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Cover

Volume 14, Issue 46
Published March 7th, 2007

White's Anatomy

Cleveland's Most Respected Neurosurgeon Reflects On Life, Love and Monkey Head Transplants.
 
 

A group of grayhairs sits in the back of the McDonald's off I-90 in Geneva, sipping senior coffees before the lunch-hour rush. They wear pants called slacks and hats called caps. They're grandpas, the sort you can find in many McDonald's this time of day.

One older gentleman sits apart from the others. He sips coffee too, and trades periodic barbs with his peers ("You need a haircut!" "Not from your barber! Is he blind?"). There's a stack of newspapers in front of him. The Plain Dealer. The News-Herald. USA Today. The Wall Street Journal. The New York Times. Next to the papers is a bundle of correspondence ready to be mailed. It seems as though this man thinks this McDonald's is his personal office.

Well, he does. Every morning when he comes in, this man picks up his nameplate from the young ladies behind the counter and places it on the end of a booth by the window. It reads: This Table Reserved for Dr. White. When he's done with the day's business, he'll hand the nameplate back to a cashier and return home.

He's here so often that everyone knows him. Drivers passing through the drive-thru stop by the window to wave. They all call him "Doctor." You can tell that he likes the attention.

Today he sits across from a reporter, who has driven in from Cleveland to pick his brain. Patrons overhear bits of their conversation as the interview progresses over several hours and they crane their necks to get a better look at the doctor they thought they knew. Did someone mention the Pope? What was that about a two-headed dog?

This section of the restaurant has grown quiet as customers listen in with growing wonder.

"Well, what can you tell me about the monkey-head transplant," asks the reporter. "Did it really work?"

The doctor leans forward, his still-youthful eyes opening from behind thick glasses. "Did it work? Let me tell you something. The damn thing tried to bite me when it woke up."

Every great hero has an origin story, that moment in his or her life that inspired every moment that followed. Dr. Robert J. White's happened in Brother Charles' biology classroom at DeLaSalle Catholic High School in Minneapolis, Minnesota, circa 1942. The day's lesson was frog dissection. It was a test to see if the students could expose the amphibian brain without damaging it. Young Robert White, known for his skills on the football field, began to cut into his frog's head. His classmates did the same.

One by one, the little skulls were pulled off hastily, most of the brains sliding out in chunks still attached to the bone. But White took his time. When Brother Charles finally made his way over to White's desk, it looked for a moment like the man might have a heart attack. White's frog brain was intact.

"White," Brother Charles said, "you should be a brain surgeon."

At THE "OFFICE" -  Dr. White does his paperwork at McDonald's these days.
At THE "OFFICE" - Dr. White does his paperwork at McDonald's these days.

As graduation neared, a military recruiter met with White, the valedictorian, to talk about enlistment. World War II raged on — his father was already MIA in the Pacific theater. White was concerned he would be drafted into the front lines and disappear too.

After the recruiter read through White's academic accomplishments, he excused himself and left the young man alone for a half hour. When he returned, he told White, simply, "I'm making arrangements to send you to Fort Lewis. You will be a member of the medical corps."

"He decided to spare me," White explains today. "I've had so many breaks in my life."

After basic training White was given a choice: become a surgical technician or work in a lab. He chose to assist in the military labs, evaluating soldiers' stool samples for parasites and diseases. "I may have been smart enough to realize there aren't many labs near the front lines."

He arrived on Luzon, not far from where his father was captured by Japanese forces. And even though he was now trained to treat malaria victims, he wound up guarding a supply depot. A few months later, the Japanese surrendered and White was sent to work on wounded soldiers in mainland hospitals. Eventually, he was assigned to a Red Cross hospital in Kyoto.

A religious city, Kyoto had been spared from much of the bombing. During his free time, White liked to walk through nearby forests to view Shintu temples. Having not witnessed the most severe skirmishes, he found it hard to equate the horrors of war with the culture that erected such monuments.

It was in Kyoto that White finally learned that his father had died in a Japanese prison. Gen. Douglas MacArthur sent a personal letter of condolence by motorcycle courier, informing him that his father's remains had been relocated to a cemetery in Manila. White visited the site before returning to the States.

