WEBVTT 00:00:01.339 --> 00:00:04.870 Lindberg: Well, we appreciate you taking thetime to meet with us, and part of the background, 00:00:04.870 --> 00:00:13.050 of course, is to develop a fuller understandingof Michael DeBakey, our iconic mutual friend, 00:00:13.050 --> 00:00:16.160 butof course you're well on your way to being 00:00:16.160 --> 00:00:17.400 an iconic master, yourself. 00:00:17.400 --> 00:00:21.170 So we don't want toneglect that aspect of the story. 00:00:21.170 --> 00:00:24.800 Tell a little bit -- you've worked with bothsides of the street, 00:00:24.800 --> 00:00:25.800 haven't you? 00:00:25.800 --> 00:00:26.800 Dr. DeBakey and Dr. Cooley. 00:00:26.800 --> 00:00:32.780 Frazier: Well, yeah, I started medical school-- actually, it was I went to the University 00:00:32.780 --> 00:00:37.230 of Texasto play football, and I got my hamstring muscle 00:00:37.230 --> 00:00:40.480 avulsed in spring training of 1960. 00:00:40.480 --> 00:00:43.630 I really neverthought about what I was going to do beyond 00:00:43.630 --> 00:00:48.280 that, which I think a lot of kids today aresort of in 00:00:48.280 --> 00:00:49.280 that mode. 00:00:49.280 --> 00:00:51.059 Most in my era were not, but I was. 00:00:51.059 --> 00:00:52.329 I didn't want to be a schoolteacher. 00:00:52.329 --> 00:00:56.090 My parentswere schoolteachers, and I knew I didn't want 00:00:56.090 --> 00:01:01.700 to be grading papers all the time, workingfor that. 00:01:01.700 --> 00:01:04.141 Lindberg: What part of Texas were they from? 00:01:04.141 --> 00:01:11.139 Frazier: Well, they were from what we callWest Texas but it's more central, and my father 00:01:11.139 --> 00:01:13.229 taught at a college called Tarleton. 00:01:13.229 --> 00:01:18.279 It's a nice little school in a small town. 00:01:18.279 --> 00:01:21.060 It was really a verygood place to grow up. 00:01:21.060 --> 00:01:26.170 I didn't appreciate it, of course, at thetime, and my mother taught 7th 00:01:26.170 --> 00:01:28.530 grade English when she was at Tara. 00:01:28.530 --> 00:01:32.389 Everybody was afraid of my mother. 00:01:32.389 --> 00:01:36.200 She was 40 years oldwhen I was born, which is very unusual in 00:01:36.200 --> 00:01:40.140 those days, and I had a sea of aunts aroundme. 00:01:40.140 --> 00:01:42.520 Lindberg: You got to be a spoiled son then? 00:01:42.520 --> 00:01:45.999 Frazier: Yeah, I never picked up a sock andI've made it to this point in life without 00:01:45.999 --> 00:01:47.939 making up abed. 00:01:47.939 --> 00:01:49.579 Lindberg: Good for you. 00:01:49.579 --> 00:01:54.130 Frazier: But at any rate, I wasn't sure todo. 00:01:54.130 --> 00:01:59.619 My mother, anecdotally, is--she had drivendown 00:01:59.619 --> 00:02:00.619 here. 00:02:00.619 --> 00:02:01.619 She was 82 years old. 00:02:01.619 --> 00:02:04.179 She had been driven down here from West Texasafter my father 00:02:04.179 --> 00:02:07.559 died over the Christmas holidays. 00:02:07.559 --> 00:02:11.313 In between Christmas and New Years, she wokeup in the 00:02:11.313 --> 00:02:15.920 middle of the night, and she clearly was havinga heart attack. 00:02:15.920 --> 00:02:23.500 I took her out and said, "Mother, Iwant you to lay down in the back seat and 00:02:23.500 --> 00:02:25.330 I'm going to drive you to the emergency room." 00:02:25.330 --> 00:02:30.349 As Iwas backing the car out she said, "Lay down, 00:02:30.349 --> 00:02:35.500 lay down--all your education, all I've triedto teach 00:02:35.500 --> 00:02:40.319 you, and you don't know that I'm not a bookor a pencil." 00:02:40.319 --> 00:02:42.170 That was her last punt. 00:02:42.170 --> 00:02:45.260 She tragicallydied a couple days later. 00:02:45.260 --> 00:02:50.110 But she wasn't going to let me get away withthat. 00:02:50.110 --> 00:02:51.430 Lindberg: That's good. 00:02:51.430 --> 00:02:56.970 Frazier: But anyway, so I decided to go tomedical school more or less on philosophic 00:02:56.970 --> 00:03:00.810 grounds,and I had to take all the pre-med courses 00:03:00.810 --> 00:03:03.799 in one year because I'd never taken a pre-medcourse. 00:03:03.799 --> 00:03:09.790 Icame to Baylor, and I came here because of 00:03:09.790 --> 00:03:15.620 the -- well, actually a friend of mine wascoming 00:03:15.620 --> 00:03:21.459 down here, and I had a girlfriend in Houston,so that was -- 00:03:21.459 --> 00:03:22.459 1 00:03:22.459 --> 00:03:23.459 Lindberg: A combination of factors. 00:03:23.459 --> 00:03:28.370 Frazier: --things you make decisions on atthat point in your life. 00:03:28.370 --> 00:03:33.670 But the one thing we had was--and Dr. DeBakey started this--every student 00:03:33.670 --> 00:03:36.420 had to write a research paper every year,which was 00:03:36.420 --> 00:03:44.400 the most helpful thing to me in my medicaleducation in medical school. 00:03:44.400 --> 00:03:50.129 I just by chance startedout with the Department of Surgery working 00:03:50.129 --> 00:03:53.340 first year in transplants and the second yearin the 00:03:53.340 --> 00:04:02.310 artificial heart with [Domingo] Liotta, andI wrote a short paper. 00:04:02.310 --> 00:04:03.749 We had to write a little paper onit. 00:04:03.749 --> 00:04:05.049 That was '66. 00:04:05.049 --> 00:04:07.340 Lindberg: That was good fortune. 00:04:07.340 --> 00:04:16.600 Frazier: Yeah, and I've stayed with it prettymuch since then, and all of this started with 00:04:16.600 --> 00:04:21.299 Dr.DeBakey or, sorry, I started working with 00:04:21.299 --> 00:04:24.050 him in the research, because it was alwaysin the 00:04:24.050 --> 00:04:26.430 Department of Surgery. 00:04:26.430 --> 00:04:35.260 But we had to have four and a half weeks atthat time with Dr. DeBakey, 00:04:35.260 --> 00:04:43.139 four and a half weeks with Dr. Cooley in oursurgery rotation. 00:04:43.139 --> 00:04:50.639 I always remember the onlyorientation we had to Dr. DeBakey was to get 00:04:50.639 --> 00:04:56.590 there early, because Dr. DeBakey always checkedon the medical students and if you weren't 00:04:56.590 --> 00:05:00.530 in the room, he would really be upset at you. 00:05:00.530 --> 00:05:06.470 Sosurgery started at 7:30, and so you had to 00:05:06.470 --> 00:05:08.039 be there by 7:15. 00:05:08.039 --> 00:05:14.770 [Frazier:] Well, the first case that I wasto be in on was a lumbar sympathectomy. 00:05:14.770 --> 00:05:17.759 An operationthey don't do much today but we did a lot 00:05:17.759 --> 00:05:18.759 of them then. 00:05:18.759 --> 00:05:21.420 But they didn't tell me they started thatat 00:05:21.420 --> 00:05:26.350 7:00, and Ted Diethrich was doing it, andI got to the room. 00:05:26.350 --> 00:05:27.350 Everybody was scrubbed. 00:05:27.350 --> 00:05:29.979 Thepatient was asleep, and Ted looked up and 00:05:29.979 --> 00:05:31.160 said, "Get in here. 00:05:31.160 --> 00:05:33.280 Dr. DeBakey has already beenlooking for you.'' 00:05:33.280 --> 00:05:38.860 There's Dr. DeBakey--when he's on the frontpage of Time Magazine, he's 00:05:38.860 --> 00:05:41.240 worried about where the medical student is. 00:05:41.240 --> 00:05:45.160 So I hurriedly scrubbed, and I got in there,and I was 00:05:45.160 --> 00:05:53.610 getting my gown on, and Dr. DeBakey comesinto the room, at the door, and starts -- everything 00:05:53.610 --> 00:05:55.360 went to dead silence. 00:05:55.360 --> 00:05:59.819 He said, "You know, I wonder where--" --hehad this sort of deep 00:05:59.819 --> 00:06:05.240 Louisiana accent when he was being informal--"I just wonder where that medical student, 00:06:05.240 --> 00:06:06.440 Frazier, could be this morning?" 00:06:06.440 --> 00:06:09.889 And he was looking at me over the -- "I justwonder where he 00:06:09.889 --> 00:06:11.550 could be? 00:06:11.550 --> 00:06:16.690 You know, it's my understanding that he doesn'twant to be a doctor at all. 00:06:16.690 --> 00:06:20.500 What hewants to be is a banker, a banker, and he 00:06:20.500 --> 00:06:24.270 can get up at nine o'clock every morning.'' 00:06:24.270 --> 00:06:25.919 So [therewas] dead silence. 00:06:25.919 --> 00:06:29.849 Nobody said a word, and I was frozen, of course. 00:06:29.849 --> 00:06:35.120 And then he said, "Yes, Ithink that's what he should be. 00:06:35.120 --> 00:06:37.340 He would be a good Republican banker." 00:06:37.340 --> 00:06:41.470 And then he startedlaughing, which was probably the worst thing 00:06:41.470 --> 00:06:44.190 you could be in his eyes. 00:06:44.190 --> 00:06:46.250 And when he laughed,everybody laughed, so -- 00:06:46.250 --> 00:06:47.979 Lindberg: The ice was broken. 00:06:47.979 --> 00:06:51.349 Frazier: And this was the case. 00:06:51.349 --> 00:06:58.060 Then later that morning--1 hadn't learnedhow to deal with Dr. 00:06:58.060 --> 00:07:01.979 DeBakey very well by then--so I went to explainwhat had happened. 00:07:01.979 --> 00:07:07.430 I said, "Well, you know, Ithought the case started at 7:30, Dr. DeBakey." 