Death of a Gallant Pioneer

By Claudia Wallis

Barney Clark: 1921-1983

No one could doubt the wisdom of the choice. The dentist from Des Moines, Wash., may have been in failing health, but it was clear from the moment he set foot in the University of Utah Medical Center that Barney Clark was a dauntless spirit. "A rugged old Rocky Mountain sagebrush. Tough. Eager for life." That was how Dr. Chase Peterson, a university vice president, described the man who was to make medical history. Those qualities, together with his obviously urgent need, convinced the university selection committee that Clark should be the world's first human to receive a permanent artificial heart. "He was a man worth waiting for," said Committee Member Peg Miller. Those same traits enabled Clark to endure the arduous operation on Dec. 1 and to struggle for 112 days through the perilous and uncharted territory of life with a plastic heart.

Last week the long struggle ended. Beset by kidney failure, chronic respiratory problems, inflammation of the colon and loss of blood pressure, Clark, 62, died quietly. The official cause of death: "circulatory collapse due to multiorgan system failure." The heart itself was in good working order at his death, having beat steadfastly nearly 13 million times. In the final days, Clark's doctors debated what steps they would take to preserve the patient's life: whether, for instance, it would be medically and ethically appropriate to try kidney dialysis on someone so ill. In the end, however, Clark's rapid deterioration obviated such questions. Said Clark's surgeon, William DeVries: "It was essentially the death of the entire being except for the artificial heart." Shortly after 10 p.m. on Wednesday, having consulted with Clark's wife Una Loy, DeVries said, "This courageous man's heart was turned off."

Clark was known for courage and fortitude throughout his life. Just twelve when his father died, he sold hot dogs and did odd jobs to help pay the family mortgage in Provo, Utah. Later he put himself through Brigham Young University and the University of Washington dental school. Father of three, the strapping 6-ft. 2-in. Clark prospered in his Seattle practice and, before his heart began to weaken six years ago, honed his golf handicap to six. "I've done everything I wanted to do in life," he told Peg Miller. "Now if I can make a contribution, my life will count for something." If that meant dying on the operating table, he was prepared. Shortly before surgery, Clark reached for the hand of Una Loy, the high school sweetheart he had married 39 years earlier, and said, "Honey, in case I don't see you again, I just want you to know you've been a darned good wife."

There were many moments before and during the operation when it looked as though Clark would not see his wife again. He was in the final stages of cardiomyopathy, a progressive deterioration of the heart muscle. Clark's skin appeared blue from lack of oxygen, fluid was collecting in his vital organs, and his ravaged heart could pump only one liter of blood a minute, about one-seventh the normal rate. When Clark's heart started fluttering abnormally a day before the implantation was scheduled, DeVries decided the operation could not wait. His patient, he said, "probably would have been dead by midnight."

The surgery was fraught with danger. Years of cortisone therapy, DeVries pointed out, had made the fabric of Clark's heart so delicate that it tore "like tissue paper" during the operation. When the team, working to a recording of Ravel's Bolero, finally succeeded in replacing the organ with the mechanical device, said DeVries, "it was a spiritual experience for everyone in the room." But the new heart failed to pump properly, and a standby unit had to be substituted. Finally, after 7 1/2 hr., Clark's heart output was normal, he had what was described as "the blood pressure of an 18-year-old," and his bluish skin was beginning to blush pink. Still, DeVries warned, "there are many more hurdles ahead."

Indeed there were, including a 2 1/2-hr. episode of convulsions one week after surgery, gushing nosebleeds a month later and the failure of a valve in the left half of the heart, which necessitated replacement of the entire section. In all, Clark was to make three trips back to surgery to correct various problems. In addition, he suffered spells of confusion for three months after the seizures. During this period he sometimes imagined that he was still practicing dentistry in Seattle; at other times he was lucid enough to complain, "My mind is shot." But Clark improved. By the end of February his confusion had disappeared, and he was able to pedal a stationary bicycle for a few minutes at a time. Only his lungs, weakened by years of poor circulation, slowed his recovery.

Clark was sustained by the work of a remarkable team. DeVries, 39, a lean, 6-ft. 5-in. former high jumper, is refreshingly indifferent to his sudden celebrity. Says he: "You lose credibility if you're too well known." A father of seven, he sleeps only four or five hours a night to make time for his family and the 16-hr, workday he favors. Typically, DeVries was standing vigil at Clark's side when his patient died.

The equally dedicated inventor of the device, Dr. Robert Jarvik, 36, was also present. The son of a doctor, Jarvik designed his first medical invention, a surgical stapler, while still in high school. His interest in the heart was prompted by his father's battle with cardiac disease. A spare-time sculptor, Jarvik was able to combine his artistic and medical interests as a design engineer at Utah's artificial-organ program beginning in 1971; he earned his medical degree there in 1976.

