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was asked to do. When Chris went back to South Africa he was set on doing heart
transplantation. He had learnt much from Norman Shumway and Lower and from early dog
experiments in Britain, and he went on to do the first human to human transplant. There was
controversy about this, but Chris ultimately pioneered six new heart operations and introduced
the concept of brain death rather than heart standstill as the definition of death.
I was once sitting next to Shumway at a dinner in New York, with a young lady on the other
side of me who was expectant. I mentioned my wife was also expectant. Shumway overheard
and jokingly said “Lars, you are much too old to be having a baby!” I said “Dr. Shumway, you
know I was trained by Dr. DeBakey, and I try and do everything the way he did things. He had
his last baby when he was 73 years.” He had a good laugh for he liked to see people
responses. He told me once he was sitting at a bar and around the corner he heard somebody
saying “you know I was the second person to do a heart transplant in the United States”. He
looked around the corner to see who it was and it was Denton Cooley talking to a young lady.
A friend of mine made the mistake of taking Shumway seriously when teased about DeBakey
and left Stanford where he was visiting for a few weeks. DeBakey was stern and demanding in
the operating room and in ICU. The second year general student resident lived three months in
ICU sleeping in an ICU bed and never was allowed to leave the hospital. If DeBakey did not
like the next resident, then some had to stay on for six months in ICU, as happened to my friend
who visited Shumway at Stanford. On Stanley Crawford's service, the “ICU/Floor” rotation
required working from Saturday morning rounds until the following Saturday and only on
Tuesday and Thursday nights, if it was quiet, could one go home to sleep. Working over 140
hours or sometimes 150 hours, on those weeks was not unusual. Nevertheless, I was never
aware of any human errors committed by residents during those sleep-deprived rotations. Yet
medicine is not the only profession in which sleep deprivation can be a concern. Professional
sailors on around the world or transoceanic sailing sleep one hour and then work for one hour,
alternating the hours. I once demonstrated surgical procedures (thoracoabdominal aneurysms)
while teaching in Sweden and the Chief had to ask for volunteers to look after the patients over
night in ICU. The residents had exceeded their time in hospital, I was told 37.5 hours by
Thursday of the week. One young surgeon volunteered and I asked him if he thought he
received a good training by working a set amount of time a week and what he would like the
hours to be. He said he would like them to be only 25 hours in total! Yet training and
maintaining a surgical competence requires constant operating to maintain skills. As Anton
Rubenstein is said to have commented, “If I don't practice daily, I notice it the next day. If I
skip two days my wife notices. If I skip three days, my audience notices.” Malcolm Gladwell
is famous for saying in his book Outliers that most experts require 10,000 hours to become top
performers at their profession. By my calculations, it takes at least three to four times as much
for cardiac surgeons to achieve peak performance and maintain it.
During my training at Baylor the fellows and residents developed a very close bond from
working hard and helping each other; the brothers in arms for the hunt principal. We often
would recollect what surgeons would say during operations such as: “Have you got hands or
flippers?” “Can you help me without leaving the room?” “Whose side are you on - the
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