Surgeon Of The Heart -- Tireless Dr. Margaret Allen Runs UW's Heart-Transplant Program
Dr. Margaret Allen of Seattle is one of those individuals whose accomplishments can inspire a sense of awe. She is the first woman to perform heart transplants and is president of the national agency that coordinates organ distribution nationally and deals with other transplant issues. Now as the UW heart-transplant program which she started turns 10, we look at her life and her work. ----------------------------------
It is midmorning in the quiet, bright operating room, and Margaret Allen is leaning far over the 52-year-old man's open chest. She is beginning one of the most crucial parts of a heart transplant.
With a tiny, crescent-shaped needle, she loops blue strands of suture material through beige tissue, sewing a donor heart into her patient. She talks quietly with an assisting surgeon about a new technique in the operation - and about research that someday could end what she does best.
"Patients would be delighted to have some solution to disease other than a heart transplant," she says as she pulls another suture strand into the air above her patient.
It is typical Allen: All business. Teaching as she goes. Looking to the future. And generally more relaxed than in her difficult early years as the world's first woman heart-transplant surgeon at the University of Washington.
"She still goes the whole nine yards. . . . She is meticulous to a fault. Sometimes it's like, `Margaret, relax!' " says Shauna Andrus, a veteran nurse who has worked with Allen for years.
Margaret Allen's drive and uncompromising attention to detail are legendary at the UW Medical Center. Her reputation as a top heart-transplant surgeon also has steadily grown since she established the UW program in November 1985.
This month, Allen, 46, winds up a year as president of the United Network for Organ Sharing (UNOS), the federally contracted agency that coordinates organ distribution nationwide and tackles a range of transplantation issues.
"She's been very open, very cooperative, has good ideas . . . (and) has given us good guidance," says Gene Pierce, executive director of UNOS.
She also is director of one of the nation's better heart-transplant programs, a program that next fall will be 10 years old.
UW patients fare better than most: About 79 percent survive at least five years, compared with the national average of 63 percent. Of 159 patients who received transplants, 130 are still alive (including three of four who had re-transplants).
Good patient care and fewer complications at the UW have also led to lower charges: The average is $84,000 per patient, compared with the national average of $194,100.
The numbers are a source of great pride for Allen. Most important, she says, is what they mean in human terms.
"I like helping provide an opportunity for patients to start a new life, but I don't make all this possible," says Allen, in her tiny office at the UW Medical Center. "It's the organ donor and the donor's family that does that. It's the fact that hearts can start up again after hours. . . . All I do is put things together."
Allen has never been comfortable talking about herself in interviews. She much prefers to focus on the intricacies of transplants, the crucial need for more organ donors, biomedical research and the work of UNOS.
But for all her intensity about her profession, the usually serious Allen smiles easily and takes off on tangents about other interests, which for years she hasn't had much time to pursue.
The outdoors is one. She has long been fascinated with animals, including one period when she learned to communicate in sign language with a gorilla. She rows, sometimes, for exercise. Now she wants to become an expert salmon angler and hang a trophy on her office wall.
"It's the fish, not degrees" that mark the well-decorated medical-school-office wall, she says with a laugh.
Back before she started the UW program, she used to make furniture. With the recent addition of four other surgeons doing heart transplants, she now hopes to have time for glass-blowing classes.
And she has long been interested in Third World cultures. She wants someday to return to Papua New Guinea, just north of Australia, where she once practiced briefly, to doctor there again. It is a wonderful place, she says; we could all learn much from the island residents' sense of community.
All of this fits with Allen's longtime quest to become a sort of Renaissance Woman. It is all part of an obvious and intense curiosity about what makes things tick, about living life to the fullest.
"I noticed early in my life that, if I filled a day with a lot of activities, it seemed as if the day was longer, (that) you could actually stretch time out," she says.
"So I figured that if I crammed as much as possible into each day, then over the years I could stretch my entire life out. Basically, sleeping is a waste of time."
HIKES, CANOES AND CRITTERS
Allen's journey toward a career in medicine began with hikes, canoeing and examinations of farm-pond critters.
Her father, Harold Allen, a Des Moines, Iowa, insurance executive, was fascinated by science, and the two loved to explore the outdoors.
They examined pond life under a microscope at the family weekend cabin outside Des Moines. They cross-country skied across farm fields. With her parents and younger sister, she camped in the Rockies and Ontario. At age 10, she stayed up all night with her dad to watch a total eclipse of the moon.
