High Spirits on a Plastic Pulse

By Claudia Wallis

Schroeder's joviality and fast recovery astound his doctors

The metal-and-plastic heart whirred and clicked in an eerie, mechanical rhythm as Dr. William DeVries, 40, removed the tracheal tube from his patient's throat. For the first time since his artificial heart had been implanted about 36 hours earlier, William Schroeder, 52, could breathe on his own and speak. "Can I get you something to drink?" the doctor asked. Replied Schroeder: "I'd like a beer." It was, DeVries admitted afterward, one of the high points of the tension-filled hours following his second successful attempt to implant an artificial heart.

Schroeder had to settle for a glass of ice chips, but that did not dampen his spirits. Later he demanded to know the time. "Six o'clock," replied DeVries. Schroeder looked skeptically at the lanky surgeon who had saved his life, pointed to a clock on the wall and wagged a finger. Wrong, he said. The clock showed that it was only five minutes before the hour.

No question about it, less than two days after undergoing two arduous operations, Bill Schroeder, a retired Government quality-control inspector from Jasper, Ind., was as sharp as a tack and feeling frisky.

By week's end the world's second recipient of an artificial heart was getting out of bed and sitting in a chair, eating solid foods--warm porridge and cottage cheese--and sipping that longed-for beer, which he promptly dubbed "the Coors cure." Well-wishers had sent cases of the Colorado brew and other brands, in addition to crateloads of cards, plants and bouquets, even a Cabbage Patch doll.

On Friday Schroeder tested a new portable power system for the artificial heart. For 22 minutes in the afternoon, and an hour later that evening, he was free of the 323-lb., air-driven unit that normally runs the heart, and was hooked up to a small, 11-Ib. device encased in a leather shoulder bag. The portable system worked flawlessly though there were two breathless 3-sec. intervals when the heart stopped beating, as technicians switched from one system to the other. Afterward, Schroeder thanked the inventor of the device, Engineer Peter Heimes of Aachen, West Germany, and shook his hand. Then he asked for some ice cream.

Doctors at Louisville's Humana Hospital Audubon were astounded by Schroeder's rapid progress and by his good humor, which, noted Dr. Allan Lansing, medical director of the hospital's heart institute, "is more important in his recovery than most medicines."

Even when he was wincing in pain as attendants tried to weigh him, Schroeder managed to get off a ones-liner. "I'm going to remember this," she griped at the staff. "I want the name of everybody in this room, starting with the big guy," he said, I pointing at the 6-ft., 5-in. DeVries. In the view of Schroeder's wife of 32 years, Margaret, her husband appeared to be "more comfortable" last week "than he had been for months before the implant." She told a news conference, "Once we went down toward that operating room, I was relieved because I felt that my husband was fading away from me, and now I feel I have him back again and that I have another chance."

From the beginning, Schroeder's treatment seemed to go more smoothly than that of his predecessor, Seattle Dentist Barney Clark, the world's first recipient of a permanent artificial heart. Clark's surgery and his 112 days of life with the man-made pump were fraught with life-and-death crises. "I felt certain that he would die on the operating table," reflected Dr. Robert Jarvik, 38, designer of the Jarvik-7 heart used in both patients. This time, he said, "I felt the opposite."

In Clark's case, surgery was complicated by the fact that the heart tissue was so damaged by years of treatment with steroids that it tore like tissue paper in DeVries' hands. To make matters worse, when the artificial heart was implanted, it failed to function properly, and a stand-by left ventricle had to be substituted. DeVries felt so frustrated, he later admitted, that "I would have picked up the artificial heart and thrown it on the floor, if the press had not been there."

In contrast, said Jarvik, Schroeder's surgery was notable for "a great feeling of deliberate, calm progress," making it seem "almost routine." The only difficulty came in removing the diseased heart, which was surrounded by a thick envelope of scar tissue, the legacy of bypass surgery performed less than two years ago. "The scarring made it difficult to identify structures," explained Lansing, who assisted in the operation. "It's like looking through a fog." As a result, instead of taking the usual five minutes, it took half an hour just to extract the organ. Once that was accomplished, DeVries easily installed the Jarvik heart, using the technique he had practiced and honed on hundreds of animals.

The first real drama of the day came about an hour after surgery when Schroeder was suddenly jolted into consciousness and, terrified by all the activity around him, tried to bolt from the bed. Doctors restrained him and increased his sedation. Five hours later they confronted a more serious problem: an alarming amount of fluid was building up in Schroeder's chest cavity and lungs and his skin was turning bluish-gray, a sign that not enough oxygenated blood was being circulated. They rushed him back to the operating room to find that he was hemorrhaging along the row of stitches connecting the artificial heart to his aorta. Doctors stanched the flow by applying pressure and clotting agents, but not before Schroeder had lost a massive amount of blood. By the next day, however, Lansing reported that the patient was back on track: his blood pressure was normal, his heartbeat steady and, he added, "where his skin was cold and gray and clammy then, it is now warm and pink and dry."

