HARVARD GAZETTE ARCHIVES
A Heart Doctor With an Extra Big Heart
Bernard Lown, who developed the defibrillator, recalls early cases that led to breakthrough
By Roberta Gordon
Special to the Gazette
Mr. C. was a chipper Scotsman with a love for life and a chronic heart condition that was killing him. Every two weeks -- always in the middle of the night -- Mr. C.'s heart would race wildly out of control.
His doctor -- a 37-year-old medical professor who later developed the direct current (DC) defibrillator that has become a lifesaving device worldwide -- would speed to the hospital and bring Mr. C. back to life.
"I'd dread it," said Bernard Lown, now cardiology professor emeritus at the School of Public Health, recalling the events of 40 years ago that led ultimately to his great breakthrough. "I gave him drugs. If the drugs didn't work, what to do then?" In 1959, doctors such as Lown had no treatment choices besides a few drugs that were not always effective.
And after Mr. C's 10th such episode, that's exactly what happened -- instead of helping him, one drug made him deathly sick. The next day, Lown tried another drug. It didn't work either. The following day, Mr. C. was ashen, his lips a deep blue, his lungs flooded with congestion.
Lown wracked his brain. Finally, he remembered a 1956 article that had impressed him, by Paul Zoll about shocking the heart in cardiac arrest with alternating current -- the kind of current found in a wall socket. Zoll, who died recently, was then a physician at Beth Israel Hospital and later a clinical professor emeritus at the Medical School.
"An electric jolt -- that was unheard of!" Lown said. "With drugs, there was much experience. If you abide by conventional methods, you can't be faulted. It happens all the time. You're at the limits of medicine. But if you do something and the patient dies, that burdens your life." Despite that, Lown was determined to try anything that could save his patient.
Returning to Mr. C.'s bedside, Lown explained to his patient's wife that her husband might die as a result of this untried therapy. It was agonizing for the doctor even to consider it. "It is always nerve-wracking to be first. Furthermore, I never saw electric shock used before. I drew courage from the patient. There was no alternative. In a few hours he would be dead.
"Do you know what it's like to try something for the first time? But the patient had such high expectations of me, he was such a very decent human being, his wife had so much confidence and trust."
Mrs. C. told Lown to go ahead.
The procedure up to that point had only been attempted on unconscious patients with cardiac arrest. The chairman of Peter Bent Brigham Hospital's (now Brigham and Women's Hospital) Department of Anesthesia, Roy Vandam, volunteered to anesthetize the patient, unwilling to delegate what might become a tragedy. Then the director of the medical service stopped the proceedings. The hospital was opposed to trying this bizarre new technique. Time was running out for Mr. C.
Lown put in writing that he accepted full and sole responsibility.
Finally the patient was anesthetized. And Lown shocked his heart.
In his 1996 book The Lost Art of Healing, Lown describes what happened next. "I heard . . . a slow, strong, regular lub-dub. These heart sounds gave me a . . . thrill, recalling my first hearing, as a youngster, the opening bars of Beethoven's Fifth Symphony."
The patient woke up feeling well and left the hospital the next day.
A Revolution in Treating Heart Problems
The story doesn't end there, though.
When Lown, now 77, looks back, it is the next chapter in Mr. C's story that made medical history. Three weeks later, after the first defibrillation, Mr. and Mrs. C. went on vacation to recover. In Miami, Mr. C.'s heart again started racing wildly. No doctor there would repeat the procedure. "I let him go to Miami too sick," Lown said. He told the couple to come back to Boston.
Mr. and Mrs. C. traveled for 24 hours through dreadful weather, trapped in fog-bound planes, landing finally in New York, where they hired a private ambulance to take them to the Brigham in Boston. Mr. C. was brought to the operating room in extremis. This time, however, Lown's electric shock threw Mr. C.'s heart into ventricular fibrillation -- "the heart wriggles like a can of worms, and then electrocutes itself," is how Lown describes the condition. "This is sudden death... You have to intervene in three to five minutes," Lown said.
"I was dismayed. How could I have done this?" Lown asked himself. He watched in horror. After three frightening minutes, the surgeons resorted to an old technique. They opened Mr. C.'s chest and shocked the heart directly. Although Mr. C. survived the operation, he died soon after.
What had happened?
