He never even wanted to become a doctor.
In college, preferring literature and history to math and science, he applied to law school. Only after reflecting upon the occupations of some of his favorite writers, Anton Chekhov and William Carlos Williams, did he set aside his acceptance letter. If they were doctors, Bud Frazier told himself, he would try it, too.
It proved a fortuitous choice.
Frazier, 67, became a gifted and prolific surgeon at the Texas Heart Institute. More importantly, after a restless youth that took him from Darrell Royal’s two-a-day football practices to Vietnam, the kid who wanted to “make a difference” found his calling. Comfort, fulfillment even, came in treating patients with the sickest of failing hearts.
Recently Frazier performed his 1,000th heart transplant — plausibly more than any other surgeon in the world. He has played a critical role in the development of most of the artificial hearts and pumps in use today. And he has implanted far more of those devices to prop up failing hearts, about 700, than any other surgeon.
More than anyone, then, Frazier can lay a rightful claim to the considerable legacies of Drs. Michael DeBakey and Denton Cooley, titans who made Houston the epicenter of cardiac science during the zenith of their fame.
It’s the joy he gets out of investigation,” DeBakey says of his former student. “Once you have gotten deeply involved in research, you become addicted, and he’s clearly addicted.”
Oscar Howard Frazier was born of sturdy Methodist stock in Stephenville, the son of teachers and reformers. A grandfather dubbed him “Bud” after a distant, gunslinging cousin who died in an 1896 West Texas saloon shootout.
The Methodist roots help explain an aversion to law and business as chosen professions. Both center, ultimately, on making money. Frazier says he has never sent a bill. He doesn’t know the fees for any of his procedures.
During much of his career, the real money has been in coronary artery bypass surgery, not implanting countless experimental cardiac devices into animals within the bowels of the Texas Heart Institute.
That’s not to say Frazier ignores finances, without which it would be impossible to bring life-saving, but costly, heart devices to market.
“Medicine has to work as a business,” Frazier says. “It’s like what St. Augustine said: ‘We try to live in the city of God, but we must live in the city of man.’ “
St. Augustine stands side by side with the heart journals and medical books on his office bookshelf, as do Plutarch, Tolstoy, Faulkner and a host of classics and history volumes. He often carries a book in his pocket — Michael Grant’s The Rise of the Greeks was a recent choice — on medical rounds. He once memorized Hamlet to see whether it could be done.
He ponders his own legacy, too. As a youth, he saw his father’s generation live and die valorously in World War II. What, he wondered, could he do?
The question went unanswered in college, where Darrell Royal asked him to play football for the University of Texas at Austin as a kicker. He did for a few practices, until a serious hamstring injury. After finally deciding on a career in medicine as a senior, Frazier had to cram his pre-med courses into a single year.
He won admission to Baylor College of Medicine on the basis of a single question. The interview took place on July 4, and the doctor asked the history major if anything significant — other than a signing of the Declaration of Independence — had taken place on that day.
Frazier responded with a torrent of answers: Presidents Adams and Jefferson both died 50 years after the signing, it was the last day of the Battle of Gettysburg and the date of Vicksburg’s surrender.
Even in medical school Frazier didn’t gravitate toward surgery until a friend enlisted his help on a research project that would bring him under the team at Baylor developing an artificial heart. The team included DeBakey and Cooley.
An early epiphany
It was at this time that Frazier, a medical student in his mid-20s, had the first of several epiphanies that pulled him toward the sickest heart patients. He recalls making rounds in The Methodist Hospital and coming upon a 19-year-old Italian boy whose enlarged heart had stopped after surgery.
“As long as I massaged his heart, he would look up at me, and he was awake,” Frazier says. “They finally told me to quit and, of course, at that age, I wasn’t going to quit as long as the kid was looking at me. But finally, the chief resident grabbed me and pulled me away.
“And I always thought that we should be able to duplicate the heart’s function some way.”
It was an era of optimism. President John F. Kennedy had announced plans to go to the moon. Doctors at Baylor were predicting the end of heart disease by the 1980s, with 100,000 artificial hearts keeping sick Americans ticking.
“We were going to the moon, and the fact that we were going to make an artificial heart just seemed to be a chip shot,” Frazier says.
As the race to implant the first artificial heart heated up in 1968, Frazier shipped out to Vietnam, serving as a flight surgeon. He was shot down once, and returned home demoralized about what men could do to one another in war.
“I was depressed over the state of man. I had seen all of these young guys killed over there, and that changes your perspective. I wanted to try to do something meaningful with my life. I felt technology could play such an important role with the heart.”
Working with DeBakey
Frazier returned to Houston and became a general surgery resident under DeBakey. Two dozen students started in 1970. Five finished. Then 64, DeBakey arose every morning at 4:30 or 5 a.m. and saw patients. His medical residents never left the intensive care unit, Frazier says.
