When Dr Christiaan Barnard stared down at the open chest of Louis Washkansky waiting for an electric shock to bring him back to life with a new heart, there was no going back. It was a Sunday morning, 6AM, on December 3, 1967. This was the moment Barnard, and his team of 30 surgeons, were waiting for; the day two lives became one.
The remarkable story is told by Christine Heydenrych, at the Heart of Cape Town museum, in the city’s Groote Schuur Hospital. It was here, half a century ago, in the hospital’s green-tiled theaters, the first successful human-to-human heart transplant was performed.
The history of this hospital is as much a part of Heydenrych herself. She began working as a pathology technician in the hospital, days after the heart transplant, when they were considered to be state-of-the-art.
“I used to see Dr Barnard walking these very halls, but I was just a lowly lab technician and would never talk to him,” she says.
Visiting the museum is worth the effort. The details of the day are made real thanks to a mass of silicon models. Lifelike dioramas depict surgeons, lab technicians and nurses, all dressed in their surgery gowns, crowded around the body of Washkansky.
It’s like being transported back to 1967.
This was the year of the Summer of Love. LP record players rocked to The Beatles’ Sgt. Pepper’s Lonely Hearts Club Band and The Monkees’ Daydream Believer. The likes of Bonnie and Clyde and the Disney’s The Jungle Book premiered in the movies and things like ATMs, the hand-held calculator, and the patent for the first computer mouse were technological breakthroughs.
Listening to Heydenrych are dozens of children from the Sea Point Primary School, who sit in the same viewing stands that medical students watched the surgery from.
The children say the operating theater isn’t like what they see on TV. This is because the museum has spent the past 10 years sourcing equipment Barnard and his surgeons would have used that day.
Everything in the theater is laid out to create an authentic representation of the pioneering operation.
The events preceding the surgery were tragic. It was a fresh summer Saturday in Cape Town, the kind of day locals spent outdoors at markets with thoughts of Christmas just around the corner.
Donor Denise Darvall, with her parents and younger brother, were on their way to buy a cream cake for their afternoon tea. As they were crossing Main Road, a kilometer from the hospital, a drunk driver knocked them over.
The accident claimed two of their lives, Darvall and her mother. The 25-year-old Darvall was taken to Groote Schuur and admitted to casualty where it was declared she had suffered severe trauma to her head.
At this time, a flurry of phone calls and decisions followed. Barnard and his team were notified that Darvall was to be a donor. The patient was 53-year-old World War II veteran Washkansky, who had been placed on the list for a new heart, having suffered from an incurable heart disease and diabetes.
Darvall was declared braindead and brought to the hospital’s Theatre B, the donor theater, shortly after midnight. She was prepared for surgery, by Dr Marius Barnard, Christiaan’s brother. By 3AM, Darvall’s heart was harvested for transplantation into the recipient Washkansky who lay waiting in the adjoining Theatre A. Her kidneys were also harvested and sent to the city’s Karl Bremer Hospital.
In Theatre A, Barnard sewed the donor heart into place in Washkansky’s chest. At 06:13AM, Washkansky’s new heart beat. Barnard looked at his team and said in Afrikaans “Dit gaan werk!” – “It’s going to work!”.
In total, the operation lasted four hours and 45 minutes.
Back in the same theater 50 years later, the bright young faces in the viewing deck are in wonder, and for some in shock, that such ‘old school’ equipment could have lead to the miracle which was the gift of a human heart.
New Kids On The Ward
These days it’s hard enough for doctors, let alone children, to imagine the pioneering days of Barnard.
“A lot has changed, from the procedure itself to reducing the need for transplant by trying to manage the cause of heart failure and the introduction of device therapies. Cardiology has become so advanced that most procedures are done by interventional cardiologists. This decreases the number of patients subjected to open heart surgery,” says Dr Viwe Mtwesi.
From the more modern hallways of Soweto’s Chris Hani Baragwanath Hospital, Mtwesi made history when she graduated from the University of the Witwatersrand to become South Africa’s youngest black female cardiologist.
Much like Mtwesi, Barnard was also a prodigy. Born in 1922 in Beaufort West, a small town in South Africa’s arid Karoo, Barnard is described as driven, commanding respect as well as dislike.
He studied medicine at the University of Cape Town and went to Minnesota University. After obtaining an MSc and a PhD, which he took two years to complete instead of the average six, he returned to Cape Town in 1958.
“Barnard is an icon of cardiothoracic and cardiology fields. He made his mark and made us realize as we grow that there is talent in Africa, and that we can also be pioneers in our own spaces. I treasure his work, boldness and pioneering spirit,” says the lively 32-year-old Mtwesi.
The year following the first heart transplant, 100 more were performed by doctors around the world. The survival rate was low – two out of three didn’t make it past three months. Washkansky only survived 18 days.
Thanks to doctors like Barnard, Mtwesi works in a very different world of medicine. Half a century later and 3,500 heart transplants are performed yearly, with survival periods averaging 15 years.
According to the Guinness World Records, the longest surviving heart transplant patient is Ted Nowakowski from the United States, who has lived for 34 years since his transplant on April 25, 1983.
These days the CAT scan, MRI and ultrasound are common tools for the modern doctor. Medicine has taken giant steps thanks to computers.
“[I’ve seen a heart] many times, I work with the heart and, through imaging and in the operation room when I watch procedures by surgeons.”
Called Cardiac Imagining, doctors these days are able to scan and create a 3D real-time video of patients’ beating hearts. This allows doctors to detect heart conditions without the need for costly and invasive procedures.
“[I’ve seen a heart] many times, I work with the heart and, through imaging and in the operation room when I watch procedures by surgeons,” says Mtwesi.
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The demand for organs is higher than ever, with waiting times that can be longer than four years in some countries. In South Africa, the Organ Donor Foundation of South Africa says there are approximately 4,300 patients awaiting life-saving transplants, but only 512 transplants were performed in 2016, 25 of them being heart transplants.
What makes Mtwesi’s journey into health even more remarkable is that she didn’t intend to be a doctor. She ended up doing medicine after she was rejected from engineering.
“Knowing that I’m there to help and seeing patients get well is motivation enough, in spite of the working conditions. Sometimes you feel like leaving but when you think about poor people who have no money or medical aid you just stay. I love being a doctor, I would not ask for any other job.”
She does however feel the profession has some challenges. She believes she can make a difference in overcoming gender inequality so that other women can also be doctors.
“The industry is male-dominated, with less than 15 female cardiologists in the country. So training was not easy due to a lack of female mentors. The specialty requires hard work, determination, sacrifice and boldness.”
“Very often you have to work extra hard to prove yourself, [prove] that you are capable as a female. I’m passionate about breaking this norm, females need to join male-dominated fields, they need to understand that they are capable, and there is no line of work that is just meant for males. These stereotypes need to be broken and females need to take themselves seriously before other people do.”
“I am a living testimony of the fact that females in the health sector can do anything. I’ve taken it upon myself to try and help young girls in medicine. We need more and more girls to join and even do better than I’ve done, achieve more and be pioneers of discoveries in cardiology.”
The future for Mtwesi is very bright. In 2018, she intends to go overseas to do electrophysiology, a specialized sub-specialty of cardiology.
“Cardiology is a super specialty already, meaning that only specialists are accepted or allowed to super-specialize in cardiology.”
Much like Barnard, Mtwesi can only dream what medicine will look like another half a century on.