As the mail ship sailed towards Cape Town on the morning of December 3 1967, a Sunday, Ann Washkansky got a phone call to say that her husband, Louis, had a new heart.
Christiaan Neethling Barnard - who took massive risks performing the world's first human heart transplant - catapulted himself and South African medicine into the spotlight with that feat 50 years ago.
Susan Vosloo, Barnard's friend and Africa's first woman cardiothoracic surgeon, said: "He took a step that nobody else was prepared to take at the time." By then Barnard, born in Beaufort West in 1922, had done many open-heart surgeries. He said: "The only time I realised something was different was when I looked down into the patient and saw no heart. You cannot imagine how lonely I felt at that moment."
When the transplanted heart started beating on its own, the team were jubilant. Barnard extended a blood-soaked glove over Washkansky's chest to shake the hand of his chief assistant, Rodney Hewitson.
"We made it! Jesus, it's going to work!" he said to Hewitson, a brilliant surgeon who later operated with Barnard on many successful heart transplants at Groote Schuur Hospital.
Hewitson responded: "It's early days yet." Calm and unassuming, unlike the mercurial Barnard, he went home to his family and had a quiet Sunday.
His son John Hewitson, who performed South Africa's first lung transplant, said: "I was 13 and it was quite common for my father to be out all night at the hospital. He said nothing about what had happened. Only on Monday at school I started hearing about the heart transplant from everybody."
'You really did it bastard'
Barnard's younger brother Marius, also a cardiac surgeon, was in charge of the donor theatre during the transplant.
The donor was 25-year-old Denise Darvall, who had been knocked over with her mother while crossing the road to buy a cake. Her mother was killed and Denise was declared brain dead.
At 2.20am her ventilator was switched off. Barnard waited for her heart to stop beating and it was excised with her kidney, also for donation.
Barnard took her small heart and walked a few paces to the adjoining recipient theatre, where he sewed it into Washkansky's chest. After three attempts, the heart started pumping rhythmically.
Chris said to Marius: "We've got to tell somebody we've done this op."
He phoned the hospital superintendent to tell him that they had transplanted a human heart. In the morning the hospital released a statement, which made the radio news and sparked a global fanfare.
Johan Brink, professor of cardiothoracic surgery at Groote Schuur, said: "There are four events I remember as a kid in the 1960s: Kennedy's assassination, the assassination of Hendrik Verwoerd, the first heart transplant and man landing on the moon."
Within a day of the announcement, the international media laid siege to the hospital and Barnard's home - and he gloried in the attention.
"Warm congratulations. You really did it bastard," proclaims a telegram from one of his colleagues in the US, where he had trained.
In interviews this week, distinguished heart surgeons across the world commended Barnard for his exceptional work ethic, incisive intellect, skill and dedication to patients - and his courage.
Vosloo said he was extremely well prepared to operate and manage the anti-rejection therapy and immunology.
Cardiothoracic surgeon Robert Frater, who worked with Barnard in the early 1960s, said: "The quality of the whole staff was exceptional. Carl Goosen, in particular, the chief perfusionist, [monitoring and oxygenating the blood] was a genius.
"More important than anything else was the complete integration of cardiology, surgery, nursing, anaesthesia and technology."
Philandering
This watershed moment made the cover of magazines like Life and Time, and Barnard - the daring and domineering surgeon who led the team - became a hero.
David Cooper, who worked with Barnard at Groote Schuur and knew him well, said he was the most charismatic person he'd ever met.
"He had a real zest for life, whether he was seeing patients, doing surgery or research or meeting people. This was very infectious," said Cooper.
"In many ways you could consider him a Renaissance man. He was a very gifted speaker and writer [authoring 14 books and some 250 publications], but this is forgotten because of the image he portrayed after the transplant as a good-time guy."
Barnard's grandstanding personality embraced the attention. A German benefactor gave him a golden Mercedes-Benz to replace his old station wagon.
Cardiologist Michael Ezekowitz, who was a student when he worked with Barnard, said an Italian family got him designer suits every week after he saved their child.
"He went from being poorly dressed to being very well dressed, with a new suit, matching shirt, matching tie, socks and shoes," said Ezekowitz.
Barnard travelled across continents meeting world leaders, princesses and celebrities. He shook Pope Paul VI's hand and Princess Diana confided in him.
With his chiselled good looks and wicked sense of humour, Barnard became a jet-setter, charming film stars like Sophia Loren and having a fling with Gina Lollobrigida.
The Playboy Club in London offered him honorary membership.
But the adulation inflated his ego, taking a toll on his six children and three wives. All of his marriages ended in divorce.
In a letter printed after his death, Barnard said: "I collected scorpions [as a boy] and the thing that fascinated me was that after they mated, the female killed the male. I'm glad that isn't the case in human terms otherwise I would have been dead many times already."
Barnard was 77 when his last wife, Karin, 41 years his junior, grew disenchanted with his thoughtlessness and left him.
