With Dr. Christiaan Barnard
Dr. Christiaan Barnard’s name has graced many headlines since December 3, 1967, when he announced to the world that he had just performed the first human heart transplant. A decade later, the flashy 55-year-old South African surgeon has passed many more surgical milestones, among them the “piggyback” technique of transplanting a second heart into a patient and grafting a baboon heart into one patient and a chimpanzee heart into another. He has also written his autobiography and two medical novels, and gained a reputation as a jet-setter by mixing with the likes of Gina Lollobrigida and Princess Grace of Monaco. His second wife, Barbara, is half his age. He is in constant demand throughout the world as a guest speaker and a sponsor of causes, and he was in Winnipeg recently to receive an award at the annual dinner of the St. Boniface General Hospital Research Foundation. Free-lance journalist Linda Matchan spoke with Barnard in his hotel lounge, where she found him eager to discuss his career and his aspirations.
Maclean’s: Do you enjoy the publicity you receive?
Barnard: I think it is part of human nature to enjoy being recognized and being praised for what you have done. I think there are very few human beings who don’t enjoy that. I think some of them pretend they don’t enjoy it, but they do enjoy it in their hearts. I’m more of an extrovert in that I show my enjoyment and my appreciation for what people do for me and what they’ve recognized and what I’ve done. You know, people have criticized me for having married a very young and beautiful wife. I think a lot of those who criticize me would like to be in my position but they just cannot. They just don’t get it, you see. Maclean’s: Do you think doctors are putting too much stress on keeping patients alive?
Barnard: Oh yes. I have no doubts. I’ve just written a novel, 7n The Night Season. It deals with this problem and I come back to my original philosophy of medicine—that the prime goal is to alleviate suffering and not to prolong life. And if your treatment does not alleviate suffering but only prolongs life, that treatment should be stopped.
Maclean’s: Should a doctor go one step further and give a patient drugs to end his suffering?
Barnard: Well yes, I think that is justifiable, that you can give drugs to alleviate suffering even to the extent that it will
shorten life. But I don’t think at this stage we have the right yet to actually go and give an overdose of drugs. I think it’s important to distinguish between active euthanasia and passive euthanasia and I don’t practise active euthanasia. But I do practise passive euthanasia and I think there are very few doctors in the world who do not.
Maclean’s: Could you explain why the first human heart transplant was performed in South Africa when other countries were just as technically advanced, if not more so? Barnard: I’d like to point out that the heart transplant is not the only surgical technique that was first performed in South Africa. There are other forms, treatment of
patients with congenital heart disease, that we were the first to describe. And 1 think the reason is the fact that medicine in South Africa is very well developed. When you’re young you are more enthusiastic, you have more go, more drive. Young people in South Africa were given the opportunity to do things and I think that is probably the reason why we did the first transplant.
Maclean’s: Okay, but there are some who feel, though, that the long-term benefits of heart transplants are far from proven. Barnard: I think the best, the most qualified people to answer are the patients. You know, Dr. Blaiberg was the second transplant, the most famous patient, he lived 18 months after the transplant. When I was busy working on my biography, One Life, with a man called Bill Pepper, he interviewed Dr. Blaiberg on this thing—the value of heart transplants, and he said: “Before that I was always terribly distressed because I was always short of breath, I was gasping for breath. When I realized that I could pull air into my lungs
I'm concerned about my patient, and what the medical profession says is not important
freely again, this operation was worthwhile.” Just the fact that they can breathe again has made this operation worthwhile. Maclean’s: But how well do you feel the medical profession has accepted the validity of heart transplants?
Barnard: Well, you see, I think that my approach to medicine is this, that the most important patient for me is the patient I deal with today. And I have to offer that patient the treatment that I have available today to help him. So what the rest of the medical profession says is not really important to me. Maybe to them, the most important patient is the patient who can pay them that day. Maybe it’s important for the patient to go home and die because they are working on a mechanical heart. You must ask them, what do they do with patients who are dying from advanced disease of heart muscle?
Maclean’s: Could you talk about your decision to transplant animal hearts into human beings.
