The Prize (9 page)

What interested Garrett even more was another exception to the rejection mechanism. There had been case after case of successful organ transplantation in identical twins. Chemically, identical twins were the same person. They emerged from the same fertilized egg. Their tissues were not foreign to each other. A kidney from one identical twin could be grafted into his ailing brother, and it would endure, because the rejection mechanism would not recognize it and would leave it alone. But the moment that the same transplantation was tried on non-identical human beings, the kidney, or any other organ, would die.

During 1958, in
Boston, a risky non-identical transplantation had been desperately attempted. A young woman from
Ohio
had lost her only kidney and was dying. A courageous team of physicians had taken the healthy kidney of a four-year-old and grafted it into this young woman. To thwart the rejection mechanism, the physicians had given the young woman massive treatments of X-rays. The young woman lived twenty-eight days. The rejection mechanism had, indeed, been neutralized, but the excessive radiation was fatal.

For a brief period, Garrett was discouraged. Then came a major breakthrough. Sir Macfarlane Burnet, of
Australia, and Dr. Peter B. Medawar, of
England, proved that the rejection mechanism in one human being could be taught to accept tissue transplants from another, under certain circumstances. Experiments with rodents showed that if a mouse embryo were injected with cells from a non-identical donor mouse, then later, when the embryo was an adult, it could accept skin grafts from the same donor without rejection. For this, Burnet and Medawar won the Nobel Prize in 1960. And, at once, John Garrett, along with hundreds of others in his field, was encouraged to believe that soon it might be possible to make a homograft of legs, kidneys, lungs, and hearts.

In that optimistic period, Dr. Robert A. Good, of the
University
of
Minnesota
, was saying, ‘Though much more basic research is needed, the first successful organ graft between non-identical human beings could conceivably, with luck, take place tomorrow.’ And Garrett, one midnight in bed beside Saralee, was telling her, ‘I believe it, I absolutely believe it—and I’m going to be the one to do it—with a living heart.’

The days spun ceaselessly past, and he had no knowledge of date or week or month. It was as if he were on a perpetual hamster’s wheel. He isolated himself from his colleagues, because he had no time for small talk or relaxation. He went ahead alone against the enemy, trying to find a weapon to overcome the immunological barrier, the rejection mechanism. He experimented with massive X-ray treatments, with steroids, with nitrogen mustards. Each led to a dead end. No matter how slight or drastic the modifications that he made, these weapons, while they did indeed neutralize the rejection mechanism, also destroyed white cell production, stripped the body of immunity to disease, killed in other ways what he was trying, after all, to save. The problem remained as large as ever: to discover a treatment or serum that was selective, that would not destroy all reactive or immunity mechanisms, that would neutralize whatever it was that rejected a foreign graft, and leave unharmed that which protected the body against disease.

Once, depressed by the impossible maze, Garrett tried to find a path around it. In that time, he fancied that he could simply ignore the rejection mechanism by circumventing it, by inventing a compact artificial heart of plastic material, that could be grafted inside the chest cavity and that would be accepted because it would be non-reactive. For months, the idea excited him. A plastic heart replacing a failing or damaged natural heart inside the human body would give its host—literally—a new lease on life.

Methodically, he studied all the mechanical hearts then in existence. These ranged from the heart pump and oxygenator created by Dr. Clarence Dennis in 1951, to a two-chamber pump run by batteries (it had kept a dog alive nine hours) produced by a team at the University of Illinois. Garrett saw that these mechanical heart-lung devices all had one factor in common—they were used
outside
the patient’s body to keep the patient alive during cardiac surgery. What Garrett envisioned was such a device
inside
the body—the natural heart removed, the machine heart substituted—located in exactly the same place: orthotropous transplantation, with an external power pack. But there were question marks here, too, not the least being how to keep the plastic bag, between the two lungs, contracting and relaxing without failure. It might be resolved in the future, Garrett decided, but he preferred to grapple with the present, the probable.

Unhappily, he returned to his maze. He must find his way on the battlefield where the familiar enemy, now so well known to him, was the rejection mechanism that barred his transplantation of a living heart, either animal or human. He abandoned the radiation treatments, the nitrogen mustards, and plunged into unknown byways. And then, it happened, came to him, as simply and undramatically as waking or walking or laughter.

It was late morning. He had been toiling over his laboratory specimens—the mice, dogs, calves—checking, noting, noting again, modifying, when he discovered the new substance that apparently—yes, it was clear, plainly evident—neutralized the rejection mechanism but did not, at the same time, destroy all immunity. For a week, Saralee and the children knew nothing of his existence except on the telephone, and after that week he was almost certain. He had a serum—the serum—and with Lincolnian simplicity and straightforwardness he christened it Anti-reactive Substance S.

Once he had his serum, and having proved it out on lower mammalian creatures, not yet on man, he gave parallel devotion to surgical techniques of organ grafts. He considered all aspects of the homograft—an organ moved from one human into another human—and vetoed it as too formidable. More logical, more probable, and his skittering mice and tractable dogs and climbing simians supported him, was the heterograft—the transplantation of an animal heart into a living man. Exulting months followed, and by then he had settled upon the heart of a calf, a calf weighing what a potential patient might weigh, as the likeliest possibility for success.

