[inaudible conversations] welcome, everybody to the

festival. we are here with mimi swartz to talk about her book which is a page turner so i'm glad you are here particularly in a best time of disasters just to be able to talk about something that affects us all in matters of the heart is a great opportunity. make sure you speak into the microphone so that everyone can hear you and then books are for sale and afterwards she will be signing copies of her book so be sure to head that way.

so this i will introduce ourselves. my name is kate and i am an editor at highline magazine and i know her because they worked for many years together and she's a longtime executive editor and many of you probably know her pieces in "the new york times" it's about the quest for an artificial heart. before we begin, i asked her to do a little reading for us so go ahead. >> guest: date hispanic business such a huge crowd i am ecstatic to be here.

many of you are like me and look what you arlike you are in the t disease prone years. [laughter] i thought that i would start with a short reading. to answerw questions i don't knw why trump doesn't have a heart attack so i will get that out of the way. i will read a page from the book about my main character whose name is bud frazier and some of you may know him if you've had issues in houston in particular, but this is about how he got started and why he decided to go into this field and he's a wonderful eccentric west texan and this starts right when he is done with middle school were he's still in med school. even so, he's already decided to specialize in heart surgery. the death toll was skyrocketing in 19 to the three.

every day another patient at methodist died because the doctors had so little to offer. there's one patient in particular was terrified expression would stay with him for the rest of his life. he worked up a medical history for one of the doctors growing list of international patients. a 17-year-oldas italian boy who was only a few years younger than god himself. the students who did the work i've also got to scrub in on the patient's surgery. he was there for what he expected to be a routine replacement of a damaged aortic valve. he was thin but handsome with dark black hair optimistic about the surgery he was eager to go back home. his mother was with him. the surgery went fine. he held and retracted. nothing glamorous but still exciting for e a student. that night though his heart stopped. this sometimes happensd

inexplicably with aortic valve disease. the only way to save him was to use a procedure that had first been tried two years back in 1961 to reopen the chest and manually massage the heart to restart. they cut him open and turned to the strongest person in the room. he showed god how to reach into his chest and squeezed his heart mimicking the pumping ofhy him oregon. around that time the boy woke up and locked eyes with him. the nurses sedated him again but he kept his eyes on him and tried to reach for him to hold on. minutes passed. his hands cramped and the pain began radiating up his arm but he kept g going. they took one look at the scene and ordered blood to stop. experience told him too much time had passed and they were

not going to be able to restart his heart but he kept squeezing andad releasing until finally a resident had to shove him out of the way. as soon as he let go of the boy slipped away and he could hear the mother sobbing in the waiting room when he went off to get the news. as it turned out that episode would change everything. the sample pumping his hand could keep someone alive he figured there should be some kind of machine to do it longer and better. it would have to be something they tech could pull off the shelf a machine that would run almost perpetually inside of a human chest, an artificial heart. ask a u.s. written this drama

about the quest for an artificial heart. there are five surgeons that you rofollow and you take us through this history with sort of followed the ups and downs off the discovery and their personal vendettas and lives at risk and it turns into an exciting reading and it reminded me of the quest dorothy has on her way to oz. my first question why this quest for an artificial heart? >> my husband has a saying that you can't step out of your front

door without stepping on a good story. first used in some of you may remember there was a time in the late 60s and throughout the 70s and 80s when houston was cthe center of heart surgery ad anything that happened happened there and one of my friends tells a joke you couldn't even get a parking place because there were so many people. it was the last stop if he were a hopeless case and in fact they saved a lot of people, so it was a chance for me to writest about houston and these fabulous characters that you mentioned and i felt like it was going to be a lost history otherwise. i'm looking at the age group again. i guess they serve beer in the headlights look you have no idea who these people wereo not changed the way that we look at heart disease.

