[inaudible conversations] >> hello? hello? welcome. welcome. welcome everybody to the book festival, or welcome back if you were here yesterday. we are here mimi swartz to talk about her book "ticker" which is

a page turner so i'm really glad you guys are here, particularly in this time of trump headlines and lots of disasters just built soccer something that affectstss all in matters of the heart, is just a great opportunity. so before we get started a couple things. were in the c-span's booktv can't which means that we are live, and we will have conversation for about 25 minutes or so and then open it up to questions for ten or 15 minutes. if you have a question at the end, saddle up to one of those microphones and make sure he speak into the microphone so that everyone can hear you. and then books are for sale right here next door and afterward mimi will be signing copies of her book in the tent beyond that. so be sure to have that way. the first i'll introduce ourselves. my name is kate rodemann and i am an editor at highline magazine which is a magazine for

"huffington post" and in no mimi because work for many years at texas monthly together and mimi as a longtime executive editor at texas monthly. many of you probably know herie pieces also in the new times. she's also been published in "vanity fair" and esquire and other journalistic outlets and she also wrote a book a while ago about thehe fall of enron called power failure, , and shes here now to talk about her newest work which is "ticker" which is about the 50 year quest for the artificial heart. so beforele we begin i asked mii to do a a little reading for uo sort of what our appetite. so go ahead. >> i'm so excited, this is such a huge crowd. i'm ecstatic to be here. [applause] many of you like me look like you're in the heart disease

prone years. [laughing] but i thought i would just start with a short reading. also just to head off to questions, i don't know better our work moment at a don't know what trump doesn't have a heart attack, so we'll get this out of the way. [laughing] i thought i would just read a page in the book about my main character whose name is buzz fraser. some of you may know him if you that part issues in houston particular but this is about how he got started, why he decided to go into this field, and he isn't this wonderful eccentric west texan. this starts right when he is done with med school, or you still in middle school. even so he had already decided to specialize in heart surgery. the death toll from heart disease with skyrocketing in 1963. every day another patient at methodist died because the doctors had so little to offer. there was one patient in

particular who's terrified pleading expression would stay with bud for the rest of his life. he worked at the medical history for one of the growing list of international patients, a 17-year-old italian boy was only a few years younger than bud himself. med student who did the work of also got to scrub in on the patient's t surgery. bud was it for what expected to be a routine replacement of a damaged aortic valve. the kid was then from his illness but handsome, with dark eyes and thick black hair. optimistic about h the surgery,e was eager to go back home. his mother was with him. the surgery went fine. but held and retracted, nothing glamorous but still exciting for student, that night though the boys heart stopped. sometimes happen inexplicably with aortic valve disease. only way to say that one was to use a procedure that at first

been tried to use back in 1961, to reopen the chest and manually massaged the heart to restart it. a resident at the boy open, then turn to the strongest person in the room, bud. you should bud how to reach in to the boys chest and squeeze his heart, mimicking the pumping action of a healthy organ. around that time the sedated boy woke up and locked eyes with bud. the nurses sedated him again at the boy kept his gaze on bud and tried to reachea for him, to hod on. minutes passed. bides hands cramped and then the pain began radiating up his arm picky kept going. they took one look at the scene and ordered bud to stop it experience told and him that tw much time had passed and that they were not going to be able to restart the boys heart. but bud kept squeezing and

releasing until finally a resident have to shut them out of the way. as soon as bud let go, the boy slipped away. he could hear the mother sobbing in the waiting room when you went out to give her the news here as it turned out, that episode would change everything for bud. if the simple pumping action of the same could keep someone alive, he figured, that should be some kind of machine i could do it longer and better. it would have to be something attack could pull off the shelf and a surgeon could implant company machine that would run almost perpetually inside a human chest. ..

