The Heart Healers (34 page)

His open and honest attitude dissolved any residual skepticism. Gruentzig was his procedure’s most severe critic, predicting that it would only be applicable in 5% of patients with CAD. On this single point he was vastly mistaken, proving why there are far more medical historians than prognosticators. Today I see few coronary lesions during our weekly catheterization laboratory conference that are beyond the reach of interventional cardiologists.

Gruentzig held three courses in Zürich. At the end of each course he put on a spectacular informal party at an exotic location. He tried to meet each individual attendee. At his final Zürich course in August 1980, Andreas Gruentzig invited Crazy Charlie Dotter, Mason Sones, Melvin Judkins, and other pioneers that made his own success possible. He chose a mountain high above Zürich’s lake. At the end of the dinner, Gruentzig passed torches to each attendee beginning with Sones, Dotter, and Judkins. Sones, tipsy as was his wont, disappeared into a ditch on the trek downhill. When he was missed and retrieved, he had his rescuers take him to the wrong hotel. But the moment of symbolism could not be missed, the cardiologic equivalent of John Kennedy’s inaugural speech, “Let the word go forth from this time and place, to friend and foe alike, that the torch has been passed to a new generation … born in this century, tempered by war, disciplined by a hard and bitter peace.” Gruentzig, the acknowledged champion, now was known by a single name, Andreas. Theirs was a movement whose members glowed with a sense of camaraderie and shared vision bequeathed by Andreas. They were marching forth to create a new worldwide subspecialty. They would call themselves interventional cardiologists. Perhaps Andreas imagined it even then, I know I did not: interventional cardiology now dominates the present and the future of cardiac therapy.

Meanwhile Gruentzig’s bosses made themselves the poster boys for the classic three phases of the establishment’s reaction to new ideas:

1) It can’t be done.

2) It probably can be done, but it’s not worth doing.

3) I knew it was a good idea all along.

By the time they arrived at stage three, however, the East German Andreas Gruentzig, low man on their totem pole, let the world know that he was thoroughly fed up. He felt that he was more respected throughout the world than he was at home. He felt he needed to realize his potential in a more open society. He wanted to resettle in the United States. I tried to lure him to Cedars-Sinai, and the Cleveland Clinic made their pitch. But we were too late. Dr. Spencer King, the consummate Southern gentleman, had charmed the Charmer. He enticed Gruentzig to visit him in Atlanta. Gruentzig joined the Emory University staff. For charismatic Andreas, leaving the confines of Zürich had an eerie similarity to Christiaan Barnard sallying forth from Cape Town fifteen years earlier. Would he succeed or would he encounter unanticipated consequences?

19

CONQUERING ATLANTA

Never regret thy fall, O Icarus of the fearless flight! For the greatest tragedy of them all. Is never to feel the burning light.

—OSCAR WILDE, IRISH DRAMATIST

FOR ANDREAS GRUENTZIG
his move to the United States was like bursting from underwater to gulp a breath of fresh air. Professionally shackled in Zürich, he arrived with instant celebrity in Atlanta. At Emory soon after his arrival, swashbuckling Andreas decided to undergo coronary angiography. His coronary arteries, of course, were entirely normal. With a typical Andreas flourish, despite the puncture in his femoral (leg) artery, he went dancing in public that night. In Atlanta, Andreas’s creativity and spellbinding teaching were expressions of a flamboyance that bubbled through every aspect of his life. Being with Andreas was like being in a cyclone. He had equal passion for partying and for work. He charmed people, particularly ladies, and he could light up a room with his zest for life. He seemed gloriously happy with a glass of wine, playing the piano, and singing. He was an elegant dancer, tall, graceful, athletic, and so strikingly handsome. One of his nurses captured him perfectly: he was an alchemist’s version of Clark Gable, Errol Flynn, and Omar Sharif. Yet Andreas made no social distinctions. Even with the acclaim that showered upon him, he was as friendly to trainees and staff as he was to those in positions of power.

The passion for life so apparent in his social life shone through his patient care, teaching, and medical research. In a seminar setting, if there was a Magic Marker and a whiteboard handy, he became a consummate artist drawing the heart and blood vessels. His hand-eye coordination extended to the catheterization laboratory, where he was an artist with catheter manipulation.