00:07:07.430 --> 00:07:09.280 And he was scrubbing at the sink. 00:07:09.280 --> 00:07:16.220 But it startedat 7:00, and he said, "Well, you know, if 00:07:16.220 --> 00:07:18.990 you really cared, if you actually cared aboutthe patient, 00:07:18.990 --> 00:07:20.610 you would have been here at 6:OO. 00:07:20.610 --> 00:07:23.580 You see, if you were here at 6:00, then youcould have seen 00:07:23.580 --> 00:07:31.310 the patient, shared his anxieties, seen whatthe anesthesia could do to help calm them, 00:07:31.310 --> 00:07:33.069 and youcould have been with him, and you could have 00:07:33.069 --> 00:07:34.610 learned a lot, but of course you would haveto 00:07:34.610 --> 00:07:35.610 care. 00:07:35.610 --> 00:07:37.620 Too bad, since you obviously don't care." 00:07:37.620 --> 00:07:42.860 He just wouldn't let you off the hook, buthe was 00:07:42.860 --> 00:07:43.860 2 00:07:43.860 --> 00:07:49.409 a unique individual, and I think that's thebest way to describe him. 00:07:49.409 --> 00:07:51.830 I've never seen anyone quitelike Dr. DeBakey. 00:07:51.830 --> 00:07:57.319 Lindberg: Well, what you describe is certainlypart of team building, but I do recall a counter 00:07:57.319 --> 00:08:01.990 example, in which at least on one occasionhe's quoted as saying, "I'm surrounded by 00:08:01.990 --> 00:08:02.990 incompetents. 00:08:02.990 --> 00:08:03.990 I' 00:08:03.990 --> 00:08:04.990 Frazier: Oh, yeah. 00:08:04.990 --> 00:08:05.990 Lindberg: Did you ever hear that? 00:08:05.990 --> 00:08:06.990 Get to hear that one? 00:08:06.990 --> 00:08:07.990 Frazier: Yeah, sure. 00:08:07.990 --> 00:08:14.430 All those things were frequently accompaniedby this heavenward gesture. 00:08:14.430 --> 00:08:17.550 "I'm drowning in a sea of incompetents." 00:08:17.550 --> 00:08:20.919 You know, he's looking up to the Almightyto 00:08:20.919 --> 00:08:21.919 somehow spare him with these idiots aroundhim. 00:08:21.919 --> 00:08:28.689 "Drowning in a sea of incompetents." 00:08:28.689 --> 00:08:34.630 He hadall these--we had one of the pioneers in electroencephalograms, 00:08:34.630 --> 00:08:41.790 Dr. Kellaway, and I rememberhim telling one of the residents one time, 00:08:41.790 --> 00:08:44.780 he says, "Call Dr. Kellaway in here and seeif there's 00:08:44.780 --> 00:08:52.890 any evidence of brain activity in Dr. Joneshere." 00:08:52.890 --> 00:08:56.250 He had all these things that were sort offunny 00:08:56.250 --> 00:08:58.840 if you weren't there, but at the time theyweren't funny. 00:08:58.840 --> 00:09:00.200 Lindberg: If you weren't the object of hisattention. 00:09:00.200 --> 00:09:09.750 Frazier: I went in one time to see one ofhis senior assistants a physician, younger 00:09:09.750 --> 00:09:15.101 surgeon likeGeorge Noon but not George at that time, and 00:09:15.101 --> 00:09:27.720 Dr. DeBakey was doing an abdominal aneurysm,and I went in and this man and his two assistants 00:09:27.720 --> 00:09:28.720 were standing in the corner. 00:09:28.720 --> 00:09:32.230 They were juststanding in the corner of the room. 00:09:32.230 --> 00:09:37.480 He looked up at me, motioned me away, andDr. DeBakey 00:09:37.480 --> 00:09:44.250 was doing the case with a nurse, and afterwardsI went and I said, "Mac, what were you all 00:09:44.250 --> 00:09:45.250 doingstanding in the corner?" 00:09:45.250 --> 00:09:49.710 And he said, "Well, Dr. DeBakey got so madat us that he said he didn't 00:09:49.710 --> 00:09:50.710 need us at all. 00:09:50.710 --> 00:09:53.350 He could do the case with just the nurse. 00:09:53.350 --> 00:09:57.430 And we had to go stand in the corneruntil the case was over," you know, like they 00:09:57.430 --> 00:09:58.830 used to do with kids. 00:09:58.830 --> 00:10:04.310 And all these men in their 30sand early 40s out there standing in the corner 00:10:04.310 --> 00:10:05.700 until he'd finished. 00:10:05.700 --> 00:10:10.190 And he did it, you know, hecould do those aneurysms by himself. 00:10:10.190 --> 00:10:14.700 Would have been interesting to get an honestanswer from 00:10:14.700 --> 00:10:21.020 him, but I'm not sure whether he consideredDr. Cooley a blessing or not when he came, 00:10:21.020 --> 00:10:23.180 becauseDr. Cooley was so slick technically. 00:10:23.180 --> 00:10:24.180 Lindberg: Yeah. 00:10:24.180 --> 00:10:28.510 Frazier: I don't think there will ever beanyone quite like Dr. Cooley. 00:10:28.510 --> 00:10:32.970 Nobody is going ever to beable to do 20 pump cases in a day. 00:10:32.970 --> 00:10:34.360 Lindberg: That's incredible. 00:10:34.360 --> 00:10:38.560 Frazier: Like Lindbergh flying that littleplane across the ocean. 00:10:38.560 --> 00:10:42.660 There's not a pilot alive todaythat would do that. 00:10:42.660 --> 00:10:49.350 I think he [Cooley] was just unique technically,and Dr. DeBakey, certainly 00:10:49.350 --> 00:10:52.580 for the aneurysms, I think he did very well. 00:10:52.580 --> 00:10:56.330 I don't think -- cardiac surgery, he was sortof a late 00:10:56.330 --> 00:11:08.590 starter and that fine sewing -- he was -- butstill I think he was a very accomplished surgeon, 00:11:08.590 --> 00:11:12.840 particularly when you consider all the otherthings he was doing at the same time. 00:11:12.840 --> 00:11:14.281 I think that's a 00:11:14.281 --> 00:11:15.281 3 00:11:15.281 --> 00:11:16.281 remarkable thing. 00:11:16.281 --> 00:11:17.281 There's a lot of good surgeons. 00:11:17.281 --> 00:11:18.281 Lindberg: What was the other one? 00:11:18.281 --> 00:11:26.770 Frazier: Well, taking a medical school thatwas as he described third-rate, and it was 00:11:26.770 --> 00:11:28.940 at least thatwhen he came here. 00:11:28.940 --> 00:11:35.170 By the time I started in '63, it was generallyconsidered the better medical 00:11:35.170 --> 00:11:42.350 school in the south, probably better thanTulane and Duke. 00:11:42.350 --> 00:11:44.360 And it didn't get there by magic. 00:11:44.360 --> 00:11:47.450 Itgot there because Dr. DeBakey just pushed 00:11:47.450 --> 00:11:54.460 it there, and he had a remarkable energy andremarkable focus. 00:11:54.460 --> 00:11:59.600 And yet on another level -- I mean he wasfrustrated with people around him. 00:11:59.600 --> 00:12:04.860 As I get older I can -- a lot of these tempertantrums that he had, I wish you could still 00:12:04.860 --> 00:12:08.770 get awaywith. 00:12:08.770 --> 00:12:14.391 He just kept that hospital always--1 thinkit was the best hospital in the world in the 00:12:14.391 --> 00:12:16.980 '50sand '60s and OS, because Dr. DeBakey wouldn't 00:12:16.980 --> 00:12:18.520 accept anything else. 00:12:18.520 --> 00:12:24.210 For example, I never sawa decubitus ulcer over there. 00:12:24.210 --> 00:12:25.330 Never. 00:12:25.330 --> 00:12:30.210 And I see them now all the time. 00:12:30.210 --> 00:12:31.820 Lindberg: Really? 00:12:31.820 --> 00:12:33.430 It's nursing. 00:12:33.430 --> 00:12:39.290 Frazier: Right, and he knew that, and at somepoint before I got there, Dr. DeBakey--the 00:12:39.290 --> 00:12:42.020 nursesknew that if they had a patient that got a 00:12:42.020 --> 00:12:44.670 decubitus ulcer, they would be fired. 00:12:44.670 --> 00:12:50.030 He would fire thenurse, and so the result was there were no 00:12:50.030 --> 00:12:52.740 decubitus ulcers. 00:12:52.740 --> 00:12:59.940 I mean it was just that sort oftightness of a system that he was able to 00:12:59.940 --> 00:13:01.040 engender. 00:13:01.040 --> 00:13:08.770 I think he had the best blood banker in theworld, a guy named Migliori [phonetic] down 00:13:08.770 --> 00:13:09.770 there. 00:13:09.770 --> 00:13:13.740 About every two weeks he would go down -- we'd be making rounds -- he'd go down into 00:13:13.740 --> 00:13:16.390 the blood bank and start yelling at Migliorito do -- 00:13:16.390 --> 00:13:18.810 he was going to get rid of him if he didn'tget the blood. 00:13:18.810 --> 00:13:26.780 He was the best guy in the world doingit, but he just never let up on anyone or 00:13:26.780 --> 00:13:28.980 himself. 00:13:28.980 --> 00:13:40.490 He really imbued in us the importance of tryingto keep focus on the patient, to the expense 00:13:40.490 --> 00:13:42.480 of yourself and your own health. 00:13:42.480 --> 00:13:46.830 He wouldn't let youout of the ICU when you were in there. 00:13:46.830 --> 00:13:51.640 When I went in, the guy ahead of me, he firedafter two 00:13:51.640 --> 00:13:59.330 months, so I actually had to spend four monthsin the ICU, so it was a world that unless 00:13:59.330 --> 00:14:00.670 you werethere, nobody would believe it. 00:14:00.670 --> 00:14:03.940 Lindberg: I guess, that means not as a patientbut you were assigned there full-time and 00:14:03.940 --> 00:14:04.940 couldn'tleave the hospital. 00:14:04.940 --> 00:14:05.940 Frazier: No, you were assigned to take careof the patients. 00:14:05.940 --> 00:14:07.050 Lindberg: And you couldn't leave, right? 00:14:07.050 --> 00:14:17.320 Frazier: You couldn't leave, and the otherthing he would do because he was such a stickler 00:14:17.320 --> 00:14:21.610 ofgrammar, and still when I was a medical student, 00:14:21.610 --> 00:14:26.690 so that was '65/'66, I guess I was rotatingon his 00:14:26.690 --> 00:14:27.690 service. 00:14:27.690 --> 00:14:32.100 So at that time, he was in his late 50s. 00:14:32.100 --> 00:14:36.770 He would grade the papers and grade them mainlyfor grammar. 