The American Academy of Achievement conducted interviews with Dr. Willem J. Kolff and Dr. William DeVries. In the following interview, Dr. DeVries's answers are interspersed with those of Dr. Kolff. Dr. Kolff, you describe yourself as an inventor. When did you know this is what you were going to do?
My father was a doctor and, when I was very young, I didn't want to become a doctor because I didn't want to see people die. It's interesting that, later in my life, the main purpose of most of the machines I have made is to prevent people from dying. I immediately want to say, I don't want to prolong life when it is misery. I want to prolong it only when it is an enjoyable life. When did you decide to become a doctor? Was there a teacher or someone in your life who encouraged you? Willem Kolff: In my early years it was undoubtedly my father.
My father was director of a sanatorium for pulmonary tuberculosis, and at that time there were no antibiotics, tuberculosis was a terrible disease. And, he and I would walk in the woods around that sanatorium and he would discuss his worries about his patients. And from him, I certainly inherited this extreme concern about the well-being of patients. I've seen him very happy when he succeeded after months and months of rest and other things to have these people go home cured. I've also seen him crying and desperate after trying for a long time and a patient did not get well, and went home to die.
We'd like to ask the same question of Dr. DeVries. What inspired you to become a physician? William DeVries: I always really wanted to be a physician. Mainly it was the mystique of the heart. I was always enamored of the fact that the heart was supposed to be the seat of the soul, the site of love. Everything was the heart. As a child I had images of that and, and I got involved in it more and more. My mother was a nurse, and she gently encouraged me along this line. Dad was a doctor. He died shortly after my birth. I always kind of felt that I owed something to him. When I was in school, biology really excited me. I was really turned on and excited by dissecting animals. So things moved along in the direction of anatomy and biology. It was just a natural. Why surgery as a specialty? William DeVries: I always liked mechanical things.
I can remember sitting in school when I was in third grade, and watching the road-graders out on the street and the steam shovels, and I always kind of liked the mechanical things about life. I always enjoyed building model airplanes, taking apart clocks. I could never get them back again, but I could always take them apart. And, the mechanical things were always amazing. But, I enjoyed working with my hands. Model airplanes were a passion with me when I was growing up, so it became a natural. I mean, I was going to do something with my hands and I enjoyed the heart, so I ended up being a heart surgeon. It was just kind of the way that I went.
Any particular experience that you remember that inspired you as a kid to pursue this?
I can remember my trip to that hospital and waking up about a day later and looking over on one side of me. And, there was a boy in an iron lung, and looking over on the other side and there was another boy in an iron lung about my age. And, then I remember being afraid to look down because I thought that I might be in an iron lung. And, finally kind of feeling around and realizing that I wasn't, and was very glad to see that. But, I can remember being in the hospital and seeing that -- the mechanics of this invention. It really promoted me after that incident, to do something about it. Also, it developed with me, really a pride in technology. You know, these kids were alive because of the mechanics of this sort of thing. And, that got me very excited about the mechanical aspects of medicine.
So that little two-week incident in the hospital made a big impression on me. Dr. Kolff, were there any teachers who had a particular influence on you when you were young?
When you were young did you read a lot? Were you good in school? Willem Kolff: No. I was never very good in school. I had a lot of other interests than school. In the gymnasium -- which you would call in the United States high school -- it was very difficult. In the Netherlands, where I grew up, you had to learn four modern languages. I'm fluent in four modern languages. You also had to take six years of Latin and five years of Greek. You didn't have electives, you had to take everything. Apart from the later years of German occupation, which were very terrible, these high school years were perhaps the most difficult of my life. I was forced to do things that I did not really like to do, but I knew that it was necessary. I knew I would always have one insufficient mark, so I switched it around so that my average at the end of the year was good enough for me to pass to the next class. Dr. Kolff, you mention that your high school years were difficult for you. Why was that? Did you not have close friends, or was it the school? Willem Kolff: Oh no, I had close friends. I had no social problems.
It's hard for anybody in the United States to realize how difficult and how exacting the program is of the Dutch high schools, certainly at that time. Here they have a little homework. I would have classes -- four in the morning, two in the afternoon -- and go home with homework for five different things. And, the following morning that had to be completed. And, if in Holland you get French, or English, you don't have it for one year or so, you have that the next year, too.
So, it is entirely different, it is very hard. The mortality rate, that means the people that drop out from high school, is very high. They then go to a lower grade school, which does not admit them to the university. But once you get through that high school, then any university would be open to you. So when you were young, instead of satisfying your curiosity by reading books, you went out in the world and explored.
So you were punished for your dyslexia. Willem Kolff: Yeah, and that was a very common thing. At that time, dyslexia was totally unknown. I've learned to live with it. I like to have a secretary who can spell, which is difficult to find. I have no further words of wisdom, except that you can learn to live with it. You can overcome it to a great extent by reading and by writing. Some of my brothers had it much more severely. My one brother who has severe dyslexia has been rather successful as a businessman, but he knows his limitations. What advice might you give to a young person who doesn't get marvelous grades, doesn't seem superior in the class, but really has this deep desire to achieve something? Willem Kolff: Some way or another he should make sure that he passes. In this day and age if they want to amount to anything, they must have an education. In Holland, if you passed the final exam of your high school you automatically could get into a university. Here is it different. If they want to go into medical school, for example, and their grades are not magnificent, let them do something in the community. Let them work in Planned Parenthood, or go to a rehabilitation center, or do a year of research in biology. Try to find something that you're interested in, that may help you get a little advantage over other students. By the way, the guys with very high grades are not necessarily the people that are the most successful in later life. They may be the ones that can regurgitate gracefully, and they get very high grades. But if the guys that have to work for it and do not have such good grades can do something extra, and prove that they can perform, they may have a chance. What did your parents think when you became an obvious success? Did they expect this of you?
What happened in your career that you didn't expect? Willem Kolff: Originally, I planned to go to Indonesia. Indonesia at that time was a Dutch colony. I knew a young doctor could go be the head of the Department of Medicine of a large plantation way in the hinterland, and get wonderful experience. You could be independent, and do very much what you wanted, and still help people. That is what I had planned to do. I even followed a course in tropical medicine, but then the war came, and you couldn't get out. Circumstances have often played an important role. Who gave you your first big break in your career?