the lives of these characters, there are five surgeons that you follow and you take us with the history, sort of the ups and downs of discovery and their personal vendettas and their lives at risk and it turns into exciting reading. and i just wanted to say it reminds me sort of a lot of the quest that dorothy had on the way to oz where you have this band sort of together and their quest, sort of like the tin man on steroids. and down the yellow brick road, why the quest for an artifical heart? >> this is sort of cheating, but i live in houston and my husband has a saying that you can't step out your front door without falling over a great story. and houston, there was a time

in the '70s and '80s that houston was the center of heart surgery and anything that happened, happened there. my friend made a joke you can't get to the hospital there were so many people coming there, it was a last stop if you were a hopeless case and, in fact, they saved a lot of people. so there was a chance for me to write about houston and to write about these fabulous characters that you mentioned and i felt like it was going to be a lost history otherwise. i'm thinking, i'm looking at the age group again, and when i say dr. debaky or dr. denton cooley, they have a deer in the headlights stare, they have no idea who they were and how we look at heart disease. and this story, this book is not homework. i wanted to write a book that

moved quickly and that was really about people. and so, it was this very compelling story i felt like if somebody didn't tell it, it was going to be lost. >> one of the this i think so -- one of the things you make a great parallel with, you talk about the research, cardiac matters happening at the same time that people were wanting to develop the space program and at the time sort of thinking as an artifical heart was as crazy as putting a man on the moon. so what made people think that an artifical heart was even possible? what kind of developments got them thinking along those lines? >> that's a great question because i think it was more of a mindset question, where in 1962, jfk went to the rice university stadium, the large he is stadium at the time and did his famous as not what you can do speech. and he promised we would have a man on the moon in ten years.

and almost within weeks of that, michael debaky, who then was the most famous surgeon in the world said we are going to have an artifical heart in ten years and i think people had a sense, a, they had a sense of possibility, of endless possibility. and what interested me is, we got to the moon in ten years and we still don't have a completely implantable an artifical heart and i think that almost the some kind of arrogance, tinged with this, that the body was more complicated that and rocket. >> that was my next question, some kind of designing an artifical heart is a lot more complicated than designing an artifical knee or an artifical

hip. >> dr. fraser who worked on this for 50 years, there's really only two problems and the main problem is the destruction of the blood for you wonky docs in the room. and the other problem was a heart that, your heartbeats 100,000 times a day, and to replicate that, doctors kept trying to make a machine that would do that, that would pump over and over. those pumps couldn't last more than two years. so if you had one of those pums pumps you would be back in for surgery and the doctor found out you needed something like in rotary cars all over the place. does anyone have-- i hate to use the term, but does anyone have an lvad?

and these support the left side of the heart, and they're simple, complex, but boiled down to two or three parts and the heart that's my mine character in the book despite dr. fraser is this big and has one disc inside that spins the blood to the heart one way and the blood to the lungs the other way. the original artificial hearts were this big and most people couldn't wear them. >> one they think you talked about, there were initial problems with the heart because the heart is the seat of our soul for many people. talk about the issues that people had working on a heart. >> heart surgery, i didn't realize this very young, it didn't start until world war ii when a surgeon realized he could pick shrapnel outside of

a cart. it was thought for time immemorial that if you were cutting into the heart you were cutting into the soul. and first they could work on the vascular system outside the heart and then began cutting in. but this idea of spirituality sort of in modern time became, well, oh my god, what happens if you put a man's heart in a woman. what happens if you put the heart of a person of color into a white person. it sort of spoke to all of the anxieties of that time, and of course, now transplants are fairly routine. but when barney clark got an artifical heart, his wife was afraid that he wouldn't love her anymore so we still have these weird things. >> well, you kind of tell the story through the lives of

these five primary doctors and you read about bud fraser and he's sort of the fulcrum of this history. so you have michael debaky, denton cooley and bud fraser and then billy kohn and daniel. >> the generation. >> find of people that you hang this history on and they all have these big egos and what you need in this field. can you paint us a quick sketch of who these guys are? >> yeah, another reason i wanted to write the book. i don't know how many of you remember, but michael debaky was a -- the most famous surgeon in the world of his time. he game to houston, he had to be lured to houston, he called baylor a third rate medical school and he through his will turned it into a first class

