Reflections on early days of cardiothoracic surgery

With the approach of the 10th anniversary of Dr. Paul Klotman as president, CEO and executive dean of Baylor College of Medicine, many people may be surprised to learn that his connection to the College started long before he stepped through our doors in September 2010.

For decades, his first cousin Woody Fox worked at Baylor College of Medicine and then Houston Methodist as a biomedical engineer, helping to develop and advance the technology used by Dr. Michael E. DeBakey in his pioneering heart surgeries.

Dr. Paul Klotman and his cousin, Woody Fox.

Dr. Paul Klotman and his cousin, Woody Fox.

The cousins – their mothers were sisters – sat down recently in Klotman’s office, where Fox reminisced about the nascent but fast-changing era in cardiothoracic surgery.

Raised in Houston, Fox earned undergraduate and graduate degrees from Rice University in electrical engineering. From his sophomore year through graduate school, he spent summers working in the physiology lab at Baylor led by Dr. Hebbel Hoff, where he first met DeBakey.

After Rice, Fox went to work at NASA but later learned that Baylor was looking for someone to manage the electronics and equipment used by DeBakey in his cardiac surgeries, much of which were developed by DeBakey himself. He recalls that he came in for an interview with DeBakey on a Sunday morning during a heart transplant surgery.

“I actually turned the job down but then had second thoughts and called back to say I’d like to reconsider. So I came to work here in 1969, never intending to work in the medical field at all. But I stayed until my retirement, from Methodist eventually, in 2017.

The Methodist Fondren-Brown building was the epicenter of DeBakey’s heart surgeries, along with the fourth floor of Baylor’s Cullen Building, where the Department of Surgery offices and labs were housed.

Fox’s early days were spent developing and maintaining life-saving cardiac devices, including the electronic controllers for a biventricular device, which was manufactured in the fourth-floor labs, and the left ventricular assist device, or LVAD. He also had a first-row seat for the genesis of the DeBakey-Cooley feud, when Dr. Denton Cooley implanted an artificial heart, an investigational device being developed by DeBakey, in a patient.

“It was a big deal because it was funded by NIH grants. The rules weren’t as tight then but even so, you didn’t just put investigational devices in people. There was concern that Baylor would lose federal funding, and I was charged with tracking down government funded equipment that was involved,” Fox said.

After a series of heart transplants proved unsuccessful in patients, surgeons stopped doing those procedures for a period of time and focused on coronary bypass procedures. Another important focus of Fox’s work was on heart-lung machines, which provide critical blood flow and respiration to the patient while the heart is stopped. These were built at Baylor and not commercially developed at the time.

“These were very early machines with DeBakey roller pumps and consoles, and when you opened the console there were just wires everywhere. We basically reengineered all of that; we made modular pumps and put in circuit boards, and then we took them over into the operating room.”

Dr. DeBakey, left, performs surgery in this archival photo.

The operating room was actually a suite of eight rooms where surgeries started at 7 a.m. and went on all day and into the night. The rooms were set up in an octagon with a center console, and computers and other equipment outside of each room in cabinets the size of refrigerators, Fox recalls.

“All eight rooms had defibrillators but each one worked differently. It was a nightmare. A lot of what I did at the time was to straighten all that out by making sure all the equipment worked the same,” he said. “Every manufacturer wanted Dr. DeBakey to have its equipment – he had one of everything. I did a lot to make sure it all worked well and everyone knew how to operate each piece properly.”

DeBakey was a surgeon but also a scientist, and he wanted to know how things were working, like the pulsatile heart-lung machine that Fox developed for DeBakey’s and his colleagues’ surgeries, and how they could be improved. Fox recalls DeBakey’s consummate pose, with his hand on hip, asking, “Woody, why is this happening?”

“We spent a long time working on the pulsatile heart-lung machine, and Dr. DeBakey was very patient. We finally got it to the point where it produced perfect aortic blood pressure. In 1979, I attended a conference in Jerusalem and presented on the technology.

“But then new technology overtook us. The centrifugal pump for the heart-lung machine was developed and with this advancement, the roller pump was no longer used as the primary blood pump, and that ended the pulsatile heart-lung pump.”

It was then that Fox’s role started to change. He no longer was assigned to just cardiac surgery, but oversaw equipment used throughout Methodist Hospital. By 1977, his employment was shared between Baylor and Methodist, and then in 1993 he became a full-time Methodist employee. Fox retired in 2017, having been involved in the planning for Methodist’s new Walter Tower, where today’s heart surgeries take place.

It was with this wealth of experience that Fox provided some input to his cousin when Klotman was being tapped to lead Baylor College of Medicine.

“Paul contacted me and said he was considering the position with Baylor College of Medicine, and I encouraged him to take it, and I’m so glad that he did,” Fox said. “I told Paul, ‘Everybody loves Baylor. You come here and you’re going to find so many people who are going to support you.’”

Now when the cousins get together, their conversations span their shared family history, as well as their shared professional experience.

Read more about Dr. Michael E. DeBakey.

-By Dana Benson