Drawing the line

The year was 1881 and a young woman was dying from the postpartum hemorrhage. The young, 29 years old surgeon was contacted and after deliberations he drew blood from his own vein and transfused it to the patient. The patient recovered. German scientist Landsteiner discovered and described ABO blood group system in 1901.

A year later, in 1882, young woman’s mother was having severe abdominal pains. Consultants didn’t know what to do since they weren’t sure about the diagnosis.

Again the same young surgeon was called. He recognized cholecystitis and promptly operated on elderly woman. Again, she recovered. Story goes that the surgery was done on the kitchen table at 2 a.m. with the help of a table light. The first elective cholecystectomy was done by Carl Langenbuch in Germany the same year. In the formal operating room.

The young surgeon was the first woman’s brother and of course son of the older woman.

And it was just a beginning of a long and very eventful career of William Halsted.

He went on to become a giant in the history of  American surgery. He established the surgical program at Johns Hopkins as a model of  American surgical prowess including precision of the diagnosis, respecting meticulousness of surgical technique and attention to details. He also established the training program for surgical residents based on the German system which was modeled on apprenticeship training for trades. The interesting fact was that there was no time limit for the length of surgical residency and one was ready only after your mentor had said you are. One of his residents after 10 years under Halsted asked him, when he will be able to start his own practice.

“Why hurry?” was his answer. “There is no rush!”

Halsted was the one who first used surgical gloves. But not for the reasons we are using them today. At his time carbol was being used to disinfect hands before surgery. Unfortunately carbol was so strong a solution that left skin on hands discolored. He himself didn’t mind it, but his scrub nurse did. The fact that she was his girlfriend also helped. So he wrote a letter to Goodyear Company asked them to design rubber gloves. Soon entire operating team was using them.

But it was also a dark side to his life. He was a cocaine addict. There were times he had to interrupt surgery and be injected with cocaine by a nurse. Later on he tried to cure his cocaine addiction with morphine. He became addicted to both.

Alfred Blalock was a surgeon trying to get to Halsted’s residency program. He wasn’t accepted. The letter written by Halsted very politely wished him luck somewhere else. Three years later he ended up at Vanderbilt. There he developed experimental canine model to create and study pulmonary hypertension. After anastomosing the divided subclavian artery to pulmonary artery dogs developed pulmonary hypertension.  The technician who was instrumental in developing the technique and doing most of the procedure was Vivian Thomas. Thomas was so competent, that Blalock had asked him to do the procedure in the dog lab most of the time.  Later on, when Blalock was offered very prestigious position at Johns Hopkins, one of his conditions was that Thomas is coming with him.

At Hopkins Helen Taussig was working on “blue babies” and thought of redirecting blood from systemic circulation to pulmonary circulation to relieve pulmonary stenosis. The procedure designed and perfected on dogs by Blalock and Thomas (Thomas and Blalock?) would do the job. After consultations the first patient was chosen and first subclavian-to-pulmonary artery shunt was done. The year was 1944, patient’s name Eileen Saxon and thus era of cardiac surgery has begun.

The procedure was done by Alfred Blalock, but Vivian Thomas was standing behind him and telling him how to do it. To have Thomas with him during first series of the operation Blalock had to have a special permission. And he needed him badly.

See, Vivian Thomas was a black surgical tech, the grandson of a slave. Vanderbilt was segregated and Johns Hopkins was even more. There was no position for a black lab technician, not to talk of real operative room access. Thomas’ official position was a janitor and he was paid accordingly.

Their relationship is being described as “complicated.” Blalock needed Thomas in the operating room, but outside their social contacts were limited at the best. So was Thomas’ pay and academic acknowledgements.

There are many high-profile persons with highly publicized flaws. We see politicians apologizing for personal “transgressions”, artists admitting their addictions, athletes being confronted with cheating. How do we balance obvious accomplishments with their obvious dearths? Do we discount Halsted’s achievements in view of his cocaine addiction? Do we judge Blalock by today’s criteria and label him as racist? Do we forgive promiscous politician for extramarital affair while tagging another one with lie or a frivolous lawsuit? Do we put an asterix after the most prestigious batting record in baseball? And what do we do with a medical discovery done after experiments on female prisoners in Ravensbruck?

We do draw the line. The famous people have their right to behave the way they chose. We have the right to assess their accomplishments and judge their shortcommings. And each of us probably draws the line in a different place according to our beliefs, education, convictions and values. Each line is in a different place and each of us surely has an argument to support it. The facts could be disputed but is hard to argue with feelings.

That is the beauty (and sometimes curse) of living in the free society where you are not told what to think and what to do, and you are responsible for your own decisions.

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