Barnard: Yes, well, let me start off by saying that the heart is a unique organ, in fact, the only organ in the body that really cannot rest completely. Never. I mean even when you sleep, the heart has to pump quite a lot of blood to keep the brain and other vital organs alive. And we believe that patients die from heart conditions that are reversible because the heart cannot rest and these conditions will recover if you rest the heart. Now, unfortunately, most of these conditions we believe the heart will recover from are very acute and the heart needs assistance immediately. You can’t wait days to give the assistance and the only method available today whereby the heart can rest adequately and where the device that you use to rest the heart adequately can completely be lodged inside the body is the transplant. We would like to use human hearts for donation but in acute situations we don’t always have a human heart available. So, we explored the possibility of using the hearts of animals because they could be immediately available. And as you know we have done two of these transplants. For one we used a baboon heart and for the other we used a chimpanzee heart. We’ve come to the conclusion with this limited experience that at the moment it’s not on because of the fact that these hearts will have to rest to recover for quite a few weeks and we are just not able to control rejection for that long. So what happens is that the animal heart at the beginning is doing very well and it assists the patient’s circulation very well. But then as rejection sets in, the animal heart’s function deteriorates and it deteriorates to a terminal extent before the patient’s own heart recovers. And that’s the reason why they then die. So, I’m not going to continue at the moment with this operation. Maclean’s: Do you have any regrets about having tried it?
Barnard: No, I have no regrets because these people would have died, there’s no doubt they would have died if 1 had not
tried it. Flaving tried it, I have killed one baboon and I have killed one chimpanzee. People say: “Well, don’t you love animals?” I do love animals, but I love human beings more.
Maclean’s: Did you always want to become successful?
Barnard: 1 think that plays a very important part in my life. I don’t think that’s bad because you must consider the ultimate
goal or the ultimate result of your activities even if you want to be successful. You have tremendous ego, tremendous drive—who is going to benefit from it? The patient is going to benefit from it because you are going to give him everything and the best. Maclean’s: Do you foresee any more “firsts” imminent in transplant surgery? Barnard: Well, you know, it really isn’t a first, but we are working on the idea to transplant the heart and a lung in patients suffering from a combination of heart and lung disease. We have worked out this idea and I think it could be done with a good chance of success. We are ready to do it, possibly early in 1978.
Maclean’s: How have your medical colleagues treated you since you 've achieved so much?
Barnard: Well, on the whole, I think very well. I’ve had many attacks, but an inter-
esting thing is that very few could attack me on a scientific basis, saying there and here you’ve been scientifically wrong. They’ve always criticized me saying that I’ve received too much publicity, you are seen with too many nice women. Well, I think that’s criticism of no real value and it doesn’t affect me very much.
Maclean’s: But there has been criticism that there hadn't been enough research done for you to proceed with the first heart transplant.
Barnard: The fact is that the whole world followed soon after we did the first transplant and no research was done in that short period afterward. So then, they must fault the whole world for being too early. The second point about it is that the initial results of our heart transplant patients have been much better than the initial results in many other forms of treatment that are completely acceptable today. Maclean’s: Do you think that the press has treated you well?
Barnard: Well, there’s nothing all good or all bad. I think that the mass media have done a lot of harm to heart transplant patients in that in many countries and especially in my own country they have tried to exploit the sensation of it and have forgotten really to stress the scientific achievements and the scientific value that it has had. And that has done a tremendous amount of harm in many, many ways. You know, in the beginning, the heart transplant was all good and then afterward it was all bad again.
Maclean’s: With the first death?
Barnard: No, not with the first death so much as when we had that tremendous spate of transplants around ’69, which by the way was generated by the mass media and precipitated by the mass media because of the tremendous amount of publicity that heart transplant patients receive. And then when things went wrong, you know, then the other side was stressed again, everything was bad and nothing was good about the transplant. They never sort of kept a very objective approach to the problem.
Maclean’s: Your lifestyle has changed greatly in the past 10years.
Barnard: I don’t think so. I think that more has been written about it and therefore people have seen more about my lifestyle, but it hasn’t really changed. I’ve always enjoyed life very much. In fact, I do less of it today than I used to because I’m so scared of all the publicity that I get. I like to go to nightclubs. I like to be with nice looking girls and today I am scared of it because they always exploit this issue. But I did it long before I did the first transplant. Maclean’s: Is it difficult for a heart surgeon, particularly one with the obligations that you have, to be a family man? Barnard: Yes, it is difficult. You know, people’s ideas of an adequate family man differ. If you think that one can only be adequate if you leave at eight o’clock in the morning and you are back at five, then I’m
The prime goal of medicine is not to prolong life, but to alleviate suffering
not a good family man because I can’t do that. And I’m not an adequate family man in that my wife may be all ready to go to a party and we have to cancel the party. But I think I can pay enough attention to my children to let them know that they have a father. I want to tell you a beautiful story, talking about a family man. 1 have a little boy, Frederick, who is six years old—and this has been my greatest satisfaction in my life, this particular incident. He came to me, he was just finished with his bath and smelling like a baby, and he put his arms around me and said: “Daddy, are you a famous man?” I was sort of a little .. . And I said to him: “Why do you say that?” And he said: “All my friends tell me you’re famous.” And I recognized that in what I’ve done in life, this little boy is proud of his father and that has really been the greatest reward I’ve had.
Maclean’s: You have said that arthritis in your hands may be ending your career as a surgeon. Is this a firm decision?
