Dr. Michael DeBakey Dead

From the chronicle:

http://www.chron.com/disp/story.mpl/front/5884576.html

uly 12, 2008, 3:52AM
Dr. Michael DeBakey: 1908-2008
'Greatest surgeon of the 20th century' dies

By TODD ACKERMAN and ERIC BERGER
Copyright 2008 Houston Chronicle
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Images from a medical pioneer's career

Dr. Michael Ellis DeBakey, internationally acclaimed as the father of modern cardiovascular surgery — and considered by many to be the greatest surgeon ever — died Friday night at The Methodist Hospital in Houston. He was 99.

Methodist officials said DeBakey died of natural causes. They gave no additional details.

Medical statesman, chancellor emeritus of Baylor College of Medicine, and a surgeon at The Methodist Hospital since 1949, DeBakey trained thousands of surgeons over several generations, achieving legendary status decades before his death. During his career, he estimated he had performed more than 60,000 operations. His patients included the famous — Russian President Boris Yeltsin and movie actress Marlene Dietrich among them — and the uncelebrated.

"Dr. DeBakey singlehandedly raised the standard of medical care, teaching and research around the world," said Dr. George Noon, a cardiovascular surgeon and longtime partner of DeBakey's. "He was the greatest surgeon of the 20th century, and physicians everywhere are indebted to him for his contributions to medicine."

Debakey almost died in 2006, when he suffered an aortic aneurysm, a condition for which he pioneered the treatment. He is considered the oldest patient to have both undergone and survived surgery for it. He recovered well enough to go to Washington earlier this year to receive the Congressional Gold Medal, one of the nation's two highest civilian honors.

He remained vigorous and was a player in medicine well into his 90s, performing surgeries, traveling and publishing articles in scientific journals. His large hands were steady, his hearing sharp. His personal health regimen included taking the stairs at work and a single cup of coffee in the morning.

DeBakey's death was mourned Friday night by the leaders of Methodist and Baylor. Methodist President Ron Girotto said, "He has improved the human condition and touched the lives of generations to come. We will greatly miss him." And Baylor President Dr. Peter Traber added that "he set a standard for preeminence in all areas of his life that those who knew him and worked with him are compelled to emulate. And he served as a very visible reminder of the importance of leadership and giving back to ones community."

Debakey was born in Lake Charles, La., in 1908, a month before Ford began making Model Ts and a quarter-century before the discovery of bacteria-fighting drugs. His genius helped shape surgery and health care as we know it. While still in medical school, he developed the roller pump for the heart-lung machine. DeBakey invented many of the procedures and devices — more than 50 surgical instruments — used to repair hearts and arteries today.

He is widely credited with laying the foundation for the Texas Medical Center in Houston by recruiting pre-eminent doctors and researchers and giving the city an international reputation for leading-edge health care. He was a maverick, running afoul of the Harris County Medical Society for insisting that surgeons be certified by the American Board of Surgery. At the time, it was common for general physicians to operate.

"DeBakey built a department of surgery at Baylor and at The Methodist Hospital, which was to become one of the most celebrated in the world, a galaxy of young stars," the late author Thomas Thompson wrote in 1970 in Hearts: Of Surgeons and Transplants, Miracles and Disasters Along the Cardiac Frontier. "In a city where 25 years ago there was practiced medicine of the most mediocre sort, there sprung up in a swampy area six miles south of downtown ... one of the handful of distinguished medical centers in the world."

He invented and refined ways to repair weakened or clot-obstructed blood vessels using replacements made from preserved human blood vessels, and later, with artificial ones. He is credited with the first successful surgical treatment of potentially deadly aneurysms of various parts of the aorta. He co-authored one of the earliest papers linking smoking and lung cancer in 1939.

During World War II, serving in the office of the U.S. Surgeon General, DeBakey's work led to the development of mobile surgical hospitals, called MASH units. He helped President John F. Kennedy lobby for Medicare; he recommended creation of the National Library of Medicine, subsequently authorized by Congress. In 1963 DeBakey won the Lasker Award for Clinical Research, considered the U.S. equivalent of a Nobel.

"At times he could act like the meanest man in the world. He didn't let you breathe," said Dr. John L. Ochsner of New Orleans, who trained under DeBakey and whose father, Dr. Alton Ochsner, was DeBakey's mentor at Tulane University School of Medicine. DeBakey baby-sat the four Ochsner children, including John, and let them do chin-ups on his arm.

Said John Ochsner, "The thing that made him so mad all the time was he was trying to conquer the world and every minute was so important to him. He didn't have time for frivolity at all."

Patients and their families saw him otherwise. To them, DeBakey was a healer with quiet authority who seemed to work miracles. Enfolding a patient's hands in his, the patient's face would relax, some recalled.

He was pained by the breakup in 2004 of the historic, 50-year marriage between Baylor and Methodist, which dissolved over disagreements about the future of the institutions. DeBakey said the breakup made no sense and hurt both parties. Friends described him as "heartbroken" about the split and in an interview earlier this year he said the description was not inaccurate.

