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King of Hearts

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In a parking lot just off Cowardin Avenue, past the used-tire centers, Dr. Richard Lower could often be found sitting in his car during lunch breaks, puffing on a pipe. He was just another volunteer at the CrossOver Ministry health clinic, and his patients -- most uninsured and many unable to speak English — usually had no idea.

To them, he wasn't the world-renowned heart surgeon who put the Medical College of Virginia on the map in the 1960s, pioneer of one of the biggest medical breakthroughs of the 20th century.

He wasn't the scientist who taught the world how to successfully remove the heart of a cadaver, cool it and transplant the organ into a living patient. To his patients he was just Dr. Lower, the gentle old physician who wrote prescriptions for minor ailments, who could be overheard advising homeless patients on how to eat and live healthier, without so much as a whiff of pretension.

Dr. Dan Jannuzzi, medical director of CrossOver Health Centers, recalls worrying that the old surgeon might not work out. He'd been out of medicine for nearly a decade. "Initially I was somewhat reluctant," Jannuzzi says, concerned that Lower might not be up-to-speed on the nuances of primary care when he first came on board a decade ago. It's a different field that requires a good bedside manner, patience and a willingness to learn a new discipline.

"I was so ignorant of his genius. He probably changed the course of history with the methodologies behind the heart transplant," Jannuzzi says. "It was that blunder of thinking, what can a heart surgeon do in a free clinic?"

Lower proved him wrong. His medical license had lapsed, and he took the state medical exam in his 70s, no small undertaking. Then he went to work studying and researching primary care medicine to become a general practitioner. Lower always wanted to be a family doctor, it turns out.

Sheila Pour, a physician assistant who worked closely with Lower, remembers seeing homeless patients with the old surgeon in a downtown church in the late 1990s. Pour had been told of Dr. Lower, the heart transplant pioneer, but it really didn't sink in until she ran across a patient who'd had a lung removed, whose chest was making an unfamiliar sound. She called over Lower. Nothing was wrong with the man, Lower explained, detailing how lung removal works from personal experience.

"I'm in a church basement, we're taking care of homeless people, and here I am talking to a person who has been in and out of people's chests many times," Pour says. "He patted the patient on the shoulder and said, 'You look great.'"

For about 10 years Lower worked at the clinic from October to April, spending most of spring and summer at his cattle ranch in Montana. He worked at the clinic until the last weeks of his life. Suffering from debilitating pancreatic cancer, he still came in and saw his patients.

He called the week before he died, just to check in. He told Jannuzzi he'd be back soon. "He went on a vacation in Montana, and when he came back he wanted to continue seeing patients even though he was having chemotherapy," Jannuzzi says.

Lower spent 40 years as a heart surgeon and beloved teacher of surgical procedures, having trained many of the country's best surgeons, including Dr. Thomas M. Krummel, head of surgery at Stanford, and Benjamin L. Aaron, who pulled a bullet out of President Ronald Reagan.

Lower muted his own celebrity. But he was a surgeon who changed history. That was the mystique of the old teacher, says Dr. James Zocco, who trained under Lower at MCV and is medical director of cardiovascular services at CJW Medical Center.

"I'm still in awe of him," Zocco says. "He is and always will be a historic figure certainly in cardiac surgery, but he walked across the stage and nobody would realize he was even there." Lower was as great a teacher as he was a surgeon, Zocco says. He always taught his students to stop, "dissect out the problem" and make the precise move, the exact cut, but never before studying and analyzing the problem fully.

"He was never frenetic in the operating room. If there was something catastrophic that happened, he would stop," Zocco says. "It was always, stop and think about it first." For those surgeons who trained under him, he says, "that's what made them great."

Lower, who retired from MCV in 1989, literally made the hospital one of the top institutions in the world in 1960s and '70s. He even taught the celebrity doctor Christiaan Barnard the procedures he used to do the first heart transplant in 1967. Lower told Style Weekly in 2004 that the flamboyant Dr. Barnard, who traveled with women in tow, once informed him that he was going to do the first heart transplant.

"I thought that would be nuts," Lower recalled thinking. The patient died within weeks from pneumonia, but not before Barnard became a star, rubbing elbows with Hollywood producers and taking lunch with Sophia Loren.

Lower should have been the first, but he refused to compromise his perfectionist standards. In 1966, Lower was poised to do the first heart transplant — he found a donor and patient who almost perfectly matched, except for blood type. Most surgeons would have done the transplant, Zocco says, but Lower refused to put the patient at risk.

Lower's first heart transplant, in 1968, landed him in court and changed medical history again. Lower had taken a still-beating heart from a brain-dead patient. The case was dismissed — but not before establishing a new standard for the legal meaning of death, allowing surgeons to remove organs from patients in prime condition. The family of the heart donor who sued Lower was represented by another well-known historical figure, a young attorney named L. Douglas Wilder.

"Obviously, he was a giant," says Dr. Marc Katz, medical director of Bon Secours Richmond's Heart & Vascular Institute. "His quiet ways have kept most people from recognizing what he's done."

Katz had been asked by Lower to accept his pioneer's award from the International Society for Heart & Lung Transplantation in April. Lower avoided awards and recognition like the plague, according to those who knew him.

During the American College of Cardiology convention in March 1968 in San Francisco, Barnard, at the height of his celebrity, spoke to a raucous crowd of surgeons and scientists who wanted nothing to do with him, furious that the South African doctor had jumped the gun in performing the first heart transplant for his own celebrity. Though photographers and reporters waited outside, Lower recalled seeing Barnard after his speech sitting alone at a table in the convention hall, shunned by the other surgeons. Lower approached him.

Lower, the man who had more reason than any of the other surgeons to be ticked off at Barnard, was the only one willing to come over and greet the man.

Zocco recalls Lower telling him the story, affectionately.

"He said, 'I felt bad for the guy, and kind of made small talk with him,'" Zocco recalls. "It's pure character with him. There was only one Lower." S



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