"It never occurred to me he had to go to work the next day," she says, savoring one of her fondest childhood memories.
In high school, Allen was the nerdy scholar immersing herself in science courses. At Swarthmore, a small, prestigious liberal-arts college in Pennsylvania, she majored in zoology and minored in English and fine arts.
"I wanted to be Renaissance Person," she says.
During summer breaks, Allen worked in a high-altitude biology lab in Crested Butte, Colo. Her duties included running trap lines for rabbitlike pikas so she could study their natural ability to conserve nitrogen.
A co-worker at Crested Butte later got a job stuffing bats for the Smithsonian Institution in Washington, D.C. When she visited her, they explored the back rooms of the natural history museum examining the many preserved animals.
Allen wanted to study physiology in graduate school, then become a researcher and teacher.
But she decided she would have more career options if she went to medical school. In 1970, she picked the University of California, San Diego, because its medical school was new and had recruited professors from all over the country.
"I thought that was exciting," she says. "But I worried about medical school because doctors are so boring. I worried I would turn out to be boring. It was the college-age view of adulthood."
Boring they weren't in med school. Allen worked in a vascular surgeon's research lab where Seattle surgeon Dr. Kaj Johansen was then chief resident. Johansen was implanting experimental artificial hearts in cows, Allen's first introduction to heart replacement.
Still, there was the Renaissance Person thing: "I was going to become a general surgeon, then return to Crested Butte because they didn't have any doctor there. I could be the internist and surgeon and do everything . . . be Renaissance Doctor."
LIKED THE HEAVY WORKLOAD
Allen was delighted when she was selected for a five-year general surgery residency at Kaiser Foundation Hospital in Oakland, Calif. Residents quickly received a heavy surgical workload there, and she liked that.
After her grueling Kaiser stint, she landed a two-year residency in pulmonary surgery at Kings College Hospital in London. Again, she had applied there because she knew the hospital's doctors performed a lot of surgeries.
"The most important thing in learning surgery is to do a lot of it, and I did a lot of it," says Allen, who at Kings finally decided she would pursue heart surgery as a career.
During the relatively few hours she wasn't in the hospital, she lived on a houseboat (once a lifeboat for the Queen Mary) on the River Thames, across from Hampton Court Palace.
While in London, she was accepted for a cardiac-surgery residency at Stanford University Medical School, where she would train under Norman Shumway, who performed the first heart transplants in the United States.
But before returning to California, Allen decided to take a break from the long hours in the OR, to quench her thirst for a new adventure. She and a friend - now her husband, who also is a physician - traveled the world for a year.
She was so fond of New Guinea that she applied for a medical license there and helped in a hospital for more than six months. The ancient culture, with its hunting and fighting with bows and arrows, fascinated her.
"I learned enough of the local language to travel around and talk to people," says Allen. "I wanted to learn how they think because they're coming into contact with the modern world now, and I don't want to read about them in somebody's revised history."
The Papua New Guinea health-care system could also teach us a thing or two, she says. Every village has a paramedic, well-trained in the capital city and able to treat 90 percent of problems. "We have places here at home that can't get any medical professionals to come and practice full time," she says. "Americans are always out to save the Third World. I think we have a lot to learn from the Third World."
In 1982, she settled into Stanford's rigorous heart-surgery residency and quickly earned a reputation as a hard-working, conscientious student. She did so much surgery, she sometimes would not leave the hospital for a week or more at a time.
"She was a take-charge person, who competed head-to-head with the other residents. She was regarded by her peers as a true leader who often times outworked her associates, while still maintaining a true spirit of comradeship," said transplant surgeon Bill Frist, who was a resident with Allen.
Frist, recently elected a U.S. senator from Tennessee, recalled how Allen's take-charge attitude was once the talk of the Stanford surgery department:
During heart transplants, the resident usually stepped aside for the staff surgeon to perform a particularly difficult suturing of a vein to the new heart. But Allen insisted on doing it herself. The more experienced surgeons were "a bit taken aback," but allowed her to do the work, Frist said.
Dr. Stuart Jamieson, now chief of cardiac surgery at the University of California, San Diego, was a staff surgeon who helped train Allen. He remembered how some faculty members had been put off by Allen's traveling sabbatical before entering the program.
