They are not what you'd think of as surgeon's hands. The left one, thick and stubby and maybe a little swollen, rakes through semishagged hair. Suddenly he bends down and pulls up his socks over strong, tanned calves. Then he grins. It is not an inelegant move.
"To me, it was the greatest thrill. To @cut. Oh, God, you don't know. I used to fight for it. But that thrill is gone now. I have to push myself every time."
Like his home country, he would be easy to despise. The excesses are so much up front, so bald-the galvanizing ego, the little balloons of self-promotion. But maybe in a way that's what saves him. Christiaan Barnard knows his failings, and will charm you in spite of them.
He has a high-pitched, pleasantly scratchy, gentry sort of voice. Listening to him is a little like listening to fine old 78 rpm records. His teeth are even and white. At 56, there is still something lean and fierce in his face-in the way he holds his mouth, for instance. He wears Gucci shoes and suits that shoot little flags of silk.
You wouldn't know he's a government-paid doctor whose stated salary, including bonuses, is $27,000.
He isn't a blueblood at all. He grew up in near-proverty, the son of a Dutch Reformed South African minister who worked among "coloreds" and never made more than 42 rands a month (about $59). His ancestors came from Holland as free burghers in the 1700s. He is an Afrikaner-in the most racially tortured in the world.
"I've often thought my need to perform might stem from my childhood," he says matter-of-factly, almost clinically. "My father introduced me to his problems all the time. In university, my greatest fear was that I would fail."
The once world-revered South African heart surgeon is sitting in his room at the Madison. He has been in America six days. He came this time to address the Pearl S. Buck Foundation in Philadelphia. In between, he found time to hop down to Largo, Fla., to lecture at an obscure hospital (he had made a promise), and to come to Washington to appear on National Town Meeting at the Kennedy Center.
It is early morning but his bed is made, his bags packed. In 10 hours he leaves for Roma, a place he loves greatly and which loves him, even though the wine-and-roses days with Gina Lollobrigida allegedly are long dead.
He sits with his legs crossed, one hand resting lightly on a knee. A lamp tosses soft light. There is a bulky knot in his rich blue tie. You have to strain to see the tube of flab around his belly. He looks like a cinema star-maybe Mastroianni's half brother.
He is talking of his rheumatoid arthritis, which has afflicted him for years and which he always knew would cut short his career with the knife.
"There are days now when I just can't put on the gloves anymore,"he says. "Arthritis is more than just a pain in your joints. It's the tiredness, too. It's always burning your body." A small sign, sans pity. "I realize I'm on the downhill side now. I've reached the peak. Give the younger boys a chance, I say." This last sounds supporting and British.
And yet even as he says it, Christiaan Barnard adds: "I'm afraid to quit. I can't. One is so afraid when he stops surgery . . . that . . . the image of himself . . . will be gone." He says it quietly.
Last summer, on another trip to America, Barnard said he had made a firm decision to stop operating before the end of 1978. He didn't of course. He kept right on operating at Groote Schuur Hospital in Cape Town with his teams of assistants, with the hot lights and O.R. pressure and fame arcing down. Already in 1979 he has performed two "piggyback," or double, heart transplants-one on an Italian, the other on a 26-year-old Smithville, Mo., man. Bob survive.
At the moment Barnard says his fingers feel surprisingly good. He thinks the arthritis may have gone into "natural remission." That doesn't stop the stiffness, the pain. He has taken drugs for years, he says, though he tries to avoid cortisone because of its side effects.
He first learned about his affliction 20-odd years ago when he was a student at the University of Minnesota Medical School. He had earned his M.D. in 1953 in Cape Town, and had come to America to study under famed surgeon Owen Wangensteen. The arthritis turned up in his foot shortly after (he limps badly today, after sitting a spell). He was "terribly depressed.
"But then my doctor told me I had tremendous natural resistance and that it probably wouldn't really retard me for years." His first clinical patient in Minnesota, ironically, was a woman grotesquely crippled by arthritis.
Need for Recognition
"People are always talking about my tremendous ambition. Well, maybe my ambition was fired by the realization I dinn't have forever."
People have talked of Christiaan Barnard's ambition. In the medical community, the consensus about him-dating almost from the time of his first historic transplant, in late 1967, of the heart of grocer Louis Washkansky-seems to be recognised. One remembers the rocketing news accounts of his being feted by LBJ at the ranch in Texas; a special audience with the pope; the guest of a hundred boards in Europe: Surgeon as savior, as superstar. Surgery as theater.
Yet today, some of the feeling in the scientific community seems to be that Barnard never really advanced the field of heart transplantation that far. He was merely first.
"If you compare him with Norm Shumway (of Stanford), he doesn't hold up," says Paul Corso, a respected heart surgeon at the Washington Hospital Center.
"But he wouldn't be hooted down at a convention, either, even though the old-line medical community frowns on his life style."
Curiously, Barnard appears undisturbed by the long-standing controversies that swirl about his name. One would be tempted to say he is unaware of them, but that is absurd. He insists he never really sought publicity in the first place. "If I were a short, fat man with a bald head," he says, laughing.
Barnard hotly rejects the idea that the world should have waited for organ transplants until the immunology problem was licked, that he rushed into the surgery. The basic plumbing of the heart operation was worked out long ago and never was that difficult, experts say. The problem was always one of tissue rejection. Many feel Barnard acted too fast.
