Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Mechanical Heart Pump

Episode Date: July 23, 2024

Sometimes the cities we visit on tour have some historical medical mess-ups, but not Detroit! Dr. Sydnee and Justin talk about Forest Dewey Dodrill, who performed the first successful heart surgery (with a pump) in a time where operating on the heart was considered a no-no. Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. Alright, this one is about some books.

One, two, one, two, three, four. Hello everybody and welcome to Sawbones, a marital tour. for the mouth. Hello, everybody. Welcome to Sawbones, a marital tour. Ladies and gentlemen, Sydney McElroy. And Justin McElroy. Do we do it opposite for some reason? Why do we do it opposite? Paul, thank you so much for pre-opening my Coke Zero. Your job is safe for another day.

And my Coors Light. It's a special music edition. That's perfect for Detroit. They love music here. Coors Light, The Detroit classic. Yeah, we are talking about an actual Detroit classic though. Am I wrong, Sid? Yes, that's true.

So it's so great to be here and get to do this. Thank you. We always try to do something relevant to wherever we are. And that's such a wide range because sometimes it's just like a weird thing. Like, Chicago reversed their whole river once, which is really wild. And then sometimes we accidentally insult somewhere.

Like we go to Salt Lake City and say, hey, you know those essential oils companies, doTERRA and Young Living? They really suck. And that's there. That's like right there. They're all about those there. You went to Indiana and talked smack about Eli Lilly,

like within view of Eli Lilly. Like you could see Eli Lilly. We could see it. Like from the theater, we were like, well, there it is. Oops. But this isn't there it is. Oops. But this isn't one of those. No. You can relax now.

This is a good one. Let your breath go free. Except for of course, the maniac doctor of Detroit, the doctor that killed a hundred people. That is the tonight's topic is the maniac doctor of Detroit. No. Is that a thing? No, but wouldn't that be like wild?

That's good. HBO, get at me. Go ahead, Sid. No, this is a good one. I kept finding good things about medical history here, which is like good and bad, because it's nice for Detroit, but it's bad when you're trying to find

really whack stuff for a podcast. It's harder. But I do want to talk about a good thing, a landmark medical intervention that came from right here in Detroit, using, utilizing all the things that me not knowing a ton about Detroit kind of knew. So, first of all, it's important to note

that for much of human history, for much of medical and human history, we really didn't think we could operate on the heart. It was thought that if there's something going wrong inside the heart or with the heart, anything that would involve like a surgery on the heart, we just, we don't do that. It's like when you get, when you're trying to fix

an electronic and then you get to a part that you know you're not supposed to be into, like, oh no, no, this isn't for me. I'm gonna put this away. I've opened the wrong panel here. This is for adults. No. And so it was, if we attempted to do anything,

it was mainly just palliative or to relieve symptoms or some sort of last ditch effort, but there really wasn't a coordinated effort to come up with a way to operate on the heart because of all the blood in there that like comes out really quickly. And how hard it is to take it out, stop it for a few minutes, fix her up,

and slap it back in, right? That's a huge challenge. That's a big deal. And it's gotta be pumping the whole time. The whole time. The whole time you're doing surgery on it, it has to keep pumping. And if it's being cut on, maybe it can't.

And so then you're gonna need something to pump for it. This is like foreshadowing. Whoa, you saying it like this, I'm realizing, man, it sounds so hard. Sounds like, like I would, right now, I don't know, I think I could crack it if I just sit here. And I'm like a 2024 guy, you know what I mean?

Like I've been on'm like a 2024 guy. You know what I mean? Like I've been on Netflix like a bunch. Like I should understand everything these Cro-Magnons are able to piece together, right Sid? Well, I mean. So you were saying, I'm sorry to interrupt. It's so notable that I was looking back like the history of cardiac surgery,

what did we do before? And there is this one instance that I kept finding repeated back in 1896 where they were like, no, this one time, one guy tried this. And the story itself is weird because there's this 22 year old gardener, Wilhelm Eustis, who was wounded by a knife. That's all you get.

A passerby finds him on the side of the road, stabbed through the heart, no explanation. Which makes me suspect the passerby. And this is how the story is repeated every time I read it. Or the victim's an absolute stinker. Like, so why did they stab you? Oh, nothing.

It was the, I didn't nothing. It's not me, the old Orbot. But it's wild because he comes in on September 7th, 1896. He's got this stab wound in his heart and all the doctors are basically like, oh, that's too bad. Not the heart. Oh, that's bad.

Why'd you let him do that? And they don't really do much for him. They like put some camphor on him. They apply a topical cream. I mean, you mentioned palliative care, which in this era must've just been making a sad face at the person, right? This is rough, you're right.

