Christiaan Barnard: “Death is often our friend”

After hard facts showed that it could and was, people wanted to know when heart transplants would start in the Soviet Union, where they would get enough donors, how long a patient would have to wait his turn and were to sign up for the waiting lists — at the local clinic or social protection department? Would there be any privileges for the Heroes of Socialist Labor and other citizens with a meritorious record as builders of the communist paradise on earth? In a word, the Soviet public’s excitement matched that caused by Yuri Gagarin’s orbiting the earth.

Now, when asked if he ever felt like Gagarin in medicine, the 76-year-old Christiaan Neethling Barnard smiles and says with a touch of professional humor:

“The difference between me and Gagarin is that during his first space flight he risked his own life, but I did my first heart transplant totally at the patient’s risk.”

This man with a sense of humor knows how to live and enjoy life. In fact, this is a certain philosophic stand. There is an old saying: if you want to be happy, do something about it.

“It so happened that I was married three times. I have four children from two previous marriages, and now am a father again. My oldest son is 27 and my youngest daughter is 16 months. My wife will be 25 soon,” he told The Day.

These authors did not intend this quotation as a piquant lead-in. The man looked genuinely happy. He was fully aware of his age, but determined to make the most of the remaining years. He radiated youthful vigor, despite the sadness that could be glimpsed now and then in the depth of his smiling eyes. “I WILL BUILD A CLINIC HERE”

Prof. Barnard had visited Odesa on a number of previous occasions. When in Warsaw, receiving the Albert Schweitzer Medal and International Gold Star for outstanding merits in science years ago, he met other contenders, among them Prof. Zaporozhan, Rector of Odesa State Medical University. They made friends quickly and Mr. Barnard calls it brotherhood. “We are a brotherhood responsible for man’s future,” he says.

He visits Odesa Medical University to lecture and hold seminars with the senior teaching staff. At present, he is busy with a project aimed at building a private clinic in Odesa to become part of an international human organs transplant network. Prof. Zaporozhan stresses that his celebrated South African counterpart was particularly helpful in organizing a health insurance system without which private medicine simply cannot exist. Here the thing is not so much to introduce progressive medical technologies as carrying out cultural transformations in Ukraine, he adds.

Prof. Barnard: “Transplanting human organs is not something one can ponder at leisure. In a modern society this is a matter of life and death. At present, about 40,000 such surgeries are made every year the world over, but not all countries have the required financial institutions. I am providing financial and institutional assistance to organize such clinics in Ukraine. There is a group of people in South Africa interested in precisely such projects in your country. The first clinic will be under the auspices of Odesa Medical University. It will test certain pilot health insurance projects that will subsequently spread over Ukraine. Back in 1983 when I retired most clinics in South Africa were state-owned. Today, 75% are private property. Prof. Zaporozhan visited my clinic and I think he could see for himself that our health service is kept at a top level. In Ukraine, medicine is based on old laws, so the clinic being built will become the basis on which your country will receive not only modern technologies, but also preconditions for developing effective medical management and upholding relations between state and private health services. This clinic will be built alongside a personnel training program, for time is pressing. AN AWARD FOR KINDNESS

Actually, this time Prof. Barnard visited to receive a unique award. Among the world’s trophies there is one conferred for what is best described as kindness. The averse side of the St. Nicholas Order reads: “For multiplying good on earth.” Kostiantyn Bobryshchev is a remarkable man, but this time he seems to have accomplished the impossible. He instituted the Order as President of the International Award Charitable Foundation. “When I was going through the required legal formalities one of the bureaucrats was amazed to learn that I was single-handedly establishing an order. ‘Are you sure you know what you’re doing?’ he asked. I said I was and that it was not forbidden by the law, was it? And the effect surpassed all my expectations. Starting in 1995 the St. Nicholas Order has been recognized and registered practically in all European countries, in Africa, and North America. At president, among its recipients are such noted personalities as Mother Theresa, Baron von Pfaltz Fein, Academician Borys Paton, Mikhail Zhvanetsky, and, finally, Christiaan Barnard.

At a news conference Dr. Barnard was asked:

“You have been awarded the St. Nicholas Order. How do you personally define the notion of good? Have you had more good or evil in you life?”

“I think one would be hard put to define human kindness. Remember the Golden Rule? Do unto others as you would have them do unto you. Mostly, I can recall good things. I like visiting Ukraine, because here I always experience good, not evil. And I enjoy helping your country. DEATH CAN DO WHAT WE CAN’T:
STOP OUR SUFFERING

I watched him stoically endure the official pomp and was struck by the man’s sage humbleness. The university stairway was jammed with students training their photo and video cameras on him, gawking at him as though he were an exotic rarity, and he managed to address a smile to each and everyone of them. I asked a young man nearby why all the fuss and he said, “If you heard one of his lectures you’d also be after him, mouth open and tongue hanging.” Later, several of my colleagues and I managed to talk to Dr. Barnard in private. I told him about the young man and he laughed:

“All right, I’ll let you in on some controversies in medicine. You can use it for your interview.

“You would be surprised, but after more than fifty years of practice I understand death much better than I do life. For example, what exactly do we mean saying that we are alive or that we enjoy our life? Or when we exclaim that our life is over? Let’s start with death. In reality, death is a clinical diagnosis based on certain symptoms and signs attesting to the death of the brain. However, this does not happen when the heartbeat stops. Sometimes the heart continues to beat after death — for 6-7 minutes after the brain dies. The body dies after the brain does, because the brain is alive while man is breathing. If we can sustain respiration in a practically dead body the heartbeat will continue. But this is not life, because the brain is dead.

“So when does the heart stop before the brain dies? Usually after a severe heart attack. A man topples to the floor not because he is dead, for his brain is still alive. If nothing is done about it the brain will stay alive for another 3 minutes. In other words, this man will die because of and after the stoppage of the heartbeat. To sum it all up, heartbeat does not necessarily mean that one is alive, just as man is not necessarily dead without the heartbeat. I don’t know how well read you are in the Scriptures, but what did God do after creating man? He did not set his heart in motion but breathed life into him. In other words, breathing is much more important than the heartbeat. You will discover that in many languages the words ‘breathing’ and ‘soul’ sound almost the same. When man stops breathing his soul departs. Now I hope you have a clearer notion of death, don’t you?

“And life. What is it? It is not only the heartbeat and breathing. It is much more. Remarkably, in a number of cases a physician can determine that his patient’s life has come to an end, although his heart is beating and he is breathing. In such cases all further treatment should be stopped. Here we come to euthanasia or mercy killing, a topic which is being debated the world over.

“However, the joy of living must be real. To celebrate it, one must have a reason. That boy had a reason to celebrate, so he did. But when life is no longer enjoyable, when one has no reason to celebrate it, one’s life is over, despite the fact that one’s heart is beating and one is breathing. Doctors say, “Death is our worst enemy and nothing will stop us in our struggle against death.” They are wrong and it is a very bad approach to medicine. Death is often our best friend, because it can do something no one else can: stop the patient’s suffering.”

Kyiv - Odesa