Authors: Jane Leavy
The surgeons proceeded, removing Mantle’s liver, which was swollen, lumpy, and hard. As the new liver was being sewn in, Mulligan said, the pathologist arrived with dire news: his cancer had spread down the central bile duct into the pancreas. And it was an exceptionally rare and voracious form of the hepatocellular carcinoma commonly associated with cirrhosis—anaplastic carcinoma.
“Oh, shit,” Mulligan said.
Number 7’s luck had run out. Fifteen years later, Klintmalm said, “We have never had anything like that before or after.”
There were only two choices: to continue with the operation, removing as much of the bile duct and pancreas as possible to eliminate metastatic tissue, or to let Mickey Mantle bleed to death on the operating table. “When the liver’s removed, that’s past the point of no return,” Mulligan said. “The new liver is going in while the pathologists are studying the old liver. So actually, we don’t know how bad things are until we’re well into the new liver getting perfused and him getting a new chance at life. At that point, they come back, and it was a surprise. It’s, like, ‘Holy cow, do you guys realize this was there?’
“I was pretty worried about Mickey. I knew this was bad, that his likeliness of recurrence was high, and that he wasn’t going to do really well long term.”
When Klintmalm briefed the press the next morning, questions focused on the success of the transplant and the identity of the donor, not on the extent or rapaciousness of Mantle’s cancer. “Well, is the donor alive?” a reporter asked. “Can you tell us that?”
The donor was a twenty-eight-year-old Caucasian male, a small-town bank teller, who had donated seven vital organs to six dying patients. “About a week before his death, the young man was at a lake near his hometown when a man trying to swim to an island started to go under,” said Pam Silvestri, the public affairs director for the Southwest Transplant Alliance. “This young man, the donor, was a water skier and former lifeguard. He swam out and pulled the man a long distance to shore. About a week later, he woke up with a headache. Before leaving home for work, he collapsed. A blood vessel had ruptured in his brain. He died of the aneurysm that afternoon.”
After a year on the transplant list and decades of heart failure, Dillard
Worthy, a chicken farmer from Pittsburgh, Texas, received the young man’s heart. Asked thirteen years later how his new ticker felt, Worthy said he couldn’t tell that much difference between it and the old one when it was working right. There is no better argument for organ donation.
The day of the transplant was Silvestri’s first day on the job. She had worked in sports administration and understood the potential of a story that would appear in 18,000 newspapers across America—with countless spins on fact and taste. Case in point: New York’s
Village Voice
published a bogus advertisement for “the ultimate in baseball memorabilia—
MICKEY CHARLES MANTLE HEPATIC ORGAN
.”
There was so much competition for news about his condition that hospital switchboard operators were offered twenty-dollar bribes to lose messages from rival TV stations. Reporters scoured obituaries and lobbied local funeral homes for information about newly arrived bodies.
In early August, Silvestri arranged an anonymous telephone interview with the donor’s mother to put an end to the ghoulish goose chase. “He’d never been sick before,” she told the
Dallas Morning News
. “He’d never been in the hospital before.”
She did not know that her son had designated himself as an organ donor until the day he died.
Despite Klintmalm’s preemptive measures, despite testimony from UNOS officials and from Dillard Worthy and other transplant recipients, the public outcry was loud, immediate, and lasting.
The fix was in. It had to be. How else could he have gotten a liver so fast? And even if it wasn’t fixed, he shouldn’t have gotten it anyway because he destroyed his own liver.
“The truth is more mundane than what people think happened,” UNOS spokesman Joel Newman said.
Several factors worked in Mantle’s favor, Newman says—none of them his fame. He had the most common blood type, O, shared by 45 percent of the population, increasing his chances for a match. The population density in the Dallas metropolitan area made the Southwestern Transplant Alliance one of the highest-volume organ-procurement organizations in the country. And, Newman said, the prominence of the transplant program at Baylor, then one of six centers in the U.S. participating in an experimental protocol to treat liver cancer patients with transplantation
and chemotherapy, “translated into higher liver donation rates than in other parts of the country.”