Ice packs, they put ice packs on it. You made it to 45 though, good job. He's 22. Aw man. But it has a happy ending because then, so like two days after he comes in, there's finally, there's Ludwig Renn was a surgeon who said, I mean, we gotta do something, right?

Like, and everybody's like, no Ludwig, we don't operate on the heart. It's the one thing we won't do. And he's like, well, maybe I'll try. So he goes in, he opens the guy up. He sews his heart back up. That was basically all he did was just sew the heart, so the, you know, the slash and the heart back together and then tell him, don't do any hard work for a few days. And the guy lived. I mean, he survived.

That's our first like heart surgery in history ever done was sewing a hole back up. Now it surprises me as much as surgeons in that period used to be real dirty dogs, like real happy for any opportunity to get in there and cut. I'm surprised that no one had thought of this before. Like, well, this one's going out. Let's mess around with the heart a little bit, see what we can figure out. Well, I mean, I think there's so much.

That's what this, you're all laughing. That's exactly what this dude did. He's like, let me just get in there real quick. What's the worst case scenario? He dies of a stab wound. That's going to happen anyway. Let me see what I can figure out in there. It was just such a taboo because you didn't want to be,

I mean, and I think this is probably, I would assume true of surgeons today. I am not a surgeon. I'm a family doctor, but I'm going to guess it's true of surgeons that you don't want to be the reason someone dies. Yeah, but like, again, I don't want to keep harping on it, but this was a heart stab. They cannot get you for this.

Like no matter how bad you mess up, they're like, oh yeah, that one was there before. Wild, wildly. Yeah, that one was before. That was not me. No, and I mean, I think it speaks to kind of having done a lot of studying of medical history for the over a decade we've been doing this show. You really get this sense that doctors have these sort

of like codes of, and I don't even wanna say ethics cause it's not ethical, but just like here is what we do and here is what we don't do. I mean, for a long time doctors didn't do surgery, right? We wouldn't cut into the human body at all because that was something that was off limits. The idea that you would, I mean the way Hippocrates wrote it, cut for the stone.

You wouldn't do that. And so we just see this evolution over time where we go, well, but we do wanna fix things. So eventually we start trying. And you see this kind of like sporadic cases. There's this one in 1896 and then in 1925, there was a surgeon in Middlesex who operated on a valve. Again, the patient lived.

No one ever referred a patient to the surgeon again. That is what is documented, is that no doctor would send this guy any patients because he cut on his heart. I mean, he lived, but still, still. It was that forbidden, it was that taboo. The first time that a patent ductant arteriosus, it's a congenital heart defect, something that goes away while you're developing in the womb but then it sometimes persists and you have to have a

surgery to fix it when you're a baby. Anyway, the first time we fixed one of those, the surgeon who did it was a resident in training. He did it without telling his chief resident and while the attending physician was on holiday somewhere so that nobody would know he was doing it and he got away with it. And still, I mean, he got in huge trouble for it because it was like, we don't do that. We don't operate on the heart.

You start to see a little- Yeah, I would kind of say, I am really glad that he got in huge trouble for that. Well, I mean... That is not a precedent. I don't need people doing night medicine. Like, secret... It's like, you've been to hospital, welcome to hospital, nights. This is where we get a little bit freaky with some of the treatment. It's all highly experimental. This is tough for me. Don't get sick at night. I do teach residents.

And so there is a part of me that's like, that is bone chilling. Like that is, please don't do that. Please don't do that. I agree. Yeah, for sure. But I also like, I watched house, you know, sometimes you got to break the rules. During World War II is really when we see this like interest and maybe we can do something with the heart really grow and it was because of the sort of the severity of the wounds

that they were seeing and you were in a situation where the risk benefit ratio really started to shift right. You have somebody that I mean mean, that has sustained a traumatic injury to the chest. So they've been shot, there's shrapnel, there's something where it's like, okay, we know this person's going to die. So we might as well try anything we can. And that- So I'm a futurist at this point, right? I was just before my time. Like I just realized it too early. Is that, must be it?