institution and he actually, despite the size of his ego which wouldn't fit in the capitol, he brought in excellent people from all he ever 0 the country and all over the world, and one of the people he brought in was a houston native and i don't know how many of you remember cooley, but he was interest-- he was from one of the families in houston and one of the best looking man who ever lived. he looked like errol flynn. and when he started doing heart surgery they didn't have a heart-lung machine and you had to get cut into the heart and do what you could do and do what you could before the person had brain problems. these two were sort of the same in the size and scope of their

ambiti ambition, and they were complete opposites and they hated each other. and they were in competing hospitals and the most famous medical feud. and if dr. cooley got his own hospital, well, then dr. debakey had to have a bigger hospital. if dr. cooley did something dramatic, dr. debakey had to do something more famous. and the reason that bud fraser is the main character in my book because he studied with both of these people and devoted his life to an artifical heart and the people

that they attracted were equally eccentric, i don't know if you know dr. cohn. he's a harvard trained surgeon, but he's also a magician and plays trombone in a band and he-- i don't think the guy sleeps, and then billy had -- and he's also a spectacular inventor, but one day he was in his office waiting to-- every week he would see people with inventions just to tell them, yes, no, maybe this will work and there was some kid coming in from australia and he could barely bring himself to meet with the guy and this kid comes in with his backpack and takes a device out of it wrapped in rags and he says i think this will work as an artifical heart. and because billy is an inventor, he looked at this thing and excuse me, he said holy s--

this is it. and the one part of my book, one moving part about this big, but saw from a prototype that this would do it and they're all crazy. every one of them. >> i was just going to say it seems to be in this field you have to sort of have a daredevil side to you and so you have plenty of anecdotes in the book about this sort of bending the rules in the name of saving lives and racing against the clock. >> oh, yes. >> one of my favorite was of denton cooley. you want to tell it? >> yeah, there was no fda for long time when cooley was operating and trying to figure out which way i want to tell this story. >> i had heard a lot of strange stories about all of these doctors doing very interesting things that we would not find normal today. and i kept hearing this story, and i had a wonderful source who helped me who is an

editorial-- she's a medical writer by training and she worked with all of these doctors and i called her and i said, mary anne, i know i've asked you a lot of stupid questions, but i have to ask you, this is really stupid, but if it's true, i want to write about it, i keep hearing this story that denton cooley put a cow's heart in a patient and she didn't miss a beat and she said, no, it was a sheep's heart. and that is in fact, he was in the operating room. it was before transplants were successful. he had run out of options and the patient was dying on the double and he turned to somebody and i had is a -- he said go down to the lab, get me a sheep's heart and let's try it. they had animals, cut the heart out of a sheep and put it in and went-- the patient died. again, why i wanted to write this book there's a houston culture i'm sure many of you are familiar with, say let's

try it first, what is it, don't ask for permission, ask for forgiveness, i think in a way that's the story of the early years of heart surgery. >> what is sort of related to that part is, heart surgery a developing the tools that you need for operating on a beating heart or stopping someone's-- or keeping someone's blood flowing and i think what i was surprised by reading the book how sort of these inventions are a lot of time sort of made in people's kitchens and down-home kind much things. do you want to talk about billy's spatula? >> yeah, he was born an inventor. he and his brother grew up in the memorial section of houston and used today blow things up. i don't think their parents were very attentive and they did rockets. billy is a natural inventor and he can look at things and

cooley could do this thing, too, and look at a surgery and i don't have the tool i need to do this so he would go to home depot and buy something and try it and at one point when he was at harvard, he wanted to start doing what's called noninvasive heart surgery, it's a lot less involved than cracking your chest and breaking all your ribs and stuff, but he needed something to keep the heart stable while he operated so he went to a bunch of stop and shop in boston, went to a bunch of grocery stores, hardware stores until he found two spatulas. kitchen spatulas that worked the way he thought they should and went to his workshop and put them in between retractors and in and out and the first one he got a patent on. and eventually it's medical