Professor Daniels had one quality which I think is very important. There are some professors who want their students to do exactly what the professor is interested in. This man was different. He set us free, and when I wanted to pursue a certain thing, he would study it and help. All my life I've tried to follow that example and, where possible, allow my students to follow their interest. I know where I want to get in the long run, and we don't go there in a straight line, because these students want to go this way or that way. It takes longer, but it makes their life much more interesting if they can do it their way. Eventually we'll get where we want to be. Dr. DeVries, who would you say gave you your first big break in medicine? William DeVries: The first big break I had in medicine was Dr. Kolff. He was the doctor who invented the artificial heart, and the artificial kidney too. I was in medical school, it was lunch break and I forgot my lunch. I didn't want to mooch off my friends, and I didn't have any money, so I followed the crowd into this lecture hall and sat at the back. Dr. Kolff was just visiting this group of students. He started talking about the artificial heart and the artificial kidney, and I was absolutely enthralled. I couldn't believe people were actually doing this. All of a sudden, parts of my life just started coming together. I wanted to know more about this.
After the lecture, I went down, and I said, "Dr. Kolff, I'm really amazed. This is a wonderful thing. Could I work with you maybe this summer?" And he said, "What's your name?" and I said, "DeVries." And he said, "Well, that's a good Dutch name. You're hired." So, because he was very proud of his Dutch heritage, my name got me into that job. And, he gave me a break, and gave Dr. Jarvik a break. You see, at that time, we didn't realize that he had talked to everybody else and tried to get them involved in it and all these older surgeons thought this was stupid. You know, "It will never work." So, he started talking to younger kids because we were young and idealistic, and impressionistic, and he could talk to us in and move us in any way he wanted to do. But, he took us and allowed us to do what we wanted to do -- what only youth could do. Stupid things! Walk into the face of criticism by learned men and never miss a beat. And, that's what we did.
He had a faith in youth, in letting us chart our own course. He let us do what we wanted to do. When we heard about the artificial heart, we said, "Why can't you do it? You ought to be able to do it." And then we did it. He gave us our first chance to try our legs and see what we could do. It was really exciting. He would never criticize you for something you missed or something you did, or making a wrong turn or making a mistake. He said that's just the way things go. But he was always quick to praise you and he always gave everybody else credit for what happened. For those lessons, I have held him in high esteem and will always have fond memories of him. He let me have the reins, and let me run. What are his major contributions to medicine? William DeVries: During the war, Dr. Kolff had the first successful dialysis patient. He has saved hundreds of thousands of people's lives with the invention of the artificial kidney or renal dialysis. At the Cleveland Clinic, in the early '50s, he got involved in the artificial heart while working on dialysis, and developed the first artificial hearts. He ushered in the whole concept of artificial circulation. He started people from all over the world refining and developing this concept. I think the credit for the artificial heart should really go to him. Dr. Kolff, the kidney dialysis was one of your first major accomplishments. And you began working on that when you were quite young. Willem Kolff: It was not the first thing, but it was the first really important thing.
When I was this young assistant at the University of Groningen my responsibility was for four beds, or rather the patients in four beds. That was all I had to do. And, one of these patients was a young man, 22 years old, who slowly and miserably died from renal failure. He became blind, he vomited, and it was a miserable death. And I, as a very, very young physician, had to tell his mother, in a black dress and a little white cap like the farmers have, that her only son was going to die. I couldn't do a damn thing about it. So, I began to think, "If I could just every day remove as much urea as this boy creates, which is about 20 grams, then the boy could live." Well, he died, but I began to work on that.
Also, while I was at Groningen, I got interested in blood transfusions. I was the first in the Netherlands -- and probably on the continent of Europe -- to apply blood by continuous drip. It was not my invention, it was done first in England. When I came to the University of Groningen, you had the donor lying there, and the recipient next to him, and you pumped blood from one to the other. But I introduced these drips, in the Netherlands. And then it became apparent that you needed to store blood. That led me to read about the blood bank in Chicago.
When the war broke out I happened to be in the city of The Hague, for the funeral of my wife's grandfather. That morning of the funeral the German planes came overhead and they threw out leaflets that the Dutch should surrender, and they bombed the barracks, and so on and so on. And, instead of going to the funeral, I went to the main hospital, where I had been before, and I said, "Do you have a blood bank?" And they said, "No." And I said, "Do you want me to set one up?" They said, "Yes." And they gave me an automobile with a soldier in front because there were snipers, and they gave me purchase orders so that I could go to every store in the city and buy whatever I had to. And, in four days time I had a blood bank ready.
That blood bank is still in existence. That was my first major thing with blood. Some of these circumstances changed the whole direction of your work and your life. Willem Kolff: Yes. Having handled blood outside the body made dialysis less difficult for me. Of all the inventions that you've explored yourself and that you've inspired others to investigate here, I wonder why you think you've succeeded in doing this. Where there are a lot of people out there with brains and potential, but they haven't been able to make this happen.
Also, be prepared that your new idea will not always be welcome. As a very young assistant at the University of Groningen, when I told the chief assistant that I was going to make an artificial kidney, he became very, very mad. What I should do, he said was just like every other young assistant: Do what he told us. But my old professor listened, and let me do it. It seems that some of the experimentation and some of the thinking that you did in developing this technique was simple. Willem Kolff: Yeah. Whenever I see a problem, I try to reduce it to simple terms. If the problem is very complicated, then look at whether or not there is a simple component to it. And if that simple component is an important part, then take that first, then you can forget about the other components. Reduce the complicated problem to something that you can understand, and that perhaps you can do something about. How did you come to leave the University of Groningen for a small city like Kampen? Willem Kolff: I didn't want to stay at Groningen because the Germans put a National Socialist (Nazi) at the head of the department. I stayed just long enough to get my certificate as an internist, a specialist in internal medicine. The night before this National Socialist appointed by the Germans came in, I left. I never saw him alive. Then I had to look for a place, and I found one in Kampen. It was a very small hospital. They were very nice to me. They wanted to have an internist, and I was the first. I made the royal sum of 10,000 guilders per year in the first year. Divide that by two and a half, and you have the number of dollars that I made. I said, "Now I can afford to make an artificial kidney."
And another thing happens. Sodium chloride and other electrolytes will also go out. So, you add them to the dialyzing fluid on the outside, and they go out and in, and you get an equilibration through this membrane. If the sodium is too low, it goes higher; if it's too high, it goes lower. This normalizes the electrolytes in the blood plasma. The treatment with the artificial kidney is relatively simple. You didn't succeed the first time you tried to figure out a solution to this, did you? Willem Kolff: No, but I knew exactly what I wanted to do. I wanted to use dialysis to remove urea and other products that are excreted by the kidney. I filled a small piece of cellophane tubing, about 40 centimeters long, with blood. I added urea to it, I shook it up and down in a bath with saline, and from this I could calculate that I needed ten meters of this stuff, and that the blood had to be continuously in motion, and the dialyzing fluid also in motion. I also had Heparin to prevent clotting. All I had to do was to make a machine with sufficient surface area to make it worthwhile, and that's what I did. I went to see the director of the enamel factory. I got him interested, and he helped me. That was the first rotating drum artificial kidney. When it came time to pay the enamel factory, it turned out that the Germans did not allow any Dutch company to work for anybody else but the German Wehrmacht, (that's the army) so they never could give me a bill, and I never paid for it.
