Posts Tagged ‘Taussig’

CHD Pioneer passes away at 101

November 13, 2010

Dr. Richard J. Bing, who was profiled on this blog back in April, has passed away at the age of 101.

 

What if…?

August 5, 2010

“Back in ’29 when I had TB, the X-rays showed a big, gaping hole in my left lung. I lay there on a freezing porch in a Sanatorium in upstate New York with eighteen blankets on me. Nothing but my nose exposed to the elements… I swore then that if I got my life back I would do something important with it.” – Dr Alfred Blalock (Alan Rickman), Something the Lord Made (2004)

I enjoy reading Alternate History. What is Alternate History? It’s not Science Fiction, it isn’t History, and good Alternate History isn’t always a time travel story. Alternate History takes a historical event – the more familiar the better – changes one fact, and then tells the story of what might have happened.

So let’s do our own Alternative History thinking. Alfred Blalock, a promising young researcher working at Vanderbilt University, really did contract Tuberculosis (also known as TB) and spent time in a Sanatorium. If we changed one fact – if Alfred Blalock had died from TB – would history change?

I think it would, and not for the better.

In real life, Vivien Thomas began to work for Blalock in February of 1930. Had Blalock died, the two never would have met. Forget their contributions at Johns Hopkins, while at Vanderbilt the pair were able to learn how and why the human body went into shock. Since they never worked together, there would have been more injured soldiers who died during World War II. Perhaps one could have been your father or grandfather? (Which raises the question: Would you even be here?)

Thomas was a skilled carpenter; he probably would have made a nice living building things in Nashville. But he would never repair a heart.

Helen Taussig‘s career would have been much different, too. The theory behind the Blalock-Taussig shunt was in her mind before she met Alfred Blalock. But she had already asked the surgeons at Johns Hopkins about performing the surgery, and had been turned down. Taussig then took a train to Boston and tried to convince Dr. Robert Gross to do the operation. Gross was the leading Heart Surgeon of the time, but he turned her down, too. Taussig would have returned to Baltimore and continued as the head of Pediatric Cardiology for the Harriet Lane Home for Invalid Children. Frustrated, she’d keep trying to understand broken hearts… but as long as there was no surgeon willing to listen to her, she’d never make much progress. And if she did find some one willing to risk a surgical procedure, it would never be named the Blalock-Taussig Shunt.

Assuming the operation was successful – Vivien Thomas did the majority of the research needed to design and execute the operation, but in our Alternate History he never worked with Blalock, never moved to Baltimore, and never met Helen Taussig. Without him standing on that milk crate talking Blalock through the operation, the chances of failure were much higher. The debacle of a failed heart operation could easily cost the unknown surgeon and Helen Taussig their jobs.

It would be a very different world for the very few CHDers who made it.

Bing

April 2, 2010

He was born in Germany and composed many works of classical music. He graduated from medical school twice. He worked with Charles Lindburgh. And he started a Cardiac Catheterization program at the hospital where heart surgery was born. Not only did Dr. Richard Bing see history being made, he helped make it.

Hired in 1942 as an instructor in the Johns Hopkins University Department of Medicine, Bing traveled from New York to his new job in Baltimore. Crossing the Chesapeake Bay on a ferry, Bing noted no less than six people with Cyanosis. Their destination, he surmised, was probably the hospital. It was two years before Blalock and Taussig would attempt the first Congenital Heart Surgery, but Johns Hopkins already had a reputation. If your child has a bad heart, it was said, get them to Hopkins.

There wasn’t much at all that could be done, but Dr. Helen Taussig knew almost everything there was to know about the human heart. Taussig was a huge believer in research, and would spend hours examining defective hearts. Despite her best efforts – she often asked the parents of her deceased patients for permission to dissect the heart, and spent hours studying them in her lab – there was very little progress being made. Even after the first heart operation, very little was known. There was ONE operation, and it was designed to help relive only ONE defect. Everyone else was still out in the cold.

By 1945  Dr. Alfred Blalock asked Bing to set up a Cardiac Catheterization unit at the hospital. Dr. Helen Taussig, who had already been eyeing him suspiciously, hit the roof. Dr. Bing explained their constant disagreements:

She was very jealous and guarded her territory; she considered the sick children as her own, having no family herself. She was also deaf, which increased her suspicion of the world beyond.

