The Puzzle People: Memoirs of a Transplant Surgeon, by Thomas E. Starzl
A Book Review by OTS Board Member, Karen Griebel
We who live with transplantation every day are so busy that often we don’t have time or opportunity to look back to recent history—when transplantation was a novel, almost outlandish idea.
The man who grew up to be the “Father of Transplantation” may have had science fiction in his DNA. Thomas Earl Starzl discovered his father’s futuristic writings in a family memorabilia trunk. He knew his father as a small-town newspaper publisher in northwest Iowa. Tom left LeMars in the 1950s and soon underwent medical schooling at Northwestern University. He journeyed to Johns Hopkins, Miami, and eventually Denver. He had little money and his young family to support. (Once he slept on a park bench before an interview!)
Surgery was emotionally difficult for him. He’d get sick with anxiety before each operation, afraid he’d “do harm” to his patient. According to his memoir, he must have performed hundreds, even thousands of medical procedures on animals to learn how the liver related to the kidneys, pancreas, heart and intestines. He wrote that “the liver was the most defiant of organs”--with massive amounts of blood flowing in and out—and the portal venous system (returning to the heart) was especially critical.
Dr Starzl wrote about many patients’ lives. He was personally involved with the children who fought and often lost their battles in the 1960s and 1970s. He knew that better immunosuppressant drugs had to be developed; cyclosporine was one of the breakthrough drugs, and the source for what became tacrolimus was discovered in the mountainous soil of Japan.
Often he himself travelled to deliver donor organs for transplantation. In PIttsburgh, he could tap into a network of corporate private jets or smaller planes for donor runs. “Overnight,” he wrote “we had a University of Pittsburgh Air Force.”
Politics at the national level, and in medical/academic associations, were a constant factor in these stories. Dr Starzl was acutely aware of personalities and history; he freely gave others praise for courage and foresight. When he wrote of disappointment with a colleague, he tried to understand, and not belabor failings. He wrote hundreds of research reports and advocated for funding at national levels and in banquet settings. Eventually his own health suffered and he needed several cardiac surgeries.
He gave up performing surgeries in late 1990, having trained others he felt could carry on. (One of these surgeons is Dr John Fung at the University of Chicago). He died just before his 91st birthday on March 4, 2017.
Why read The Puzzle People now? Dr Starzl believed that everyone who was touched by transplantation became a “puzzle person,” changed in physical, mental, social and spiritual ways. He was the “ultimate humanitarian,” as stated in a memorial tribute co-authored by Dr Fung (Gastroenterology May 2017). Treat yourself to this poignant, majestic memoir. You can find it via online vendors or with the help of a librarian.