I had one patient with chronic renal failure that was in 1943, during the war. And, I dialyzed one-half liter of blood, and had it run through that artificial kidney and gave it back to her. And then waited two days to see if anything terrible would happen. Nothing happened. And so, I then took a little more blood, and so on. By that way, at that time if either an institutional review committee for research on human patients, or the FDA had been breathing down my neck, the artificial kidney would never have been made. Never.
You mean you worked in circumstances that allowed you to do this. Willem Kolff: Yes, without the FDA was in existence and before IRBs (Institutional Review Boards). My conscience was my only brake. Otherwise, I could do what I wanted. But I had to explain to the patient what I was going to do, and I always did. Dr. Kolff, can you tell us about the first patients you treated with dialysis? Willem Kolff: Of the first 15 patients I treated with dialysis in Kampen, only one survived. And that one might have survived if I had used another sequence of treatment, without the artificial kidney.
Sophia Schafstad was the first patient where you can honestly say she would have died had she not been treated with dialysis. And she was in a prison right after the war, for collaborating with the Germans and many of my fellow countrymen would have liked to wring her neck. And, she was brought to us in renal failure. My duty is not to wring her neck, but to treat her. And, we treated her. And, she was comatose when she came in. And after so many hours of treatment I bent over her and said, "Mrs. Schafstad, can you hear me?" And she slowly opened her eyes and said, "I'm going to divorce my husband," and she did.
Well, this woman was a National Socialist, and when I talked about her a few months later in London I said, "It's now been proven that the artificial kidney can save a life, but it's not been proven that it's of any real use to society." The moral is that we have to treat patients when they need help, even if we don't like them. I've been mortally opposed to the so-called life and death committees that were instituted. When there were many more patients that needed to be dialyzed, and not enough artificial kidneys available, you had the institution of the life and death committees. You had a medical committee, and the first question they asked is, "Is this patient an emotionally mature adult?" If he was not, he didn't qualify. And the next question was to the lay committee, in which sat two cleaning women, a minister, a banker, a union leader, and a lawyer. This lay committee had such questions as, "Does he go to church? Does he give to the community chest? Is he employed? Does he have children? Is he divorced?" Depending on the answer to these questions, he could be dialyzed. Otherwise, he could go to hell. I've been mortally opposed to that. When I set up a dialysis center here with a grant from some government agency, I was forced to put in a life and death committee, but it never met. How was the artificial kidney received? Was there criticism? How did you handle it?
Willem Kolff: When the artificial kidney had become in my eyes a reality that did not mean that the medical profession was going to say, "Hurrah! Now we have something!" And, there were some that were receptive, there were many more that thought that the idea to have blood outside somebody's body was a horrible idea, and they did whatever they could to prevent using the artificial kidney and some of them wrote articles that said the artificial kidney was not needed. I've done one very good thing. I have never responded to any of those articles, for the simple reason that I had seen the improvement in patients so clearly that if I could just keep going, and have a few other people do it too, I would win.
If I had responded to unreasonable criticism, I would have made a lot of enemies. I would have become a paranoiac probably. Fortunately, I did not. On the other hand, when somebody tries to prevent me from doing something I want to do, I will do whatever I can to do it anyway. Why do you think there been so much opposition to your work from the medical establishment? Willem Kolff: A large number of people react in negative way to anything that is new, anything they have not heard about before, that is not what they were taught, in school or in the university. I decided early that I would never be negative when I hear of something new until I have heard the full story, and have had the time to look at it. Right after the war, the artificial kidney which we had made in occupied Holland opened the world for me. I was in England, and I met with a wonderful man, a Professor Pickering. He told me about the operation on blue babies. At the time, you could not repair the defect in the ventricle. They would put blood from the aorta, or from the subclavian artery, into the lungs, so that more blood would be oxygenated.
That's another thing you must remember. If you're sufficiently far ahead of the field, you don't get any support. I remember what Professor Borst in Amsterdam said when he heard that I was going to work on a heart/lung machine. He said, "But Mr. Kolff, this is impossible!" If something is impossible, these guys in the NIH are not going to give you high grades for your grant proposals, and no money. Many of your early experiments and inventions were done with very ordinary materials. I read somewhere that you made something with beer cans. Willem Kolff: Yeah. I'm glad you brought up that question. I came to this country in 1950, and I realized that nothing was very popular here unless it was disposable. So in 1955 I decided to make a disposable artificial kidney. I took up a thing that had been explored earlier by Inoyn and Engelberg. They put some coils of window screening and cellophane tubing into a pressure cooker, but they abandoned it. I made a twin-coil kidney with the cellophane tubing wound in the coils. The blood comes in through the inner tube, and it goes out through the outer tubes. First I tried a beer can to make these things but it was too small. All the early twin coil kidneys were made out of fruit juice cans or the equivalent. Later we used the plastic equivalent of a fruit juice can. At that time, it was thought to be unethical for a doctor to make any money on an invention. That was the point of view of the American Medical Association; it was also the point of view of the Cleveland Clinic. So I gave this invention to Baxter Traveno, and they sold this type of artificial kidney worldwide. It put the artificial kidney on the map.
Maybe I should show you now how much urea I have at one time removed from one patient. There was a patient who was comatose, absolutely comatose, He was a big man. And, this white powder is urea and all this urea was removed in one dialysis, which is incredible, isn't it? It goes very fast. And, in the beginning there were always people that said, "Well, urea is not toxic." I would say, "Eat it, and see how you feel."
That's 263 grams there. How did you begin development of the blood oxygenator for the heart/lung machine? Willem Kolff: We had seen in Kampen that blood that was blue became red when it came into the artificial kidney. It took up oxygen from the air. It was an oxygenator. I began to make blood oxygenators to be used in heart/lung machines, but the hospital in Kampen was too small for open heart surgery. One of the reasons I left for the United States was that I had to be in a hospital large enough to have a cardiac surgical department. When I came to Cleveland I brought three excellent heart/lung machines, but nobody in the United States was interested. I had to wait five years before the heart surgeon began to realize that he could not do all the surgery blindly. How do you sustain yourself during that time when you're far ahead and you're all alone?
Willem Kolff: The first years in Cleveland were very, very difficult. Fortunately, I have many interests, so if I cannot make progress with the heart/lung machine, I can improve the artificial kidney. And, I can also then begin this kidney transplantation, and that's what we did. At that time when we entered the field of kidney transplantation, people did not use cadaver kidneys anymore. And, we proved that if we would take a cadaver kidney, put it in a patient without kidneys and dialyze them with one of these machines, that we could keep them alive long enough so that the cadaver kidney would recover from the rigors it had gone through when its previous owner died. That was very important, and also very fascinating and very beneficial.