so i have to say this book is not homework. i wanted to write about something that moved quickly and was about people and so it was just a compelling story i felt like if someone didn't tell it was going to become lost. one of the things you make a great parallel with when you talk about the research into cardiac matters happening at the same time people were wanting to develop the program if one is as crazy as putting a man on the moon. what made people think that it was possible. what i've been thinking along those lines? >> that is a great question. in 1962 jfk went to the stadium, it was the largest stadium at

times and he did his famous ask 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, the then famous surgeon in the worli said wthat we will have an artil heart in them years and i think people have this sense of possibilities and what interestedea me we got to the mn in ten years and we still don't have a completely artificial heart and ind think almost that same kind of arrogance tends to the optimism is why we don't. i think it ended up being more confiscatecomplicated. >> input designing it's more complicated than an artificial

knee or hip. >> doctor fraser was worked on this for 50 years says there's only two problems and the main problem is the destruction of the blog and the other problem was your heart beats 100,000 times a day. to replicate that they kept trying to make a machine that would do that. what doctor fraser pointed out this something that spins like a rotary pump which isll now in cs all over the place. i hate to use this term but does

anybody here have an l. bag? they support the left side of the heart they are complex but they've been boiled down and the one that is my main character in the book besides doctor fraser is about this big and has one disc inside that spins one way and another way and the original artificial hearts were about this big so most people couldn't even wear them. >> there was initial resistance not just to artificial parts but the idea of an artificial heart transplant because the heart is sort of the seat of our school for many people so talk about the challenge people had in terms of the sort of spiritual component of working on a heart. >> heart surgery i didn't realize this until it started in

world war ii a surgeon realized he could pick shrapnel out of the heart was fought for mostly thai memorial if you cut into the heart of killing the soul it was seen as turnbuckle drama coh drove him insane. they could work on the system and then began cutting in to this idea of virtue out of the in modern times became what happens if you put a man's heart and a woman and what happens if you putut the heart of a personf color into a white person. it spoke to all of the anxieties of that time and of course now transplants are fairly routine. but his wife was afraid he wouldn't want her anymorwouldlol

have these things. >> you tell the story through the lives of these five primary doctors and you read about both fraser and he's sort of the fulcrum in this history so you have denton cooley and then fraser and daniel s. the sort of people you hang this history on and they all have these big egos and drive to succeed. can you paint a quick sketch of who these guys are? >> that's another reason i i wanted to write a book. i don't know how many of you remember god, but the most famous surgeon at the time he had to be lured to houston. heay called baylor a third rate

medical school and he threw his oil, turned it into a first-class institution and he actually despite the size of his ego which wouldn't fit in the capital, he brought an excellent people from all over 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 him but he was from a family in houston he was one of the most handsome men who ever lived and he also, i've gotten in trouble for saying that but he was also one of the best surgeons who ever lived. he was so fast which was important because when he started doing heart surgery they didn't have a heart and lung surgery so you have to do what you could do before the person had like brain problems.

but these two were sort of the same in the size and scope of their ambition otherwise they were complete opposites and if they hated each other and they ended up with dueling hospitals and this was the most famous medical feud probably even to this day and it made the artificial heart possible and also the texas medical center possible because if doctor cooley got his own hospitals and ere doctor had to get a different hospital and i he gotn award for doing something dramatic than he had to do something even more dramatic. and it really created the medical center that we have in houston today. but the reason by the fraser is the main character in my book is because he studied with both of these people and devoted his

life to creating an artificial heart, but then the people that he attracted were equally eccentric. i don't know if any of you know billy cowan wha but he is also m houston. he's a harvard trained, baylor trained a surgeon but also a magician and plays trombone and a band. i don't think that he sleeps. and then he is also a spectacular inventor. one day he was in his office waiting every week he would see people with inventions just to tell them yes, no, maybe and there was some kid coming in from australia and he could barely bring himself to meet with the guy. he comes in with his backpack and takes out a device wrappeds in bags and said i think this would work as an art artificial heart and because billy is an inventor he looked at this thing

and excuse me, she said holy shit this is it targets of the latest iteration i write about predominantly in my book has one moving part and that is the one that's about this big but they saw from a prototype that this would do it and they are all crazy. >> it seems like in this field you have to have a sort of daredevil side to you. you have plenty of anecdotes in the book about theot sort of bending the rules in the name of saving lives and racing around the clock. one of my favorite anecdotes. there was no l fda for a long te when he was operating and trying to figure out which way i want to tell the story. i had heard a lot of very strange stories about all these doctors doing very interesting things that we would not find