In 2003, his MicroMed DeBakey LVAD was implanted in a 10-year-old girl, the youngest patient in the world to receive the device. In 2004, a special child-sized version became available for children as young as 5. DeBakey developed the device, which boosts the heart's main pumping chamber, in collaboration with heart surgeon Dr. George Noon and NASA.

"The man has an incredible mind and an incredible grasp of details," said former MicroMed CEO Travis Baugh . "He's also never stopped inventing. We are working on a project with him a new way of attaching sutures to the heart.'"

In his prime — and it was an unusually lengthy prime — DeBakey, with his sharp-nosed profile and dark brown eyes, had the power to intimidate and awe his acolytes. In surgery, DeBakey was famous for his withering remarks, delivered in a velvety Louisiana drawl, directed at the anxious and ambitious residents operating alongside him.

John Ochsner recalled how, if an operation was going slowly, DeBakey might ask, ''Am I the only one here doing anything?"

Or a clumsy resident might prompt DeBakey to say, ''Do you have two left hands?"

If DeBakey was displeased by the progress of a procedure, he would remark with an air of faint disgust, ''I am surrounded by incompetence."

DeBakey's trainees cringed at his criticism but, among themselves, recounted the barbs in a sometimes dead-on imitation of the revered surgeon. Ochsner, now chairman emeritus of the Department of Surgery at Ochsner Clinic in New Orleans, said DeBakey's stern manner came from a desire to prepare his students for the demanding career that lay ahead.

''He's not hard to work with if things are done right," said Noon, DeBakey's colleague of more than three decades, in a 1995 interview. ''He was hard on people who slacked off or made mistakes. But he was so busy. He had to depend on people, and he could be tough. But he was always tough for a reason."

DeBakey was the eldest of five children born to Lebanese immigrants Raheehja and Shaker Morris DeBakey. Shaker Morris DeBakey was a well-to-do businessman and pharmacist in Lake Charles who invested in real estate and rice farming. Michael DeBakey grew up with his brother and three sisters in a large house two blocks from the public school with maids, butlers and gardeners.

The DeBakeys ate healthy foods — fresh vegetables, fresh fruit, seafood, rice and beans. They didn't smoke or drink. They encouraged their children to check out books from the library every week. At dinnertime, the family chatted about things that happened at the drugstore or the doings of politicians who sought out Shaker's advice.

"You could not get a word in edgewise until one of our parents announced who had the floor," DeBakey recounted to a reporter in 1997. "It was very stimulating."

Each Sunday after services at their Episcopal church, the DeBakeys would take clothing to a nearby orphanage. One time, the give-away bundle included DeBakey's favorite cap. When the youngster protested, his mother sat him down and said, "You have a lot of caps. These children have none."

"It made a great impression on me," he said.

DeBakey's mother also taught him one of his future career's essential skills — sewing. He would help her repair items headed for the orphanage. He also learned to tat, using a little bobbin to make lace. Years later, in the 1950s, DeBakey would introduce artificial arteries made from Dacron; he sewed the prototype on his wife's sewing machine using fabric purchased at Houston's downtown Foley's.

He went to medical school at Tulane after graduating as valedictorian from his high school class. During his senior medical school year, he developed the roller pump, a device which two decades later became a crucial component of the heart-lung machine used on patients during open-heart surgery.

As a surgery resident at New Orleans' Charity Hospital, DeBakey caught his first glimpse of a living human heart — pink and pulsating in the chest of a knifing victim.

''I saw it beating and it was beautiful, a work of art,'' DeBakey said in 1987. ''I still have an almost religious sense when I work on the heart. It is something God makes, and we have yet to duplicate."

Later, at Charity Hospital, DeBakey experienced a potentially catastrophic near-miss — he accidentally punched through a patient's aorta — which gave him an appreciation for the steadying influence of his mentor, Alton Ochsner.

He and Ochsner were operating in an amphitheater with a full audience of visiting surgeons. DeBakey was on one side of the patient, Ochsner on the other. DeBakey was attempting to lift up the aorta, which had been weakened by infection "when I suddenly realized, with a gripping terror, that I had entered the aorta."

DeBakey whispered this to Ochsner, who calmly instructed DeBakey to leave his finger over the hole. Ochsner stitched it up, and no one realized a near-fatal accident had occurred.

During the late 1930s, DeBakey married his first wife, Diana, a nurse he met in New Orleans. They had four sons: Michael, Ernest, Barry and Denis. When he came to Houston in 1948 to head up Baylor's surgery department, he moved his family into a home near Rice University, only five minutes from the Texas Medical Center, so he wouldn't waste time commuting. He never moved from that home.

Diana DeBakey died of a heart attack in 1972. They had been in Mexico for a medical meeting, staying with a close relative of the President of Mexico. They ate well and stayed up late, and when the DeBakeys got back home, Diana was complaining of an upset stomach.