It was almost unheard of, but he said he encouraged her acceptance "because it showed a desire to explore new fields, that she was inquiring enough to be part of new developments."
Jamieson and Frist both said Allen had no problems with the male-dominated surgery department. Allen called herself "just one of the guys." Jamieson said her acceptance was based on what her colleagues saw in her.
"She was an exceptional resident," he said. "She held her own, she was a tireless worker and she wouldn't take any nonsense from anyone."
In the midst of all this, Allen found time to help a neighbor with her graduate-school project in linguistics: communicating in sign language with a gorilla named Koko. Allen learned the signs and worked for hours with the animal every Sunday afternoon.
"It was humbling," said Allen. "Years after getting my medical degree, I was the beginner, Koko was the intermediate. She was very impressive."
GOOD FIT FOR PROGRAM
At the end of her residency, Allen again looked for a job where she could take charge and work very hard. In 1985, the UW was just starting its heart-transplant program, the first in the Northwest. It was a good fit.
The first years, however, were not the smoothest.
Some politicians questioned startup costs for such a high-tech program that would benefit relatively few patients. Money was scarce. Some still questioned the value of heart transplants, even though they had been around for 18 years by then. And there was the first-woman-as-heart-transplanter thing.
At her first, reluctant news conference after the UW's first heart transplant, breathless reporters asked Allen if she had any comments about being the first woman to direct such a program. Her complete, unblinking reply: "No."
Allen had to hit the ground running. She was very demanding, often uncompromising and sometimes outright unpleasant, said some staff members who worked with her then. Some doctors and nurses gave her a hard time in return.
"They thought she was too tough and too particular and too much a perfectionist in her approach to patient care," says Dr. Tom Ivey, director of cardiac surgery at the time, now at the University of Cincinnati.
They also criticized her in the early days as being too slow at the operating table, though technically very proficient. That's because when she chatted with others during routine parts of the surgery, she was animated and took her hands off her work, she and Ivey agreed. Always there were some looking for defects in her performance.
"She had to be real tough, she was under a microscope," Ivey says.
No one, however, has ever questioned Allen's devotion to patients - then or now.
There is nothing more important to her, colleagues say. She still checks and rechecks on them. She zealously protects their privacy. She makes sure they do what they're supposed to do in taking medications and exercise.
Sometimes, some of her co-workers say, she continues treatment for too long on a patient they don't believe has a realistic chance for survival.
"She doesn't give up. We haven't been able to sway her on that in years," says Andrus, the veteran intensive-care nurse. "We still go head to head sometimes."
Allen doesn't deny she can be very stubborn. There are bound to be differences in opinions, she said. "I'm persistent. It's how I get by. I never give up on whatever problem. I see what's the right thing to do and I just get there."
Still, Andrus, who obviously has a deep respect for Allen, says her longtime associate has a 10-year perspective on her work now, and it has made a difference in her outlook.
"SHE'S MORE RELAXED"
She can still be very stubborn, says Andrus, "but she has lightened up some. She's more relaxed."
Patients and their families understand Allen's zeal. And they see both sides of her.
Bud Moss of Tacoma loves to recall Allen's reaction when she transplanted the perfectly matched heart from an Alaska woman to Moss' wife, Vada, on Aug. 19, 1991. Allen lost a little bit of her cool when the heart started up again on the very first electrical shock.
"She just came flying out of the operating room," says Bud Moss. "She was so thrilled. She told the whole family. She was so excited about it being such a perfect match."
Vada Moss, now healthy and working full time in a Tacoma ticket and label factory, could not have felt more confident with Allen.
In her hospital room, Allen required nurses, visitors, everyone, to wear gowns and masks to protect against infection. She encouraged Vada Moss to walk as soon as she was able. She talked a lot about medications.
"You knew she was all business when she came in to talk," says Moss, now 53. "But she was also very kind. You knew she was a kind lady."
Allen often asked Moss how her husband and children were handling her illness. Allen explained that the heart donor was the very first one from Alaska and explained the logistics of how that was accomplished.
Most of all, says Moss, Allen explained what had happened with the surgery, with her body, and what Moss could expect during her recovery and the ensuing years. She was at once the scientist and the care-giver.
"She tried to make you understand, really understand," says Moss.
----------------------- ORGAN DONOR INFORMATION -----------------------
To obtain an organ donor card and information about organ and tissue donation, call the Northwest Donor Program at 1-800-206-3011.
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