D.T. Siebert
You Bet Your Life might seem an unlikely title for a book documenting amazing medical achievements. However, Dr. Paul A. Offit emphasizes that almost any medical procedure is fraught with some degree of risk. The ultimately lifesaving advances he documents—almost without exception—also include tragic episodes of failure. One can take two aspirins with little risk, but heart transplantation, for example, is a different story. In its dawning, heart surgery involved an extremely high percentage of patient mortality. Now, this type of surgery is almost routine—with a success rate of about 90%. But that percentage is hardly 100%, as Offit reminds us throughout his book. Besides heart transplants, Offit treats breakthroughs in anesthesia, blood transfusion, antibiotics, vaccines, radiography, chemotherapy, and gene therapy—with a brief inclusion on the recent Covid-19 pandemic.
Offit’s first detailed history is that of heart transplants, which had their beginning in the 1950s. Slightly antedating heart transplantation—but not mentioned in Offit’s book—was open-heart surgery itself, whose pioneer was Dr. C. Walton Lillehei of the University of Minnesota Medical Center. His achievements are featured in a quite interesting book, G. Wayne Miller’s The King of Hearts, which might appeal to readers of Offit’s own book. I might note that my own wife, Annette Kennedy, at the age of five, was one of Lillehei’s successful patients, indeed among only a few successes at that time; also that the famous Dr. Christian Barnard (see below) was trained by Lillehei—as were many early cardiac surgeons.
Early attempts of giving a patient a viable new heart were failures. The earliest experiments involved transplanting hearts from animals. Recipient patients might live for a short time but would inevitably succumb to heart failure. Both rejection and infection proved to be stumbling blocks.
Then appeared a previously unknown South African surgeon, Dr. Christian Barnard. Offit’s dramatic account of Barnard’s first human-to-human heart transplant is exciting. The heart recipient survived for only seventeen days, but determining the precise balance between rejection and infection ultimately proved the answer to much longer survivals. In any case, a medical miracle had just happened.
Barnard soon became an international celebrity. Offit spins a good tale of Barnard’s rise and fall. Barnard appeared on the covers of news magazines and on TV screens. “He had lunch with Sophia Loren, was invited to Dean Martin’s Hollywood home and Peter Seller’s yacht, and had a very public affair with Gina Lollobrigida. ‘We celebrated with champagne several times during the night and I left early the next morning,’ said Barnard. ‘She drove me back to my hotel in her Jaguar—absolutely naked in her mink coat.’” He traveled around the world to receive tributes. Even Pope Paul VI granted him an interview. He was on the top of the world, but hubris often leads to a reverse of fortune.
He divorced his first wife and remarried twice—first a 19-year-old heiress, and later a model 28 years younger than he. Eventually his professional vanity, his flamboyant lifestyle, and his promotion of medical nostrums led to his being ostracized by the medical profession. At the age of 79, while vacationing in Cypress, he died of an asthma attack. Offit notes that Barnard was “still lamenting that his third wife had left him”—and he died alone. Offit offers this poignant F. Scott Fitzgerald remark: “Show me a hero, and I’ll write a tragedy.”
Another interesting chapter concerns the development of anesthesia. Perhaps we never realize how excruciating it would have been, at least until the latter 19th century, to find ourselves under the knife. Before effective anesthesia, surgeons had to operate as quickly as possible to limit the extreme agony of patients, and indeed to minimize the surgeons’ own distress in performing the operation.
Offit describes the discovery of three reasonably effective methods of general anesthesia—nitrous oxide (laughing gas), chloroform, and ether. Each has a history of success and limitation. Nitrous oxide is still used in dental surgery, but it works only for a limited amount of time—thus making it unsuitable for lengthy surgery. Chloroform is effective, though with risks of cardiac arrest and other problems. Of the three, ether is the most effective, although its flammability in the operating room is problematic. (T.S. Eliot’s famous poem “The Love Song of J. Alfred Prufrock” begins and ends with an operational ether dream.) Thankfully, recent advances have made anesthesiology reliably effective, but even in this case, no medical procedure is without risk. “You bet your life,” again.
Another very interesting chapter concerns the discovery of X-Rays. A German physicist, Wilhelm Conrad Roentgen, discovered that radiation could penetrate human flesh and display what is inside (1895). Roentgen did note that the mineral lead could block the rays. However, this observation went largely unnoticed—so promising did his discovery seem. There were grim consequences for the researchers and clinicians who enthusiastically embraced this miraculous discovery—that is, without the protection of lead shields. “At a 1920 professional gathering of radiologists, where so many attendees were missing hands and fingers, when the chicken dinner was served, no one could cut their meat.” This is a rather bizarre story, occasionally typical of Offit’s sensational presentation. The source he quotes by name in his text is not listed in his bibliography or endnotes.
Shoe store radioscopes were a less sensational but typical examples of the early X-Ray infatuation in the 1930s-1950s. In fact the last such machine was found in a shoe store in Maddison, West Virginia, in 1981. I recall having my feet radiated while being fitted for shoes. I assume the exposure was too brief and limited to have mattered very much. Now, of course, radiology is carefully controlled, and X-Rays generally involve only a few seconds of exposure.
There is much more information about medical discovery and progress in this book—including interesting anecdotes. Offit’s constant theme is that these invaluable medical advances came often about at an unfortunate price—the cost of human suffering and death.
Reviewer D.T. Siebert (ΦBK, University of Oklahoma) is Distinguished Professor of English Literature, Emeritus at the University of South Carolina. He recently contributed the chapter “Hume’s History of England “ to the Oxford Handbook of David Hume.