I mean, I do think that happens in medicine. Sometimes eventually we go, well, I guess before my time. Like I just realized it too early. Is that, must be it. I mean, I do think that happens in medicine. Sometimes eventually we go, well, I guess it's bad enough that we should try it anyway. Did they have a meeting where they're like, okay guys, we've all been putting it off. We got to figure out how this frigging thing works. Like I know how hard it seems, Tony,

you're always talking about it, how hard it is. I know it seems really, really hard, but we gotta figure something out, because this is embarrassing. And that's exactly what they said. They were like, okay, we need to find a way to keep the heart pumping, keep blood circulating through the body while we are kind of disabling the pump for a minute,

is a good way. I mean, we're all just like electricity and plumbing, really. So, I mean, it's plumbing is what we're dealing with. And I mean, basically. And so they start coming up with different ways to do it. There's this one great technique I was reading about like throughout the 40s. There was a medical student at Harvard

who suggested a way to do it, where you like create this little tunnel in the wall of one part of the heart. And the way you know you're in it is you stab yourself in the finger with the needle. And that's when you know you're in the right. That was part of the documented technique of this procedure is like, and then you insert the needle and when you feel it stabbing into the tip of your index finger, you're in. So that didn't last very long.

People were like, well, that seems bad. And then there were people who proposed like, well, maybe we just get them real cold. I love that. Let's freeze them. That makes sense. We've done that. Everything flows down. That's happened.

And the thought was if you made them super cold, and then you just clamped the whole heart off and worked so fast. You had like eight minutes in and out. Get in, get out, stay cold. Only do it outdoors in January. You gotta keep this stuff chill. It feels like an oceans movie.

You get in, you get out. We've frozen the heart. The medicines, the medicines that escalate my cough for the mouth. Hello sleepyheads. Sleeping with Celebrities is your podcast pillow pal. We talk to remarkable people about unremarkable topics, all to help you slow down your brain and drift off to sleep. For instance, the remarkable actor Alan Tudyk.

You hand somebody a yardstick after they've shopped at your general store. The store's name is constantly in your heart because yardsticks become part of the family. Sleeping with Celebrities, hosted by me, John Moe, on MaximumFun.org or wherever you get your podcasts. Night night. The following are real reenactments of pretend emergency calls. 911. My husband, it's my husband!

Calm down please, what about your husband? He mocks the dishwasher wrong. he calls. There are plenty of podcasts on the hunt for justice, but only one podcast has the courage to take on the hunt for justice, but only one podcast has the courage to take on the silly crimes. Judge John Hodgman, the only true crime podcast that won't leave you feeling sad and bad and scared for once, only on MaximumFun.org. So all of this was obviously not super successful. And then this enters like the hero of our story.

And I really love this because we're from West Virginia. And this is like a connection between Detroit and West Virginia because Dr. Forrest Dewey Dodrill was born in 1902, January 26, 1902 in Webster Spring, West Virginia. He went to WVU, which we're from, honey, you all probably don't know this. We're from Huntington, we like Marshall. That's not the good college in our state.

Sorry, no, I'm kidding. WVU stinks, that's where I'm at. We went to Marshall, so I gotta say that. But anyway, he went to WVU, he went to Harvard. So like better than WVU, probably, we can all agree, right? Then he went to Harvard. And then he did his internship and residency at Detroit's Harper hospital and became a mastery a master of surgery

and got a degree from the University of Michigan in 1942 so he came from from our home state and then right here to Detroit and started practicing medicine and it occurred to him while working in Detroit that you know kind of like I said, a pumping of the heart isn't that unlike pumping other fluids. And if you know how to pump some kind of fluid in some sort of like engine type of thing, maybe you could figure out how to pump fluids in the human body in its engine, you know, the heart. And he was right here in Detroit. So what did he do?

He went to General Motors. He figured that if you could pump oil and gas and everything, you could probably figure out how to pump blood through the heart. And that is exactly what he tried to do. And this was, so this idea of a machine that was external, like something that would sit outside the human body and pump fluids through the human body

for a period of time so you could work on it, had been, like other people were doing these experiments. So he wasn't the first guy to kind of consider this idea, but the only other guy who had done it at that point, Dr. John Gibbon had only done it on cats. Lots of cats. No, I mean, they live, they were okay. Don't worry. The cats way said did they all live? All the cats lived. It says they're right there in her nose, folks. All the cats lived. It says it right there in her nose folks. All the cats lived. It's amazing.

So we have today everybody lives. All the so he had published all these papers on like how to keep a cat alive but he had never tried it in humans and so this like opened the door for Dr. Dodrell like well I'm gonna do it in humans and I'm gonna get General Motors to help me. So he went to one of the cardiologists who was president of the Michigan Heart Association who also had a good friend named Charles Wilson who worked it he was the GM president at the time he also sat on the board of the hospital and so it was just like a match made in heaven he went to him and he was like you know what I think you guys could do is build me an engine for the heart.

