Monday, July 14, 2008
Michael E. DeBakey, 1908-2008
by Syed Tasnim Raza
Michael E. DeBakey died on July 11, 2008 of natural causes, just two months short of his 100th birthday. He was a pioneering, innovative, and world-renowned cardiovascular surgeon, whose surgical career spanned close to 70 years. While his name is most associated with Methodist Hospital of the Baylor College of Medicine in Houston, Texas, his career began at Tulane University in New Orleans in the late 1930s. It is at Tulane that he first described surgery for aortic aneurysms (ballooning of the aorta secondary to atherosclerosis) by cutting out the enlarged portion of the aorta and replacing it with a tube made out of Dacron. This operation has been performed millions of times throughout the world since then with great success.
Dr. DeBakey also described surgical treatment of another condition affecting the aorta, so-called aortic dissection, in which case the inner layer of the aorta (the intima) is torn, thus letting blood enter between the inner and outer layers, and as this condition progresses it shuts off the origins of major arteries coming off the aorta, causing stroke, heart attack, kidney failure and death if it remains untreated in a vast majority of patients. The classification of aortic dissection is named after DeBakey (DeBakey Types I, II and III). In December 2006, Dr. DeBakey himself suffered from Type I aortic dissection himself. He was 97 at the time and refused surgery due to his advanced age. But as the condition progressed he went into a coma and his wife and a long time associate, George Noon, asked for surgery to be performed against his expressed wish. The Ethics Committee of the hospital met, and in a controversial decision, permitted the operation to be performed, which was successful, although the recovery was complicated and he was hospitalized for over eight months, at a cost of over a million dollars. He fully recovered and remained active until his death.
Heart surgery was developed during the 1940’s, ‘50’s and ‘60’s in Boston, Philadelphia, Baltimore, and Minneapolis and Rochester in Minnesota. Dr. DeBakey, while working independently and outside of those major centers, made significant contributions in this field also. The heart lung machine was developed by the pioneering efforts of John Gibbon in Philadelphia and first used there in 1952, but it was the roller pump invented by DeBakey as a senior medical student in 1939, which made it much more useable and widely applicable after late 1950’s. Rene Favalaro, a Brazilian surgeon working at the Cleveland Clinic in Ohio, developed coronary artery bypass operation in 1967 using the saphenous veins from the legs to bypass obstructed coronary arteries in the heart. It turns out that Dr. DeBakey had successfully done this operation as a desperate measure in a patient who could not be weaned off the heart lung machine in 1964 in Houston, but did not report it at the time. It was eventually reported in 1974. Dr. DeBakey developed the first ventricular assist device (VAD), a mechanical pump which can support the heart for weeks or months, 300 of which have been implanted in humans, and newer versions of his device are still being used.
During the Second World War, Dr. DeBakey proposed that surgeons and nurses be deployed on the front lines with army units for providing immediate care to the injured, thus avoiding delays of evacuation to army hospitals. These became the M.A.S.H. units in the Korean war.
Another area in which Dr. DeBakey contributed greatly was making the Baylor College of Medicine and the Methodist Hospital in Houston one of the great medical education and research institutions in this country. At one time or the other he served there as the Chief Cardiovascular Surgeon, Chairman of Surgery, director of Cardiovascular Center, President of the hospital and Chancellor of the college. He took great pride as a teacher of surgery and trained hundreds of heart and vascular surgeons who are practicing throughout the world. He was known to be very demanding of the residents (though very charming to the patients and medical students), so much so that there are stories about his having slapped a resident on morning rounds, for having missed some minor point.
Another story which circulates among heart surgery residents is that a patient died just before morning rounds and no one wanted to break the news to Dr. DeBakey, so the patient was covered over by a sheet and Dr. DeBakey was told that there was no change in his condition, and they moved on. Another story about his dedication to surgery involves his first wife who died in 1972. Dr. DeBakey was operating when some one came in the room to give him the news. He asked not to be disturbed while he was operating and finished his day's schedule at 7:00 PM, at which time he asked what was so urgent that could not wait for him to finish! Even if there is partial truth to these stories, they have circulated in the surgical circles for so long that most of us take them as true, since they do reflect his personality. By the time he retired in his late 80’s, DeBakey had performed over 60,000 operations! His former trainees have formed the highly prestigious Michael E. DeBakey Surgical Society.
Dr. DeBakey received numerous awards throughout his long career, including the Lasker Award, United Nations Lifetime Achievement Award, Presidential Medal of Freedom with Distinction, The National Medal of Science, Congressional Gold Medal and at least 38 other major awards form various professional medical associations and societies. I first met and heard Dr. DeBakey during my residency training in Buffalo where he came to receive the Roswell Park Gold Medal, an award given by the Buffalo Surgical Society annually to a distinguished surgeon. At that meeting Dr. DeBakey told us that he had interviewed for the position of Chairman of Surgery at the Buffalo General Hospital in 1963, but then decided to stay on in Houston! The last time I heard Dr. DeBakey was in 2000, when he was 92, still vigorous and active, and was given the American Association of Thoracic Surgery Lifetime Achievement Award.
The greatest protégée DeBakey produced was Denton Cooley, a surgeon originally trained under Alfred Blalock in Johns Hopkins Hospital, who then joined DeBakey in Houston. Within a few years Cooley broke from DeBakey and opened a competing heart center, the Texas Heart Institute, across the street form the Methodist Hospital. The two centers competed vigorously and both became internationally recognized centers of excellence.
Once when Dr. DeBakey was out of town, Dr. Cooley stole an early version of an experimental ventricular assist device from Methodist and implanted it in one of his patients. Dr. Cooley to this day says he did it as a desperate measure to save his patient’s life, Dr. DeBakey says he did it to be the first to implant a VAD! This became a national scandal and Dr. Cooley was censured by the American College of Surgeons. The two did not speak after that and feuded publicly at professional society meetings. Finally after 40 years of this widely reported feud last year the Denton Cooley Cardiovascular Surgical Society gave Dr. DeBakey a Lifetime Achievement Award, and with urgings from mutual friends, Dr. DeBakey agreed to attend the meeting. There he finally shook hands again with his long-time nemesis.
Michael Ellis DeBakey was born in New Orleans to Shaker and Raheeja Dabaghi (Anglicized to DeBakey), Maronite Christians from Lebanon, who immigrated to the United States because of religious persecution back home. He was one of five children and credits his parents for inculcating in him the values of education and hard work and service to others, which led him to his successful career. Dr. DeBakey is considered one of the greatest surgeons of the last century. His name will live on in many patient’s hearts, on many buildings and departments in Houston, with the work of hundreds of his trainees, and in his numerous publications and the devices that he developed, for many years to come.
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