The Remarkable Story of Vivien Thomas, the Black Man Who Helped Invent Heart Surgery – Washingtonian

In 1989, Washingtonian published what might be the most popular article in its history. Like Something the Lord Made, by Katie McCabe, tells of Vivien Thomas, an African American lab assistant to white surgeon Alfred Blalock from the 1930s to the 60s. Thomas hadnt gone to college, let alone medical school, but through their pioneering work together, the two men essentially invented cardiac surgery. The story of Thomass unlikely and inspiring journey won a National Magazine Award for feature writing and became an Emmy Awardwinning HBO movie starring Mos Def. Read it here and raise a glass to lifesaving medical professionals everywherewith or without an MD.

Say his name, and the busiest heart surgeons in the world will stop and talk for an hour. Of course they have time, they say, these men who count time in seconds, who race against the clock. This is about Vivien Thomas. For Vivien theyll make time.

Dr. Denton Cooley has just come out of surgery, and he has 47 minutes between operations. No, you dont need an appointment, his secretary is saying. Dr. Cooleys right here. He wants to talk to you now.

Cooley suddenly is on the line from his Texas Heart Institute in Houston. In a slowTexas drawl he says he just loves being bothered about Vivien. And then, in 47 minutesjust about the time it takes him to do a triple bypasshe tells you about the man who taught him that kind of speed.

No, Vivien Thomas wasnt a doctor, says Cooley. He wasnt even a college graduate. He was just so smart, and so skilled, and so much his own man, that it didnt matter.

And could he operate. Even if youd never seen surgery before, Cooley says, you could do it because Vivien made it look so simple.

Vivien Thomas and Denton Cooley both arrived at Baltimores Johns Hopkins Hospital in 1940 Cooley to begin work on his medical degree, Thomas to run the hospitals surgical lab under Dr. Alfred Blalock. In 1941 the only other black employees at the Johns Hopkins Hospital were janitors. People stopped and stared at Thomas, flying down corridors in his white lab coat. Visitors eyes widened at the sight of a black man running the lab. But ultimately the fact that Thomas was black didnt matter, either. What mattered was that Alfred Blalock and Vivien Thomas could do historic things together that neither could do alone.

Together they devised an operation to save Blue Babies infants born with a heart defect that sends blood past their lungs and Cooley was there, as an intern, for the first one. He remembers the tension in the operating room that November morning in 1944 as Dr. Blalock rebuilt a little girls tiny, twisted heart.

He remembers how that baby went from blue to pink the minute Dr. Blalock removed the clamps and her arteries began to function. And he remembers where Thomas stoodon a little step stool, looking over Dr. Blalocks right shoulder, answering questions and coaching every move.

You see, explains Cooley, it was Vivien who had worked it all out in the lab, in the canine heart, long before Dr. Blalock did Eileen, the first Blue Baby. There were no cardiac experts then. That was the beginning.

A loudspeaker summons Cooley to surgery. He says hes on his way to do a tet case rightnow. Thats tetralogy of Fallot, the congenital heart defect that causes Blue Baby Syndrome. They say that Cooley does them faster than anyone, that he can make a tetralogy operation look so simple it doesnt even look like surgery. Thats what I took from Vivien, he says, simplicity. There wasnt a false move, not a wasted motion, when he operated.

But in the medical world of the 1940s that chose and trained men like Denton Cooley, there wasnt supposed to be a place for a black man, with or without a degree. Still, Vivien Thomas made a place for himself. He was a teacher to surgeons at a time when he could not become one. He was a cardiac pioneer 30 years before Hopkins opened its doors to the first black surgical resident.

Those are the facts that Cooley has laid out, as swiftly and efficiently as he operates. And yet history argues that the Vivien Thomas story could never have happened.

In 1930, Vivien Thomas was a nineteen-year-old carpenters apprentice with his sights set on Tennessee State College and then medical school. But the depression, which had halted carpentry work in Nashville, wiped out his savings and forced him to postpone college. Through a friend who worked at Vanderbilt University, Thomas learned of an opening as a laboratory assistant for a young doctor named Alfred Blalockwho was, in his friends words, hell to get along with. Thomas decided to take a chance, and on February 10, 1930, he walked into Blalocks animal lab.

