Medicine: Living on Borrowed Time

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Barney Clark gets the first permanent artificial heart

Shortly after he awoke last Thursday morning in Salt Lake City, Barney Clark recognized the familiar sight and voice of his wife Una Loy, who was near by. There was also an unfamiliar noise: a soft, rhythmical clicking coming from his chest. And he realized, to his surprise, that he was still alive.

Clark, a 61-year-old retired dentist from Des Moines, Wash., had just become the first human to receive a permanently implanted artificial heart. As he stirred to consciousness, Clark signaled Surgeon William DeVries that he was not in pain. For DeVries, 38, that satisfying moment was the culmination of the three years he had spent perfecting the technique that made the implant possible, and waiting for a patient who met the rigorous criteria established for implant candidates by the Food and Drug Administration. No wonder DeVries described the 7½-hr. operation as being "almost a spiritual experience."

When he flew to Salt Lake City on Monday, Clark was clearly dying. Once a vigorous man and an avid golfer (handicap in his prime: six), Clark was suffering through the final stages of cardiomyopathy, a progressive weakening of the heart muscle that inevitably leads to congestive heart failure. The only permanent cure for cardiomyopathy is replacement of the heart, but at 61 he was eleven years over the usual age limit agreed upon by surgeons for a transplant.

Last September, Clark visited the University of Utah Medical Center to review his only real option: a pneumatically powered heart developed there by Dr. Robert Jarvik, a 36-year-old medical prodigy who began to design his first invention, a surgical stapler, at age 17. Clark toured a facility where several sheep and calves are kept alive by Jarvik's hearts, and even witnessed an implantation. A calf named Tennyson set the survival record of 268 days before succumbing to an infection last year.

Clark went home because his condition "wasn't bad enough," recalls r. Chase Peterson, vice president of the Utah hospital. But in recent weeks Clark's heart deteriorated rapidly, and he became bedridden. Finally, says Peterson, "he called us last Saturday and said, 'It's time.' "

It was almost too late. When Clark arrived at the hospital, his heart was pumping one liter of blood per minute, one-fifth the normal rate. Surgery was set for 8 a.m. Thursday. Clark had already been approved by the hospital's selection committee. In addition to suffering from a fatal heart condition with no alternative treatment, he more than met the criteria for psychological stability and a strong will to live. "This man was worth waiting for," said Committee Member Peg Miller.

On Wednesday night, Clark's heart began to beat irregularly. "Why don't we get this over with?" he murmured to his wife. A few minutes later, DeVries decided to do just that and readied himself for his third operation of the day and the most significant of his career.

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