SAVING THE HEART

Entertaining, enlightening, and often hair-raising: a history of the development of medical and surgical treatments for coronary-artery disease. Klaidman (Kennedy Institute of Ethics, Georgetown Univ.; Health in the Headlines, 1991, etc.) looks at how the contributions of various clinicians, biomedical engineers, and entrepreneurs developed the patchwork of options used by today’s physicians. His starting point is the 16th-century anatomists who first drew the details of the heart’s structure, showing the coronary arteries (those vessels that serve the heart muscle itself). He fast-forwards to 1912, when James Herrick published an article in the Journal of the American Medical Association in which, “by careful comparison of the symptoms of living patients to those who died and were shown to have blocked arteries, [he] demonstrated that coronary artery disease was recognizable in living patients.” Klaidman’s realistic description of how Werner Forssmann was able to perform the first cardiac catheterization—on himself!—in 1929 is particularly unsettling, but as the author makes clear, he was far from the only inventor—guinea pig working in this field. After tracing the development of the heart-lung machine and, from there, bypass surgery in all its incarnations, Klaidman pays homage to numerous individual heart patients who died to pave the way to the current state of the art—many lost during procedures that would not be allowed under today’s ethical guidelines. Then he addresses what sort of temperament and training make a successful cardiac surgeon. Throughout, his narrative is illustrated with gripping clinical accounts, like that of a man who woke up to feel “my chest . . . collapsing in on me. . . . I had a pain like someone had attached a 220 electric line to my chest. . . . I thought: ‘Well, this is really interesting, it’s 6:20 a.m. and I’m having a heart attack.—” This patient’s treatment and prognosis make clear what advances in heart treatment mean in human terms. An eye-opening account, tied in to today’s reality.