Out came Blalock, a Coke in one hand, cigarette in the other. A remote cousin of Jefferson Davis, Blalock was in many ways a Southern aristocrat, flashing an ebony cigarette holder and smiling through clouds of smoke. But the 30-year-old surgeon who showed Thomas into his office was even then, Thomas said, a man who knew exactly what he wanted.

Blalock saw the same quality in Thomas, who exuded a no-nonsense attitude he had absorbed from his hard-working father. The well-spoken young man who sat on the lab stool politely responding to Blalocks questions had never been in a laboratory before. Yet he was full of questions about the experiment in progress, eager to learn not just what but why and how. Instinctively, Blalock responded to that curiosity, describing his experiment as he showed Thomas around the lab.

Face to face on two lab stools, each told the other what he needed. Thomas needed a job, he said, until he could enter college the next fall. Blalock, well into his groundbreaking work on shockthe first phase of the bodys reaction to traumaneeded someone in the lab whom I can teach to do anything I can do, and maybe do things I cant do.

Each man got more than he bargained for. Within three days, Vivien Thomas was performing almost as if hed been born in the lab, doing arterial punctures on the laboratory dogs and measuring and administering anesthesia. Within a month, the former carpenter was setting up experiments and performing delicate and complex operations.

Blalock could see Thomas had a talent for surgery and a keen intellect, but he was not to see the full measure of the man hed hired until the day Thomas made his first mistake.

Something went wrong, Thomas later wrote in his autobiography. I no longer recall what, but I made some error. Dr. Blalock sounded off like a child throwing a temper tantrum. The profanity he used would have made the proverbial sailor proud of him. . . . I told him he could just pay me off . . . that I had not been brought up to take or use that kind of language. . . . He apologized, saying he had lost his temper, that he would watch his language, and he asked me to go back to work.

From that day on, said Thomas, neither one of us ever hesitated to tell the other, in a straightforward, man-to-man manner, what he thought or how he felt. . . . In retrospect, I think that incident set the stage for what I consider our mutual respect throughout the years.

For 34 years they were a remarkable combination: Blalock the scientist, asking the questions; Thomas the pragmatist, figuring out the simplest way to get the answers. At their black-topped workbench and eight animal operating tables, the two set out to disprove all the old explanations about shock, amassing evidence that connected it to a decrease in blood volume and fluid loss outside the vascular bed.

In a few years, the explanations Blalock was developing would lead to massive applications of blood and plasma transfusion in the treatment of shock. Methodically, from their lab at that school down in the backwoodsas Blalock called Vanderbilthe and Thomas were altering physiology.

All that was inside the laboratory. Outside loomed the Depression. In a world where men were walking the streets looking for jobs that didnt exist, Thomas watched his own college and medical-school plans evaporate. I was out of school for the second year, he wrote, but I somehow felt that things might change in my favor. . . . But it didnt happen. With each passing month, Thomass hopes dimmed, something not lost on Blalock. The two men discussed it, and Thomas finally decided that even if he someday could afford college, medical school now seemed out of reach. By 1932, Thomas had made his peace. For the time being, he said, I felt secure in that, at least, I had a job. Things were getting to the point that it seemed to be a matter of survival.

But the young man who read chemistry and physiology textbooks by day and monitored experiments by night was doing more than surviving. For $12 a week, with no overtime pay for sixteen-hour days and no prospect of advancement or recognition, another man might have survived. Thomas excelled.

Coached by Blalocks young research fellow, Dr. Joseph Beard, Thomas mastered anatomy and physiology, and he plunged into Blalocks round-the-clock research. At 5 PM, when everyone else was leaving, Thomas and The Professor prepared to work on into the nightThomas setting up the treasured Van Slyke machine used to measure blood oxygen, Blalock starting the siphon on the ten-gallon charred keg of whiskey he kept hidden in the laboratory storeroom during Prohibition. Then, as they settled down to monitor all-night shock experiments, Blalock and Thomas would relax with a whiskey-and-Coke.

Blalock and Thomas knew the social codes and traditions of the Old South. They understood the line between life inside the lab, where they could drink together in 1930, and life outside, where they could not. Neither one was to cross that line. Thomas attended Blalocks parties as a bartender, moonlighting for extra income. In 1960 when Blalock celebrated his 60th birthday at Baltimores Southern Hotel, Thomas was not present.