Back home, White used his GI bill to enroll in med school at the University of Minnesota. In his sophomore year, a professor there arranged for a full scholarship at Harvard. White made sure he earned it. He attacked his studies, leaving little time for any social life. He couldn't afford one anyway. Nor could he afford a bus ride home to Minnesota at times, so occasionally he hitchhiked back with a handmade sign that read: Great Conversationalist.

White graduated from Harvard Medical School with honors, and was on to Peter Bent Brigham Hospital in Boston, where he studied under renowned surgeon Dr. Francis D. Moore, who revolutionized the treatment of burn victims. It was in Boston, in 1953, during a not-quite-routine appendectomy, that he met his wife, Patricia.

She was a student nurse and White had scrubbed in to assist the surgeon's assistant — which basically meant passing instruments. But just before the procedure began, Dr. Moore pulled the two trained surgeons out of the room to work on emergency cases, leaving White alone for the first time. Patricia passed the instruments as White performed his first major surgery.

"I fell in love with my wife over that operating table," says Dr. White. "It was the beginning of a long association. We'll celebrate out 52nd wedding anniversary this summer." The 10 children that resulted from that association are likely to be there, too.

"My wife made me. Whatever I am, my wife is responsible for it."

Never stop learning - Dr. White at the Allen Memorial Library catching up on reading.
Never stop learning - Dr. White at the Allen Memorial Library catching up on reading.

Dr. White completed his education at the Mayo Clinic in the late 1950s. Doctors there were attempting to design a way to surgically remove the brain of a dog. The brain was the only organ that had yet to be successfully isolated in animals. No one could perform the meticulous surgery involved in safely separating the brain from the skull without damaging it. Dr. White was drawn to the challenge.

The brain can only survive outside the body for a few moments before the loss of blood flow, and resulting lack of oxygen, destroys the delicate neural pathways. A way to maintain circulation had to be engineered. They would have to create, basically, an artificial body (lungs to oxygenate the blood and heart to keep it pumping) to keep the brain from dying during transplantation.

Dr. White and his contemporaries at the Mayo Clinic realized that they could buy themselves some time in the operating room if they first cooled the brain before removal, slowing its metabolic processes and reducing its dependence on oxygen.

The Mayo Clinic doctors didn't succeed in isolating the brain, but they realized that their cooling technique could be used in the treatment of spinal-cord injuries. Paralysis does not usually take place at the moment a spinal-cord injury occurs, but three to four hours later when the injury becomes inflamed and cuts off blood circulation to the thin nerves that run like wires down the spine, carrying commands to the arms and legs to move. Dr. White thought that if he could cool the fluid around these nerves immediately after an injury, the swelling could be reduced and the patient might not lose mobility.

Experiments were performed on dogs first. They were given anesthesia. Then the animal's spine was broken. The doctors discovered that if they cooled the spine within four hours of the injury, the damage was minimized. "In almost every case, we could return them to normal function. Spinal injuries do not have to result in quadriplegia. We've done it. We did it."

In 1961, Dr. White was asked to create a neurosurgery department at Cleveland Metropolitan General Hospital — now known as MetroHealth Medical Center — and offered an appointment at University Hospitals and an assistant professorship at Case Western Reserve University's School of Medicine if he moved to Ohio. He brought his experiments, his colleagues and his growing family with him.

Life at the White family home in Shaker Heights consisted of a controlled chaos akin to a small zoo. Patricia organized their six boys and four girls, assisted, at times, by hired maids and cooks. Special treats — donuts, ice cream — had to be hidden in hallway closets and then a basement freezer, until the older boys discovered that a Bic pen, unscrewed, fit perfectly into the rudimentary lock that kept it secure. School clothes were purchased in bulk through catalogues just before the first day of classes.

Their first daughter, Patty, remembers her father calling the house "a fraternity-slash-sorority 24-hour restaurant."

In the mornings, Dr. White walked to the nearby RTA depot. On the way he stopped at the local coffee shop where he often stepped behind the counter to serve coffee to the commuters. He knew most of them by name and whether they took cream and sugar. After work, he attended the daily 5:30 mass at Our Lady of Peace. "Where I could offer my triumphs and sins of the day," says Dr. White. Then, it was dinner with the family, typically the only meal he ate.