(That link contains not only a good description of Taussig-Bing Anomaly, but an in-depth look at Johns Hopkins Hospital during the Blalock-Bing-Taussig years. I highly recommend reading it!)

Dr. Bing eventually left Johns Hopkins, continuing to do major research in the Cath Lab. While at Wayne State University he did some of the early work involving PET scans, using computers belonging to Ford Motor Company to run the scanner.

Dr. Bing retired and now lives comfortably in California, and last year celebrated his 100th birthday!

Stay in the Race

July 20, 2009

Wherefore seeing we also are compassed about with so great a cloud of witnesses…let us run with patience the race that is set before us. – Hebrews 12:1

Foot on the line; lean forward.

Ready…Go!

Out of the starting gate not with a blast, but with a whimper. Unusually enough, I can’t seem to get my feet under me, can’t find the rhythm. Instead of a smooth stride, I stumble and trip and almost fall at the 5/12th of a mile mark of the race. I’m losing – badly. I never expected to win, but I wanted to make a decent showing. Let everyone see that I gave my best.

But the crowd is really screaming, and they seem to be yelling at me. Yeah, if I were watching I’d be yelling at me, too. But no, they are cheering, and the worse my feet seem to tangle, the more they shout encouragement. Hey, I recognize some of these people… that’s Dr. Blalock! Vivien Thomas is next to him, shouting my praises as I struggle by.

I get my balance back – slowly – and soon I have a smooth motion going. Gotta pick it up, all I’m seeing is the backs of the other runners. Dr. Taussig waves at me as I pass.

My feet get tangled up again at mile 10 and I go down, coughing blood as I fall. Somehow I get back up – hard to do when your legs don’t want to do what you tell them. They’re working again – but still a little weak – by mile 11 and then I really start cooking. Steady and smooth, chasing the pack down. I’m not gaining that much, but at least I can still see them.

Then at mile 22 I fall flat on my face. I can’t even get up.

“Keep moving!” a little girl yells. “Never stop!”

So I’m dragging myself, pulling myself along with my hands, and this same little girl yelling at me to keep going, try harder, I can do it. She’s familiar, but I don’t…. Eileen Saxon. The first one of us.

Slowly I get to the point I can push as well as pull myself, then back to my feet and into my familiar half walk, half stumble. I get my stride back until mile 36, when I go down again. I can’t feel my right side at all.

“Come on, you aren’t going to let a stroke stop you?” another little girl asks. It’s Gracie. “Come on now, you cheered for me, I’ll cheer for you.”

But you lost, I think as I feel my energy start to drain away. I’m losing, too.

“I lost, ” Gracie says, reading my mind. “But I fought. That’s the important thing.” So once again I’m digging in, pulling along with one hand, keeping a forward motion and not much else. Slowly I get the feeling back in my right side, and then I am able to stand and shuffle, and eventually run.

I passed the 42nd mile mark a while back and I’m getting close to mile 43. I wonder who I will see next… and what I will do if it is someone I am close to.

And I wonder how long this race is. The longer the better, and if I can help it, I’m not going to go down on the course.

I’m going to cross the finish line standing.


Our heroes are human

January 3, 2009

Don’t get me wrong, the man is a hero. But like a lot of heroes, we tend to overlook their shortcomings.

I’m guilty of that with my hero, Helen Taussig. She’s deaf, she’s dyslexic, she’s a woman working in a man’s world. But you rarely hear about her stubborn streak. When Helen Taussig made her mind up, she was right, and that was all there was to it. Being that focused usually served her well but it did occasionally get the better of her. At times, she was so stubborn she would continue to do research even when the data was not showing any progress.

Alfred Blalock had his own little habits and faults, too. But rather than harm the man’s standing and reputation, they just make him that much more interesting.

While Blalock gets credit – and deservedly so – for performing the Blalock-Taussig Shunt, he was not the best surgeon. After all, he did call for Surgical Technician Vivien Thomas to stand beside him and guide him through the surgery. Not once, not until Blalock felt more sure of the procedure, but every single time.