00:14:36.770 --> 00:14:43.570 If you abbreviated something or had somethingwrong grammatically, he'd call you 00:14:43.570 --> 00:14:47.780 in and sort of chew you out about your grammar. 00:14:47.780 --> 00:14:48.780 He was such a perfectionist. 00:14:48.780 --> 00:14:52.380 Lindberg: Well, his standards were high, butI'm interested to hear you say that they infused 00:14:52.380 --> 00:14:54.190 thewhole hospital operation. 00:14:54.190 --> 00:14:55.530 Frazier: Yes. 00:14:55.530 --> 00:14:56.530 4 00:14:56.530 --> 00:15:00.200 Lindberg: He didn't stop with surgery. 00:15:00.200 --> 00:15:02.410 He worked the whole thing over. 00:15:02.410 --> 00:15:07.020 Frazier: No, everybody was -- and I thinkagain it was just a community hospital. 00:15:07.020 --> 00:15:09.070 I mean this is amedical center. 00:15:09.070 --> 00:15:14.590 I mean Houston was known for the oil industryand that sort of thing, but it 00:15:14.590 --> 00:15:15.590 wasn't known for medicine. 00:15:15.590 --> 00:15:16.590 Lindberg: Yeah, not in those days. 00:15:16.590 --> 00:15:18.350 Frazier: In 1948 and '49 when he came here. 00:15:18.350 --> 00:15:22.560 Lindberg: Yeah, he told me he was the onlysurgeon in town with the boards [certification]. 00:15:22.560 --> 00:15:24.530 Frazier: Yeah, I think that's probably right. 00:15:24.530 --> 00:15:26.200 Lindberg: Yeah, that's amazing. 00:15:26.200 --> 00:15:30.000 And the photos of this Texas Medical Centerwere essentially of 00:15:30.000 --> 00:15:31.080 a cow pasture. 00:15:31.080 --> 00:15:32.150 Frazier: Yeah. 00:15:32.150 --> 00:15:33.310 Well, more a forest. 00:15:33.310 --> 00:15:37.230 We're on the edge of the east Texas forest. 00:15:37.230 --> 00:15:41.820 I had Olivia deHavilland's son as a patient one time, and 00:15:41.820 --> 00:15:46.810 I got to know her reasonably well just becauseof her 00:15:46.810 --> 00:15:48.080 son. 00:15:48.080 --> 00:15:53.480 I remember her telling me one time the mostinteresting thing to her in coming to Houston 00:15:53.480 --> 00:15:56.600 --where she had only been temporarily in the 00:15:56.600 --> 00:15:59.720 past -- was that when you came in -- it wasin the 00:15:59.720 --> 00:16:01.670 '80s -- it was all green. 00:16:01.670 --> 00:16:08.530 You'd see all these trees, and that's theway this medical center was, just 00:16:08.530 --> 00:16:14.440 sort of a forest here, and of course Hermann[Hospital] was the first built and then Baylor 00:16:14.440 --> 00:16:21.620 wasthe next building and that's 60 years ago 00:16:21.620 --> 00:16:26.700 it was nothing. 00:16:26.700 --> 00:16:29.870 I understand it's the largest medicalcenter in the world. 00:16:29.870 --> 00:16:32.320 Lindberg: Oh, it must be. 00:16:32.320 --> 00:16:34.760 Frazier: For good or bad. 00:16:34.760 --> 00:16:38.180 Lindberg: You haven't even stopped growingapparently. 00:16:38.180 --> 00:16:40.140 Frazier: It's still growing. 00:16:40.140 --> 00:16:41.610 Yeah, it's amazing. 00:16:41.610 --> 00:16:46.010 It's like an institution is always the lengthand 00:16:46.010 --> 00:16:52.700 shadow of one man, and his shadow was quitea large one. 00:16:52.700 --> 00:16:54.580 Lindberg: Marvelous man. 00:16:54.580 --> 00:17:00.410 I asked George Noon about Mike's work in Washington,and he said 00:17:00.410 --> 00:17:06.250 [they] knew nothing at all about it exceptthey wouldn't be operating on Tuesday and 00:17:06.250 --> 00:17:07.250 Wednesday. 00:17:07.250 --> 00:17:08.250 Frazier: That's it. 00:17:08.250 --> 00:17:09.250 He's right. 00:17:09.250 --> 00:17:13.770 Lindberg: So that part of his life he didn'tshare with the surgical colleagues apparently. 00:17:13.770 --> 00:17:29.210 Frazier: Well, I think he was so -- I don'tknow it's--one of the--Walker Percy was a 00:17:29.210 --> 00:17:32.730 writer fromCovington, Louisiana. 00:17:32.730 --> 00:17:34.440 He was from Mississippi. 00:17:34.440 --> 00:17:38.049 He won the National Book Award, very good 00:17:38.049 --> 00:17:39.049 5 00:17:39.049 --> 00:17:40.049 writer, essayist. 00:17:40.049 --> 00:17:45.370 In one of his essays he was talking aboutthe South and how it produced all these 00:17:45.370 --> 00:17:46.700 great writers. 00:17:46.700 --> 00:17:51.930 He would go to New York up to this Algonquinroundtable and discuss all these 00:17:51.930 --> 00:17:58.960 things with all these northeastern intellectuals,and they always were amazed that the South 00:17:58.960 --> 00:18:04.029 keptproducing these wonderful writers, and they 00:18:04.029 --> 00:18:09.120 had this illusion, he reflected, that therejust must be 00:18:09.120 --> 00:18:15.370 something that people down here are readingall the time, studying all the time, and he 00:18:15.370 --> 00:18:17.679 said, ofcourse, he knew it was just the opposite. 00:18:17.679 --> 00:18:21.750 Nobody really cared and nobody read that muchor 00:18:21.750 --> 00:18:23.539 cared what they did. 00:18:23.539 --> 00:18:28.200 William Faulkner was always just the peculiarFaulkner boy, lived up in 00:18:28.200 --> 00:18:30.629 Oxford, Mississippi. 00:18:30.629 --> 00:18:36.500 And he [Percy] lived in Covington, Louisiana,and he said in this essay that 00:18:36.500 --> 00:18:40.340 actually nobody knew exactly what he did. 00:18:40.340 --> 00:18:46.750 The Jax Beer distributor -- and there wasone guy 00:18:46.750 --> 00:18:52.710 from Louisiana that played professional football--weremuch more well known than he was. 00:18:52.710 --> 00:18:57.240 Nobody--Covington didn't care anything abouthim [Faulkner], and in a way I think it was 00:18:57.240 --> 00:19:00.880 sort ofthat way here in that nobody really knew what 00:19:00.880 --> 00:19:03.039 [DeBakey] did, or cared. 00:19:03.039 --> 00:19:10.110 In some odd way maybethat was an advantage of being here, is he 00:19:10.110 --> 00:19:11.919 could do whatever he wanted to do. 00:19:11.919 --> 00:19:14.040 I mean nobodywas up there stopping him. 00:19:14.040 --> 00:19:15.750 There wasn't a bunch of committees. 00:19:15.750 --> 00:19:20.809 It wasn't like an organized,structured medical school to be curious about 00:19:20.809 --> 00:19:24.420 what he was doing or he'd have to presentanything. 00:19:24.420 --> 00:19:27.900 Just run as far has his legs would carry him. 00:19:27.900 --> 00:19:33.019 He was very good at getting the support ofthe community leaders. 00:19:33.019 --> 00:19:39.260 He told me that recently, three or four yearsago when I was going up to 00:19:39.260 --> 00:19:45.870 Cleveland with him, the problem that Baylorwas having then was the lack of leadership 00:19:45.870 --> 00:19:47.740 in thecommunity, and he went-- 00:19:47.740 --> 00:19:48.740 Lindberg: Yeah, I believe that. 00:19:48.740 --> 00:19:50.700 Frazier: --to the Brown brothers. 00:19:50.700 --> 00:19:52.130 He went to Ben Taub. 00:19:52.130 --> 00:19:53.420 He went to Mr. Cullen. 00:19:53.420 --> 00:19:56.490 He went to thesepeople that were the community leaders, and 00:19:56.490 --> 00:20:03.030 he impressed on them that they wanted a first-classmedical school, that he didn't want the guys 00:20:03.030 --> 00:20:07.370 that were just competing between Hermann Hospitaland Methodist administrators. 00:20:07.370 --> 00:20:09.370 He didn't deal with them. 00:20:09.370 --> 00:20:11.770 He dealt with the community leaders. 00:20:11.770 --> 00:20:19.529 Houston was fortunate at that time they hadsome of these people of substance but of also 00:20:19.529 --> 00:20:20.529 vision. 00:20:20.529 --> 00:20:25.510 Lindberg: Well, your remarks kind of leadup to the big break. 00:20:25.510 --> 00:20:29.789 I wouldn't feel right withoutasking you about the Baylorl Methodist Hospital 00:20:29.789 --> 00:20:30.789 break. 00:20:30.789 --> 00:20:33.090 Frazier: Well, St. Luke's, I guess. 00:20:33.090 --> 00:20:34.919 Oh, the most recent one? 00:20:34.919 --> 00:20:36.190 Lindberg: Yeah. 00:20:36.190 --> 00:20:44.000 Frazier: Well, I think so much of that hadto do with failure of communication, as Cool 00:20:44.000 --> 00:20:45.570 HandLuke said. 00:20:45.570 --> 00:20:48.720 It's just a failure of communication. 00:20:48.720 --> 00:20:52.570 But also I think one of the liabilities of-- and I'm 00:20:52.570 --> 00:20:57.240 not impugning the leadership at Baylor, butthey just weren't familiar with the culture 00:20:57.240 --> 00:21:03.629 down hereand what they could do and what they really 00:21:03.629 --> 00:21:08.289 shouldn't do and couldn't do, and I thinkdown here 00:21:08.289 --> 00:21:09.289 in the South in general -- 00:21:09.289 --> 00:21:12.120 Lindberg: That's a Faulknerian tendency. 00:21:12.120 --> 00:21:22.370 Frazier: Well, they were from the Northeastand in general everybody understates what 00:21:22.370 --> 00:21:23.960 theywant here. 00:21:23.960 --> 00:21:31.029 You don't go in demanding 100 percent whenyou really will accept 50 percent. 00:21:31.029 --> 00:21:34.950 Youjust try to deal with them, and I think there 00:21:34.950 --> 00:21:41.860 was a lot of that problem with Methodist thatwas 00:21:41.860 --> 00:21:42.860 6 00:21:42.860 --> 00:21:47.789 engendered by the audacity to think they firstof all wanted more or less to take over the 00:21:47.789 --> 00:21:48.789 hospital. 