100,000 Hearts: A Surgeon's Memoir by Denton A. Cooley, MD

Each time I opened Denton Cooley's memoir, intending to breeze through a couple of chapters, I could not close it without advancing 100 pages. Some chapters, such as the “Reconciliation with Mike,” I read twice. No cardiac surgeon could be indifferent to this book. It is a superb memoir of a gifted human being who rose to the peak of his profession. As an intern at Hopkins in 1944, Cooley found cardiovascular surgery a paltry field; he is leaving it a blooming one.

The first thing that strikes me about the book is its thoroughness. Cooley seems to cover life from early to late, including the highs and the lows, with a full range of telling photographs. In the appendices, we find diagrams, a glossary, various lists (personal contributions to cardiovascular surgery, inventions and products, and selected publications), and a curriculum vitae. The beauty of the book, however, is in the story, told as if he is there in the room.

A cardiac surgeon, Dr. Michael D. Crittenden, with whom I worked at the National Institutes of Health some 25 years ago, used to say, “Cardiac surgery is a brutal business.” For a long, successful career in cardiac surgery, physical stamina is necessary, as well as a kind of emotional resilience, both of which Cooley clearly had. He was a gifted athlete who worked as a surgeon from 6:00 am to 8:30 pm daily for decades—one of the few who were able to continue operating beyond the age of three score and ten. He appears to have lived by the dictum Labor omnia vincit, which means “Labor conquers all.”

Along with endurance, Cooley had that human quality that allowed him to take in stride the brutal lows in cardiac surgery, along with the wonderful highs. Osler called that quality aequanimitas, or equanimity (1). The old television show, Wide World of Sports, used to open with the phrase, “The thrill of victory … and the agony of defeat.” I knew one surgeon who would cry in his office after a patient died. Another would hardly speak for a week. Another would take it out on subordinates. Cooley shares with us that a round of golf in the open air helped him move forward.

Thomas Jefferson founded a university; Cooley founded an institute. One expects that the Texas Heart Institute will endure. As a natural leader, Cooley also seems to have lived by the Jeffersonian recommendation to “take things by the smooth handle.” In his autobiography, Dr. Christiaan Barnard, the South African who later performed the first heart transplant, made these observations of Cooley during a visit to the Texas Heart Institute as a young surgeon:

It was the most beautiful surgery I had ever seen in my life. Every movement had a purpose and achieved its aim. Where most surgeons would take three hours, he could do the same operation in one hour. It went forward like a broad river—never fast, never in obvious haste, yet never going back. … Dr. Cooley's skill was matched by his grace and kindness toward me. He invited me into his theater, showed me everything, and politely answered all questions (2).

Nearly every cardiac surgeon in North America whose surgical career overlapped that of Denton Cooley can find some connection to him. I am no different. Cooley's book on Techniques in Vascular Surgery, coauthored with Dr. Don C. Wukasch, was my go-to book in vascular surgery (3). Published in 1979, the prose is simple and clear and the illustrations are superb. And yet it is surely one of Cooley's minor publications.

Another connection was more personal. As an Emory medical student, I spent a month as an extern at Duke in 1985 and happened to board in the same home in Durham in which one of Cooley's daughters lived while receiving treatment at Duke. The homeowners, who had no children, were very fond of her and lamented her early death, which Cooley described poignantly in his memoir, some 30 years later, as the greatest tragedy of his life.

Cooley spent a year at the Royal Brompton Hospital in London, and his description of that year is delightful. I too spent a year there (1997–98), and my mentor, Mr. Christopher Lincoln, occasionally spoke of Cooley—how he became a “locum consultant” during the medical leave of the thoracic surgeon Oswald Sydney Tubbs, how he had a full operative “list,” and how he wrote in a large handwriting. The impression Cooley made at the Brompton had lasted decades.

In 1999, my chief at the University of North Carolina, Dr. Benson R. Wilcox, handed me a letter that he received from Cooley concerning a book I wrote (4). The letter, handwritten by Cooley, reads:

Dear Ben,

Not knowing Charles Roberts personally, I am writing you to express my enjoyment of reading his book, Stoking the Fire. Of course my appreciation comes from having spent a similar year in London with Russell Brock and the other surgical dignitaries at the Brompton and the U.K. Dr. Roberts' observation and descriptions brought back vivid memories which I hold. As an author he has a real talent and may consider a future as a John Grisham! Please extend my congratulations and encouragement to him. I wish that I had kept a full diary of my year. I can still quote sayings from Brock, Tubbs, Barrett, and Price Thomas.

I hope the summer is going well—

Sincerely yours,

Denton

The passages in Cooley's memoir concerning Dr. Michael E. DeBakey (“Mike” as he is called in the book) are interesting to many of us who have observed this rivalry in Houston from afar. Of course, the Cooley memoir represents one perspective. We will have no perspective from DeBakey, though I suspect he would disagree on many points, including various firsts in cardiovascular surgery. Nevertheless, their reconciliation, in the end, was good for the field of medicine. The photograph of the two surgeons together, shaking hands, late in life, is framed in my office, as a kind of inspiration. Both men are founding fathers of cardiovascular surgery in the 20th century.