Fifteen years later, Mantle’s liver remains fodder for conspiracy theorists, medical ethicists, sports radio loudmouths, and sitcom wise guys, among them Larry David, who worked riffs on the transplant into a two-episode story arc on
Curb Your Enthusiasm
with the comic Richard Lewis entitled “Lewis Needs a Kidney.” With each new “celebrity” transplant the blogosphere erupts with renewed howls of protest. The
New York Times
attributed the resurgence of “dark theories” occasioned by Steve Jobs’s 2009 liver transplant to a “holdover from the case of Mickey Mantle.”
Arthur Caplan, the director of the Center for Bioethics at the University of Pennsylvania, says the uproar over presumptive favoritism obscured other equally important questions about organ allocation. “I don’t believe he jumped the queue, although I think arguably he could have been too sick,” Caplan said. “The combination of alcoholic cirrhosis and hepatitis C might have led some transplant teams to say, ‘Yeah, he’s sick, but he’s way too sick.’”
Klintmalm said every possible diagnostic test then available was done prior to surgery to detect whether Mantle’s cancer had spread. “We kind of smelled that there could be a tumor there, and we did virtually everything in the world to find that tumor, but we couldn’t find it,” he said.
The bile duct, an organ no bigger than a pinky finger, is difficult to biopsy, especially when a patient lacks enough platelets to clot blood. “It’s something you never get close to with a needle,” Klintmalm said, “and if you do, the patient usually bleeds like a pig and dies.”
With today’s enhanced imaging technology, he said, “We probably would have had a much better chance to make a positive diagnosis. If we had found the tumor before the transplant, we would not have done it. If we could have figured that out [during surgery], we would have interrupted, closed him up, and brought back a backup patient.”
In 2002, UNOS instituted a new system of organ allocation that ranks every patient in the country waiting for a liver on an objective numerical scale that determines the risk of dying within ninety days without a transplant. Patients with cancer in danger of progressing get additional points and move up the list. But if a tumor is found to be beyond a certain size or there is evidence of metastatic spread, that
score drops. The goal is to give organs not just to the sickest patients but to “the patients who have cancer with the best possible prognosis,” Mulligan said.
Added Caplan, “They’re really more oriented toward outcome than they were then. It doesn’t make sense just to say, ‘Who’s sickest?’ If they’re almost dead, then you’re not going to rescue them.”
In Caplan’s view, Steve Jobs, a California resident who received a transplant in Tennessee, illustrates the advantage of celebrity: money. “It’s not that they get a liver,” Caplan said. “It’s that they get admitted to the waiting list in the first place. You don’t even get considered if you’re some poor homeless guy whose liver’s blown out because you’re drinking wine in the park. You’re going to be dead. That’s where Mantle or David Crosby or Evel Knievel, the drug-damaged livers of the Fifties and Sixties, had an advantage.”
When Mantle awoke after surgery, doctors told him what they had already told his family: the operation was a success, but the prognosis was uncertain at best. It was a bittersweet result—the gift of a new life might prove to be no opportunity at all. In the hospital, he was inundated by an outpouring of public affection—20,000 cards and letters were delivered to him c/o Baylor—and a torrent of outrage. Robert Goldstein told reporters that Mantle wouldn’t have gotten out of the hospital alive without the surgery. Mantle told the New York
Daily News
that doctors had told him he had just one day to live.
Though Merlyn complimented her husband on his newly trim shape—she hadn’t seen his stomach that small since he was twenty—Mulligan saw little of the joy he usually sees in transplant patients, an indication, perhaps, that Mantle sensed how little time he had. But when Klintmalm asked him to go public with his support for organ donation, he readily agreed. “Mickey was absolutely committed,” True said. “I told him, ‘If you promote it, you’ll save so many lives it will eclipse baseball.’ He said, ‘I know.’”
True began making plans for “Mickey’s Team.” Mantle coined the
slogan for a campaign he wanted to announce at Arlington Stadium at the end of August: “Be a Hero, Be a Donor.”
He left the hospital on June 28, exactly one month after he checked in. He went back to the house he shared with Danny and Kay and to the accustomed routine, organizing his days around the clubhouse at Preston Trail. At first he was strong enough to ride a stationary bike a bit. But two weeks later, the stomach pains returned and there were new ones in his chest. It was hard to eat; he subsisted on protein drinks and lost forty pounds. One Monday morning, he called Pat Summerall from the clubhouse and said, “Get your ass over here, I need to talk to you.”