00:21:48.789 --> 00:21:51.490 Well, they couldn't take over the hospitaland they shouldn't. 00:21:51.490 --> 00:21:54.880 And then, of course, they convincedsome of the Baylor board members -- I think 00:21:54.880 --> 00:21:58.220 this is what Dr. DeBakey was referring to-- who 00:21:58.220 --> 00:22:08.759 really didn't adequately study the situation,that they needed to have their own hospital. 00:22:08.759 --> 00:22:12.039 Well,Harvard has never had their own hospital. 00:22:12.039 --> 00:22:15.759 Harvard's had the same relationship that Baylorhas 00:22:15.759 --> 00:22:18.720 [with Methodist Hospital] with the Mass Generaland the Brigham. 00:22:18.720 --> 00:22:20.260 It was fine. 00:22:20.260 --> 00:22:24.669 They did need agood clinic, which they ended up getting, 00:22:24.669 --> 00:22:28.360 but they didn't need a hospital, and that'ssort of one of 00:22:28.360 --> 00:22:36.390 the tragedies that I think toward the endof his life, I know it concerned him a lot, 00:22:36.390 --> 00:22:37.809 but I know he 00:22:37.809 --> 00:22:38.809 was-- 00:22:38.809 --> 00:22:39.809 Lindberg: It did concern him. 00:22:39.809 --> 00:22:40.809 He felt terrible about it. 00:22:40.809 --> 00:22:47.019 Frazier: I think he had a certain amount ofoptimism that I hope will be justified. 00:22:47.019 --> 00:22:49.889 We'lleventually do the right thing. 00:22:49.889 --> 00:22:53.820 What's that Churchill said about the Americans? 00:22:53.820 --> 00:22:56.400 That they wouldalways do the right thing eventually. 00:22:56.400 --> 00:22:58.309 Lindberg: After they tried everything else. 00:22:58.309 --> 00:23:03.860 Frazier: Yeah, you give them enough time,and I think that will probably happen here, 00:23:03.860 --> 00:23:09.889 but it'sjust painful, and I think a lot of it was 00:23:09.889 --> 00:23:10.889 frankly cultural. 00:23:10.889 --> 00:23:22.509 These guys sort of overstating their case,and assuming both of them came--the chief 00:23:22.509 --> 00:23:28.559 people involved came from medical schoolsthat 00:23:28.559 --> 00:23:35.470 always had a university hospital, but it waspart of their tradition. 00:23:35.470 --> 00:23:41.100 Perm, the oldest hospital andprobably the first medical school, as you 00:23:41.100 --> 00:23:46.039 know, and the Strong Memorial, I think reallywas the 00:23:46.039 --> 00:23:49.519 first sort of academic hospital. 00:23:49.519 --> 00:23:55.440 But it just didn't work down here that way;that wasn't the culture. 00:23:55.440 --> 00:23:57.690 I don't know. 00:23:57.690 --> 00:24:01.460 I hope it will recover. 00:24:01.460 --> 00:24:04.389 I think the whole paradigm of medical schoolsas we 00:24:04.389 --> 00:24:12.110 discussed--1 mean the financial base, havingto start out on the financial base as Dr. 00:24:12.110 --> 00:24:16.519 DeBakeyinstituted of the clinicians revenue generating 00:24:16.519 --> 00:24:17.519 -- 00:24:17.519 --> 00:24:19.799 Lindberg: Supporting the hospital. 00:24:19.799 --> 00:24:22.980 Frazier: --the revenues supporting the medicalschool. 00:24:22.980 --> 00:24:29.619 I think that was first done by Dr. DeBakeyand at that time it worked great, because 00:24:29.619 --> 00:24:32.039 insurance companies were just coming in. 00:24:32.039 --> 00:24:36.440 The medicalschools were doing the procedures and that 00:24:36.440 --> 00:24:41.080 sort of thing, but it was a house built onsand. 00:24:41.080 --> 00:24:45.970 Lindberg: Is there a good relationship nowbetween Baylor and St. Luke's? 00:24:45.970 --> 00:24:54.320 Frazier: Well, it's the same relationshipthere always was, and I think, again, historically 00:24:54.320 --> 00:24:55.320 they hada relationship. 00:24:55.320 --> 00:24:59.240 We'd rotate over here as medical students. 00:24:59.240 --> 00:25:03.499 Two students out there -- Baylormedical students. 00:25:03.499 --> 00:25:06.779 They'd come over here. 00:25:06.779 --> 00:25:13.230 We have some departments that--our generalsurgery 00:25:13.230 --> 00:25:16.119 chief is also the Baylor chief. 00:25:16.119 --> 00:25:17.580 Lindberg: Chuck Brunicardi. 00:25:17.580 --> 00:25:24.789 Frazier: Yeah, and the head of the liver transplantprogram here is a full-time Baylor -- But 00:25:24.789 --> 00:25:30.830 thatrelationship is sort of a quid pro quid between 00:25:30.830 --> 00:25:36.700 the medical school and St. Luke's, which theyalways had that. 00:25:36.700 --> 00:25:42.290 They worked mainly at Methodist, of course,but they had the same relationship 00:25:42.290 --> 00:25:43.290 7 00:25:43.290 --> 00:25:44.290 with St. Luke's. 00:25:44.290 --> 00:25:52.830 They could come over here and -- Historically,I think Dr. Cooley was, of 00:25:52.830 --> 00:25:57.190 course, the -- here it was -- and part ofBaylor. 00:25:57.190 --> 00:26:01.590 It was probably a little tighter relationship,but it's 00:26:01.590 --> 00:26:04.490 still what it always was mechanistically. 00:26:04.490 --> 00:26:08.759 There's no--Baylor doesn't run the hospital,and that's 00:26:08.759 --> 00:26:15.629 what Dr. Stein I think had envisioned wasthat again Baylor--they couldn't do it at 00:26:15.629 --> 00:26:22.200 Methodist, butthey would do it at St. Luke's, and he made 00:26:22.200 --> 00:26:23.830 an important error. 00:26:23.830 --> 00:26:33.850 I think if--1 remember him tellingme that he dealt with administrators who alluded 00:26:33.850 --> 00:26:41.470 to certain promises that they would let Baylorplay a stronger role, but he told me one time, 00:26:41.470 --> 00:26:45.010 he said, "You know, I have a lot of troublewith this 00:26:45.010 --> 00:26:46.010 bishop. 00:26:46.010 --> 00:26:54.740 He doesn't seem to be interested in establishingthis stronger relationship, and I've never 00:26:54.740 --> 00:26:59.860 had trouble with the bishop at Methodist,but I had trouble with everybody else. 00:26:59.860 --> 00:27:01.669 But I said,"Well, this is an Episcopalian hospital. 00:27:01.669 --> 00:27:04.980 Do you know the meaning of the word Episcopalian?" 00:27:04.980 --> 00:27:06.419 Heconfessed he didn't. 00:27:06.419 --> 00:27:12.970 I said when you look it up in the dictionaryit says "system ruled by 00:27:12.970 --> 00:27:21.169 bishops," and the bishop unfortunately hehas the only ultimate vote, and it's like 00:27:21.169 --> 00:27:24.629 the pope as faras this hospital is concerned. 00:27:24.629 --> 00:27:28.430 People can say what they want to, but he hasthe ultimate vote, and 00:27:28.430 --> 00:27:34.639 it's unlikely he's going to turn it over toone of the few Episcopalian hospitals in the 00:27:34.639 --> 00:27:38.970 country, andone of the most successful to a former Baptist 00:27:38.970 --> 00:27:44.159 school, I think you're going to levitate beforethat 00:27:44.159 --> 00:27:46.249 happens." 00:27:46.249 --> 00:27:51.909 And he never really understood that eitheranyway, but hopefully it will work out. 00:27:51.909 --> 00:28:01.869 [Frazier:] But I think one of the things thataffected me is like so many things was just 00:28:01.869 --> 00:28:06.649 when Iwas under Dr. DeBakey's service, we would 00:28:06.649 --> 00:28:09.899 work up a patient, and then we would go withthem 00:28:09.899 --> 00:28:15.240 to the surgery the next day, so we got toknow the patients pretty well. 00:28:15.240 --> 00:28:22.140 I had this young Italianboy, he was 17, and he had severe aortic insufficiency, 00:28:22.140 --> 00:28:28.049 but he was otherwise a very healthylooking boy. 00:28:28.049 --> 00:28:36.700 He was a real nice looking boy, and he wasthere with his mother from Italy. 00:28:36.700 --> 00:28:39.580 Hecould speak English somewhat. 00:28:39.580 --> 00:28:41.279 His mother couldn't at all. 00:28:41.279 --> 00:28:44.169 I remember talking to him the nightbefore. 00:28:44.169 --> 00:28:46.789 He was very cheerful and optimistic. 00:28:46.789 --> 00:28:48.289 He had this huge [indiscernible]. 00:28:48.289 --> 00:28:52.529 He had a big hugeheart, and you know that valve surgery was 00:28:52.529 --> 00:28:54.960 very high risk in those days and Dr. DeBakey-- 00:28:54.960 --> 00:28:58.740 Lindberg: But essential, though, because hehad six months or so to live. 00:28:58.740 --> 00:29:00.720 Frazier: Yeah, I'm sure of it. 00:29:00.720 --> 00:29:06.649 But Dr. DeBakey put in a Starr-Edwards orhis valve, which was a 00:29:06.649 --> 00:29:11.759 similar valve, and a ball valve, and he didpretty well. 00:29:11.759 --> 00:29:18.120 I was on the surgery, and Dr. DeBakeywas obviously very--he was Dr. DeBakey. 00:29:18.120 --> 00:29:25.379 But the surgery went well, and he was in theICU later 00:29:25.379 --> 00:29:32.340 that evening, and about six o'clock that eveninghe arrested. 00:29:32.340 --> 00:29:36.679 In those days and what you still do,actually, immediately after surgery we opened 00:29:36.679 --> 00:29:41.749 the chest, and we started massaging his heart,and 00:29:41.749 --> 00:29:47.970 I was still the youngest and strongest andin the best condition, so I ended up massaging 00:29:47.970 --> 00:29:48.970 hisheart. 