Each summer, Dr. White gave his wife a break by taking the children to Cedar Point for several days. They climbed into the family station wagon and drove out to the Breakers Hotel, where Dr. White set up a "command post."

"He used to take us to the beach down there," says his daughter, Patty. "He gave us all T-shirts with numbers written on them. And he would sit on the beach next to a stack of papers he was working on. He took a megaphone with him, too. That way he could say, "Number Two, you're too far out, please come back toward shore!' if he wanted us closer."

While his wife commanded the family in Shaker Heights, Dr. White assembled a dream team of surgeons on the fourth floor of MetroHealth, a section of the hospital innocuously dubbed the Brain Surgery Laboratory.

METRO health's brain surgery lab - Currently being dismantled.
METRO health's brain surgery lab - Currently being dismantled.

The experiments conducted inside the lab were led by Dr. White, neurosurgical resident Dr. Javier Vedura and anesthesiologist Dr. Maurice Albin. Together they developed a machine that could pump blood from a brain through an artificial lung and cool it, before returning it to the organ, and they tested it on the brain of a rhesus monkey. At temperatures just above freezing, the brain was kept alive in the machine for 24 hours.

Electrodes attached to the disembodied brain revealed that higher-brain functions continued. Ringing a bell close to the stump of a brain's auditory nerve initiated the same chemical reaction that would be seen in living monkeys. An article that appeared in Time magazine following these experiments discussed some chilling ramifications of an imprisoned brain capable of performing calculations.

"Still far in the future is another favorite idea of science fiction: using the isolated brains as cheap, efficient computers to do routine jobs."

In 1964, Dr. White performed the first successful brain transplant when he attached the isolated brain of a canine into the neck of a "host" dog, keeping it alive for several hours using the host's circulatory system.

"But how could I demonstrate that this transplanted brain was conscious, was still thinking?" poses Dr. White. "I had to prove that consciousness could be transplanted, too. So, I went back to the drawing board."

In between groundbreaking research at the lab, Dr. White also performed delicate brain surgery on emergency patients at MetroHealth. He was known for his delicate bedside manner, as well as his delicate maneuvers in the operating room. He prayed for his patients. He sat with their families. Drifting off to sleep before a big operation, Dr White liked to envision strategies for removing brain tumors.

"I would replay videos of the surgery in my mind," says Dr. White. "They were drawn from my memory of the surgeries I had done before. It was almost an obsession and I was always concerned. I knew if I screwed it up, they would wind up like a stroke victim. I was millimeters away from causing death."

As soon as he stepped up to the scrub sink, however, he felt the anxiety wash away like so much grime. "I could feel the excitement, the joy of the operation. I was a part of it."

And when the occasional spine injury came his way, he continued experimenting with the effects of cooling.

In 1969, a 17-year-old gymnast living in the Greater Cleveland area was working out on a trampoline when he accidentally came down on his head. The boy, whose name was Peter, knew immediately that his neck was broken and instructed the paramedics not to move his head too much.

He was rushed to MetroHealth where Dr. White met with his frightened parents. The doctor explained the cooling procedure, explained that time was of the essence. The sooner they got Peter's spine cooled, the better the chances were that he'd retain some mobility. Peter listened as his parents asked whether the experimental procedure had worked in the past. "Well, it worked on some of the monkeys we tried it on," said one doctor. The parents consented and soon Peter was on Dr. White's operating table. His spine was opened, the fluid inside cooled before inflammation could destroy all his nerves. Then they put him back together and waited.

People who'd suffered similar injuries had become quadriplegics. But Peter started to move his arms in rehab. Today, he has limited mobility in his hands and credits Dr. White's intervention with giving him the ability to have a career where he too can make a difference in people's lives.

PIGGYBACK POOCH - That's GOTTA be a lot of barking when the mailman shows up.
PIGGYBACK POOCH - That's GOTTA be a lot of barking when the mailman shows up.

