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The Dufek File


happens that Dr. Tim Takaro from Oteen, N.C., a thoracic surgeon, is currently in the Soviet Union under the auspices of the U.S.-U.S.S.R. Exchange program. He has one of my pacemakers with him, and I am sure that he would be willing to operate on you if you can manage to have him invited to visit your institute in Prague. I am forwarding to Dr. Takaro through official channels a copy of your letter, and I will write to you again to inform you of his current address in Moscow.

The pacemaker I had with me was a demonstration model—a small, battery-operated gadget about twice as big as a spool of Scotch tape and much the same shape. Attached to the body of the device were two insulated wires the thickness of a piece of spaghetti. The whole thing—except for a short segment of exposed, coiled metal at the ends of the electrodes—was encased in silicone rubber. The device could be programmed to deliver tiny electrical shocks regularly and indefinitely to a heart whose normal impulses had been blocked by disease.

Yet the concept of regulating the heart's beat was still quite new in 1962. External pacemakers had been around only 10 years, and the first internal model had been developed just three years earlier. But in short order, the implantable pacemaker had revolutionized the treatment of heart block—so much so that I had asked its inventor to let me take one to demonstrate behind the Iron Curtain, where it would be very much a novelty. He had graciously complied, and so I packed the cream-colored apparatus—as well as a short movie on its use—in my bags, along with my own surgical stapling devices. I'd already shown off the pacemaker at Moscow's Vishnevsky Institute of Surgery, and elsewhere in Russia, by the time Dr. Dufek's first letter reached me in Moscow.

Pardubice, No Date
Dr. Takaro: I am sure that by now you have received Dr. Chardack's letter, and I would be glad if you could write me whether it could be possible to make the implantation of your pacemaker. For the time being I am using large amounts of Isoproterenol [at the time the best drug available for his condition] and feel a little better. But being a cardiologist, I know that the only right solution of my complete heart block is the implantation of a pacemaker. I should like to know whether it would be possible for you to carry out that operation here in Prague, where they specialize in heart operations. We should be glad to welcome you in this country. If your program does not permit you a visit in Czechoslovakia, I am ready to get to Moscow. . . .

Above: Brochures and handbooks marketing and explaining the use of the pacemaker Takaro had with him.

Please let me know about the costs connected with the operation. I should be very glad if my working possibilities were restored and thank you in advance for your kindness.

I marveled at the calmness of this letter from the hand of a writer who could drop dead at any moment. I myself was feeling somewhat more nervous. I had implanted a pacemaker once, shortly before I left the U.S., and I knew that it was a fairly simple procedure. However, that surgery had been done in my own operating room with an expert anesthesia service and up-to-date instruments and equipment. During the two months I'd been in Moscow, I had been shocked by how far Russia (and presumably the rest of the countries behind the Iron Curtain) lagged behind the U.S. and Western Europe in ordinary medical technology. To begin with, I knew they didn't have the right equipment to sterilize the pacemaker, which could not be steam-sterilized.

But the possibility of helping out this Czech cardiologist excited me, so I resolved to do my utmost to carry out his request. As far as I knew, the device itself was in perfect working condition. It was one of the latest models and had even been modified to permit external control of the strength and frequency of the electrical stimuli after implantation, by means of a needle designed to be inserted through the skin and into a control port on the pacemaker. Yet technological problems weren't the only ones I had to solve. To pay a visit to

I had asked the device's inventor to let me take one to demonstrate behind the Iron Curtain, where it would be very much a novelty. He had graciously complied, and so I packed the cream-colored apparatus—as well as a short movie on its use—in my bags.

Prague, I would need permission from the U.S. State Department and both the Russian and Czech governments. But undeterred by either political or medical hurdles, I responded to Dr. Dufek that I would do everything in my power to help him. He replied:

Prague, May 3, 1962
Dear Dr. Takaro: I thank you very much for your letter and for the care you devote to my problem. I myself try to get received by a minister in the government whom I once treated, who as I hope could make the solution seasier.


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