[inaudible conversations] . >> book tv coverage of the texas book festival from this weekend continue. [inaudible conversations] . >> hello everybody to the festival.

and her book ticker which is a pagei' turner. and with those disasters with matters of the hard it is a great opportunity. before we get started he will have a conversation over 25 minutes then opening to questions. saddle up to one of the microphones.ph

my name is kate and i'm an editor at highline magazine and many of you know, from "the new york times" with other journalistic outlets. and with the fall of enron m4 failure. the year quest for the artificial heart. . >> this is such a huge crowd i'm a static to be here. [applause]

many of you, like me look like you are from here. [laughter] you are in short sleeves but i would start with a short reading i don't know why child doesn't have a heart attack. [laughter] but i thought i would just read a page about my main character whose name is bud fraser, that this is about how he got started and why he decided to go into this field as a wonderful eccentric past texan. but even so he already decided to specialize in heart surgery. the death toll was skyrocketingg in 1963 because

the doctors had so little to offer more that italian boy had to have a routine replacement of the aortic valve to be optimistic about the surgery the surgery went fine but held and retracted to still exciting for student and

sometimes it stops with a aortic valve disease. with that use a procedure from two years back and then had to ennually massage the heart to restart it. and how to reach into his chest to squeeze his heart mimicking that pumping action and around that time the sedated boy woke up and locked eyes with a bed. the nurses sedated him again but he kept his gaze on bed and tried to reach for him to hold on. minutes past his hand cramped and the pain began to radiate going arm but he kept they took one lid at the scene and ordered him to stop experience told himd too much

time had passed and they were not going to be able to restart the boys heart but he kept squeezing and releasing until finally a resident had to shut him out of the way. as soon as he let go the boys slipped away. you could hear the mott - - the mother sobbing in the waiting room. as it turned out that episode would change everything the simple pumping action of his hand could keep something alive then there should be a machine that can do it longer and bette better. it would have to be something attack could call off the shelf and the surgeon couldnt, implant to run almost a humanlly inside chess. . >> and with that medical drama

but what makes it so readable as you see the lives of these characters and you take us through this history with the lives at risk and that reminds me on this quest like that attend man on steroids. so my first question of going down the yellow brick road, why the quest for the r artificial heart? we make this is cheating but i live in houston my husband has a saying you can go outside

the front door without falling over. so there t is a time in the late sixties and seventies where houston was the center anything that happened, happened there. if you tell a joke in the med because it was the last stop go if you are a hopeless case. so it was a chance for me to write about houston and these fabulous characters. i felt it would be a lost history otherwise looking at the age group and with that deer in the headlights and to change the way we look at

heart disease. so i want to say that this book is not homework i want to write a book that moved quickly and was about people. where is a very compelling story. and to make a great parent know one - - parallel. and then to have a space program. so what made people think an artificial heart was possible? . >> so that's a great question where in 1962 jfk went to the right stadium which was the

largest stadium at the time if you are famous ask not what you can do speech he promised a man on the moon in a ten years. then the most famous surgeon in the world said we will have an artificial heart in ten years. and then to have an endless possibility i and what interested me we got to the moon in ten years and we still don't have a completely implantable artificial heart. and with add incredible optimism and to be more complicated. >> but that was my next question to design the artificial heart that was

complicated so what are those complications? . >> so there's really only two problems p in the main problem is the destruction of the bloodn for those doctors in the room go the other problem was your heart beats 100,000 tons a day and to replicate that doctors tried to make a machine that would do that to pump over and over. those can last two years so if you have one of those you are back for life-threatening surgery but you need something that spins instead of a motor. i hate to use this term but

does anyone here have that? no? they support the left side of, the heart but does nothing more than spend. incredibly complex but down at two or three parts so it's about this big in the book and now one fifth the size and has been. with the original artificial hearts so most people cannot even wear them. >> was there the initial resistance but the idea of a heart transplant because the heart was at the seat of our soul for many people. talk about that challenge with that spiritual component. >> this is very young y and in

the start until world war ii a surgeon realized he was picking shrapnel out the heart people thought you were killing the soul. so this was seen as radical. as time goes on first to work on the system outside the heart but this idea and with the person of color into a whiteoko person? it spoke to all of the anxieties of that time. . >> and barney - - barney clark said she was afraid he would

not love her anymore. . >> and with those five primary doctors a and to be the fulcrum and those that you hang the history onto with the drive to succeed so give us a quick sketch of who these guys are. . >> i wanted to write the book i don't know how many of you remember but the most famous surgeon in the world of his tim time. he had to be leeward to

houston and called baylor a third rate medical school he turned into a first-class institution and actually despitee his ego, he brought in excellent people from all over the country and all over the world and one of the people he brought in was a houston native. i don't know if you remember but he was from a fine family in houston one of the most handsome man who ever lived. [laughter] have got in trouble for saying that he looked like errol flynn and also one of the best surgeons who ever lived. when he started to do heart surgery they didn't have a heart lung machine you had to cart one - - cut into the heart and get out before the