If you could build something that can pump blood instead of all these other fluids that you pump, we could probably use this. And that is exactly what General Motors decided to devote time and resources to. So they put together a team of more than a dozen engineers and researchers, and they had to work, obviously, with physicians to kind of get together and discuss,

okay, here's how the heart works, here's how your engines work, which I don't really know, but I assume it's like a heart, because I know how that works. And we're all going to get together and figure out how can we make this something we can use in an operating room. And again, this is like a temporary thing.

This would lead to like later on, if you think about like a mechanical heart, this is the precursor to this that you're hearing about right now. At this time, we're talking about something that would just sit outside the body and would be used temporarily, but this is what they're starting to discuss.

Can we make a mechanical heart? And so they start working on how is this gonna go. It took them 20 months. It was all under Mr. Rippinggill was the leader of the team of engineers who put all this together and they tested 10 different versions of the mechanical heart and the design that they finally settled on most closely resembles

a V12 engine. Yes, and so they built an engine for the heart. It has six pump units on each side of the two banks on it, which, I mean, again, I think this is what an engine would look like. And one bank is going to replace the left side of the heart. The other is going to replace the right side of the heart. And the pump units are going to circulate the blood using positive and negative air pressure throughout the body for a temporary period of time

while you're able to hop away. I hope the AI never finds out about this one, Sid. Cause I'm looking at it right now and I think this is the last piece they've been missing. It's really- This is the only thing keeping them from taking over is they don't have a heart and they can't love. And now I'm looking at this and I'm like kind of freaking out

because if the AI scrubs this one with its spiders, they're going to be like, hey, 101110011111001110, come take a look at this. Oh, that's the name of one of them. Yeah, it's a binary. Why would they have names like ours? Exactly. Maybe they already do.

Well, they don't, but now they have hearts and can feel in love. They're gonna have their own names because that's the only thing stopping them from taking over. Good job, Sid. Sorry, now I showed him how to make a heart. Just don't tell the AI about this one episode.

It's not that hard. Just don't tell Alexa or whatever about it. It's really General Motors fault. It's not my fault. That's true. I don't know how to build an engine. And I love the idea of this. Something about it, for some reason,

lately TikTok keeps showing me Mad Men clips. I don't know why. Is this anyone else? Is it just me? Right? OK. I feel like that it circulates sometimes, certain things. And they're like, you seem like you like this.

Do you want more? You want more? You want more? And this feels like something that they'd be talking about on episode of Mad Men. Like, how are we going to pitch this? How are we going to look? They built an engine for the heart.

It seems like the perfect non-free for ad campaign. So anyway. It's good enough for your heart, then it's good enough for your GM brand car. It's to sell cars though. So they built this prototype and they were really excited. And then they had to test it. Listen, how big of a cat can you get down here right now? Don't ask any more questions. Just find the biggest flipping cat you can.

I have like 30 minutes, I'm serious. A big cat too, Jerry, big. They had to test it, and let's just, I'm sure you're all smart enough to figure out what happened, but at the end of this story, I mentioned that Rippengill was the name of the lead engineer. Mr. Rippinggill's family got a brand new pet dog that had been kept alive on this amazing mechanical GM heart machine. And like all the other

dogs that it was tested on. It was all fine anyway. That part was true though. I don't think she's lying. Did they really get to keep the dog? They did. That was their family pet. Oh, okay. Good.

It was a good one. Yay. That's a true story. No, that really was, that was their family pet, which is like a great thing. Like, hey, you see our family dog? Guess what? I built an engine and it kept this dog alive.

Maybe it wasn't necessary to put the dog on the machine, but the point is the dog was fine. So they have this machine, they've tested it out, the Rip and Gills have a new pet, everything's great, but they need to try it on a human. And the perfect human walked in the doors of Harper Hospital on July 3rd, 1952, Mr. Henry Opitech, who was a 40-year-old

man, 41-year-old man, who had a mitral heart valve problem that he'd had since he was a kid and his mitral valve was failing. And he came in with basically like a heart failure. He was fluid overloaded. He was very sick. He couldn't breathe. And up until then, there wouldn't have really been much you could do because they knew they needed to fix the valve. They they needed to fix the valve.

They knew how to fix the valve, but in order to do so, they needed to keep the heart pumping the entire time. So up until this moment, there would have been nothing to do for Mr. Opitech except basically just palliative care, make him comfortable, let his family say goodbye. But instead, he walked into Harper Hospital and Dr. Dodd-Rill said, we're going to use the machine. And he's like, can I see the machine? And they're like, you

don't want to see the machine. You can see the machine after, okay? But you don't want to, you don't want to see it before. This must have been the craziest operating room. It looks like a cut scene from Grease. Go Grease Pumper, you're pumping that blood clean right through Grease Pumper. Because what you've got is this huge team of surgeons because they're doing essentially the first open heart surgery. I mean that is what is happening right now, the first open heart surgery. There's two guys working on the machine. The doctors are wearing a mask and the two guys working on the machine aren't.

