Just Tick, Tick, Ticking Along

By Anastasia Toufexis

Schroeder: "I feel like I've got ten years left right now "

As a federal inspector, William Schroeder evaluated the quality of Army munitions. He passed judgment on another potent but more personal invention last week: the artificial heart that doctors implanted in his chest on Nov. 25. "My heart is just tick, tick, ticking now," he told his surgeon, William DeVries, a week after the operation at Louisville's Humana Hospital Audubon. The plastic-and-metal device felt "like an oldtime threshing machine, just apumping like everything." When Schroeder, 52, entered the hospital's heart institute early last month, he recalled, he knew that he had almost 40 days to live. He had been so weak that two of his sons had carried him in, making frequent stops for their father to place his head between his legs.in order to breathe. With his new heart, "I feel like I've got ten years left right now. I feel I can sit out and go fishing and watch baseball games."

That is unlikely. But his doctors agreed last week that he was "progressing beautifully." Upgrading his condition from "critical" to "serious," they noted that he has experienced none of the crises that beset Barney Clark, who received the first permanent artificial heart two years ago at the University of Utah Medical Center. (The memory of the retired dentist continues to haunt DeVries, who has occasionally caught himself calling Schroeder "Barney.") Schroeder's lungs, kidneys and liver are functioning normally, and there has been no sign of infection. To help control his diabetes, he is being put on a strict diet, which may eventually limit favorite treats like pineapple sherbet and grape Popsicles. "He doesn't like that particularly," said DeVries.

Alert and exuberant, Schroeder spent some of his time last week reading newspapers, listening to tapes of Country Singer Ricky Skaggs and joshing with family, friends and visitors he had called in from the halls of the coronary-care unit. Indeed, the festivities got so lively at one point that a patient next door complained. By week's end Schroeder had taken his first trip outside his room, riding a wheelchair to the X-ray department and using an 11-Ib. portable air pump to drive his heart. The 323-lb. air system was pushed along in front. On doctors' orders, he has begun exercises to strengthen his arms and legs and is taking brief walks around his bed.

Schroeder's high spirits may dim somewhat, physicians warn, as the hospital staff begins to treat him more like a "usual patient" and less like a celebrity. He will have to come to grips psychologically with being permanently tied to an air-pump system, in much the way that paraplegics learn to accept their wheelchairs. To date, Schroeder's good humor has been strained only once, when he took part in a series of experiments last Monday. Doctors first injected him with Isuprel, Neo-Synephrine and Nitroprusside, three drugs frequently used to treat shock or high blood pressure. The chemicals are known to affect both the heart and the flow of blood through arteries, veins and capillaries, but researchers had never before been able to watch the drugs' effects on discrete parts of the circulatory system. Because the mechanical heart remains unaffected by the drugs, doctors were able to study how the chemicals constrict or relax blood vessels. Schroeder was asleep for this phase of the tests and felt nothing, but he was awake for two other experiments.

In one, doctors varied the rate of the heartbeat, at one point lowering it to 30 beats per min. (75 is customary for Schroeder), leaving him weak and short of breath and looking exactly as he did before the implant. The other experiment was also uncomfortable: to measure his lungs' output, a tight-fitting mask was placed over his nose and mouth. The test was expected to last 45 min. but took 1 1/2 hr. "He was very upset about that but still cooperated with us," said DeVries, adding, "He kind of told me off." Though Schroeder agreed to the tests before the implant, new questions have been raised about the ethics of further experimentation on a patient who has already undergone experimental surgery. Replied DeVries: "If you ask Schroeder what it means being a guinea pig, which we have, he says it's kind of a tradeoff. He gets life and he's able to help people after him."

Controversy continues to swirl about the implant. Los Angeles Internist David Olch, a member of the American Medical Association's judicial council, which proposed guidelines for the replacement of failing organs, issued a scathing criticism of the Humana hospital chain in last week's American Medical News. Asked Olch: "Will the artificial heart benefit Schroeder as much as it benefits [Designer Robert] Jarvik, Humana and the surgical team?" Responded Dr. Allan Lansing, medical director of the Louisville hospital's heart institute: "Business in the health industry has been criticized for not supporting research. Now they're being criticized for doing it." DeVries has called for a national panel to review his research and study the attendant ethical and economic questions. The debate is sure to intensify. Last week Cardiac Surgeon Lyle Joyce, who worked with DeVries at the University of Utah and now heads a heart team at the Minneapolis Heart Institute, announced that he will apply to the Food and Drug Administration in March for approval to begin performing artificial heart implants. -ByAnastasia Toufexis. Reported by Barbara B. Dolan/Louisville

With reporting by Barbara B. Dolan/Louisville