Within the lab, they functioned almost as a single mind, as Thomass deft hands turned Blalocks ideas into elegant and detailed experiments. In the verbal shorthand they developed, Thomas learned to translate Blalocks I wonder what would happen if into step-by-step scientific protocols. Through hundreds of experiments, Blalock wondered and Thomas found out, until in 1933 Blalock was ready to challenge the medical establishment with his first named lecture.

Almost overnight, Blalocks shock theory became more or less Gospel, as Thomas put it. By 1935, a handful of other scientists had begun to rethink the physiology of shock, but no one besides Blalock had attacked the problem from so many angles. No one else had compiled such a mass of data on hemorrhagic and traumatic shock. No one else had been able to explain such a complex phenomenon so simply. And no other scientist had a Vivien Thomas.

In his four years with Blalock, Thomas had assumed the role of a senior research fellow, with neither a PhD nor an MD. But as a black man doing highly technical research, he had never really fit into the systema reality that became painfully clear when in a salary discussion with a black coworker, Thomas discovered that Vanderbilt classified him as a janitor.

He was careful but firm when he approached Blalock on the issue: I told Dr. Blalock . . . that for the type of work I was doing, I felt I should be . . . put on the pay scale of a technician, which I was pretty sure was higher than janitor pay.

Blalock promised to investigate. After that, nothing more was ever said about the matter, Thomas recalled. When several paydays later Thomas and his coworker received salary increases, neither knew whether he had been reclassified as a technician or just given more money because Blalock demanded it.

In the world in which Thomas had grown up, confrontation could be dangerous for a black man. Viviens older brother, Harold, had been a school teacher in Nashville. He had sued the Nashville Board of Education, alleging salary discrimination based on race. With the help of an NAACP lawyer named Thurgood Marshall, Harold Thomas had won his suit. But he lost his job. So Vivien had learned the art of avoiding trouble. He recalled: Had there been an organized complaint by the Negroes performing technical duties, there was a good chance that all kinds of excuses would have been offered to avoid giving us technicians pay and that leaders of the movement or action would have been summarily fired.

Thomas had family obligations to consider, too. In December 1933, after a whirlwind courtship, he had married a young woman from Macon, Georgia, named Clara Flanders. Their first child, Olga Fay, was born the following year, and a second daughter, Theodosia, would arrive in 1938.

The satisfaction of making a public racial statement was a luxury Thomas would not have for decades, and even then he would make his point quietly. Meanwhile, he worked hard, making himself indispensable to Blalock, and in so doing he gained a powerful ally within the system. When they confronted discrimination again, they confronted it together.

The test of their partnership was not long in coming. In 1937, Blalock received an offer of a prestigious chairmanship from Henry Ford Hospital in Detroit. As surgeon-in-chief there, he could run his own department, train his own men, expand his research.

He and Thomas were a package deal, Blalock told the powers at Henry Ford. In that case, the answer came back, there would be no deal. The hospitals policy against hiring blacks was inflexible. So was his policy on Vivien Thomas, Blalock politely replied.

The two bided their time, teaching themselves vascular surgery in experiments in which they attempted to produce pulmonary hypertension in dogs. The hypertension studies, as such, were a flop, Thomas said. But they were one of the most productive flops in medical history.

By 1940, Blalocks research had put him head and shoulders above any young surgeon in America. When the call came to return to his alma mater, Johns Hopkins, as surgeon-in-chief, he was able to make a deal on his own terms, and it included Thomas. I want you to go with me to Baltimore, Blalock told Thomas just before Christmas 1940. Thomas, always his own man, replied, I will consider it.

Though Blalock would take a pay cut, the move to Hopkins offered him prestige and independence. For the 29-year-old Thomas and his family, it meant leaving the home they had built in Nashville for a strange city and an uncertain future.

In the end, it was World War II that caused Thomas to take his chances with Blalock. If he were drafted, it would be to his advantage to be at Hopkins, Thomas decided, because he would probably be placed with a medical unit. Always the family man, he was thinking practically. So Blalock, with everything to gain, and Thomas, with nothing to lose, as he put it, made their move together.

When they came to Hopkins, they brought with them solutions to the problems of shock that would save many wounded soldiers in World War II. They brought expertise in vascular surgery that would change medicine. And they brought five dogs, whose rebuilt hearts held the answer to a question no one yet had asked.