At that time, gastrointestinal problems were not widely recognized as a heart attack symptom in women. When her discomfort worsened, DeBakey had her admitted to the hospital to find out what was wrong. While DeBakey was in surgery on someone else, he got a call that there was an emergency. When he reached his wife's bedside, she had died.

Three years after her death, DeBakey married German film actress Katrin Fehlhaber, whom he met through Frank Sinatra. They had a daughter, Olga. In 1978, DeBakey was hospitalized for smoke inhalation sustained in rescuing his daughter after a Christmas tree caught fire in his home, he told the New York Times.

The workaholic DeBakey rarely slept more than five hours a night, awaking at 5 most mornings to write research papers or read medical journals. He rarely drank, never smoked, ate sparingly — mostly salads, late in life — and didn't watch television. Lean and nearly 6 feet tall, he weighed the same as he did in 1926 when he graduated from high school — about 160 pounds. He spent much of his adult years in light-blue scrubs, and wore a pair of gleaming-white cowboy boots for the operating room. He liked to say that he conducted the presidency of Baylor between cases.

In 1948, when DeBakey came to Houston, he had turned the Baylor job down twice. The fledgling school had moved to Houston from Dallas just five years earlier, and Baylor students were scattered all over the city doing their clinical rotations, a situation that didn't appeal to DeBakey. He finally was persuaded to come when Hermann Hospital promised the school a 20-bed surgical service, according to Ruth SoRelle's history of Baylor, The Quest for Excellence.

The Hermann deal fell through, and DeBakey nearly left. But the Truman administration asked DeBakey to transfer Houston's Navy hospital into aVeterans Administration hospital, an idea championed by DeBakey that evolved into the national VA system. There, DeBakey's students started the city's first surgical residency program.

DeBakey's program was legendary for cutting its participants off from all contact with the outside world. As a DeBakey trainee, Dr. Edward Lefrak once spent 91 consecutive days on duty in the cardiovascular intensive care unit, missing the birth of one of his children, sleeping when he could in the patient recovery ward. Lefrak's rotation was supposed to last just 30 days, but DeBakey had a tendency, when things were going well, to keep arrangements unchanged.

''It was like a compliment,'' said Lefrak, medical director of cardiac surgery at the Inova Heart and Vascular Institute in Falls Church, Va. ''But then, on the other hand, it was another 30 days."

One of the most talked-about events of DeBakey's life was his legendary feud — more Arctic freeze than hot-tempered spat — with Dr. Denton Cooley, his one-time close collaborator. DeBakey hired Cooley in 1951 after the Houston native finished his training at Johns Hopkins University School of Medicine in Baltimore.

In 1965, DeBakey participated in a federally funded program to design an artificial heart. Within a few years he had a device that some physicians felt was ready for human trials, but DeBakey believed it needed more work.

Then, to international acclaim in 1969, Cooley performed the first implantation of an artificial heart into the chest of 47-year-old Haskell Karp, a dying heart surgery patient. Karp lived with the heart in his chest 65 hours before dying shortly after a heart transplant.

Cooley's fame was quickly tarnished after DeBakey said the heart was identical to one under development in the Baylor labs, and that Cooley had used it without permission.

Cooley said he and Dr. Domingo Liotta, who also designed artificial hearts in DeBakey's lab, had built the heart privately, and that he had no choice but to use the heart because the patient's life was in jeopardy.

After the incident, the American College of Surgeons voted to censure Cooley, and, amid a dispute with the trustees of Baylor, Cooley resigned from the institution. The two men never collaborated again and rarely spoke. DeBakey changed his focus and decided funds would be better spent developing pumps to assist failing hearts. Such devices became the mainstream treatment for patients with failing hearts.

The episode ''stole DeBakey's shot at a Nobel Prize," Methodist heart surgeon Mike Reardon said in 2004. ''What Mike needed was one crowning event to make him a candidate. And that was going to be the artificial heart."

But the two buried the hatchet last year. Cooley inducted DeBakey into his surgical society and, in a surprise, DeBakey accepted, telling his former colleague he was touched by the gesture. Earlier this year, DeBakey returned the favor, granting Cooley membership in his surgical society. In April, when DeBakey was given the Congressional Gold Medal, Cooley made the trip to Washington too.

For a man who outlived most of his peers, he seemed surprisingly unphilosophical about death, appearing to view it as a personal enemy. Losing a patient put him in a black mood and set his mind spinning with thoughts of what he might have done differently.

''You fight (death) all the time, and you never really can accept it," he once said. ''You know in reality that everybody is going to die, but you try to fight it, to push it away, hold it away with your hands."

DeBakey was preceded in death by his sons, Houston lawyer Ernest O. DeBakey, who died in 2004, and Denis, who died in 2007. In addition to his wife Katrin and their daughter Olga, DeBakey is survived by sons Michael DeBakey of Lima, Peru; and Dennis of Houston; brother Dr. Ernest G. DeBakey of Mobile, Alabama; and sisters Lois and Selma DeBakey, both medical editors and linguists at Baylor.