Dr. Barnard's Life Transformed By Heart-Transplant Fame -- South African Surgeon Found Both Pleasures, Perils Of Glory

CAPE TOWN, South Africa - It all began with twin tragedies. A horrible traffic accident had left 25-year-old Denise Darvall brain-dead, though her heart was beating. Louis Washkansky, suffering from heart disease, was hours, perhaps minutes, from death.

On that day 26 years ago, a gutsy South African surgeon transplanted Darvall's heart into Washkansky's body.

Washkansky lived only 18 days, but the feat made Dr. Christiaan Barnard, at age 45, an instant worldwide celebrity. Now this pioneering surgeon is 71, and the story of his years in the relentless limelight is itself a kind of modern tragedy.

"At one stage, I had the whole bloody world at my feet," Barnard recalled recently, sipping tea in his living room. "I was a famous guy. But I always realized it wouldn't last forever."

TOO MUCH TO RESIST

In the beginning, back in 1967, there were television appearances, honorary degrees, an audience with the pope and long chats with presidents, princes and kings. There were beautiful film stars, illicit affairs, yachts, champagne and more forbidden fruit than this son of a church missionary, reared in South Africa's raw Karoo Desert, could resist.

The fame "was a habit-forming type of thing. I regret that I ran after that so much," Barnard said.

"My (heart transplant) unit suffered so much. We had all the facilities and ingredients to be great. But I was away too much. And I often wonder what I could have achieved."

Barnard still is one of South Africa's most famous, outspoken and controversial sons. Retired from surgery for a decade, he lives in Cape Town with his third wife, Karin, 29, and their 4-year-old son on a 30,000-acre farm at the edge of the Karoo.

He has just finished his 13th book, "The Second Life," a surprisingly frank memoir of the aftermath of his first transplant. The book, sometimes sentimental and often bitter, recounts in vivid detail his surgical procedures, sexual conquests and fondness for the spotlight.

FIGHTING THE AGING PROCESS

His passion these days is research on ways to stop or slow the aging process.

Although Barnard has had painful arthritis for the last 35 years, he appears extremely healthy.

"Aging is the commonest disease in the world," Barnard said. "Unfortunately, I know how my own quality of life has deteriorated."

After retiring in 1983, Barnard worked for four years as "scientist in residence" at Baptist Medical Center in Oklahoma City, earning enough to buy his farm.

He also was associated with a Swiss medical institute studying ways to halt aging; his controversial endorsement of an anti-aging skin cream prompted the American College of Surgeons to consider disciplining him.

Barnard resigned from the group in a huff rather than fight the disciplinary action.

A PROMISING SURGEON

Barnard's odyssey began the day of the first transplant. Before that, he had been just a promising government surgeon.

Being the first to do a heart-transplant operation, though, was "just luck," he said.

"It was not a scientific breakthrough, just a technical one," Barnard said. "There were many surgeons in the United States at the time who could have done it."

Barnard expected and welcomed critical attention from colleagues.

"Many in the medical profession will say their first concern is for the patient," he writes in his book. "But a doctor, like anyone else, wants above all, to satisfy his own ambition and ego."

Most cardiac surgeons agree: If Barnard had not done it, someone else would have. But when it happened and when the patient lived, it touched off a flurry of transplants worldwide.

Although Barnard blamed the media for breaking apart his first marriage, he conceded it was on rocky ground even before the transplant. He writes of affairs with, among others, Gina Lollobrigida and an unidentified former Miss Italy.

"It was an unbelievable experience for a barefoot Karoo boy - suddenly able to get virtually any girl he wanted," he said.

Between travels abroad, Barnard participated in 165 heart transplants.

"For the first few years, I did most myself," he said. "At the end, though, I didn't even lift a scalpel."

He does not remember most of his patients.

"I can't remember thousands of my operations," Barnard said. "After the second or third, I can't even remember the transplants."

A SURGEON'S NIGHTMARE

One case that does stick in his mind, though, is that of Dirk van Zyl, a 47-year-old white government clerk whose doctor had given him weeks to live.

Barnard accepted van Zyl as his sixth transplant patient in 1971; a week later, the heart of Damon Meyer, a 35-year-old farm worker, became available.

(Meyer, in the argot of apartheid, was "colored," or of mixed race. Barnard had avoided using a nonwhite donor for the first transplant for fear that, if it failed, he would be accused of experimenting on blacks, a sensitive topic in a country where the voteless black majority was ruled by a white minority.)

Van Zyl's case turned out to be the doctor's worst nightmare. As the patient lay on the operating table and doctors prepared to administer the anesthetic, van Zyl's heart stopped beating. Without restarting the heart, doctors did not have time to open the patient's chest, put him on a heart-lung machine and do the transplant.

The doctors battled for half an hour to restart his heart, using defibrillation and massage. They were about to give up when one last surge of electric current restarted it, allowing the transplant to proceed.

Today, van Zyl is 67, the longest-surviving heart-transplant patient in the world.

EXPERIMENTAL SURGERY

After the first few transplants, Barnard continued to do other experimental surgery.

He performed the world's first double-heart transplant in 1970, leaving the patient's own heart and adding a donor heart. That patient lived 18 years.

But his personal life was, at times, a shambles.

His son, a pediatrician and father of two, became addicted to prescription drugs and was found dead in his bathtub, a suicide.

"It was probably because of a lack of support from me," Barnard writes in his book.

Barnard also was under pressure to use his international standing to push for changes in the apartheid system.

Although the surgeon had raging fights with hospital administrators, who wanted him to keep his patients in racially separate wards, he smarted from the ostracism he encountered as a white South African abroad. And he now admits he probably did not do enough to fight apartheid.

"I only did enough to assuage my conscience," he said, "but not enough to rock the boat."

"I'm proud of the things I've done in heart surgery, especially in congenital heart surgery. I've been able to restore life to people who would have died.

"But I think my greatest accomplishment is that . . . I have always refused to . . . live the way other people wanted me to live."