Barnard: Yes, I think unless some miracle happens. But honestly it’s just impossible to operate because of the agony I have in my hands.
Maclean’s: How does it feel to know that you may be putting away the scalpel after so many years?
Barnard: It is probably about the same feeling you have in divorcing a wife that you have been living with for 20 years. You know you are to leave her but you’ve had a good life with her and you had your ups and your downs, but there has been more positive than negative out of it. And there is certainly a sadness about it but you have reaped the benefits of the association and you have to be satisfied with it.
Maclean’s: What will you do next? Barnard: Well, I’m going to do several things. The one thing I’m very keen on is helping countries who are trying to establish modern facilities for diagnosis and treatment of heart disease and I’m going to concentrate a lot on that. I’ve been asked by several countries to help them. And I have some very good ideas for some novels that I would like to write. I think 1 will probably get more involved in political problems in South Africa.
Maclean’s: In The Unwanted there emerges the idea or feeling of remoteness in South Africa from world centres of research. Is this a real problem?
Barnard: This is a real problem, and I’ll tell you that a lot of the political problems stem from it. And also, a lot of the reactions of white people stem from that. We are really, in many ways, a very highly developed Western country where everything is based on Western standards. Yet we are removed by about 6,000 miles from the next country that we can really compare ourselves with. You know, you can compare yourself with the country across the border, the United States. We haven’t got that comparison. So, you see the white man is very much inclined to compare his own achievements, abilities and strengths
with the man across the border and therefore he gets an unrealistic impression of his importance and his strengths. I mean, you can imagine if I compare my surgical results with the surgical results from across the border, I would think that I am God because of the fact that I am so much better.
Maclean’s: How do you respond to the world’s attitude toward South Africa—the
United Nations arms boycott and the talk about an oil embargo? Wilt it accomplish anything, do you think?
Barnard: Well, yes, I do believe that the criticism, and to a certain extent the punishment, have had good results. For example, in the field of sports, I don’t think we would have changed so much, I must be honest, unless we had been sort of ostracized. But I think it’s got a lot of negative aspects, too. You see, the one thing that has made me nearly become, and I can’t say a racialist because I will never be a racialist, but it has made me feel much stronger for South Africa, and it’s the pressure that’s put on our country. The more they squeeze, the more pressure they put on us, the stronger the feeling for your country. I think there is even the danger of saying, “Well, this is their attitude, their attitude is completely unrealistic, so to hell with it.”
When you are driven into a corner, you see, then I think people of a kind start standing together and sticking together to see it out. There has been so much double-standard in the world. I am the last one to argue that there is not a lack of human rights in South Africa. But, my God, it’s very infinitesimal compared to other parts in Africa where human rights are completely denied to people. I cannot understand why the world can condemn a white minority rule as racist, but say black majority rule is not racist. Maclean’s: In your first novel you were critical of the South African political system.
Barnard: I’m still critical. It’s a segregation and a denial of rights mainly on the basis of the color of the skin and I’m against that sort of thing.
Maclean’s: Do you see a political solution? Barnard: You’re really asking me a difficult question. Firstly, 1 don’t believe that white minority rule is just. I don’t believe that black majority rule isjust. 1 don’t think that sharing of power is practical. It’s not going to work in practice. I think the only realistic solution would be just a sort of a division in the country. Let’s divide the country into two halves and say, that’s your half and that’s our half. In one half the white man will rule and in the other half the black man will rule. This is actually government policy. I don’t think that they have a just idea of dividing it, with real justice in it, at the moment. I always say that the Nationalist government may not be on the right road, but they’re in the right direction.
Maclean’s: What do you think of the future of the English press in your country? Barnard: I think it’s got a fantastic future. Maclean’s: Even with the closing of two newspapers now?
Barnard: They closed one newspaper, a section of another and the Sunday issue of the same newspaper. I don’t think that’s permanent. But the point is this: South Africa still, with all of these restrictions, has the freest press in Africa.
Maclean’s: But there are many freer presses in the world.
Barnard: Oh yes, but there are also many, many less free presses in the world. I think it’s fair to attack, but attack all over the world, notjust in South Africa. I mean, has Russia got a freer press than South Africa? China? Why don’t you and Carter attack them, too, for the restrictions of freedom of press?
Maclean’s: Why do you stay in South A frica?
Barnard: Firstly, because I am a South African. My forefathers came to the country in the beginning of the 18th century. Secondly, the country has been extremely good to me and it’s given me opportunities to do what I have done. Thirdly, there is a great challenge in that country to try and make it a better country and a more acceptable country. And these are all things that I believe are a challenge to me and keep me in the country.
At first transplants were ‘good’ news, but when things went wrong they were ‘bad’ again