The Puzzle People: Memoirs of a Transplant Surgeon

Abraham Verghese respects Thomas Starzl and notes in his best-selling novel Cutting for Stone that Starzl is the model for one of the lead characters in the novel. He describes Starzl as a “surgeon's surgeon.” He also notes that “[i]t is fair to say every organ transplant surgeon in the world was trained by Starzl or someone who trained with Starzl” (1, p. 662).

When I saw Verghese's review, it brought up memories of my medical school training at the University of Colorado in the early to middle 1960s. There was tremendous excitement in Starzl's early work on kidney transplantation. A number of my classmates were involved in laboratory work helping to understand how to do the procedure. In fact, one of my classmates became a transplant surgeon.

In the early 1980s, Starzl left Colorado to go to the University of Pittsburgh. About the same time, I met Keith LaGrenade, M.D., who went on to become, and still is, hospital director at the Colorado Mental Health Institute at Fort Logan. Keith had a kidney transplant done by Starzl in 1971 from a cadaver kidney, which he rejected, and then from the kidney of a relative in 1973, which is still working well. Keith corroborates what Starzl illustrates in his book, which is the intense devotion to his patients. He is able to remember patient histories and write about them in detail. These are people he clearly knew very well. It is obvious that his individual patient care was exquisite and caring. These were his “puzzle people.”

Despite Starzl's ultimate success in developing the operation for liver transplantation, his fear of performing surgery was profound. Starzl admits that he harbored anxieties, which he was unable to discuss openly until more than 30 years later. At that point, he had stopped surgery. He says:

As psychiatrists, we can understand this terrible anxiety and the difficulties it would cause. It also may help explain why Starzl's most significant work and energy went toward the laboratory, where he developed new strategies to deal with the rejection phenomenon. Even as he trained a new generation of transplant surgeons, surgery would become secondary to his interest in solving the rejection problem. His major success was to develop a team of basic and clinical scientists that eventually gave him and his patients a clinically acceptable immunosuppression strategy.

The Puzzle People is an engaging and engrossing work, which takes the reader along the path of mastery. It is written in a friendly, personal manner, which speaks of the author's intense humanity.

Starzl devotes a brief chapter to a political conflict with Richard Lamm, who was governor of the state of Colorado from 1978 to 1986. I discussed this recently with Governor Lamm. The issue was regarding the cost of doing a liver transplantation versus how many other people could be treated with the same amount of money. Lamm notes his respect for Dr. Starzl and now sees transplantation as a successful medical option.