Because of his injury, Peter couldn't be the physician he had once hoped to become. Instead, he went into law. Today Peter M. Sikora is a judge in Cuyahoga County Juvenile Court.

In 1966, at the height of the Cold War, Dr. White was invited by Russian doctors to travel behind the Iron Curtain and share with them his secrets for isolating the animal brain.

"They were stuck at heart transplantation," says Dr. White. "Even they realized that the reason you die is not that the heart stops but that the heart stops and doesn't feed the brain anymore."

He made dozens of trips to Leningrad in the years that followed, giving lectures and visiting hospitals. Sometimes he took his wife, who was learning Russian at Case, writing her term papers at 3 a.m. after the children were asleep.

As a visiting American neurosurgeon, Dr. White occasionally found himself in the middle of diplomatic squabbles between the two superpowers. When an American Marine fell four stories from a legation in Russia, onto the street below, the Marine was taken to a Russian hospital. The State Department consulted with Dr. White on the best way to remove the Marine without instigating World War III. Dr. White explained how the military could arrange for a plane from Helsinki, in neutral Finland, to pick up the wounded soldier and fly him to a base in Germany without sending US troops into Russian territory. When the State Department called back later to ask Dr. White how they could properly thank the Russians, he suggested the government send Russia a collection of microsurgical textbooks and journals, which were barred from export to the communist country.

He saw those textbooks in a Russian library years later.

Eventually, Dr. White endeared himself to the Russians enough that they allowed him access to "Room 19," an off-limits section at the Brain Institute, filled with jars of brains suspended in formaldehyde. The brains were taken from some of Russia's most prominent leaders and artists for study.

"I have handled Vladimir Lenin's brain," says Dr. White coolly. "Lenin's brain was all sliced up and placed between glass sheets in folders. Here is one of the most incredible brains of the 20th century. Why shouldn't I see it? I'd given lectures in that building. But they didn't let me in Room 19 for quite some time."

The Russians weren't the only ones interested in Dr. White's work. The Vatican kept an eye on him as well.

In 1970, Dr. White was invited to Rome to give a two-day seminar to Jesuit scholars on the topic of whether brain death equals human death. Dr. White believed that brain death was the end of the soul, and should be used as the determining factor of death itself. Critics believed that a person could be ruled dead, and their organs harvested, in some cases, if the heart and lungs could no longer function. There were hospitals that wanted to be able to harvest vital organs in patients that showed brain function but could not be kept alive without machine support.

After the seminar, Dr. White was invited to meet with the Pope. "Next thing I know, I'm sitting down with Paul VI," says Dr. White. "Through an interpreter, I explained to him scientifically what brain death was — that the patient was never going to wake up — and should be determined to be dead even if the body could be kept alive by machines."

Ultimately, Pope Paul VI decided against weighing in on the subject. "He said, "Look, the responsibility of defining death is the doctor's problem,'" recalls Dr. White. "That's the science part of it. It's sort of like he put the monkey back on the doctor's back."

THE MONKEY-HEAD TRANSPLANT - Proof that the conciousness resides in the brain.
THE MONKEY-HEAD TRANSPLANT - Proof that the conciousness resides in the brain.

Speaking of monkeysŠ

In Russia, Dr. White had taken special interest in the experiments of Vladimir Demikhov, an experimental surgeon. Demikhov had transplanted the upper half of a puppy onto the back of a mastiff. This "two-headed dog" lived for several days, the puppy drinking milk from a saucer held up to its muzzle. Clearly, the puppy was conscious. Dr. White realized that if he transplanted not just a monkey's brain but an entire monkey head, he could prove it was conscious by facial expressions and eye movement.

On March 14, 1970, the first successful head transplant was conducted by Dr. White and his Brain Surgery Laboratory staff, with special help from microneurosurgeon Dr. Yoshiro Takaoka.

Two rhesus monkeys were sedated and laid out on separate tables inside the fourth-floor laboratory and labeled with letters A and B. The heads of both were removed and the head of A was attached to the body of B.

"And it woke up and almost bit me," says Dr. White. "It moved the muscles in its face. It blinked its eyes. It chewed on pencils."

