The nurse at the desk rings a silver bell three times.
About 100 people, many who have traveled thousands of miles to get here, murmur excitedly. "It's him," they whisper. "He's here."
For a moment, worry leaves their faces. But it returns. They are waiting for the daily rites of The Doctor -- world-renowned heart surgeon Denton A. Cooley.
They are family and friends of the 27 people whose open-heart surgeries were supervised that day by Cooley. They are waiting for him to tell what happened behind the operating-room doors.
He stands tall in the middle of the room, his starched white jacket a contrast to the drabness of the waiting room at St. Luke's Episcopal Hospital. He calls off the names of the patients on his operating list that day.
"Froidcoveur, Bernard Froidcoveur's family," he says. The family members rush up to hear about their 8-year-old son. "He's doing fine. We fixed his heart. You can visit him at 7:30," Cooley says, "Garza, Maria Garza's family."
With split-second precision, he reels off the 27 names. The families had recieved hourly reports, but they waited all day to hear from The Doctor.
More than half the people are from foreign countries. Many speak little English. Cooley speaks "Tex-Mexc Spanish to some. To others, his words mean nothing. These people come from countires such as the Netherlands and Yugoslavia. His presence and smile is enough for them. Even those who speak English don't ask questions. They stare at him, look at his hands and mumble "thanks, thanks."
In 10 minutes, the rites are completed. Cooley walks to his unmarked office and finishes some paperwork.
He has supervised 27 open-heart surgeries this day, his hands touching and repairing 13 of those hearts. A few complications, nothing serious. No mortalities. (There usually aren't. The death rate is about 2 percent.)
Cooley, 59, attended the University of Texas, and some of the world's best medical schools. He belongs to the right organizations, lives in the right neighborhood, knows the right things to say. Most people say he is brilliant. nHe and Houston surgeon Dr. Michael DeBakey helped develop the heart-lung pump in 1955, opening the frontier of open-heart surgery.
Though less famous than DeBakey, Cooley has built a reputation for speed and dexterity and a large patient workload. He has been honored by foreign countries (about half his patients are from abroad). While DeBakey is known for flamboyance, Cooley is known for his cool, methodical methods; his dry wit. "He is the perfect gentleman," said a hospital resident.
Cooley takes the pressure, the fame, the busy schedule in stride. "There's nothing to get excited about," he says.
He has performed 40,000 open-heart surgeries, a world record. About 90 percent of the patients at the Texas Heart Institute are his. In the late 1960s, he performed 22 heart transplants. In 1969, he was the first surgeon to implant an artificial heart. Although that patient did not survive, Cooley retains his dream of a successful implant.
His fetish is efficiency.
They call the eight-operating-room section "the heart surgery factory." Everything there works with the precision of an assembly line. That's the Denton Cooley way.
His day begins at about 6:45 a.m. He drives a few minutes from his River Oaks home to his office dons his white coat and enters the intensive-care unit of the institute, which he created in 1962. It is connected to St. Lukes, where 40 ICU beds are reserved for heart-surgery patients.
Cooley first visits the patients he operated on the previous day. He strides from bed to bed, followed by about a dozen residents and surgery fellows.
In 26 minutes, he sees about 35 patients. Then he returns to his office for breakfast and a short dose of "Good Morning, America."
The four oriental rugs on his office floor give understated testimony to his status at the hospital -- but his messy hideaway seems the antithesis of his legendary efficiency. Gifts from foreign patients are piled on a chair; a basketball rests under a table; posters, books and honorary papers are strewn around.
But beyond the mess is a systematic method for handling the letters, patient charts and other paperwork. Nothing is lost. And when he is ready to return telephone calls, his secretary carefully times them so that when he finished one, the next is waiting. Denton Cooley's feet are never on his desk.
However, there are signs that he has time for relaxation -- a well-stocked liquor cabinet, a deck with tapes of Willie Nelson, Johnny Mathis and Steve Martin.
Recreation is a big part of Cooley's life. He is proud not only of his surgery, but of his physical endurance and athletic ability.
He likes tennis. He recently fell and broke his wrist, but did not miss a day in the operating room despite his cast. "You got to bite the bullet," he says.
Twenty-three minutes after arriving in his office, he changes into his surgical dress in an adjoining private bathroom. Other physicians change in communal locker rooms. And while other scrub suits have the hospital's name stamped on the front, Cooley's have his name and the institute's open-heart symbol monogrammed on the chest and a back pocket.
He enters the surgical area, scrubs for a few minutes and goes into an operating room. His hands dripping with water, are outstretched. A nurse helps him into his surgical gloves. He puts on a sterile paper gown, and is ready to begin.
The residents, technicians and nurses have been preparing the patient for about an hour, draping her, opening her chest, placing her on heart-lung pumps.
When Cooley walks in the Patient's heart is exposed and connected to heart-lung pumps, but still beating. Cooley grabs a plastic pitcher with an ice-water solution and pours it on the heart.
The heart stops. Life is maintained by the machine, which pumps blood out of the body, oxidizes it and then returns it.
Cooley begins his work, making it look easy. He does not gaze at the patient's face to remember the problem; instead, he is guided by a cardiologist's diagram.
The first patient is a 22-year-old woman with a heart valve scarred by childhood rheumatic fever. Her face is covered by a blue paper drape. Her eyes are taped shut. An anesthesiologist intermittently shoots drugs into the tubes attached to her.
The only part of her body that is visible is an area about a foot square. It encompasses the cavity that holds the heart. The skin, muscle tissue and some fat can be seen.
Cooley lightly moves the sharp instruments through the heart, finds the bad valve and cuts it out. Handed a synthetic valve, he sews it into place. The stiches are exact and close. To see the delicate work, he peers through lighted, magnifying eyeglasses.
In 10 minutes, he is done and the residents take over. Cooley moves to the next operating room.
The process is repeated 13 times on this day. In between, he checks on his other 14 patients, who are being operated on by associates.
Each case is different. And so is each operating room -- with different music, and different doctors, nurses, anesthesiologists and technicians.
In the room where Cooley knows the staff well, the talk is of sports, world events, heart surgery, bad jokes, social events. In the other rooms, the only sounds are the music and the heart-lung pump.
In the afternoon, Cooley returns to his office to answer phone calls and letters, and to review medical writings. Every few minutes, he pauses to study two closed-circuit-television monitors that bring the operating rooms of the institute into his office.
Cooley's speed is legendary. During one operation, the team joked that it would take another doctor eight hours to do what Cooley did in 45 minutes.
But his speed, fame and skill do not add up to a larger bill for his patients. His fees average about $2,500 for his work and $2,500 for the team's work. If the patient cannot pay, he will drop his fee. If the patient is wealthy, the price may double or triple, he says.
After his surgeries for the day are completed, he is off to visit patients' families and the 37 patients admitted for future operations.
"We'll be operating tomorrow. We'll take good care of you, make you well," he assures them. Some ask for his autograph and insist that he pose for pictures. Some bear gifts.
"It's somewhat embarrassing. But it's efficient. They don't burden you with a lot of trivial questions and problems. There are other people to handle that," Cooley explains.
"I think I'm a pretty ordinary man. This situation just developed. It would happen to anyone who applied themselves well," he added. "I've excelled in almost everything I've done -- scholastically, athletically. I'm what people call an achiever.
"Surgery is not all fun and games, not everything is exciting and stimulating. I wouldn't say it's boring, but it does get exhausting. But so many of the cases are interesting, so much of it is stimulating, that it's worth it."