In memoriam: Denton A. Cooley, MD, FACS, a fierce competitor

Dr. CooleyA giant sequoia of surgery has fallen. Denton A. Cooley, MD, FACS, a cardiothoracic surgeon and Past-Governor of the American College of Surgeons (ACS), was born on August 22, 1920, in Houston, TX. He passed away just a few miles from his place of birth, surrounded by family, on November 18, 2016.

In an iconic life of 96 years, the name Cooley became synonymous with bold surgical innovations that shaped the field of cardiovascular surgery. Dr. Cooley leaves a professional legacy of technical advances; bold institutional vision; loyal and successful trainees; and, most important to him, the nearly countless patients who benefitted from the care he and his colleagues provided at the Texas Heart Institute (THI), Houston.

The following comments are personal reflections on the man I knew for almost 40 years—a man I loved, admired, and respected. He was my wife’s father, a personal mentor, and an interested, engaged colleague to the end. We shared much in life—family, profession, and the Texas Medical Center (TMC), Houston. Despite this closeness, I could never bring myself to call him anything other than Dr. Cooley. The names others people used—Darl, Daddy, Granddaddy, Denton, Bubba, Buckwheat—all had their place, and he enjoyed the personal nature of those designations. Yet, I always chafed a bit when he was referred to by any name other than Dr. Cooley. I believe he earned that degree of reverence. Perhaps in sharing my own viewpoints, I may conjure up some of other Fellows’ personal recollections as we celebrate his life.

A man of many loves

The heart is known to most of us as the symbol of love. Dr. Cooley, who became famous as a healer of the heart, had many professional loves—starting with the city of Houston, where he attended San Jacinto High School. His university and medical education and surgical training took place in a variety of locations, but ultimately, he always found his way home. He completed his undergraduate studies at the University of Texas-Austin. Medical school started at the University of Texas Medical Branch, Galveston, and ended at Johns Hopkins University School of Medicine, Baltimore, MD, from which he graduated with highest honors in 1944.

Dr. Cooley joined the surgical house staff of the Johns Hopkins Hospital under the direction of Alfred Blalock, MD, FACS. Dr. Cooley quickly earned a reputation for surgical dexterity and intellect. At Hopkins, Dr. Cooley was present for Dr. Blalock’s first “blue-baby operation” in November of 1944. This was an inspiring time for him, as was his association with other residents on the Halsted surgical service, most of whom went on to assume positions of influence in American surgery.

After completing his residency, he served as senior surgical registrar at the Royal Brompton Hospital, London, U.K. But Dr. Cooley was determined to return home to Houston. In 1952, he joined the Baylor College of Medicine surgical faculty under the direction of department chair Michael E. DeBakey, MD, FACS. He held this position for 18 years and was enormously productive.

The 1958 Baylor department of surgery. Dr. Cooley is in the front row, second from right; Dr. DeBakey is in the front row, center.

The 1958 Baylor department of surgery. Dr. Cooley is in the front row, second from right; Dr. DeBakey is in the front row, center.

In 1967, Dr. Cooley established what is perhaps his most enduring and visionary legacy—the Texas Heart Institute at neighboring St. Luke’s Episcopal Hospital, a first-of-its-kind institution with a singular focus on cardiovascular disease treatment, education and research. For the last 50 years, the THI has treated hundreds of thousands of patients, conducted cutting-edge research, and educated the next generation of leaders in cardiovascular medicine and surgery. The THI remained Dr. Cooley’s point of grounding focus throughout his professional life.

He loved all of these institutions very much, and they loved him back with reverence and respect. Dr. Cooley was loyal and grateful to these institutions, and he showed it through endowments, scholarships, athletic facilities, and chairs. Each of these storied institutions has paid him tribute and claims him as its own, as they each should. Dr. Cooley was immensely proud of the institutions that shaped him and that he helped to shape.

Fierce competitor

Anyone who came to know Dr. Cooley quickly learned that he did not like to lose. He was polite and had a charming wit, but he thrived on competition. As a surgeon, he knew where he wanted to go and how to get there in the most direct, expedient manner—“Modify, simplify, apply” was his motto. He was fast, he was bold, and he was creative.

Dr. Cooley receiving the Presidential Medal of Freedom from President Reagan in 1984.

Dr. Cooley receiving the Presidential Medal of Freedom from President Reagan in 1984.

It is hard for a cardiovascular surgeon, including myself, to fully grasp the magnitude of the surgical leaps that Dr. Cooley and his colleagues of the era made. For example, I recently had the opportunity to operate on a patient who required a pulmonary valve replacement some 50 years after his index tetralogy of Fallot repair by Dr. Cooley. I found the original operative report succinct and breathtaking. “Complete correction of tetralogy of Fallot with support of heart and lung bypass”—total pump time seven minutes. Speed, accuracy, and courage translated into early successes in congenital heart surgery, vascular surgery, and ultimately, the explosion of surgery for acquired cardiac disease.

It is safe to say that almost the entire medical world is aware of the competition between Dr. Cooley and Dr. DeBakey. It has been referred to as a 40-year feud that started when Dr. Cooley implanted the world’s first total artificial heart, a device that had been developed by Cooley/DeBakey colleague Domingo Liotta, MD. Dr. DeBakey, who had been focused on developing a total artificial heart, was furious, and a professional divorce ensued. In fact, Dr. Cooley was subsequently censured by the College for these activities.

Despite the public drama that ensued, I choose to characterize the Cooley/DeBakey relationship as fierce competition—a strange Texas horse race, which catalyzed the rapid development of heart surgery and established Houston, and specifically the TMC, as the epicenter of cardiovascular medicine at that point in history. Despite their vast differences in background, physical stature, personality, and approach, I never once heard Dr. Cooley speak negatively about Dr. DeBakey, and I did try to prod him on that subject.

