way. these institutions become co-opted by the political process and because we only listen to media outlets we already agree with that demonization becomes self perpetuating but against the very way of life to destroy that is the part of the answer. >> suicide of the west. jonah goldberg's new [inaudible conversations] ..

>> we're here with mimi swartz to talk but her book, "ticker," which is a page turner. i'm glad here here particularly in terms of headlines and disasters, just to be able to talk but something that affects us all in matters of the heart. is just a great opportunity. so, before we get started, a couple things. we're in this c-span booktv tent, which means we're live, and mimi and i will have a conversation for about 25 minutes or so and then we'll open its up to questions for ten or 15 minutes. if you have a question at the end, go up to a microphone and

speak into the microphone and then books are for sell next door, and afterward mimi will be signing companies of their book -- copies of her book in the tent beyond that. so head that way. first my name is kate, and i'm an editor at highline magazine and i know my my because we worked for men years at texas monthlying to and mimi a longtime executive editor at texas monthly and many of you know her pieces from "the new york times." she has also been published in "vanity" fair and "esquire o'and wrote a book but the call of enron called" power failer nye poise is a book called "ticker," but the artificial heart. i asked her to do a reading to

whet our appetite. so go ahead. >> i want to -- i'm so excited. this is such a huge crowd. ike ecstatic to be here. [applause] >> many your like me look like you're in the heart disease prone years so this is -- [laughter] -- i thought i would just start with a short reading and also, just to hit off two questions, i don't know if bette doesn't win and i don't know why trump doesn't have a heart attack. i thought i would just read a page from the become but my main character named buzz frazier. some -- bud frazier, some of you may know him. this is about how he got started -- why he decided to go into this field and he is this wonderful eccentric west texan. and this starts right when he is

don with -- still in med school. even so, he had already decided to specialize in heart surgery. the death toll from heart disease was skyrocketing in 1963. every day another patient at methodist died because the doctors had so little to offer. there was one patient in particular whose terrified pleading expression would stay with bud nor rest of his life. he had worked up a medical history for one of doctor debakey's growing lift of international patients, 17-year-old italian boy who was only a few years younger than bud himself. students who did the workup got to scrub in on the patient's surgery. bud was there no what the expected to be a routine replacement of a damageed aortic valve. the kid was thin but handsome, dark eyes and thick black hair. optimistic, he was eager to go home.

his mother was with him. the surgery went fine, bud held and retracted, nothing glammous but still exciting for a student. that new england the boy's heart stopped. this sometimes happened execs mix by with aority vac disease, the only way to save the boy was to use a proceed your that was tried in 1961, to reowe the chest and manually massage the heart to restart it. a resident cut the boy open, then turned to the strongest person in the room, bud. he showed bud how to reach into the boy's 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 but the boy kept his gaze on bud and tried to reach for him to hold on. minuted passed.

bud's hands cramped and then the pain began raiditying up his arm. he kept going, debakey strode in, too one look at the scene and ordered bud to stop. experience told him that too much time had passed and that they were not going to be able to restart the boy's heart. but bud kept squeezing and releesing national final lay resident had to shove him 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 debakey went out to give her the news. as it turned out, that episode we change everything for bud. if the simple pumping action of his hand could keep someone alive, he figured, there should be some kind of machine that could do it longer and better. it would have to be something a tech could pull off the shelf and a surgeon could implant, machine that would run almost perpetually inside a human chest, an artificial heart. [applause]

>> you have written essentially what this page-turning medical drama but the 50 year quest for an artificial heart and what makes it so readable is that you keep the lives of the characters, their five surgeons that you follow, and you take us through this history with all the ups and downs of the discovery, and their personal vendettas and lives at risk, and it turns into a really exciting reading, and i just wanted to say it reminds me of sort of the quest that dorothy had on her way to oz where you have this band, sort of together, on their quest and it's like the tinman on steroids. so, my first question for you was kind of that sense of starting down the yellow brick road.

buy and why the quest for an artificial isn't that right. >> this is sort of cheating but i live in houston and my husband has a saying you can't step outside your front door without falling over a great story, and houston, for some of you may remember, there was a time in the late '60s and throughout the '7'sed and the 780s when houston was the center of heart surgery, and one friend tells a joke where you couldn't get a parking place in the met center because there were so many people. like lords so many people comping there because it was the 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 you mentioned, and i felt like it would be a lost history otherwise. i think on looking at the age group again and when i say doctor michael debakey or

denton cooley to someone in their 20s i get this deer in the headlights stare. they don't no who these people were that changed american health and the way we look at heart disease. so i want to say -- i have to say this book is not homework. i wanted to write a book that moved quickly and was about people. so it was this very compelling story i felt like if somebody didn't tell it, it would be lost. >> one thing that you make a great parallel with, you talk about the beginning of the research into cardiac matters, kind of happening at the same time that people were wanting to develop the space program, and at the time sort of think of an artificial heart was as crazy as putting a man on the moon. so, what made people think that an artificial heart was even possible? what kind of developments got them thinking along the lines.

