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The Art of Incision

In praise of the greatest surgeon ever.

Among Dr. Michael DeBakey's approximately 30 visits to various parts of the former Soviet Union, there seems little doubt that one in November 1996 had the greatest potential for influencing the course of world history. The Russian president, Boris Yeltsin, was in dire need of a coronary artery bypass graft, and DeBakey was chosen by Yeltsin's physicians to judge whether to operate on their high-risk patient. "I took one hard look at him and saw that he had hyperthyroid heart disease, which they'd apparently missed, in addition to his coronary occlusive process," DeBakey told me one evening ten years later, while we were having dinner together in Houston. "He needed to have his thyroid function brought under control before it was safe to operate--or even administer an anesthetic." Following pharmacologic treatment of the overactive gland, the operation was accomplished without complication, and Yeltsin once again took his larger-than-life place on the world stage.

In choosing DeBakey to be their consultant, the Russian physicians were turning to the man who had performed the first successful such operation, in 1964, and even--while still a medical student--invented the roller pump used in the heart-lung bypass portion of the procedure. But he had done far more than that: I claim for him that he was the greatest surgeon of all time. And by this I include the humanism and artistry that are of necessity at the core of the complete surgeon's work.

Michael DeBakey, who died in Houston on July 11 at the age of 99, performed some 60,000 operations on the heart and major arteries during his career and had a hand in the introduction of virtually every significant cardiac procedure now being done, as documented in his approximately 1,600 publications in the medical literature. Among the DeBakey firsts was the replacement of sick or damaged arteries with Dacron grafts, the prototype for which he sewed himself from material he bought in a department store. Nor were his contributions solely in the field of technical surgery. It was a paper by him and Dr. Alton Ochsner in 1939 that was among the first to point out the connection between cigarette smoking and lung cancer. He was also instrumental in organizing the structure that evolved into the Veterans Administration hospital system.

I first met him in 1998, when we spent a morning together in New York in connection with the release of a book with which we were both involved. We kept in touch over the years, and I traveled to Houston in 2005 to spend a few days with him. On that trip, and over the course of several conversations in both cities during the intervening years, he revealed the spectrum of his knowledge in various areas.

DeBakey had a knack for one-on-one talk and spoke with the authority of a man who is accustomed to being listened to. But he was a good listener as well--at least to people who had something significant to say. He was of average height, five-foot-ten by his own account, but the cowboy boots he usually wore, as well as that air of authority, made him seem taller than he was. Adding to that impression was his long, narrow head, which, augmented by a high widow's peak of thin black hair, was almost bladelike in its configuration.

Our conversations encompassed topics as varied as the history of science, the Industrial Revolution, the origins and theology of Islam and Christianity, the Reformation, the Renaissance, the eighteenth-century background to American democracy, literature, poetry, and a seeming score of other subjects. Nor was there a superficial quality to his knowledge. In each area, he proved himself to have mastered large amounts of information and to be very articulate in expounding on them.

But none of this broad-ranging description catches the essence of the man, or the driving force that propelled him into so many areas with so much effectiveness. During one interview, I asked him about such things. His answer was deceptive in its seeming simplicity:

Curiosity and the seeking of knowledge is a transcendent life force--almost, you might say, spiritual. It has a driven character to it. It drives you intellectually and, to an extent, physiologically. The brain influences the body in ways we don't know about.

Ambition is not enough and even talent alone cannot explain why some men or women make great strides in their fields of endeavor and others come up short. When curiosity is combined in one person with the energy that DeBakey applied to his every exploration of the body's workings, an irresistible momentum is created, in the face of which one problem after another is solved.

DeBakey's eminence may be said to have begun during World War II, when he was director of the Surgical Consultant Division of the Office of the Surgeon General. In this capacity, he played a crucial role in the founding of the National Library of Medicine and the mobile surgical hospitals called mash units.

In 1948, DeBakey arrived to be chairman of surgery at Baylor, which, at the time, had a struggling medical school with neither an affiliated hospital nor a residency training program. Today, it is one of the leading medical centers of the world, largely because he guided it along the path to that eminence, in the process raising vast amounts of money (and contributing hundreds of millions of his own dollars, made from heart, vascular, and other operations) and attracting an all-star faculty. He served as president from 1969 to 1979 and chancellor from 1979 to 1996, all the time pursuing what amounted to a full surgical schedule.

When I asked DeBakey why he finally stopped operating at the age of 90, his reply was, "Because there were so many other things that needed to be done." Those "other things" included laboratory research developing a cardiac assist device and his never-ending travels as a consultant to so many organizations and governments. In addition, he has maintained long-term follow-up studies on 95 percent of his operated patients, an archive of immense value.

Despite all of his efforts to bring surgery closer to science, in the long run DeBakey, like all surgeons, recognized that it is ultimately an art form. For there is indeed an aesthetic to surgery, and an observer is aware of it within minutes of stepping into an operating room. I doubt that it is possible to do a completely satisfactory job of the various techniques that make up an operation without being acutely conscious that one is involved in an art.

The first major operation I saw looked like a ballet of fingers to me, and I have never lost the sense when I am operating that my fingers are engaged in a kind of complicated and tightly coordinated dance with those of my colleagues during those precious moments. The gentle touch is crucial. Sensitive tissues do not respond well when handled roughly, and may not heal. Living biological structures tolerate very little abuse, and are quick to express their displeasure when treated with less than the consideration that Mother Nature has made them accustomed to. The man or woman who cannot be an artist will never be more than a pedestrian surgeon.

That notion was epitomized in the work of DeBakey, not only in the technical sense but in the intellectual as well. He had what I can only call a graceful mind, to match the grace and precision of his surgery. In fact, it was that graceful mind that made me want to see more of him after that first day in New York. Like all the best surgeons, DeBakey had a panoramic eye that swept all manner of detail into its field of vision. When that very first sweeping, get-acquainted look (which physicians call "inspection") was completed, he already had important information at his fingertips that he used in forming his all-encompassing impression of the disease process and how best to approach it.

It was always said of DeBakey that he was a hard taskmaster, anything but easy on his trainees. He applied to them the same standards he applied to himself, and he could be harsh when they were not fulfilled. The performance of a ballet leaves no room for error, especially when a life is involved. In surgery, to be an aesthete is merely to fulfill the expectations one has of oneself. Mike DeBakey's expectations--of himself and others--were always the highest.