Vivien Thomas: Surgical Pioneer
A man who revolutionized surgery — with no education beyond high school and in the face of outrageous racism
6–20–17, Adil (written 7–5–17)
Vivien Theodore Thomas was born in Louisiana in 1910, the grandson of a slave. He attended the racially segregated Cotton Picking High School in Nashville in the 1920s (which thankfully has been renamed, in fact for MLK Jr). This would be the extent of Thomas’s formal education. Nevertheless, and against all odds, Vivien Thomas would go on to completely revolutionize the world of surgery.
After high school, he planned to attend college and ultimately pursue his dream of becoming a doctor, but the Great Depression threw a big, juicy wrench into those plans. In the summer of 1929, he got a job at Vanderbilt University doing carpentry, but was laid off by autumn. He enrolled in the Tennessee Agricultural and Industrial College as a premedical student, but after the stock market crash, he had to hold off on the education. Through a buddy of his, he got a job in February 1930 as a surgical research technician under Dr. Alfred Blalock at Vanderbilt. Now, this Blalock fellow would go on to be a hero in the field of surgery, and he was seen as a total legend (for good reason). Blalock was known to be hard to get along with (side FF: Blalock was a descendant of Jefferson Davis, lol). Thomas and Blalock would have a back-and-forth relationship, which we’ll get into. But at this time, Thomas was relieved to just have a job and pay the bills during the Depression to support his family (wife and two daughters).
On Thomas’s first day of work, he helped operate on a dog. At the end of the same day, Blalock told him “okay boyo, now that you’ve seen this once, tomorrow come in and put this animal to sleep and get the experiment set up.” Remember, he had no high school education, and was now supposed to known how to use anesthesia. Within just a few weeks, he was starting these surgeries on his own. By the mid 1930s, Thomas was doing the work of a postdoctoral researcher, but he was classified and paid as a janitor.
In these first years, Thomas and Blalock were studying hemorrhagic and traumatic shock. The theory back in the day was that some blood toxin caused shock; our homies here definitively proved that this was bogus, and in fact the cause of shock was severe fluid loss. Their work evolved into big time research on crush syndrome (major shock after a crushing injury), which ultimately saved the lives of thousands in WWII.
The workflow for these 2 dudes was pretty wild, in the early days. Essentially, Blalock would wonder out loud “hmm, I wonder if X problem could be caused by Y. And maybe solved by Z. Yo Vivien, go figure this out in dogs.” So first, Thomas had to actually figure out how to replicate the problem in dogs. This alone is a huge feat to which people dedicate decades of their careers. But of course, Thomas then ALSO had to figure out how to actually solve the problem. He did this by doing thousands of procedures on dogs.
After their work on shock, which earned them quite some fame, the team moved to vascular and cardiac surgery. Before them, the heart was effectively untouchable for surgeons. Today, millions of cardiac surgeries are performed every year, with patients leaving just days after the procedure… this all started with Thomas and Blalock.
In 1941, Blalock was offered the position of Chief of Surgery at Johns Hopkins, and he requested that Thomas come with him. Thomas arrived with his family and encountered not only a housing shortage, but also a level of racism that was worse than anything in Nashville. The only black employees at Hopkins were janitors. When Thomas walked the halls in his white lab coat, he would get huge amounts of attention — so much so, that Thomas actually started changing into city clothes when he walked from the lab to Blalock’s office.
In 1943, in walks Helen Taussig, a pediatric cardiologist. She hears that our boys are doing some good surgical work, and mentions that she’s looking for a surgical solution to a congenital heart problem called Tetralogy of Fallot (aka blue baby syndrome). Basically with ToF, infants’ blood is shunted past the lungs, creating oxygen deprivation and a blue color. Babies have trouble breathing, become limp, occasionally lose consciousness, and would always die (not always immediately). So the 3 of them come up with the answer. The specifics are a little unclear; according to Taussig, she had an idea of what the procedure should look like, but according to Thomas and a 1967 interview with a medical historian, Taussig just suggested they might be able to “reconnect the pipes” in some way that might help. Regardless, Thomas and Blalock eventually realized that the answer was connecting the subclavian artery to the pulmonary artery, which allowed for increased blood flow to the lungs.
Thomas was charged with the task of first creating the animal model for ToF. After about two years of research, he was able to do a pretty good job of this. Then, he had to figure out how to do the actual procedure — what would ultimately be their landmark breakthrough. After about 200 dogs, Thomas convinced Blalock that the procedure was safe enough to attempt on a human.
On November 29, 1944, the procedure was first tried on an 18 month old infant. This scene must have been truly remarkable. As a black man, Thomas was of course not allowed to operate on humans, so it would be Blalock’s hands at work. Recall that all 200+ practice operations had been done by Thomas; in fact, Blalock had only been involved in one of those operations, in the capacity of Thomas’s assistant. But alas, here we are. In those days, surgeries were often still a show, performed in a true operating theater, with the tiers of rising seats for physicians to observe the procedure. Here at Hopkins where all black people were janitors, Thomas stood on a stool immediately behind the famed Dr. Blalock’s right shoulder, coaching the Chief of Surgery through each and every step of the operation. Thomas had even created the needles for the first procedure using silk from his own lab (had to make ’em real small).
The operation was not a total success, but it did prolong the infants life for several months. The pair then repeated the procedure on an 11 year old girl with complete success — she left the hospital 3 weeks after surgery. And then they had success again with a 6 year old boy, who dramatically regained color at the conclusion of the procedure. Together, these 3 cases were the subject of a report in the May 1945 issue of the Journal of the American Medical Association (one of the most famous journals in the world). Blalock and Taussig were given all credit for the work. Vivien Thomas was not mentioned.