With fame came a flood of angioplasty referrals to his partnership with Drs. Spencer King and John Douglas. With the referrals and catheter company contracts came sudden wealth. You said Andreas to any cardiologist anywhere in the world and he knew you referred to the acclaimed, elegant, handsome, smiling, multilingual center of Atlanta’s medical and Emory hospital society. Andreas loved the attention, but his wife Michaela did not. She returned to Zürich with their daughter, Sonja. Andreas’s wandering eye settled on a new companion much younger than him. Margaret Anne Thornton was a bright young medical student with the classic good looks and charm of a Southern belle. Andreas was smitten. They were married in 1983.

Andreas’s life morphed into the antithesis of his former life in Zürich. He bought a mansion. He and Margaret Anne put on lavish parties there at the end of his angioplasty teaching courses. He bought a Porsche. As he had in Zürich, he drove recklessly. He bought a vacation home on Sea Island, about an hour’s flight south of Atlanta. To travel to Sea Island, he bought a powerful private plane, a Beechcraft Baron, and became a pilot.

According to his biographers David Monagan and David Williams, in his transition from Zürich to Atlanta some felt that Andreas’s values changed, whereas others saw a natural progression that accompanies sudden new wealth and a new young wife. Some of the wives who knew his first wife, Michaela, remained loyal to her, making the relationship with Margaret difficult. His detractors muttered that he was becoming a modern Icarus, flying too close to the sun for his own good, while his supporters countered that no one soars too high if he soars on his own wings.

Andreas began leaving work at 5 p.m., putting strain on his professional relationships. Soon we heard that he was looking at other opportunities, at the possibility of leaving Atlanta to join his friend Richard Myler in San Francisco.

On a Friday in late October 1985, Andreas performed an angioplasty on a vascular surgeon, then hurried to fly with Margaret and their two dogs for their weekend in Sea Island, anxious to beat a powerful incoming storm. On Saturday morning he received a call that the coronary artery he had treated was closing, and that his partners Spencer King and John Douglas were taking his patient back to the cath lab. By now Hurricane Juan began to unload on the Southeast. Juan would ultimately kill sixty-three people and cause $1.5 billion in property damage. From his Sea Island cottage, Andreas looked out at torrents of rain slamming into the sand, steps away from frothing waves churning an angry Atlantic Ocean. Margaret’s instinct was to hunker down, but Andreas, who had five cases scheduled for Monday, felt he was obligated to get back to Atlanta. He argued that he had some experience flying in bad weather, and that his new Beechcraft Bonanza had sophisticated instruments. Andreas checked with meteorologists, who reported that Juan’s force was already dissipating over Georgia. His plane was at St. Simons’s McKinnon Airport, just five minutes away. The control tower informed him that his planned northwesterly route from the airport to Atlanta was not particularly violent, although visibility was poor.

Andreas made his decision. He and Margaret and their two Irish Setters, Gin and Tonic, would fly at 3 p.m. Just as they were leaving Margaret’s mother called to say she had heard a very different forecast, that Georgia was still being deluged. She begged them to reconsider. Her entreaty was ignored. Andreas couldn’t wait; his compulsion for action took over. He would fly. As he prepares to return to Atlanta, let’s meet one of my friends who owed years of his life to Andreas’s balloon.

*   *   *

I KNEW AARON
Stein as a friend for many years before I knew him as a patient. Aaron was about ten years older than me when I first met him. He was a short, balding, slightly overweight man in his mid-fifties whose preferred attire was shorts, a Hawaiian shirt, and sandals. His unimpressive features camouflaged his strongly held opinions and his intolerance of fools. He liked to describe himself as a nice Jewish boy from Brooklyn. But he wasn’t. Aaron’s street-smart intelligence poked up its head in every conversation, often with a scathing and hilarious wit. He was a tough, motivated, highly successful entrepreneur in the import-export business. He prospered as most of his competitors fell by the wayside. His secret lay in combining impeccable taste, a network of contacts in Asia, a willingness to use money to make things work, and tough negotiating with those who supplied him services. He was not in business to make friends.