“He fired most of the medical residents. He was tough. With time, you really see the merits. He put patient care above everything else.”
The lessons stuck. Frazier still awakens nearly as early every morning, working 15- or 16-hour days. The couch in his office serves as a bed about three nights a week, when patients are too ill for him to leave.
By the end of his residency in 1974, Frazier saw that much of the city’s experimental device work had flowed to the Texas Heart Institute, where Cooley had implanted the first artificial heart and had performed the first successful heart transplant in the United States.
There, he began working on all manner of devices, including second-generation artificial hearts, which had limited success, and left-ventricular assist devices, which eventually would have more success.
The LVAD experience emphasizes the trial-and-error of medical device development. During the 1970s, Frazier and colleagues implanted 22 patients with LVADs, which assist the heart’s main pumping chamber to circulate blood through the body. The pumps worked, but the patients all died.
“It’s like any new and radical therapy; you generally start it on patients who look like they’re about to die anyway,” he says. “The reality was that patients had already reached the point of irreversible heart failure, so it didn’t matter what we did. Even if we restored the total cardiac output, the patient was still mortally wounded.”
Since then, Frazier and others have had considerably more success with LVADs, both as a means to tide patients over to transplant and, now, to give tired hearts time to recover, after which time the device is removed.
The surgeon at work
On a recent morning, Frazier walked into the operating room, parting a sea of blue-green scrubs. After donning an operating apron with the help of a nurse, he walked directly to a platform on the left side of the table. Standing beneath the bright lights, he looked down at his patient, an elderly woman about to receive a heart pump.
His gloved fingers dived into the woman’s open chest cavity, to feel the heart and gauge its health. There was little small talk and, unlike the operating rooms on nightly television, no music.
In contrast to the contemplative, almost weary drawl with which Frazier speaks in his office, his hands were a blur of technical precision in the operating room. A burnt-orange T-shirt beneath his scrubs served a reminder that he was an excellent athlete as a youth.
His boss, Denton Cooley, himself a former University of Texas athlete, says those skills translate well into surgery.
“He has the qualities of intelligence, persistence and endurance, which are a must for highly complex procedures that can take six to eight hours,” Cooley says. “It takes a man of some physical strength to do it as well as being technically dexterous.”
Several hours later Frazier still was going strong. In the basement of the Heart Institute, he worked with Dr. Billy Cohn to implant an experimental artificial heart — a contraption of two pumps clasped together. This time, the patient was a calf.
“He’s completely dedicated to this, and has been for decades,” says Dr. Robert Jarvik, inventor of the first permanent total artificial heart. “His outlook is unshakable optimism about the future of these things.”
It’s a job that requires persistence, given the limited success with heart devices since DeBakey, Cooley and others began experimenting nearly half a century ago. Numerous failures with artificial hearts — the vision of widespread use by the 1980s hasn’t come close to being fulfilled — have been punctuated by some gains, however.
Both the Jarvik and AbioCor artificial hearts recently were approved by the U.S. Food and Drug Administration for limited medical use. Frazier was instrumental to the development of both, and implanted one-third of the AbioCor artificial hearts in humans prior to its approval.
He continues to work on new devices with colleagues at the Texas Heart Institute.
Critical of federal agencies
Along the way, Frazier has endured many run-ins with the FDA, which he says is too slow to approve medical devices, and the National Institutes of Health, which he says “doesn’t fund anything practical.”
In a world of managed care and processed messages, Frazier is marvelously blunt. As the movie Apocalypse Now played on a small TV in his office recently, he stared at one of the artificial hearts he has tested. “Hmmm,” he muses. “Kind of looks like the skull of a lawyer, doesn’t it?”
A lifetime of late-night surgeries — transplants are done when hearts become available — and tinkering with new medical devices leaves little free time. What he has Frazier spends with his wife, Rachel, and two grown children, Todd and Allison. He beams when speaking of them, Todd a Julliard School of Music graduate and a composer, and Allison, a writer.
Frazier has had a litany of medical firsts, such as implanting the first Jarvik 2000 LVAD and the first HeartMate II LVAD in the United States, but he prefers a living legacy.
He has had that in large supply since 1982, when the drug cyclosporin became available. It helps the body not reject donated tissues and opened a new era of heart transplants.
Among Frazier’s former patients is Penny Eastham, a 61-year-old speech pathologist from Houston. She was just 39 when she received a transplant in 1985.
A few weeks ago, Eastham held her first grandchild, a boy. Eastham said she cried after laying him down.
“I knew I would have tears in my eye the first moment I put him down … I just never imagined I would make it that far.”
For every success, however, there has been failure, which comes all too often in Frazier’s profession.
“You try to keep your aequanimitas,” Frazier says, employing the Latin word for even-temperedness. “It’s one thing you learn in this field quickly: As soon as you get happy about something good happening, something bad happens.”