Dec 10th 2009, 00:00

Looking into a living body without a heart in the chest cavity was a moment that altered history. Like stepping onto the moon, it crossed a frontier of what people considered possible. 021 recreates the drama of the first heart transplant that took place at the Groote Schuur Hospital in Observatory. Rushing towards town at Hospital Bend on the N2 is not the best time to appreciate the splendours of Groote Schuur Hospital. The imposing historic architecture is hardly visible behind the huge modern concrete wing blocking it from view. The other side of the freeway might be more serene, with springbok and mountain zebra roaming on the grassy slopes of Devil’s Peak, but the flurry of 2010 construction activity on the road itself lends a rather hazardous note to your car-window safari. So slow down and follow busy Main Road in Observatory towards the hospital’s inner courtyard. It is here, that you can travel back 42 years to an event that put South Africa in the global spotlight. Outside South Africa, the mid-sixties arrived in a purple haze of paisley stripes. Worldwide, it was a time of rebellion, a refusal to stay within limits. The economy was booming and science was pushing boundaries. Two scientific innovations in particular gripped the attention of the world: space exploration and heart transplants. Both expanded the notion of life itself, and what is possible. The cool charms of the moon offered space and freedom, whereas heart transplants drew deep into the mystery of our own body and redefined what it means to be alive – and dead. The race to perform the first heart transplant is thrilling from the outset. The starter gun fires on 22 July 1958 when the pioneers of heart surgery, Norman Shumway and Dick Lower, succeed in bringing a dog’s heart back to life after storing it in saline for one hour. Imagine the implications. If a heart that has stopped beating can be brought back to life, how close are we to resurrecting the dead? In 1959, the two surgeons transplant a dog’s heart. The dog lives for eight days. But it is an outsider, a South African from the small town of Beaufort West in the Karoo, who is destined to seize victory. Professor Christiaan Barnard’s mythology is well known. One pertinent detail sums up his considerable willpower. In 1956 he enrols at the University of Minnesota to train in the department of cardiothoracic surgery. On learning that a PhD takes six years to finish, he announces that he’ll complete it in two. True to his word, two years later he receives his PhD thesis on the Aetiology of Congenital Intestinal Artesia, adding a Master of Science in Surgery for good measure. Impressed, his professor awards him a generous bursary from the Oppenheimer Memorial Trust and a heart-lung machine, a vital component in heart-transplant operations. When he returns to Groote Schuur, he is soon appointed head of the department of Cardiothoracic surgery. In 1960, Barnard transplants a dog’s head. In September 1966, after watching Dick Lower transplanting dogs hearts, he vows, ‘I’m going faith, Mr Washkansky, fighting for breath, agrees to risk the groundbreaking surgery. When Barnard explains the procedure to Mrs Washkansky, she cries in anguish, ‘But he won’t be the same man if he has someone else’s heart in his body.’ Returning home from the hospital, Anne Washkansky, unaware of the strange synchronicity at play, slows down and shudders as she passes the accident in Salt River. Barnard and his team of 40, poised on the brink of attempting the most daring operation in history, wait anxiously for a donor. Soon after Denise is brought to the hospital, two neurosurgeons declare her brain dead. As the current law in South Africa doesn’t detail the specifics of ‘being dead’, Barnard has sufficient justification for the removal of her healthy heart. Tests reveal Denise to be a perfect donor. One doctor reports, ‘If they’d been identical twins, they wouldn’t have been a better match.’ 11pm: Denise’s father, sedated and wracked by grief at the loss of his wife, is told that while Denise can never be brought back to consciousness, her heart continues to beat and could be used to save the life of a dying man. He consents to the operation after reflecting for only four minutes, saying, ‘If you can’t save my daughter, you must try to save this man.’ 4 December, 2.20am: Denise’s ventilator is shut off . ‘Alright, start cutting,’ commands Barnard. The medical term for cutting open a body for heart surgery is median sternotomy and hides the brutality of the act. The removal of a heart is a messy business. The heart is nestled behind the rib cage that acts like an iron cage. A vertical cut is made along the sternum that is sawn open with a device like a pastry cutter. The chest is then pulled apart. The heart is cooled to 16°C and the blood flow stopped. It takes two minutes to detach the heart from Denise’s body. The heart is placed in a bowl of salt-water solution with the same chemical composition as a teardrop. Fixing his eyes on the petite girl’s tiny heart, Barnard walks into the adjacent theatre. 3.01am: The donor’s heart arrives at the second theatre. Mr Washkansky is already hooked onto the heart-lung machine that provides his body with oxygen and circulates his blood while bypassing the heart and lungs. Barnard lifts the bloated, ravaged heart out of Washkansky’s body. He peers into the empty cavity of Washkansky’s chest, feeling the enormity of the moment. It is Barnard’s finest hour, and his most forsaken. Later, he recalls, ‘You can’t imagine how lonely I felt. There was no-

one I could ask, am I doing this right?’ Denise’s heart is placed inside but is too small for the size of the cavity. The area is folded to make it fit snugly. Denise’s heart is stitched to Mr Washkansky’s arteries using silk thread. There is a hushed silence while the team waits to see if the heart will start beating when the blood comes back in. Barnard recalls, ‘The heart lay paralysed, without any sign of life. We waited – it seemed like hours – until it slowly began to relax. Then it came, like a bolt of light. There was a sudden contraction of the atria, followed quickly by the ventricles in response – then the atria, and again the ventricles. Little by little it began to roll with the lovely rhythm of life.’ As soon as they switch off the bypass machine, however, the heart falters. They revert to the pump and try again after five minutes. The pump is cut and they make another attempt. 5.58am: The heart begins to beat steadily. A triumph in medical history. With the transplant, the course of medicine is changed forever. The following day, the image of Mr. Washkansky, smiling beatifically from his bed, with the headline ‘I was given a second chance,’ is wired across the globe. A media sensation ensues. To receive another’s organ is an act of intriguing intimacy. For a 53-year-old man to be given the heart of a 23-yearold girl has, for some, a touch of blasphemy. However, most people root for Mr Washkansky’s heart (or does etiquette, or logic, require that we refer to it as Denise’s heart inside Mr Washkansky’s body?) The initial euphoria would last a mere 18 days until Mr Washkansky dies of pneumonia, probably as a result of the massive dose of steroids he was given to prevent organ rejection. Christiaan Barnard, always hard on himself, says ‘I actually killed him.’ Mr Darvall finds the termination of his daughters heartbeat for the second time as a double loss. Mr Darvall described himself as ‘completely destroyed’. A new era in medicine was accompanied by the eternal human emotions of hope, fear, joy and grief.

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