When people have criticized you, Dr. Kolff, do you think the criticism has been unjust? Willem Kolff: It has very rarely, or never been personal. I mean, even people that disagree with me totally, and said there was no place for the artificial kidney did not say, "Kolff is an idiot." At the Cleveland Clinic, I was a member of the Department of Research and I was also a member of the Department of Surgery. If I couldn't get what I wanted through Surgery, I got it through Research, and vice versa. But around 1966, it became apparent that they didn't want a guy straddling two departments, and wanted me to make a choice, either one or the other. By 1967 I had worked at the Cleveland Clinic for 17 years. I wanted set up an institute for biomedical engineering that would be second to none. I couldn't do it at the Cleveland Clinic, so I began to look elsewhere, and I came to Utah. There was no money, so I had to write grant proposals to the government, and collect money from other people, but they did help me.
The artificial ear, which was an offshoot of our artificial eye program, is much simpler. You do not stimulate the brain, you stimulate the acoustic nerve. We all have a snail's house here in our head, and the acoustic nerve is beautifully arranged in that cochlea or snail shell. We can thread electrodes into the cochlea, and when you stimulate one point you hear a high tone, and when you stimulate another point you hear a low tone. Of the patients treated here at the University of Utah with this artificial ear, 60% can have a telephone conversation. They're totally deaf otherwise. There's good proof that it works. Now, that's very important for the deaf. We've made artificial arms, and that is kind of a sorry project. A lot of people with artificial arms are veterans, but for a long time the Veterans Administration didn't want to spend enough money to provide these people with decent arms. Our artificial arm is so good that it can peel an orange, and so strong it can crack a nut. It can move very fast, but when it comes close to your mouth it goes slowly suddenly, because otherwise you would knock your teeth out. You've met with a number of setbacks, but you didn't accept them as setbacks. Willem Kolff: No. In the long run, setbacks have often worked to the benefit of my program. Let me give you a few examples.
The University of Utah is bonded -- insured against that kind of stuff. The year the sheep were stolen, I had enough money from the NIH. I got the bonded money back in a year that I had no support from the NIH, so it saved my laboratory. The same guy put a torch to my building, and burned it out. The insurance company paid $125,000 to replace the equipment. Instead, I had it rebuilt by my own personnel. The lab is still brown from the smoke and the fire, but that money saved my department. You don't see it the minute it happens, but sometimes disasters work to your advantage. Dr. DeVries, how did you come to play such a role in the artificial heart program after your student years? You must have got the hang of this kind of work very quickly, because you were invited to head up the University of Utah's heart surgery division at a very young age. How did that come about? William DeVries: After I graduated from the University of Utah medical school, I was interested in going away. I wanted to come back to Salt Lake City someday, because I was raised there, but I wanted go somewhere else to see what I was made out of. I chose Duke because it was in the East, and it had a great reputation. Dr. David Sabiston, who was probably the premier teacher, was there. I was at Duke nine years, learning to be a heart surgeon. At the end of that time, I remember going to him and saying, 'Well, Dr. Sabiston, it's time I start looking for a job." Dr. Sabiston said, "What do you mean? You are going back to the University of Utah. We've already talked to Dr. Kolff and he wants you back." It was some kind of a deal they had made. Dr. Kolff had told Dr. Sabiston, "You can have him but I want him back in nine years." So I got in my car and went back to Utah. Let's trace the history of your breakthrough experiments with the artificial heart. What led up to your historic 1982 operation? Where had you been? William DeVries: I happened to be at the right place at the right time. I got back to Utah and walked into a rich and fertile field. The artificial heart program had not progressed that much, except in animals. When I left in 1970, it was in its embryonic stages of development. We had a sheep that lived 50 hours with an artificial heart, but that animal couldn't even lift its head, it was so weak. That was the state of the art. 50 hours of an animal that just lay on the floor. When I came back in '79, animals were walking around, moving. They looked normal except that they were connected to a machine. Hundreds of people had devoted much of their lives to develop this. We had worked for years and years on the artificial heart in animals and were ready to put it into a patient. All of the necessary things were ready to go. My job was to move it from the animal lab into the people. I started talking about putting it into patients and I noticed everybody was afraid.
I went up to the guy that made the artificial hearts for animals, and he had made thousands of artificial hearts. And, he made the best artificial hearts in the world, and I said to him, "Tom, I want you to make a heart that we are going to put into a patient." And, he just froze. He said, "My God, you can't do that. These are just for animals. I can't do that. I mean, I can't make one good enough." I said, "Tom, I want you to do things exactly like you've always done them before and I don't want you to make it too tight, or too loose. I want it just perfect, just like you are making them."
It's the same way with everything. They were going along well with animals, but to say the next step is a person, that was way out.
When I went back to the University of Utah in '79 and saw the tremendous development of this device, it worked and it pumped blood and these animals looked great. And then, on the other hand, I'd look over and see these patients that were dying around me for want of a heart. It was a natural. It was just natural. I mean, there was nothing unusual or strange about it to me. And, so we got ready to put that in with Barney Clark. It was amazing, those early days before putting the heart in Barney Clark and dealing with all of the questions, the ethical problems and the emotional aspect of it. And, I just saw that we have the device, and we have a need for the device, and let's put them together. But, there was a tremendous block in that. And, as we got ready to implant the heart in Barney Clark, these people were just very afraid.
Suddenly all the successful work in animals was just something of another kind that wasn't related to this human implant. That fear was one of the things we really had to work with, within the group. The hurdle seemed insurmountable at times. Once we overcame that and did it with Barney Clark, the door opened up. "Hooray, it works!" How was Clark chosen? Why was he chosen? William DeVries: We chose Barney Clark for many reasons. We spent almost two years developing the criteria for Barney Clark. We considered all kinds of factors. Many times when your heart fails, your brain, your intestines, your lungs will fail too. So first of all we had to find a patient whose heart was bad but the rest of him was good. That's hard to do. We also had to find was a patient who was not a candidate for transplant. We couldn't take a patient and remove his heart and put in a machine if there was another treatment that was more effective or better. At that time, we weren't giving heart transplants to anybody over 50 years of age. Nowadays, interestingly enough, he probably would have had a heart transplant.  Get the Flash Player to see this video. 