normal today. i kept hearing this story, and i had a wonderful source who helpeded me, a medical writer by training and she worked with all these doctors. rsi called her. i'm sorry i know i've asked a lot of stupid questions but i have toy ask you come if it's true i want to write about it. i said i kept hearing a story that cooley put a cow hearts in a patient and she didn't miss a beat she said though it was a sheep's heart. it was before transplants were successful. t he'd run out of options and the patient was dying on the table. he turned to somebody and said go down to the lab and bring me a sheep's heart we will try it. somebody went down, they had lab animals, she put it in and it promptly just -- the patient

died. why i wanted to write a this bok is a houston culture i'm sure many of you are familiar with, let's try it first. it's don't ask for permission, ask for forgiveness. in a way that is the story of the early years of heart surge surgery. >> what sort of related to that part of heart surgery is developing the tools that you need for operating on a beating heart or stopping someone, keeping someone's blood flowing. whai was surprised by is how a t of times they are made in people's kitchens and so do you want toan talk about? born in inventor he and his brother grew up in the memorial section of houston they used to blow b things up. [laughter] i don't think their parents were

very attentive. they did a lot of rockets. billy was just a natural inventor. he can look at things and cooley could do s these also he could look at a surgery and think i don't have the tools i need to do this so he would go to home depot and buy something and try it. at one point when he was at harvard he wanted to do what was noninvasive heart surgery. it's a lot less involved than cracking your chest and breaking ribs. he needed something to keep the heart stable while he operated so he went to a bunch of stop and shop grocery stores and hardware stores until he found to kitchens -- it was the work the way he thought they showed and he went to his workshop and kind of puts them between two retractors so they would go in and out and that was the first device he had a pattern on.

patent on. it's made with medical grade materials but most of these medical inventors start out at their local hardware store and he's almost 40 now, he's this heart he would go with his father to a hardware store and they would clear out space and basically invented the circulatory system. people would come and watch and say what are you doing and he would say we are building a sprinkler system that's what they were doing is trying to understand how the body worked. it's not that hard i guess. >> one of why old things about these devices that help is how you end up withoutut a polls because there is this flow and so one of bud frazier's breakthroughs was figuring out

the heart beat was used for the left ventricle and he realized this man craig lewis could maybe put together two of them for the left han and the right side like very beginning of what was the whole thing. if you want to tell us a little about craig lewis and that story? >> this is a love story these are two people very much in love, craig lewis was a engineer for houston and was another guy obsessed with making things work better. he had been healthy all his life and then he got sicker and sicker and it took a long time for the doctors to understand what was wrong with him. he ended up having a disease that he was in total organ failure so you can just be a surgeon and decide okay we are going to try this artificial

heart and put it in this guy. they went to h the fda and you have to go through several steps to get emergency use permission. 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 fairly short time, most of the people i wrote about opted for a little more time and lewis was fascinated in how this machine would work and said let's try. he lived for about three weeks or so before the disease killed him and that is one of the things that interests me about medical experimentation is that in order to try these things on very sick people so you don't really know whether your

invention works, you don't know if someone dies because they wereto going to die anyway, you don't know how much more time you bought them so it's just interesting to see. they probably would have kept going with that except they showed up with what they thought was a better device so they threw that away basically and their focus on this. one story i forgot to tell, the story of the wright brothers people try to fly by imitating nature and it never worked. it's the same thing with the artificial heart it was never going to work as well as it should if you try to copy the beating of the regular heart and that is why i think this works they've sort of transcended nature.

>> but they listen to the test and she's like i don't hear anything because there is no beat. >> you just hear a sound and again she was like does he love me or not is it really him still and add one of the interesting stories about the left ventricle device which is a small they call it an artificial hear heart it just helps the left side you see people walking around with tckpacks and it's happened is that someone will be too far away to plug themselves back in or someonene was in europe and someone came by and thought he was snatching a purse that it was his backpack so that's why you want and implant it device. i want to bring up one of the questions at the center of the book which is this work is high

a risk and high reward but there are always lives at stake. i was thinking of craig lewis because it was a sort of hail mary pass and he had another condition that was going to kill him but inn this first versiont kept him alive for three more we and recently i was thinking about how all these surgeons have to make that calculus and the sort of growing field in cardiac technology is bucking up the field of bioethics and so how do you take these into account which is something the book tries to address and it's interesting because just this last summer the media did an investigation sort of looking into his record and accusing him of sending ethical rules and being a mad scientist and he has been sued for defamation.