grade materials. but most inventors start at their local cal hardware stores. and daniel tims, almost 40 now, and invented this, and he would go with his father and basically invent the circulatory system with pipes and people would come and watch, what are you doing in he said we're building a sprinkler system, but what they were doing was trying to understand how the body worked. so it's not that hard, i guess. >> one of the wild things about these pump devices that help the ventricles of the heart. you end up without a pulse. an endless flows. and one of the bud's breakthroughs, one of the pumps was used for the left ventricle and he realized what this man named craig lewis, sort of out

of chances that he could perhaps put together two heart mates for the left and right side, the sort of the beginning of possibly like the whole thing. do you want to tell us a little about craig lewis and just that story? . he was -- this was a love story. and these were two people, and he was a guy who made things work better. he was a healthy guy and he got sicker and sicker and sicker, and took the doctors a long time to know what was wrong with him. he had amyloidosis. he was in total organ failure. you can't just be a surgeon and way okay, we're going to try an artifical heart and put it it this guy.

bud went it the fda, you have to go through and get emergency use permission to put this in a person and lewis. i think one of the interesting things about the book is when faced with having more time. no one knows how much more time or dying in a short time, most of the people i wrote about opted with more time and lewis was fascinated with how the men would work and let's try. and he lived for about, i think, three weeks or so with in artificial heart before the disease killed him. and that's one of the things that interested me about medical experimentation is that in order to -- you have to try these things on very sick people so you don't really know whether your intention works. you don't know what -- if someone dies you don't know if they were going to die anyway, you don't know how much more time you bought them.

so it was just interesting to see that device worked fine and they probably would have kept going with that except daniel tims showed up with what they thought was a better device. so they threw that away basically and put their focus on this. one story i forgot to tell is that the -- dr. fraser and dr. cohn will tell the story of the wright brothers. people tried to fly imitating nature, it never worked. the same thing with the article heart of the it was never going to work as well as it should if you try to copy the beating of the regular heart. that's why these worked transcending nature. >> and after he put it in craig, his wife says i don't hear anything, there's no beat.

but he's alive. >> you hear a whiring sound and again, she was sort of like, well, does he love me or not? is it really him still? one of the interesting stories about the left ventricle device, which is a small sort of-- it's called an art heart, but it helps just the left side. you see people walking around with what looked like backpacks and it just happened that someone will be too far away to plug themself back in or someone was in europe and a guy came back into moto and thought he was snatching is purse and snatched a battery pack so that's why you want an implantable device. so-- >> i want to bring up one of the sort of questions at the center of the book, which is that the kind of work is high risk, high reward, but there are always lives at stake and i

was thinking of craig lewis because it's sort of a hail mary pass and he had this other condition that was going to kill him anyway. the first version of the artificial heart kept him alive for three more weeks. recently, i was thinking how all of these surgeons have to make that calculus and sort of growing field in cardiac technology butting up the field of bioethics. how do you take these things into account, which the book tries to address. it's interesting because just this last summer the media did an investigation into bud fraser, sort of looking in his record and accusing him of bending some ethical rules and, you know, not-- >> scientist. >> mad scientist. he's since sued for defamation. without getting into the lawsuit i just wanted to ask you to talk about sort of how these things have elapsed, this

idea of innovation crashing up against your duty to the patient. >> well, what i realized -- how many of you remember barney clark? most of you remember. barney clark was a dennis, a seattle dennis, who in 1982 was implanted with an artifical heart invented by robert jarvik and it was the first real media -- it was a huge media circus, you know, there were reporters trying to sneak into the hospital in laundry bags and it was supposed to be this great triumph american medical innovation. but because it was an experiment and it wasn't billed that way, but it was. and clark survived this surgery. the heart worked. in fact, that heart is still in use today a variation of that, but then clark declined, and