The next indicators that were a little bit different than usual, such as a strong family background and an understanding of the situation. We looked about nine months for Barney Clark. We were getting very discouraged. We thought he would never come along. One day I was in the shower down at the gym and I got a telephone call. It was Dr. Jeff Anderson, a cardiologist, who called. He said, "I've got a patient you may be interested in. He's a dentist, he's intelligent, he's bright, he's got a great family, very supportive." Everything just fell into place. It started moving very fast at that point. Why does the Food and Drug Administration accredit you and you alone to do this surgery?
At that time, Denton Cooley went ahead and put an artificial heart in a patient without FDA approval. At that point, the FDA had to say, "Denton, you did it wrong. You shouldn't have done this. You should have gone through the approval process." It also certified us as having something that might be valid. They either had to punish him or give us approval. Shortly after his implantation, they slapped him on the wrist and told us we could go ahead. So he really did help us move forward. After Barney Clark was implanted, Denton acknowledged the fact. He knew that was something he had helped us with. But we decided we were going to do everything the FDA wanted us to do, and we did. We complied with their every wish. Dr. Kolff, your work on the artificial heart, does it have anything to do with people thinking that a person's heart is where their soul is? Willem Kolff: Yes. The heart, as you know, is the symbol of love, the habitat of the soul, and the source of life. To replace that by a simple pump goes against everybody's feeling. People are also afraid that if they have an artificial heart maybe they can't love anymore. We had Barney Clark to prove the opposite. We knew that the artificial heart could sustain the circulation, because we'd seen it in animals many times. But Barney Clark proved that the artificial heart did not cause any pain, did not cause any disagreeable sensation. The click-click noise of the pump did not bother him. He still loved his family, he still had a very considerable sense of humor, and he still wanted to serve his fellow man. Dr. DeVries, tell us about the day of the surgery. William DeVries: According to the rules at that time, we had to take the patient when he was almost dead. He had to be almost drawing his last breath. The criticism had come up that we couldn't take a patient who was already alive and then kill him. So we had to have him sign a consent form, then we had to wait 24 hours and have him sign the consent form again to say, "I've thought about it, and I still want to go ahead with this." Barney came in and saw us about a month earlier, when he was a little more healthy. He saw the animals, saw the implantation, and said he didn't want to go ahead with this because he wasn't ready yet. He went home and started getting real sick. He couldn't even get out of bed. His family gathered for Thanksgiving dinner, and they carried him down the stairs. Barney was a big man, he was a really tall and heavy guy. They carried him down the stairs and sat him at the Thanksgiving table. He said the prayer, and they carried him back to bed. That was all the strength he had. And that night, when he was with his wife, he said, "I've decided to go ahead and have the operation." And his wife said, "Why, Barney?" And he said, "First of all, I don't think it will work. I'm weaker and more tired than those animals I've seen, and I don't think it's going to save my life. But I have been kept alive for the last year on medicines that other people have given their lives to give me. Now it's my turn to pay those people back." He came back to the University of Utah, and said, "I want to go ahead with this." He saw this as kind of a mission. His death, his life, his existence, his 118 days on this heart, were going to give other people something. We all felt that call when we got involved in this. It was something that had to go on.
Talk us through that operation. William DeVries: The operation was at the University of Utah Medical Center, which sits on a hill. It was a snowy day in December. It snowed so much during the 24-hour waiting period that I asked the operating room team to stay, because I knew if they went home and got off the hill, they wouldn't be able to get back. So we had everybody stay there. Everybody was waiting. We decided around ten o'clock that he wasn't going to make it much longer and we went ahead in the middle of the night. There was a blizzard outside, and you couldn't even get up to the medical center. About 2:30 at night, while we were still in the middle of the surgery, I said to this circulating nurse, "How is it outside?" Meaning, "Is it still snowing? What are the conditions?" And she said, "Dr. DeVries, you wouldn't believe it. I just went down to the cafeteria for a cup of coffee, and there are 288 reporters down there." At that point I realized what this was going to be like. Some of these guys had put on snow shoes to get to the medical center. That was the first time it really struck us that there was so much interest in what we were doing. Up until that time, we had spent so much time getting ready, getting things going that we never really thought about it. It was like being on a train. It stops, some people get off and more people get on, and it keeps going. It just keeps moving forward. People say, "What was it like?"
We had prepared ourselves so much and run mock circulations and everything that it was just automatic. It didn't ever really hit you what had gone on until after it was all over. And, we were all sitting down, and this patient was sitting up with this artificial heart, and someone said, "My God, look at it! He doesn't have a heart anymore. He's got a machine in his chest." Then you realized what was going on.
But you couldn't stop and pat everybody on the back and high five and say "Didn't we do a great job?" because it had just started at that point. We were always going to have a party in which we were going to thank everybody and say, "You all did a great job." We never had it, because every day something else came up, and then he died. After he died, everybody was so sad they didn't want to have a party anymore. So we never had a chance to sit down and realize what it was until it was all over. It took people several years to find out what they had gone through. People who worked with him every day would come back to me and say, "I didn't realize what this meant until I went home, and my mother in Tallahassee understood what this was all about." Then they would understand it. The people around it didn't realize it was such a big deal. Dr. Kolff, what are your memories of the Barney Clark surgery?
Willem Kolff: When that heart was put in Barney Clark, when it worked, I remember that I cried for a moment because I had started to work on the artificial heart in 1957, and this was 1982. So, you have to have some staying power if you do this kind of stuff. And then the publicity around it was incredible. They had to cordon off one-half of the hospital cafeteria, and there were seven television teams, if I'm correct and about a hundred reporters who camped there day and night. And, some of them tried to bribe personnel to give them information. When that became apparent, the vice president of medicine of the university gave a press release twice a day. Even then, reporters tried to get information from a resident, or a nurse, or a cleaning woman, or a janitor.
So, don't ever underestimate the enormous pressure that was on the people who put the heart in Barney Clark. Dr. DeVries the surgeon, and others, including myself. Whatever happened during those days, I will forgive anybody, because the pressure was almost unbearable. When Barney Clark, finally died after 112 days, and we went to his funeral, there were helicopters overhead to film it. Do you ever have a feeling when something like that is accomplished that there's an end to the project, or does that just make you think about moving on to something else? Willem Kolff: No. You see immediately what your next task will be. I've been asked all kinds of silly questions like, "Aren't you proud? Aren't you this? Aren't you that?" I have no time for that, because the next project is upon me. Dr. DeVries, it seemed to hit you pretty hard when Barney Clark finally died. William DeVries: Yeah. But he was ready to die. It was over for him, and he did the best he could do. The world was a better place for the fight he fought. He died for something that was very important. This guy gave everything he could -- his very being -- in order to do this. We felt very strongly that we had an obligation to carry the project on. It was not a failure in any of our eyes. It was a call to arms. There was criticism afterwards, about the quality of his life after the implant. How did you respond to that? William DeVries: There was a lot of criticism. But the quality of his life wasn't that good before. He was in a darkened room, his wife couldn't even go in to see him. Then, suddenly, he's up and around. He was putting golf at one point. It was a much better quality of life than he had before. He wasn't afraid of dying all the time. Whenever we got real down, we'd just walk into a patient's room and talk to him. They were glad to be alive.
