The Puzzle People: Memoirs Of A Transplant Surgeon

by Thomas Starzl

Given the tensions and demands of medicine, highly successful physicians and surgeons rarely achieve equal success as prose writers.  It is truly extraordinary that a major, international pioneer in the controversial field of transplant surgery should have written a spellbinding, and heart-wrenching, autobiography. Thomas Starzl grew up in LeMars, Iowa, the son of a newspaper publisher and a nurse.  His father also wrote science fiction and was acquainted with the writer Ray Bradbury.  Starzl left the family business to enter Northwestern University Medical School where he earned both and M.D. and a PhD.  While he was a student, and later during his surgical internship at the Johns Hopkins Hospital, he began the series of animal experiments that led eventually to the world’s first transplantation of the human liver in 1963. Throughout his career, first at the University of Colorado and then at the University of Pittsburgh, he has aroused both worldwide admiration and controversy.  His technical innovations and medical genius have revolutionized the field, but Starzl has not hesitated to address the moral and ethical issues raised by transplantation.  In this book he clearly states his position on many hotly debated issues including brain death, randomized trials for experimental drugs, the costs of transplant operations, and the system for selecting organ recipients from among scores of desperately ill patients. There are many heroes in the story of transplantation, and many “puzzle people,” the patients who, as one journalist suggested, might one day be made entirely of various transplanted parts.  They are old and young, obscure and world famous.  Some have been taken into the hearts of America, like Stormie Jones, the brave and beautiful child from Texas.  Every patient who receives someone else’s organ - and Starzl remembers each one - is a puzzle.  “It was not just the acquisition of a new part,” he writes.  “The rest of the body had to change in many ways before the gift could be accepted.  It was necessary for the mind to see the world in a different way.”  The surgeons and physicians who pioneered transplantation were also they too became puzzle people.  “Some were corroded or destroyed by the experience, some were sublimated, and none remained the same.”

Genres: Medicine, Nonfiction, Medical, Science, Biography Memoir, History, Biography

400 pages, Paperback

First published July 21, 1992

About the author

Thomas Starzl was an American physician, researcher, and expert on organ transplants. He performed the first human liver transplants, and has often been referred to as "the father of modern transplantation." Starzl performed the first human liver transplant in 1963.

Reviews

[El · Rating 4 out of 5]

Why, you ask, would I read a book like this? If you don't know the extent of my dorkdom by this point, you probably don't deserve a place on my GR list. Just sayin. There are a couple different answers to that question:

1. I dig medical stuff. I work with surgeons, I love learning the words, and figuring out what certain surgeries entail and pretending like I know things. You would think that I would get sick of it at the end of the day and go home and want to do nothing related to medicine, but evidently that's not the case.

I just realized how depressing that sounds.

2. Starzl is a local hero! He's the guru of organ transplantation. If you know someone who has ever been an organ donor or an organ recipient you should really sing your praises to Starzl because he made that happen. The Thomas E. Starzl Transplantation Institute is connected to the building I work in, and occasionally, for some reason, people calling Information who are looking for the Institute get transferred to me. Don't ask me how. (That's actually sort of annoying. But I have the Institute's number memorized now, so I sound very knowledgeable when these calls come through. I'm pretty awesome.)

3. One of the doctors I supported up until his retirement last year highly recommended this book to me. He has known Starzl for years and used to rave about Starzl's work and just how incredible a person he was. This coming from one of the all-time best surgeons (in my opinion) and someone I considered both a very good friend and mentor, I couldn't think of a better book to read.

Coincidentally I found from reading this that Starzl lived in just about the exact same states that I have in my years, though in a slightly different order than myself: He was born in Iowa, went to college in Missouri, medical school in Chicago, and ultimately landed here in Pittsburgh where his Institute continues to do its work. I was surprised by the humanity in these pages. Starzl talked, yes, about his successes, but also his failures. He remembered many of the patients' names - again, the failures as well as the successes. He knew he would not have gotten to where he was if it hadn't been for all the children, the men and the women who needed transplantation, and he probably never will forget it.

It seems so often in the medical field now that everyone is in it for the money - all those jokes about doctors going out and playing golf during their office hours, refusing to do surgeries because it wouldn't give them top dollar, etc. We all know some horror story. I'm not defending the entire medical profession - you have some douche-bags, but you also have your winners. Starzl was a winner.

So much so he even got a street named for him. You know you rock when that happens.

Do I think everyone and their mother should read this book? Probably not. Do I think everyone who does read this book will love it? Not likely. Starzl is a surgeon, not a writer, and that's evident here. Knowledgeable and skillful in his line of work, absolutely. Crafty in the writing know-how... eh, no. Someone reading this book who doesn't care about medicine or organs or port veins or inferior vena cavas will probably be bored to tears. They're not likely to care about the ethic wars of the early 80s to try to get transplantation to where it is now. It's not for everyone. Personally, however, I liked it. I totally geeked out over it. I enjoyed seeing some of the names I know from my own work, like Hank Bahnson. I loved seeing references to things from my town. (Apparently there used to be a Pizza Hut on Fifth Avenue!?) I had a good time with it and I feel like I could totally hold my own in a conversation with the surgeons in my office.