When Blalock and Thomas arrived in Baltimore in 1941, the questions on most peoples minds had nothing to do with cardiac surgery. How on earth was this boyish professor of surgery going to run a department, they wondered. With his simple questions and his Georgia drawl, Blalock didnt sound much like the golden boy described in his letters of reference. Besides, he had brought a colored man up from Vanderbilt to run his lab. A colored man who wasnt even a doctor.

Thomas had doubts of his own as he walked down Hopkinss dimly lit corridors, eyed the peeling green paint and bare concrete floors, and breathed in the odors of the ancient, unventilated structure that was to be his workplace: the Old Hunterian Laboratory. One look inside the instrument cabinet told him that he was in the surgical Dark Ages.

It was enough to make him want to head back to Nashville and take up his carpenters tools again.

After a day of house-hunting in Baltimore, he thought he might have to. Baltimore was more expensive than either he or Blalock had imagined. Even with a 20 percent increase over his Vanderbilt salary, Thomas found it almost impossible to get along. Something would have to be done, he told Blalock.

Blalock had negotiated both of their salaries from Nashville, and now the deal could not be renegotiated. It seemed that they were stuck. Perhaps you could discuss the problem with your wife, Blalock suggested. Maybe she could get a job to help out.

Thomas bristled. His father was a builder who had supported a family of seven. He meant to do at least as well for his own family. I intend for my wife to take care of our children, he told Blalock, and I think I have the capability to let her do soexcept I may have the wrong job.

If neither Hopkins nor Thomas would bend, Blalock would have to find another way to solve the problem. Blalock was not wealthy, but he had an ally at Hopkins, world-renowned neurosurgeon Dr. Walter Dandy, who was known for his generosity. That afternoon Blalock presented his situation to Dandy, who responded immediately with a donation to the departmentearmarked for Thomass salary.

So Thomas ordered his surgical supplies, cleaned and painted the lab, put on his white coat, and settled down to work. On his first walk from the lab to Blalocks office in the hospital across campus, the Negro man in a lab coat halted traffic. The hospital had segregated restrooms and a back entrance for black patients. Vivien Thomas surprised Johns Hopkins.

Inside the lab, it was his skill that raised eyebrows. What he was doing was entirely new to the two other Hopkins lab technicians, who were expected just to set up experiments for the medical investigators to carry out. How long had he been doing this, they wanted to know. How and where had he learned?

Then, one morning in 1943, while Johns Hopkins and Vivien Thomas were still getting used to each other, someone asked a question that would change surgical history.

For this part of the story, we have Thomass own voice on tapedeep, rich, and full of soft accents. In an extensive 1967 interview with medical historian Dr. Peter Olch, we meet the warm, wry Vivien Thomas who remains hidden behind the formal, scientific prose of his autobiography. He tells the Blue Baby story so matter-of-factly that you forget hes outlining the beginning of cardiac surgery.

For once, it wasnt Blalock who asked the question that started it all. It was Dr. Helen Taussig, a Hopkins cardiologist, who came to Blalock and Thomas looking for help for the cyanotic babies she was seeing. At birth these babies became weak and blue, and sooner or later all died. Surely there had to be a way to change the pipes around to bring more blood to their lungs, Taussig said.

There was silence. The Professor and I just looked at each other. We knew we had the answer in the Vanderbilt work, Thomas says, referring to the operation he and Blalock had worked out at Vanderbilt some six years earlierthe failed experiment in which they had divided a major artery and sewn it into the pulmonary artery that supplied the lungs. The procedure had not produced the hypertension model they had sought, but it had rerouted the arterial blood into the lungs. It might be the solution for Taussigs Blue Babies.

But might wasnt good enough. Thomas first would have to reproduce tetralogy of Fallot in the canine heart before the effectiveness of their pipe-changing could be tested.

Off he went to the Pathology Museum, with its collection of congenitally defective hearts. For days, he went over the specimenstiny hearts so deformed they didnt even look like hearts. So complex was the four-part anomaly of Fallots tetralogy that Thomas thought it possible to reproduce only two of the defects, at most. Nobody had fooled around with the heart before, he says, so we had no idea what trouble we might get into. I asked The Professor whether we couldnt find an easier problem to work on. He told me, Vivien, all the easy things have been done.

Taussigs question was asked in 1943, and for more than a year it consumed Blalock and Thomas, both by then working in the Armys shock research program. Alone in the lab, Thomas set about replicating the Blue Baby defect in dogs and answering two questions: Would the Vanderbilt procedure relieve cyanosis? Would babies survive it?

