Shantelle’s current project concerns her great uncle, Louis Washkansky, who was the recipient of the world’s first heart transplant in South Africa in 1967. She is writing this story from a new angle, involving the recipient (Washkansky), the young woman whose heart was used in the ground-breaking procedure, as well as a group of black laboratory technicians, whose role in the transplant was not acknowledged until recently. This chapter concerns them.
THE BACKROOM BOYS
November 1967, a few weeks before the operation Cape Town after dark is no place for a black man. But this does not deter Hamilton Naki. He sets out wearing his usual well-pressed suit and tie and carries his pass in his pocket. It is a requirement of the Native Abolition of Passes and Co-ordination of Document Act of 1952 that he always has it on his person as it contains his photograph and fingerprints, his tribal connections, and a registered number. He is a digit. A unit. Classified like the 14-million other black people into one of eight ethnic groups. Hamilton is Black, Bantu,
Xhosa: a deconstructed heritage that splits and pits. He faces prosecution, and possibly jail, if he does not produce this documentation when demanded, and will join the 1-million black people arrested so far this year. There are often rumours circulating about the pass-laws; people who disappear; never to be heard from again. But these stories are nothing new and they do not frighten him. He simply ensures he goes nowhere without his pass. That, and his bible. They are foils to the other: the one ensnares him while the other is his liberty. Later that day, as always, he will preach to the local vagrants at the old cemetery about the freedom that can be found within its pages.
He takes just under three hours for the eight miles from the single men’s living quarters in the township of Langa to reach the laboratory in Observatory. He finds comfort in walking long distances. He spent most of his childhood herding cattle in the rural part of the Eastern Cape, where he would walk many miles in a day. He sees the outline of the buildings with a faint shadow of the imposing mountain behind. Groote Schuur (Afrikaans for Big Barn) dots the base of Table Mountain like a cluster of toadstools with its red-tiled roof, cream rendering, teak shutters and cupolas. In the night, it becomes a vibrant version of its daytime self. Disease and death find an oasis here after dark where all of society converges: black, white, coloured and all the hues in
between; though they are kept apart by walls and wards reserved for each. Hamilton Naki knows every inch of this institution and the adjacent medical school, even though most parts are off-limits to a man of his skin colour. The hospital had to conform, on the surface at least, to apartheid rules. Illness never discriminates, but the hospital must. ‘Net Blankes’ (Whites Only) is a familiar sight to Hamilton. But he is a well-liked person here and can generally gain unfettered access, especially if he is hunting for a piece of equipment. Where he cannot find an ally, he moves deftly through the corridors and stairwells and borrows what he needs for the laboratory in which he works.
By now he is approaching Anzio Road, the major artery up to the hospital. It is perpendicular to Main Road Observatory, where in a matter of weeks, Denise Darvall will be fatally wounded. Hamilton passes a cafe called Chippies. He will come here later to buy his Bunny Chow, a white loaf of bread stuffed with a sweet meat curry. The meal is a staple amongst the poor and costs twenty cents. On a paltry salary of fifty rands a month, the bulk of which goes to his wife and two sons living in another province, he can just about afford this. But not every day and only if he shares it with some of the technicians if they each contribute 5 cents. While it is big enough for them to divide into four, they will not be full. As supplementation, he brings in some fat cakes and brown bread with liver paste from home.
He reaches the University library at 3:00am, and slips by its side until he comes to the small square, squat building that is the JS Marais Laboratory, named after a wealthy Afrikaans patron of the hospital. At this institution, they officially employ him as a cleaner, though, on just a primary school education, he is now a competent anaesthesiologist for the dogs and baboons. The single story bungalow has large wooden double doors, a 10-metre high ceiling (that helps dissipate the consistently unpleasant odours), walls made from Table Mountain sandstone and bricks that are painted offwhite to fit in. It does not fit in though. It is a place where a two-headed dog once sipped milk, where animals routinely swap hearts and where apartheid is denied entrance. Black and coloured technicians share everything with their white medical colleagues: a lunchroom, toilets and the common goal of pushing the boundaries of science: to be the first to accomplish the unthinkable – transplanting a human heart.
Doctors Shumway, Lower and Kantrowitz in America were well positioned to win the race to perform this operation. They had done all the research already. Christiaan Barnard had, in fact, learned a large portion of what he knew from the Americans and had been studying under some of their most eminent surgeons. But there were many rules in the United States that inhibited certain success: brain death being the key issue.