The man who brought Jarvik and DeVries together was Dutch-born Surgeon and Medical Engineer Willem Kolff, 72, who calls himself "the oldest artificial organist." The founder of Utah's artificial-organ program got his start in the field by creating the first artificial kidney, a crude dialysis machine he pieced together from cellophane and other simple materials he found in Nazi-occupied Holland in the early 1940s. He designed his first artificial heart in 1957 when he was at the Cleveland Clinic. It sustained a dog for 1 1/2 hr.

The heart that Barney Clark received thus represented more than a quarter of a century of research. Like Kolff's original device, it is powered by air, compressed by an external electric pump. Two 6-ft.-long air tubes, which emerge from beneath the rib cage, connect the heart to the pump and to emergency tanks of compressed air and other equipment, all of which are stored on a cart. Total weight of the awkward external system: 375 Ibs.

The cost of the heart: $9,050, plus $7,400 for the drive system. But Clark's equipment was donated by the manufacturer, Kolff Medical, Inc., and his doctors waived their fees. Had Clark done well enough to leave the hospital, he probably would have spent $2,700 to equip his home with ramps, wall outlets for air and other fittings. Then there was the hospital bill. At the time of Clark's death, it exceeded a whopping $200,000, to be paid by donations and U.M.C. endowment funds.

The cost, the 375-lb. encumbrance and the siege of postoperative ailments have all raised doubts about the use of artificial hearts. Said Dr. Michael DeBakey, the noted heart-transplant surgeon from Houston: "To be a success, the heart must restore the individual to normal life. If all it does is keep the patient alive, it has not succeeded." DeBakey and fellow Houston Transplant Expert Denton Cooley therefore favor transplants, which now offer recipients a 70% to 80% chance of surviving a year and a 42% chance of living five years. The best use of the mechanical heart, says Cooley, may be "to sustain a patient until a donor heart can be found."

Clark's experience will undoubtedly help doctors build a better heart. "We have learned more in a few months with Clark than in the past nine years with animals," says Larry Hastings, a U.M.C. heart-pump technician. Jarvik has already designed a portable drive system the size of a camera bag that can run the Utah heart for twelve hours. It may be ready by 1985. Researchers at the Cleveland Clinic, as well as Jarvik, are now working on hearts with implantable motors. In ten years, the only external apparatus needed by an artificial-heart patient may be a 5-lb. battery pack.

Yet even if these technological wonders occur, the costly artificial heart is sure to raise some difficult questions. "How much is life worth?" asks Dr. George Lundberg, editor of the Journal of the American Medical Association. "How much is one or more days of longer life worth? Is every life worth the same amount, and if not, why not?"

According to a 1982 study published by the U.S. Office of Technology Assessment, as many as 66,000 Americans a year might qualify for an artificial heart, should it be approved for general use. Clearly, very few individuals could afford the device. The U.S. Government now spends $1.8 billion a year on Medicare assistance for the 60,000 Americans who require kidney dialysis. If Medicare were to be extended to artificial-heart patients, that could mean an added burden to tax payers of as much as $5.5 billion annually. Dr. Willard Gaylin, president of the Hastings Center, an institute just north of New York City for the study of biomedical ethics, points out that such patients might be a drain on the nation's health-care system throughout their lives. Says Gaylin: "We Americans like to think of ourselves as having an open-ended attitude toward health care, the more the better, but we've come to the point where we're running out of resources."

A better course would be to develop ways of preventing such chronic ailments as cardiomyopathy and coronary artery disease. "If such work is not done," wrote Dr. Lewis Thomas, chancellor of the Memorial Sloan-Kettering Cancer Center, "we will be stuck forever with this insupportably expensive, ethically puzzling halfway technology." But preventing heart disease, as Thomas readily admits, is a long way off. Says Dr. William Friedewald, associate director of the Na tional Heart, Lung and Blood Institute: "Of course, our goal is prevention, to have no Barney Clarks in the future, but right now that's pipe-dreaming."

Though the Utah team is looking for a second artificial-heart candidate, it plans to proceed slowly. "The artificial heart today is at the stage that the transplants were when those operations began 16 years ago," says Stanford Cardiologist Philip Oyer. "Then no one knew how a patient would do, and there was a lot of skepticism." An encouraging note is that the world's first mechanical-heart recipient survived nearly six times as long as the first heart-transplant patient, who lilived only 19 days. And Clark, for all his suffering, said he would not hesitate to recommend the procedure to others "if the alternative is that they will die." Said the gallant pioneer: "It is worth it." -- By Claudia Wallis. Reported by Cheryl Crooks/Salt Lake City and Joseph J. Kane/Los Angeles

With reporting by Cheryl Crooks/Salt Lake City, Joseph J. Kane/Los Angeles This file is automatically generated by a robot program, so viewer discretion is required.