>> that's a great equipment think i was more of a mindset question, where in 1962, jfk went to the rice stadium, rice university stadium, the largest stadium at the time, and 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, michael debakey, who then was the most famous surgeon in the world, said we'll have an artificial heart in ten years. i think people had a sense, a., they had a sense of possibility of endless possibilities, and what interested me is we got to the moon in ten years, and we still don't have a completely implantable artificial heart, and i think that almost the same kind of arrogance tinged with this incredible optimism is why we don't. i think the body ended up big a

lot more complicated than a rocket. >> in fact that was my next question, which is that kind of designing an artificial heart is a lot more complicated than designing an artificial knee or hip. what are to the economic indications. >> this funny. dr. frazier, who works on this for 50 years, says 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 heart beats 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 cooperate last more than two years so if you had one of those pumps, you'd be back in the hospital two years later for life-threatening surgery, and

what doctors phase 'er firth out is you need something that spins instead -- something like a rotary pump, which is now in cars all over the place, and the latest -- i hate to use this term but does anyone here have an lvad? no. these are machines that support the left side of the heart, which are -- which spins. they do nothing more than spin. they're very simple. they're incredibly complex but have been build down to two or three parts. the heart that is my main character in the book, besides dr. frazier, is about this big and it just has one disk inside that spins and it spins the blood to the heart one way ask the blood to the lungs another way. the original artificial hearts were this big so most people couldn't even wear them. >> one thing you talk about was there was initial resistance not just to artificial heart and the idea of a heart transplant because the heart is sort of the

seat of our soul for many people. so talk about that challenge that people had in terms of the spiritual component of working on a heart. >> heart surgery, i didn't realize, it's very young. didn't start until world war ii when a surgeon realized he could pick shrapnel out of the heart. it was thought if you cut into the heart you were killing the soul, it seemed her -- the 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. spoke to all of the anxieties of that time, and of course now

transplants are fairly routine. but when barney clark got an artificial heart his wife was afraid he wouldn't love her anymore so we do still have these weird things. >> well, you've kind of told the story through the lives of five primary doctors and you read about bud frazier and he is the fulcrum in the history so you have denton cooley -- michael debakey first and then denton cooley and then buzz frazer and then billy comb and daniel timms as the kind of the people that you hang this history on, and they all have these big egos and sort of a drive to succeed which is 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 debakey was a -- the most famous surgeon in the world of his time. he came to houston -- he had to be lured to houston. called baylor a third-rate medical school and he, through his will, really, turned it into a first-class institution. he actually disspeed the size of his egg go, which wouldn't fit the capitol, he brought in excellent people from all over the country ask 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 from a fine 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 about he looked like errol flynn and was one of the best surgeons who ever lived. so fast which was important

because when he started doing heart surgery, they didn't have a heart-lung machine so you lad to cut into the heart, get in there do what you could do and get out before at the person had brain problems. but these two were sort of the same in this size and scope of their ambition, but otherwise they were completely opposite, and they hated each other, and they ended up with dueling hospitals and this was the most famous medical feud probably even to this day. it made the artificial heart possible. it also made the texas medical center possible because if something got -- if dr. cooley got his own hospital, well, then, dr. debakey lad to get a bigger hospital and if dr. cooley got an award, dr. debakey had to do something more dramatic and it really created the medical