As he was working out the final details in the dog lab, a frail, cyanotic baby named Eileen Saxon lay in an oxygen tent in the infant ward at Johns Hopkins Hospital. Even at rest, the nine-pound girls skin was deeply blue, her lips and nail beds purple. Blalock surprised Eileens parents and his chief resident, Dr. William Longmire, with his bedside announcement: He was going to perform an operation to bring more blood to Eileens lungs.

Overnight, the tetralogy operation moved from the lab to the operating room. Because there were no needles small enough to join the infants arteries, Thomas chopped off needles from the lab, held them steady with a clothespin at the eye end, and honed new points with an emery block. Suture silk for human arteries didnt exist, so they made do with the silk Thomas had used in the labas well as the labs clamps, forceps, and right-angle nerve hook.

So complete was the transfer from lab to operating room on the morning of November 29, 1944, that only Thomas was missing when Eileen Saxon was wheeled into surgery. I dont think Ill go, he had said to chemistry technician Clara Belle Puryear the previous afternoon. I might make Dr. Blalock nervousor even worse, he might make me nervous!

But Blalock wanted Thomas there not watching from the gallery or standing next to the chief resident, Dr. William Longmire, or the intern, Dr. Denton Cooley, or next to Dr. Taussig at the foot of the operating table. Blalock insisted Thomas stand at his elbow, on a step stool where he could see what Blalock was doing. After all, Thomas had done the procedure dozens of times; Blalock only once, as Viviens assistant.

He and Thomas were a package deal, Blalock told the hospital. In that case, the answer came back, there would be no deal. Their policy against hiring blacks was inflexible.

Nothing in the laboratory had prepared either one for what they saw when Blalock opened Eileens chest. Her blood vessels werent even half the size of those in the experimental animals used to develop the procedure, and they were full of the thick, dark, blue blood characteristic of cyanotic children. When Blalock exposed the pulmonary artery, then the subclavianthe two pipes he planned to reconnect he turned to Thomas. Will the subclavian reach the pulmonary once its cut off and divided? he asked. Thomas said it would.

Blalocks scalpel moved swiftly to the point of no return. He cut into the pulmonary artery, creating the opening into which he would sew the divided subclavian artery. Is the incision long enough? he asked Thomas. Yes, if not too long, the reply came.

In and out of the arteries flashed the straight half-inch needle that Thomas had cut and sharpened. Is this all right, Vivien? Blalock asked as he began joining the smooth inner linings of the two arteries. Then, a moment later, with one or two sutures in place: Are those bites close enough together?

Thomas watched. In such small arteries, a fraction of a millimeter was critical, and the direction of the sutures determined whether the inside of the vessels would knit properly. If Blalock began a suture in the wrong direction, Thomass voice would come quietly over his shoulder: The other direction. Dr. Blalock.

Finally, off came the bulldog clamps that had stopped the flow of blood during the operation. The anastomosis began to function, shunting the pure blue blood through the pulmonary artery into the lungs to be oxygenated. Underneath the sterile drapes, Eileen turned pink.

Youve never seen anything so dramatic, Thomas says on the tape. It was almost a miracle.

Almost overnight, Operating Room 706 became the heart room, as dozens of Blue Babies and their parents came to Hopkins from all over the United States, then from abroad, spilling over into rooms on six floors of the hospital. For the next year, Blalock and Longmire rebuilt hearts virtually around the clock. One after another, cyanotic children who had never been able to sit upright began standing at their crib rails, pink and healthy.

It was the beginning of modern cardiac surgery, but to Thomas it looked like chaos. Blue Babies arrived daily, yet Hopkins had no cardiac ward, no catheterization lab, no sophisticated apparatus for blood studies. They had only Vivien Thomas, who flew from one end of the Hopkins complex to the other without appearing to hurry.

From his spot at Blalocks shoulder in the operating room, Thomas would race to the wards, where he would take arterial blood samples on the Blue Babies scheduled for surgery, hand off the samples to another technician in the hallway, return to the heart room for the next operation, head for the lab to begin the blood-oxygen studies, then go back to his spot in the OR.

Only Vivien is to stand there, Blalock would tell anyone who moved into the space behind his right shoulder.