00:29:48.970 --> 00:29:52.999 It was fibrillating, and I would massage theheart and they would shock it, and they 00:29:52.999 --> 00:29:58.769 couldn't get it going, but as I was massaginghis heart -- I don't know if this has happened 00:29:58.769 --> 00:30:01.639 to mebefore or since, but I think this was the 00:30:01.639 --> 00:30:03.370 first time it had happened to me. 00:30:03.370 --> 00:30:05.960 The kid woke up. 00:30:05.960 --> 00:30:08.379 I wasmassaging his heart, and he was looking up 00:30:08.379 --> 00:30:13.279 and his hand came up trying to get up, andI thought 00:30:13.279 --> 00:30:23.139 -- and he was looking up at me, and I thoughtwere we going to be able to get this thing 00:30:23.139 --> 00:30:24.919 started,but we couldn't. 00:30:24.919 --> 00:30:31.999 Finally, Dr. DeBakey came in he said we hadto quit and he left. 00:30:31.999 --> 00:30:33.129 I was 25- 00:30:33.129 --> 00:30:34.840 Lindberg: It's terrible. 00:30:34.840 --> 00:30:36.549 You're very close. 00:30:36.549 --> 00:30:40.950 Frazier: He was looking up at me, and theyfinally sedated him, but he actually reached 00:30:40.950 --> 00:30:45.769 up andfinally the resident just sort of knocked 00:30:45.769 --> 00:30:47.480 me aside. 00:30:47.480 --> 00:30:51.490 I remember his mother crying and crying. 00:30:51.490 --> 00:30:55.409 But Ithought at that era if my hand could keep 00:30:55.409 --> 00:30:57.710 him alive, why couldn't we develop somethingthat 00:30:57.710 --> 00:30:58.710 8 00:30:58.710 --> 00:31:01.490 could at least do what my hand did. 00:31:01.490 --> 00:31:10.659 And really from that time I went through mytraining, of 00:31:10.659 --> 00:31:16.909 course, and it always involved surgery, butmainly I was interested in research and developing 00:31:16.909 --> 00:31:18.820 these pumps. 00:31:18.820 --> 00:31:24.120 That's really the main reason I came overhere with Dr. Cooley. 00:31:24.120 --> 00:31:28.070 I worked with bothof them as a medical student, as an intern. 00:31:28.070 --> 00:31:34.929 But I was in Vietnam when the great breakup[between DeBakey and Cooley] occurred. 00:31:34.929 --> 00:31:37.179 When I came back, of course, [Domingo] Liottaand 00:31:37.179 --> 00:31:39.679 [William] Hall and all those people were gone. 00:31:39.679 --> 00:31:41.340 There was no [artificial heart] program leftat 00:31:41.340 --> 00:31:44.549 Baylor, because it had dissolved. 00:31:44.549 --> 00:31:47.070 Dr. Cooley had started a program over herewith Jack Norman. 00:31:47.070 --> 00:31:48.909 Lindberg: Oh, Jack, yeah, I remember him. 00:31:48.909 --> 00:31:56.980 Frazier: And he came down and so that wasthe only sort of device research going on. 00:31:56.980 --> 00:31:59.119 That wasthe main reason I came over here to finish 00:31:59.119 --> 00:32:02.450 my cardiac training. 00:32:02.450 --> 00:32:05.900 We worked and worked on it. 00:32:05.900 --> 00:32:10.269 Itwas very high mortalities in the OS, very 00:32:10.269 --> 00:32:11.419 high in the '80s. 00:32:11.419 --> 00:32:14.529 I did--the first 23 implantable LVADswere done here. 00:32:14.529 --> 00:32:21.640 They finally in the early '90s at ClevelandClinic and Columbia started on them, 00:32:21.640 --> 00:32:27.779 and all the pumps that are being widely usedtoday started here. 00:32:27.779 --> 00:32:31.779 What they call the HeartMate I1is an extension of the Hemopump, which was 00:32:31.779 --> 00:32:35.679 a continuous flow pump. 00:32:35.679 --> 00:32:42.690 I was always interestedalso in a continuous flow pump support because, 00:32:42.690 --> 00:32:45.609 of course, you could make them much smaller. 00:32:45.609 --> 00:32:48.549 But you can also make them much more durable. 00:32:48.549 --> 00:32:57.200 It occurred to me just from a teleologicstandpoint as a medical student that the only 00:32:57.200 --> 00:33:00.869 organ that really needs a pulse is the heartfor 00:33:00.869 --> 00:33:02.220 diastole. 00:33:02.220 --> 00:33:10.809 The other organs really basically at the capillarylevel its pulses flow anyway. 00:33:10.809 --> 00:33:14.659 So I wasable to develop the first implantable pump. 00:33:14.659 --> 00:33:18.359 I don't say--well, because I'm not an engineer. 00:33:18.359 --> 00:33:21.609 I don'teven like math, you know. 00:33:21.609 --> 00:33:25.899 I never liked it, but I've always worked withthese-- 00:33:25.899 --> 00:33:28.350 Lindberg: How did you cure the hemolysis? 00:33:28.350 --> 00:33:33.490 Frazier: I don't know. 00:33:33.490 --> 00:33:39.799 The first pump to be successfully used was,of course, the Hemopump, and 00:33:39.799 --> 00:33:48.649 it was done in 1986 at the contractor's conferencein Louisville, Kentucky. 00:33:48.649 --> 00:33:54.049 [Robert] Jarvik, whohad been fired by the Symbion company came, 00:33:54.049 --> 00:33:57.570 and I'd known him a long time, he came tome. 00:33:57.570 --> 00:33:59.720 Iwould go to these meetings, and I was getting 00:33:59.720 --> 00:34:10.220 in debates with Glen Pennington and Peer Portnerand these other people in the field on pulseless 00:34:10.220 --> 00:34:11.929 versus pulsatile flow. 00:34:11.929 --> 00:34:15.850 They knew I had an interestin it, and both of them came to me at that 00:34:15.850 --> 00:34:19.050 meeting and Rich Wampler, who I didn't knowvery 00:34:19.050 --> 00:34:28.870 well, had a very small pump--it was the sizeof the eraser on a No. 2 lead pencil. 00:34:28.870 --> 00:34:32.660 He [Wampler]wanted me to do some research on it, and I 00:34:32.660 --> 00:34:36.390 saw it, and I said, well, "Rich, yeah, wecan do that 00:34:36.390 --> 00:34:43.910 but I'm telling you it's going to hemolyzeand it's just going to thro,mbose." 00:34:43.910 --> 00:34:48.290 Then Jarvik came tome with an implantable version of the same 00:34:48.290 --> 00:34:50.750 thing. 00:34:50.750 --> 00:34:56.880 That was really the first implantablecontinuous flow pump Dr. Jarvik started working. 00:34:56.880 --> 00:35:02.420 I started working on this with Rich Wampler,and we did some calves down here. 00:35:02.420 --> 00:35:04.430 It didn't hemolyze. 00:35:04.430 --> 00:35:05.430 This was '86. 00:35:05.430 --> 00:35:07.530 Things were a little simplerthen. 00:35:07.530 --> 00:35:10.850 So in '88, we had enough data we could putit in a patient. 00:35:10.850 --> 00:35:17.550 There's a thing on the wall outthere about that first patient, and it didn't 00:35:17.550 --> 00:35:18.550 hemolyze. 00:35:18.550 --> 00:35:21.780 Morbidly ill, [his] heart was hardly moving. 00:35:21.780 --> 00:35:25.260 He was suffering rejection after a transplant. 00:35:25.260 --> 00:35:27.400 We were able to reverse the rejection andhe lived 00:35:27.400 --> 00:35:29.260 another ten years. 00:35:29.260 --> 00:35:35.850 We did four patients, and I presented thisat a meeting, and I was amazed that 00:35:35.850 --> 00:35:37.390 there was no hemolysis. 00:35:37.390 --> 00:35:45.610 At this meeting I presented these four patientsthat had survived, and I 00:35:45.610 --> 00:35:53.680 said, "It's amazing that this pump is rotatingat 2500 rpm, and it doesn't cause hemolysis." 00:35:53.680 --> 00:35:59.880 Andafter the talk--Rich Wampler was in the audience--he 00:35:59.880 --> 00:36:03.510 said, "Bud it's rotating at 25,000 rpm." 00:36:03.510 --> 00:36:05.100 Lindberg: Yeah, I thought so. 00:36:05.100 --> 00:36:06.100 9 00:36:06.100 --> 00:36:07.100 Frazier: ''You're logarithmically off." 00:36:07.100 --> 00:36:09.480 And the first thing I said nearly spontaneously,I said, 00:36:09.480 --> 00:36:13.970 "You know, Rich, if I'd have known that, Iwould have never tried this!" 00:36:13.970 --> 00:36:19.140 It was just somethingthat was sort of fortuitous. 00:36:19.140 --> 00:36:21.580 Lindberg: Pretty damn amazing. 00:36:21.580 --> 00:36:25.190 Frazier: I would have never done it, and Idon't know anybody else that would have been 00:36:25.190 --> 00:36:31.110 interested in it, and it's like Columbus miscalculatingthe circumference of the earth. 00:36:31.110 --> 00:36:34.930 If he hadn'tmiscalculated, he would have never thought 00:36:34.930 --> 00:36:39.340 that he could reach the Indies going west. 00:36:39.340 --> 00:36:44.290 I askedRich Wampler the same question. 00:36:44.290 --> 00:36:47.980 I said, "Why do you think it doesn't hemolyzerotating at that 00:36:47.980 --> 00:36:48.980 speed? 00:36:48.980 --> 00:36:53.540 It should be like a Waring blender for blood,"and he said, "I don't know." 00:36:53.540 --> 00:36:58.930 I thought hehad some sort of dynamic thing that he'd figured 00:36:58.930 --> 00:36:59.930 out that wouldn't hemolyze. 00:36:59.930 --> 00:37:01.650 He just wanted totry. 00:37:01.650 --> 00:37:08.220 Dr. DeBakey and I both spontaneously whenasked--1 was asked that question one time. 00:37:08.220 --> 00:37:10.650 Isaid I think it's just like that trick you 00:37:10.650 --> 00:37:16.800 do when you're a kid where you scare yourbrother or sister 00:37:16.800 --> 00:37:19.150 by passing your finger through a candle. 00:37:19.150 --> 00:37:24.180 It just doesn't stay long enough to affectit, and it's about 00:37:24.180 --> 00:37:25.180 the only explanation. 