They would probably just laugh at me, but I like to think they would at least be mildly impressed.

[Mark · Rating 4 out of 5]

I have spent a good part of the last 30 years covering the author of this book for my newspaper, and I have to say that this autobiography captures him very well. On the one hand, it shows his remarkable persistence, courage and intelligence in pursuing the dream of organ transplantation, especially in the days when death rates were high and much of the medical establishment stood against him.

It also reveals his big heart, especially for the children whose lives he sought to save. Many have said that Tom Starzl was never happier than when he attended the reunions of children who had received transplants. In the course of his obsessive dedication, however, he also saw his first marriage crumble, and his relationships with his own children were hurt as well.

Starzl the doctor writes well, except for those moments in his life when he wants to be vague, either to protect himself and others, and then his prose becomes more than a little opaque. The failure of his first marriage, the attacks his program suffered when a Pittsburgh newspaper wrote a Pulitzer-winning series about favoritism shown to Middle Eastern kidney patients, and other touchy episodes are mentioned briefly or not at all.

But when he wants to explain the importance of the liver to human health and the vital need for transplants for those who have no other option, he is clear, compelling and does not ever lapse into jargon. And he shows clearly why research was always as important to him as surgical mastery. In fact, he reveals, he never liked doing surgery, and was always afraid of failing his patients.

The book is also filled with many poignant moments. Two that stick in my mind are Dr. Starzl visiting his ailing father, who had suffered two strokes and was paralyzed from the neck down, and being mystified by the background noise. A nurse told him that his father, who had long run the town's newspaper, had asked that the everyday noises of the newsroom be piped into his room to give him comfort. Another was after a very long operation, when one doctor on Starzl's team had to manually pump pint after pint of blood into the patient over a 20-hour period, and collapsed sobbing at the end of the successful operation, both from pain and sheer relief.

The Puzzle People is well worth reading if you want to understand the uphill swim that organ transplantation went through in the 1960s and 1970s, and for its sharply etched portraits of some of the pioneers in the field.

[Peter Sidell · Rating 5 out of 5]

I enjoyed this a great deal. I am a retired surgeon - not involved in transplants, but went to UCLA Medical School so some of the people he mentioned are familiar to me. I left UCLA to do my surgical training elsewhere in 1969 so my memories and knowledge of the people he mentions from UCLA are remote. I recall James Maloney quite well.
Clearly Starzl was smart, talented, and dedicated to his patients and work. He helps us get to know some of his patients and their bravery quite well. Of course he had to be brave as well to attempt what he did. One can only begin to guess the amount of time and effort he invests - the sleepless nights, and lonely times.
I am glad I found out about this book and took the time to get a copy and read it.
His discussion of his education at Johns Hopkins was fascinating. The mention of Vivien Thomas - the African American lab tech who played an essential role in the development of the first blue baby operations was interesting. A movie has been made about his life.
If you have only a peripheral interest in the development of surgery in the 2nd half of the twentieth century or the development of transplant surgery you may well find the drama captivating anyway.
Personally I am sorry this book has remained on the margins. People need to understand the foundations of their healthcare.

[Anand · Rating 5 out of 5]

Thomas Starzl is one of the pioneers in the field of liver transplant His audacity, persistence, compassion towards his patients and sheer hard work has converted the field of liver transplant from the mystery and debatable issue it was to a routine standard of care for so many diseases afflicting the liver which would otherwise have been deemed incurable. This autobiography encapsulates the major hurdles he had to face, how they impacted him personally, the so many brilliant other scientists who together were part of the ensemble cast which created and fine tuned this wonderful creation by breaking new frontiers in organ transplantation.
As a surgeon myself, this book has made me realise what it takes to strive for something which will be a paradigm shift in the field and will impact the future course of health care in the generations to come.
The prose which impacted me maximum and beautifully highlighted by Dr.Starzl was that how we tend to forget the patients who had to endure the procedures when they were still in experimental stages and how they are the real heroes on whose existence and loss we have mastered the trade. I feel forever indebted to all the patients on whose suffering the modern medicine has fine tuned itself.
This book is a must read for any medical professional who is related or interested in organ transplant as it portrays all the major revolutions which has occured in the field of transplant.

[Jeff Bobin · Rating 5 out of 5]

I picked this up after it was referred to in a new book on transplants and that author took the time to go to Pittsburgh and interview Dr Starzl a few years ago shortly before his death. Intrigued by that authors comments I wanted to learn more about Dr Starzl since I remember reading about him in the many years I lived in the Pittsburgh area.

What a wonderful gift I found in his sharing his story, the good, the bad and even the ugly, and getting a look at the challenges and costs of being a medical pioneer. While this was written and published in 1992 I found it just as interesting today.