It was an hour’s drive. When Summerall arrived, he was dumbfounded by Mantle’s request. “He said, ‘I want you to have a look at my ass.’ He pulled his pants down. It was all bruised and black and blue. He said, ‘I used to have a good ass. I wanted you to have a look because you remember what a good ass I used to have.’”
Chemotherapy left him anemic and in need of transfusions. He returned to the hospital for treatments, and surgeons implanted a catheter in his chest, like the one Billy Mantle had used and abused.
At the end of the first week of July, as Mulligan was packing up his apartment to move to Cleveland for his new position at Case Western Reserve University, a reporter for the
Dallas Morning News
came to interview him for a profile of his newly famous mentor, Göran Klintmalm. Mulligan had been up all night doing his last transplant at Baylor. When the reporter asked how Mantle was doing, Mulligan showed him the data on survival rates of patients with his cancer. An unexpected and unwelcome headline appeared in the morning paper: “Mantle’s Outlook Uncertain.” Mulligan was quoted as saying, “There was tumor left behind that was unremovable. There was no way we could remove all of it.”
Goldstein tried to quell the furor, dismissing Mulligan’s comments as those of a “junior” surgeon who hadn’t seen enough cases to justify such pessimism. Klintmalm’s protégé had performed 104 transplants during his two years at Baylor.
On July 11, Mantle held his last press conference. It was a standing-room-only crowd. He greeted reporters he knew, including Jerry Holtzman from Chicago, and acknowledged Barry Halper, a limited
partner in the Yankees, a memorabilia maven. “Hey, Barry, did you get my other liver?” Mantle asked.
His comic timing was still acute, but the robust physique, the Popeye biceps, and the untroubled face of American plenty were gone. His tracksuit hung on his desiccated frame. His face looked like a dry riverbed. The band on his blue-and-white 1995 All-Star Game cap couldn’t be made tight enough to fit his skull. He looked like death. In fact, he looked a lot like Mutt in the family photograph taken just before he went off to Denver to die.
When he pointed his thumb at himself, it seemed as if his chest might collapse. “God gave me a great body and an ability to play baseball,” he said. “God gave me everything, and I just…
pffttt
!”
What would be remembered most was the anguished plea directed at children: “I’d like to say to kids out there, if you’re looking for a role model, this is a role model. Don’t be like me.”
Some scorned the tortured mea culpa as the moral equivalent of a death row confession. “The most decent thing he ever did may be the only decent thing he did that ever mattered,” the sports columnist Jerry Izenberg said. But even the most hard-boiled scribes agreed it was his finest inning. David Mantle said the family received hundreds of letters, saying, “We used to hate you, but you doing that on national TV, apologizing and making amends, you have got new fans.”
A reporter asked Mantle if he had signed a donor card. “Everything I’ve got is worn out,” he said. “Although I’ve heard people say they’d like to have my heart…it’s never been used.”
Two days later a CAT scan showed cancer in his right lung.
One day, not long after, Halper pulled up in front of Mickey Mantle’s Restaurant and asked Bill Liederman to come out to the curb. Halper said he had “some shit in the car” he wanted Liederman to see. “He actually had a bag of shit,” Liederman said. “Mickey sent him a bag of shit.” And a pair of signed shit-stained examination gloves. “He was going home to put it in the freezer.”
Liederman thought it was Mantle’s final comment on the memorabilia industry that had made him a rich man, a very Mantle way of saying, “You’re all full of it.”
Ten thousand donor cards were distributed at the All-Star Week
FanFest at the Ballpark at Arlington. Interest in organ donation surged. “Before the transplant and the news conference most organ donation agencies were getting a call a week, if that,” Silvestri said. “Post–Mickey Mantle, calls were in the thirty-to-forty-a-week range. People were saying ‘Where can I get that Mickey Mantle donor card?’ ‘What do I have to do to be a donor?’ Or ‘I’m ripping up my donor card because of what happened to Mickey Mantle.’ Just getting people to talk was our goal because it wasn’t a conversation people were having.”
That was enough to persuade her that The Mick had done his job. “At a time when he didn’t feel good and his family didn’t feel good, they opened their lives to anyone who wanted to talk about organ donation because they felt like they could do some good,” she said. “And the bottom line is, they did some good.”