The Heart Healers by James Forrester Page A

again retreated to home and went to bed. Harken, always an endearing mix of bombast and uncompromising self-criticism, referred to his decision to enter the high-pressure left ventricular chamber as “my devastating mistake.” Doctors who care for terribly ill patients, including me, all know the awful feeling … a decision, an action, a path taken, a mistake that cost a patient’s life.
    During my years in clinical cardiovascular research, I have felt the remorse that Harken felt that day. He called it the Pain of the Pioneer. The pain seems far more intense than that experienced when you have an adverse outcome in the course of patient management. When patients have complications during routine care, the rationalization that I did the best that could be done comes easily enough, since both physicians and patients recognize complications are an inevitable consequence of disease. But when I am testing an unproven new drug or device and experience an adverse outcome, I replace the disease as the cause of the adverse outcome with myself, even though the disease itself may be fatal. The difference is guilt. Whether rational or not, it is a tough emotion to shed. As Harken so poignantly observed, “When we’ve created the vehicle of death, the bridge to destruction for our patient, that’s another kind of pain.” He had convinced himself that he would do great good, and now had to confront the reality that instead he had done great harm.
    Late that afternoon a woman appeared at the door of Dwight Harken’s home, carrying a note she had promised to deliver in the event of her friend’s death. Harken opened the note, which read:
Dear Dr. Harken:
Thanks for the chance. A small portion of my estate has been left to see that this doesn’t happen again.
    The voice of forgiveness had come from the grave.
    Remarkably, Harken was not the only surgeon to attempt the closed approach to aortic stenosis. In the South, following Bailey and Harken’s lead, young surgeon Dr. Horace Smithy was also gaining success with closed heart surgery on mitral stenosis. He convinced Johns Hopkins Medical Center’s renowned thoracic surgeon Dr. Alfred Blalock that they should jointly attempt closed aortic valve surgery. He identified a suitable patient and brought him to Blalock. Smithy had a very personal reason for approaching Blalock. He, too, had aortic stenosis. He knew from experience that once symptoms began he had only a few years to live. If he and Blalock were successful, Smithy wanted to be the famous surgeon’s next patient. But when Blalock put a finger-sized hole in the left ventricle, it was like a bullet hole: their patient’s heart literally blew up in their faces. Blalock, never enthusiastic about Smithy’s idea, now adamantly refused to attempt another case. A few months later, Charleston lost its brilliant young cardiac surgeon when Horace Smithy collapsed and died of aortic and mitral valve stenosis at the age of thirty-four.
    Today, aortic valve stenosis and mitral insufficiency are the most common valve deformities in adults. As in Smithy’s time, after an aortic valve stenosis patient develops chest pain, heart failure, or fainting, it is particularly deadly. If left surgically untreated, the average survival is only two to four years. Valve surgery, on the other hand, can eliminate symptoms, restore vitality, and add many years of life. A number of American celebrities including Arnold Schwarzenegger, Barbara Walters, Garrison Keillor, and Charles Rose all have suffered from aortic valve disease and publicly discussed their therapy.
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    HARKEN HAD DISMANTLED the myth that the heart was untouchable. When he and Bailey succeeded in extending his battlefield technique to the treatment of mitral stenosis, an important killer of young adults, they created a scintillating new vision for surgical treatment of heart disease. But in medicine, profound answers always create new questions. While the blind