center that we have in houston today. then as -- the reason bud frazier is the main character is because he studied with both of these people and then devoted his thrive creating an artificial heart, but then the people he attracted were equally eccentric. i don't know if you know billy koehn but he is from houston., a harvard trained, baylor trained, harvard trained and unalso magician and plays trombone in a band and -- i don't think the guy sleeps and then billy -- he is 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 this backpack and takes a device out of that's wrapped in rags and says, i think this will work as an art artificial heart, and because billy is an inventer he looked at the thing and, excuse me, he said, holy shit, this is it. so the latest iteration in the heart that i write about predominantfully in my book has one moving part and that's about this big. but they saw from a prototype this would do it. and they're all crazy. every one of them. >> i was just going to say to be in the field you have to have a daredevil side to you. so you have plenty of anecdotes about the bending the rules in the name of saving lives and racing against the clock. >> oh, yes. >> one of my favorite anecdotes was denton cooley. >> there was no fda for a 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 very strange store about this doctors doing interesting things we would not find normal today, and i kept hearing this story and i had a wonderful source who helped me, an editorial -- a medical writer by training traid worked if always these doctors and i said 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 and i said, i keep hearing this story that denton cooley but a cow's heart in a patient, and she didn't misa beat and said, no, i it was a sheep's heart and 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 table, and he turned to somebody and said go down to the lab, bring me a

sheep's heart. let's try it. and somebody went down, they had lab animals, they cut a heart out of a sheep, brought it back up, he put it in and it promptly went -- the patient died, but this -- again, why i wanted to write this book, there's a houston culture that i'm sure many of you are familiar with, that the, let's try it first, what is it, don't ask for permission, ask for forgiveness, and i think in a way that is the story of the early years of heart surgery. >> what is related to that part of heart surgery is 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 is how these inventions are a lot of times made in people's kitchens and really sort of down-home kind of things. do you want to talk about billy

koehn's spatula. >> he was born an inventor, he and his brother grew up in the memorial center of houston and used to blow things up. i don't think their parent were very attentive and they would do -- they did a lot of rockets, and billy just a natural inventor, and he can look at things and cooley could do this, too. look at a surgery and think i don't have the tool i need. to do this, and so he would go to home depot and buy something and try it. and at one opinion when he was at harvard, he wanted to start doing what is 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 and hardware stores until he found two spatulas, kitchen spat las

that worked the way he thought they should and went to his workshop and put them between two retractors so they'd good in and out and in and out and that was the first device he got a patent on. eventually it's all made with medical grade materials but most of these medical inventers start out at their local hardware store, and daniel timms, i this young -- almost 40 now who invented the heart -- would go with his father to hardware store and they would clear a space and basically invent the circulatory system with pipes and people would come and watch and say, what are you doing? and he would say we're building a sprinkler system. they were 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 helped

the different ventricle of the heart -- you end up without a pulse because it's this continuing flow idea and so one of bud frazier's breakthroughs was figuring out that one of these pumps, which is called the heart mate 2 -- used for the left ventricle and he realize with this man, craig lewis who was out of chances, he could put together two heart mates for the left and rightside which was the beginning of possibly the whole thing. do you want to tell us about craig lewis and that story. >> he -- this is a love story. these were two people very much in love and craig lewis was an engineer for the city of houston. another guy who was obsessed with making things work better, and he had been healthy all his life, and then he got sicker and sicker and sicker, and it took very long time for the doctors to understand what was wrong with him.

he ended up having a disease called amyloidow sis which he was in total organ failure you can't just be a surgeon and decide we'll try this artificial heart and put it in this guy. bud went to the fda and got something -- you have to go through several steps to get what is called 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 very short time, most of the people i wrote about opted for a little more time, and lewis especially was fascinated how this machine would work, and said, let's try. and he lived for about i think three weeks or so with this artificial heart before the disease killed him, and that is one of the things that interests 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 invention works. you don't in the 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 interesting to see -- that device worked fine and they probably would have kept going with that except daniel timms showed up waist that it thought was a better device so they threw that away, basically, and put all their focus on this. one story i forgot to tell is that the -- dr. frazier and -- cohn will tell the story of the wright brothers. we didn't -- people tried to fly by imitating nature, and it never worked. and i think it's the same thing with the artificial heart. it was never going to work as well as it should if you tried

to copy the beating of the regular heart. and that's why things -- this worked, they transcended nature. >> after be huts into craigy, bud asks -- craig's wife, linda to listen to his chest and she's like issue don't hear anything because there's no beat. but he is alive. >> you just hear a whirring sound and i think -- and again, she was, like, sort of, well, does he love me or not? is it really him still? and at one interesting story about the left ventricle device, which is a small sort of art -- it's called an artificial heart but just helps the left side. you see people walk around river what looks like backpacks and it happened that someone will be too far away to plug themself back in, or they -- someone was in europe and a guy came buy in a moto and thought he was