I have known many that have received transplants over the years, including one that had a heart transplant more than a quarter of a century ago and still going strong.

This a a book about failure as well as success and the importance of both in that advance of science and medicine.

[Joseph · Rating 5 out of 5]

My rating is probably biased because of Thomas Starzl's stature and outsized impact within the transplantation community, but this was a fascinating read and serves as an excellent companion to Donald McRae's Every Second Counts. This story needed to be told. While there is a hint of bias within Starzl's writing, leaving me with a desire read "the other side" of some of the encounters, I am reminded of Churchill's quote "History will be kind to me for I intend to write it."

[Amanda · Rating 4 out of 5]

I would actually give this a 3.5 if that was possible. It is a very robust book containing an immense amount of information about one of the father’s of transplant and the origins of the field of transplantation. At times it was super interesting, but at other times it was VERY dense, technical and slow. It is clear that Dr. Starzl is brilliant and unbelievably compassionate, and I loved the stories about both the individual clinicians and the patients. I had trouble following his writing at times, it seemed like he would often go on tangents that made it hard to follow. If you’re interested in a very deep dive into the evolution of kidney and liver transplant, then this may be a book for you.

[Katie · Rating 2 out of 5]

As far as transplant memoirs go, this one was disappointing. It's probably great for people in the field of transplantation, but as someone touched by it on the outside, there are better books (When Life Becomes Death remains the favorite for me).
There was one disturbingly intimate paragraph about the cadaver he purchased to get better at anatomy, but otherwise I skimmed through the second half.

"Late at night and on the weekends I learned her body lovingly as if she were an old and dear friend, making amateur drawings as portions of her came off."

[Grant Volpe · Rating 3 out of 5]

More like 2.5 stars. Although I love learning about medical history, this book was particularly dry. None of the patient anecdotes stuck with me, and there were more names to remember than a Dostoyevsky book. Constant callbacks to the names of researchers and surgeons made the story line very hard to follow, not to mention he literally skips around in the timeline and goes off on small biographical tangents which left me wondering what year at the beginning of every chapter. Just overall not nearly as enthralling as I expected the story about such an incredible advancement in medicine to be.

[Shannon · Rating 4 out of 5]

Fascinating read. Starzl was The Guy in the world of transplant, particularly of the liver, which he pioneered. No other single person was more important or influential. This book is dense, mostly because of all of the people he describes: decades worth of patients, surgeons, researchers, and others. It might be a slog for a casual reader, but for those with a deep interest in the history and science of transplant, this book is essential.

[Eric Mole · Rating 4 out of 5]

The trials and tribulations along the path to developing the field of organ transplantation make this book pretty engaging. And that Starzl might have been as talented a storyteller as he was a surgeon. But if I wasn’t soon entering the field of medicine I’m not sure I’d be as interested in the topic.

[Jeff P · Rating 2 out of 5]

Very interesting subject matter, but this might be the most poorly written book in the history of books. It literally feels as if Starzl sat down with an audio recorder for a few hours and published the result. Incoherent at times and rambling throughout.

[Tyler · Rating 5 out of 5]

Great account of the history of transplant medicine and the 'father' who made so much of it possible.

[Lori Zarichniak · Rating 2 out of 5]

Didn't finished this book. Got too bogged down and was hard to follow.

[Will · Rating 5 out of 5]

Phenomenally written, brimming with the energy the author surely demonstrated in life.

Longer review incoming...

[Kathy Matts · Rating 4 out of 5]

My dad was a liver transplant recipient 12 years ago so this book was very insightful as to how the liver functions, how and why liver failure happens, and how to control rejection of transplanted organs. Dr. Starzl's passionate commitment in the field of kidney and liver transplantation paved the way for higher survival rates and lower rejection risks. His work has made a once-controversial practice commonplace. The book is a little tough to follow at times but otherwise I did not want to put it down

[Stefan Vitko · Rating 5 out of 5]

Když jsem TS (*1926) poprvé potkal na kongresu v Singapuru v roce 1993, nevěděl jsem, kdo je ten hubený přísné vypadající pán v červeném roláku, který budí takový respekt. Pak jsem na jeho jméno narážel stále častěji v medicínské literatuře, když jsme začínali připravovat program transplantací jater v IKEM. Jeho kniha ozřejmuje mnoho z historie transplantací, je cenná zejména proto, že to není historie, ale často detailní vzpomínky na to, při čem sám "asistoval". Je napsána věcně, skromně. Vynikající člověk, zemřel 4.3.2017.

[Peter Moore · Rating 1 out of 5]

Couldn't finish it...

[Brett Marshall · Rating 4 out of 5]

Amazing story of the pioneer of Transplant. One of the great medical reads of a truly inspiring man.

[Beth · Rating 1 out of 5]

I can't finish it. It is so dry. I have been trying for months.