00:37:25.180 --> 00:37:29.850 Lindberg: Well, Mike attributed some contributionof NASA to, I guess, changing the edges of 00:37:29.850 --> 00:37:30.850 those impellers. 00:37:30.850 --> 00:37:42.000 Frazier: Well, yeah, in some ways I think--hewas such a brilliant man. 00:37:42.000 --> 00:37:49.520 He had a goodunderstanding also of engineering, and he 00:37:49.520 --> 00:37:57.080 actually got into it later than he would like. 00:37:57.080 --> 00:38:02.240 I mean Dr.Jarvik had already done a number of animals 00:38:02.240 --> 00:38:08.080 here and had done--this Hemopump work hadalready been done. 00:38:08.080 --> 00:38:14.850 Of course, he knew this man at NASA, and Ithink he certainly contributed to 00:38:14.850 --> 00:38:15.850 the pump. 00:38:15.850 --> 00:38:20.640 The problem with the pump and the reason it'snot used--and this is sort of a--he 00:38:20.640 --> 00:38:30.020 would speak to me, but not regularly and hestill considered this sort of Dr. Cooley's 00:38:30.020 --> 00:38:32.660 program,which it was. 00:38:32.660 --> 00:38:40.720 He didn't ask me anything about the designof the pump and how it would interface 00:38:40.720 --> 00:38:41.720 biologically. 00:38:41.720 --> 00:38:47.160 They really didn't have any medical advisorsthat had any experience with it but 00:38:47.160 --> 00:38:49.640 they made the inlet cannula too long. 00:38:49.640 --> 00:38:53.410 In my opinion the pump itself is a great pump,but the inlet 00:38:53.410 --> 00:38:57.860 cannula was too long, it has to generate somuch negative pressure that it results in 00:38:57.860 --> 00:39:03.340 plateletactivation, which they studied. 00:39:03.340 --> 00:39:08.610 I knew from the '70s that's why the Jarvikpump we put inside the ventricles so there 00:39:08.610 --> 00:39:09.890 would be noinlet cannula. 00:39:09.890 --> 00:39:12.052 There's advantages and disadvantages to that. 00:39:12.052 --> 00:39:19.140 The HeartMate 11 is right next to theheart so you don't have that platelet activation 00:39:19.140 --> 00:39:23.110 and the clots and the strokes that they got,so 00:39:23.110 --> 00:39:26.020 eventually sort of terminated the program. 00:39:26.020 --> 00:39:28.380 But the pump itself is a good pump. 00:39:28.380 --> 00:39:32.370 It's a very goodpump, and it's smaller than the other pumps. 00:39:32.370 --> 00:39:34.000 Lindberg: I was amazed at how small. 00:39:34.000 --> 00:39:35.330 It's like a thumb-size thing. 00:39:35.330 --> 00:39:42.160 Frazier: Yeah, and his is smaller than whatwe call the HeartMate 11, which is the pump 00:39:42.160 --> 00:39:48.850 that'smost widely used today, which again it started 00:39:48.850 --> 00:39:50.140 here in our lab. 00:39:50.140 --> 00:39:53.710 We started that pump, the initialresearch on that. 00:39:53.710 --> 00:39:59.901 Lindberg: Does NIH, have they returned tosupport of the artificial heart or are they 00:39:59.901 --> 00:40:00.901 still-- 00:40:00.901 --> 00:40:01.901 10 00:40:01.901 --> 00:40:06.520 Frazier: No, they--1 think--of course, ClaudeLenfant was sort of reluctantly involved from 00:40:06.520 --> 00:40:07.520 thestart. 00:40:07.520 --> 00:40:09.320 Lindberg: Well, he was trained as a surgeonhimself. 00:40:09.320 --> 00:40:11.270 Frazier: Yeah, I know. 00:40:11.270 --> 00:40:16.650 But hell hath no fury like a Frenchman scorned. 00:40:16.650 --> 00:40:21.390 When he came here, if Italked to him more than 15 or 20 minutes, 00:40:21.390 --> 00:40:24.840 he'll start telling me about the time he took[Willem] 00:40:24.840 --> 00:40:27.770 Kolff his design for an artificial heart. 00:40:27.770 --> 00:40:29.120 He was interested in artificial hearts. 00:40:29.120 --> 00:40:30.120 Lindberg: Yes, I thought so, too. 00:40:30.120 --> 00:40:34.820 Frazier: He was like in his late 20s or early30s, and he went to Kolff, who was clearly 00:40:34.820 --> 00:40:38.440 the leaderin the research and had already done some 00:40:38.440 --> 00:40:41.220 experiments on animals. 00:40:41.220 --> 00:40:47.470 I think he was the one thatsaid--he came in and met Kolff--Kolff was 00:40:47.470 --> 00:40:48.960 sort of a curmudgeonly guy himself. 00:40:48.960 --> 00:40:50.050 Lindberg: Yeah, a tough old Dutchman. 00:40:50.050 --> 00:40:57.260 Frazier: And he said this is what I thinkof your work. 00:40:57.260 --> 00:40:58.990 Lindberg: Oh, that's nice. 00:40:58.990 --> 00:41:05.130 Frazier: I think Lenfant must have embellishedit to some degree, but he certainly didn't 00:41:05.130 --> 00:41:08.170 accept it,and he -- 00:41:08.170 --> 00:41:11.490 Lindberg: Be better to be called an incompetent. 00:41:11.490 --> 00:41:16.330 Frazier: Yeah, he really I think was alwayssort of against it. 00:41:16.330 --> 00:41:28.830 There was so much interest in it atthe time that I was appointed to the NHLBI 00:41:28.830 --> 00:41:29.830 Advisory Council. 00:41:29.830 --> 00:41:32.090 I was much too young to be on it. 00:41:32.090 --> 00:41:33.610 I was in my 40s. 00:41:33.610 --> 00:41:34.610 Everybody else was at least in their 60s. 00:41:34.610 --> 00:41:39.370 The only other surgeon on it was Dr.DeBakey. 00:41:39.370 --> 00:41:46.430 I went to the first meeting in January of'85, and the head of the HEW at that time 00:41:46.430 --> 00:41:49.310 wasa Reagan appointment, and I've forgotten her 00:41:49.310 --> 00:41:50.310 name. 00:41:50.310 --> 00:41:51.730 It's sort of an odd name. 00:41:51.730 --> 00:41:54.050 She was fromBoston, a nice-- 00:41:54.050 --> 00:41:57.280 Lindberg: Oh, yeah, Margaret Heckler. 00:41:57.280 --> 00:41:59.220 Yeah, Maggie Heckler. 00:41:59.220 --> 00:42:03.190 Frazier: She [M. Heckler] came and gave atalk. 00:42:03.190 --> 00:42:05.060 Well, first of all, I went to the first meeting. 00:42:05.060 --> 00:42:09.390 They had a reception there and Dr. DeBakeydidn't speak to me, because he hadn't spoken 00:42:09.390 --> 00:42:18.420 to mesince I left and went to work with Dr. Cooley. 00:42:18.420 --> 00:42:19.520 It's ten years. 00:42:19.520 --> 00:42:24.680 This Heckler gave a nice talk and inthe course of it she said that she'd just 00:42:24.680 --> 00:42:33.950 come from Louisville, where she saw the greatestachievement of NHLBI, the Jarvik heart. 00:42:33.950 --> 00:42:37.980 Well, of course, NHLBI had nothing to do withthe 00:42:37.980 --> 00:42:44.270 Jarvik heart, and Lenfant, I think, nearlyfell out of his chair. 00:42:44.270 --> 00:42:52.430 At that meeting he asked me tocome up with a recommendation for what the 00:42:52.430 --> 00:42:57.210 NHLBI should do in the artificial heart fieldat the 00:42:57.210 --> 00:42:59.320 next meeting. 00:42:59.320 --> 00:43:01.140 That was in January. 00:43:01.140 --> 00:43:05.120 The next meeting was in May. 00:43:05.120 --> 00:43:15.530 I $Parked out this presentationto all of the faculty of the NHLBI and there 00:43:15.530 --> 00:43:22.290 were about 300 people there, and I basicallyrecommended that they have a pump that the 00:43:22.290 --> 00:43:23.960 patient could walk out of the hospital with. 00:43:23.960 --> 00:43:24.960 It 00:43:24.960 --> 00:43:25.960 11 00:43:25.960 --> 00:43:34.330 couldn't be bound to this huge pneumatic drivesystem and that was durable and quiet and 00:43:34.330 --> 00:43:39.410 youcould power it either from inside the body. 00:43:39.410 --> 00:43:42.140 We were still looking at plutonium for that,or you 00:43:42.140 --> 00:43:43.270 know through the skin. 00:43:43.270 --> 00:43:45.890 Lindberg: Yeah, Jack Norman was an enthusiastfor atomic power. 00:43:45.890 --> 00:43:48.970 Frazier: Yeah, we did a lot of that. 00:43:48.970 --> 00:43:54.380 Anyway it was a very well received talk andeventually that's 00:43:54.380 --> 00:43:56.600 what resulted in the AbioCor. 00:43:56.600 --> 00:43:59.190 It was the funding for that. 00:43:59.190 --> 00:44:00.240 That's how it was developed. 00:44:00.240 --> 00:44:01.950 Lindberg: Was that developed with Heart [and]Lung [Institute] money? 00:44:01.950 --> 00:44:02.950 Frazier: Yeah. 00:44:02.950 --> 00:44:03.950 Lindberg: I didn't know that. 00:44:03.950 --> 00:44:08.900 Frazier: Yeah, it was developed by them and,of course, initially there were four programs 00:44:08.900 --> 00:44:10.550 likethey always had four programs. 00:44:10.550 --> 00:44:14.490 Then they went to two and then AbioCor wasthe only one left 00:44:14.490 --> 00:44:15.490 standing. 00:44:15.490 --> 00:44:20.060 But after the talk, I remember I was talkingto a guy named Ralph Nachman who was a 00:44:20.060 --> 00:44:27.320 hematologist from Yale -- nice guy, againsome years my senior -- and everybody was 00:44:27.320 --> 00:44:28.320 verycongratulatory. 00:44:28.320 --> 00:44:33.100 Lenfant was very impressed and that sort ofthing. 00:44:33.100 --> 00:44:34.100 And Dr. DeBakey comes up tome. 00:44:34.100 --> 00:44:38.990 He hadn't spoken to me in ten years. 00:44:38.990 --> 00:44:42.980 And I was talking to Nachman and Dr. DeBakeyjust 00:44:42.980 --> 00:44:50.040 comes up and he says, "You know, Bud, thatwas a very inadequate presentation. 00:44:50.040 --> 00:44:57.390 You left outsome of the most important points about the 00:44:57.390 --> 00:44:58.390 blood/biomaterial interface." 