Each morning at 7:30, the great screened windows of Room 706 would be thrown open, the electric fan trained on Dr. Blalock, and the four-inch beam of the portable spotlight focused on the operating field. At the slightest movement of light or fan, Blalock would yell at top voice, at which point his orderly would readjust both.

Then the perspiring Professor would complete the procedure, venting his tension with a whine so distinctive that a generation of surgeons still imitate it. Must I operate all alone? Wont somebody please help me? hed ask plaintively, stomping his soft white tennis shoes and looking around at the team standing ready to execute his every order. And lest Thomas look away, Blalock would plead over his shoulder, Now you watch, Vivien, and dont let me put these sutures in wrong!

Visitors had never seen anything like it. More than Blalocks whine, it was Thomass presence that mystified the distinguished surgeons who came from all over the world to witness the operation. They could see that the black man on the stool behind Dr. Blalock was not an MD. He was not scrubbed in as an assistant, and he never touched the patients. Why did the famous doctor keep turning to him for advice?

If outsiders puzzled at Thomass role, the surgical team took it as a matter of course. Who else but Vivien could have answered those technical questions? asks Dr. William Longmire, now professor emeritus at UCLAs School of Medicine. Dr. Blalock was plowing new ground beyond the horizons wed ever seen before. Nobody knew how to do this.

It was a question of trust, says Dr. Alex Haller, who was trained by Thomas and now is surgeon-in-chief at Hopkins. Sooner or later, he says, all the stories circle back to that moment when Thomas and Blalock stood together in the operating room for the first Blue Baby. Had Blalock not believed in Thomass lab results with the tetralogy operation, he would never have dared to open Eileen Saxons chest.

Once Dr. Blalock accepted you as a colleague, he trusted you completelyI mean, with his life. Haller says. After his patients, nothing mattered more to Blalock than his research and his boys, as he called his residents. To Thomas he entrusted both and, in so doing, doubled his legacy.

Dr. Blalock let us know in no uncertain terms, When Vivien speaks, hes speaking for me, remembers Dr. David Sabiston, who left Hopkins in 1964 to chair Duke Universitys department of surgery. We revered him as we did our professor.

To Blalocks boys, Thomas became the model of a surgeon. Dr. Blalock was a great scientist, a great thinker, a leader, explains Denton Cooley, but by no stretch of the imagination could he be considered a great cutting surgeon. Vivien was.

What passed from Thomass hands to the surgical residents who would come to be known as the Old Hands was vascular surgery in the makingmuch of it of Thomass making. He translated Blalocks concepts into reality, devising techniques, even entire operations, where none had existed.

In any other hospital, Thomass functions as research consultant and surgical instruction might have been filled by as many as four specialists. Yet Thomas was always the patient teacher. And he never lost his sense of humor.

I remember one time, says Haller, when I was a medical student, I was working on a research project with a senior surgical resident who was a very slow operator. The procedure we were doing would ordinarily have taken an hour, but it had taken us six or seven hours, on this one dog that had been asleep all that time. There I was, in one position for hours, and I was about to die.

Well, finally, the resident realized that the dog hadnt had any fluids intravenously, so he called over to Vivien, Vivien, would you come over and administer some I-V fluids? Now, the whole time Vivien had been watching us out of the corner of his eye from across the lab, not saying a word, but not missing a thing, either. I must have looked white as a ghost, because when he came over with the I-V needle, he sat down at my foot, tugged at my pants leg, and said, Which leg shall I start the fluid in, Dr. Haller?

The man who tugged at Hallers pants leg administered one of the countrys most sophisticated surgical research programs. He was strictly no-nonsense about the way he ran that lab, Haller says. Those dogs were treated like human patients.

One of the experimental animals, Anna, took on legendary status as the first long-term survivor of the Blue Baby operation, taking up permanent residence in the Old Hunterian as Thomass pet. It was during Annas era, Haller says, that Thomas became surgeon-in-residence to the pets of Hopkinss faculty and staff. On Friday afternoons, Thomas opened the Old Hunterian to the pet owners of Baltimore and presided over an afternoon clinic, gaining as much prestige in the veterinary community as he enjoyed within the medical school. Vivien knew all the senior vets in Baltimore, Haller explains, and if they had a complicated surgical problem, theyd call on Vivien for advice, or simply ask him to operate on their animals.

