Cinema science: Actual surgeons doing science! In the 1940s!

i-e7a12c3d2598161273c9ed31d61fe694-ClassicInsolence.jpgLast night was grant crunch time to get a truly serviceable draft to my collaborators today as promised, leaving enough time to revise it by the February 5 deadline. That means the blog has to take a hit today, which is a shame, because Joe Mercola and Age of Autism have laid down some idiocy this week that I’m just dying to take down. Oh, well, it’ll wait, and if it won’t I’m sure there’ll be new idiocy to take down (or, if I need a break, some good science to discuss) when I come up for air again. (In the case of Mercola, it’s part one of a promised three part series; so waiting until he’s pumped out the continuations might be prudent anyway.) In the meantime, enjoy this bit of Classic Insolence from 2006. It comes from a long-defunct feature that our Seed overlords had us doing way back when called “Ask a ScienceBlogger.” Remember: If you’ve been reading less than about three and a half years, it’s new to you!

Our Seed overlords beckon:

What movie do you think does something admirable (though not necessarily accurate) regarding science? Bonus points for answering whether the chosen movie is any good generally….

This one’s a bit of a toughy. First off, I waited too long to answer it, which means that other ScienceBloggers have copped answers that I had thought of, movies such as Real Genius and Apollo 13. Those were definitely among the first movies that came to mind. Even though the science itself in Real Genius is downright silly, its celebration of the joys of being a science geek is infectious and fun, and the comeuppance the geeks visit upon the professor who is trying to appropriate the fruits of their labors in order to make a weapon is satisfyingly hilarious. Apollo 13 is great at showing the old can-do spirit of NASA in the Apollo era, in which no problem is seen as unsolvable, with Ed Harris as Gene Kranz summing it all up when he said: “We’ve never lost an American in space, we’re sure as hell not gonna lose one on my watch! Failure is not an option.”

I miss that kind of attitude, which seems sorely lacking these days.

And, of course, given my interest in Holocaust denial, Dr. Freeride definitely one-upped me by including Mr. Death: The Rise and Fall of Fred A. Leuchter, Jr. as one of her choices. Even so, after a bit of thought, I’ve come up with a pick that may be stretching the definition a bit, because it’s not a movie that ever saw theatrical release. Rather, it was a made-for-TV movie that aired on HBO a couple of years ago called Something The Lord Made (HBO link here), starring Alan Rickman and Mos Def. This movie tells the tale of Vivien Thomas (Mos Def), the surgical technician for surgical pioneer Alfred Blalock (Alan Rickman). Although the casting of Rickman as Blalock seemed a bit dubious to me when I first saw ads for the movie (Blaylock was Southerner), he acquitted himself well, albeit not without the occasional slip of his his affected southern accent. Thomas was unusual in that he was black and only had a high school education, yet he, as much as Blalock and his collaborator Helen Taussig (the pediatric cardiologist who came up with the initial concept of how this defect might be surgically ameliorated), was responsible for the development of a surgical procedure (the Blalock-Taussig shunt) to treat blue baby syndrome, which is most commonly due to a constellation of cardiac defects known as the Tetralogy of Fallot and 100% fatal during childhood without intervention. Much of the drama of the story comes from the “odd couple” aspect of the pairing and the unlikely friendship between these two men in the era of segregation. Blalock was white, wealthy, and highly respected surgeon. Thomas was poor and black, only had a high school education, but he had the intuitive grasp of anatomy and the dexterity of a truly great surgeon. However, because of his background, he could never become that surgeon and instead ended up having to settle for being a surgical technician, a job whose pay at times was so poor that he had to work a second job and frequently had trouble paying the rent. Indeed, in middle age, Thomas briefly went to college as a precursor to applying to medical school and fulfilling his dream of becoming a surgeon, but reluctantly abandoned his plan when it started to dawn on him that he would be 50 years old before he finished his training. Blalock admired Thomas’ drive and realized, when he was offered the job of Chief of Surgery at Johns Hopkins in 1941, that he needed Thomas to help him build his research effort and persuaded him to come with him from Vanderbilt to Baltimore.

