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The Man Who Touched His Own Heart

True Tales of Science, Surgery, and Mystery

Little, Brown and Company

The Bar Fight That Precipitated the Dawn of Heart Surgery

Any surgeon who would attempt an operation of the heart should lose the respect of his colleagues.

—T. H. Billroth, German surgeon

It was July of 1893, and the city of Chicago was melting. It was the summer of the World's Fair, when inventions from around the world began to transform America. By fall, the first hamburger would arrive in Chicago, as would the first machinery for making chocolate commercially and the first tinny version of Alexander Graham Bell's phone. It was also the summer in which Daniel Hale Williams (1856–1931), a young doctor on the rough side of town, would make the biggest decision of his life.

Williams was born of African American–Scots–Irish–Shawnee parents, but he was viewed by the society in which he lived, the society of Hollidaysburg, Pennsylvania, as African American. Williams's father died when he was young, leaving his mother to care for him alone. She was sufficiently overwhelmed that she sent Daniel to be an apprentice to a shoemaker in Baltimore when he was just eleven. That might have been the end of the story, except that young Williams decided to go to Wisconsin, where he began working in a barbershop. The store's owner took an interest in helping Williams finish high school, where he excelled. Then the owner helped him apprentice in medicine, at which he also excelled. Finally, in 1880, the owner helped him apply to the Chicago Medical College at Northwestern University, where he was accepted and where he, once more, excelled. Williams was the first African American student in the program.

In 1883, the new Dr. Williams set up a small practice on Michigan Avenue in Chicago. He also taught anatomy at Northwestern University and worked as a doctor for the City Railway Company and, later, the Protestant Orphan Asylum. He was one of just four African American doctors in Chicago at the time and yet his abilities were so obvious that in 1889, just six years into his career, he was appointed to the Illinois Board of Health. Williams wanted more. He wanted to do something more for the city and himself. He was aware that African Americans in Chicago often received poor care from white physicians and nurses. He also watched as African American doctors and nurses struggled to get training and positions, due to racism in hospitals and universities. The challenges facing young African Americans were not waning. At just this moment, a man Williams knew and respected, the Reverend Louis H. Reynolds, came to Williams asking for his help. Emma Reynolds, the reverend's sister, had recently applied to various Chicago hospitals to train as a nurse (she was the first African American to attempt to do so), but she was refused by every hospital because of her race. Her story moved Williams. After discussions with the Reverend Reynolds and other community members, Williams decided there was only one thing he could do: he would open a hospital. At that hospital, he would train African American nurses.

The hospital would come to be called the Provident Hospital and Training Association. It was a bold dream, one in which Williams convinced other doctors, white and black, and even donors to believe. Donations came from many sources, including both Frederick Douglass and the Armour meatpacking company (which would also supply the hospital with many patients due to injuries workers incurred on the job). In 1891, Williams signed the lease on a three-story, twelve-room red-brick house at the corner of Twenty-Ninth and Dearborn. Its living room was turned into a waiting room, and a small bedroom at the end of a hall would serve as a surgery ward. In its first year, this makeshift hospital trained seven nurses, one of whom was Emma Reynolds. It also treated hundreds of patients.

Nothing was ever easy at Provident Hospital, but the doctors and nurses made do with what they had. They had to improvise, because of a lack of supplies and the fact that, more than other Chicago hospitals, they dealt with a large number of trauma patients. Everything was difficult, but Williams and his team persevered. His was a story of hardworking man who overcame and hardworking nurses who helped him.

But elsewhere in the city, events were conspiring to change Williams's story. James Cornish worked as an expressman, a person charged with the care of packages on trains. The job was a good one, but July 9, 1893, was a bad day. The heat left him soaked with sweat, from morning until six. Worse, the heat did not fade, not even when the sun set. It was the kind of heat that called for a whiskey, which is just what Cornish proceeded to order that night at his favorite saloon. While others in Chicago sampled the best of the world at the White City, as the World's Fair had come to be called, Cornish settled in across town from the fair, among friends. He got his whiskey, took a sip, cracked a flirty joke to the waitress, and walked over to play poker with two friends who were already seated. He felt lucky. A song called "Daisy Bell" was playing loudly from the jukebox. He bounced a little as he walked, eager to laugh, wager, needle his friends, and laugh some more. Then things changed irrevocably.

The sounds around Cornish grew louder. Noise rose like dust. A fight had started. A chair was smashed over the bar. Punches began to land against sweat-damp bodies. Cornish stood on his toes to watch, and then suddenly he was in the scrum. A knife appeared. The man with the knife lunged toward Cornish and stabbed him in the chest. The man pulled the knife back out, someone screamed, the crowd dispersed, then sirens started and several women bent toward Cornish's body, which now lay on the ground.