snatching a purse and snatched the battery pack so that's why you want an implantable device. >> host: i want to bring up one of the questions at the center of the book which is that the kind of work is sort of high-risk, high-reward, but they're always lives at stake. and i was thinking of craig lewis, the hail mary pass and he had another condition that would kill him anyway but this kind of first version of the artificial heart kept him alive for three more weeks. recently -- i was thinking how all these surgeons have to make that calculus, and this sort of growing field in cardiac technology is also sort of budding up against the feel of bioethics and how to take the two things into account, which something the book tries to address and it's interesting because this last summer, the media did an investigation into bud frazier, sort of looking

into his record and accusing him of bending some ethical rules and not -- >> mad scientist. >> mad scientist and he has sense sued for definition, and so without be e getting into the lawsuit i want to ask you to talk about how these things overlap, this idea of innovation crashing up against your duty to the patient. >> well, what i realized -- how many of you remember barney clark? mast of you -- barney clark was a dentist, seattle dentist, who in 1982 was implanted with an artificial heart invented by robert jarvik it and was the first real media -- a huge media circus. there were reporters trying to sneak into into the hospital in laundry bags and supposed to be this great triumph of american medical innovation.

but because it was an experiment, and it wasn't billed that way but it was, and clark survived the surgery, the heart worked, in fact that heart is still in use today, veriation of that. but then clark declined, and evenly died so -- eventually died so people were watching on television, watching this man first thrive more or less and then decline, and the public really turned on medical innovation at the time. what i saw in my reporting was you have this invention, and there would be this great excitement and then wouldn't work perfectly so you would have the ethical investigations and then the device would work and then it was hailed as progress and then everyone would-digit like transplants and becomes

ho-hum so the move on to he next innovation and the same thing happens over and over again. so we say we love innovation but we only like it when it works and it doesn't always work the first 25 times. anybody who has been in a clinical trial for cancer knows that it why they're called a clinical trial. i think painting dr. frazier as dr. frankenstein is not correct. that's not the person i saw. >> well, when we get to the end of the book it's a cliff-hanger because we're still in the middle of trying to get to at artificial heart and before i ask you about where we are now, i wanted you to give us the numbers so that everybody has a sense of why the quest still matters. so kind of in as heart surgery developed, the heart transplant came to be, and so a lot of people have figured into having

the heart transplant and there's preventive medicine. people can improve with exercise and diet so why go to the lengths of developing an art facial heart so give us a sense of the numbers numbers so we kn. >> i'm trying to remember the numbers. 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 have to check the number. it's in the book -- waiting for hears. an enormous lating list and the -- 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 learn, don't smoke, try to drink less, try eat healthy, but they haven't done enough. so heart attacks are going down, heart failure is going way up.

just soaring and that is a very long, slow, painful death. so it a device like this, if you can't convince people to change their habits, which history has shown is a -- it's easier to walk to the moon -- then we'll need devices. there's a lot of work being done in stem cell research, trying to build a heart from your own cells but that's a long way off. you'll still need the devices. >> are we now? what's on the horizon. >> i think human trials will start with this heart in a year. at the end -- about a year from now. and i think they've got it. i'm pretty convinced just -- >> this one isn't baitry battery operated. >> that's the last thing. still right now -- i'm going to back up. 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 company and if you give it a snack i will take the snack and eats its hay and takes a nap, and then you listen to its heart, and all you hear is -- it's got an artificial heart. you can't tell the difference. just this mind-blowing thing to look at this healthy animal that doesn't have a heart or doesn't have a real heart. so, we'll see. i'm curious, question i was always asked. who would volunteer here if you had no other choice? to get one? well, i think it depends. my research shows age. if you -- my father was 90 when he died and i knew he was in the early stages of heart failure, and i thought maybe dad could be a volunteer, and -- 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 if was in my 30s with small children, i would definitely get one. so, it's just -- you realize that they're mechanical nuances and also a lot of psychological knew nuances. >> we'll open it up to questions in a minutement i had one last question. you are a journalist and not a medical student. so how -- tell us about process of getting into just learning how the heart works. >> well, i'd written a book about enron ten years ago and i -- when i started this book i thought can't be as harding a enron and i like biology and i meant to bring as a prop this book for five-year-olds called "your heart" and that's where i hard to start. every journalist is reinventing

