Medical pioneer DeBakey broke racial barriers
In excerpt from new biography, author explores famed surgeon’s complex personality
A60-year-old man was admitted to Houston’s Jefferson Davis Hospital in early November 1952, complaining of severe back pain that radiated down both legs. He also had a large, pulsating mass in his lower abdomen. X-rays showed that his aorta, the large vessel carrying blood out of the heart, was severely dilated in his abdomen. The diagnosis of aortic aneurysm was unmistakable — even worse, it appeared to be responsible for his symptoms. Having had two documented heart attacks the previous year, and plagued by severe shortness of breath on exertion, this man was hardly the picture of health. Any contemplated surgery would be attended by great risk. Nevertheless, when Baylor Department
of Surgery Chairman Dr. Michael E. DeBakey was brought into the case, he saw no reasonable alternative.
What DeBakey did next would help to open up a whole new field of surgery and set the Texas Medical Center on a path of international prominence for medical innovation. The broad outline of this story is well known, but the details are more remarkable than even DeBakey’s many admirers know. Even less well-known is that the young DeBakey not only broke medical barriers but played an important role in the turbulent social struggles of the 1950s around racial segregation.
At this point in time, DeBakey and others had come to consider aortic aneurysms to be a highly fatal problem: In some studies, few patients survived as much as a year after the ominous
diagnosis was made. A patient with symptoms from an aortic aneurysm seemed to be on the slipperiest of slopes: Back pain was a sign of impending — or even actual — rupture. The trouble was that a reliable and safe surgical technique for treating aneurysms of this most essential of blood vessels remained elusive. When DeBakey came onto the case, he was not aware of any successful operation of the kind having ever been performed. Still, there was no choice but surgery:
On Nov. 6, 1952, DeBakey took the patient to the operating room for a new kind of aortic aneurysm repair. The abdomen was opened and the aneurysm exposed. It involved the aorta from a few centimeters below the renal arteries to where it forks into the right and left iliac arteries in the pelvis. The aorta was clamped above and below its dilated segment, then the aneurysm was completely removed. The diseased section was replaced with an aortic homograft — a portion of the aorta donated from a human cadaver. DeBakey sewed this to the patient’s normal aorta above and below the segment that had been removed.
But once the blood flow was re-established through the aorta, DeBakey was disappointed to see that, although the new aorta was clearly functioning well, it was just as clearly too long. In his haste to get the graft into the circulation, he had neglected to trim it to the correct length.
With every heartbeat it folded forward and nearly kinked. DeBakey clamped the arteries again, removed the redundant segment and sewed the graft to itself end to end.
The patient’s postoperative course was not smooth, but the subsequent stay was, in the parlance of the profession, “uneventful,” and he was discharged after 30 days.
Only a few weeks later, DeBakey performed his second aortic aneurysm repair. On this case, he had an assistant surgeon of some capability to help him: a recent addition to the Baylor surgical faculty named Denton A. Cooley.
Before long, the successful aortic aneurysm repairs in Houston led to a steady stream of referrals from afar — elsewhere in Texas, and even other states. Typically, DeBakey would discuss these out-of-town cases on the telephone with either the patient in question or the referring physician. If he felt the patient would best be served by a trip to Houston for evaluation or definite surgery, he would arrange their admission to Methodist Hospital. On the appointed day they would appear and be admitted, previously sight-unseen. Ultimately this led to Methodist confronting an issue that would soon face the entire country.
Much later, Debakey recalled that, “I had a patient who was sent to me. This patient turned up to be a negro, and I had already made the reservation for him to be admitted to the hospital. When he got there, they wouldn’t admit him.”
At this time, there was a facility in the city called the Houston Negro Hospital, which was staffed entirely by African American physicians, and served that population. The city-county Jefferson Davis Hospital treated patients of all races, too. The remaining hospitals saw, nearly exclusively, the white community.
DeBakey’s patient, however, had come from outside the state and had no knowledge of any of this. Even though Methodist was expensive, he was prepared to cover all costs. In the mind of DeBakey, there was no sensible reason to exclude him. That did not mean, as it happened, that there would not be considerable resistance. DeBakey later recalled: “I went to see the hospital administrator and told him that this man needed this kind of operation and he needed to be put in the hospital for this purpose. So they said, ‘Well, we just can’t admit him because we’d have a terrible problem on our hands with the staff.’ I said,
‘Well, I think it’s wrong. This is a Methodist Hospital. This is a Christian hospital. How can you say you’re a Christian hospital and do this?’ ”
DeBakey threatened to confront the board of trustees about the matter. Privately, he did consult with some of them. Away from the spotlight, they agreed with him. He also learned that the discrimination was, in fact, not statutory: “They had no policy of excluding Negroes. They hadn’t made a policy. It was just the custom.”
