ICU and You · The Screening Room · Number 1
A fifteen-month-old, an operation nobody had done, and the man who was not in the paper
The Screening Room is for films that know something. Not films that get the medicine right — that is a low bar and a dull conversation — but films that understand something about illness, or about the people who treat it, that is hard to teach any other way. Some will be great films. Some will be flawed films with one true scene in them. The question each time is the same: what does this know that we keep having to relearn?
On 29 November 1944, in an operating theatre at Johns Hopkins with the gallery full, a fifteen-month-old girl weighing about five kilograms had her subclavian artery joined to her pulmonary artery. Her name was Eileen Saxon. She was blue, she was failing, and nobody had ever done this before.
Alfred Blalock performed the operation. He had done it once, in a dog. Standing behind his right shoulder on a step stool, telling him what to do, was Vivien Thomas — a black man with no medical degree, employed as a laboratory technician, who had done the operation dozens of times and had designed most of it.
That sentence contains the whole film. Hopkins in 1944 was segregated, and Thomas entered the building by the back door. What was extraordinary about his presence in that theatre was not that he was advising the surgeon — it was that a black man was standing there at all. He was the only person in the room who knew how to do what was about to be done.
Eileen Saxon had tetralogy of Fallot. Obstruction to right ventricular outflow, a ventricular septal defect, an aorta sitting over it and a hypertrophied right ventricle — so deoxygenated blood takes the path of least resistance, crosses the defect, and goes out to the body without ever visiting a lung. Her lips and fingers were blue. She could take a few steps before she had to stop.
Helen Taussig, the paediatric cardiologist, worked out what these children actually needed. Not a repair, which was inconceivable in 1944, but more blood to the lungs — and she had noticed that the babies who did best were the ones whose ductus arteriosus stayed open longest. Her proposal was to build one surgically.
That is the same physiology this fortnight's aphorism warns about from the other direction: a duct that has closed is one of the few things in a collapsing newborn that will not respond to a better mask seal. Taussig's insight and that warning are the same fact, seen eighty years apart. Today we hold the duct open with a prostaglandin infusion while the retrieval team travels. In 1944 there was nothing to give, so somebody had to make one out of the arm.
The shunt Thomas built and Blalock sewed is still done, in modified form, and is now more often called the Blalock–Thomas–Taussig shunt. Before it, almost every child with this heart died.
Vivien Thomas had trained as a carpenter and had saved to go to medical school. The savings went in the 1929 crash. He took a job as a laboratory technician, and over the next decade became the person who could do the operations — hundreds of them, on dogs, refining the anastomosis and making the instruments when the existing ones were the wrong size.
He was paid as a janitor. Hopkins had separate wards, separate dining rooms and separate water fountains, and its only black employees were janitorial. Thomas earned extra money working as a bartender at Blalock's parties, serving drinks to the men he had supervised in the laboratory that afternoon.
When Blalock and Taussig published the first three cases in 1945, the paper thanked a number of people by name. Thomas was not among them. The operation was called the Blalock–Taussig shunt for the next half century.
Blalock looks at an anastomosis Thomas has made and says it looks like something the Lord made. It is meant as the highest compliment he has, and the film lets you notice, without underlining it, that a compliment is what was available to give. Not a co-authorship, not a title, not a salary. A remark.
Hopkins hung Thomas's portrait in 1971, gave him an honorary doctorate in 1976, and appointed him an instructor in surgery. In 2020 the congenital heart centre was renamed to carry all three names. All of which is right, and all of which took a very long time.
The operation worked. She pinked up on the table, put on weight, and went home about three months later. Then the cyanosis came back. A second shunt was attempted on the other side two days before her second birthday, and she died about five days after that.
She is the patient at the centre of one of the most celebrated operations in the history of surgery, and she did not live to be two. It is worth holding both of those at once, because we are quite good at telling the first part.
What she did do was prove the thing worked, which is why tens of thousands of children after her are alive. That is a real and large fact, and it is also not much comfort to the family in 1945, and both of those are true in intensive care most weeks.
It exists because of a magazine article. Katie McCabe heard about Thomas on the day he died, from a Washington surgeon who called him a legend, and spent four years on the piece that ran in Washingtonian in 1989 under the title Like Something the Lord Made. It won a National Magazine Award, and it is the reason any of this is widely known outside cardiac surgery. A producer found the article, and it took another fifteen years to reach the screen.
Joseph Sargent directed it, near the end of a very long television career, and he was well chosen: he had already made Miss Evers' Boys, about the Tuskegee syphilis study, so he had form in exactly this territory — American medicine and the people it used. He handles the surgery itself unusually well, taking the operating scenes seriously enough to be tense rather than decorative, which most medical drama cannot manage.
Alan Rickman plays Blalock with the reserve turned all the way up, so that the warmth and the thoughtlessness both come through the same clipped delivery — a man who cannot see what he is doing to somebody he genuinely values. Mos Def, cast against the expectations of a rapper turned actor, plays Thomas almost entirely in stillness, and the performance is built out of what a man does not say in a room where saying it would cost him his job. Both were nominated for Emmys and Golden Globes. Mary Stuart Masterson is a properly unsentimental Helen Taussig, and Charles S. Dutton plays Thomas's father.
Donald M. Morgan's photography won one of the film's three Emmys, from nine nominations — the others were for the film itself and for Michael Brown's editing. It also took a Peabody, and awards from the Directors and Writers Guilds and the NAACP. Vincent Peranio's production design, all wood and brass and green tile, does a lot of quiet work: the laboratory looks like a workshop, which is precisely what it was and precisely how Thomas came to it, as a trained carpenter.
If the film leaves you wanting the documentary version, McCabe's article also prompted Partners of the Heart, made for public television in 2003, which has the people themselves.
Because it is a good film, and because it asks a question that has not gone away: who is credited with knowing something? Thomas's case is extreme and its cause was plainly racism. But the shape of it is ordinary. The person whose hands know the procedure is not always the person whose name is on it. The nurse who has done a thousand of them teaches the registrar who will be thanked for it. The technician who solved the problem is in the acknowledgements, or nowhere.
Worth watching with that in mind, and then worth a look around your own unit.
What film knows something about this work — and what does it know?
It does not have to be a medical film, or a good one. Send me the film and the scene, and what it understood. This column will run on other people's answers, and I will credit you unless you would rather I did not.
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