When Blalock graduated Johns Hopkins in 1922, he applied for a surgical residency. He didn’t get it. He chose to hang around and try again, so he interned in Urology and even tried Ear, Nose, and Throat work. Finally he left for a hospital in Boston but turned right around and left for Vanderbilt University. “I didn’t even unpack my trunk,” he said of his stay in Boston.

Although the first Professor of Surgery at Vanderbilt, Blalock was more of a researcher. Very few stories of him in the operating theatre exist but he produced scholarly research by the truckload.  Assisted by Vivien Thomas, the two changed everything that was known about shock at the time.

Thomas was certainly the better cutter of the two. After his return to Johns Hopkins, Blalock was again Chief Professor of Surgery. He usually conducted the classroom lectures, with Thomas running the surgical labs. The labs is where medical students learned how to operate – you learn by doing, and it was Vivien Thomas who was showing them how to cut.

Blalock was possessive, and felt that what was his was… well, it was his, and if he though you deserved special treatment he would share. As shown in the movie Something the Lord Made, Blalock really did brew his coffee in a graduated cylinder heated over a Bunsen burner. He figured that was one way he could insure no one bothered his coffee. After all, who’s going to drink a liquid out of a scientific instrument in a hospital lab, even if it does smell like coffee? One thing the movie doesn’t mention is Blalock’s stash of Cokes hidden in a box he had labeled “medical waste”!

I’m not a fan of Coke, but Cheerwine… I can see myself keeping a few cans of that under lock and key! Obviously, Alfred Blalock was a hero to a lot of us. But better still, he was just as human as you and I.

The Woman Who Solved Crossword Puzzles

September 2, 2008

Born in 1898, Helen Taussig was the Dyslexic daughter of a world famous Economist. School was always difficult for her, which confounded her father to no end. Trying to help her, he took her to his beach cottage every summer. Helen played on the beach until mid afternoon, when her father would put away his Economics projects and work with her into the night. Progress was slow but they never gave up.

It finally “clicked” for Helen; not only did she make it through high school, she graduated college and medical school. One of the few female doctors in America, Dr. Edwards Park hired her to run the Cardiac Clinic in the Harriet Lane Home for Invalid Children, located at Johns Hopkins Hospital.

When she took the job in 1930,  cardiac care was practically nonexistent. Her patients fell into one of two categories: Children whose heart valves were damaged by Rheumatic Fever, or children born with Congenital Heart Defects. The Rheumatic Fever children usually recovered but were slowed by the heart valve damage. The Congenital Heart Defect kids rarely survived at all. Those with Cyanotic defects were the most helpless, as the lack of oxygen in their blood caused them to suffocate.

Determined to do something – anything – to help her patients, Helen began to collect and study the hearts of those that died. “These children are my little crossword puzzles,” she often said, “and one day I shall figure them out.” She also noticed and described a behavior known as the Tetralogy of Fallot Squat, in which the children either sat or squatted with their knees fully bent. Bending the knees cut off the blood flow to the lower legs, making more blood available for circulation to the lungs.

She finally determined that getting more blood to the lungs would help her Cyanotic patients, and the best way to do that was not through the heart itself, but by rerouting blood vessels. Not being a surgeon, Helen’s plan went untested until she heard that the new Chief of Surgery, Dr. Alfred Blalock, was looking for a new research project.

Hopkins legend states that Taussig confronted Blalock with her idea in the hospital lunchroom, when she barged her way into a discussion between the surgeon and her boss, Dr. Park. Like a bulldog she cornered Blalock and wouldn’t let him go until he agreed to seriously consider attempting heart surgery. Little did she know that Blalock already the beginnings of a plan; he and Research Assistant Vivien Thomas had surgically connected two blood vessels in a dog as part of their research. That particular experiment had failed, but it had produced an increased blood flow to the lungs.

Thomas developed the procedure and on November 29, 1944, Alfred Blalock cut Eillen Saxon’s Left Subclavian Artery and connected it to her Left Pulmonary Artery. Vivien Thomas stood on a stepstool behind him, offering instructions. About 90 minutes after the first incision, Blalock removed the final clamp from the Pulmonary Artery. Despite the odds, Eillen was still alive, and the Blalock-Taussig Shunt was born.