00:44:58.390 --> 00:45:01.090 Well, I only had 30minutes, so I couldn't cover everything. 00:45:01.090 --> 00:45:04.200 I knew what he was talking about and that'salways been 00:45:04.200 --> 00:45:16.720 a big theme of his, and I didn't respond tothat. 00:45:16.720 --> 00:45:20.050 Then he said, "You know, Bud, inattentionto 00:45:20.050 --> 00:45:22.940 detail is the hallmark of mediocrity." 00:45:22.940 --> 00:45:25.680 Which was another one of his sayings. 00:45:25.680 --> 00:45:26.680 Lindberg: That was in case you weren't listening. 00:45:26.680 --> 00:45:30.920 Frazier: "Inattention to detail was the hallmarkof mediocrity," and he walked away. 00:45:30.920 --> 00:45:33.470 And thisguy, Nachman, he was appalled. 00:45:33.470 --> 00:45:38.340 He said, "Bud, I've never heard a professionalman speak to 00:45:38.340 --> 00:45:41.010 another professional man like that. 00:45:41.010 --> 00:45:42.250 You gave an excellent talk. 00:45:42.250 --> 00:45:46.420 It was the first time I ever reallyunderstood the problem." 00:45:46.420 --> 00:45:48.030 And I said, "Ralph, don't worry about it. 00:45:48.030 --> 00:45:49.030 Don't worry. 00:45:49.030 --> 00:45:50.030 He was beingnice. 00:45:50.030 --> 00:45:54.900 That was as nice as he gets.'' 00:45:54.900 --> 00:45:56.440 And he always spoke to me after that. 00:45:56.440 --> 00:45:57.440 It was interesting. 00:45:57.440 --> 00:46:01.350 Every time I saw him, he would come up anddiscuss things. 00:46:01.350 --> 00:46:10.450 I always had a good relationshipwith him in that regard, and I think he began 00:46:10.450 --> 00:46:15.040 to appreciate the--and I would say anytimeanybody 00:46:15.040 --> 00:46:22.580 asked me that I got involved in this fieldbecause of Dr. DeBakey and because of the 00:46:22.580 --> 00:46:25.800 enthusiasmhe imparted and this terrible problem with 00:46:25.800 --> 00:46:29.160 the -- like the Italian boy. 00:46:29.160 --> 00:46:33.710 And it's very rewarding tome -- let's see. 00:46:33.710 --> 00:46:34.800 There's a picture. 00:46:34.800 --> 00:46:37.440 See that young girl over there? 00:46:37.440 --> 00:46:38.740 Lindberg: Yeah. 00:46:38.740 --> 00:46:42.960 Frazier: She was a very nice young girl. 00:46:42.960 --> 00:46:47.680 She came here about a year and a half agowith a 00:46:47.680 --> 00:46:54.220 cardiomyopathy, and I was massaging her heartwhen we went to the operating room, and we 00:46:54.220 --> 00:46:56.210 puther on the heart/lung machine, we put a pump 00:46:56.210 --> 00:46:59.890 in, and she is getting married next month,and 00:46:59.890 --> 00:47:01.500 she's still on the pump. 00:47:01.500 --> 00:47:10.400 She's still doing fine; and so from the Italianboy 00:47:10.400 --> 00:47:12.450 to her it's been a long 00:47:12.450 --> 00:47:13.450 12 00:47:13.450 --> 00:47:18.720 struggle, just personally with myself; butto realize that we were able to accomplish 00:47:18.720 --> 00:47:23.240 that so thisyoung person who was just starting out in 00:47:23.240 --> 00:47:27.221 life has a chance to see three score and tenwhen a 00:47:27.221 --> 00:47:35.350 young boy didn't, and I think that more thantransplants--I've done probably more transplants 00:47:35.350 --> 00:47:38.840 thatanyone in the world but this to me is the 00:47:38.840 --> 00:47:40.770 greatest personal thing I've done. 00:47:40.770 --> 00:47:42.380 Lindberg: This is the future. 00:47:42.380 --> 00:47:46.960 I think resting myocardium through the useof these VADs is a very 00:47:46.960 --> 00:47:48.870 sensible thing. 00:47:48.870 --> 00:47:51.610 This bridge to transplant is just sort ofa legalism. 00:47:51.610 --> 00:47:53.130 Frazier: Right, yeah. 00:47:53.130 --> 00:47:56.440 Will you hand me that picture? 00:47:56.440 --> 00:48:06.630 This is a man who's a PhD in Fort Worth atConsolidated working on the jets and things, 00:48:06.630 --> 00:48:10.780 really nice man, and he knew enough abouttransplants--because the discouraging thing 00:48:10.780 --> 00:48:14.930 to me about transplants -- it's a wonderfultherapy for 00:48:14.930 --> 00:48:21.080 a patient group, but the mortality with timeis really there. 00:48:21.080 --> 00:48:26.320 And you've got about a 10 percent 20-year survival, which is alright if you're 00:48:26.320 --> 00:48:29.770 60 when you have it, but if you're 20 whenyou have it, 00:48:29.770 --> 00:48:35.910 it's not or you're 30--he was about in hisearly 30s, and he knew that I had always been 00:48:35.910 --> 00:48:39.220 anadvocate of resting the heart, trying to remove 00:48:39.220 --> 00:48:42.840 it, and he nearly insisted that I try it onhim, and 00:48:42.840 --> 00:48:48.760 he's the first one I took this HeartMate I1out of, which I do think that's going to be 00:48:48.760 --> 00:48:53.890 the mostimportant contribution--is that not that it 00:48:53.890 --> 00:48:56.650 normalizes heart function but it improvesit if they go 00:48:56.650 --> 00:49:01.850 from an ejection fraction of 10 percent, whichis what his was, to 45 percent, you can treat 00:49:01.850 --> 00:49:04.920 thosepatients medically for years and years. 00:49:04.920 --> 00:49:05.920 t 00:49:05.920 --> 00:49:06.920 Lindberg: Yeah, that's great. 00:49:06.920 --> 00:49:07.920 That's a big step up. 00:49:07.920 --> 00:49:09.982 Frazier: And that's what we did with him. 00:49:09.982 --> 00:49:11.260 He was the first patient. 00:49:11.260 --> 00:49:17.550 We've had 11 since then -- I'min the process of writing it up as you can 00:49:17.550 --> 00:49:19.840 see, but--and I've discussed it and presentedit because I 00:49:19.840 --> 00:49:21.900 do think that's going to be its main use. 00:49:21.900 --> 00:49:25.070 Another decade, that will be its main use,to try and get 00:49:25.070 --> 00:49:29.510 these patients to a point you can take thepump out and then treat them medically if 00:49:29.510 --> 00:49:34.570 you have to,and maybe just again like remissions in cancer. 00:49:34.570 --> 00:49:36.590 Think what we do.We induce sort of remissionof 00:49:36.590 --> 00:49:37.590 the heart failure. 00:49:37.590 --> 00:49:42.600 If that remission is going to last more thanfive years maybe you can wean them 00:49:42.600 --> 00:49:43.600 off it. 00:49:43.600 --> 00:49:46.691 I don't roll the dice. 00:49:46.691 --> 00:49:53.750 This is his baby he had after we removed thepump. 00:49:53.750 --> 00:49:54.890 Lindberg: That's great. 00:49:54.890 --> 00:50:00.280 Frazier: He named -- the baby's name is DouglasFrazier Shockwyler [phonetic]. 00:50:00.280 --> 00:50:01.490 Lindberg: Wonderful. 00:50:01.490 --> 00:50:09.441 Frazier: So anyway I think he's very representative,I think, of what has the potential most far- 00:50:09.441 --> 00:50:10.790 reaching consequence. 00:50:10.790 --> 00:50:17.560 I think these pumps will certainly last fiveto ten years, but still the best 00:50:17.560 --> 00:50:22.490 thing, particularly the younger patients withidiopathic myopathies, is to get rid of these 00:50:22.490 --> 00:50:23.510 pumpsaltogether. 00:50:23.510 --> 00:50:25.780 Dr. DeBakey was always interested in that. 00:50:25.780 --> 00:50:32.730 And I think my great debt to him is hegave me a path to do something meaningful 00:50:32.730 --> 00:50:33.980 with my life. 00:50:33.980 --> 00:50:36.350 Lindberg: And you've done it. 00:50:36.350 --> 00:50:39.240 Frazier: I'm sure I wouldn't have had thatopportunity without him. 00:50:39.240 --> 00:50:40.240 13 00:50:40.240 --> 00:50:42.470 Lindberg: Any progress in finding out what'scausing the myopathy to begin with? 00:50:42.470 --> 00:50:43.470 Frazier: No. 00:50:43.470 --> 00:50:48.300 I mean to me that's like having an alcoholicaunt in your family or something. 00:50:48.300 --> 00:50:51.211 Yougo to all these heart failure meetings and 00:50:51.211 --> 00:50:54.610 all the cardiologists and researchers, they'lltalk about 00:50:54.610 --> 00:50:55.610 the treatments. 00:50:55.610 --> 00:50:57.960 They'll talk about the LVADs now. 00:50:57.960 --> 00:51:05.240 The International Heart and Lung TransplantSociety is going to meet in Chicago this year. 00:51:05.240 --> 00:51:09.350 Over half the presentations are going to beon 00:51:09.350 --> 00:51:19.710 pumps and mechanical assists, but no one issaying what's causing this. 00:51:19.710 --> 00:51:24.890 What can cause a normalhealthy young girl that was on the rowing 00:51:24.890 --> 00:51:28.520 team at Texas A&M to suddenly come in withthis 00:51:28.520 --> 00:51:37.450 huge heart that's taking up her whole cavityand there's no -- sort of virus. 00:51:37.450 --> 00:51:40.450 To me a virus is justthe thunder god of modern medicine. 00:51:40.450 --> 00:51:42.320 If you don't know what it is, you call ita virus. 00:51:42.320 --> 00:51:43.320 Lindberg: Yeah, I agree. 00:51:43.320 --> 00:51:46.480 When I started medical school there were threethings we didn't 00:51:46.480 --> 00:51:47.480 understand at all. 00:51:47.480 --> 00:51:50.930 The first was is what makes this myocarditisidiopathic, and I figured, well, it 00:51:50.930 --> 00:51:51.930 is virus. 