"Not at all. The timing was right back then. If we were performing our first transplants today, our results would be no better. Maybe our selection of patients would be better; that's all."
He adds: "People like Shumway, Richard Lower, Denton Cooley, myself-we all knew that transplants weren't curative; just palliative. The press distorted the operation from the beginning."
He is defensive abouts how many of his transplant patients have died. That is a wrong he has been saying, in speeches and interviews, that the primary goal in medicine (which he pronounces "med-san") is not to prolong life, but to enhance its quality.We are not here to conquer death, he says. Death is part of life; in fact it is its only certainty.
"The first question is always 'How long did he live?' I remember a journalist asking Philip Blaiberg, my second transplant, when did he realize the operation was worthwhile. Blaiberg said he realized it as soon as he came 'round from the anesthesia and found he could breathe again."
In all, Christiaan Barnard has performed 34 single and double transplants. Roughly 45 percent survive. One of his single-transplant patients just celebrated her 10th anniversary with her new heart.
As a stay against that grim day when it is all over, Barnard has, in the last year, taken over a restaurant in Cape Town. He was thinking of calling it The Pacemaker; he named it LaVita instead. Then there are his books and his gardening and his exotic bird collection and his wine farm with a quarter of a million vines, and of course his young wife-his second-and their two young children. That's a lot. You get the idea it's not enough.
"I don't think I'm going to continue," he says now, pacing in circle. "I'm really tired. Oh, I don't know." And then he blurts: "My ego so needs it! And actually, I'm not even the surgical type. I'm a very emotional person. You may have heard."
In the spring of 1970 in a secret midnight ceremony, Barnard divorced from his wife of 20 years, married 19-year-old Barbara Zoellner, a Johannesburg debutante and daughter of a steel and oil tycoon. "Lots of people were making bets it wouldn't last," he says.
Barnard's wife doesn't often come with him to the States, or to other places, for that matter. "She doesn't like it when I travel about so violently." She also doesn't like him traveling alone, he says. (He has an aide along.)
Doesn't she trust him?
Roaring: "No, I doin't think she does!"
Christiaan Barnard is a South African patriot. These are not halcyon times for his country. South Africa is condemned-millions feel correctly so-around the world for its system of apartheid. By birth, Barnard is a member of the class that instituted and still supports the country's doctrines of white supremacy. It is hard to know exactly where he stands on the question of race. He has helped integrate his hospital, and he says his restaurant is open to non-whites. Yet scratch him, some people say, and you will find a "Verkrampte" (enclosed). He talks of himself as a "Verligte" (enlightened). He has flipped and flopped back.
"I feel we should abolish social discrimination. As a white South African and a member of a minority group, I have to find a solution that will not endanger my future. That's where politics comes in. If we settle for oneman-one-vote, then of course we would have a black government. That would be a threaat. I don't think I'm better than the black man. I feel that as a group, whites have more experience, more competence."
He looks frustrated. "You can't talk about it without being misunderstood. I know some people will hear that and say, "That's damn unfair.' But look at the rest of Africa-the strongest tribe rules. Look at the Middle East-the royal families are in control."
At his hospital they've begun to mix the patients in the wards, he says. "But it has to be done very quietly. The government is so scared. When a newspaper comes, we must make sure the beds are moved."
Some day Christiaan Barnard is the Yevtushenko of South Africa, the showcase liberal. He does not deny he is a kind of self-appointed roving ambassador.
"I tell you what, I decided several years ago, when we began taking an unmerciful hiding, that I would use the abilities I have to get access to the media to try and counter the criticism. Americans may understand our situation better than some, but tell me, why must it suit you always to back the extremist groups?"
Barnard the writer has produced a novel, "In the Night Season," and a couple of political tracts. He says he approached "In the Night Season" as a scientific project, isolating for himself exactly what he wished to accomplish. "My books are written so accurately they could almost be textbooks," he says. Little wonder his fury at the New York Times when a reviewer accused him of writing sensationalist passages, about blood spurting off the operating table into a surgeon's eye. "Little does he know that often happens. It's happened to me."
Some time ago Barnard and his brother, also a physician in South Africa, made the headlines by signing a so-called "death pact." Barnard calls it an agreement on passive euthanasia. He says if he or his brother should suffer a stroke, the other would agree to pull the plug on the life-support machinery. This situation they actualy faced with his mother, he says, when she was unconscious after two strokes. She also had pneumonia. "What do we do? Treat her? Tubefeed her? No. We respected her wishes and took no extraordinary means. She died two days later."
His voice grows soft. Maybe he is thinking of his own mortality. "In the old days, before antibiotics, pneumonia was called 'the old people's friend.' It would carry them off. Now people don't have a friend to carry them off."
It is not easy to stump Christiaan Barnard. But this does, for a moment anyway: Did he ever wonder what he might have become if not a doctor?
"A farmer, perhaps. Yes, a farmer."
But how would a farmer named Christiaan Barnard satisfy his need to walk in the limelight?
"Um, that's right. Though he might invent a new crop. Actually, I always liked law, too. A criminal lawyer-now that would have been nice. What was that man's name-Darrow? Yes, Darrow. Oh, he was splendid. I love Clarence Darrow."
He hestitates, Mitty before the jury: "I think I would have been excellent." CAPTION: Picture, Christiaan Barnard, by James A. Parcell.