By the late 1940s, the Old Hunterian had become Viviens domain, says Haller. There was no doubt in anybodys mind as to who was in charge. Technically, a non-MD could not hold the position of laboratory supervisor. Dr. Blalock always had someone on the surgical staff nominally in charge, but it was Vivien who actually ran the place.

As quietly as he had come through Hopkinss door at Blalocks side, Thomas began bringing in other black men, moving them into the role he had first carved out for himself. To the black technicians he trainedtwenty of them over three decadeshe was Mr. Thomas, a man who represented what they themselves might become. Two of the twenty went on to medical school, but most were men like Thomas, with only high school diplomas and no prospect of further education. Thomas trained them and sent them out with the Old Hands, who tried to duplicate the Blalock-Thomas magic in their own labs.

Perhaps none bears Thomass imprint more than Raymond Lee, a former elevator operator who became the first non-MD to serve on Hopkinss cardiac surgical service as a physicians assistant. For the Hopkins cardiac team headed by Drs. Vincent Gott and Bruce Reitz, 1987 was a year of firsts, and Lee was part of both: In May, he assisted in a double heart-lung transplant, the first from a living donor; in August, he was a member of the Hopkins team that successfully separated Siamese twins.

Raymond Lee hasnt come into the hospital on his day off to talk about his role in those historic 1987 operations. He has come to talk about Mr. Thomas, and as he does so, you begin to see why Alex Haller has described Lee as another Vivien. Lee speaks so softly you have to strain to hear him above the din of the admitting room. Its been almost 25 years, he says, since Mr. Thomas got a hold of me in the elevator of the Halsted Building and asked me if I might be interested in becoming a laboratory assistant.

Along with surgical technique, Thomas imparted to his technicians his own philosophy. Mr. Thomas would always tell us, Everybodys got a job to do. You are put here to do a job 100 percent, regardless of how much education you have. He believed that if you met the right people at the right time, and you can prove yourself, then you can achieve what you were meant to do.

Alex Haller tells of another Thomas technician, a softspoken man named Alfred Casper: After Id completed my internship at Hopkins, I went to work in the lab at NIH. I was the only one in the lab, except for Casper. He had spent some time observing Vivien and working with him. We were operating together on one occasion, and we got into trouble with some massive bleeding in a pulmonary artery, which I was able to handle fairly well. Casper said to me, Dr. Haller, I was very much impressed with the way you handled yourself there. Feeling overly proud of myself, I said to Casper, Well, I trained with Dr. Blalock.

A few weeks later, we were operating together in the lab for a second time, and we got into even worse trouble. I literally did not know what to do. Casper immediately took over, placed the clamps appropriately, and got us out of trouble. I turned to him at the end of it and said, I certainly appreciated the way you solved that problem. You handled your hands beautifully, too.

He looked me in the eye and said, I trained with Vivien.

Alfred Blalock and Vivien Thomas: Their names intertwine, their partnership overshadowing the individual legacies they handed down to dozens of Hallers and Caspers. For more than three decades, the partnership endured, as Blalock ascended to fame, built up young men in his own image, then became a proud but reluctant bystander as they rose to dominate the field he had created.

As close as Blalock was to his protgs, they moved on. It was Thomas who remained, the one constant. From the first, Thomas had seen the worst and the best of Blalock. Thomas knew the famous Blue Baby doctor the world could not see: a profoundly conscientious surgeon, devastated by patient mortality and keenly aware of his own limitations.

In 1950, six years after he and Blalock had stood together for Blue Baby One, Blalock operated on Blue Baby 1,000. It was a triumphant momentan occasion that called for a Yousuf Karsh portrait, a surprise party at the Blalock home, gifts of Scotch and bourbon, and a long evening of reminiscing with the Old Hands. Thomas almost wasnt there.

As Blalock was laying plans for his 1947 Blue Baby Tour of Europe, Thomas was preparing to head back home to Nashville, for good. The problem was money. There was no provision in Hopkinss salary classification for an anomaly like Thomas: a non-degreed technician with the responsibilities of a postdoctoral research fellow.

With no regret for the past, the 35-year-old Thomas took a hard look at the future and at his two daughters prospects for earning the degrees that had eluded him. Weighing the Hopkins pay scale against the postwar building boom in Nashville, he decided to head south to build houses.

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The Remarkable Story of Vivien Thomas, the Black Man Who Helped Invent Heart Surgery - Washingtonian