An hour or so later, at Provident Hospital, Cornish was laid out on a stretcher. His clothes were soaked with blood. He was wheeled into an operating room, where the nurses and Daniel Hale Williams gathered around him. To Williams, Cornish's wound, about an inch in diameter, looked as though it might be superficial. But its location, just to the left of the breastbone, was worrisome. Without x-rays (they were to be discovered two years later, in 1895), there was no way of knowing how deep the wound might be or whether it had reached the heart. The only diagnostics available to Williams were ancient ones. He could feel Cornish's pulse. He could listen to his breathing. He could also put his head or, if he could afford one, a wooden stethoscope to Cornish's naked chest and listen for its wild sounds.

Initially, apart from the hole in his chest, Cornish seemed okay. His pulse was normal. His heart beat. He was cleaned up, sewn shut, and left to rest overnight. Cornish slept in a bedroom with a window that looked out across the city. He had not yet had a chance to inspect his surroundings. He was too weak and then too tired. Warm air blew through the curtains over him. Within hours, his condition, which had seemed stable, began to deteriorate. Dr. Williams was called back in. He ran to the room and up to Cornish's side, where he put his ear to his chest. Cornish's heartbeat was weak, and then, as Williams listened, it seemed to disappear entirely. The heart was still beating, but faintly. On July 10, Williams concluded that the knife must have penetrated more deeply than he had initially thought—all the way into the heart.

A knife to the heart can wreak havoc, though the precise sort of havoc depends on the details of where and how the knife enters. The heart has two sets of pumps. Together, the left atrium (LA in the figure) and left ventricle (LV) make up one; the right atrium (RA) and right ventricle (RV) the other. Each atrium (from Latin for "hall or court, a gathering place") sits atop its corresponding ventricle. When the left atrium contracts, it gently squeezes blood into the left ventricle. The blood does not need much of a push, as it moving from an area of high pressure into one of low. All it needs is a little nudge. The left ventricle then contracts much more forcefully, sending blood throughout the entire body, down the arteries, to the arterioles, and then through the six hundred million capillaries, each tube of which is just a single cell wide. The force of the left ventricle's contraction would be sufficient to push water five feet up into the air or, as is the need in the body, to push blood through the more than sixty thousand miles of blood vessels in the human body.

At the same time that the left atrium and then left ventricle contract, something similar happens in the right atrium and then right ventricle, except with less force because the blood leaving the right ventricle does not need to go through the whole body. It needs only to find its way to the lungs, where capillaries rest on three hundred million air sacs, and hemoglobin, in red blood cells in the blood, releases carbon dioxide and gathers oxygen.

The sounds of the heart, at least the most conspicuous sounds, are those of the valves between the atria and ventricles (the mitral on the left; the tricuspid on the right) closing when the ventricles contract (and, in doing so, preventing blood from flowing back into the atria) and then, more loudly, the valves between the ventricles and the arteries (the aortic on the left, the pulmonary on the right) closing once the ventricles have finished contracting (which prevents blood from flowing back into the ventricles): lub-dup, lub-dup. The sound of the heart is the closing of these valves, day in, day out, billions of times in a fortunate human life.

So much depends upon the heart's pumps. The blood that is pumped out of the left ventricle travels into the aorta, which serves as a superhighway from which blood is shunted off into branches to the arms and brain, to the internal organs (intestines, liver, kidneys), and to the legs and genitals. Meanwhile, the right atrium and ventricle receive the blood that has come back in a different form than it went out—now the blood is depleted of oxygen and full of carbon dioxide. This "used" blood is pumped to the lungs (via the pulmonary circulation; pulmo- comes from the Latin for "lung"), where blood cells, in effect, exhale carbon dioxide and inhale oxygen. The oxygenated blood then flows to the left atrium, where the process begins again.

All of this is happening in you right now. It happens in waves: contraction, relaxation. The contraction is referred to as systole (from the Greek for "to pull together"), the relaxation, diastole (from the Greek for "to separate"). Hold your hand to your neck, and you can feel, in the expansion and relaxation of your carotid arteries (which supply your brain with oxygenated blood), the consequence of your heart's pumping.

That is what you hope for, anyway, but when Williams felt his patient's neck, that is not what he found. Some assault on Cornish's internal machine had made the heart both weak and slow, and the pulse could barely be felt. A knife wound can provide a new hole through which blood pours into the body cavity instead of into arteries. It can also—and this is far worse—interrupt the ability of the heart to contract.

Just what was happening in Cornish's body was hard to say. Today we would have many more clues than Williams had. We could look at an x-ray, a sonogram, a CT scan, or an MRI. A catheter might be threaded into a patient's heart to release dye that would reveal, in the x-ray, the location of the damage. A machine would record the rhythm of the heart. What we would know today would not be perfect, but it would be useful. Williams had virtually nothing except the weakening of Cornish's heartbeat and his obviously deteriorating condition.