Twice, he grafted calves’ hearts into dogs, and one dog died and one lived for a while. More modifications of the serum and the surgical technique, and on a black and forbidding winter’s night in Pasadena—he had already telephoned Saralee that he would not be home for dinner, and that she need not wait up for him—he prepared for his third transplantation of the heart of a calf into the chest cavity of a huge dog. He had assistance now, and by eight o’clock all was in readiness. The donor calf’s heart was under perfusion and cooling. The host dog had been treated with improved Anti-reactive Substance S, and was already hooked to the heart-lung bypass machine. What remained was the crucial surgery. But Garrett never accomplished it, not on the dog, at least.

In another room of the Medical Centre, in those hours, an elderly truck driver—later to be known in scientific papers as Henry M.—had been rushed to the hospital, suffering a severe coronary occlusion. In emergency surgery, his heart began to fail, and there was no hope of his survival. In those dark minutes, through the influence of the resident surgeon (an admirer of Garrett’s) upon the patient’s weeping family, John Garrett was encouraged to attempt his transplantation of the calf’s heart into this suddenly available human chest, instead of the waiting canine.

The responsibility was staggering. Garrett had never before introduced Anti-reactive Substance S into a fellow human, let alone attempt a heterograft. But by now, he possessed a fanatic’s belief in his as yet only partially proved findings. The nervous impetus that had geared him for the experiment on a canine was now automatically transferred to the unconscious truck driver. The mass of tissues on the table before him might be man or beast, for all Garrett knew. His conscience was in his fingers. Henry M., who hovered on the far edge of death, was injected with Anti-reactive Substance S. He was hooked to the cardiopulmonary bypass machine. Surgery proceeded. The heterograft, with all its complexity, was made surely and swiftly. And then, the question. Would the patient live?

When the clamps and catheters were being removed, Garrett’s mind went to an old paper he had once read. In 1934, the Russian physiologist, Dr. S. S. Briukhonenko, had applied a mechanical heart and lung to a suicide victim, a man who had hanged himself, and the machine had brought the man back to life. The patient had opened his eyes, been aware of the physician and staff surrounding him, and had then closed his eyes forever. Even though this was different, the all-important serum, a mammalian heart, Garrett feared the same pattern when the truck driver, Henry M., opened his eyes at daybreak and blinked his bewilderment and then his gratefulness.

But Henry M.’s eyes stayed open, then and since, and he lived on with his sturdy calf’s heart, unaffected by the rejection mechanism, and in medical circles and soon in the press Garrett became the Jesus who raised Lazarus from the dead.

In short months, Garrett would learn that only one cardiac patient in twenty possessed the proper blood and tissue qualifications compatible to accepting the sensational serum that would neutralize the rejection mechanism and allow the body to accept the radical transplantation. Nevertheless, encouraged and supercharged by the case of Henry M., Garrett succeeded in grafting his substitute hearts into seventeen more human beings, whose blood and tissue had been screened beforehand. Every one survived. The implications were fantastic.

When Garrett read his definitive paper on his work at the Western Surgical Association in
Denver, he was hailed by scientists throughout the world. Despite the limitations of his discovery, everyone seemed to sense that the first giant step towards longevity, even immortality, had been made. It was as if, in his day, Ponce de Leon had actually found the Fountain of Youth and bottled its waters. From a nonentity with a wild dream, John Garrett had become a saviour unique. He held his rarefied position exactly ten days. On the tenth day, he was asked to move over. There was another to share the occupancy of the spotlight with him.

The wire services of
America carried the long and dramatic story from
Rome, and the newspapers of
America paraded it across their front pages. It appeared that Dr. Carlo Farelli, the eminent Italian physician, had just published a brilliant paper claiming and proving the very same discovery that Garrett had made. Farelli had also found a serum that, like Anti-reactive Substance S, made a heterograft acceptable, and had successfully transplanted resurrecting mammalian hearts into twenty-one persons from
Italy,
Switzerland, and
Austria.

Overnight, Lazarus was multiplied, and Jesus was not one but two.

The world rejoiced. John Garrett was confused. His fame, while no less secure, seemed dimmed because his glory was shared. Colleagues abroad made inquiries not only of Garrett, for further work in the field, but of Farelli. The press quoted not only Garrett but also Farelli, and the Italian was quoted more frequently because he was a colourful showman as well as a great scientist, and better equipped than the reticent John Garrett to communicate his ideas to laymen.

Several months after the advent of Farelli, John Garrett’s headaches began.

And here I am, he told himself, conscious once more of his surroundings and that Mrs. Zane’s interminable recital of her libidinous history was coming to an end.

‘—until at last he fell asleep,’ Mrs. Zane was saying in a voice become hoarse. ‘But can you imagine two times in one night? I mean, I wouldn’t mind, I’m not that old, but when you’re tending five children all day, well, enough is enough. Anyway, I got dressed and took a taxi, but it must’ve been after midnight when I finally had the dishes cleared away and changed Joanie’s bed—she’s still wetting—and got to sleep. I’m at my wit’s end, is what I want to say. I think I’m the most depraved person in the world.’

Her voice trailed off on the last, and she settled back in her chair, the sordid saga of infidelity again exorcised, and her features now relaxed as if her tensions had been relieved.

‘You’ll find your way, Mrs. Zane,’ Dr. Keller murmured, as he studiously jotted some notes on the pad before him. ‘You’re further advanced than you think.’

He peered up from beneath his bushy eyebrows, his enormous chest heaving as he inhaled and exhaled, and he studied his group. No one spoke. It was as if the smash main attraction had been on, and no one wished to follow it with a lesser act.