This movie was mostly conventional in the interpersonal relationships and the race tensions of the 1930’s and 1940’s. (One scene, for instance, has Thomas asking Blalock, “You know… in 13 years, Doctor Blalock, I don’t recall you ever stopping by our house.” Blalock’s response: “I don’t recall ever being invited.” Predictably, this scene is followed by a scene in which Blalock visits Thomas’ house for an uncomfortable dinner with his family. Where the movie shines is in showing the difficulties and ethical dilemmas involved in the surgical research of the period and, by analogy, of today. Most interesting from a science standpoint, it portrays brainstorming sessions, where Blalock and Thomas discuss possible ideas of (1) how to induce the blue baby syndrome in dogs, in order to produce an animal model of the defect, without which they could not develop a surgical procedure to ameliorate the cyanosis; and then (2) how to correct the condition in the animal model; and then finally (3) how to operate on a child’s heart, construct the shunt proposed by Taussig, and have the patient survive the operation. These scenes are presented with great gusto and give a sense of the tough work involved in medical research, as together Blalock and Thomas try out different procedures on dog after dog, only to have them die, one of them quite unexpectedly after they had thought they had hit upon the right technique. They also have to invent a variety of new surgical instruments in order to carry out the then difficult and technically challenging procedure. All of this was done after overcoming years of neglect in the Department of Surgery at Johns Hopkins that had left the surgical research labs in an appalling state of neglect as Blalock strugged to refocus the department on surgical research, in the process turning it into a research powerhouse.

Eventually, as we know from history, the two men eventually did come up with a workable animal model of the blue baby syndrome and an operation to reverse the lack of oxygen in the arterial blood. In November 1944, a critically 15 month old girl with blue baby syndrome named Eileen Saxon was near death, and she became the first patient upon whom Blalock was to try this new operation. Indeed, when just how nervous Blalock was at what he was about to attempt was obvious, and the palpable bewilderment and shock of Blalock’s colleagues and residents when he invited Thomas into the operating theater showed just how different attitudes were then. Thomas stood next to Blalock for the whole case and guided him through it, as he had done the operation in the animal laboratory many more times than Blalock had.

That’s where another area that should be of great interest to any medical researcher came in: The ethical dilemmas involved in this research. Much of this story took place during World War II, and there was no such thing as an Institutional Review Board to oversee human research. Indeed, from the perspective of the 21st century, the discussions Blalock had with the parents of the first child upon which he wanted to try his new operation were jarring in the vagueness of the description of the risks. There was also the agony of weighing Blalock’s wanting to take more time to perfect the operation in dogs versus the very real possibility of children who might have been saved by the new operation dying while he dithered. Yet, as heart surgeon Denton Cooley recalled, “The real worry was could a little blue child like this withstand surgery?” This is an aspect of medical research that basic scientists often don’t understand; as physicians and surgeons, we feel a burning urgency to do something for patients now, but we also know the potential terrible price to be paid by our patients if we try to bring a procedure to the clinic prematurely. Remember, also, that in this era the heart-lung bypass machine hadn’t been invented yet, and anaesthesia techniques, particularly in pediatrics, were far less developed and sophisticated than they are today. Watching the film, I couldn’t help but wonder whether such a radical surgical procedure could ever be developed today in such a short period of time, as I can’t imagine a modern IRB giving the green light for such an untried procedure.

After Blalock died in 1964, Thomas carried on as the first black Director of Laboratories for Johns Hopkins, and the movie concludes with his portrait being placed in the main hall of Johns Hopkins Hospital, right next to that of Blalock, and in the same hall as other portraits of medical luminaries from that storied institution a dramatic, as well as a moving scene of his being awarded an honorary doctorate in 1976.

As a movie overall, Something the Lord Made is solid, but fails to achieve greatness. Nonetheless, it does achieve something admirable in its accurate period description of the surgical research of one of the true giants of 20th century surgery, plus its depiction of the unlikely friendship that developed between a young black carpenter who helped develop an operation that prolonged the lives of thousands of babies with congenital heart defects, as well as helping to train generations of Johns Hopkins surgical residents in operative techniques in the animal lab. Later, when more black medical students were admitted, he became mentor to many of them. My main complaint about the movie is that it’s perhaps a bit too respectful of its characters, as historical biopics tend to be. For example, it left out some of the more serious slights that Blalock showed Thomas. As described in a documentary Partners of the Heart, when experiments forced Blalock and Thomas to work late, the two would sometimes share a drink, discuss science, and argue their points with each other. In the privacy of the lab, they didn’t have to follow the rules of a segregated society. However, outside, Blalock still largely followed the old rules, and even as late as his 60th birthday, in public he would not always give Thomas the respect he deserved. Other than insisting on Thomas as his right hand man in the laboratory, he did little or nothing to combat the segregation that predominated at Johns Hopkins. Another deficiency is that the movie relegated Helen Taussig to a minor role, even though she strongly pushed Blalock to keep working on the development of the Blalock-Taussig shunt. Finally, in its laser-like focus on the development of the Blalock-Taussig shunt, the movie probably shortchanged the other major contributions these two men made in understanding shock and how to treat it.

Despite these problems, it’s still a movie well worth checking out the next time that HBO decides to bring it back for another run, and, if you’re a surgeon, it’s inspirational in spite of those flaws. And, of course, it’s also available on DVD.