The Dufek File
The story of the first pacemaker implantation performed behind the Iron Curtain is as suspenseful as any John le Carré novel. But this saga's literary twists and technological turns—from the pen of the DMS graduate who performed the operation—have to do not with espionage, but with surgery. And humanity.
The Cold War—when Communism was a constant specter and few Americans were allowed behind the Iron Curtain—now seems long ago and far away. I was recently reminded of the divisions and fears of that era when I came across a file of correspondence more than 40 years old. The cache of letters, cables, and news clippings stirred up memories of an unusual experience I had back then—and of the fact that human connections can be forged even across seemingly impenetrable barriers.
It was the spring of 1962. Just over a
year earlier, Russian leader Nikita Khrushchev had disrupted a session of the United Nations by banging his shoe on a desk. The Berlin Wall had been up for eight months, sealing off East Berliners from all contact with the West. The Cuban Missile Crisis was nearing its denouement.
Yet amidst the tensions, there were glimmers of the detente to come. I was about to leave to spend several months in the Soviet Union under the auspices of the newly signed U.S.-U.S.S.R. Scientific and Cultural Exchange Agreement. I had gotten approval to take a leave from my post as associate chief of staff at the VA Hospital in Oteen, N.C., and had acquired a working knowledge of Russian. My mission was to study specialized surgical stapling devices made in the Soviet Union.
A few weeks before I left for Russia, Dr. William Chardack—chief of surgery at the VA Hospital in Buffalo, N.Y., and a friend of mine—had received a letter from a Czech cardiologist. Bill Chardack was the coinventor of the world's first completely implantable cardiac pacemaker. In impeccable English, Dr. Jan Dufek wrote to him as follows:
Prague, March 10, 1962
Dear Sir: I am writing to you in the following matter. I am a heart specialist, head of the cardiologic department in the hospital in Pardubice (a town about 60 miles east of Prague.) At present I am myself a patient of the Institute of Experimental Therapy in Prague. I have read with great interest your papers on the pacemaker and did not realize at the time that I shall have to address you in this matter for help on my own behalf.
The Czech doctor went on to explain that he'd recently had a heart attack—his second—and that it had left him with a heart block, a condition in which the normal electrical impulses that make the heart beat had been cut off by scarring. His usual heart rate of 80 beats per minute had dropped to 30. He was almost completely incapacitated and could no longer work. He had sudden fainting spells when his heart rate would briefly drop still lower. And the threat of a complete cardiac standstill, meaning sudden death, was ever-present. He knew that acquiring a pacemaker was the only way to avert this catastrophe.
His letter continued:
As a specialist, you will understand my desire to be fit again and to resume my work without the threat of cardiac
syncope. I am writing, therefore, for advice on how to procure a pacemaker. I realize that it is still in the experimental stage, but I know I must have one to survive. Unfortunately, I have no foreign currency to cover the expenses, but unless I get a pacemaker I am faced with the perspective of going into invalid pension and living the life of a glasshouse flower. Lately, the fainting attacks have been more frequent.
I will not presume on your apparent Czech origin for any special consideration—yet I thank you very much in anticipation and apologize for taking up your precious time.
Bill Chardack responded as follows:
Buffalo, N.Y., April 9, 1962
I have your letter of March 10. It so
Takaro, a 1942 graduate of DMS, is a retired thoracic surgeon and former chief of staff at the VA Medical Center in Asheville, N.C. He has written several previous features for Dartmouth Medicine, including—for the Fall 2004 issue—"The Man in the Middle," about the crucial role played by Dartmouth College alumnus Basil O'Connor in the development of the Salk polio vaccine. The punctuation and spelling of the letters included in this issue have been standardized, and in some cases the original wording has been adapted slightly or excerpted from longer passages.