The carpenter’s apprentice who changed the face of cardiac surgery
The year is 1944 and deep within the infant ward at Johns Hopkins a 15-month-old baby named Eileen Saxon gasps for breath under an oxygen tent. Her skin is a deep blue, her lips a dangerous purple. She has a heart condition—a complex combination of four congenital defects in the structure of her heart—preventing proper blood flow to the lungs and slowly starving her body of oxygen. The doctors at her bedside call it tetralogy of Fallot. Parents like the Saxons call it “Blue Baby Syndrome.” They know most die in the first two years. And they know there is no treatment for their baby girl.
Which makes it even more surprising when a cardiovascular surgeon named Dr. Alfred Blalock tells them he can save her life.
For the next four-and-a-half hours, with the observation decks of the surgical theater crammed full of onlookers, Blalock snips, slices, clamps and sews, manipulating Eileen’s impossibly small blood vessels with all the delicacy he can manage. If he can surgically reroute a healthy artery to bypass Eileen’s malfunctioning pulmonary artery, it will redirect the blood flow and save her life. It’s a game of millimeters and one that no surgeon has attempted before. Through it all, Blalock consults a man standing at his shoulder who gives careful instruction in a quiet voice, telling Blalock where to cut and how long to make the incision, where to place the sutures and in which direction.
The operation comes to a dramatic and successful conclusion as little Eileen turns from blue to pink before their eyes.
In an instant, Blalock is a legend, and the operating room becomes known as “the heart room,” where parents from all over the nation bring their Blue Babies to witness the miracle themselves. The medical community names this miracle the Blalock-Taussig shunt, the surgeon sharing credit with cardiologist Helen B. Taussig, who first conceived of such a procedure.
But it will be decades still before the world is ready to acknowledge the man at Blalock’s shoulder, a carpenter’s apprentice turned surgical savant who, with no college education or medical degree, helped usher in the age of modern cardiac surgery.
His name is Vivien Thomas and he was the only black man in a lab coat at Johns Hopkins that day, 30 years before the university would allow its first black surgical resident. His story defies history. His impact is only now being fully recognized.
Only 14 years prior to that fateful day at Johns Hopkins, Thomas was a carpenter’s apprentice in Tennessee, saving money for college with his sights set on medical school. He was 19 years old. And when the Great Depression wiped out his work and his savings alike, he thought it had snatched away his dreams too. Then a friend told Thomas about a job opening at Vanderbilt University, where he could work as a laboratory assistant on groundbreaking research into trauma and shock. The catch? He would be assisting an aristocratic young physician who already had a reputation for ill-temper and was supposedly a distant relation to Jefferson Davis himself.
And that’s how, on February 10, 1930, Vivien Thomas met Dr. Alfred Blalock.
According to the story, the two men took to each other at that very first meeting in Blalock’s animal lab, each recognizing in the other a kindred spirit of sorts—an inner drive matched only by insatiable curiosity. It was Thomas’ first time in a lab of any sorts but he was full of questions revealing almost instinctual insight. By the end of the tour, Blalock offered Thomas the job. By the end of the first month, Thomas could measure and administer anesthesia, carry out experiments in the lab, and operate on Blalock’s animal test subjects. It was the beginning of a historic 34-year partnership.
According to Thomas’ autobiography, Blalock’s ill temper surfaced only once in those early days. Thomas had made a mistake—minor enough that the exact error is forgotten—and Blalock erupted in anger, hurling profanity and throwing what Thomas described as a “temper tantrum.” Thomas said that he would sooner leave than take such abuse. Blalock apologized, and the mutual respect that would characterize their relationship continued from that point forward.
Outside the lab, years passed and the Great Depression roared and Thomas put aside his dreams of college and medical school. Still, he studied chemistry and physiology textbooks by day, and sought instruction in anatomy and more from Blalock’s research fellow. Soon enough, Thomas was Blalock’s right-hand-man, staying in the lab with him long into the night, when all others were done for the day, monitoring experiments, dreaming of new ones, and drinking whiskey-and-Coke, Prohibition be damned. Before long, they settled into a comfortable—and fruitful—rhythm, where Blalock would hypothesize and speculate, while Thomas would devise ingenious experiments to test his ideas.
In 1933, Blalock presented the results of their research, becoming the definitive authority on shock. Thomas received no credit. Rather, he discovered that Vanderbilt’s employee records classified him as a janitor. He brought the matter to Blalock, who said he would take care of it. Not long after, Thomas received a salary increase. Blalock would stand up for his colleague again when the Henry Ford Hospital in Detroit approached him to serve as chairman. Blalock would be surgeon-in-chief and have an entire department at his disposal for whatever research he wanted. But he could not bring Thomas with him, they said. They would not hire a black man.
Blalock told them to kick rocks.
Three years later, Johns Hopkins called. They wanted Blalock for surgeon-in-chief. Blalock wanted Thomas. Thomas wanted to think it over. In the end, they all agreed. Three years after that, Blalock and Thomas met Eileen Saxon. By that point, Blalock recognized that Thomas’ surgical expertise had surpassed even his own and reserved a small stool at his right shoulder for every surgery, where no one but Thomas was permitted to stand.
“Today, all of us who have done this work know the name ‘Vivien Thomas’ and what he did,” says Dr. Jeffrey Sell, Chief of Cardiovascular Services at Sarasota Memorial Hospital – Sarasota. “And that was in the 1940s. But he worked and he worked and he taught himself. He took helping those babies very seriously.”
In his time as a cardiovascular surgeon, Dr. Sell has seen plenty of babies like Eileen Saxon—and even performed the life-saving operation pioneered by Blalock, Thomas and Taussig, though the modern version uses a small flexible tube to reroute blood flow, as opposed to surgically moving an existing artery. It’s an operation, he says, with an impact far beyond treating tetralogy of Fallot.
“It opened a door,” Dr. Sell says. “It kept kids with other complicated heart problems alive too. It kept them alive until they were old enough for a larger operation and a complete repair.”
Similarly, Thomas’ impact spread far beyond his partnership with Dr. Blalock, who died of cancer in 1964. Though holding no formal degree, Thomas became a storied teacher in the profession, with surgeons claiming proudly, decades after the fact, that they learned from the Vivien Thomas. He would use his position to make opportunities for other black men, finding them jobs in the lab and teaching them what he knew. In 1968, it was these men, grown respected in their field, who commissioned a portrait of Thomas to display in the Alfred Blalock Clinical Sciences Building, right next Blalock’s own. Eight years later, in 1976, Johns Hopkins University would grant Thomas an honorary doctorate.
But it would not be until 2023 that the medical community would finally fully recognize Dr. Thomas for that miraculous day in 1944, officially renaming the Blalock-Taussig shunt, the Blalock-Taussig-Thomas shunt.
Learn More:
And read the famous Washingtonian article by Katie McCabe that first told Dr. Thomas’ story to the world back in 1989.
Follow Up:
Find more about cardiovascular surgery at Sarasota Memorial here.
Find more about cardiovascular services at Sarasota Memorial here.
Find more about Dr. Jeffrey Sell, and request an appointment here.