TIME: Almanac 1993/TIME Almanac 1993.iso/time/caps/83/83capmil.4

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                └±                                                            April 4, 1983

Death of a Gallant Pioneer

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 DeBries:  "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,
DeBries 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
then 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, DeBries 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 standby unit had to be substituted. Finally, after
7 1/2 hr., Clark's heart output was normal, he had what was
described a "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 William 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 lbs.

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 it 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 taxpayers 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 National 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 lived
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 Wa