I can remember, after Bill Schrader had been alive for over a year with an artificial heart, I had Christmas morning with him and he grabbed my hand, and pulled me in. And, by this time he'd had like two strokes by this time and everything, and he grabbed my hand, and he said, "Thank you for giving me this day." You know, and at that time it didn't matter what anybody in the world said. This guy was alive, and he was happy to be alive. He'd seen the wedding of his son, the birth of a grandchild, and he was happy to be alive. And anybody could have said anything they wanted to about the project, but this man had a gift. Now, I can look back on it philosophically. Now there are almost over 200 patients that have had life because of the Jarvik ventricle and the bridge to transplant. They simply would not have had it. They would be dead right now if it wasn't for those gifts that those early pioneers gave, and we can go back and look at it, and it's incredible contribution.
Dr. DeVries, why the Jarvik-7 heart? How did it work and why was it the right design? William DeVries: The work with the Jarvik ventricle had been going on for a long time. The air-driven heart came from NASA experiments in the early days. Dr. Kolff was smart enough to pick up on that, and pull NASA into it from the beginnings at the Cleveland Clinic. When he came to the University of Utah we had a Swan-Ganz heart made by Clifford Swan. That's the one we put in the sheep that lived 50 hours. Jarvik was a very bright engineering student who was also a medical student. He took that and modified it all in the right ways. He made several models: a Jarvik-1, Jarvik-3, Jarvik-5 and Jarvik-7. There wasn't ever a 2 a 4 or an 8, because he wanted the freedom to name it what he wanted. Many people had worked on it before that time. At the time Barney Clark came along, that was by far the most successful heart around. That, again, was due to the good administrative capabilities of Dr. Kolff and his lab. He had young people, machinists, he had biochemists. He brought everybody together to make that Jarvik ventricle the best ventricle it could be. And at the time Barney Clark had that implanted, there was no competition. That was by far the very best heart available. What was it made of? William DeVries: It's made of polyurethane. That's the plastic you make roller skate wheels or skateboard wheels out of. It's a very tough plastic. It's able to move well, and is very durable in the body. The body destroys almost everything that's encapsulated in it. The body recognizes any foreign tissue. The body will try to absorb metal, and it will try to cast plastic out of the body. Polyurethane is inert. It's not entirely non-reactive, but it's very safe to put into the body. We chose polyurethane because it was strong, it was flexible, it was durable, and it was able to withstand the body's attempts to push it out. Dr. Kolff, could you tell me why the Jarvik heart is called the Jarvik heart?
For convenience's sake, when I had Dr. Kwan Gett's work on an artificial heart in my laboratory, we called that the Kwan Gett heart. When we had another doctor's work on it, we gave it his name. We have had many different hearts. But Jarvik stayed with me for seven years, and he was assigned to work on that heart, and therefore it was called the Jarvik heart. We've had the Kwan Gett heart, the Unger heart, the Westheimer heart, the Donovan heart, the Jarvik heart. We've never had a Kolff heart. It would have been rather dull otherwise. We would have had Kolff one, two, three, four. Nobody cared until the first patient came along. Then somebody threatened to sue us and said, "It should not have been called the Jarvik heart, it should have had another name. I don't want to say who. At that time, I suggested that the man who complained review the history of the Society of Artificial Organs. I gave his name to the society, but they wanted me to do it. So we counted the names of all the people who had worked with me on artificial hearts at the time the Jarvik heart was implanted in Barney Clark. We counted 247, and Jarvik was one of them. Dr. DeVries, what is the status today of artificial hearts? William DeVries: There are about four different companies that make artificial hearts. The company that makes the Jarvik artificial hearts recently went out of the business. Artificial hearts are being put in all over the world. Many of these are used as ventricular assist devices, but they're really artificial hearts. Almost every place that has a heart transplant program has artificial hearts that they use. It is estimated that 400 or 500 of these have been implanted, but it's not news anymore. Can you tell us exactly what the operation consisted of? What were you physically doing from the beginning? William DeVries: We took a patient into the operating room.
Usually, we tried to do it on a Sunday morning, because it was usually quietest, and non busiest time in the hospital, didn't disrupt the other patients. We put the patient asleep, and we would open the chest, split the bone and opened the chest up. And then we put them on what's called the heart/lung machine. This is the machine that supported their circulation while we were removing the heart; then we actually removed the heart. We cut the heart out. Now the patient was kept alive on this profusion machine. And, then we would take this artificial heart, and divide it in two pieces. We'd sew one piece in, and then sew the other piece in. We'd click it together, and then start it pumping. That's how we did it. Sewed everything up, and the patient went back to his room. Most of these patients got better much faster than patients -- even patients with real hearts. And, they did real well with it.
Dr. Kolff, how would you describe to someone who doesn't really know anything about your field of work, how would you describe what's so exciting about the work to you?
Willem Kolff: The exciting thing of course, is not so much what people say about it, but to see somebody who is doomed to die, live and be happy. I got a letter three days ago from a woman who I've never seen. And, she wrote me, "Dr. Kolff, I've been on dialysis for 18 years. You see here a picture of myself with my first grandchild. I've had a very rich life, a very full life, and thank you very much." That is the reward, that of course makes you [feel] very good. And, that also sustains you to not pay too much attention to the detractors of what you're doing.
Do you think you were always destined to be an achiever in this field? Willem Kolff: I don't think that's the proper way of looking at it. I wanted to make an artificial kidney that would save people. Who did it was not so important, as long as it was done. I was convinced that I could do it, and I clung to it until it was done. Dr. DeVries, you were attracted to the hands-on aspect of surgery, literally, wouldn't you say? William DeVries: I enjoy that.
You start talking to patients, and the patients look at you, and they say, "You mean, you've held my heart in your hands?" And you say, "Yes, I did." You see the gleam in their eye, and the passion that they have for you at that time, and it feeds back to you. You realize, "Gee, I really did that." And it's something you would do for free.
For that feeling that you have had communication with someone's soul. It may not be the seat of the soul and the site of love, but it magnetizes me, pulls me into it. I love it for that reason.
It pays me every time I do it. It's the most magnificent organ in the body as far as I'm concerned, and it's a very captivating thing. We have nurses and doctors come in and watch the surgery from time to time on an educational basis. It's always fun to open the chest up, expose the heart, and the first thing they do is they go, "Ooohhh!" You know, "Is that what the heart looks like?" You can be kind of proud to say, "Yes. This is what it is and these are the skills and the art that I have, and it's very rewarding."
