Into the heart, a medical odyssey

Back to Chapter Six: The King of Hearts

Richard DeWall in 1964

Chapter 7:
Saved by Bubbles

When he arrived at University Hospital with his plaster-of-Paris heart model that day in early 1954, Richard DeWall went to see Richard Varco, whom he remembered from medical school. The surgeon was impressed. In 1954, only the wildest of dreamers believed artificial heart valves would ever be practical, but DeWall, a suburban family doctor, was evidently ingenious. Who knew what other ideas might come out of his head?

Maybe we can have you work in our laboratory, Varco said.

I'd like that, said DeWall.

Varco sent him to see the head of the lab, Dr. C. Walton Lillehei.

Like Owen Wangensteen, the chief of surgery, Walt Lillehei did not believe in judging books by their covers; neither of them found it easy to ignore anyone with ambition. Still, Richard DeWall seemed an unusually poor prospect. DeWall was soft-spoken — shy — and more familiar with a stethoscope than a scalpel. He'd interned at an undistinguished hospital, and his University of Minnesota Medical School grades ... let's just say Dick DeWall wasn't valedictorian.

DeWall explained that his interest in the heart went back to World War II; as a Navy draftee, he'd contracted rheumatic fever, an infection that can permanently, sometimes fatally, damage heart valves. Since then, he said, life as a general practitioner hadn't proven to his liking. He thought research would be more exciting.

Lillehei was not put off by DeWall's medical-school grades (Lillehei himself had nearly flunked high-school chemistry, prompting his teacher to predict he wouldn't last six weeks in college), but he knew that Minnesota's graduate-school dean, who had final say in admitting surgical residents, would reject DeWall for his lackluster academic performance. In any event, the department of surgery didn't have the money for another residency.

We're working on a shoestring budget, Lillehei told DeWall. I'm sorry — we just don't have a position for you.

But Lillehei had money to hire DeWall as an animal attendant in his lab. DeWall fit right in. Cheerfully, he tended the dogs, mopped the floors, assisted in canine operations, calibrated and ran the Sigmamotor pump. He quickly proved extraordinarily clever, with an affinity for mechanical devices and an uncanny understanding of synthetic materials and their interaction with living cells. Lillehei knew he'd found a diamond in the rough. DeWall quit his family practice and went to work full-time in the lab.

Weeks passed. Lillehei performed his first three cross-circulation open-heart operations. He then asked DeWall to replace the pump technician in his next operations. DeWall, animal attendant, was now a full-fledged member of the clinical team.

Like the others, DeWall could see firsthand cross-circulation's limitations. He knew they had to find a better method than using a human donor.

They needed a machine.

One day, Lillehei talked to him about possibilities.

Dick, said Lillehei, we've got to have an oxygenator. It has to be something simple.

DeWall got right on it.

He soon looked at bubbles. Bubbling was an efficient way to oxygenate blood: many surgeons, including Morley Cohen with his aquarium airstones, had done that. The difficulty was on the other end: no one could figure out how to get rid of bubbles once they'd done their job. Bubbles in the bloodstream blocked capillaries. Bubbles in the bloodstream were silent assassins.