The existing literature didn't give a clue about the hazards of using alternating current. Lown went into the laboratory to find answers. "It was disquieting to learn of the enormous damage that this form of electricity did to the heart," Lown said. "We didn't know any better."
Lown's quest was to seek among the infinite number of electrical wave forms for the one form that would be safe, if indeed it existed. "It took a year's intense work, morning, noon and night," he recalled. After meticulous laboratory trials, Lown discovered a single direct current (DC) pulse in a wave form that was safe. The shock momentarily stopped the heart and allowed its natural pacemaker to reestablish a normal heartbeat.
Lown asked Barouh Berkowitz, an engineer he had worked with at American Optical Company, to build him a DC defibrillator.
Lown defibrillation had wide amplifications. The cardiovertor, Lown's invention that uses electric shock to correct rhythm disturbances that are not life-threatening, grew out of it. "At first no patients were available. Each physician wanted it tried on someone else's patient," he recalled.
Shocked by an Angel?
Finally, a resident physician in training at Brigham Hospital called Lown with a terminal case. The patient had suffered a massive heart attack; her blood pressure was unobtainable; she was unconscious and in very rapid tachycardia. Every remedy had been exhausted.
Lown had his 60-pound defibrillator brought on a trolley down the dark street from his lab at the School of Public Health to the Brigham Hospital.
"We gave [the patient] a single cardioversion discharge," he said. "A minute later she awoke. Her heart rhythm was regular and steady."
The only problem was that she was sure that Dr. Lown, in his white coat, was the angel Gabriel. "It took some doing to convince her that she was not in the sweet hereafter," Lown has written.
The technique soon spread like wildfire. By enabling surgeons to restore the arrested heart safely, the DC defibrillator made modern cardiac surgery possible. The organization of coronary care units was stimulated by it. And most of all, it enabled the resuscitation of hundreds of thousands of people.
Medical Accomplishments, and a Peace Prize
"Great thoughts come from the heart," a French sage once said, and Lown has gone from a cardiology practice to trying to doctor the world itself into better health. Not only a humanist physician interested in his patients, Lown is also a teacher interested in public health and public policy. In 1960, he was one of the founders of Physicians for Social Responsibility, and in 1980, the co- founder of International Physicians for the Prevention of Nuclear War. He and a Russian colleague received the Nobel Peace Prize on behalf of the organization in 1985.
Where does the doctor's prodigious energy come from?
"Anger," he said.
Born in Lithuania, Lown emigrated to Lewiston, Maine, in 1935 at age 13. He barely avoided the Holocaust, which destroyed much of his family. "My grandfather, a rabbi, perished, burned alive in his own synagogue. He was told to give a speech welcoming the Nazis. He said Hamans [a Biblical prince who tried to destroy the Jews] come and go, but the Jewish people will live."
With this example before him, Lown has spent much of his life combating racism and building bridges among cultures.
As a young medical student at Johns Hopkins in Baltimore, Lown was often threatened with dismissal for desegregating the blood used for transfusions and for calling Afro-Americans "Mr." and "Mrs.," using their last names instead of their first names.
"The attending physician told me, 'Get the hell off my service.' But my colleagues, who were Southerners, started using the patients' last names," Lown recalled. "This was during the War, when we were fighting a war against racism in Germany, and here in my own medical school, there was racism," he said. "I learned not to be afraid."
And these days he is still broadcasting his ideas for improving the world. Lown spends a good deal of his time these days, in addition to practicing medicine, on SatelLife, a space communication system using a low-orbit, low-cost satellite that goes from pole to pole four times a day, relaying medical information to developing parts of the world. He also recently founded, with colleagues, the Ad Hoc Committee to Defend Health Care, a physicians' group against corporate domination of health care. The Lost Art of Healing, Lown's most recent book, has just been released in paperback by Ballantine Books.
Treat Not the Heart, but the Human Being with a Heart
His equal measures of indignation, meticulous observation, tenacious research, and originality have sustained Bernard Lown throughout a life's work that has gone a long way toward changing the course of heart disease, though sudden cardiac death still claims one life every minute in the United States. Racism abides, as do poverty and greed. But Bernard Lown can say he did something about them, and future researchers can do no better than to follow his guiding maxim: "A doctrinal pillar," Lown has written, "is that one treats not a heart, but a human being who has a heart."
Copyright 1999 President and Fellows of Harvard College