the wheel every time and you have to start with very basic questions and i was lucky that dr. phraser liked talking about this. he was intread my patient. it was like enron, lad to question cities -- i don't understand why the platelets don't do this or that and then you have to decide how much the reader really needs to know. >> did you follow bud around the hospital. >> i spent a lot a time. a transplant is a mind-blowing thing to see. highly recommend it. there's a -- they have a viewing sort of -- i don't know -- kind of like there is, you're in this dome and you can look down on the operating room through a dome and it is kind of looks like car repair. this cut open the chest and you see -- usually if it's a diseased heart. a normal heart is the size of your fist and these look like

basketballs. and he cuts them out, and then they go to a styrofoam cooler and they take out something that likes lying something you get at the grocery store and sew it back in and there's a moment where everybody pauses they're taking the patient off the heart lung machine and you start the transplanted heart start to beat. >> host: how many calves did you get to meet. >> you name a calf after it survives the surgery, they're named margurite and big red. i've lost track of them all. it was like nine or ten. >> does anyone have any questions? anything about the heart? circumstance please. >> hi there. >> you asking about anything now. >> great. my name is shawna and i'm a cardiac nurse and i got play with the inter -- the pump, very

first cardiac transplant so thank you for the work on that. one of the challenges -- i go around the world building innovation net,'s. nurses are not included. they're absolutely active and they frequently are left out of the story. and i'm curious in -- also i want to make sure we mention the patient innovators he. we innovate for patient but we are looking for patient generated innovation and craig lewis is a good story. i'd you're building stories but it's really physician centric, physician dominated and undercuts all of the enormous contributions that nurses and engineers and scientists are making. >> my son is in nursing school so, i apologize. i think that's change over time. the nurses were season at ancillary and now they're incredibly important so i think if i were moving the book forward there would be nurses who we woo be very important to

the story. but i was -- i'll tell you, when i was researching this -- this will sound really dumb but i went to interview dr. jarvik and was asking him this these, how does the pump do this and that and that he has an implantable heart that starts in the ear, which is really bizarre, but he finally looked at me and said, the think you should be talking to patients and i was like you know, you're right. and this book really is a story of patients in a lot of ways and what they went through, because i think that -- he was dead right. the only way people really can connect is by putting themes in the patient's place, and even -- i don't want to give too much of the story away but some of the patients are reallying my favorite people in the book because they were so brave. just incredibly brave. >> when you talk to a lot of them -- >> i talked to a lot of patients

and their families and the only thing in a lot of times that gives the comfort -- i heard them over and honever den may mott help me but maybe it will help something down the road, which i do. they wouldn't be where they are today -- this has taken forever because the heart and the body are so complex, but if it weren't for these people, we'd never be where we are now. >> any other questions? >> thank you all very much. >> one more question. >> she has another question. >> mimi wrote this book at the same time that she was saying her ailing father, through his last days and so since this is a kind of a book blot life and death and big things at stake, can you talk a little bit about how that overlapped for you. >> mortality was -- like i said, it did pass through my mind, maybe dad could get this heart. and you just -- again, it was

really -- if you have had a long, happy life, most people want to stay alive. if their suffering is tenable. i watched my dad get to the point where he was ready to go. but i think we all -- denton cooley used to say, people live too long and he lived to be 96 so kind of knew, but i think we are going to have to think but people our age, they're going to be an awful lot of us and we could end up walking around with artificial hearts and total dementia and do we want that? they're going to have to be decisions made about future health care. >> what surprised you about the choice for people? >> just, again, that -- i think a lot of people think they wouldn't want an art facial or be in a clinical trial, and then suddenly you think 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. >> i was struck just as in

closing one final anecdote. when michael debakey -- i forget how old -- toward the end of his life he self-diagnosed himself with -- >> almost lived to be 100. >> was going to -- >> he was ready to go and his wife made the surgeons a methodist hospital operate on them and they saved him and he lived three or four more years. he was almost immortal. >> host: as a surgeon himself he was like, i'm ready to go but his wife said you need this heart surgery you have been pioneering for yourself. >> most of the doctors were afraid to operate on him. nobody wanted to. finally -- he was mean. for nose who don't remember, he was one of the meanest people who ever lived and terrorized his interns and med students, and the only person that could finally find to operate on him was his former partner, who did and saved his life, but nobody else would touch it. >> i just wanted to confirm for

you, billy cohn does not sleep. >> he is not -- he is a book in and of himself i think. a book foul of ex-send trick eccentrics. >> host: the book is "ticker" so get your company and have mimi sign and thank you so much. >> thank you, kate. best editor in america. [applause] >> thank you all very much for coming. [applause] [inaudible conversations] [inaudible