Dr. Helen Taussig – the Mother of Pediatric Cardiology – had solved her first crossword puzzle.

Remove Shoes Before Viewing

August 12, 2008

Would you like to know how we got here?

If you ever wondered exactly how, when, and where Congenital Heart Surgery began, you need to rent a copy of the movie Something the Lord Made. There is no warning sticker on the box, so I’m telling you right now: Remove your shoes before the movie begins. It will literally blow your socks off. After all, there is no use in ruining a perfectly good pair of socks!

The story begins in Nashville, just before a young Vanderbilt researcher named Alfred Blalock hires a young Black man named Vivien Thomas as an assistant. Thomas, an out of work carpenter, is glad to get the job, but it is obvious Blalock sees him as just another in a long line of janitors. The work is simple, but apparently this researcher is a hard taskmaster as he implies that no one (so far) has been able to maintain the lab to his standards.

Blalock soon finds Thomas studying one of his anatomy books and gives him more responsibility, and the young assistant rises to the occasion. But the doctor’s famous temper flares when an important piece of equipment is neglected, and Thomas walks off the job. “I was not raised to be spoken to in this manner,” he says as he exits the building. Blalock recants, chases Thomas down, and apologizes. “It won’t happen again,” he says, and historically, he was true to his word. Blalock lost his temper often and chewed out almost student or assistant he ever had, but never again with Thomas. (Blalock’s temper was rooted more in frustration than anger; often he mutters phrases such as “Will no one help me?” and even asks a nurse “Can’t you see my ears?”)

The two do masterful work in solving the problem of shock after injury, their research saving the lives of many World War Two soldiers. The doctor is noticed and hired away by Johns Hopkins and he takes his right hand man with him.

The camera work done on the Baltimore campus captures the hospital perfectly, but what is even more impressive is what it does not capture. Johns Hopkins Hospital is a mix of traditional and modern architecture, often with one style practically on top of the other. Masterful camera work prevents you from seeing “modern” Hopkins until the time comes. Todays visitors to the Hospital know that there are large modern towers located on either side of the Billings Administration building (the large domed structure) but tight shots and closeups prevent you from seeing them until the 1960’s era. I’m not a Hopkins historian, but I did not see anything appear before its natural timeframe.

Our heroes meet Dr. Helen Taussig, who convinces Blalock that if he wants a major project to work on, he needs to consider Heart Surgery. (Specifically, a surgical procedure to relieve Tetralogy of Fallot, also known as ToF) Taussig is a personal hero of mine and I wish her part could be bigger; but understandably this not her story, so she takes a minor role. Also at the first discussion of cardiac surgery are two other minor characters, Doctor Longmire and Doctor Cooley. Both of these men would go on to become giants in heart surgery (Longmire at UCLA and Cooley at the Texas Heart Institute) but the movie treats them both as just two more medical students… which is exactly what they were at the time.

The movie hits all the little details perfectly. Blalock DID use his scientific equipment to brew his coffee (he didn’t like to share and figured no one would drink out of a test tube, no matter what it smelled like!) and two of Dr. Taussig’s young patients are shown in the “ToF squat” that many Blue Babies of the time preferred. By bending deep at the knees, blood flow to the lower legs would be restricted and more would be available for the lungs. A photo of a child in the ToF Squat appears in her medical textbook, Congenital Malformations of the Heart. The girl in the wheelchair is also duplicated in a scene from a Hopkins waiting room; she’s only on the screen for a moment, but it lends historical accuracy to the scene.

The 800 pound Gorilla in the room is, of course, the racism of the time. It’s almost never mentioned, though Thomas’ wife comes close (“He’s getting a raise to do the work he’s already doing!”). But it is there, and it affects everything. Thomas does the work but Blalock and Taussig get the glory. And in keeping with the time, neither doctor sees anything unusual about that. Having one (or both) be a crusader for Thomas would only weaken the story; they are reacting the way a White person from that era would normally react. In the end Thomas is recognized, and it is Taussig who redeems him.

Rent it. And take your shoes off before you watch it.