In Search of Vivien Thomas

Throughout the history of medicine, and particularly that of cardiovascular surgery, unlikely heroes are the bases of many intriguing stories. By today's medical-training standards, many of these heroes were not formally educated in the sciences, which makes their accomplishments and contributions all the more laudable.

The history of cardiovascular surgery shows us that necessity is undeniably the mother of invention. One example is the story of Earl Bakken, a television repairman who also repaired the electrical equipment in the operating room of C. Walton Lillehei, MD. In those early days of cardiovascular surgery, Dr. Lillehei was searching for a way to pace a patient's heart postoperatively. His initial attempts necessitated placing metal paddles on the patient's chest to “shock” and pace the heart. Although the system accomplished its goal, the patient was shocked up to 60 times per minute. Bakken, using the skills learned from his television-repair training, devised a battery-powered transistor (reportedly the size of a paperback novel) that could be attached to the myocardium via a wire. The device, worn on a string around the neck, paced the heart without the unpleasant shock. Bakken continued to develop homemade medical devices, and he eventually founded the company known today as Medtronic.¹

Perhaps the ultimate example of an unlikely hero is that of Vivien Thomas.² A black man who grew up in the early 1900s in the South, Thomas graduated from high school and adopted his father's trade: carpenter. Through a series of events, Thomas eventually took a job as lab assistant for Alfred Blalock, MD, of Vanderbilt University Hospital. His responsibilities involved basic laboratory testing of the cardiac physiology of laboratory animals. Eventually, these responsibilities evolved into more complex evaluations of preoperative, intraoperative, and postoperative changes in cardiac and surgical shock physiology in laboratory animals. Many of these studies were devised and performed before the development of much of today's standard medical equipment—pulse oximetry, defibrillation, and automatic laboratory analysis. All calculations were performed in longhand and repeated twice for accuracy.²

As Dr. Blalock's clinical activities increased, so did Thomas's responsibilities, and he soon began performing innovative cardiovascular surgical techniques in laboratory animals. Thomas followed Dr. Blalock to Baltimore when Dr. Blalock was appointed chair of surgery at The Johns Hopkins Medical School. It was at Hopkins that Thomas continued his research and was directly involved in the development of the Blalock-Taussig shunt, also known as the blue-baby operation.²

Denton A. Cooley, MD, a surgical resident in Dr. Blalock's program at Hopkins, observed firsthand Thomas's key role in the innovation and pioneering of such previously unimagined surgeries.² Thomas remained in the teaching laboratory to train residents, which enabled Dr. Blalock to attend to his increasing clinical responsibilities. After 30 years, Thomas was honored with the title Instructor Emeritus in Surgery at The Johns Hopkins Medical School, and his portrait was commissioned and presented to The Johns Hopkins Medical Institutions.²

Those who gave speeches at the presentation of this portrait to The Johns Hopkins Medical Institutions talked of Thomas's influence and of the high regard in which he was held. Dr. Alex Haller, Jr., relayed the following story:

After I finished my internship here under Dr. Blalock, I joined Dr. Glenn Morrow at the National Institutes of Health and worked there in the laboratory. I was the only one there, except for the technician, Mr. Alfred Casper. Casper had spent some time observing Vivien here at the Hunterian Laboratory. As I worked with him in the first couple of weeks, on one occasion we got into trouble with some massive bleeding, which I was able to handle fairly well. At the conclusion of the operative procedure, Casper said to me, “Dr. Haller, I was very impressed with the way you handled yourself in that situation.” Feeling overly proud of myself, I said to Casper, “Well, I was trained by Dr. Blalock.”

… A few weeks later again we were operating together and we got into trouble for a second time. I did not know what to do. Casper immediately took over, placed the clamps appropriately and promptly and we got out of trouble. I turned to Casper at the end of it and said, “I certainly appreciated everything you did. You knew exactly how to handle your hands very well, too.” He looked me in the eye with a little twinkle and said, “I trained with Vivien.”²

Why are these stories of continued interest and value? Considering the time at which the events took place and the relatively limited scientific training that Bakken and Thomas received, these stories demonstrate the successes of the underdog. For instance, Thomas, who very well could have become a carpenter, would later be recognized by many leading physicians as a pioneer of cardiovascular research and surgery. How would surgery's history and progress have changed had Thomas not had the opportunity to exhibit his innate intelligence and drive?

I am motivated to understand what drove these men to make profound contributions in the pioneering field of cardiovascular surgery. I wonder, in today's world of educational standards and regulations, Is it even be possible to find another Earl Bakken or Vivien Thomas? I believe that everyone has talents and gifts—gifts that aid society as a whole or benefit one person at a time. These gifts bring fame to some, while others are content to work behind the scenes.

In pursuing my education and training, I am drawn to persons on the periphery of medicine—those who exhibit commendable character or innate intelligence. Our goal should be to cultivate and encourage such people to follow in the footsteps of Earl Bakken and Vivien Thomas. I hope that this person still exists. With this hope in mind, I am forever in search of Vivien Thomas.

Damon M. Kennedy, DO

Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston

Acknowledgment

Special appreciation is extended to Denton A. Cooley, MD, for his personal time and insight in writing this essay.