It was a stunning improvement over Schroeder's condition before surgery. According to Humana doctors, Schroeder has truly cheated death. Without the Sunday-morning implant, he "would not have survived the weekend," says DeVries. "Saturday night, I was very worried."

Like Clark before him, Schroeder had entered the hospital suffering from the final stages of cardiomyopathy, a progressive weakening of the heart muscle. While the cause of Clark's condition was unknown, Schroeder's was due to the most common form of heart disease: atherosclerosis, a narrowing of the arteries that chokes off the blood supply to the heart.

Up until about two years ago, Schroeder had lived a normal and active life. He was a popular figure in Jasper, a tightly knit farming community of 9,900 people, mainly of German-Catholic heritage. His home--a modest, white frame house with yellow plastic flowers hanging on the door--had been his father's before him; Schroeder's two brothers, ten aunts and uncles and numerous cousins all live within ten miles. After graduating from Jasper High School, he spent 15 years in the Air Force, serving as a flight controller, mostly overseas. He returned to Jasper in 1967 to provide a more stable life for his six children: Monica, 31, Melvin, 30, Stan, 27, Terry, 25, Cheryl, 21 and Rod, 19.

He took a job as a production worker at the Naval Weapons Support Center in nearby Crane, Ind., and rose to quality-control specialist.

He was active in the American Federation of Government Employees, eventually becoming president of the chapter representing Ohio, Kentucky and Indiana. His former boss, Dick McGarvey, describes him as a "tough negotiator" and as "a good friend." Schroeder was also a leader in the Knights of Columbus, a Catholic fraternal society.

In January 1983, Schroeder's busy family life and career were disrupted by a massive heart attack, which seriously damaged his heart muscle and left him crippled with angina, or chest pain. Two months later he underwent double-bypass surgery.

The operation helped relieve his an gina but failed to check the deterioration of his heart; he was forced to retire from his job. Over the next 18 months, his condition continued to deteriorate. In June 1983 he called together some 220 members of the Schroeder clan for a reunion at a local club. Although Schroeder played master of ceremonies and joked with his relatives, the gathering was a kind of farewell party. By this autumn, the once vigorous man was largely bedridden, unable to walk 20 ft. without chest pain and shortness of breath. At night, he would awake gasping for air.

Ordinarily a man in this condition might be a candidate for a heart transplant, but Schroeder had two strikes against him. First, at 52, he was two years over the age limit set by most heart-transplant centers. Second, like 12 million other Americans, he suffers from diabetes, which is also grounds for disqualification. "If he received a transplant, the antirejection drugs would just throw his diabetes out of control," noted Dr. J.P. Salb, the Schroeders' family physician. It was Salb, along with Schroeder's cardiologist, Dr. Phillip Dawkins, who suggested that he look into the possibility of an artificial heart. By chance, DeVries, the only surgeon authorized by the Food and Drug Administration to implant the device, had moved this summer from the University of Utah Medical Center in Salt Lake City to Humana Hospital Audubon, about 70 miles east of Jasper.

Almost from the moment he set foot in Humana Hospital on Nov. 8 to meet DeVries and Lansing, there was no question about what Schroeder wanted. He made a tape of the meeting and played it for his family the next day. "We just kind of sat down and asked, 'Dad, what do you want to do?' " recalled Margaret Schroeder.

"He said, 'I have no other thought. I want to go all the way.' " Schroeder's family and his clergyman supported his decision. Said his brother Paul:

"He had the choice between life and death, and he chose life."

As a man in the final stages of terminal heart disease, Schroeder met the main criterion for receiving an artificial heart. In addition, the patient-selection committee at Humana was impressed with what Lansing called his "pure, smalltown, mid-America background" and strong family support. They were worried, however, about Schroeder's secondary health problems. In recent months his diabetes, once controlled by diet, had become more serious and required daily injections of insulin. Doctors at Humana believed the problem was related to infections in six of his teeth and in his gallbladder, which was inflamed by the presence of gallstones. Before the implant could be approved, these sources of infection had to be removed. The teeth were pulled and, just eight days before the implant, Schroeder, despite his fragile heart, underwent surgery to remove the gallstones. His need for insulin promptly declined, and the hospital gave the go-ahead for the artificial heart.