eventually died. so, people were watching on their televisions, they were watching this man, first thrives more or less, and then decline. and the public really turned on m he had-- medical innovation at the time and what i saw in my reporting was you'd have this invention and there'd be this great excitement and it wouldn't work perfectly so you'd have these ethical investigations and then they would get the device to work and hailed at progress. it's like transplants and it becomes sort of ho-hum and then on to the next invention. we say we like innovation and we only likes it when it worksment and it doesn't always work the first 25 times. anybody in a clinical trial for

cancer. i would say at that painting dr. fraser as dr. frankenstein is not correct. that's not person i saw. >> well, when we get to the end of the book, it's sort of a cliff hanger because we're still in the middle of trying to get to an artifical heart. before i ask you about where we are now, i wanted you to give us the numbers so that everyone has a sense why the quest still matters. sort of as heart surgery developed, the heart transplants came to be, and so, and a lot of people have figured into having a heart transplant and then there's also this idea of preventative medicine. so heart disease is rampant, but people can exercise with exercise and diet and why go to the length of the artificial heart. and the numbers to know why. >> i'm trying to remember the number. there are 2500 hearts available

a year for something like-- available for transplant a year, there's something like 4,000 people a month or so. i've got to check the number, i apologize. it's in the book. waiting for hearts. there's an enormous waiting list so you could die waiting on the list for a transplant. and the other issue is, the number of heart attacks is actually going down. people have learned, you know, don't smoke. try to drink less. try to eat healthy, but they haven't done enough. so, heart attacks are going down. heart failures going way up. it's just soaring. and that is a very long, slow, painful death. so, a device like this, if you can't convince people to change their habits, which history has shown it's easier to walk to the moon, then we will need

devices. there's a lot of work being done in stem cells from your own cells, but that's a long, long, long way off so you're still going to need the devices. >> where are we now? what's on the horizon? >> human trials will start with this heart in a year, at the-- about a year from now. and i think they've got it. i'm pretty convinced. this isn't battery operated? >> you still right now-- i'm going to back up a little. when you go into a lab at texas heart institute now, you can walk up to a cow and it looks like a very normal cow and if you give it a snack, it will take the snack and eats its hay and takes a snap and then you listen to its heart and all you hear is-- it's got an artifical heart. you can't tell the difference.

it's just this mind blowing thing to look at this healthy and animal that doesn't have a heart. or doesn't have a real heart. >> i'm curious to see. who would volunteer here, if you had no other choice to get one? well, yeah, i think it depends. my research shows age. my father was 90 when he died and i knew he was in the early stages of heart failure and i thought well, maybe dad could be a volunteer, no, you're not going to put a device like that in a 90-year-old man, but i sort of thought if i were out of options i'd get one. if i was in my 30's with small children, i would definitely get one. so, it's just-- you realize there are mechanical nuances, but also psychological knnuances, too.

>> and we'll open it up to questions, so you can start lining it up now. i have one last question. you are a journalist and not a medical student. so, how -- tell us about the process of sort of getting into just learning how the heart works. >> well, i'd written a book about enron ten years ago and when i started this book, i thought it can't be as hard as enron, and i sort of liked biology and i meant to bring as a prop a book for five year olds "your heart." every journalist is starting with very, very basic questions and i was lucky that dr. fraser really liked talking and talking about this because he was incredibly patient. like enron i'd have to ask a question-- i don't understand why the

platelets don't do this or that. and then when you're writing it, how much the reader really needs to know. >> did you follow bud around the hops? >> yeah, a transplant is mind blowing thing to see. i highly recommend it. they have a viewing sort of, i don't know, it's kind of like this, you're in this dome and you can look down on the operating room through a dome and it kind of looks like car repair. they cut over the chest and you see it, usually if it's a diseased heart. a normal heart is the size of your fifth and these will look like basketballs and he gets them out and then they go to a stire foam cooler and takes out something that looks like you'd get it at the grocery star and they sew it back in and everybody is pausing, what

