Wednesday, 16 July 2014

The Hot and the Dead – Dr Vivien Thomas

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Heartbroken? Feeling blue? Trying to learn how to redirect subclavian arterial blood to the pulmonary artery? Then you need a Vivien Thomas!

If you’re unfamiliar with Dr Vivien Thomas, stereotype-smashing surgical technician and champion of paediatric cardiology, you’re not alone. Also, keep reading, because I’m about to write quite a bit about him, and if you read it you’ll learn things, save yourself a trip to the library and help pad out my résumé.

It took the world a long time to understand and acknowledge the contributions Dr Thomas made to the development of life-saving techniques and the acceptance of cardiac surgery as a viable treatment for heart defects. A large part of his obscurity was due to the widely accepted notion at the time that young African Americans should “know their place”. And their place was not generally considered to be “standing in an operating theatre being a frikkin’ genius”.

So what did he do, exactly?

First, he was born in Louisiana in 1910, son of a carpenter and grandson of a slave. But that’s not the best bit.

Next, he was educated at Pearl High School in Nashville, where he dreamed of going to medical school. After graduating, he spent the summer working as a carpenter to help fund his tertiary education. Then the stock market crashed all over his plans.

Along came the Great Depression, sitting on Thomas’ educational future with its great bony bum and wriggling around a bit. His carpentry work dried up and Vivien, like so many others, took to scrounging for whatever work he could find to feed himself, much less pay for college. This is definitely not the best bit.

Eventually, though a friend he knew at Vanderbilt University, he scored a job as a surgical research technician in a medical lab there. A surgical research technician is the person who prepares surgical research subjects (usually animals)* for operations, with drips and equipment and sterilisation and such. Thomas was assistant to Dr Alfred Blalock, a surgical resident investigating the causes and treatment of shock. Not the oh-no-I-drove-off-with-my-coffee-on-the-roof kind of shock; the other one.

Most 20-year-olds might spend their first week of work learning the filing system or where the sticky-tape is. Vivien Thomas spent his first week anaesthetising dogs. Within the first month, he was assisting with surgery and playing an instrumental role in determining the cause and effect of traumatic shock and haemorrhagic shock. Blalock’s research, facilitated by Thomas, proved that shock could be effectively treated with fluid replacement, advanced the understanding of crush injuries, saved many lives during World War II and made Dr Alfred Blalock famous.

Blalock and Thomas turned their attention to heart surgery, which in the late 1930s was still considered a bit of a risk. And by “bit of a risk” I mean “sure, give it a crack if you want all your patients to die and mess up your floor”. But Blalock was game, and Thomas was gorgeous. I mean capable.

When Blalock accepted Johns Hopkins University’s invitation to be Chief of Surgery, he brought Thomas with him. There, Blalock collaborated with Helen Taussig, an acclaimed paediatric cardiologist, who was interested in a surgical solution to a particular heart condition, and had heard that he and Thomas had the skills, experience and gigantic balls to try it

Taussig’s particular interest was in Tetralogy of Fallot, which is either a congenital heart defect involving four anatomical features or a character in a Tolkien novel. This defect prevents the heart from sending blood to the lungs, resulting in “blue baby syndrome”. If you were born with Tetralogy of Fallot in the 1930s, your prognosis was quite purple and not very good. Blalock and Thomas were able to figure out a technique, based on their tinkering at Vanderbilt, which would divert blood from the subclavian artery to the pulmonary artery, effectively increasing the blood flow to the lungs and improving oxygenation. Or, in layperson’s terms: Turn sad blue baby happy pink** YAY.

Before Dr Blalock could try his technique on baby humans, it had to be tested. And that job was Thomas’. Over the next two years, Thomas tested the technique on around 200 dogs. Because of Thomas’ hard work, dedication, beautiful hands and incredible mind, the technique was eventually refined to the point at which it could be safely attempted on humans. Thomas was not allowed to perform surgery, so he stood by Dr Blalock’s shoulder and instructed him through the technique, step by step. Blalock performed the procedure several times successfully, each with Thomas by his side, coaching and advising his senior. And that, my friends, is the good bit.

News of the new technique spread far and wide, and families came from across the US to benefit from Thomas’ brilliance. Naturally, Thomas was rewarded with an enormous pay rise, his own bathroom, a Nobel prize and a new suit made of gold and rubies. At least he would have been, if all this hadn’t happened in Baltimore in 1944, where segregation was in effect and politicians campaigned for the “white man’s city”. Thomas got very little recognition, and even less coin.

As a black man in a white coat, Thomas was considered quite an anomaly. He was paid a wage roughly equivalent to that of a cleaner. To make ends meet, he would sometimes work as a bartender at Blalock’s cocktail parties, serving drinks to doctors he had instructed in surgery earlier that day. And despite years of work on hundreds of patients, he was given no credit for the procedure he helped to develop – it was named the Blalock-Taussig shunt.

The 1940s rolled on, and Thomas trained many students in surgical techniques, and even scored a pay-rise at the suggestion of Blalock. His boss and mentor died in 1964, and Thomas continued at Johns Hopkins for nearly two decades, becoming director of surgical research laboratories and later receiving an honorary doctorate in 1976.

After a long, stellar and belatedly recognised career finding better ways to save lives, Dr Vivien Thomas died in November 1985 of pancreatic cancer.

I have one more, rather soppy, thing to say about Dr Thomas. I’m not dead. I didn’t die. I was born blue and struggling for oxygen, and if it wasn’t for the Dr Thomases of the world, I wouldn’t be here to write soppy things like this.

I would also like to thank all the dogs.

*All people wishing to launch into a long and complicated debate about whether or not performing surgical research on animals is a good thing to do: please form an orderly queue on the left.

**All people wishing to point out that not all babies are pink: noted. In a 1930s private university hospital in Baltimore, however, most babies were.

Vivien Thomas



Shelley Stocken

Shelley Stocken is a freelance writer when she’s not feeding, clothing and wiping family members.

Follow her on twitter @shellity