In Memoriam: Jimmy Frank Howell (1932–2014)

On 22 December 2014, the field of cardiovascular surgery lost a legend upon the passing of renowned surgeon Jimmy Frank Howell at the age of 82 years. With more than 50 years of service at Baylor College of Medicine, Jimmy had a legendary career, one difficult to describe adequately because it might be beyond the comprehension of today's young surgeons. For one, the sheer volume of operations that he performed was staggering. He was often teased that he was a “hand surgeon” in that he would get his hands on any case in sight, no matter how complex. During his lifetime, Jimmy performed nearly 60,000 operations; about half of these involved the heart, and about one quarter involved cardiac revascularization. Jimmy leaves behind an unparalleled legacy of improved lives for his numerous patients, and he generously supported the city of Houston through the Howell Family Foundation's support of a wide variety of charitable organizations. This includes the founding of the Jimmy and Roberta Howell Chair in Cardiovascular Surgery at Baylor College of Medicine's Department of Surgery.

Jimmy Frank Howell (Fig. 1) was born on 10 September 1932 in Winnfield, Louisiana, and spent his formative years in East Texas. He graduated from Stark High School in Orange, Texas, in 1950, and from Lamar University in Beaumont, Texas, in 1953. When he began his medical studies at Baylor College of Medicine that year, little did he know that he would spend his entire medical career at Baylor and in Houston. He graduated from Baylor College of Medicine in 1957, completing his general surgery residency in 1962 and his thoracic surgery residency the next year. Dr. Howell (known as “Slick” by his fellow residents because of his carefully combed hair), was then asked by Michael E. DeBakey to join the developing Department of Surgery. There, he continued to work with mentors such as Denton A. Cooley, E. Stanley Crawford, Oscar Creech, and George Morris. Jimmy participated in the spectacular early growth of cardiac and vascular surgery during the DeBakey era at Baylor, in the 1960s and 1970s. The development of arterial substitute grafts and adjuncts such as cardiopulmonary bypass fueled busy cardiovascular clinical practices, of which Houston was the epicenter. Stories were often featured in Life magazine, including one with DeBakey and his first assistant, Jimmy, in the 24 September 1965 issue (Fig. 2).

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Of those early days, Howell stated,¹ “It was a new era. It was something that was being developed, and it seemed like it had a lot of opportunities. Nobody had ever operated on the heart much. It was sort of a sacred item. Once people learned that they could operate on it successfully, it became something that was exciting to do to correct abnormalities—valvular, congenital, and acquired abnormalities. It seemed a very exciting frontier in medicine.”

Jimmy took part in many groundbreaking aortic repairs. He assisted Harvey “Ed” Garrett during the first successful coronary artery bypass grafting (CABG) procedure, which was performed in November 1964 under DeBakey's tutelage.² Jimmy was a co-author of DeBakey's notable 1965 publication in the Annals of Surgery, which presented outcomes for 42 patients undergoing thoracoabdominal aortic aneurysm repair, 84% of whom survived the operation.³ This paper helped to establish Houston as the primary center for this repair.

In 1966, Jimmy co-authored another landmark paper,⁴ which detailed the DeBakey classification of aortic dissection (the final model with types I, II, and III). This classification system continues to be useful to today's clinicians in making life-or-death early treatment decisions. In addition, he contributed to the first long-term report on the surgical repair of aortic dissection.⁵

In regard to Jimmy's difficult-to-fathom clinical experience, he exceeded every benchmark for morbidity and mortality rates. His clinical outcomes⁶ detail his resounding success as a surgeon—one who continuously put the individual needs of his patients first. His interests included aneurysmal and peripheral vascular disease (such as Leriche syndrome), myocardial revascularization, cardiomyopathy, carotid endarterectomy, heart valves, left ventricular aneurysms, cardiac tumors, pacemakers, heart-lung technology, and more. It is fitting that the man who was there at the inception of CABG performed this gold-standard myocardial revascularization procedure more than 12,000 times, with results that were well under the 5% mortality-rate benchmark established by the Society of Thoracic Surgeons in 2002. Today, CABG is the most frequently performed cardiac operation, and contemporary evidence supports its superiority, in many patients, to more recent alternatives such as coronary stenting.

Jimmy had a naturally outgoing and friendly nature. He stood tall in his cowboy boots. He shared with many the intricacies of East Texas linguistics, such as the use of the phrase “all hat and no cattle” to describe an empty boast. At Baylor College of Medicine, he personally contributed to the education of generations of cardiothoracic and vascular surgeons, particularly when he served as the Director of the Vascular Surgery Residency Program at Baylor College of Medicine and The Methodist Hospital. He was a talented surgeon and an esteemed colleague of all who knew him. His peers considered him to be one of the hardest-working men they knew. At the height of his career, he worked 16-hour days and oversaw 80 to 100 patients at a time. He was one of the last of the original DeBakey protégés to remain in practice, and in October 2013, he received the Lifetime Achievement award from the Baylor Alumni Association.

Jimmy was a member of multiple professional societies, including the American College of Surgeons, American College of Chest Physicians, American College of Cardiology, American Medical Association, The Society of Thoracic Surgeons, International Cardiovascular Society, Southern Association for Vascular Surgery, Society for Clinical Vascular Surgery, Texas Medical Association, Texas Surgical Society, Harris County Medical Association, Houston Surgical Society, and the Osler Society, and he was elected to the Alpha Omega Alpha Society.

Jimmy was a dedicated family man: a husband to Roberta Blankenstein Howell for 60 years, a father to 6 children, a grandfather to 13, and a great-grandfather to 3. He actively pursued such typically Texan activities as hunting, cattle ranching, and oil exploration. Typically of Jimmy, he was no “hobby” rancher: his ranch in Liberty, Texas, spanned a respectable 12,000 acres with approximately 2,000 head of cattle. Although we hunted together regularly over the years, our most memorable hunt involved his shooting a sandhill crane while we were duck-hunting. I rescued our hunting dog from the bird's razor-sharp beak and rescued Jimmy by providing my Federal hunting license. The bird made its way to the valet at the Doctor's Lounge, who assured me that it was the best duck that he had ever eaten. It is with sincere fondness that I reflect on the legacy of Jimmy Frank Howell.