Faculty Bibliography

In fact, only a few hours after the artificial heart was implanted, Richard Smith, a biomedical engineer who operated the machinery powering Mr. [Michael Drummond]'s heart, was excited. He said he ''couldn't draw more perfect graphs'' of the pressures in the left and right sides of the artificial heart. ''I must have felt his feet 100 times or more during the course of the day,'' Dr. [Jack G. Copeland] said, but graphs of the mechanical heart and other test results looked so good that he believed ''everything was going to be O.K.'' ''We were caught in a bit of a trap there,'' Dr. Copeland said. ''It's a lesson that we learn over and over again - that you have to follow the patient, you have to feel the patient, you have to look at the patient, you have to be on top of the patient at all times.''

''He is doing very well,'' Miss Trasoff said. ''He is alert and responsive and everybody seems very pleased at the progress he has made so far.'' At today's news conference, Richard Smith, a biomedical engineer who regulates the system that powers the air-driven Jarvik-7 heart, said Mr. [Michael Drummond]'s first words after the implant were: '' 'What's this clunking?' in his chest.'' ''For example,'' Mr. Smith said, ''not only do you have a heart, but then you have your tubes, drive lines coming down the side, and you've got this machine at the end of the bed. Maybe he was aware that he was going to get an artificial heart, but doesn't understand what that all entails.''

His mother, Joan Drummond, said she had known ''very little about the artificial heart'' and was ''dead set against them using it'' but relented when there was no alternative but death. ''He would sooner have had a heart, a human heart,'' [Clarence Drummond] said. ''But he seems to be well satisified that he's got this, and he's hanging on until he gets one.'' Just after the implant operation, Dr. [Jack G. Copeland] took Mr. Drummond off the list of most severe cases. ''If a donor heart became available, for instance today, we would not accept it,'' Dr. Copeland said, because he wanted Mr. Drummond's condition to remain stable for ''four or five days.''

Mr. [Michael Drummond]'s condition was reported as critical but stable. Dr. [Jack G. Copeland] said his team was ''very surprised and extremely pleased at'' his progress to date. ''He couldn't be doing any better,'' Mr. [Richard Smith] said. In an interview Dr. Robert K. Jarvik, the designer of the artificial heart used in Mr. Drummond, said he was particularly pleased that Mr. Drummond had avoided the severe bleeding complication that forced most other artificial heart recipients back to the operating room in the first few hours after the implant. First, he said, he used ''meticulous care'' in placing the sutures in the artificial heart and blood vessels in Mr. Drummond's chest. He also took special care to make certain that there was no bleeding before he sewed the chest closed

The recipient in the current operation, Michael Drummond of Phoenix, an assistant manager of a grocery store, was reported doing ''fine'' and in critical but stable condition after the operation, which lasted about 4 hours and 15 minutes. Last Aug. 22, Hershey doctors left the severely damaged natural heart of Peter Dowger, 48, of McAdoo, Pa., in place while they implanted two partial artificial hearts, or ventricular assist devices, in his body. Since then the ventricular assist devices, acting in tandem, have been sustaining Mr. Dowger's life while doctors give his circulatory system a chance to stabilize. Mr. Dowger went into shock after a heart attack. Mr. [Carl Andrews] said that Mr. Dowger was in critical condition yesterday. Three of these individuals are alive. They are William J. Schroeder, the longest surviving artificial heart recipient, and Murray P. Haydon. Both are living in Louisville and have suffered serious complications of the procedure. Mr. Schroeder's memory and speech have been severely impaired by two strokes. Mr. Haydon has suffered a stroke that has left him with no apparent permanent damage. But Dr. [William C. DeVries] has said that Mr. Haydon is psychologically dependent on a mechanical respirator to breathe for up to several hours each day

The Milbank Memorial Fund Quarterly, which devoted a special issue of the prestigious journal that highlights the problems of health and society to the oldest old, makes clear that not enough is known about the economic impact on the aged. Most members of this group have their assets in home equity, which is not easily converted to income when medical bills are due. Moreover, the consequences of a public policy that might try to contain costs by placing greater reliance on the economic resources of the oldest old could be self-defeating. Such a policy could eventually force this age group to rely even more on publicly financed health care

Richard Suzman and Matilda White Riley of the National Institute on Aging noted that the rapid expansion of the oldest old in a population ''is so new a phenomenon that there is little in historical experience that can help in interpreting it.'' * Too often physicians are likely to ascribe a disability or an abnormal physical or laboratory finding to ''old age,'' when the actual cause is a specific disease process. For instance, when an older-aged patient has anemia, a physician may fail to pursue its source. Also, some hereditary disorders such as polycystic kidneys - a common cause of kidney failure -may not cause symptoms until the advanced years. Further, older people are peculiarly susceptible to certain conditions such as fractures of the hip from falls. ''Election exit polls have shown over and over again that the votes of older persons distribute among candidates in about the same proportions as the votes of midde-aged and younger persons,'' Dr. [Robert Binstock] said

Mr. [Nancy Reagan]'s White House is particularly sensitive because at 74 he is the oldest man to hold the office. In 1981, after he was shot in an assassination attempt, it took many days to confirm that the bullet had come to rest in a section of lung about an inch from his heart. There was also a serious discrepancy in the first public account of the number of blood transfusions Mr. Reagan received. Later, Mr. Reagan's doctors revised their account to about twice the original number after being challenged by data presented by this reporter. Dr. [T. Burton Smith], a urologist who is now the White House physician, customarily sees the President every day, as did Dr. Daniel Ruge, the neurosurgeon who was his predecessor. Additionally, Navy doctors examined Mr. Reagan in routine checkups. Moreover, Dr. Steven Rosenberg, the chief of surgery at the National Cancer Institute, was on the team that removed Mr. Reagan's cancerous colon polyp. Doctors often speak of the inadequate care that often goes with V.I.P. medicine. They point out that potentially life-saving steps, which should often be taken as routine, are omitted in deference to the patient's status. It is not known whether Mr. Reagan's doctors examined his skin carefully and yet missed the pimple for the skin cancer that it was, or whether his condition was one of those unusual cases in which it takes irritation or some other factor to highlight the appearance of a skin cancer

The skepticism of the doctors interviewed was passed along to the White House by this reporter. Mr. [Mark Weinberg] replied that they were ''all wrong.'' Later, however, Mr. Weinberg called back to say, ''We went back based on your skepticism, which was well-founded.'' Last week, Mr. [Larry Speakes] said a local dermatologist had performed the procedure in the White House medical office. On Tuesday, Mr. Speakes said ''it was done at Bethesda'' by military doctors. It is unclear whether he meant that the procedure or the examination of the tissue was done at Bethesda. ''The conventional approach is to scrape it deeply and to burn it with an electric needle three times,'' Dr. [Bernard S. Goffe] said. ''That is an extremely painful procedure.''

The White House yesterday revised its description of the procedure used last week to remove the skin cancer from President [Reagan]'s nose after several dermatologists expressed concern about whether all the cancer cells had been removed by the procedure as originally described. Shaving is usually done with a scalpel. Curettage is done with a curved blade that scoops deeper into the skin. Because the skin cancer is softer than the surrounding tissue of the nose, the doctor is generally able to follow the curve of the tumor. An electro-dessicator uses a charge of electricity to burn blood vessels to seal them. Without anesthesia electro-dessication is painful. [Larry Speakes] has said he had not asked doctors whether they were satisfied that all of the skin cancer had been removed from Reagan's nose