they're doing is taking the patient off and you hear the heart to beat. >> how many calves have ydid yo to meet? >> i don't know, you name the cav after they survive. and meth addiction-- i don't know, i've lost track of them all. . >> anyone have any questions, about the heart. >> you can ask about anything now. >> i'm shauna, a cardiac nurse and got to play with the interaortic balloon pump, the very first cardiac transplant so thank you for the work on that. one of the challenges, i go around inno vase networks, nurses are not included in these and they're active and left out of the story. i'm curious-- and make sure we mention the

patient innovators. we're moving to patient generated innovation and craig lewis is a good story and you're telling these stories, but it's physician centric and dominated and undercuts the enormous contributions that nurses, engineers and others are making. >> my son is a nurse in school. yes, i apologize. i think that's changed over time. rig right. the nurses were seen as ancillary and now they're incredibly important. if i were moving the book forward there would be nurses important to the story, but i was-- i tell you when i was researching this, this is going to sound really dumb, but i went to interview dr. jarvik and i was asking him all of these questions, well, how does the pump do this and do that? and he has an implantable heart that starts in the ear, which

is really bizarre, but he finally looked at me and he said, i think you should be talking to patients. and i was like, oh, you know, you're right. and this book is really the story of patients in a lot of ways and what they went through. he was dead right. the only way people can really connect is by putting themselves in the patient's place. and even, i don't want to give too much of the story away, but some of patients are really my favorite people in the book because they were just so brave, just incredibly bravements well, you talked to a lot of them, right? >> i talked to a lot of patients and their families and the only thing in a lot of times that gives some comfort, i heard them over and over again, he will with, it may not help me, but maybe help somebody down the road. which it did. they wouldn't be where they are today. this is tacken forever because the art and the body are so complex. but if it weren't for these

people we'd never be from where now. now. >> any other questions? thank you very much. >> and i have a question, and mimi wrote this at the time that her father was through his last days so it's about life and death and big things at stake. can you talk about how that overlaps for you. >> mortality, it did pass through my mind, maybe dad could get this heart. again, if you've had a long, happy life most people want to stay alive, i think. if their suffering is tenable. i watched may dad get to the point he was ready to go. but i think we all-- and denton cooley said

sometimes people live too long and he lived to be 96 and he kind of knew. people our age there are going to be an awful lot of us and we could be end up walking around with artificial hearts and total dementia. there are going to have to be decisions made about health care. >> what surprised you about that for people? >> again, i think a lot of people think they wouldn't want an artifical heart or be in a clinical trial and suddenly, you think, well, i want to see my kid graduate from school or be at my daughter's wedding or whatever and you think if this helps, i'll do it, so-- >> just in closing one final anecdote. i didn't know this about when michael debakey. i forgot how old he was, he self-diagnosed himself. >> yeah, he almost lived to 100. >> and he was not going to deal with that. >> and he was ready to go and his wife made the surgeons to

operate on him, and he lived, three, four years. he was immortal. >> and as a surgeon i'm ready to go and his wife, you need this heart surgery you've been pioneering. >> most doctors were afraid to operate on him. nobody wanted to. he was mean for those of you who don't remember he's one of the meanest people who ever lived and he terrorized his interns and med students. and the only one to operate on him was his former partner, his partner and saved his life. nobody else would touch him. >> i want to confirm for you billy cohn does not sleep. >> he's a book in and of himself. this is a book full of eccentrics, i promise. the book is "ticker", it's a page turner. and please get your copy and

mimi could sign it. best editor in america, thank you all very much for coming. [applause] [inaudible conversations] [inaudible conversations] >> hello shall everyo, everyon thank you for joining us. i know you have a lot of choices here at texas book festival. race and gender with dr. ashley farmer. her areas of expertise, we're going to get into this, black history, black wos