00:51:51.930 --> 00:51:53.240 They'll figure that out in time. 00:51:53.240 --> 00:51:56.240 And the other two were whether it was worthwhileto 00:51:56.240 --> 00:52:00.930 have careful control of diabetes and it tookawhile, but we know the answer there, and 00:52:00.930 --> 00:52:05.470 the otherwas can you treat breast cancer with radiation. 00:52:05.470 --> 00:52:07.350 So those two got answered. 00:52:07.350 --> 00:52:12.420 Those seemed like thetough ones, and the myocarditis we're still 00:52:12.420 --> 00:52:14.130 waving our hands about. 00:52:14.130 --> 00:52:22.850 Frazier: Yeah, we're still trying to impugnthe virus and it may well be. 00:52:22.850 --> 00:52:26.920 To me again we may notknow the cause. 00:52:26.920 --> 00:52:30.750 That's one of Dr. DeBakey's favorite things. 00:52:30.750 --> 00:52:38.230 He was chewing out -- it wasn't me-- actually, a young staff member of his was 00:52:38.230 --> 00:52:40.860 complaining that he couldn't get the potassiumup 00:52:40.860 --> 00:52:41.900 on this patient. 00:52:41.900 --> 00:52:46.520 He was hypokalemic, and Dr. DeBakey in hiswonderful way said, "You know, I 00:52:46.520 --> 00:52:49.750 don't care how you get the potassium up. 00:52:49.750 --> 00:53:00.420 I don't even care why it's down, but you getit up. 00:53:00.420 --> 00:53:03.640 Get itup, and that's that. 00:53:03.640 --> 00:53:05.330 Fix the potassium. 00:53:05.330 --> 00:53:07.040 Give him some potassium." 00:53:07.040 --> 00:53:10.730 Fortunately, to me there's acertain statistical incidence that does point 00:53:10.730 --> 00:53:14.530 to--of course, the other thing that everythingis is 00:53:14.530 --> 00:53:20.550 genetics at some level, but I'm sure there'ssome role of that. 00:53:20.550 --> 00:53:25.920 Lindberg: Do you have an opinion about stoppingthe use of atomic power for powering these 00:53:25.920 --> 00:53:26.920 hearts? 00:53:26.920 --> 00:53:29.070 Frazier: Yeah, I think that's what we'll do. 00:53:29.070 --> 00:53:32.780 I mean, the plutonium--like these continuousflow 00:53:32.780 --> 00:53:37.000 pumps will last indefinitely as long as they'respinning. 00:53:37.000 --> 00:53:38.450 We haven't had a pump failure. 00:53:38.450 --> 00:53:41.270 None ofthe pumps have been pumped to failure, so 00:53:41.270 --> 00:53:45.720 the only problems we've had is with thecommunication to the power source and the 00:53:45.720 --> 00:53:47.560 power source. 00:53:47.560 --> 00:53:54.200 And all that work we did in the '70s --we had these plutonium sources that are about 00:53:54.200 --> 00:53:58.400 this size or a little smaller, about likethat, that you 00:53:58.400 --> 00:54:05.080 could implant, and they would last nearlyindefinitely, and I think when we combine 00:54:05.080 --> 00:54:10.921 that withthe continuous flow pumps that have more or 00:54:10.921 --> 00:54:14.880 less indefinite lifetime we'll really havea 00:54:14.880 --> 00:54:18.060 meaningful total cardiac replacement. 00:54:18.060 --> 00:54:21.680 I don't think it will apply to a lot of patients,because I 00:54:21.680 --> 00:54:25.930 think most of them -- the other thing that'sgoing to happen is that most of the hearts 00:54:25.930 --> 00:54:27.560 will getbetter with time. 00:54:27.560 --> 00:54:34.700 But still the severest damaged ischemic hearts,the acute VSD infarcts, all these problems, 00:54:34.700 --> 00:54:37.510 we'renot going to -- we'll just have to replace 00:54:37.510 --> 00:54:38.770 it in some way. 00:54:38.770 --> 00:54:41.633 I think that's -- and the technology is outthere. 00:54:41.633 --> 00:54:42.740 We did all that work. 00:54:42.740 --> 00:54:43.970 We know its durability. 00:54:43.970 --> 00:54:50.630 The real concern was as I'm sure you'llrecall, the increased malignancy that it may 00:54:50.630 --> 00:54:53.660 impart, all that radiation, but Parsonnetwrote this 00:54:53.660 --> 00:55:03.170 nice paper about ten years ago following allthe plutonium pacemakers, all the nuclear 00:55:03.170 --> 00:55:04.170 14 00:55:04.170 --> 00:55:09.300 pacemakers, and there was no increased incidentsof malignancies in the long term, so that 00:55:09.300 --> 00:55:10.520 seemsto be put to rest. 00:55:10.520 --> 00:55:18.120 The other was still at that time maybe somebodycould steal enough from 00:55:18.120 --> 00:55:24.360 patients to make a bomb out of them, but Ithink that's pretty unrealistic also. 00:55:24.360 --> 00:55:28.730 So I think it'ssomething we should get into again. 00:55:28.730 --> 00:55:29.810 Lindberg: I do, too. 00:55:29.810 --> 00:55:34.580 Frazier: Have to take a younger man to startout and say, hey, why can't we power this 00:55:34.580 --> 00:55:35.580 withplutonium? 00:55:35.580 --> 00:55:37.960 Lindberg: By the way, have you identifiedthat young man yet? 00:55:37.960 --> 00:55:39.160 Frazier: I haven't. 00:55:39.160 --> 00:55:44.070 I'm discouraged somewhat that--1 don't know,I think most of the students we 00:55:44.070 --> 00:55:54.370 have now are a little more--they have a littlebetter passions. 00:55:54.370 --> 00:55:58.260 Man is only as good as his passions,and if your passion is just to make money, 00:55:58.260 --> 00:56:00.730 well maybe you'll make a lot of money, butit's 00:56:00.730 --> 00:56:07.500 unlikely that in itself is going to--as aprimary goal is going to be something meaningful. 00:56:07.500 --> 00:56:14.320 It canbe a secondary goal, to actually doing something, 00:56:14.320 --> 00:56:16.330 but I think more and more these-- 00:56:16.330 --> 00:56:21.490 Lindberg: I have to confess, I find medicalstudents better motivated in year one than 00:56:21.490 --> 00:56:22.890 in yearfour. 00:56:22.890 --> 00:56:27.440 I think we have to fix the medical schools,not the medical students. 00:56:27.440 --> 00:56:35.730 Frazier: I think the system has gotten sobizarre with this continual testing and all 00:56:35.730 --> 00:56:40.560 of these thingsare real retrograde stuff, and I think they 00:56:40.560 --> 00:56:47.960 need to focus more on patients and what we'resupposed 00:56:47.960 --> 00:56:48.960 to do. 00:56:48.960 --> 00:56:49.960 Lindberg: Hear, hear. 00:56:49.960 --> 00:56:51.660 Frazier: Take care of the sick. 00:56:51.660 --> 00:56:52.660 Lindberg: Well, thank you. 00:56:52.660 --> 00:56:53.660 I'm so grateful to you. 00:56:53.660 --> 00:56:54.660 Frazier: Anyway, well, I appreciate you comingby. 00:56:54.660 --> 00:56:57.170 Lindberg: We've gone from the distant pastto the real future. 00:56:57.170 --> 00:57:00.560 Frazier: Yeah, it's been quite a journey 00:57:00.560 --> 00:57:12.270 But I think both Dr. Cooley and Dr. DeBakeyinfluenced me personally a lot, but in a lot 00:57:12.270 --> 00:57:17.781 ofways, Dr. DeBakey pounding on you--but the 00:57:17.781 --> 00:57:29.680 concept--he always--was the great statement:"what man can conceive, he can achieve," and 00:57:29.680 --> 00:57:33.370 it's a little farfetched, but there's a lotof truth to it. 00:57:33.370 --> 00:57:38.330 You have to have the goal, otherwise you'llnever go anywhere. 00:57:38.330 --> 00:57:39.589 Lindberg: Absolutely. 00:57:39.589 --> 00:57:43.540 Both you and George Noon as medical studentsgot into the research lab. 00:57:43.540 --> 00:57:46.560 Ithink that's the critical contribution. 00:57:46.560 --> 00:57:48.070 And I wish they would start that again. 00:57:48.070 --> 00:57:50.100 Lindberg: No reason in the world they can'tbe in the research lab. 00:57:50.100 --> 00:57:51.100 15 00:57:51.100 --> 00:57:55.000 Frazier: That was--of course, we only hadlike 75 or 80 students to a class and that 00:57:55.000 --> 00:57:58.840 helped, but Idon't see there's any reason they can't do 00:57:58.840 --> 00:57:59.840 it. 00:57:59.840 --> 00:58:02.750 Lindberg: Right, and not everyone will havethat impulse or talent, but at least some. 00:58:02.750 --> 00:58:05.090 Frazier: Yeah, some of them should. 00:58:05.090 --> 00:58:07.690 I mean, it was required of all of us. 00:58:07.690 --> 00:58:11.550 I don't think that'snecessary, but it should be available to all. 00:58:11.550 --> 00:58:15.900 Lindberg: I couldn't wangle my way into aresearch lab at Columbia Presbyterian for 00:58:15.900 --> 00:58:18.970 anythingeven though I had done research at Amherst 00:58:18.970 --> 00:58:20.480 for years before that. 00:58:20.480 --> 00:58:23.360 It just simply wasn't part of themedical curriculum. 00:58:23.360 --> 00:58:24.360 Frazier: Yeah. 00:58:24.360 --> 00:58:28.690 We had Tuesday afternoon and Thursday afternoonoff our first and second years 00:58:28.690 --> 00:58:30.200 just to work on our research program. 00:58:30.200 --> 00:58:31.200 Lindberg: That's great. 00:58:31.200 --> 00:58:32.220 Well, that's the only way. 00:58:32.220 --> 00:58:33.220 You've got to provide some time. 00:58:33.220 --> 00:58:39.530 Frazier: Yeah, and as I said, to me it wasclearly the most valuable thing to me as a 00:58:39.530 --> 00:58:40.530 student. 00:58:40.530 --> 00:58:43.240 Lindberg: Well, now we've solved the problemof medical education as well as all the rest. 00:58:43.240 --> 00:58:44.240 Frazier: That's right, yeah. 00:58:44.240 --> 00:58:45.460 Lindberg: So I'm indebted to you.