Harken, Dwight Emary

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Harken, Dwight Emary

(b. 5 June 1910 in Osceola, Iowa; d. 27 August 1993 in Cambridge, Massachusetts), cardiologist who pioneered early surgical techniques on the human heart and created intensive care units for critically ill patients.

Dwight Emary Harken was the son of Conreid Rex Harken, the town doctor in Osceola, and Edna Emary. Dwight’s academic prowess took him away from Iowa to Harvard University, where he earned a B.A. degree in 1931 and an M.D. in 1936. Dwight married his childhood sweetheart, Anne Hood, in 1934; they had two children.

After Harvard, Harken interned at Bellevue Hospital in New York City at the height of the Great Depression, earning just $15 a month. His father refused to help the young couple unless they returned to Osceola, but they survived on Anne’s salary as employment manager at Stern’s Department Store. Dwight subsequently won a New York Academy of Medicine fellowship to study in London, worth $1,800. There he studied with the famous British surgeon A. Tudor Edwards, developed a special interest in cardiac care, and began devising surgical techniques for heart infections.

With the outbreak of World War II, Harken served in the U.S. Army Medical Corps in the European theater of operations. With the rank of lieutenant colonel, he joined the Massachusetts General Hospital Medical Unit, headquartered in London. He was one of the youngest men in the Medical Corps qualified in thoracic surgery. In the brutality of wartime conditions, Harken began to distinguish himself as a bold and innovative surgeon.

Faced with massive casualties and desperate conditions, Harken was among a handful of military doctors willing to experiment with new and risky techniques that would not pass muster in a stateside hospital. The result was a number of medical advances that could not have arisen in more pristine conditions. Harken was the first to operate on the human heart, an organ previously considered untouchable—too complex and delicate to endure a surgical incision. But Harken had little choice. Many of his patients had shrapnel or unexploded bullets lodged in their hearts. Removing shell fragments would almost surely be fatal, but leaving a foreign object in the heart was equally dangerous. Indeed, his advances would have been impossible without the war and the resulting stream of young, strong, wounded men. Looking for a surgical technique to stem the flow of casualties, Harken began to experiment with animals. His goal was to improve his skill to the point where he could cut into the wall of a live human heart, insert a finger, locate the shrapnel and remove it.

His first test group consisted of fourteen animals, all of which died. His technique improved markedly with the second group, producing a survival rate of 50 percent. In the third test group, only two of fourteen animal subjects died. Emboldened by his progress, Harken was ready to try the technique on humans. During the remainder of the war, he successfully removed bullets, shrapnel, and shell fragments from the hearts of more than 130 soldiers without a fatality. Harken was the first to have consistent success with this kind of procedure and, by his work, single-handedly shattered the taboo on heart surgery. “We discovered that the heart wasn’t such a mysterious and untouchable thing after all,” he said later.

After the war Harken accepted an appointment at Tufts University for two years before returning to his alma mater, the Harvard School of Medicine, where he taught for twenty-two years, from 1948 to 1970. During those years he was also chief of thoracic surgery at the Harvard-associated Peter Bent Brigham Hospital in Boston and at Mount Auburn Hospital in Cambridge.

Harken set out to apply his technique to address defective heart valves. Just as with military casualties, a small hole was cut in the side of a beating heart and a finger was inserted to widen the narrowed valve. In 1948 Harken and Charles Bailey, a Philadelphia surgeon, operating independently but acting within days of each other, tested a technique to correct mitral stenosis, a condition where the mitral valve is narrowed and will not open properly, typically stemming from rheumatic fever. Early results were less than promising, with the majority of patients dying. Gradually, however, surgeons were able to improve the technique. The procedure, known as closed-heart surgery, became quite safe over time, with Harken and Bailey gaining joint recognition as creators of the technique. In 1960 Harken furthered his pioneering work, becoming the first doctor to successfully perform a totally artificial aortic heart valve replacement. He also developed and implanted the first device to assist the heart’s pumping and the first internal pacemaker.

Harken was also an innovator in broader dimensions of health care, including systemic care regimes, psychological aspects of care, public health, and medical education. In 1951 Harken opened the world’s first intensive care unit at Brigham Hospital. Convinced that low survival rates could be ameliorated, Harken provided extra staffing and equipment to monitor patient vital signs during the critical hours after surgery. He created a systematic response that could be applied quickly if and when difficulties arose. This approach proved to be an important medical innovation with utility in the care of all patients in life-threatening conditions. Survival rates skyrocketed and intensive care protocols were adopted worldwide.

In the same year Harken began to focus on the emotional and psychological needs of patients. He brought together four of his cardiac patients to form a support group. This effort grew into what is now Mended Hearts, Inc., an international support group for patients, families, and care-givers with branches in 260 cities.

Harken was an early critic of tobacco smoking, cofound-ing Action on Smoking and Health, a leading proponent of the link between smoking and lung cancer. Harken helped found Heart House, a Washington, D.C.—based center for information on heart disease and treatment that later became the headquarters of the American College of Cardiology, of which Harken was a past president. He also helped found the American Board of Thoracic Surgery and was a former president of the Association for the Advancement of Medical Instrumentation. He wrote or edited more than 200 scientific articles and several books and served on the boards of eight academic and health journals. Harken died of pneumonia in a Cambridge hospital at the age of eighty-three, leaving behind a legacy as the father of heart surgery and the originator of the intensive care unit.

There is no full-scale biography of Harken but judging from his foreword in To Mend the Heart: The Dramatic Story of Cardiac Surgery and Its Pioneers (1980) by Lael Wertenbaker, Harken prompted the writing of the book and collaborated closely with Wertenbaker. The book is not solely about Harken but is one of the few sources of personal information about him. Harken’s professional story is chronicled adequately elsewhere, including Stephen L. Johnson, The History of Cardiac Surgery, 1896-1955 (1970), and the documentary Pioneers of Heart Surgery (1997), produced for the PBS television program Nova. Obituaries are in the New York Times and Washington Post (both 30 Aug. 1993).

Timothy Kringen