Since there was no bylaw prohibiting the admission of African Americans to Methodist Hospital, the board and administration’s decision in this and future cases would be based on conscience. Only time would tell, but it was a reasonable expectation that certain elements of the staff and clientele would be opposed to the idea. A tentative and temporary compromise was reached. For the time being, in his unique position of offering services that were unavailable in most of the country, DeBakey would be permitted to admit black patients to Methodist Hospital on an ad hoc basis. Other physicians followed suit over the months and years to come and, gradually, this invisible barrier was eliminated.
Those two episodes — the introduction of the life-saving new surgical technique and his insistence that his African American patient be admitted — show DeBakey at his best. He was a complex man, however, whose personality as seen by others was defined by an essential dichotomy. There was the “public” persona — the charming, witty intellectual with a quick, beaming smile and the extraordinary ability to converse comfortably on virtually any topic. This was the DeBakey seen by most surgical peers, interviewers, patients and philanthropists.
The other was “Black Mike”: the fierce taskmaster quick to criticize and slow, if ever, to praise. This was the DeBakey that was, all too often, most familiar to his trainees.
For some who had known this complex man the longest, the two sides were sometimes difficult to reconcile. His great mentor from Tulane University, the legendary New Orleans surgeon Alton Ochsner, often struggled to understand his protégé: “I’ve been in the Clinic over there several times when he’s been very curt. This is very foreign to the Mike I know. When he was here I never saw this. He was the sweetest character. When I saw him in the operating room over there, when he would speak curtly, this was not Mike.”
Ochsner believed that the tension of the complex cardiovascular procedures, as well as professional competition with Cooley, his clearly threatening junior colleague drove the change he observed in DeBakey.
In fairness, many of the leaders of academic surgery throughout the 20th century were famous for their dominating and authoritarian personalities, in the United States and elsewhere. This phenomenon only became more florid in America when the midcentury generation of such leaders returned, like DeBakey, from military service, and the discipline this entailed, in World War II.
For his part, DeBakey did not pretend not to know what was said about him, but he attributed these perceptions to his unwillingness to compromise his high standards: “Most people are mediocre,” he said in a 1972 interview. “That’s the whole definition of mediocre. It’s very difficult for me to put up with mediocrity. The most difficult thing I have to deal with is to put up with mediocrity. I still can’t get adjusted to it, and what happens is that I’m turned off to these people, I don’t want to associate with them. I don’t want to teach them, I don’t do anything to them. I just want to leave them alone, just not worth fooling with.”
During the decadus mirabilis of the 1950s, DeBakey and his Houston team conquered a succession of cardiovascular diseases of blood vessels long thought to be incurable. The medical terms are full of Latin roots but they have their own poetry. His team performed one of the first successful abdominal aortic aneurysm repairs by resection and homograft replacement in the world. They then went on to perform the first successful such procedure on aneurysms throughout the aorta, the first successful carotid endarterectomy and the first successful repair of an aortic dissection. These were not merely academic or even technical achievements. Each represented a new hope for thousands of individuals who were hitherto condemned to death, stroke, limb loss or intractable pain. Along the way, the Baylor team also spearheaded the development of a legitimate, effective synthetic replacement for diseased arteries, brought to reality or perfected essential and novel instruments for the performance of delicate vascular procedures, and devised important new surgical techniques, all of which continue to be in clinical use to the present day. This was arguably the most outstanding period of sustained surgical innovation by a single group in the history of medicine; its impact was both global and lasting.
The relentlessness of DeBakey’s drive to develop new techniques for heart surgery in the 1950s should be understood in its historical context. Here was a surgeon changed by military service. He had worked in Germany before the war and experienced firsthand the profoundly unethical use of medical expertise there. In Houston, his rigor carried through in his research, in how he treated his colleagues and in his insistence on access for people of all racial backgrounds.
As the decade of the 1960s dawned, there was much more yet to come.