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Partners of the Heart

By Ronica Roth | HUMANITIES, January/February 2003 | Volume 24, Number 1

The surgeon stood over the tiny baby, poised to try a new life-saving technique on her heart. He had not yet had a chance to practice on an animal, but the baby’s situation was acute. He turned to Vivien Thomas, an African American lab assistant who had only a high school diploma. Thomas had helped develop the procedure, test the surgery, and even design the instruments.

Before a gallery of onlookers, Dr. Alfred Blalock summoned Thomas to the operating room to guide him through the surgery. That morning, and for the next hundred surgeries, Thomas stood on a stool behind Blalock and looked over his shoulder, quietly offering help and advice.

The partnership of Alfred Blalock and Vivien Thomas defied convention and revolutionized cardiac surgery. Their story is told in the NEH-funded documentary Partners of the Heart, narrated by Morgan Freeman. The film premiered at the Museum of Tolerance in Los Angeles and will air as part of PBS’s American Experience series on February 10. The film depicts how Blalock and Thomas resisted the rules of segregated America during thirty-five years of collaboration.

“It was a relationship that transgressed the rules, that crossed the boundaries, that subverted the hierarchy,” says Don Doyle, professor of Southern history at Vanderbilt University. “Despite all the laws aimed at keeping the races apart, these men met as two human beings, as two scientists, as two minds."

Blalock and Thomas began their relationship at the height of Jim Crow segregation, in Nashville in 1930. Vivien Thomas grew up in North Nashville, the city’s African American community, which had a thriving middle class with its own doctors, lawyers, and entrepreneurs.

Thomas, the son of a carpenter, planned to become a doctor, but shortly after his graduation from Pearl High School in 1929 the stock market crashed and Thomas lost seven years’ worth of money he had saved for college. Bitterly disappointed, the nineteen-year-old took a job as a laboratory assistant at Vanderbilt Medical School working for Blalock. His job classification: janitor.

Alfred Blalock, thirty-two at the time, was from an old, aristocratic south- Georgia family. Blalock went to Johns Hopkins University to study medicine. There he developed a reputation as a playboy more than a student. When he was denied a residency at Johns Hopkins, he ended up in the “backwater” of Nashville and eventually became the director of the research laboratory.

Blalock set his laboratory onto the task of researching shock trauma, a phenomenon that at the time cost thousands of lives during surgery. Blalock quickly saw potential in Thomas and taught him to be his technician, running and recording experiments.

Blalock was short-tempered and a perfectionist. One day when Thomas had made some mistake, he hurled expletives at the young man. Thomas first walked away, but then decided he would not accept that kind of treatment. “I went across the hall to Dr. Blalock’s office,” Thomas wrote in his autobiography. “I told him I had not been raised to take that kind of language. I was leaving.”

According to historian Nat Crippens, “Dr. Blalock actually apologized to this nineteen-year-old young’un. And he said, ‘I’ll never do that again.’ And through the subsequent thirty-four years, Dr. Blalock never did yell at Thomas again. And that was the beginning of their mutual respect for each other.”

The two men worked together for the next several years. They succeeded in proving that shock was caused by loss of blood and other fluids, a discovery that within a decade would save millions of lives on the battlefields of World War II.

In late nights together at the lab, Thomas and Blalock would share a drink and talk about science. Outside the laboratory, however, they maintained the separation that was both practice and law.

“Vivien was not a coequal by any stretch of the imagination,” says Surgeon Levi Watkins. “So I think the gentlemen both were products of their time. And in an incredible way, complemented each other. But at the same time, kept the constraints.”

Five years after they began, Thomas was still on the Vanderbilt payroll as a janitor, one of the few jobs an African American could hold at the university. Blalock arranged for a small raise after Thomas complained.

As Blalock began to be courted by other medical institutions, he put a condition on any move: Thomas had to be part of the package. Blalock got an offer to return to Johns Hopkins in Baltimore as chief of surgery and Thomas went with him.

Baltimore in 1941 was a shock to the Thomas family. The city was segregated and hostile to African Americans and lacked the thriving black middle class of Nashville. They had left a comfortable house in Nashville that Thomas had built; in Baltimore, African Americans were relegated to tenements in crowded streets. Overcrowding in black neighborhoods made the incident of tuberculosis seven times higher than in white neighborhoods. “Many apartments I looked at were hardly fit for human habitation,” Thomas wrote.

Johns Hopkins Hospital was a hierarchical institution with strict codes of protocol and dress. As a technician, Vivien Thomas was entitled to wear a white lab coat, but at that time the only other blacks at Hopkins worked in the laundry. One day, Thomas left his laboratory and walked to the main hospital building. People there were appalled to see this black man walking around wearing a professional uniform, Baltimore Sun reporter Fraser Smith says, and they complained.

Koco Eaton, a surgeon and Thomas’s nephew, tells the story: “He said there was such a big stink raised about it. People wanted him fired. So actually Blalock had a talk with him and said ‘Listen, when you go over to the hospital, take your lab coat off.’ He was a man with pride, but yet a lot of times that pride couldn’t show. So I think it was very tough for him.”