More important, it mimicked tests that it had been trained to perform before the operation, proving, for the first time, that consciousness — or the soul, as Dr. White believes — can be transplanted by removal of the brain. What they had performed, the doctors realized, was not a head transplant at all, but a whole-body transplant. The monkey that had survived was the A monkey, after all — the head.

"Your body is a machine for the brain," says Dr. White. "The brain is where consciousness is located."

While the head was kept alive by the circulation provided by the "B" monkey's body, the spinal cord had been severed at the neck, and so the new brain could not control the body itself; nerve endings cannot be sutured like blood vessels. Machines were required to keep the monkey's lungs breathing, its heart beating.

"The problem was, we were not really set up for survival," says Dr. White. "We only wanted to show that it could be done."

Consequently, this first body-transplant patient only lived a few hours. The experiment was conducted only a few more times, because of its success and hence, mortality rate.

It was a giant leap for mankind, performed right here in Cleveland. And, for a while, Dr. White even stayed under the radar of People for the Ethical Treatment of Animals. But then he wrote an article blasting PETA's effect on medical research in Readers' Digest.

Animal-rights activists destroyed a lab at Case's School of Medicine, mistakenly believing it was where Dr. White's experiments were conducted. "They called us at home, said stuff to my children," he says. It scared him at the time. "Listen, people are dying every day. This is an animal. I kill dogs, monkeys. Animal-rights activists kill people."

Friends in high places - Dr. White advised several Popes on ethics of brain transplants.
Friends in high places - Dr. White advised several Popes on ethics of brain transplants.

The City Club invited Dr. White and a woman representing PETA to debate the issue in public. At first, the doctor refused, incensed that a former dogcatcher was given an equal platform with a respected neurosurgeon. Instead of backing down, he used his head.

He brought a very attractive young woman to the debate with him and at the appropriate moment, introduced her to the crowd. She had once been Dr. White's patient. He had successfully removed a tumor from her brain using techniques developed through animal testing.

While he may have won the battle, local supporters of animals' rights still consider him an enemy. Jenna Bates, an Akron English teacher who protested Dr. White at a lecture in 1989, sums her feelings up by paraphrasing Jeff Goldblum's character from Jurassic Park: "He was so busy trying to see if he could, he never stopped to ask himself if he should."

Dr. White retired in 1998, at the age of 72. "I think what I miss most is the operating room," he says. "As the lead surgeon, you are the commander of this group of people and you must feel that what you are doing is as good or better than what anyone else can do. It's very delicate work and there's a certain sort of pride involved."

His eyes sparkle as he remembers the excitement and nuance of brain surgery. "In the city of Cleveland at the time, no one could do it as good as I could."

These days, he bounces between Geneva restaurants — McDonald's, the Sunrise Café, Gales coffee shop — never really eating, but taking the time to know the people who stay through the winter. Dr. White drives into Cleveland a couple of times a week, either to meet with his secretary at a West Side McDonald's to go over his schedule of speaking engagements or to visit his old lab on the fourth floor of MetroHealth.

Recently, he was told by MetroHealth staff to clean up his things. Though Dr. White's contemporaries suggest the lab should be turned into a museum, MetroHealth officials intend to renovate it into new space for the Department of Dentistry.

Even though the hospital is not interested in preserving his legacy, it's not likely Cleveland will forget the doctor anytime soon. The History Channel was here last month filming a documentary about his life and his work, scheduled to air later this year.

And though he was appointed into the prestigious Pontifical Academy of Sciences in 1994, making him an official scientific advisor to the Pope — and putting him in the company of Stephen Hawking and a trove of Nobel laureates — Dr. White's proudest achievement is the fact that in 40 years, he was never sued for malpractice.

His old comrade, Dr. Maurice Albin, who co-authored many papers on the experiments conducted inside the BSL, believes that Dr. White's most important contribution is actually the many doctors he trained throughout his career, 10 of whom went on to become chiefs of neurosurgery at various hospitals throughout the country.

"He trained some of the world's best surgeons," says Albin, a professor now at the University of Alabama. "He taught them how to think. He was ahead of his time."

jrenner@freetimes.com

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