His first family were most acutely affected by his fame. His eldest daughter, Deirdre Barnard Visser, said: "In 1967 we lost him to the world."
Second transplant
Washkansky died of an infection after 18 days but on January 21 1968, Barnard's team did their second heart transplant and the recipient, Philip Blaiberg, lived for 593 days.
Hugh Killops, grandson of the fourth heart transplant patient, said: "It was difficult then to know what you were letting yourself in for."
Douglas Killops had acute organ rejection and died after 64 days.
The only time I realised
— Chris Barnard
something was different was when I looked down into the patient and saw no heart.
The results at Groote Schuur were far superior to those in the rest of the world when transplant fever gripped surgeons in 1968. At Groote Schuur, four of the first 10 patients survived for more than one year, two living for 13 and 23 years.
Only 18% of the 166 patients who had heart transplants in other countries from 1968 to 1970 lived for more than a year.
Brink said: "Groote Schuur had exceptional results. This was an era when small mistakes could lead to premature death."
Superb surgeon
On November 25 1974 Barnard achieved another world first: a "piggyback" heart transplant, when the donor heart is put in to support the patient's heart.
Israeli professor of cardiology, Mervyn Gotsman, said Barnard was a superb surgeon despite having arthritis.
"He wasn't difficult," said Gotsman.
"He was impatient. He wanted to get the job done properly and he couldn't stand fools."
Barnard exuded confidence and instilled it in his patients. All the surgeons said he was very caring and committed to patients.
Gotsman said: "We would operate all day and that night he wouldn't go home. He would spend the night beside a patient's bed himself, nursing them intensively and staying until he was satisfied the patient was getting better. Even younger doctors struggled to keep up with him."
He was impatient. He wanted to get the job done properly and he couldn't stand fools.
— Mervyn Gotsman
Barnard was particularly devoted to children. By the '60s he had done trailblazing research in treating congenital heart defects and had made advances in paediatric surgery.
He operated on a six-year-old Irish girl who had been refused surgery in the US and UK.
"When the girl saw him, she said: 'Dr Barnard, my heart is broken. Can you fix it, please?'" recalled Dene Friedmann, who controlled the cardiopulmonary bypass machine during the operation.
Upon examining her heart, Barnard decided there was nothing he could do. The operation seemed to be over.
But after he unscrubbed, Barnard got a pencil and paper, sketched out a solution and went back into theatre to try it.
"She survived and grew into a lovely teenage girl," said Friedmann, who visited her in Ireland.
Vosloo said Barnard was never acknowledged enough for his landmark medical contributions, ranging from new cardiac techniques to curative operations.
He established the principles of intensive care in South Africa, setting up the first unit at Groote Schuur.
Barnard studied and practised medicine in South Africa, then went to the US where he earned a master's and PhD. When he returned home in 1958, he brought with him South Africa's first heart-lung machine.
His interest in transplant techniques brought him into contact with surgical researcher Hamilton Naki, a former University of Cape Town gardener who worked in the animal lab studying first heart and later liver transplant surgery.
Barnard said Naki was "one of the great researchers of all time in the field of heart transplants".
Naki named one of his sons Barnard.
Flawed hero
Barnard's peers said he challenged racial barriers in the hospital. He had security police driven out of Groote Schuur when PAC leader Robert Sobukwe was being treated there, and he transplanted the heart of a white woman into a black man.
He fought to keep the ICU open to all races and strong-armed politicians to allow nurses to work with patients of different races during a flu epidemic in the early '70s, said Ezekowitz, a colleague at the time.
But South Africa's golden boy also, at the height of apartheid, took cash from the discredited secretary of the department of information, Eschel Rhoodie, to be an ambassador abroad, the book Celebrity Surgeon reports.
Barnard said his "greatest excitement was to put on surgical gloves". He retired at 61 when he started losing this hunger.
In 1998 he established the Christiaan Barnard Heart Foundation to support paediatric and cardiac medicine.
A vain man, he struggled with a disfiguring skin cancer on his nose and arthritis in his hands and feet. As he got older, he even touted an anti-ageing cream.
Age did not temper his sharp tongue. Frater tells the story of a journalist who asked: "Dr Barnard, you were a famous cardiac surgeon. And now you are selling cosmetics. Why are you doing that?"
"For the money" Barnard replied, leaning in to inspect the interviewer's face. "As a matter of fact, your skin looks as though it needs my product quite badly."
On September 2 2001, while travelling alone, he died from an asthma attack next to a pool in Cyprus.
Cooper, who recently published The Surgeon Who Dared, said: "Barnard was considered lightweight because of his personal lifestyle but until a few years after the transplant, he was a medical heavyweight."
Vosloo, who is active in the Organ Donor Foundation, said Barnard should also be celebrated for his support of organ donation. "He had a brilliant mind but he could relate to anybody," she said. "He never lost the human touch in the way he treated people."