News of the procedure spread around the world, and Hopkins and Blalock continued their rise to fame. Thomas remained totally unacknowledged. Even in photos of doctors involved in the procedure, he was not pictured. Within a year, this new procedure had been done on 200 patients at Hopkins, with families coming from thousands of miles away.
In 1946, Thomas developed another complex procedure called atrial septectomy, which was used to improve circulation in patients whose aorta and pulmonary artery were transposed. And he did it flawlessly. In fact, he did it so perfectly, that Blalock couldn’t even find the suture lines in the heart tissue. This led him to famously say, “Vivien, this looks like something the Lord made.” In 2004, HBO released a documentary called Something the Lord Made, which I just watched and is fantastic.
To really emphasize how incredible of a surgeon he was, one has to look no further than his students, who became world-renowned surgeons in their own right. “Even if you’d never seen surgery before, you could do it because Vivien made it look so simple,” the famous surgeon Denton Cooley told Washingtonian magazine in 1989. “There wasn’t a false move, not a wasted motion, when he operated.” Thomas was a figure of legend.
He took these skills to Raymond Lee, an elevator operator at Hopkins. Thomas amazingly taught Lee how to assist in a lot of surgeries, telling him it would be better for him and his family. He went on to be a Physician’s Assistant, assisting on the famous first double heart-lung transplant and the separation of conjoined twins done at Hopkins.
Here’s the real kicker: Thomas was still paid sickeningly little for his extremely high level work. His salary this whole time was about $12 per week (wtf??). [Number depends on the source; the movie says $16/week, but does it really matter?] To support his family, Thomas sometimes worked as a bartender… at Blalock’s parties. This led to him serving drinks to people he had taught surgery to earlier in the day. This was the only way he ever “attended” any of Blalock’s affairs.
This is where we see some of the contradictory nature of his relationship with Blalock. Blalock never gave Thomas academic credit for the work he did, and he had this weird social relationship with him. But Blalock did fight to give him his job, and eventually (by 1946) he did negotiate with Hopkins to make Thomas the highest paid technician at Hopkins (sort of making a payment tier just for him), and by far the highest paid African-American at the institution. Not that that meant much — an extra $25/month (according to the movie), to be precise. And it took ages — this pay bump didn’t happen for decades, and it still didn’t match his contributions.
Ultimately, Thomas’s work helped pave the way for cardiac surgery of all sorts. In addition to saving thousands of lives directly through his own work, it was also the first time surgeons ever really touched the heart. Every cardiac surgery performed today has its roots in the work of Vivien Thomas.
Legacy
Vivien Thomas died of pancreatic cancer in 1985, and his autobiography was published just days later. His widow revealed that, for years, Blalock had toyed with the idea of going back to school and getting the formal degrees he lacked. However, Morgan State University wouldn’t give him credit for life experiences and wanted him to start with freshman year requirements, and this was obviously a turn-off. I mean seriously — this guy has essentially given birth to the field of cardiac surgery, developed multiple life-saving procedures, and taught the world’s leading surgeons, and you want him to take Bio 101? Get outta town. Thomas realized he would be 50 years old by the time he finished school, and he decided against it.
Thomas stayed at Hopkins for 15 years after Blalock’s death in 1964, serving as director of Surgical Research Laboratories. He had a storied legacy: he mentored Hopkins’ first black cardiac resident, Levi Watkins, Jr., and assisted him in his pioneering implantation of the automatic defibrillator.
As hinted earlier, he also had other tremendously successful students prior to this — in addition to Cooley, others included Alex Haller, Frank Spencer, and Rowena Spencer. In 1968, these and other homies, who had now became surgical Chiefs across the country, came together and commissioned a painting of his portrait, which now hangs next to Blalock’s in the lobby of the Alfred Blalock Clinical Sciences Building.
In a small bit of irony, Thomas’s nephew actually graduated from Hopkins Med, trained by many people who were trained by his uncle, and he is now the orthopedic surgeon for the Tampa Bay Rays.
Finally, in 1976, Vivien Thomas was rewarded an Honorary Doctorate by Johns Hopkins. However, in a crowning example of SUPREME bullshit, Hopkins actually gave him an Honorary Doctor of Laws rather than a medical doctorate, because of some asinine restrictions… are you kidding me? This guy was the first to conceive surgeries for the human heart, his work led to the saving of countless lives, and he trained the world’s leading surgeons — all in the face of unbelievable discrimination and with no formal education. And now you can’t even give him the honorary degree he deserves.
Anyway. After being at Hopkins for 37 years and revolutionizing surgery across planet Earth, students and staff could finally call him “Dr. Thomas.”
Dr. Thomas was thankfully also appointed to the faculty as an Instructor of Surgery. He continued to receive more of his deserved recognition in the 90s and 00s (posthumously, obviously). In 1993, the Congressional Black Caucus Foundation instituted the Vivien Thomas Scholarship for Medical Science and Research sponsored by GlaxoSmithKline. In 1996, the Council on Cardiovascular Surgery and Anesthesiology began giving the Vivien Thomas Young Investigator Awards. In 2004, the Baltimore City Public School System opened the Vivien T. Thomas Medical Arts Academy.
In 2005, Hopkins started organizing first year med students into 4 colleges named after faculty who had major impacts on medicine. Rightfully, one of them is named Thomas College. And today, the Vivien Thomas Fund at Hopkins aims to reach out to under-represented minorities and bring them into medicine and science. Full circle, no?
PS: If in your daily conversation you ever hear someone refer to the Blalock-Taussig shunt (the famous life saving procedure for ToF), be sure to correct them — it is obviously more accurately known as the Blalock-Thomas-Taussig shunt. Or if you ask me, it’d be the Thomas-Blalock-Taussig shunt….
Sources:
Sawbones podcast, episode from May 18th, 2017