Aaron had a youthful joie de vivre that made it seem like he would outlive us all. I was a little surprised when he called to say, “Jim, I went in for a routine physical and now my family doc is trying to tell me I have diabetes. I don’t have diabetes. I don’t add sugar to my coffee, I don’t eat sweets, I cut the fat off my steaks, and I walk on the beach a couple times a week.
Goyishe kopf.
I shouldda gone to Bernstein. Can you talk to him?”

I had learned long ago never to challenge a family doctor with a curbstone consult unless you have the all information he has. So I called Aaron’s doctor. Aaron’s blood tests spoke clearly. He had diabetes. Worse, the doctor’s opthalmoscopic exam of his eyes, which provides a direct view of arteries as they traverse the retina, revealed that Aaron had advanced atherosclerotic disease in his blood vessels.

When I got back to Aaron, he was as feisty as ever. Pointing an accusing finger at me as if I had joined the doctor’s conspiracy against him, he challenged, “You tell me why I have diabetes when I am not obese?”

“Aaron. How did your parents die?” I asked. His father and his grandfather had early heart attacks and his mother had a stroke.

“It’s in your damn genes, Aaron,” I said. “Blame your parents, rest their souls.”

When a disease is chronic and progressive, the doctor-patient relationship can subtly evolve as the disease progresses. At this point in his illness, my role was to be unyielding, like a parent finding the delicate balance between affection and authority. First Aaron had to admit he had a problem, and then take responsibility. “Aaron, listen to me. Stop arguing. This is what you need to do.” I demanded he alter his diet. He resisted. I asked about exercise. He shot back, “I already get enough exercise on the golf course. When my friends collapse, I run for the paramedics.” That was quintessential Aaron. But like the good child, in the end he listened.

Soon after Aaron’s diagnosis, however, he began to have typical angina. A fiftysomething man with diabetes, typical angina, and vascular changes has a very high likelihood of having obstructive atheromas in his coronaries. Drugs proved insufficient to relieve his symptoms. I referred Aaron to Steve, one of the most talented interventionalists on our staff. As we expected, Aaron’s coronary angiogram revealed CAD. Faced with a choice between the scalpel and the balloon, Aaron chose the balloon. Balloon angioplasty completely relieved his angina. But was that sufficient to slow his disease?

*   *   *

ANDREAS TOOK OFF
for Atlanta under the watchful eyes of air traffic controllers in Jacksonville, Florida. He took off east, turned north, and quickly rose to 11,000 feet. He would be handed off to Atlanta Approach Control, and given exact instructions for his descent into the congested skies of Atlanta. As he approached Macon, Georgia, there were patches of heavy rain and dense fog, with cloud cover beginning at 600 feet and visibility to three miles. The conditions were challenging, but not difficult for an experienced pilot. Below him on the ground the fog was so bad that as he drove toward Macon to visit his mother, Spencer King reversed his course and went back home to Atlanta.

About ten minutes into flight, Andreas received his instructions from Atlanta Approach Control to descend to 5,000 feet, and perform a 360-degree clockwise loop, which was designed to delay him for a few minutes so that he could get in line for final descent into the Atlanta corridor. Andreas acknowledged the instruction. It was the route he had flown innumerable times on his return home from Sea Island. But instead of turning northwest, Andreas inexplicably turned southeast. A few minutes later, he reported that he had a malfunction in his autopilot system. Clearly he believed that he had turned northwest and now did not believe his instruments telling him he was flying southeast. Andreas’s quaking voice revealed he knew he was in terrible trouble. “I have to fly with my backup,” he reported. “The autopilot and whole first system is gone.” Three minutes later his Beechcraft Baron 583AM disappeared from Macon’s radar.

In a pine forest near Bolingbroke, Georgia, about eight miles northwest of Macon, deer hunters were hidden in a tree stand peering into the fog when they heard a high-pitched shriek like a World War II dive bomber, followed by an earthquaking explosion. Soon thereafter police, alerted by a nearby resident, found the wreckage of a plane. Clothing dangled from the broken limbs of pine trees surrounding a thirty-eight-foot crater. The devastation at impact made it impossible to identify the occupants. They found a few pages of a cardiology manuscript, and an emerald ring. Protruding from the wreckage like a memorial tombstone was the Beechcraft Baron’s tail with its painted identifying logo, 583AM, chosen by Andreas and Margaret to commemorate their marriage in the fifth month of 1983.