Hamilton can navigate this 36 by 30 feet room without switching the lights on and so he heads straight to the hyperbaric oxygen chamber. It had been a gift from the South African Navy and occupied a quarter of the space in the laboratory. His shift only starts at 7:30 am so he can use the next few hours to nap. He opens it and settles into the coffinlike structure. Even for a large man, there is still some place to manoeuvre himself and it serves him well as a makeshift bed; proving significantly more comfortable than one of the two stainless steel operating tables and still better than what he has back in the township. Hamilton often sleeps at the laboratory. Riots and frequent uprisings in the township meant there was often no reliable way to get to work and so he takes to walking. Under the apartheid regime’s new Terrorism Act, the government recently hanged four members of Pan African Congress’s armed wing and they could expect some
He does not switch on the machine. There is no need. Even if he wanted to use it therapeutically, he could not. They had run out of compressed air and there was no budget to purchase any more. They always needed to improvise. It was the way of the laboratory and everybody who joined the team quickly learned how to find new uses for things. Like the time a colleague, Carl Goosen, produced a mitral valve modelled on a Morris Minor exhaust valve, which he was making in his wife’s pressure cooker at home. At the very least, this kind of invention kept everyone busy; Chris Barnard had no tolerance for laziness and even less for a bad excuse.
The dogs are moving in the next door room. It is a background noise Hamilton is used to; the banging of tails on the wooden frames of the small cages and the occasional bark. All the animals here are stray, taken from the pound and face imminent destruction, but Hamilton still treats them with kindness. He knows, though, never to name them, never to get attached. Most will not go on to a new home: this is their last stop. A little after 7:00am Hamilton gets up, puts on his green surgical gown, and begins cleaning the equipment by boiling each piece in sterilising liquid. The scent of fresh bleach mixes with the overpowering smell of Jeye’s Fluid, the cleaning agent of choice in the hospital. He cannot detect the general odour of the animals that laces this medicinal smell. That is what comes from working in an animal laboratory for over ten years. It is a pungency reserved for visitors, who always baulk at the stench. Sometimes, Hamilton catches a whiff of Halothane, a key chemical component of anaesthesia. He knows it has escaped only when he feels dizzy, though he can identify the slightly sweet residue it emits. It is able to find an easy exit through the leaky old pipes of the machines, proving, yet again, how obsolete they were. But it was all they had. And they made do.
Hamilton sits down to focus on the ritual of setting out all the instruments on the tray – in the precise order that the Barnard brothers, like all doctors, would expect. He does not know which one of them – possibly both – will be in today, but doubtless there will be an altercation. If it is Marius, the younger brother, he will be there perfecting his surgical skills with little fanfare, but if it is Chris, then they must be prepared for some histrionics. And if he was experiencing an arthritic flare-up, where his hands appeared swollen and angry, then they could be sure that his general mood would be one of belligerence. Chris’s frustration is becoming palpable. He had already transplanted 48 hearts into the animals. The longest had survived only ten days. Now he believed he was ready to do it on a human. He just needed the head of cardiology, Val Schrire, to agree to find him a patient critical enough and willing to be the first subject to undergo this. What irks Chris most is the idea that the Americans would beat him. It gnaws at him each day. They have the money, the technology and the collective know-how. He recognises he has the skill, perhaps he is overly confident of this. But he is stuck in a pariah country with no funding and no support.
Hamilton’s gloved, chubby fingers line up the instruments like soldiers. His movements are precise and fluid. He knows the weight of each instrument before he lifts it up; some look identical but his hands are like scales and can easily feel the difference. It is subtle but unmistakable to him. The stainless steel is cold to the touch, even through his gloves. First, he picks up the 17-blade scalpel, with its rounded edge. It will make the initial incision that tears into the dermis exposing tissue. He follows this with the sharper 21-blade which will cut deeper, with little resistance; slicing through fat, muscle, fascia and vessels until it reveals the organ – the heart, the control centre. The retractor, or rib spreader, is next. It is a thud of metal and comes with a sinister smile of teeth and two movable legs, propped up by blunt talons that look poised to grab flesh. In a separate half-moon bowl, he has scissors and forceps that curve and curl one over the other in a tangle of silver. He knows well how he will use the forceps with the zig-zag edges to grasp tissue and the much finer pair to pick up the wall of the tiniest blood vessel. He can use the thinnest pair of scissors to dissect across the blood vessels and free the heart from the surrounding tissue. To free a heart… and in some instances to transplant it himself. How many men can say they are able to do this? And a Black man at that! Granted, it was only on animals. But they lived and breathed too. And for someone who started here rolling the lawns of the university tennis courts, this was progress indeed.
The operating light, a touch bigger than a standard Anglepoise reading lamp and also adjustable, blinks over Hamilton’s shoulder. The others are arriving now. He hears the dogs squealing in excitement. John Rosseau must be in. He is a small, Coloured man in charge of cleaning the animal cages and the general gopher of the laboratory. His whistle acts as an early warning system to signal he is there. They all know him for his permanent merriment, which some of his co-workers ascribe to the marked dent on his forehead. This depressed skull fracture, that gives him a second smile, is of unknown origin. And although it seems to limit him in the laboratory, it does not do the same in other aspects of his life. His colleagues can often find him drinking at the local watering hole down the road from the hospital, marching with his fellow band members (he was actually the clarinettist), singing as loud as his lungs would allow, until the police would break them up for disturbing the peace.