Dr. DeVries, during all of this time, with this skyrocketing career, have ever had any doubts about your abilities? William DeVries: No. I never had doubts about my abilities. I was trained to be a heart surgeon. I was trained with my hands. I was trained to practice medicine and I went to one of the best medical schools, and the best training program for surgery. For nine years I learned about surgery. We worked with some of the best people in the world. I always had confidence in myself that I could do it. I was shocked sometimes that the circumstances in which you work were not the best. At times it looked like everything was kind of going against you. But when you do in the work that I do, you deal with people. People come to you, and they are sick, they hurt, and they are in pain, and you get them better. And they look you in the eyes and they say, "You've done something for me." There is nothing in the world that can top that for you. When you get that contact, the only people that can evaluate your work are your peers or yourself. When you know you've done a good job, and you have confidence in your work, and the patient tells you that, and you know that's true, it's a reward in itself. With the artificial hearts, some patients had strokes, and people started saying "This is a stroke machine. It ought to be stopped!" People would criticize you, and sometimes you would say to yourself, "I don't know. Maybe this isn't working." All you had to do was walk down the hall into a room where there was a patient with the artificial heart in place and he would look up at you and say, "Thank you for keeping me alive. Thank you for this day that I've had." From then on, it didn't matter what anybody said. It was worth it to us. When you go into something like heart surgery, you come up to the patient, and you say, "I'm going to do the best job that I can do and the best job that I think can be done." The patient trusts you. He puts his heart in your hands, so to speak, and he doesn't want you to say, " Maybe the guy next door can do it better than me, but if you just give me a chance, maybe it will work out okay somehow."
You can't work with life and death situations, coming out of a table when a patient has died in your hands and say to yourself, "Gee, you know, maybe someone could have done it better." You've got to know that you did the very best you can, and the people around you did the best you can, and the guy just died. You know, sometimes people die. We as physicians have people -- we fail all the time, because ultimately, people are going to die regardless of whatever we do. With the artificial heart, we may have kept someone alive a little bit longer, but they are going to die sooner or later. You know? And, you've got to be able to say when they die that you had done the best that you could do, and you accept the consequences of what went on. And, then you go back after it's over and look and say, "Is there something that could have been done differently?" or assess it, and then learn from that and move on to the next step. That's the important thing. You learn from your failures and your mistakes, but you move on.
Dr. Kolff, what part of your work do you think will most benefit the world? Willem Kolff: I've worked on so many different subjects, it's hard to compare. Each is important for an entirely different set of the population. 540,000 people have been treated with dialysis worldwide, over half a million. If you realize that all these people have families too, you see how many people are involved. There are 33,000 people that need artificial hearts in the USA. Our artificial heart has been applied so far in only 260 people. There is so much work to be done that there is little time to be glorious about the things we've done. Dr. Kolff, why do you think many people seem unwilling to donate organs in this culture? Willem Kolff: In the first place, I'm not sure that that is so. I think the main reason is that they're not properly asked. Some people are better at asking than others. I recall once, I was walking through the halls of the Cleveland Clinic and...
I heard desperate crying coming from a room. I went in and saw that a husband had just died, and it was the woman that was crying. So, I went to see the doctor who was in charge and said, "May I ask her for the man's kidneys?" And, while she was still crying she said, "Oh, please, please, take them, let something good come out of this." I had one Turkish assistant. He could get an organ from anybody, nobody refused him.
Do you think organs are going to become more available? Willem Kolff: Yes, but not enough. We have two kidneys, so we can give one away. The number of patients on dialysis is leveling off because there are so many kidney transplants, and the results are so much improved. But for hearts it's different. There are at least 35,000 people in the United States that have irreparable heart disease and could be helped with an artificial heart. There are definitely no more than 2,000 heart donors. So that leaves 33,000 people per year that die for lack of an artificial heart. The FDA has stopped the use of artificial hearts because the paperwork was less than optimal. So now you know for certain that these patients are going to die. The regulatory system -- the FDA, against which there is no appeal -- is so difficult and so expensive for manufacturers that they don't undertake new projects. It's the danger of lawsuits.
FDA regulations are making it impossible to come out with new products. And we should definitely put a cap on liability suits, of any kind, because we cannot afford this. I'm sending artificial hearts to eleven different countries in the world, where surgeons are willing to implant them in animals, and do the experiments I cannot finance here. These are very exciting things, but it makes me very worried about the position the United States will have in this kind of work. I would like to have them made here. If I cannot have it made here, should I accept a contract from Japan? Of course I must, because it must be made. Later on we in the United States will have to buy these things from the Japanese, as we buy Japanese cars. We will not be defeated on the battlefield, but defeated because we're not educating our people, we're not doing long-term research for industry, What are some of the challenges you see for the next century in the field of medicine, or in any field? Willem Kolff: I feel very strongly that our priorities are wrong. Our priorities have been defense, killing people, more bombs when they were not needed. The military industrial complex has a momentum of its own. So many people depend on it. So many of our representatives try to keep it alive because there's a factory in their district, and jobs are dependent on it and therefore they have to support it. But finally we should have the sense and the courage to see that we may be the strongest nation militarily, but we are becoming weaker every day commercially. Do you work out of a sense of duty? Willem Kolff: I have a great sense of responsibility towards patients. I have a responsibility to bring the things I have invented to the marketplace. I have a new artificial heart here now. I've worked on these artificial hearts very hard. If they're not produced, I might as well not have done it. How do you see the responsibility of someone in your field to our society in general?
Those of us who are not dependent for a paycheck on the military industrial complex should use whatever influence we have to steer us away from this enormous, unjustified expense on defense. Our present administration, with Russia out of the picture, still wants to spend $3 billion on Star Wars! I think this is criminal. We need these $3 billion for education, we need them to help the poor, we need them to retrain the unemployed. 35 million people are uninsured! We need a health system. In the Netherlands, everybody is insured. The government saw that it was less expensive to pay insurance fees for the poor than to set up a welfare program. You still have private insurance companies, so there is competition, but they're both guaranteed by the government. The other thing we need in this country is a better control system in the application of medicine, and the spending of our funds. We need to end the stealing of money from the government. They finally closed the dialysis center in Ogden, and we were asked to take care of these patients for a few days to bridge them over. Eleven patients died because they were under-dialyzed, and a large number of patients had been treated with dialysis who did not need it, only for the financial gain of the physician and the dialysis center. Another point that I would like to make is about the war on drugs. I just saw in the newspaper that 73,000 Colombians have been arrested for trafficking cocaine. They are mainly mules carrying the cocaine from one place to another. And we don't have the courage to say that we're losing the war on drugs! We'll never win that war. We don't need a war on drugs, we need a drug program. We need to take the profit out of the drug business, because the drug lords have a hundred times as much money as the police. But if we take the profit out of it, and use that money to rehabilitate drug addicts, then we have a program. Then we can re-educate our children. There are some addicts that are lost, so make the drug available to them, so they don't have to steal or murder to get it. Cocaine costs almost nothing to grow; marijuana even less. Make it available, do it the way the Dutch do. When somebody says, "We're winning the war on drugs," that means that fewer children of well-to-do families in suburbia are taking drugs. But you know that in the inner cities it's getting worse and worse. The number of murders that we've had in the last year (1991) is larger than it has ever been. What challenge are you going to take up next, Dr. Kolff? What is personally fascinating you right now?