The weakening of a patient's heartbeat might be due to a problem in the heart itself, but it might also be due to loss of blood, to which, we now know, the body can partially respond. The arteries in our bodies are muscular. They contain a layer of smooth muscle. Smooth muscle is not under our conscious control, but it is under our bodies' unconscious, autonomic control. The muscles in our arteries do not push blood along—that is the heart's unique role—but they can widen or narrow the vessels to slow or speed up its passage. And one sort of artery, the arteriole, can actually stop the flow of blood. Arterioles are the narrowest arteries—they meet up with the capillaries, which then connect to venules, which in turn connect to the veins that carry the oxygen-depleted blood back to the heart—and arterioles are narrow enough that when they contract, they close. They do so to influence the flow of blood in the body. When your fingers are cold, blame the arterioles, but also thank them because they are, based on the condition of your body, helping to move blood where it is most needed.

If Cornish was losing blood, the arterioles would have begun to shut off the flow through nearly all of the capillaries in the body (except those in the three organs that never, except in the very worst circumstances, lose their blood flow: the brain, the heart, and the lungs). When this happens, the pulse weakens, the extremities grow cold, and the body struggles to preserve that which it cannot do without.

With his patient deteriorating, Williams had to make a decision. He knew Cornish's heart was broken, but he was at a loss to say precisely how or why. No matter the cause, the most likely scenario seemed to be that Cornish, friend to many, son to one good mother, was about to die.

Knife wounds to the heart were remarkably common in 1893. They remain common today, though they are now rarely fatal. If you are stabbed in the heart, raced to the hospital, and operated on, you stand about an 80 percent chance of survival. A trauma to the heart can be operated on in any of a variety of ways, or not operated on at all, depending on the condition of the heart. The odds are now good for victims of stabbings, thanks to both technology and the learned skills of surgeons. But in 1893, the most likely consequence of a stab wound to the heart was death. Once the heart started to bleed, whether from a stab wound or some other assault, a patient depended purely on fate to survive, a kind of cardiac destiny. Sometimes the body was able restrict blood to the core and heal the wound before too much blood was lost. More often, it couldn't. Infections took over, or the heart lost its rhythm. Doctors sought medicines that might cure such wounds, but they sought in vain. And no doctor in the world was known to have successfully operated on a heart, wounded or otherwise. No one, as far as Williams knew, had even tried. It was the Mount Everest of the body, the great mountain not yet climbed. Yet, if Williams was anything, he was the kind of man who tried, the kind who might scale a mountain to save someone. He had tried working on shoes as a young man. He had tried working in a barbershop. He had even tried music and law. He had tried surgery and running a hospital. Now, on July 10, one day after Cornish was stabbed, he would try something even more novel.

Williams and the nurses looked down on Cornish. They all bent over him to closely inspect the damage. It seemed likely that his heart—that bloody engine—was torn, though even that was not entirely certain. If it was torn, Cornish would die from internal bleeding or, depending on the severity of his wound, heart failure. Williams could do what every other doctor in the same situation had done for the past ten thousand years, which was walk away. Or he could operate. Whatever he did, the heart was there, just inches from his face as he bent over his patient, just under the surface and yet for all of time so very far away.

One can imagine the sort of person it takes to perform the first surgery ever on a heart. He or she would need to be self-confident but also eager to go beyond what had been done, both to save a patient and to advance humanity. Williams was such an individual. On July 10, 1893, the operation began. Williams was handed a scalpel and the other tools necessary to cut into Cornish. He was about to attempt a feat surgeons all over the world had advised was too dangerous and immoral. Success or failure, Williams was about to make history.

The human heart beats, on average, about a hundred thousand times a day, pumping 7,500 liters of blood through arteries and veins. But this was no average day. On this day, Williams's heart would have rabbited along, pushing extra oxygen to his eager brain. Six other doctors had also gathered in the room. Williams swore he could hear their hearts too. This is the great irony of surgery and, more generally, medicine: that a doctor in one body bends to mend a patient in another body, the doctor relying on the same parts (her heart, her brain, her skin and flesh) she aims to fix in her patient. The room was more than a hundred degrees, and even before Williams began, everyone was sweating. Now, with anxiety and adrenaline, they were dripping so much that the floor was wet. Williams wiped his head and then, with the nurses at his side, inserted the blade into Cornish's wound and cut a six-inch incision. He inserted his right hand through the incision and pulled one of the ribs away from the sternum to make a hole, a kind of window through which he could look at Cornish's heart. He siphoned away the excess blood and, for the first time, had a clear view of the heart. In general terms, it was an ordinary heart, somewhat larger than a clenched fist, about five inches long, three and a half inches wide, and two inches thick. What was not ordinary was that it lay bare, as naked as a heart can be, suddenly at the mercy of insight, skill, and luck.

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Excerpted from The Man Who Touched His Own Heart by Rob R. Dunn. Copyright © 2015 Rob R. Dunn. Excerpted by permission of Little, Brown and Company.
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