Clifford Syders, otherwise known as Boots, likes to sing too. He often arrives at work inebriated or suffering from the remnants of the previous evening. But he gets straight to his job of preparing the designated dog for anaesthesia; his narrow face, pixie ears and smile, that grows more crooked with each unit of alcohol, disarms the dogs quickly. He can corral any of them to the mouth of a cage. (Later in his career, this would extend to baboons, in a six-foot tall cage, who he would extract with minimal fuss). They prepared a dog the night before. It has not eaten for twelve hours and so it comes sluggishly to the front of the crate. Boots grabs it by the neck and inserts a needle containing the pre-operation sedative. The dog barely registers this, and so it licks his hand while he gives it a quick scratch. The animal is black, like most of those from the pound, doubtless the offspring of many experimentations of nature. It wags its tail, grateful for the little attention and becomes groggy almost immediately, at which point Boots whisks it off to the surgical table in the main room where he shaves its thorax and paints it with iodine until it is bleached a rusty pink. He has done this many times before.
When Victor Pick walks in, everybody knows he is there. It is not so much his large physical presence, but rather the stark contrast of his soft voice. He is mixed race, and those he works with know him as ‘Big Vic’ or the ‘humble giant’, though he is often found wielding a huge mortuary knife, belonging to the old pathology museum, in an effort to scare first-time visitors. He is over six feet tall and very wide: even the biggest surgical gown plays tug of war across his belly. But when he holds his scalpel and splits a dog’s sternum with the precision of a surgical registrar, he is both delicate and quick. He is head of the cleaning staff, though in reality he is the boss of the laboratory ‘technicians’ and the principal assistant to the doctors. Nothing surprises Victor Pick when it comes to the ongoings in the laboratory. He has worked here for more than a decade and is the Ernest to Victor Frankenstein, having been left by Christian Barnard to care for the twoheaded dog himself. Everyone admires his surgical prowess. But they revere his ingenuity more. Living in the poor coloured township of Bonteheuvel on the Cape Flats (an area to the north of Cape Town) means resourcefulness comesnaturally to him. He is someone who sees the potential of cardboard boxes from medical equipment as furniture for his family home and, on a quiet Sunday, at the laboratory, neuters dogs for extra cash. This is how he drives a nice car on his 20-rand a week salary.
Hamilton has now intubated the dog. The skill of protecting an airway is something many doctors struggle with while training, but the polythene endotracheal tube glides down into the windpipe of the animal. He attaches it to the ventilator. Within seconds, the dog is breathing normally again; its large tongue capsized onto the surgical sheet. Victor makes his incision. He knows the exact depth he must cut to – no more than two centimetres. There is no need to measure; it is all muscle memory for him now. He moves through the subcutaneous tissue and a thin fibrous layer until he reaches the peritoneum. The organs peek through this liquid murkiness. He applies more pressure on his blade further and exposes the heart and its great vessels. It looks like a small fennel bulb with thick, tangled branches on the top. The pumping motion of the organ has no sound. But they feel its motion. Observing a beating heart is something they see every day.
Prescott Madlingozi comes to stand at a metal table behind the dog. He is the last of the laboratory staff and the other black man in the room. His voice is syrupy and granular and often breaks into French and German (languages he picked up during the war) when Europeans visited. The first job he performs is checking the contents attached to the counter on wheels. There are many drawers, a pump, two cylinders and looping plastic piping that will turn crimson – like a helter-skelter – when they place clamps and catheters into the dog’s vessels. This is the heart-lung, or bypass, machine, and will do the job of the organs while they are being operated on. It has only been in use for a decade in medicine and looks like something out of the space programme. A trained perfusionist will be the professional in charge of it in an operating theatre. But Prescott has no title and no training. He has instinct and sharp eyes that have learned to seek out the tiniest air bubble gathering inside the tubes. He knows well that this can cause an air embolus that will kill in seconds. And so his fingers default to a milking motion as he redirects any bubbles elsewhere. The dog is now ready for the procedure. Chris Barnard is due in any minute.
The technicians of the JS Marais laboratory are not technicians at all. At least not officially. Not one has finished school or had any form of secondary education. Some, in fact, are barely literate. But ask them to do an arterial dissection or spot a defect, like a short portal vein, and they are as good as any trained professional. Their sutures are not fancy embroidery, but they hold and hold well. They have all learned this on the job and ‘stolen with their eyes’. The ‘backroom boys’ is an affectionate, though pejorative, term that accounts for their lack of visibility. No one knows how this phrase came into being. They are not seen beyond the walls of this modest building, dwarfed by all the surrounding structures. Inside, they are like magical elves working on impossible imaginings in medical science. Black, Coloured and White work together under this roof. They laugh together, sit and drink tea at a table together, cut together. It is a legacy that has their fingerprints all over it. But they will not feature in the pictures that are taken after the first human heart transplant and will remain the colourless ghosts in the shadows. Louis Washkansky’s heart will beat strong for eighteen days, not in small part to the work and contribution of these unknown men in a remote laboratory on the furthermost tip of Africa.