On one hand, they insist that more people be put in prison, but they don't expand the prison, so the prison is overpopulated. Last year in Salt Lake City, it was a cold winter, so the prison system had a bill that was $150,000 more than they had counted on. The only place they could take the money from was from the education program. If they are uneducated, 65% come back. If they're educated, then the recidivism is very much lower. What would you like to contribute in this field? Willem Kolff: All I can do is try to use my influence. So I write small articles in the local newspaper. Then I get responses, sometimes threats. Another thing I think is very wrong is the attempts to make abortion illegal. I was in Lima, Peru and they said, "Dr. Kolff, would you like to meet four women who have been saved by your artificial kidney?" They were middle class women, who had already had three or four children. They decided that they could not afford a fifth, they had illegal abortions and they were infected. They would have died if they had not been dialyzed, but they're the lucky ones. I will never forget a young girl who was brought to my hospital in the Netherlands in the middle of the night. She had been injected with copper sulfate by somebody trying to do an illegal abortion. Every red blood cell was broken by the cooper sulfate. I can still hear her older sister calling through the halls, "Oh, Marika! Oh, Marika!" when she died. There was not a thing I could do about it. Now we're going back to that, and I can't understand why. We should resist it. What about you, Dr. DeVries? What do you think the next great medical frontier is?
William DeVries: We're going to have replaceable artificial hearts they are going to put in patients. You know, a lot of people die, you know. It's estimated that probably about a thousand people a day die of heart disease in the United States. And, many of these could have machines put in their chests and keep them alive. So, I think we are, over the next several years, going to develop an artificial heart that is fully contained, and will be replacing that. There's very clear artificial kidneys that are wearable. We have artificial intestines. Almost every single joint in your body can be replaced. And I think that, as these organs die or become useless, other artificial organs are going to be used, and be useful in the future.
I think the next real push is getting into the genes. That's going to be incredible, as we start doing gene splicing and curing diseases by genetic alteration. I think that's where the next fascinating frontier of medicine will be. Dr. Kolff, are there any personal inventive challenges that you're taking on right now? Willem Kolff: Yes. I can show you an invention that's four days old. In the last few years, some surgeons have been wrapping a large muscle, the latissimus dorsi, around a failing heart. This skeletal muscle, when stimulated electrically, can be retrained and can begin to pulse and take over part of the heart function. The problem, however, is that you must have a very sick patient, or you wouldn't do it. And you need six weeks before this muscle is trained. About a week ago we conceived the idea that we would combine it with an air pump. I called Dr. Stevenson in Detroit, who is a world expert on this. I said, "I'll make one for you. Give me ten days and you'll have one." He said, "I'll put it in an animal and I'll test it for you." These are the exciting things for the inventor. So, you've just invented that?
The previous artificial hearts were all very rigid and hard. If you were to take the Jarvik heart and hit it on the table you could damage the table. So I make hearts that are softer, to make it easy for surgeons to implant them. You can take this one apart, and then the surgeons can implant this very easily. Now, what I have just told you has never been done. It should have been done, and it can be done, but it has not been done yet. You've described invention as the place where there was the excitement, the breakthroughs and the fun. Willem Kolff: I still have a wonderful life. To suddenly see that you can do something that was not done before! Also, when a new thought is born, in a meeting with young students and co-workers, that is fun. I see you smile when you talk about your work being fun. What about the frustrations?
I studied pathological anatomy for two years when I was a student. That cut a lot of fun out of my student times. I had to work extra hard, I didn't lose any time. When I came to Kampen, the first thing I did was set up an autopsy room. If one of my patients died, I did the autopsy. That was usually very satisfying, because it showed me that although the patient was dead, I had been right. I remember, for example, one young man who died from a bleeding ulcer. I was very unhappy about it, and did an autopsy. It proved that it was not a regular ulcer, it was a carcinoma of the stomach. Then you don't have any guilt feelings anymore, because there's nothing that you could have done about it. When you're away from your work, do you still think about it all the time? Willem Kolff: I wouldn't say all the time, but a great deal of the time, yes. It's one of the complaints -- and probably a very legitimate complaint -- of my wife. If I have a problem, I get involved with all my personality. Inventions are rarely made when you're sitting at your desk, or when you're writing. Inventions come at four o'clock in the morning. My wife has said, "I can't sleep, the bed is full of electricity." Poor thing. She's been very supportive, but it must be difficult. In Holland I would take my bicycle and bicycle through the meadows. That's also a time when inventions come. Another time inventions may come is when you discuss it with others. This is why I have my morning conference with not more than eight people, very young people, and it is a delight. By the way, in Holland, if you study medicine, the government will pay you. The Dutch students that I have here are paid by the Dutch government, even while they're here. I wish it was that way in this country. Dr. Kolff, can you talk about having a balance in your personal life versus your work life? How do you work that out?
Then of course we had a lot of visitors. I've never been paid very much, so I didn't have the money to take them to a restaurant. The only thing I could do was call my wife and say, "I have a Spaniard here, may I bring him for dinner?" That was at five o'clock, and at six o'clock I brought the guy for dinner. Then he had to have dinner with the whole family, and there was one rule: medicine could not be discussed. Our oldest son is now a heart surgeon. When he was in school, he looked over our guest book before he made a tour around the world. He stayed in a hotel only once. Otherwise he stayed with people who'd had dinner with the family. Is it difficult to maintain a balanced life when you're so intent on what you're doing?
We're both bird watchers. We both like nature. We did the sculptures of the animals from roots and branches together. So we've done many great things together, and we have many common interests. I am sure it's been hard on my wife when I wrote too many grant proposals. That was very difficult for her. Do you have any more questions? Do you have any more answers? Willem Kolff: Some things I've said are not very encouraging. I can't help that. But it does not discourage me. I would say to younger people, even as of this moment, when the prospects are bleak, the need is still there. And if you're young, maybe by the time that you're ready to do this kind of work, the sky will be bluer than it is now.
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