Simon & Schuster £12.99 pp356
On December 6, 1967, three days after the operation, the recipient of the world’s first human heart transplant woke up and asked for a boiled egg. “Heart man: I’m hungry” said the headline in the local paper, neatly describing both surgeon and patient. The surgeon, Christiaan Barnard, was a man ravenous with ambition, determined to overcome the stigma of his impoverished Afrikaner upbringing. In a four-and-a-half-hour operation at Groote Schuur hospital in Cape Town, Barnard took the healthy heart of a 25-year-old woman who had been killed in a traffic accident and sewed it into the chest of Louis Washkansky, a 54-year-old white South African suffering from heart failure. The operation was to bring Barnard what Donald McRae, an excitable writer, calls “the searing burst of celebrity” as well as “medical immortality” and a night in the sack with Gina Lollobrigida. Through this story we learn that a great doctor may be many things — a bad-tempered, philandering egomaniac, for example. What he need not be is a nice person.
Barnard’s rivals at Stanford Medical Center in California, Norman Shumway and Dick Lower, were nice. They were kind to their inferiors, and scrupulous in their research. At “exactly 2.25pm” on December 31, 1959, Shumway and Lower verified their success in transplanting a heart from one dog to another. (McRae’s precision reporting never rests — Shumway, he tells us, had a “95.7% success rate in the operating room”). They would spend a further eight years perfecting their technique. Meanwhile, another nice fellow, Adrian Kantrowitz of Maimonides Hospital in Brooklyn, was also engaged in the race. At “exactly 11.45 pm” on June 29, 1966, Kantrowitz attempted the first human heart transplant. It failed, in part because American law at the time forbade the removal of a beating heart, even from a brain-dead patient. South African law had no such scruples; neither did Barnard.
Washkansky got his boiled egg — “Heart man has breakfast!” — but he didn’t have long to enjoy it. He survived only 18 days. His own heart had been a wreck (“its walls were as scarred as the humps of ancient whales,” Barnard observed poetically) but, although his death was probably hastened by his poor health prior to surgery, he might have lasted longer but for a postoperative mistake. He contracted pneumonia; Barnard, convinced he was seeing the onset of rejection, increased Washkansky’s immunosuppression, and in doing so rendered him incapable of fighting the infection. It was an error anyone could have made; it was an error Barnard was perhaps more likely to make, focused as he was on getting ahead. But the race to be first is never about what happened next, any more than romantic novels are about life after the wedding.
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McRae accordingly spends more time on the before than the after. While Shumway and Lower cut up what McRae calls “canines”, “mutts”, “hounds”, “mongrels” and “pooches”, Barnard’s approach is less concentrated. He is pretty good, for all that. He does fine work in fixing the congenital heart defect called Tetralogy of Fallot. He carries out Africa’s first kidney transplant. He persuades a colleague to help him graft the head of a puppy onto the neck of a larger dog, so creating a dog with two heads (the surgical sense of humour is quite specialised). He allows his younger brother Marius — once unkindly described as “the poor man’s Chris Barnard” — to join the transplant team: Marius gets to be scut monkey. Christiaan briefly displaces his ambition onto his 14-year-old daughter, becoming convinced that the “girl in the next-to-nothing swimsuit” , as he creepily describes her, will be the next world waterskiing champion. Most important, he spends three months at Lower’s lab, where, standing discreetly in a corner, he observes Lower’s transplant technique. This is the operation he will later replicate at home, without crediting or namechecking its inventors.
In a profession that rewards front, Barnard’s cool annexation of this famous first is still a stand-out. His subsequent antics — a couple of 19-year-old wives, a late obsession with anti-ageing treatments that saw him stripped of his membership of the American College of Surgeons — did little for his reputation. McRae has spoken to everyone, and recorded everything, for which he deserves credit. He doesn’t judge; but then he doesn’t need to. Whatever the backstory, Barnard will always be first.
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