so without getting into the lawsuit, i want to ask you to talk about how these things overlap for innovation crashing up against your duty to the patient. >> how many of you remember barney clark? a dentist, seattle dentist who in 1982 was implanted with an artificial heart invented by robert jarvik and it was the first real media circus. there were reporters trying to seek and to th into the hospitad laundry bags and it was supposed to be this great triumph of medical innovation but it was an experiment and clark survived the surgery, the hard work and in fact it is still in use today

but then clark declined and eventually died, so people were watching on their televisions they were watching this man first arrived more or less and then declined. the public really turned on medical innovation at the time. what i saw in my reporting is you have this invention andex there would be this great excitement then it wouldn't work perfectly so you have all of these ethical investigations and then they get it to work so it would be hailed as progress and then it becomes sort of -- so they move t off to the next innovation and the same thing happens over and over so we say we love innovation, a debate buy like it when it works and it

doesn't work the first 25 times. anybody that's been in a clinical trial for cancer knows that's why they are called clinical trials. painting him as doctor frankenstein is not correct thit isn't the personth i saw. >> when we get to the end of the book it is sort of a cliffhanger because we are still in the middle of trying to get an artificial heart and before i ask where we are now, i wanted give us the numbers so everyone has a sense of why it still matters, so kind as heart surgery develops, the heart transplant came to be and a lot of people have steered into having a heart transplant and there's also this preventative medicine so heart disease is rampant and people can improve with exercise and diet so why go the length of developing an artificial heart if i want to get a sense of the numbers we

know why. >> i'm trying to remember the numbers. there are 2500 heart available a year for something like available,0 like 4,000 people a month or so. i have to check the number. i apologize. it's in the book. it's an enormous waiting list. so you could die waiting on the list for a transplant. the other issue is the number of heart attacks has gone down. people have learned to smoke, avtry to drink less and eat healthy but they haven't done enough, so heart attacks are going down but heart failure is coming up. and that is a very long and slow painful death. a device like this if you can't convince people to change their habits which history has shown it easier to walk to the moon,

then we will need the devices. there is a lot of work being done in stem cell research trying to build a heart from your own cells but that is a long way off all so so you worse though going to need these devices. >> tell us where are we now, what's on the horizon? >> trials will start with this in a year about a year from now. i think they've got it. i am pretty convinced. it's the last thing. i'm going to back up a little arbit. when you go to a lab at the institute now you can walk up to a cow and it looks like a very normal cow and if you give it a smack it will take it and it eats it and take a nap and then

you listen to its heart and all yyou hear is swooshing. itit has an artificial heart. you can't tell the difference, looking at this animal that doesn't have a real hard. so we will see. a question i asked who would volunteer here if you had no other choice? i think it depends. my research shows my father was 90 when he died and i knew he was in the early stages of heart failure and i thought maybe he could be a volunteer. you are 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 would get one if i were in my 30s with small children i wouldd definitely get one. you realize the mechanical nuances but there's also a lot of psychological nuances.

>> we will open up to questions in a few moments. i had one last question. you are a journalist and not a medical student. tell us about the process of getting into learned about how the heart works. >> i'd written a book about enron ten years-- ago and when i started the book i thought it can't be as hard as enron and i sort of like biology and i meant to bring a prop. every journalist is reinventing the wheel every time you have to start with very very basic questions. i was lucky doctor frasier liked talking and liked talking about this because he was incredibly patient.