person had been problems. that this was the same of the sky - - size and scope of ambition otherwise they were completely opposite and hated each other and ended up with the dueling hospitals and this was the most famous medical feud maybe even to this day. it made the artificial heart possible and also me the texas medical center possible because if somebody got their own hospital than the other doctor had to have his own hospital phone got an award and the other doctor had to do something more dramatic. it really created the medical center we have in houston today. that the reason of the main character and then to with the

artificial hearts but the people he attracted were equally ask them - - eccentric but he's also from houston and harvard trained surgeon that is also a magician who plays trombone and band. i don't think he sleeps and to be a spectacular inventor but one day he was in his office because every week he would see people with inventions and tell them yes or no or maybe there was a kid coming in from australia and he could barely bring himself to meet with the guy he c comes in with his backpackck and takes this box out that was wrapped in rags and set i think this will work as an artificial heart. and because he was an inventor

he looked at this and excuse me but he said only shit but it does have the one moving part but they saw the prototype and thought this would do it. they are all crazy. every one of them. [laughter] . >> itie seems you have that daredevil side see a plenty of anecdotes in the book about ending the rules in the name of saving lives. and one of my favorite anecdotes was currently. >> there was no fda for a long time when cooley was operating. i had heard a lot of very strange stories about all these doctors doing very interesting things we would

not find normal today. so i worked with a medical writer by training and i said i know i ask a lot of stupid questions but i have to ask go i keep hearing this story that could leave a cows heart into a patient and did not miss a beat and said no. it was a sheep'ssh heart. in fact, he was in the operating room and before transplants were successful h , he ran out of options and the patient was dying on the table and said go down to the lab and bring me a sheep's heart and lasts - - let's try it so they brought it up and he put it in and probably stopped and the patient died

but why i wanted to write the book there is a houston culture that many are familiar with let's try it first don't ask for permission but ask for forgiveness if it passes. that's aar story of the early years of heart surgery. . >> related to that is developing the tools you need for operating on a beating heart or keeping someone's blood go so these are made in people's kitchens so. >> so he and his brother grew

up in houston they would blow things up. i don't think their parents were very attentive. [laughter] they did a lot of rockets. billy was just a natural inventor and he could look at things and community could also do this to say i don't have the tool i need to do this. he would go to home depot and buy something and try it. at one point when he was at harvard he wanted to start doing noninvasiveur heart surgery it's a lot less involved than cracking the chest and breaking the ribs but you keep your heart stablech so he went to stop & shop's in grocery stores and hardware stores until he found two kitchenke spatulas that worked the way he thought they should and went to the workshop to present between two retractors

and that was the first device he got a patent now it's all made with medical grade material but most of these inventors start out at the local hardware store and this young kid was almost 40 now would go with his father to the hardware t store and clear a space and basically invented the circulatory system with pipes people would come and watch and say what are you doing? he would say we are building a sprinkler system. [laughter] but they were trying to understand how the body worked. it's not that hard i guess. >> one of the wild things about these pump devices that helped them is they end up without a pulse. so one of the breakthroughs was figuring out one of these

pumps was for the left ventricle and realized on man could put together two hearts for the left and the right which was very beginning the possible of the whole thing so tell us about craig and that story. >> this is a love story to people very much in love he was an engineer for the city of houston so another guy who was obsessed with making things work better. he was healthy all his life and got sicker and sicker and sicker and it took a very long time for the doctors to understand what was wrong he had a decedent - - a disease of total organ failure. you can just be a surgeon and

say we will try this artificial heart and put it in this guy. he went to the fda to go through several steps to get emergency use permission. one of the interesting things of the book is when faced with having more time and nobody knows most of the people that i wrote about opted for more timehi and melissa specially was fascinated how this machine would work and said let's try. he lived for about three weeks with this artificial heart before the disease kill him and that is what interested me about medical experimentation is you have to try on very sick people so you don't k really know if your invention

works if someone dies you don't know if they were going to die anyway how much more time that you bought them so it was interesting but that device worked fine and probably would've kept going except kim showed up with what they thought was a better device so they throw that away basically import their focus on this. one story i forgot to tell is the story of the right to brothers people try to fly by imitating nature and it never worked. it's the same thing with the artificial heart it would never work as s well if you tried to copy the beating of the regular heart from the transcendent nature. >> but craig's wife linda said

i don't do anything. >> you just hear a sound but again she was thinking does he love me are not? is it really him crack someone of the interesting stories of the left ventricle device which is a small artificial heart but just for the left side people walk around with backpacks and it just happens someone will be too far away to plug-in or somebody was in europe some by one - - somebody tried to snatch the battery pack that's you want the implantable device. >> so to bring up one of the

questions of the center of the book but the work is high risk and high reward but all of these lives are at stake because of the hail mary pass he has another condition to kill himf anyway but the first version kept him alive three more weeks for recently i was thinking how all the surgeons have to make that calculus without growing field of cardiac technology so this is something the book tries to address because just last summer the media did an investigation looking into his record that he was bending some ethical rules like mad uescientist and was sent suing

for defamation so without getting into the lawsuit so what about this idea of innovation crushing up against your duty to the patient? he was the seattle dentist in 1982 implanted with an artificial heart invented by robert jarvis and it was the first real media it was a huge media coverage reporters were sneaking into the hospital in laundry bags. [laughter] it was supposed to be this great medical triumph of innovation but because it was an experiment it wasn't billed that way but it was he survived in the heart worked