Like, it's fine. We're the machine guys. So we don't actually need one of those. That is who they are. Those are General Motors employees. Those are engineers. Notably germ-free, always like sterilized. Which do you, here's, there are two possibilities.

Either they came walking in with like no gown, no gloves, no mask, and everybody just went, I don't want to mess with them, it's fine. Or somebody said, you guys really need to wear, you know, this stuff. And they went, no. Nope. Maybe after the history picture,

you guys can cover up your faces for the history picture. We want to be in the history picture. Maybe you guys will be in a lot of these. We're just guys that work on this weird little heart at GM. We got to be in history. So they, it took about 50 minutes that they kept Mr. Opitech on the machine and it pumped for his heart during the procedure

while they repaired his mitral valve. And like I said, they had the entire team, they have the GM employees. It was I said they had the entire team they have the GM employees it was successful it worked the entire time I I'm assuming it's all been sterilized and all that good stuff because mr. Appetite came through the surgery really well and survived another 29 years thanks to what came to be known as the Dodrill GMR heart machine, which is really cool. I know, look at the kids just love it.

I did that one just dispenses slushies. Actually kids that pumps the slushies directly into your bloodstream. It sent me on this really weird. As I was looking up all these pictures of the surgery, you see, not only do you see people in the operating room who are like no gown, no glove, no mask, nothing like not what we would do today.

You also see lots of pictures of surgeons with their masks under their nose. Right, like it sent me down this weird rabbit hole where I was trying to figure out when did we start putting our masks over our noses. And I can't, it was sometime in the 40s. So this feels late. We should have known, this is the early 50s.

We should have known, but it's sometime in the 40s, we knew to pull our masks over our noses and we just didn't. So I gotta ask. In the operating room. What is, why, this does not look like an early version of something that I recognize from modern medicine. Was this, did this become like the standard that was like refined and retooled and built on?

So like a lot of, I think not just in medical advancements but like scientific advancements in general, there were lots of people working on this idea all over the country at a similar time period, right? And so this exact model that looks like a car engine wouldn't be the one that would eventually become what we think of as cardiopulmonary bypass today because we can do that, right? We can put people on what are I think kind of commonly known as like heart-lung machines that will do the

work of the heart and lungs for a temporary period of time while we operate on them or while they're out of commission or for whatever reason we need to. And certainly we have a lot of devices that we can use to artificially make the heart pump now that are much smaller and again wouldn't be used in a car. But this was, I mean, this was a landmark moment because this was the first time that a machine was used to pump blood through the body while a heart procedure was performed. And while this exact model didn't lead to what we use today, it definitely is a big piece of the story.

And it's really, it was really interesting because as I found this, I was reading all these sort of survey articles of like the history of cardiac surgery. And this isn't given enough, like mention or credit, like Detroit, you should demand this. This was a huge accomplishment. And it, it's kind of glossed over. But it really was. And you should demand this. This was a huge accomplishment, and it's kind of glossed over, but it really was, and you can find this, so if you wanna see the original.

Oh man, if this is the Huntington though, you all got like cars and lots of music and stuff. Like if this happened in Huntington, it would be all we talked about. It would be the mascot of the city, like Robie the robot heart, for sure. Yeah, we talk a lot about like, Chili Fest.

Chili Fest, like Billy, like Billy Crystal went to Marshall for a year on a softball scholarship. Like that's what we, You know, the voice of Chuck is actually from Huntington. That's true though, he's right. Jennifer Garner is from Charleston, which is 45 minutes away, but that's really close.

She probably likes WVU. If you want to see the original, what they call the Michigan Heart Machine, it is at the Smithsonian. So you can check out the original. They built another model that is in the Harper Hospital lobby, I believe. I have not been there, but perhaps someone here has.

And there's another on display at the GM Heritage Center. They built like four of these different ones and then they would add on to them to add oxygen so that it would be not just a heart machine, but a heart and lung machine. And like I said, it wasn't, well, this exact model, obviously you would notice if you had seen this, if this was in operating rooms,

someone would have noticed. It was a, it's a big piece in the story of how we learned how to operate on the heart. So thank you Detroit. Congratulations Detroit. That is gonna do it for us for this episode of Sawbones. We wanna thank the taxpayers for using their song, Medicines, as the intro and outro of our program.

That's gonna do it for us. Until next time, my name is Justin McElroy. I'm Sydney McElroy. And as always, don't drill a hole in your head. Thanks. Woo! Yeah! Yeah!

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