Heart: Vivien Thomas and his work with Alfred Blalock. A hardback copy of the original title, Pioneering Research in Surgical Shock and Cardiovascular Surgery: Vivien Thomas and his work with Alfred Blalock is usually valued at over $100.

** This photo has been identified by Johns Hopkins archivists as being a photo of the third Blalock-Taussig Shunt taken in early 1945. Dr. Helen Taussig normally would have been in the operating room but is not identifable in this photograph.

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5 Responses to “Teamwork”

  1. Laura Albovias Says:

    In addition to being thankful for what they’ve done for you my friend, I am thankful for what they did for me. In 1996 my fallopian tube ruptured due to an ectopic pregnancy. I lost 2 liters of blood (all internally), my veins collapsed, and I went into shock. I am very greatful for my doctor who knew what to do to keep me alive and for the generous donors who provided the 2 liters of O+ that filled me back up!

  2. Steve Says:

    I never knew that! I owe you yet another hug, Laura!

    Steve

  3. kelly Says:

    Kinn’s, The Medical Assistant, 2007Sanders……….. My textbook states that Thomas regularly looked over Blolocks shoulder during surgery at a time when African Americans weren’t even allowed on the floor. That in fact he performed the first surgery. So why do you say he wasn’t allowed in the O.R. I wanted to celebrate this mans contibution to my class. You shouldn’t make up your own history to validate a perceived misconception. Dr. Blalock could not, during that opressive era, put Thomas on the pedistol he deserved. But he accepted him as a partner and friend. I find it offesive that you make your artical into another Black Man down story. I don’t see it that way at all.

    • Steve Says:

      Kelly;

      Everything I have read says that Thomas was in the Operating Room for the first time for the Blalock-Taussig Shunt procedure, done on November 29, 1944. In his autobiography (Partners of the Heart: Vivien Thomas and his Work with Alfred Blalock, p. 92, 1985 University of Pennsylvania Press edition) Thomas states “When all was ready, Dr. Blalock asked me to stand where I could see what he was doing. The best vantage point was on a step stool placed so that I could look over his right shoulder.” Katie McCabe, in her article Like Something the Lord Made (August 1989 issue of The Washingtonian) writes “Blalock insisted Thomas stand at his elbow, on a step stool where he could see what Blalock was doing.”

      Thomas did almost all of the technical work and the operations on test subjects (Dogs, usually from the Baltimore City Pound) needed to recreate the defect and then to correct it. By the time of the first human B-T shunt, Thomas had done the procedure on dogs over 200 times; Blalock had assisted once. Although he isn’t credited for it (There is a movement to rename the operation the Blalock-Taussig-Thomas Shunt) it’s accepted that Taussig conceived the operation; Blalock performed it, and Thomas was almost 100% responsible for designing and testing it.

  4. J-Carolina Says:

    Love the story. Please see the HBO movie “Something The Lord Made”. This is a very encouraging story.

    Thanks,

    J-Carolina

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