Dr. Cooley receiving the National Medal of Science and Technology from President Clinton in 1999.

Dr. Cooley receiving the National Medal of Science and Technology from President Clinton in 1999.

I may have a unique perspective on some of the myth and hyperbole surrounding the Cooley/DeBakey quarrel. As a young congenital heart surgeon (and Dr. Cooley’s son-in-law), I came to Houston in 1995 to join Texas Children’s Hospital and Baylor College of Medicine, and thereby went to work for Dr. DeBakey, not Dr. Cooley. In many personal meetings with Dr. DeBakey, I never heard anything from him but compliments for Dr. Cooley. These two giants were simply too large in their personalities, in their determination to lead the developing field, to work in the same hospital. But they quietly respected and admired one another. Each also personally benefited from the attention.

As a talented, bold competitor, Dr. Cooley never hesitated to act when he saw an opportunity—and the world was the beneficiary. His list of surgical “firsts” is inspiring and spanned the spectrum of congenital, vascular, and acquired cardiac repair. Among them, I count the first successful human heart transplant in the U.S. in 1968 and, one year later, the world’s first total artificial heart implantation as equivalent in scope to Neil Armstrong’s footsteps on the moon. These accomplishments, among others, led to Dr. Cooley being awarded the Presidential Medal of Freedom by President Ronald Reagan and the National Medal of Science and Technology by President William Clinton.

Dr. Cooley, the physician

Dr. Cooley’s consistent and enduring career successes were the result of his adherence to his core identity as a physician. He never lost sight of his purpose. Despite the notoriety, the awards, the public attention, he remained a dedicated physician throughout life. Dr. Cooley traveled the world, met with dignitaries, received awards, and would then get up on Monday morning bright and early and go take care of patients. As a surgeon leader, he remained true to the principle of putting the patient first. He was on the front line, in the trenches, doing the hard work every day. He embodied a physician-leader lifestyle for us all to emulate.

He was an example for all in medical leadership. He became a Fellow of the ACS in 1952 and was a Governor (1965−1968). He also was a prominent member of the International Society of Surgery, Society for Vascular Surgery, Society of Thoracic Surgeons, American Association for Thoracic Surgery, Society of University Surgeons, Western Surgical Association, Southern Surgical Association, and American Surgical Association.

Author, investigator, speaker, and a paradoxical celebrity

Dr. Cooley was a prolific author, contributing to more than 1,400 peer-reviewed journal articles and numerous textbooks. He chronicled his incredible life in 100,000 Hearts: A Surgeon’s Memoir.* He was a stickler for proper punctuation and grammar.

Dr. DeBakey accepting honorary membership in the Denton A. Cooley Cardiovascular Surgery Society with a handshake from Dr. Cooley, marking an end to their decades-long silence.

Dr. DeBakey accepting honorary membership in the Denton A. Cooley Cardiovascular Surgery Society with a handshake from Dr. Cooley, marking an end to their decades-long silence.

He was a highly sought-after lecturer, and this meant traveling the globe. His accomplishments attracted worldwide attention and resulted in amazing accolades—from professional societies, universities, U.S. Presidents, the Pope, kings, queens, and numerous countries. Yet he remained incredibly approachable.

I had the opportunity to first meet Dr. Cooley at his home in 1982. I did not know what to expect from the world-renowned cardiac surgeon and also the father of my then-girlfriend. On that memorable day, we arrived at Helen’s home and entered the family library where Dr. Cooley had his evening meal at the end of his long days. What I found was not what I expected—seated in a soft chair, with dinner on a TV table, TV remote control in one hand and fork in the other, was one of the world’s most famous living surgeons. After greeting me, he carried on with his meal, but what caught my attention was the Cooley family dog, Atticus, who rested his chin on the same TV tray as Dr. Cooley’s plate. I watched in disbelief as Dr. Cooley alternately fed himself and Atticus with the same fork. This epitomized the Dr. Cooley I came to know. Despite his celebrity, he was a man we could all relate to in unexpected ways.

A builder

Dr. Cooley’s professional legacy is embodied in the THI. His vision for a unified institution dedicated to the care of patients with cardiovascular disease was radical thinking in 1962. Indeed, it changed the world for patients with heart disease. Dr. Cooley was enormously proud of his colleagues at THI, whom he considered the best surgeons in the world. The team of professionals in all aspects of cardiovascular care personify the iconic THI “symbol of excellence,” including the intrepid researchers and innovators exploring new frontiers in the fight against heart disease. Dr. Cooley was particularly loyal to his able successor as president of THI, Jim Willerson, MD, for his vision and determination.

100,000 Hearts recounts the almost unbelievable journey of personal and institutional accomplishment in heart surgery. Yet, the story is even larger. Consider that Dr. Cooley educated 136 cardiothoracic surgery residents—known as the “Cooley Hands”—and 927 cardiovascular fellows. His trainees now practice in 47 countries. The impact of the work of the THI is immeasurable.

Through his many roles, Dr. Cooley was able to reach and influence not only the TMC but the world of medicine and the patients who benefited from his knowledge and dedication to surgical innovation. His legacy lives on in the hearts and lives he touched, the caregivers with whom he worked with and trained, and in the family he so cherished.

Dr. Cooley was predeceased by his wife of almost 70 years, Louise Thomas Cooley. He is survived by four daughters, Mary Cooley Craddock (husband, John Craddock Jr., MD); Susan M. Cooley, PhD; Louise Cooley Davis, MD (husband, Richard Davis); and my wife, Helen Cooley Fraser, as well as 16 grandchildren and 17 great-grandchildren.

*Cooley DA. 100,000 Hearts: A Surgeon’s Memoir. Austin, TX: Briscoe Center of American History, 2012.


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