Schroeder and his family were made well aware of the risks of the procedure in a 17-page consent form spelling out in detail everything that could go wrong. The document had been expanded since the days of Barney Clark to include the medical problems that Clark had suffered, including brain seizures and serious depression. The last was included because Clark had complained to psychiatrists that he wanted to die, that his "mind was shot" and that he found it enormously disappointing to wake up and find that he was still alive with the artificial heart pounding away in his chest. DeVries revealed last week that before Clark's surgery, a group of doctors had actually tried to talk their patient out of the operation as a means of testing his will. "We didn't do that this time," said DeVries. But doctors did describe the risks to Schroeder in what DeVries termed "very graphic language such as 'becoming a vegetable.' " Schroeder, like Clark before him, remained devoutly willing. "I trust you," he told DeVries just before surgery. Nonetheless, he was prepared to die and received the last rites of the Roman Catholic Church from a home-town priest the night before the implant operation.

DeVries had waited nearly two years for a second opportunity to implant the artificial heart. The long delay tried his patience. "It was very frustrating to me to have patients who might die while I have that thing sitting on the shelf," the surgeon told a reporter last January. Because of the medical problems that Barney Clark had experienced, both the FDA and the University of Utah hospital where the first implant surgery was performed wanted to reconsider any further use of the device. DeVries pressed both hospital and agency for permission to use the heart in a somewhat healthier patient than Clark, who had suffered from both lung and heart disease. It was not until June of this year that the FDA finally consented, allowing a total of six implants on healthier patients. Meanwhile, the University of Utah had authorized only one operation, a decision that infuriated DeVries and was partly responsible for his decision to move on to Louisville.

The forthright and unconventional DeVries had spent virtually his entire career at the University of Utah. Born in Brooklyn, the son of a doctor and a nurse, he had moved to Ogden, Utah, as an infant after his father's death in World War II. DeVries attended medical school at the state university and became interested in the artificial heart after accidentally wandering into a lecture by Dr. Willem Kolff, the Dutch-born doctor who founded Utah's artificial-organ program. After the lecture, DeVries asked Kolff for a job. "What's your name?" the distinguished doctor asked him. "When I told him," DeVries recalls, "he said, 'That's a good Dutch name. You're hired.' " The surgeon's move from a university hospital to the profit-making institution in Louisville was criticized by his peers. It also forced him to uproot his brood of seven children and leave behind his beloved Rocky Mountain ski slopes. Nonetheless, DeVries expresses no regrets about coming to Humana: "I have been able to set up this project exactly the way I wanted to, and what's more important, I have been able to select the patient without consideration of whether he can pay his bill," said DeVries last week.

Indeed, for Schroeder, a man of modest means, cost has not been an issue. Humana paid for the $15,500 Jarvik-7 heart and its drive system. They also provided free rooms at the hospital for the entire Schroeder family. Should Schroeder become well enough to leave the hospital, Humana plans to give him use of a specially designed house, with a built-in air system for his heart. Throughout, Humana has spared no expense and taken no risks. Because security had been a problem during the Clark case--two artificial hearts were stolen from DeVries' office--the hospital has posted four uniformed guards on Schroeder's floor, one directly outside his room. Concerned about the strain of the patient's long hospitalization and the intense media coverage, Humana is providing his family with instruction in "stress management."

For Schroeder's doctors there is much stress ahead as they worry about their patient's survival. DeVries told reporters last week that he will worry for as long as Schroeder lives about the risk of infection, which is a greater problem for diabetics, or about a breakdown in the equipment. "We live on the edge of possible disaster at any time," he said. By applying the lessons learned from Barney Clark, DeVries hopes that certain earlier calamities can be avoided. For example, because Clark's brain seizures were attributed to the sudden increase in blood circulation following surgery, doctors are taking a more gradual approach to increasing Schroeder's heart rate. In addition, since one of the valves used in Clark's heart broke two weeks after the heart was implanted, Schroeder's heart contains valves of a different make, which, DeVries says, are "substantially stronger."

A few other changes in equipment have been made: the heart's drive system, though still unwieldy, is 52 Ibs. lighter than it was two years ago. Better yet, the new portable pump system may eventually free Schroeder from the contraption for several hours every day. "I think it's the beginning of the end of the view of the artificial heart as a cumbersome device that doesn't give people the type of life they really need," observed Jarvik after the first successful use of the device. According to Jarvik, other improvements in the technology are on the horizon. The current heart, which weighs three-quarters of a pound, is too large to fit in most women's smaller chest cavities; its successor, the Jarvik-8, will ultimately be available in more than one size, including a streamlined model for people with small frames.

DeVries wistfully expressed the hope last week that his patient would be home for Christmas, although he quickly acknowledged that it was "very, very unrealistic." For the Schroeders, every extra heartbeat was gift enough. "It's different, but at least it's beating, and I can feel it," said his wife Margaret. Added their son Melvin: "He's just the old Dad again."

--By Claudia Wallis. Reported by Barbara B. Dolan/Louisville

With reporting by Barbara B. Dolan