inl fact, that heart is still in use today as a variation. but then he declined and eventually died. 's of people were watching on their television first drive and then decline and the public turned on medical innovation at the time. what i saw in my reporting you have this invention and then it wouldn't work perfectly so these ethical investigationsti then they get the device to work then it is hailed as progress like transplants and then move on to the next innovation and it happens over and over we say we want innovation but only when it works and it doesn't always

work the first time so anybody who has been in a clinical trial for cancer knows that's why they are called clinical trials. to call him as doctor frankenstein is not correct. >> if we get to the end of the book it is a cliffhanger we are still in the middle to get to the artificial heart. ando to ask you where we are now but to give you the numbers of why it matters so as heart surgery develops the heart transplant came to be. a lot of people have this idea and also preventative medicine like heart disease and people can improve with exercise and diet so why go to the links of developing the artificial

heart? . >> i'm trying to remember the numbers there are 2500 parts available per year that something like 4000 people a month or so i need to check the number i apologize. it's in the book. it is an enormous waiting list you could die on the list waiting for a transplant. the number of heart attacks has actually gone down people have learned don't smoke and drink less and eat healthy but heart attacks are going down but heart failure is going way up and it is soaring that is a very long and slow and painful death if you cannot convince people to change their habits it is easier to walk to the

moon. [laughter] then we will need devices. there is a lot of work being done with stem cell research to build a heart out of your own cells but that's a long way off. you will still need these devices. >> where are we now with a horizon? . >> human trials will start with this heart in a year about one yeart. from now. i think they have got it. i'm pretty convinced. >> right now i will back up a little bit when you go into the lab at the texas heart institute you can walk up to a cow it looks normal it will take the snack and it takes a nap if you listen to his heart

it has an artificial heart you cannot tell the difference it is just mind blowing to look at this animal does not have a real heart. >> so who would volunteer if you had no other choice? . >> i think it depends. my research shows age my father was 90 when he died i knew he was in the early stages i thought maybe he could be a volunteer he said no you're not that in a 90 -year-old man but i thought if i were out of options i would get one in my thirties with small children. definitely.

there are mechanical nuances but also psychological also. >> you are a journalist and not a medical student. so talk about the process of learning how the heart works quick. >> my book about enron ten years ago i thought it cannot be as hard as enron. [laughter] i meant to bring as a prop from five -year-olds called your heart and that's what i start every journalist is reinventing the wheel every time and you have to start with very basic questions and it was lucky that doctor fraser like talking and like talking about this because he was incredibly patient but

with l enron i would ask the question 50 times i don't understand why the platelets don't do this but then when you buy it you have to decide how much "the reader" really needs to know. >> did you follow them at the hospital? . >> yes transplant is a mind blowing thing to see i highly recommend it. they have a viewing dome you can look down on the operating room it looks like car repair they cut open the chest if it's diseased and normal heart isur the size of your fist in these look like basketballs and he cuts them out it goes into a styrofoam cooler and they take out something you get at the grocery store to put it back in and then

everybody pauses in that moment and they are taking the patient off the heart and lung machine to see if it starts to beat. it is awesome. >> how many did you get to meet? . >> you name a calf after it survives they are named like big red and marguerite and meth addiction. [laughter] there were nine or ten. havees anybody questions? . >>. >> i'm a cardiac nurse these are absolutely active and they

are cut a lot out of the story and also to mention those patient innovators and we have some really good stories but i would love to hear the stories but really it is physician centered and dominates the underco cuts the nurses and patients are making. >> my son is a nursing school that's why i apologize. it has changed over time the nurses were seen as ancillary now they are incredibly important but moving forward nurses would be very important to the story. but when i was researching this, it will sound dumb but i went to interview doctor jarvis and asking all these

questions how does the pump do this proxy has an implantable heart that starts in the ear which is bizarre but they finally looked at me and said i think you should be talking toe patients. i said you are right. the book really is a story of patience and what they wentth through. the only way people can connect is by putting themselves in the patient's place. not to give too much of the story away but some of that patients are my favorite people in the book because they were so brave. >> i did talk to a lot of patients and their families. . . .

through his last days can you talk about how that overlapped for you? if you've had a long happy life most people want is a alive i think if they're suffering is tenable. i mean i watched my dad gets ton the point where he was ready to

go but we used to say people live too long and he lived to be 96, so he kind of new. there are an awful lot of us and we could walk around with artificial hearts and total dementia. there have to be decisions made about futureth healthcare. >> what surprised you about that choice for people? >> when he was towards the end of his life --

>> hit wife made them operate on him and he left like three or four more years. he was immortal almost. >> and i thought that was so curious. like you need this heart surgery that you've been pioneering for your selfoc and most of the doctors were afraid to operate and no one wanted to be only person they defined t could fino operate with his former partner. i just wanted to confirm to you.

please get your copy and have it signed. and thank you so much. [applause] best editor in america. [applause] >> thank you all very much for coming.e] [applause]