A Child's Heart at the Talbot County Free Library

by Bill Peak

As soon as I learned there was a new biography of Dr. Helen Taussig out, I raced to my computer, pulled up the library's website, clicked on the “Find” tab at the top right of the screen, scrolled down through the drop-down menu to “Suggest a Title,” and in less than a minute had asked that a copy of the book be added to our community's collection.

It's easy to explain my excitement. When I was in college and dreaming of becoming a physician, I spent two summers working in a pediatric catheterization lab. My primary responsibility in Louisville's old Children's Hospital was to create a database (we did this by hand in those days) of all the cases we had treated of the most common form of congenital heart defect: tetralogy of Fallot. Up until 1944, when Dr. Taussig proposed a novel surgical solution for the condition, babies born with tetralogy of Fallot were doomed to short, often miserable lives.

Tetralogy of Fallot is the result of a dreadful misstep in fetal development that, as the name would suggest, results in four anomalies in the child's heart and its major vessels. These are: (1) pulmonary artery stenosis: narrowing of the vessel meant to carry unoxygenated blood from the heart to the lungs; (2) interventricular septal defect: a hole in the wall separating the two lower chambers of the heart, the ventricles; (3) misplaced aorta: the aorta seems to arise not from the left ventricle as in a normal heart, but from both ventricles; and (4) right ventricular hypertrophy: a muscular build-up of the lower right side of the heart due to the increased pressure under which (thanks to numbers 1-3) it must labor.

Children with tetralogy of Fallot may appear normal at birth (their bodies having been supplied with oxygen-rich red blood through their mother's placenta), but soon afterward their lips and nail beds grow blue (in doctor-speak, “cyanotic”), a sure sign that their hearts are struggling to deliver a proper amount of oxygenated blood to their bodies. As they grow and the demands on their heart increase, the condition worsens and, untreated, the child eventually dies.

Helen Taussig was a bright young woman who, in 1927, despite suffering from dyslexia, managed to graduate second in her class from the Johns Hopkins School of Medicine. The profession that Dr. Taussig was entering was famously unfriendly to women. A few years earlier Harvard Medical School had hired its first female professor, but only after making the poor woman sign a contract forbidding her to eat in the faculty club or walk in any academic procession. One of the country's leading academic physicians was known to tell his students that there were three types of human being: men, women, and women doctors.

As male doctors were uninterested in caring for “blue babies” destined to die anyway, one of the few opportunities offered Dr. Taussig was the underpaid directorship of a small, poorly funded pediatric cardiology clinic at Hopkins. She accepted the position.

Adding to the difficulties Taussig faced when she set out to study the blue babies no one else seemed to care about was that a recent bout of whooping cough had left her functionally deaf. It has been my privilege to place a stethoscope on any number of newborn chests and listen to the determined little beats of a heart no bigger than a walnut. To distinguish by ear between the sounds made in such a tiny heart by, say, an interatrial septal defect and an interventricular one requires intense concentration, patience, and lots and lots of practice. I never accomplished it.

Dr. Taussig taught herself to do it by touch. Placing her hand on a child's naked chest, she could make an accurate diagnosis based entirely on the minute vibrations she detected with her palm. Indeed, her diagnoses were famously more accurate than those arrived at by ear. Her clinical skills gave a whole new dimension to the phrase “the laying on of hands.”

Perhaps most important for the cyanotic children in her care, Taussig quickly discerned that those whose parents treated them with tender pity (everyone knew these children would be lucky to see their tenth year) sure enough soon died, while those whose parents insisted upon giving them hope tended to live longer. Taussig began to require a similar hopeful attitude from herself and her staff in the belief that even a year or two of additional life meant a child might survive until a medical remedy for his or her condition had been discovered.

And then she came up with the remedy.

In a child with tetralogy of Fallot, Taussig reasoned, if you took a portion of the left subclavian artery (which issues from the aorta) and surgically attached it to the pulmonary artery above the stenotic obstruction, then at least some of the poorly oxygenated blood being sent out to the body by the left ventricle should be recirculated to the lungs for an additional dose of oxygen.

Eventually she talked a surgeon, Alfred Blalock, into attempting the operation after his brilliant assistant, Vivien Thomas (of Something the Lord Made fame), proved the surgery could be performed successfully on dogs. Overnight, children who were expected to die received a new lease on life, and parents from all over the country began bringing their blue babies to Hopkins for the miracle cure.

The problem with reading a biography of someone you admire is that, as you approach the end of the book, you know you are also approaching the end of your hero's life. And Dr. Taussig was not just admirable, she was a tough but loving doctor who was still working hard at 87 to save lives when her own was taken in a tragic traffic accident.

You can find A Heart Afire—Patricia Meisol's testament to the good doctor's remarkable career—among the biography volumes under TAUSSIG in the New Books section of the Talbot County Free Library's Easton branch. And even today, anyone whose child is born with tetralogy of Fallot should get down on their knees and give thanks that a sweet yet fierce woman named Helen Taussig refused to give up on children like theirs.