TIME: Almanac 1990/1990 Time Magazine Compact Almanac, The (1991)(Time).iso/time/caps/83/83capmil.4

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╒                                                        ?««Death of a Gallant Pioneer

April 4, 1983

Barney Clark:  1921-1983

No one could doubt the wisdom of the choice.  The dentists from Des
Moines, Wash., my 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
C, 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, well 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