Work in the laboratory continued and Blalock searched for a new project. An idea came from pediatrician Helen Taussig. Thousands of babies each year were born with a heart defect that deprived them of oxygen, causing severe weakness and giving their skin a blue hue. There was no cure for these so-called Blue Babies--the condition was fatal. Taussig suggested that Blalock and Thomas develop a way to create a pathway from the heart to the lungs by surgically bypassing the malformation in the heart. It was a daring idea at a time when cardiac surgery was experimental and even taboo. The first successful adult open heart surgery wouldn’t take place until 1952.

Over the next year, while Blalock attended to running the hospital, Thomas worked out the technical details of the surgery. When equipment they needed didn’t exist, Thomas designed it and Blalock got the medical companies to manufacture it. It was Thomas who performed the surgery a hundred times on lab animals.

Before Blalock had a chance to practice the surgery he got his first real case: a nine-pound, gravely ill baby named Eileen Saxon. Thomas coached Blalock through the surgery. The results were dramatic. As soon as Blalock had successfully rerouted the blood, little Eileen Saxon turned pink for the first time in her life. The surgery was a success.

News of the operation spread, and people brought their children to Hopkins from all over the world. Blalock traveled to Europe to lecture and teach the procedure.

Vivien Thomas, of course, received none of this acclaim.

“I think he is the most untalkedabout, unappreciated, unknown giant in the African American community,” says Watkins about Thomas. “What he helped facilitate impacted people all over the world.”

Through the forties and fifties, Thomas conducted ground-breaking experiments by day, but still made a low wage. At night he sometimes waited tables or bartended, even in Blalock’s home. He served drinks to the same residents and physicians he worked shoulder to shoulder with, and those he helped train.

“I don’t think any of us realized how bizarre it was to have a person of his talents waiting tables or waiting the bar. But nobody thought the less of him for doing it,” says retired surgeon William Grose, who was one of Blalock’s students and spent a year working with Thomas in the research lab.

Viewers are surprised that Blalock allowed Thomas to bartend, or that Thomas himself would have so little pride, says the film’s director, Andrea Kalin. But segregated America was complicated. “Dr. Blalock was not opposed to segregation and he had the same attitudes about race, I think, as anyone else raised in southern Georgia,” says Blalock’s colleague Robinson Baker. Thomas’s contemporaries in Nashville told Kalin that they respected his choice. “That was a good gig in those days, to work in someone’s house. That was good money,” Kalin reports. She also points out that the situation strangely provided the opportunity to engage in meaningful off-hours discussions. “That would be the only way to socialize. They worked within the system to get around it.”

In the wake of the success of the Blue Baby operation, Blalock and Thomas prepared the next generation of surgeons. Blalock’s students were required to study surgical technique with Thomas. And Blalock made it clear to his students that when Thomas spoke he was speaking for Blalock.

Thomas helped teach not only Blalock’s white students, but became a mentor for the first generation of African Americans who came through Hopkins Medical School.

“Mr. Thomas was the first male African American that was operating in an operating room, albeit the surgical research laboratories, that I could relate to,” says Richard Scott, an African American who first came to Hopkins in 1957 and trained under Thomas. In 1967, Scott became the first African American appointed as a surgical intern at Johns Hopkins Hospital. He went on to be medical director and chief of cardiovascular surgery at the Washington Cardiovascular Institute.

Demand for the Hopkins residency program skyrocketed as the two men gained a reputation for teaching. Their students became some of the top surgeons in the country. Denton A. Cooley conducted one of the first successful heart transplants in 1968, and in 1969 implanted the first artificial heart. Watkins was the first to implant an internal defibrillator and was Hopkins’s first black chief resident in cardiac surgery. Alex Haller Jr. established the nation’s first regional trauma center for children. Rowena Spencer was the first woman to become a surgical intern at Johns Hopkins and one of the first female pediatric surgeons in America.

In 1971 a group of former students called the Old Hands Club presented Thomas with a portrait of himself to hang at the Hopkins medical school, on the same wall with other Hopkins surgical greats, including Blalock. In 1976, Hopkins awarded Thomas an honorary doctorate; after thirty-seven years he was officially recognized as a teacher and appointed to the medical school faculty.

The relationship between Blalock and Thomas transcended the restrictions of their time but only to a degree. The two men did not unequivocally throw out the rules of race relations. “I could have been strident, but I decided to present facts and let the audience draw the conclusions,” says Kalin. Kalin has been told that she is too easy on Blalock, who could have done more for Thomas. Others are angry at Thomas for being an “Uncle Tom.”

“Historians told me not to paint Thomas as a civil rights activist, because he was not,” Kalin says. “He was not the rebel, but in his very presence, by his life, he defied the stereotypes necessary to maintain the system.”

Ronica Roth is a writer in Denver, Colorado.

Spark Media, Inc. has received $663,875 from NEH to produce Partners of the Heart and its accompanying website.