i would get asked the same question. i don't understand why they don't do this or that and then when you are writing you have to decide how much the reader needs to know. >> did you follow him around the hospital? >> a transplant is a mind blowing thing to see.ly i highly recommend it. they have a viewing sort of its kind of like this you are in a dome and you can look down on the operating room. it kind of looks like car repair they cut open the chest and if it is a disease heart, normal one isis the size of your fist d these look like basketballs. he cuts them out and then they go to a styrofoam cooler and they take out something that looks like h you would get at te grocery store and so it's back in and there's a moment you see

everybody pause and what they are doing is taking the patient off the machine and t you watch the transplant heart start beating. it's pretty awesome i have to say. >> how many did you get to meet? >> you name after it survived the surgery. they are named like marguerite, i don't know i've lost track of them all. it was like nine or ten. >> does anyone have any questions? >> you can ask about anything. >> i am a cardiac nurse and got to play with [inaudible] one of the challenges i go around building innovation networks. they are active and left out and

i'm curious also i want to make sure we mentioned the patient innovators. we are moving to a patient generated innovation and craig lewis is a good story i would love to hear from the standpoint you are building the stories and telling these great stories but its physician centric and undercuts the contributions that thend nurses and patients are making. >> my son is in nursing school. i apologize i think that has changed over time. the nurses were seeing this ancillary and now they are incredibly important. i think if i were moving to look forward there would be nurses who would be very important to the story. i will tell you when i was researching this i went to interview and asked questions how does the pump do this or

that. he has anth implantable heart tt starts in the ear which is really bizarre but he finally looked at me and said i think you should be talking a to patients and i was like you are right and this book really is a story of patience and a lot of ways and what theyhi went throu. he was right the only way people can connect is by putting themselves in the patients place. i don't want to give too much of the story away but some of the patients are my favorites in the book because they were so brave, just incredibly brave. i talked to a lot of patients and their families. the only thing a lot of times that gives them comfort and i heard this over and over again it may not help me but maybe it will help somebody down the it did.ich they wouldn't be where they are

today. this has taken forever because the heart and the body are so complex that if it were not for these people, we would never be where we are now. >> any other questions? >> thank you all very much. >> this is kind of a book of life and death and big things at stake. can you talk about how that overlapped? >> id data passed through my mind maybe dad should get this heart. if you cut a long happy life most people want to stay alive i think if they're suffering isn't -- if the suffering is attainable. i watched my dad gets to the point that he was ready to go.

cooley used to say some people live too long and he lived to be 96, so he kind of knew but we will have to think about people our age there are going to be an awful lot of us and we could end up walking around with artificial hearts and total dementia. there have to be decisions made about future healthcare. what surprised you about that choice? >> of people think they wouldn't want an artificial heart or they wouldn'thatthey wouldn't want ta clinical trial you think i want to see my kids graduate from school or i want to be at my daughter's wedding and you think if this helps i will do it. >> i didn't know this but i forget how old he was when he was towards the end of his life

they saved him and he lived like three or four more years. >> i thought that was so curious it was like he was ready to go but y you need this heart surgey you've been pioneering for yourselves. >> and none of the doctors wanted to operate on him. edr those who don't remember, he was one of the meanest people who ever lived and he cared or rightist his interns and med students and the only person that would operate on him was his former partner who did it and saved his life but nobody else would. >> i just want to confirm for you she gets no sleep. >> is a built in and of himself. it's a book full of eccentrics. >> of the book is thicker and it is a page turner.

please get your copy and have her sign it. think you so much. [applause] >> best editor in america. >> thank you all so much for coming. [applause] [inaudible conversations] hunter s. thompson saw an opening through the remaining crowd of police and protesters he moved about 60 feet away with cops near the entrance clubbed him back i live here he screamed i pay $50 a day.

he was shoved into the door and pulled out his room key and and wasted overhead until someone let him push through to the lobby. he locked and changed his door. his eyes burned close with chemicals. but he was unharmed. he held a cloth to his face to soak out the teargas and sat on the bed with his legs crossed. his body was shaking and he couldn't write. none of it made sense. the police had known he was a member of the press but the political officials and a member of the nonviolent young protesters were staffers for democratic candidates that was the point. years later looking back on this moment they knew my position and wanted to beat me anyway. they were powerful enough to break anybody that thought about getting in their way. what i learned is the police were capable of hiring thugs to break the rules we thought we were operating under.

the violence he witnessed was state sanctioned and had originated in the electoral process of the democratic system. in this sense we were the intended audience and all along it had been with us and was us. a song for america we have been singing from the start. just after 9 p.m. the balloting for the presidential nomination was about to begin. thompson still had his pass around his neck the entire time and he planned to put it to use now for something other than an invitation to a beating.

.. >>host: welcome to community activist deray mckesson. you wrote a