Books: Extract – Heartbreaker by James Styan

December 21, 2017

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Fifty years ago, on 3 December 1967, Christiaan Barnard and a team of South African medical specialists did what was considered to be impossible and performed the world’s first successful human to human heart transplant. Barnard’s success was preceded by decades of hard work and intensive research. But it all came together when he successfully transplanted a human heart.

It was late evening 2 December 1967, when the phones started ringing all across the Cape Peninsula.

Amelia ‘Pittie’ Rautenbach, Sannie Rossouw and Tollie Lambrechts were at a costume party in the Cape Town suburb of Mowbray. The three scrub sisters were dressed in 1920s-era bathing suits – a sensible choice for a warm, December evening in Cape Town.

‘We were all very jolly and had already had a few drinks. No-one could’ve expected us to sit there the whole night without having a drink,’ says Rossouw. Lambrechts, who was hosting the party, says they’d been drinking punch but hadn’t even got to the fruity bits yet when the phone rang and they got the message to go to the hospital. The three women dropped everything and ran.

‘We were just told we must come, there’s a donor,’ says Lambrechts.

They drove to Groote Schuur in two cars. Rossouw had no opportunity to change from her bathing suit, so she went into the operating theatre wearing her costume under her theatre scrubs. ‘Everyone was so busy with their own tasks, no-one even noticed it.’

That night a team of 30 people were called in for an operation that would bring the world to a standstill – the world’s first human-to-human heart transplant.

Christiaan Barnard was the leader of the Groote Schuur team. For this surgeon, who had been born in the Karoo, the operation was a tremendous personal risk. It took enormous courage and self-confidence to cut out one patient’s sick – but still beating – heart and replace it with a donor heart. Barnard had been relentless in pursuit of achieving the impossible and had studied under master surgeons in America and Russia where he had to go behind the Iron Curtain.

In Cape Town Barnard had revitalised the JS Marais research laboratory making it an experimental facility that would prove vital to his success. In the 1950s, this laboratory was stocked with animals, mostly dogs, baboons and rats who were used in medical experiments to assist surgeons and other specialists in preparatory work before big operations. Inside this innocuous-looking building, surgical techniques were tested, honed and improved. In addition, Barnard established a open-heart surgical team that worked with the heart-lung machine he brought to Cape Town from America. The initial open heart surgery team consisted of a technician, Carl Goosen, a surgical assistant, Dr Malcolm ‘Mac’ McKenzie, and a coloured assistant named Victor Pick, known as Big Vic and who was the senior laboratory assistant.

The experimental work done on the animals in the research laboratory enabled the Barnard team to prepare for complex open-heart operations and organ transplantation. The work was never easy. Still the team pressed on with the heart-lung machine at the centre of it all.

‘It sounds like a bit of dry medical history,’ Barnard wrote in later years with regard to the heart-lung machine, ‘but it wasn’t. It was blood, sweat and not a few tears.’

The laboratory team worked for years as a tight unit under the leadership of Pick. Along with Pick, the mainstays who were added to the team included Hamilton Naki, Prescott Madlingozi, John Rossouw and Frederick Snyders, nicknamed Boots. Each member of the laboratory team had unique skills: Boots was very good at anaesthetising baboons before the animals knew what was going on. Big Vic ensured that the laboratory was ready before the experiments. Naki was an anaesthetist who specialised in liver and kidney work on dogs.

While these men were acknowledged in the books written after the first heart transplant, including in Barnard’s own autobiography, the media largely ignored them and the team’s roles were largely forgotten. Then matters took a turn after Naki’s death in 2005. When he died, Naki became world famous following the release of a controversial documentary film and several resultant obituaries from sources including The Economist and Time magazine. These sources claimed that Naki had been done in by Barnard and the apartheid regime, and stated that Naki had actually played a crucial role during the first heart transplant at Groote Schuur. Some reports even indicated that Naki had removed the donor heart during the operation in 1967.

Nothing could be further from the truth.

Anwar Mall, an emeritus professor at UCT, had known Naki since 1981 when the two started working together. He says there can be no doubt that Naki and his co-assistants in the laboratory played a significant role in the research being undertaken at UCT and that they were involved in the preparatory work for the heart-transplant programme.

‘However, it is a fact that neither Naki nor any of the other assistants were present the night that Denise Darvall’s heart was transplanted into the chest of Louis Washkansky.’

Besides the fact that Naki was black and apartheid legislation would have prevented him being present at the bed of a white patient, the fact is that Naki was simply not medically qualified to enter an operating theatre in any hospital. Mall says that there is no doubt that Naki was an extraordinary person and it is tragic that the world knows about the Barnards but not about Naki.

‘Sadly, the image of Hamilton Naki was damaged by the misinformation that was spread after his death. I will repeat: he had no part in the first heart transplantation in 1967. He was never involved with human patients. It would have been illegal since he was not a qualified medical doctor. Naki never qualified as a doctor, but he received an honorary master’s degree from UCT shortly before he died.’

Another surgeon to correct the narrative was John Terblanche. He had been Barnard’s research assistant in the laboratory in 1960 and had assisted Barnard with transplanting dog hearts. He said that the falsehoods around Naki’s role during the first heart transplant cast aspersions on the legacy of Naki, the Barnards and the entire transplantation team. He said that Naki’s role at the time consisted of acting as a nurse and helping with the animals. This would have included duties like applying anaesthesia. Big Vic was still in charge in the laboratory at that time and continued in this role until 1969 when he died in a motor-vehicle accident.

‘After Pick’s tragic death, Naki’s role as surgical assistant in the lab started. Therefore, to claim he was an integral part of the first heart transplantation team and that he was involved with the first operation, is fiction,’ Terblanche has stated on the record.

Prof. Rosemary Hickman who was the surgeon in charge of the research lab from 1968 to 1995, corroborates these facts. She was appointed to this position in 1968, only the second female surgeon to be appointed at Groote Schuur. Naki and the rest of the team reported to her for years. She confirms that Naki was an exceptional man.

‘However, he had no part in the first heart transplant. Hammy only ever worked on animals. It’s a great pity the falsehoods that are linked to him. The assistants in the animal laboratory only ever worked on animals and never had any human patients.’

There can be no doubt that Naki was a talented experimental surgical assistant. Barnard himself said as much. Sadly, Naki never had the opportunity to qualify as a doctor and treat people and there can be no doubt that neither him nor any of the other assistants in the animal laboratory were present at the first heart transplantation. The tragic reality of apartheid-era legislation simply made that impossible.

 

This is an excerpt from Heartbreaker by James Styan, published by Jonathan Ball – used by permission of the author and publisher.

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